Immune sys Interventions Flashcards
Corticosteriods are drug of choice for
Short term anti inflamm therapy
Why aren’t steroids used long term
Significant adverse effects
Lymphocyte effect – reduce circulating lymphocytes
Monocyte effect – deplete body of monocytes and macrophages
Neutrophil effect – increase neutrophils in blood
Decrease production of prostaglandins and interleukins
Long term adverse effects of corticosteroids
Osteoporosis
Cataract formation
Mental status changes
Fluid and salt retention
Hypertension
Hyperglycemia
Obesity
Adrenal atrophy
Nursing considerations for assessing someone on immunosuppressants
Obtain complete health history including allergies and drug history
Obtain baseline laboratory values for complete blood cell count, electrolytes and liver enzymes
Obtain vital signs, especially temperature and blood pressure
Assess skin integrity, look for lesions and changes in skin colour
Immunosupressants and BP
Fluid retention - HTN
What to assess for immunosuppressant therapy
Assess renal function and liver function
Monitor vital signs with emphasis on body temperature and blood pressure
Monitor for possible adverse effects including leukopenia, hyperkalemia, hirsutism, sinusitis, gynecomastia, gingival hyperplasia
Monitor for signs and symptoms of infection
Ensure patient does not take grapefruit juice with cyclosporine in particular
Nutritional therapy
Avoid salad bars and buffets
Avoid raw meat
Avoid soft cheeses
Wash fruits and vegetables
Beansprouts should be avoided
Passive immunity
From your mum
Active immunity
First exposure to pathogens that creates antibodies
Hep B
Lives outside the body for a time
Vaccines are for individuals who are at risk of exposure to hepatitis B virus
Adverse effects: pain and inflammation at injection site, transient fever or fatigue, potential for hypersensitivity
Biggest public health measure preventing death
Vaccines
Herd immunity
If enough of a puplation is vaccinated, the rest of the population is safe
Inflammation
Non-specific response to physical, chemical, traumatic, infectious, necrotic injury to tissue
Purpose of inflammation is to contain injury or destroy invading pathogens
Inflammation intended to be acute and local
Acute or chronic, but usually acute
Can last up to 10 days
Includes vascular and cellular phases
Acute inflammation
Vascular phase related to actions of histamine and prostaglandins
Cellular phase associated with neutrophils
Chronic inflammation
If inflammation cannot resolve injury or contain invading pathogen, inflammation can persist
Chronic inflammation is underlying problem of autoimmune disorders including lupus and rheumatoid arthritis
Associated with macrophages and lymphocytes
Acute and chronic inflammation may include
febrile response
Body temperature over 38.8oC
Pulse over 90 beats/minute
WBC count over 12,000/mm3
General principals for dealing with inflammation
Treat the underlying cause
Usually allowed to sef resolve, therefore, non pharm approaches are better
Drugs given via topical route cause fewer adverse effects than enteral route
Non-steroidal anti inflam drugs
are the primary drugs for the treatment of mild to moderate inflammation
block inflammation by inhibiting cyclooxygenase (COX) the key enzyme in the biosynthesis of prostaglandins
prostaglandins promote inflammation
COX 1 enzyme responsible for
Present in all tissues
Protective functions such as;
Reducing gastric secretion
Promoting renal blood flow
Regulating smooth muscle tone in blood vessels and the bronchial tree.
COX 2 responsible for
Present only after tissue injury and promotes inflammation
Sensitizes pain receptors
Causes fever
Three classes of NSAIDS
Salicylates (ie ASA)
Ibuprofen and ibuprofen-like drugs
COX-2 antagonists (ie celecoxib)
Ibuprofen (NSAIDs)
Mechanism of action: to inhibit prostaglandin synthesis both COX-1 And COX-2
for musculoskeletal disorders such as rheumatoid arthritis and osteoarthritis, mild to moderate pain, reduction of fever, dysmenorrhea
Adverse effects of NSAIDS
Possible GI bleed
Decreased kidney function
Interfere with mucosal protection in stomach
COX-2 inhjibs
Indicated for mild to moderate pain and inflammation associated with RA and osteoarthritis, dysmenorrhea
Less GI bleeding and ulcer formation than with ibuprofen or aspirin
Celecoxib is widely used though there is an elevated risk of myocardial infarction and stroke
Aspirin
Potent effect
so the potential for bleeding must be carefully monitored.
