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Immune System Flashcards

1
Q

Type 4 hypersensitivity**

A

Delayed
Cell mediated

Caused by activated T cells NOT ANTIBODIES
Th1, Th2, CTL
24-72 hrs
Contact dermatitis/TB lesions/graft rejection/chronic asthma

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2
Q

Innate immunity self-vs-nonself discrimination

A

Based on self-vs-nonself

So it needs to be perfect

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3
Q

What exacerbates SLE?

A

Infection
Pregnancy
Surgical stress
Drugs (procainamide, hydralazine, captopril, enalopril, isoniazid, methyldopa, d-penicillamine)

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4
Q

SLE effects (high risk)

A 
Seizure
Stroke
Dementia
Neuropathy 
Psychosis
Pericardial effusion >50% pts
Tamponade rare
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5
Q

Mast cells**

A

Immediate hypersensitivity responses
Tissue fixed (perivascular spaces of skin/lung/intestine)
IgE receptors on surface (bind to antigens)
Activation=release of mediators important to immediate hypersensitivity rxns

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6
Q

Mononuclear cells**

A

Ingestion and destruction of damages and neoplasticism cells and bacteria

Effector cell-migrates to inflammation areas

Agranulocyte
Phagocytosis
Release cytokines
Present pieces of pathogens to t-lymphocytes

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7
Q

Hypersensitivity acronym

A

A (allergic/anaphylaxic/atopic)
C (cytotoxic)
I (immune complex)
D (delayed)

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8
Q

Adaptive immunity specificity

A

Highly specific! Can discriminate b/t pathogen and non-pathogen structures and minute differences in molec. structures

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9
Q

HIV/AIDS most common opportunistic pathogen

A

Pneumoncystic carinii
Pneumonia responsible for most deaths

Strict aseptic technique

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10
Q

Innate immunity response time

A

Fast (mins-hrs)

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11
Q

Adaptive immunity key components**

A

Antibodies (antigens interact with lymphocytes to form antibodies)

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12
Q

Innate immunity specificity

A

Only specific for molecules and molecular patterns associated with general pathogens or foreign particles

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13
Q

Anaphylaxis treatment**

Standard

A

EARLY!!

Standard (non-life threatening):

  • Epi - 100-500 mcg subq or IM, repeat q 10-15 min for adults, kids 10 mcg/kg q 15min x2 then q 4 hrs
  • Benadryl - 1-2 mg/kg or 25-50 mg IV
  • Corticosteroid - questionable
  • H2 blocker - Pepcid
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14
Q

Adaptive immunity memory

A

Memory good- when used can lead to faster response to recurrent or subsequent infections

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15
Q

Innate immunity diversity and customization

A

Limited- receptors are standard and only recognize antigen patterns. No new receptors are made to adapt the immune response

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16
Q

HIV/AIDS common comorbidities

A

CV - abnormal EKG 50%
Pericardial effusions 25%

Wasting syndrome - malabsorption/metabolism changes, <10% wt loss, eval fluid status

Neurological - dementia, peripheral neuropathy, autonomic abnormalities

Hematologic - platelet stability and f(x) impairment, steroid therapy or splenectomy

Cancer - non-hodgkin lymphoma (space occupying lesions in CNS), Kaposi’s sarcoma (endothelial tissue)

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17
Q

Type 2 hypersensitivity**

A

Cytotoxic
(Autoimmune hemolytic anemia)
Antibodies specific to antigens attach to cell surface

Antibody mediated/ IgG
5-8 hrs
PCN/chronic urticaria/BLOOD TRANSFUSION/ autoimmune hemolytic anemia

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18
Q

HIV/AIDS assessment

A

Current physical exam
Labs
Xrays

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19
Q

Type 3 hypersensitivity**

A

Immune complex
Antibodies bind antigens and release enzymes that cause tissue damage

IgG/ immune complex mediated
2-8 hrs
Serum sickness/arthus/glomerulonephritis/RA/systemic lupus/erythematosus

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20
Q

High risk latex allergy people**

A 
Healthcare workers
Neural tube defects
Multiple surgeries
Spina Bifida
GU tract defects
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21
Q

Innate immunity memory

A

None

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22
Q

HIV/Aids anesthetic concern

A

Non-nucleoside reverse transcriptase inhibitors (NNTIs)

Induce CYP450

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23
Q

Adaptive immunity self-vs-nonself discrimination

A

Worse than innate system
But still pretty good
When it has problems causes autoimmune disease

