Exam 4 - Immune Flashcards
what is innate memory?
non specific; immunity we were born with
what is adaptive memory?
specific; immunity that is changing through life
what is a hypersensitivity reaction?
a reaction by the immune system that is undesirable
what are the types of hypersensitivity reactions?
type 1: allergy
type 2: cytotoxic
type 3: immune complex disease
type 4: delayed type, cell mediated, antibody independent
what is an antibody
fights against invader
what is an antigen
bad guy that produces immune response
what is cytotoxic?
antibodies produced by the immune response bind to the antigens on the patients own cell surface
what is the immune complex disease?
occurs when there is accumulation of immune complexes that have not been adequately cleared by innate immune cells
what are the steps of an allergic reaction?
allergen introduced plasma cell creates IgE IgE antibodies attach to mast cells allergen is reintroduced allergen attaches to IgE histamine released
what are treatments for an allergic reaction (10)
remove the allergen administer epipen antihistamines corticosteroids bronchodilator o2 IV fluid for BP vasopressors intubation tracheostomy
what are the ways to administer the epinephrine
subcut/IM/IV
what are the two types of immunodeficient disorders
primary and secondary
what is a primary immunodeficient disease
genetic mutations; found in children and infants
what is a secondary immunodeficient disease
acquired; viral infection; toxin; med therapy
what is the cause of RA?
unknown etiology; immune related
what are the autoantibodies related to RA?
rheumatoid factors: IgG and IgM
what do rheumatoid factors do?
attack healthy tissue especially in the synovium
what are the other autoantibodies related to RA?
CD-4 T helper cells
Neutrophils
Immune complexes
B and T cell lymphocytes
what are the stages of RA?
Synvotitis
Pannus
Fibrous anklosis
Bony anklosis
Synvoitis
synovial membrane is inflamed and thickened
pannus
extensive cartilage loss/exposed
Fibrous anklosis
joint invaded by fibrous connective
bony anklosis
bones are fused
what are the types of deformities
swan neck
ulnar drift
boutinnere
nodules
what are the signs and symptoms of RA
joint pain tenderness swelling AM stiffness fatigue, anorexia, low grade fever
what is the pattern to find RA
bilat; symmetrical
what are systemic issues deriving from RA
vasculitis
parasthesia
pleurisy/pulmonary hypertension
sjogrens
what is sjogrens?
dry eyes, mouth and vagina
how many tests should be abnormal to get an idea of RA?
3 or more
what tests are usually all high to determine
CRP
anti-nuclear
eythrocyte sedimentation
what other tests do they run to determine RA
CBC
ANTI CCP
RHEUM. FACT.
what is first course of treatment for RA patients?
NSAIDs
what is a DMARD
disease modifying anti rheumatic drugs
what are the DMARD I
methotrexate
hydroxycholeoquine (plaquenil)
sulfasalozine (azulfidine)
what are the DMARD II
Enbrel (etanercept)
remicade (infliximab)
what drug is
- an immunosuppressant
- should have no sun exposure
- no alcohol use
- causes bleeding, jaundice, dry cough, SOB, blood in urine and clay stool
methotrexate
what drug is
- an antimalarial
- causes retinal damage and psychosis
- eyes start seeing orange
plaqenil (hydroxycholroquine)
what drug causes
- lymphoma
- chf and seizures
enbrel
what do DMARD II do?
block cytokines which cause no immune response
what corticosteroid is taken by mouth for RA
prednisone
what corticosteroid is taken through IV for Ra
methylprednisolone (solumedrol)
what do corticosteroids do for RA
anti inflammatory, immunosupress
help while DMARD is starting to work
what drugs for RA increase risk of infection increase risk of osteoporosis increase blood glucose increase gastric acid secretion and cause ulcers cause mood disturbances increase sodium and water cause retention and loss of potassium CUSHING
corticosteroids
what are nursing interventions for corticosteroids
give in the morning with food monitor mood increase insulin PRN watch infection give supplements (calcium and vit D) TAPER OFF
what happens if you don’t taper your corticosteroid?
