Immune Dysfunction pt2 Flashcards
What rhythm occurs with untreated anaphylaxis?
PEA/arrest
What causes the hypotension noted with anaphylaxis?
Vasodilation from NO release with subsequent extravasation of protein and fluid
What is the pathophysiology of anaphylaxis?
What is Biphasic anaphylaxis?
Secondary anaphylactic episode occurring 8 - 72 hours later after an asymptomatic period.
What are risk factors for a secondary anaphylactic episode?
- Severe initial response
- Initial response requiring multiple epi doses
What are risk factors for perioperative anaphylaxis? (5)
- Asthma
- Female
- Prolonged Anesthetic
- Multiple past surgeries
- Presence of other allergic conditions
What lab can verify mast cell activation and release?
Plasma Tryptase
Plasma histamine concentration should be at baseline within _____ minutes of treatment.
within 60 minutes of treatment
When is anaphylactic response skin testing typically done after an episode?
Wheal and flare response 6 weeks after initial reaction.
What is the primary treatment for anaphylaxis? (5)
- Call for help
- Stop blood, drugs, colloids
- 100% O₂
- Epi
- Fluids
What is the epinephrine dose for adult anaphylaxis?
10 mcg - 1000mcg (1mg) IVP q1-2 min
What is the epinephrine dose for child anaphylaxis?
1-10 mcg/kg IVP q1-2 min
If a patient experiencing anaphylaxis is resistant to epi, what should be given? Why?
Vasopressin or Methylene blue
These will inhibit NO production and thus counteract vasodilation.
What is the crystalloid dosage for anaphylaxis?
NS 10 - 25 mL/kg over 20 min PRN
What is the colloid dosage for anaphylaxis?
10 mL/kg over 20 min PRN
Why is epinephrine the drug of choice for anaphylaxis?
- ↓ degranulation of mast cells & basophils → reduced vasodilation
- α1 = supports blood pressure (vasoconstriction)
- β1 = Inotropy & chronotropy
- β2 = Bronchodilation
What drug classes are secondary treatments for anaphylaxis? (3)
- Bronchodilators
- Antihistamines
- Corticosteroids
What are the antihistamines (and dosages) typically used as secondary treatments for anaphylaxis? (2)
- H1 → Diphenhydramine 0.5-1 mg/kg IV
- H2 → Ranitidine 50 mg IV
What are the corticosteroids (and dosages) used as secondary treatments for adult anaphylaxis?
- Hydrocortisone 250 mg IV
- Methylprednisolone 80 mg IV
What are the corticosteroids (and dosages) used as secondary treatments for pediatric anaphylaxis?
- Hydrocortisone 50-100 mg IV
- Methylprednisolone 2 mg/kg IV
What is Graves disease? What causes it?
Hyperthyroidism caused by Autoantibodies to TSH receptor
What is affected by the immune response characteristic of SLE? (5)
Autoimmune antibodies against:
- RBCs
- WBCs
- nucleic acids
- platelets
- coag proteins
What is/are the cause(s) of hereditary angioedema?
C1 Esterase inhibitor deficiency/dysfunction → excessive bradykinin production.
What factors can cause C1 esterase problems? (5)
- Menses
- Trauma
- Infection
- Stress
- Oral contraceptives
What typically limits the production of excessive bradykinin?
C1
C1 limits kallikrein and Factor XIIa.
What occurs anatomically with excessive bradykinin? (2)
- Laryngeal swelling
- potent Vasodilation
What dose of antihistamine should be used for hereditary angioedema?
Trick question. Hereditary Angioedema = excessive bradykinin and is unaffected by antihistamines.
What body parts are typically affected by hereditary angioedema? (4)
- Legs
- hands
- face
- upper resp tract
What is the typical cause of acquired angioedema?
- ACE Inhibitors
What symptoms are conspicuously absent with acquired angioedema?
No Urticaria or Pruritus
What is responsible for the breakdown of bradykinin?
ACE
Thus ACE inhibitors = ↑ bradykinin = angioedema.
What are the treatments for Angioedema? (6)
- Airway maintenance
- FFP
- C1 Inhibitor concentrate
- Epinephrine
- Antihistamines
- Glucocorticoids?
What cells are destroyed by the HIV virus? (3)
Monocytes
Macrophages
T-cells
How long does seroconversion take after inoculation with the HIV virus?
2-3 weeks
What are the initial signs and symptoms of HIV conversion to AIDS? (2)
Weight loss and failure to thrive
How is HIV/AIDS diagnosed? (4)
- ELISA: 4-8 weeks after infection
- Viral Load
- CD4/Helper T lymphocytes < 200k
- HAART agent sensitivity
Inhibition of the liver’s ________ has huge implications for anesthetic delivery in HIV/AIDS patients.
CYP 450’s
What s/s characterize scleroderma? (3)
- Inflammation
- Vascular Sclerosis
- Fibrosis of skin/viscera
At what age does scleroderma typically occur?
What gender is typically affected?
- 20-40
- Females
What GI symptoms of scleroderma are particularly pertinent to anesthesia? (2)
- GI Tract Hypomotility
- ↓ LES tone
______ fibrosis and ______ artery stenosis are prominent considerations for anesthesia in scleroderma patients.
Pulmonary fibrosis and renal artery stenosis
What are the overall anesthesia implications of scleroderma? (5)
- Arterial catheter issues
- Contracted intravascular volume
- Aspiration risk
- Limited neck mobility
- ↓ pulmonary compliance
What do inhalation agents do the immune system? (3)
- Suppress NK cells
- Induce apoptosis of T-cells
- Impair phagocytes
Unclear effects on tumor cells.
This benzodiazepine, ________, decreases the migration of neutrophils.
Midazolam
This induction agent, _______, will depress natural killer cell activity.
Ketamine
This induction agent, ________, decreases cytokines and promotes NK cells.
Propofol
What drug class will suppress NK cells?
Opioids
Particularly morphine and fentanyl.
What cell type plays the greatest role in chronic inflammation?
T-Cells
What cell type activates IgE and produces interleukins and interferons?
T-Cells
