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Pharmacology > Immune System > Flashcards

Immune System Flashcards

1
Q

skin layers

A
  1. epidermis - outer
  2. dermis - 2nd layer, bulk of skin
  3. subcutaneous - attaches skin to underlying structures
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2
Q

chemical mediators to cell injury

A

chem in the plasma that is activated by cell injury is called Hageman Factor (XII)

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3
Q

Hageman Factor activates what?

A
  1. Kinin system
  2. Clotting cascade
  3. Plasminogen system - starts dissolution of clots
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4
Q

Kinin system and role

A

Bradykinin role -

  1. local vasodilation
  2. stimulate nerve endings to cause pain
  3. causes release of arachidonic acid - > release of autocoids
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5
Q

types of autocoids

A
  1. prostaglandins - stim or block inflammation
  2. leukotrienes - can cause vasodilation, increased capillary permeability. can also block these reactions
  3. thromboxanes - cause local vasoconstriction and facilitate platelet aggregation and blood coag
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6
Q

order of inflammatory process

A
  1. rubor - red; increased blood flow (vasodilation)
  2. tumor - swelling; fluid leaks into tissues
  3. calor - heat
  4. dolor - pain; activated pain fibers
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7
Q

tx for bee sting

A

ice
scrape out stinger
antihistamine if necessary (benedryl)

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8
Q

tx for twisted ankle

A

R - rest
I - ice
C - compression
E - elevation

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9
Q

tx for injection site

A

ice

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10
Q

Bone marrow function

A

produces stem cell -> myelocytes, lymphocytes (both WBC)
myelocytes -> inflammatory and immune response
lymphocytes - T (mature in thymus - cell mediated) and B cells (bone - humoral)

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11
Q

types of myeloid stem cells

A

granulocytes

monocytes

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12
Q

types of granulocytes

A

neutrophils
mast cells
basophils
eosinophils

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13
Q

types of monocytes

A

macrocytes = macrophages

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14
Q

neutrophils action

A

60% of WBC
first to arrive, increase during infection (shift to L) - band cells increase
patrols tissues - squeeze out of capillaries
# increases during infection
short lived after phagocytosis
dead neutrophils make up pus

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15
Q

basophils action

A

circulation

emit chem substance to initial and maintain immune inflammatory response - histamine and heparin

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16
Q

mast cell action

A

incapable of circulation
found in resp, GI, skin
release chem mediator to stim inflammation and immune response

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17
Q

macrophage character

A

larger than neutrophil
found in organs
made in bone marrow (monocytes), called macrophage when enter organ
long lived
initiate immune response as they DISPLAY ANTIGENS from pathogens

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18
Q

antigen

A

substance with protein coat that causes immune system to produce antibodies
may be foreign substance
may be formed within body (bacterial toxins of tissue cells)

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19
Q

lymphocyte products

A

T lymphocytes - helper T 4, suppressor T8, cytotoxic T cells

B lymphocytes - plasma cells and memory cells

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20
Q

where is stem cell found

A

bone marrow

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21
Q

where do B cells go after they mature

A

lymph nodes and spleen, also circulate in blood

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22
Q

what is the purpose of t and b cells in circulation

A

come into contact with pathogens and each other

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23
Q

when are helper T cells activated.

A

activated when they recognize an antigen for example macrophage membrane or infected cell

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24
Q

what do t helper cells secrete

A

cytokines

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25
Q

what is action of T helper cells

A

secrete cytokine to help B cells divide and stimulate macrophages.

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26
Q

action of cytotoxic T cells (CD 8)

A

aka killer T cells

kills body cells displaying antigen

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27
Q

action of T suppressor cells

A

suppresses immune system

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28
Q

action of memory T cells

A

remains in body. faster immune response when recognizes antigen again

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29
Q

function of plasma cells (B)

A

produce antibodies (Ig)

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30
Q

Memory Cells action

A

divide rapidly as soon as antigen is reintroduced

pathogen can be destroyed before symptoms show

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31
Q

factors that affect immune system negatively

A 
stress
anxiety
fear
social isolation
lifestyle choices
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32
Q

action of salicylates

A

inhibit synthesis of prostaglandins

ie: ASA

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33
Q

NSAIDS action

A

blocks COX 1 and COX 2 (enzymes)

inhibits synthesis of prostaglandins

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34
Q

steroidal anti inflammatory agents

A

prednisone (deltasone)

