Latex Flashcards
is irritation dermatitis immune or non-immune?
non-immune
is irritation dermatitis limited to area of direct contact?
yes
Type 1 or Type 4: spectrum of IgE reactions?
type 1
Type 1 or Type 4: delayed, immune mediated contact dermatitis?
type 4
type 4 is mediated by what lymphocytes?
T-lymphocytes
does type 4 occur on initial exposure or re-exposure?
re-exposure
are antibodies or complement involved with type 4 reactions?
no
what 2 compounds mediate type 4 reactions? (H,T)
histamine, tryptase
what are the hour ranges for type 4:
- onset
- peak
- duration
- 18-24 hours
- 40-80 hours
- 72-96 hours
which reaction type to latex is the most common?
type 4
are anaphylactoid reactions mediated by IgE?
no
anaphylactic reactions are which type of reaction?
type 1
what is the phase called in type 1 after 1st exposure to the antigen? (SP)
sensitization phase
what 2 things degranulate in stage one of type 1 reaction?
mast cells and basophils
mast cell and basophil degranulation cause what to be released?
histamine
stage 2 of type 1 is the release of what 5 compounds? (C,L,E,P,P)
cytokines, leukotrienes, eosinophilic chemotactic factor, plt activating factors, prostaglandins
H1 receptor activation:
- increases permeability where? (C)
- causes the release of what from vascular endothelium? (EDRF)
- constriction in what 2 areas of the body? (A,VSM)
- capillaries
- endothelium derived relaxing factor
- airway, vascular smooth muscle
H2 receptor activation
- increases what 2 secretions?
- inhibits the activation of what cells?
- vasodilates in what 2 vascular areas? (C,P)
- increases what 2 C/V related things?
- increases permeability where? (C)
- gastric acid, mucus
- mast cells
- coronary, peripheral
- chronotropy, inotropy
- capillaries
eosinophilic chemotactic factors of anaphylaxis and neutrophilic chemotactic factors are what type of substance in the body? (P)
peptides
does serotonin cause bronchoconstriction or bronchodilation?
bronchoconstriction
Leukotrienes:
- fast or slow reacting substance of anaphylaxis (C4,D4,E4)
- bronchodilation or bronchoconstriction?
- increased or decreased capillary permeability?
- vasodilation or vasoconstriction?
- coronary vasoconstriction or vasodilation?
- myocardial stimulation or depression?
- slow reacting
- bronchoconstriction
- increased
- vasodilation
- coronary vasoconstriction
- depression
what are the 2 type 1 effects of prostaglandin D2? (V,B)
vasodilation, bronchoconstriction
what are the 2 type 1 effects of thromboxane B2?
pulmonary hypertension, increased capillary permeability
what are the 3 type 1 effects of kinins? (V,B,ICP)
vasodilation, bronchoconstriction, increased capillary permeability
what are the 3 type 1 effects of plt-activating factors? (AAAP, SMC, ICP)
aggregation and activation of plts, smooth muscle contraction, increased capillary permeability
what are the 2 latex allergy tests for at risk ppl?
RAST, AlaSTAT
what are 5 characteristics of at risk pts? (HoAA, MS, M, UA, MA)
- history of atopy or asthma
- multiple surgeries
- myelodysplasia
- urological anomalies
- multiple allergies
what 2 workers are in the at risk group, especially with a history of atopy or asthma? (HCW, RPW)
healthcare workers, rubber product workers
what number case should the latex allergies surgery be?
first case
the OR should be latex free for at least how many hours?
1 hour
is the use of non-latex (powder free) glove the most important cutaneous contact precaution?
yes
intraoperative anaphylaxis symptoms can persist for up to how many hours?
36 hours
What % goes with these S/S of intraoperative anaphylaxis?
- hypotension/CV collapse
- rash/urticaria
- bronchospasm/wheezing
- angioedema and stridor
- 74%
- 70%
- 44%
- small percent
fluid resuscitate intraoperative anaphylaxis with what range of mL/kg?