adrenal insufficinecy
what is a cytokine
a protein that has an effect on the interaction of cells (general)
what is systematic erythrematosus lupus?
progressive inflammatory connective tissue disease
what does SLE do?
immune complexes form in serum and organ tissues and cause vasculitis, depriving them of oxygen and blood
what organs are usually effected by SLE
kidney lung and brain
why do they think SLE is caused
over exposure to sun, autoimmune
what is a side effect of SLE?
paranoid psychosis
butterfly rash alopecia osteonecrosis polyarthritis myotitis(muscle inflam) pericarditis decrease in WBC and platelets
systemic lupus
what are diagnostic criteria of systemic lupus?
same as RA usually ANA CBC CRP ESR PT/PTT urinalysis kidney and liver function
what are pharmacological treatments for lupus
topical cortisone (rash) hydroxycholroquine (plaquenil) NSAIDs corticosteroids immunosuppressants (methotrex) cyclosporin psytotoxin
alloimmunity
immune response to non self antigens from members of same species
prep for blood or tissue transplant
typing:
- same blood type
- type donor and receiver
- 3 antigen match
what is the goal of immunosuppression
to calm it down and not attack everything
common immunosuppressive drugs
cyclosporin
lmuran
corticosteroids
acute rejection signs
fever, loss of function and clots
what is broad spectrum
against gram positive and gram negative bacteria
what is narrow spectrum
only against a family of bacteria
what is an advantage to narrow spectrum antibiotics
less change on resistance
will not kill as many of our normal bacteria
what are the two types of immunity
nonspecific
specific
nonspecific immunity
initial reaction against foreign antigen
specific immunity
production against a particular antigen
what are the different WBC
neutrophils eosinphils basophils lymphocytes monocytes
neutrophil
innate
attach to walls and eat cells, block passage of germs
lymphocytes
humoral
make antibodies
monocytes
eater of dead cells
eosinphils
release toxin to kill pathogens
what is a raise in eosinophils tell you?
allergy
basophils
dilate vessles to bring more immune cells in - contains histamine
leukocytosis
increase in total number of WBC
what are the antibiotic classifications (7)
penicillins cephalasporins aminoglycosides sulfonamides fluoroquinolones antiprotozoals vancomyocin
disrupts bac cell walls
gram positive - narrow spectrum
allergic rxn is common side effect
penicillin
largest of the antibiotic class
inhibits cell wall synthesis
gram negative
each generation has a broader spectrum
1-4th gen effective against gram positive
after 4th gen can enter CSF and help brain infections
cephalasporins
bacterial protein synthesis inhibitor
aerobic gram neg
narrow spectrum
measure peak and trough!
aminoglycoside
inhibits bacterial growth
gram positive and negative
broad spec
high resistance
sulfonamides
disrupts bacterial DNA synthesis gram negative some new gen can do gram positive broad (newer) do not pair with anti coagulants increase fluids for the kidneys cipro, levofloxican -oxican
fluroquinolones
inhibits pathogen DNA and RNA synthesis effective against anaerobes bacteria and parasite give by mouth or iv used for infection and peptic ulcer disease
antiprotazoals
serious gram positive infection given IV measure peak and trough for dosing nephro and liver toxic dilute in 100 ml at least
vancomyocin
how to treat pseudomembranous colitis (c. diff)
vancomycin by mouth
macrophages in the elderly
toxicity in tumor cells decrease
T cells in elderly
function decreases
B cells in elderly
fewer number and less effective
What is an example of specificity theory
Nociceptor and neuropathic pain
What is the example of gate control theory
Pain transmission fibers
Neuromatrix pain is exemplified by what
Phantom limb pain
What are endorphins
Peptides released in the CNS
What do endorphins do?
Activate opioids receptors
What other peptides have opioid like properties
Enkephalins and dynorphins
amoxicillin
penicillin
cephtriaxones, cephalexine
chephlasporin
gentamiocin, streptomyocin
aminoglycosides
ciprofloxican, levofloxican
fluroquinolones
pentamide, nitazoxnide
antiprotazoals