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35
Q

Key components of protection

A
  1. skin, mucous - 1st line of defense
  2. bone marrow - WBC
  3. Lymphoid tissue - fight pathogens. includes tonsils
  4. chem mediators - triggered by inflammatory reaction
  5. Interleukins 1 - regulate growth and differentiation of lymphocytes
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36
Q

Aspirin properties

A

antipyretic
anti inflammatory
anticoag
analgesic

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37
Q

s/e of aspirin

A 
GI upset/ulcer
Prolonged bleeding
anemia - Hb 14g/dl
hemorrhage
ototoxicity (tinnitus)
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38
Q

nursing interventions for aspirin

A 
DO NOT GIVE before surgery
give with food/milk
monitor for bleeding
monitor Lv fx
prevent injury
DO NOT GIVE WITH OTHER FOOD DRUGS THAT PROLONG BLEEDING
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39
Q

with whom should you never use aspirin

A

children with viral infections (reyes syndrome)
clients with LV dysfx
clients in last trimester of pregnancy

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40
Q

NSAIDS Ibuprofen (Advil) actions

A

decrease inflammatory response without interfering with immune response of body’s ability to fight infection

for mild to mod pain mgmt - RA, OA, gouty arthritis
dysmenorrhea

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41
Q

Advil interventions

A

Give with food - aggravates St lining

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42
Q

Gouty arthritis

A

deposits of needle like crystal of uric acid.
inflammation begins in big toe
tends to be chronic

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43
Q

what is action of celecoxib (celebrex)

A

inhibits synthesis of prostaglandins - blocks COX 1 COX 2 enzymes

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44
Q

name 2 propionic acids

A

feneprofen

ibuprofen

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45
Q

name 3 acetic acids

A

diclofenac
etodolac
indomethacin - used for gout

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46
Q

fenamates (1)

A

mefenamic acid

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47
Q

c/i for NSAIDS

A 
presence of allergy to NSAID or salicylate
CV dysfx or HTN
peptic ulcer or known GI bleeding
pregnancy, lactation
Caution with LV KD dysfx
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48
Q

indications for NSAIDS

A

s/s/ RA OA
mild to mod pain
primary dymenorrhea
fever reducer

49
Q

NSAID a/r

A

GI upset
n/v, diarr
LV dysfx - prolonged bleeding

50
Q

consideration for advil

A

give with food, milk
monitor for effectiveness
monitor LFT’s - ALT, Ast, alkaline phosphotase, bilirubin, PT/ PTT

51
Q

uricosurics are for?

A

tx gout

52
Q

how does uricosuric work?

A

decrease reabsorption of and enhances excretion of uric acid

53
Q

examples of uricosurics

A

allopurinol/zyloprim - chronic gout
colchicine - acute gout
probenecid

54
Q

s/e of anti gout meds

A

altered urine pH -> more alkaline -> kd stone

diarrhea - f/e imbalance, impaired skin integrity

55
Q

nursing consideration for uricosurics

A

monitor uric acid level
encourage fluids unless c/i
teach client avoid high purine foods

56
Q

which type of foods have purines

A

organ meat
shellfish
sardines

57
Q

prednisone (deltasone) is an example of?

A

steroidal anti inflammatory

58
Q

actions of steroidal anti inflammatory

A

used to decrease the inflammatory response and or suppress the immune system

59
Q

indications for steroidal anti inflammatory

A

head trauma
asthma mgmt
addison’s disease (deficient glucocorticoids)
organ transplant patients

60
Q

s/e of prednisone

A 
immunosuppressant - masks infection
increased appetite
weight gain
hyperglycemia
elevated BP
GI upset/ulcer
buffalo hump
moon face
Hirsutism
61
Q

define hirsutism

A

hairy face and body esp in women

62
Q

examples of steroid anti inflammatory agents

A 
prednisone
decadron
solumedrol
solucortef
cortisone
63
Q

consideration for prednisone

A 
give at same time q day
give with food/milk
monitor bs
monitor for infection
do not d/c abruptly - taper
64
Q

acetaminophen(tylenol) actions

A

acts directly on thermoregulatory cells of hypothalamus
thought to inhibit prostaglandin synthesis
used to treat pain and fever assoc with variety of conditions including flu.
prophylaxis of children getting DPT immunization
relieves musculoskeletal pain assoc with arthritis