High doses may cause salicylism which includes symptoms of
Tinnitus
Dizziness
Headache
Sweating.
Assessments in NSAIDs
Assess for changes in pain, reduction in temperature and inflammation
Monitor for bleeding
Assess for gastrointestinal bleeding, hepatitis, nephrotoxicity, hemolytic anemia
Aspirin is dangerous for babies bc
It can cause Ryes syndrome
Systemic Glucocorticoids
are anti-inflammatory drugs that can suppress severe cases of Inflammation
suppress histamine release
inhibit the synthesis of prostaglandins by COX-2
suppress certain functions of phagocytes and lymphocytes
Prednisone
Synthetic glucocorticoid to treat inflammation
Long term therapy may result in cushings syndrom (Moonface, abdom obesity)
Increases risk for infection
Used for autoimmune disease)
Long term use for systemic glucocorticoids
Consider alternate day therapy plan
Signals adrenal cortext to continue producing steroids
CANNOT be stopped abruptly - can can cause adrenal shut down and adrenal crisis when glucocorticoid is withdrawn
Why cant glucocorticoids be stopped abruptly
can cause adrenal shut down and adrenal crisis when glucocorticoid is withdrawn
Antipyretic Drugs
Fever is a normal part of body’s defense against invading pathogens
Prolonged fever is dangerous and can be life-threatening
Acetaminophen and NSAIDs are most commonly used drugs to reduce fever
Why does acetaminophen not work for inflammation
Acetaminophen does not have anti-inflammatory properties; has different adverse effects than NSAIDs
How does acetaminophen work and what for
Mild to moderate pain
Osteoarthritis of the hip or knee
Dysmenorrhea
Dental procedures
Headache and myalgia
Fever
How does acetaminphen work
Mechanism of action
Inhibits COX activity in CNS but not in rest of
body
Antipyretic action may be due to action at hypothalamus
Serious adverse effects
Hepatotoxicity, acute liver failure
Renal failure
Pancytopenia
Routes of Acetaminophen
PO PR
Two categories of allergy drugs
Preventors and relievers
Histamine receptors
H1
(related to allergy response)
Found on smooth muscle cells, vascular endothelium
Stimulation of H1 receptors promote vasodilation and increased permeability of blood vessels, consistent with vascular phase of inflammation
H2
Found in stomach on parietal cells
Stimulation of H2 receptor triggers release of HCl by parietal cells
H1 recepor antagonist
H1 receptor antagonists block histamine receptors associated with inflammation
Benadryl uses
Hypersensitivity Type I allergic reaction
Allergic rhinitis, URT and GI allergies
Skin rashes, irritations, urticarias, angioedema
Antiemetic for vertigo and motion sickness
Antitussive
Insomnia (hypnotic agent)
Parkinson’s disease
Hypersensitivity Type I allergic reaction
Allergic rhinitis, URT and GI allergies
Skin rashes, irritations, urticarias, angioedema
Antiemetic for vertigo and motion sickness
Antitussive
Insomnia (hypnotic agent)
Parkinson’s disease
Trade name for diphenhydramine
Benadryl
Adverse effects of benadryl
Increased HR, pupil dilation, urinary retention, constipation, hallucinations (high doses
What should be monitored for benadryl pts
Monitor vital signs and monitor ECG for possible dysrhythmias
Monitor for vision changes, especially with patients that have narrow angle glaucoma
Monitor neurological status and LOC, especially with patients with seizure history (and older adults)
Flonase (fluticansone)
Intranasal glucocorticoids
Intranasal glucocorticoids uses
Seasonal and perennial allergic rhinitis
Mech of action for intranasal glucocorticoids
Inhibits histamine release by mast cells
Prevents macrophage accumulation
Reduces leukotriene release
Adverse effects for decongestants
Few
Dry nasal passages
Repound congestion
Anaphylaxis
Overwhelming allergic response that is life threatening
Skin, respiratory and Cardiovascular
Flushing, then cold, clammy with shock
Sense of dis-ease/foreboding
Angioedema (welts/swelling) and hives
Difficulty breathing as throat swells and bronchi constriction
Epinephrine mech of action
Non-specific adrenergic agonist with action at alpha1, beta1 and beta2 receptors which increased blood pressure and open airway
Alpha1 – vasoconstriction
Beta1 – increased HR, force of contraction
Beta2 – bronchodilation
Adverse effects
Hypertension, dysrhythmias are a risk so careful monitoring is crucial`