25-50 mL/kg
what is the initial drug for intraoperative anaphylaxis?
epinephrine
what process does epinephrine attenuate to make it the initial drug for intraoperative anaphylaxis? (MC&BD)
mast cell and basophil degradation
Epinephrine intraoperative anaphylaxis doses:
- hypotension (mc/kg, range)
- CV collapse (mg)
- 1-10 mcg/kg
2. 0.1-0.5 mg
do antihistamines inhibit anaphylactic reaction or the release of histamine?
no
do you give an H1 and H2 blocker for secondary treatment?
yes
diphenhydramine (mg/kg, range)
0.5-1 mg/kg
for secondary treatment, what is the epinephrine gtt rate? (mcg/kg/min, range)
0.05-0.1 mcg/kg/min
what are the 2 refractory symptoms that corticosteroids are used for? (B, S)
bronchospasms, shock
hydrocortisone (mg/kg range)
5-10 mg/kg
albuterol:
- how many puffs via MDI? (range)
- how many mL via nebulizer? (range)
- 4-12 puffs
2. 0.25-1 mL
Aminophylline
- what is the IVP dose given over 20 minutes? (mg/kg, range)
- what is the gtt rate? (mg/kg/hr, range)
- 5-6 mg/kg
2. 0.5-0.9 mg/kg/hr
what is isoproterenol dose rate? (mcg/kg/min, range)
0.01-0.02 mcg/kg/min
what is NaHCO3 dose range for refractory hypotension? (mEq/kg, range)
0.5-1 mEq/kg
what is the IVP glucagon dose? (mg)
1 mg
what is the NE dose range? (mcg/kg/min)
0.05-0.1 mcg/kg/min
Post anaphylaxis, close observation is needed for a minimum of how many hours?
12 hours
biphasic anaphylaxis will occur 5-32 hours in what % of pts?
20%
serum tryptase levels remain elevated what range of hours post anaphylaxis?
1-4 hours
what meds can be used for refractory bronchospasm? (H, M, I, A, A)
hydrocortisone, methylpred, isoproterenol, albuterol, aminophylline
what med can be used for refractory hypotension? (G, N, N, E)
glucagon, NE, NaHCO3, epi
H1, H2, leukotrienes, thromboxane B2, or plt activating factor:
- SM contraction
- myocardial depression
- pulmonary HTN
- inhibition of mast cell activation
- plt aggregation and activation
- coronary constriction
- coronary vasodilation
- slow reacting substance to anaphylaxis
- increased chronotropy and inotropy
- increased gastric acid and mucus
- release of endothelium derived relaxing factor
- plt activating factor
- leukotrienes
- thromboxane B2
- H2
- plt activating factor
- leukotrienes
- H2
- leukotrienes
- H2
- H2
- H1
what 5 compounds cause bronchoconstriction? (Someone HeLP Karen)
serotonin, H1, leukotriene, prostaglandin D2, kinins
what 5 compounds cause vasodilation? (Hey HeLP Karen)
H2, H1, leukotriene, prostaglandin D2, kinin
what 6 compounds increase capillary permeability? (Hey HeLP Trap Karen)
H2, H1, leukotriene, plt activating factor, thromboxane B2, kinin
H1, H2 or both:
- increased capillary permeability
- vascular SM constriction
- coronary vasodilation
- peripheral vasodilation
- endothelium derived relaxing factor release
- increased gastric acid secretion
- inhibition of mast cell activation
- airway constriction
- increased inotropy and chronotropy
- increased mucus production
- both
- H1
- H2
- H2
- H1
- H2
- H2
- H1
- H2
- H2
leukotrienes depress and constrict what organ?
heart
what compound causes pulm htn?
thromboxane
methylprednisolone q 6 hours (mg/kg, range)
1-2 mg/kg
Sensitization phase:
- upon 1st exposure to the Ag, T-helper cells synthesize what? (L)
- this causes B-lymphocytes to synthesize what? (A)
- this product binds to receptors on what 2 cells? (M, B)
- lymphokines
- antibodies
- mast cells, basophils
ranitidine (mg/kg)
1 mg/kg
what is the minute range onset for intraop anaphylaxis?
5-150 minutes
suspect intraop anaphylaxis when HR drops how many beats per minute?
30
suspect intraop anaphylaxis when BP drops greater than how many torr?
30
for intraop anaphylaxis, up to what % of IV volume can be lost into the interstitial space?
40%
irritation dermatitis:
- gradual or fast onset?
- what type of agents cause it? (D/D)
- gradual
2. defatting/degreasing
what 5 chemical additives in latex act as haptens? (ABCTT)
amines, benzothiazole, carbamate, thiurams, thiourea derivatives
what is formed during Type 1 sensitization phase?
IgE antibodies
Type 1 reactions:
- what happens in stage one?
- what happens in stage two?
- mast cells and basophils degranulate causing histamine to be released
- CLEPP is released (cytokines, leukotrienes, eosinophils, prostaglandins, PAF)
do you give premedication to pts with latex allergies?
no