65
Q

examples of anti inflammatory agents

A

tylenol
gold compounds
anti arthritis drugs - solganal

66
Q

peak time for tylenol

A

.5- 2 hours

67
Q

tylenol a/r

A

h/a, hemolytic anemia, Kd dysfx, skin rash, fever, hepatotoxicity, increased bleeding

interactions - oral anticoags increase bleeding

68
Q

action of gold compounds, indications

A

absorbed by macrophages, resulting in inhibition of phagocytosis

decreased tissue destruction

69
Q

how long do gold compounds take to be effective

A

3-6 months

70
Q

c/i for gold compounds

a/r and interactions

A

c/i - allergy, diabetes, CHF, Kd Lv impairment

a/r - stomatitis, glossitis, gingivitis, bone marrow depression, dermatitis

interaction - penicillamine, antimalarials, cytotoxic drugs, immunosuppressive agents

71
Q

other antiarthritis drugs

A

aurothioglucose (solanal)
etanercept (enbrel)
anakinra (kineret)
off label - choroquine (aralen) - antimalarial - used for long term RA; notify MD Of blurring vision

72
Q

vaccine types

A
  1. microbes that have been killed
  2. microbes hat are alive but weak
  3. bacterial toxins called toxoids modified to remove hazards
73
Q

titer

A

presence of an antibody

measure to assess effectiveness of vaccines

74
Q

active immunity

A

immune system stimulated to produce antibodies due to exposure to antigen (vaccine)

75
Q

passive immunity

A

obtained by directly administering antibodies to patient

is only temporary

76
Q

natural immunity

A

active - result of infection

passive - transfer from mom to baby

77
Q

artificial immunity

A

active - result of vaccine

passive - injection of serum with antibodies

78
Q

indications for vaccines

A

stim active immunity in people who are at risk
depends of exposure the person will have to pathogens
thought to provide lifelong immunity - sometimes needs booster

79
Q

c/i for vaccines

A 
immune deficiency
pregnancy
allergies to any part of vaccine
pt who received Ig or blood or blood products w/i last 3 months
presence of infection and fever
80
Q

a/r of vaccines

A

fever, rash, malaise, chills, fretfullness, drowsiness, anorexia, vomiting, PAIN RED SWELLING AT INJECTION SITE

81
Q

education for vaccines for adults

A

pneumonia x1 - can get booster if

82
Q

immune sera definition

A

sera that contain antibodies to specific bacteria or viruses

83
Q

types of immune sera

A

antitoxin
antivenom
spider or snake bites

84
Q

indications for immune sera and toxins

A

provide passive immunity to a specific antigen or disease
used a prophylaxis against specific disease after exposure
may lessen the severity of disease

85
Q

caution with immune sera and antitoxins

A 
hx of severe rxn to any immune sera
cautions:
preg
coag defects
previous exposure to immune sera
rash
n/v
chills fever
86
Q

allergic reaction to immune sera/ antitoxin

A

chest tightness, decreased BP, difficulty breathing

local reaction - swelling, tenderness, pain, musc stiff at site

monitor client >1 hr after injection

87
Q

examples of impaired immune system

A 
chronically ill - need immunizations
elderly - monitor infections, esp UTI
pt on immune suppressant therapy
pt on chemo
pt with disease that suppress immunity - HIV
88
Q

immune stimulators - bio response modifiers action

A

used to energize the immune system when it is exhausted from fighting
prolonged invasion or needs
help fight specific pathogen or cancer cell

89
Q

which cells help fight specific pathogen or cancer cell

A

interferons
interleukins
T/B/ modulators

90
Q

immune suppressant actions

A

drugs used to block or suppress the actions of t cell and antibody production
used to prevent transplant rejection and treat autoimmune dz

91
Q

which are used to prevent transplant rejection and tx autoimmune dz

A

t/b cell suppressors
monoclonal antibodies
steroids

92
Q

types of immune modulators

A

interferons - act to prevent virus particles from replication
interleukins - stim immunity by increasing the activity of natural killer cells; aldesleukins (proleukin)
t/b cell modulators - ie: levamisole