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24
Q

Allergic Tendency people**

A

Genetic

Large IgE quantity

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25
Innate immunity major cell types
Natural killer cells, neutrophils, macrophages, basophils, eosinophils, dendritic cells
26
Anaphylaxis vs. Anaphylactoid**
Anaphylaxis= IgE mediated (Requires prior exposure) Anaphylactoid= NOT IgE mediated (May occur with 1st exposure) *nearly identical*
27
HIV/AIDS = ____ branch
Retrovirus invades cell-mediated branch of immune system
28
SLE treatment
Corticosteroids Antimalarial Immunosuppressants
29
What to do after HIV exposure
Wash and clean area Immediate baseline test you & pt Empirical treat with 2 or more antiretrovirals (w/in 1-2 hrs/1-2 weeks) Periodic testing for 6 months
30
Anaphylaxis secondary treatment** | 1-7
1. Antihistamines (.5-1 mg/kg Benadryl) 2. Catecholamines 3. Bronchodilators 4. Corticosteroids 5. NaBicarb 6. Eval airway before extubation 7. Vasopressin for refractory shock
31
Antigen activity w/in adaptive immunity**
B lymphocytes have millions of distinctive antigen-specific receptors inherent to organism’s DNA T lymphocytes can only recognize antigens bound to receptor molecules MHC1 and MHC2
32
Natural killer cells**
No specific tumor cell and antibody-dependent cytotoxicity
33
Adaptive immunity major cell types**
``` T cells (cell mediated) B cells (humoral) And other antigen-presenting cells ```
34
Neutrophils**
Phagocytosis, cytokine release, secretion of hydrolytic enzymes, secretion of reactive oxygen species Effector cell-migrates to inflammation areas Granulocyte (most numerous WBC) 6 hr 1/2 life, 1st on scene in inflamm. rxn. Fight bacteria/fungus Contain acid hydrolases, neutral proteases, and lysosomes. After activation produce hydroxyl radicals, superoxide, and hydrogen peroxide
35
RhoGAM**
To Rh NEG mom to prevent immune sxs from developing antibodies fetal Rh antigen -after exposed once mom develops Rh antibodies (next child would cause reaction)
36
Innate immunity key components
Antimicrobial peptides and proteins (such as toxic granules)
37
Anaphylaxis initial therapy** | (1-5)
1. Stop drug 2. Maintain airway/ 100% FiO2 3. D/C anesthetic agents 4. Fluids (2-4 L crystalloid / colloid) 5. Epi (5-10 mcg IV)
38
``` HIV occupational exposure** Most common needle type ___ Risk after percutaneous exposure ___ Risk after mucous membrane exposure ___ Non intact skin to infected fluid other than blood ___ ```
Open bore most common Perc exposure O.3% Muc meme exposure 0.09% Non-intact skin & not blood 0%
39
Macrophages**
Process/present antigens to effect inflamm., tumoricidal, and microbicidal functions Arise from ciculating monocytes-may be confined so specific organ Recruited/activated in response to microorg. or tissue inj. Ingest antigens before they interact with lymphocyte receptors
40
HIV/AIDS two major concerns
Infection of patient Infection of staff -look at regional or laparoscopic options
41
Polymorphonuclear cells**
Ingestion or phagocytosis; killing of microorganisms; facilitation is bodily clearance of dead cells
42
Plasma cells**
Active in protein synthesis for formation of immunoglobulins
43
Platelets**
Facilitation of coagulation, influence tissue reactivity to injury
44
SLE presentation
Polyarthritis and dermatitis Malar rash in 1/3 pts Renal disease in <50% (most common cause of death, 10-20% require dialysis)
45
HIV/AIDS Prevent exposure
``` Ensure everyone is aware Highest risk with open bore needles DO NOT RECAP PPE (mask/eye ware/gloves/gowns) Hand washing Clean machines regularly ```
46
B lymphocytes**
Humoral immunity Transformation into plasma cells which react to foreign substances by producing antibodies and immunoglobulins, active in circulatory system, cytokine release Agranulocyte Produces antibodies!!!
47
Basophils and mast cells**
Sources of histamine and heparin, which combat insult by increasing vasc. permeability/ smooth musc. contractility (bronchospasm)/ and inflamm responses Granulocyte (least common type) Hypersensitivity rxns Release histamine/leukotrienes/cytokines/prostaglandins IgE receptors on surface Increase if given blood causing immune resp.
48
Active immunity diversity and customization
Very diverse! | Customized by genetic recombination do epitomes and antigenic determinants
49
Active vs passive immunity | ?both types of adaptive/acquired?
Active= given pathogen (vaccines) Passive=given antibodies from someone immune (Immediate but short effect)(fetus, IgA breast milk, RhoGAM)
50
What are antibodies?
Immunoglobulins Each specific for particular antigen Protect by direct attack or activation of complement system
51
Histidine action
``` Stimulates gastric secretion (H2) Contracts smooth muscle (other than blood vessels) Cardiac stim (H2) Vasodilation (H1) Inc vasc perm (H1) ```
52
High risk for autoimmune**
``` Female African Americans Native American Hispanics Child bearing years Working age ```
53
T lymphocytes**
Recognize/react to foreign material inside fixed tissues and to harmful organisms like neoplasticism and TB cells Impt. in transplant rejection Cytokine release Agranulocyte Cell-mediated immunity Does NOT produce antibodies!!!!
54
Rank Drug reaction culprits**
1. Muscle relaxants (60%) - Roc - females more 2. Latex (15%) 3. ABX (5-10%) {“4” Hypnotics} 4. Opioids (<5%) {“5” colloids}
55
SLE Anesthesia concerns
Prone to PE/pneumonitis/alveolar hemorrhage/pulm HTN 1/3 pts cricoarytenoid arthritis & RLN palsy May require corticosteroids Cyclophosphamide (inhibits plasma cholinesterase, :. Impacts ester LA & succs)
56
Eosinophils**
Phagocytosis, combating parasitic diseases; defense in allergic response Effector cell-migrates to inflammation areas ``` Granulocyte Heavy in GI, resp, and urinary mucosa Can cause esophagitis ?f(x) Collect at site of parasite infect., tumors, and allergic rxns ```
57
Type 1 hypersensitivity rxn**
Anaphylaxis (Allergic/atopic) IgE Mediated 20-30 mins Mast cell activation
58
Anaphylaxis treatment** | Life threatening/Anaphylaxis
* Airway maintenance * 100% O2 * Epi IV (50-100 mcg or more, repeat prn) - restores normal cap perm/relaxes smooth musc * CPR, pressors, fluids * bronchodilators * H1 & H2 blockers * corticosteroid
59
Adaptive immunity response time
Slow (days)
60
Systemic Lupus Erythmatous (SLE)** | type of disease and what it produces
Chronic inflammatory disease Production of antinuclear antibodies

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