93
Q

action of t/b cell suppressors

A

block antibody production, inhibit suppressor and helper t cells

94
Q

monoclonal antibody action

A

produced by a single clone of b cell that react with specific antigens

95
Q

interferons definition

A

naturally occuring glycoproteins used for their ability to interfere with viral replication, suppress cell proliferation, enhance macrophage activity and increase cytotoxicity of lymphocytes for target cells

96
Q

types of interferons

A

alfa - from leukocytes injected into wart
beta - from fibroblasts (connective tissue cells)
gamma - from fibroblasts and lymphocytes

97
Q

action of interferon alfa 2b (intron A)

A

prevents virus particle from replicating inside other cells
stimulates interferon receptor sites on non invaded cells to produce antiviral proteins
inhibits tumor growth and replication

98
Q

caution for interferon alfa

A

teratogenic

99
Q

c/i for interferon alfa

a/r

A

allergy, pregnancy, lactation
caution in cardiac, myelosuppression, CNS dysfx

a/r - lethargy, myalgia, arthalgia, anor, nausea, h/a, dizzy, bone marrow depression

100
Q

interleukin definition

A

chemicals produced by t cells to communicate bet leukocytes (type of cytokine)

101
Q

types of interleukin

A

aldesleukin (proleukin) - human, made by DNA tech using E Coli
Oprelvekin (neumeg) - newer

102
Q

action indication of aldesleukin

A

increase # of natural killer cells and lymphocytes
activate cellular immunity and inhibit tumor growth

for specific Kd carcinoma and possible tx of AIDS and AIDS related disorder

103
Q

indication for oprelvekin

A

prevention of severe thrombocytopenia after myelosuppressive chemo - stimulates growth of platelets

104
Q

c/i for interleukin

A

known allergy to e coli products, pregnancy, lactation
caution with Kd Lv Ht impairment

a/r - lethargy, myalgia, arthalgia, fatigue, fever, resp difficulties, hypotension, bone marrow suppression

105
Q

levmisole (ergamisol) action/indication

A

stimulates b cells to stim antibody formation, enhancing t cell activity
used for tx of duke’s stage C colon cancer

peaks in 1.5-2 hrs. 1/2 life 16 hrs

106
Q

c/i levamisole
a/r
interactions

A

allergy, pregnancy, lactation
use barrier protection

a/r - h/a dizzy, ataxia, n/v diarr

interaction - disulfiram type rxn, increased phenytoin level, ETOH

107
Q

azathioprine action

A

prevents rejection in renal hemotransplants

tx RA

108
Q

cyclosporine action

A

suppresses rejection in variety of transplants

tx RA and psoriasis

109
Q

glatiramer acetate (copaxone) action

A

reduces # of relapses in MS adult pt

110
Q

mycophenolate mofetil (cell cept) action

A

prevents rejection after Kd Ht transplant in adult

111
Q

sirolimus (rapamune) action

A

prevents rejection after Kd transplant

112
Q

Tacrolimus (Prograf) action

A

prevents rejection after LV transplant

113
Q

cyclosporine

A

inhibits dna synthesis
c/i - allergy, preg, CNS & LV disease

interactions - monitor for toxicity due to multiple interactions

114
Q

a/r cyclosporine

A

increased risk for infection and neoplasm development
LV toxicity
Kd toxicity and dysfx
Pulmonary edema
possible h/a, tremors, 2nd infections such as acne, GI upset, diarr, HTN
fatigue and flu like sx

115
Q

interventions for cyclosporine

A

s/s of infection
teach pt avoid risk of infection (flowers, fresh fruit, raw febbies)
monitor i/o
teach about importance of LIFE LONG COMPLIANCY

116
Q

anakinra (kineret) action

A

tx RA
block activity of interleukin 1
peak 3-7 hr
1/2 life 4-6

117
Q

c/i for anakinra
a/r
interaction

A

allergy, preg, lact, Kd impairment

a/r - h/a, sinusitis, nausea, diarr

interaction - etanercept may cause severe, life threatening infection

118
Q

muromonab CD3 (orthoklone OKT3) action

A

antibodies attach to specific receptors - antibody to T cells

119
Q

c/i, a/r, interaction for muromonab CD3

A

c/i - allergy and fluid overload
a/r - pulm edema, fluid retention, flu like sx
interaction - severe immune suppression

Pharmacology (8 decks)

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