Module - Immune System Flashcards
- Inflammation is? With a purpose of?
- Symptoms
- Is it good or bad
-itis
Inflammation is a defence mechanism, with a purpose to contain the injury and destroy a foreign agent
Swelling, pain, redness, warmth
Good until it hinders healing
Inflammation Mediators 6
Histamine Bradykinin Leukotrienes Cytokines Interleukins Prostaglandins
Classes of Inflammation System Drugs 2
Non-steroidal anti-inflammatories (NSAIDs)
Corticosteroids
Inflammation NSAIDs -What do they inhibit -What properties do they have -What are they for
-Forms of things they inhibit
C1 & C@
- Inhibit cyclo-oxygenase (COX), which reduces prostaglandin synthesis - >inhibiting inflammation
- Also have analgesic and antipyretic properties
- For mild to moderate inflammation
-COX-1 – In all tissues, stomach lining (mucosa), involved in platelet aggregation
(Responsible for most adverse effects of NSAIDs)
-COX-2 – more specific for inflammation
Inflammation (NSAIDS) Ibuprofen -What are the primary uses -What are the NSAID adverse effects -Take with? -Caution when?
Primary use: mild to moderate inflammation, fever, mild to moderate pain, dysmenorrhea, musculoskeletal pain, arthritis
NSAID adverse effects: nausea, dyspepsia, ulcer with long-term use, potential anti-platelet action, hypertension, increased risk of cardiac event with long-term use
Take with food
Caution in kidney disease, cardiovascular disease, GI conditions
CV Risks of NSAIDS
- What happened 15 years ago
- Increase in CV events from?
- What drug was safe
- Further analysis showed?
- 15 years ago – large influx of selective COX-2 inhibitors
- increase in cardiovascular events in those patients using long term (for arthritis, chronic conditions)
- [only drug left = celecoxib]
- Further Analysis: celecoxib and non-selective show risks, only use short-term as needed
Inflammation Corticosteroids -Mimic what -Two forms -Whats it for -Adverse effects? -How to give
- Mimic endogenous cortisol, attempting to bring body back to homeostasis after a fight-or-flight response
- Anti-inflammatory and immuno-suppressive
For severe inflammation
Serious systemic effects, limit use to emergencies and severe inflammation (multiple sclerosis, rheumatoid arthritis, auto-immune diseases)
Local administration, short-term use preferred whenever possible
Anti-inflammatories: Nurses Role
- First job
- Screen for?
- What do you find in the labs
- Find out what?
- Monitor what adverse effects (NSAIDs, Corticosteroids)
- Take with?
Cause of inflammation – remove or treat
Screen for contraindications (kidney or liver disease, GI disease, cardiovascular disease, active infection, etc.)
Labs – CBC, liver & kidney function
Response to treatment
Monitor adverse effects
[NSAIDs – GI upset, bleeding, cardiovascular risk?
Corticosteroids – hyperglycemia, hypertension, nausea, insomnia, psychosis (↑ doses)]
Take both with food
Fever
- What mechanism is it
- What can it cause in children
- Fever is a indicator of? (can you solve it)
- Treating fever is for
- Drugs that reduce fever are for?
-Fever is a defence mechanism (many species of bacteria are destroyed by high temperature)
-Fever can cause febrile seizures in children (6mos to 5 years)
[Cannot prevent a febrile seizure besides avoiding infections]
- Fever is a indicator of immune system functioning
- Treating a fever is for comfort
- Drugs that reduce fever = antipyretics
Classes of Fever Medications 2
Acetaminophen
NSAIDs
Fever Acetaminophen -What is the mechanism of action -Primary use? -Adverse effects (Liver toxicity dose? Avoid? interacts with what and how?)
- Mechanism of action: acts at hypothalamus to cause peripheral vasodilation, which enables sweating and allows body to rid excess heat (No anti-inflammatory action)
- Primary use: fever, mild to moderate pain, osteoarthritis
- Adverse effects: very rare liver toxicity (max dose of 4g/24hours), avoid alcohol, interacts with warfarin (but doesn’t ↑ bleeding on its own)
Max dose of Acetaminophen
- what is the max dose?
- OTC contain? (says?)
- Ingestion by unaware consumer has caused what?
3g / 24 hours
over-the-counter products contain acetaminophen as an additional ingredient
(“…..& Flu”)
inadvertent ingestion by unaware consumers, warnings for public have been reduced to allow for safer use
Fever NSAIDs -Mechanism of action? -Why is it the first line for fever -When is NSAID more appropriate? -ASA is contraindicated in?
- Same mechanism of action as acetaminophen (for fever)
- Acetaminophen’s safety record (few drug interactions and side effects), it is first-line for fever
- NSAID appropriate if inflammation is also present (ibuprofen > ASA)
ASA is contraindicated in children = Reye’s Syndrome (ASA + virus + fever in child)
Fever: Nurses Role
- Find what?
- Monitor?
- Assess adverse effects:
- Symptoms
-Cause of fever – if other treatment is needed such as antibiotics
- Monitor response to treatment – can use fever as indicator if safe to do so
- Vitals
- Watch warfarin levels (NSAIDs, acetaminophen)
Assess adverse effects: GI upset, sudden change in urine output (kidney!), signs of liver toxicity
-Jaundice, pale, tired, sweating, dark urine, confusion, coma
Allergies
Allergic Rhinitis (hay fever)
-symptoms similar to?
-Antigen labeled as what and causes?
Symptoms similar to common cold but no fever
Antigen – causes the symptoms – anything that the body has ‘labeled’ as foreign
- Tearing eyes
- Sneezing
- Nasal congestion
- Postnasal drip = cough
- Itchy mucous membranes (inside of nose, mouth, eyes)
Histamine
- When are they released
- The two kinds and what do they affect
Body responds to antigen by releasing histamine = causes most annoying symptoms
H1 – smooth muscle of vascular system, bronchial tree, digestive tract
H2 – lining of stomach, producing gastric acid
Classes of Allergy Medications
4
Antihistamines
- 1st-generation
- 2nd-generation
Intranasal Corticosteroids
Decongestants
Drugs for Anaphylaxis
Allergies 1st-Generation Antihistamines -What do they block -Difference from 2nd generation -Used to treat -2 common types -Have what kind of effects -Significant?
Block H1 receptors
Shorter acting, cause more drowsiness, and work faster than 2nd Generation
Used mostly to treat allergic response
Diphenhydramine and chlorpheniramine most common
Have anticholinergic effects
Significant sedation – some use as a sleep aid
Allergies 2nd-Generation Antihistamines -What do they block -Difference from 1nd generation -How long for the effect -Used to treat -Have what kind of effects -Take how often - effectiveness ? -4 common types
-Significant?
Block H1 receptors
Longer acting (12-24h), less sedating, and take longer to start working (onset of action) than 1st Gen.
Can take a few hours days for full effect, but safe to use for years
Still some anticholinergic activity (much < than 1st Gen)
Take daily to prevent symptoms during troubling season
Trial-and-error for effectiveness
Cetirizine (Reactine®), loratidine (Claritin®), desloratidine (Aerius®), fexofenadine (Allegra®)
Allergies Intranasal Corticosteroids -What do they do -used to prevent -how long does it take -Local administration does -Adverse effects
To reduce inflammation in nasal mucous membranes, and local immunosuppression
Used daily to prevent symptoms
Can take up to 2 weeks for full effect
Local administration prevents systemic side effects
Adverse effects: nasal irritation, dryness and bleeding (epistaxis), bad taste, loss of smell
Allergies
Decongestants (Phenylephrine, pseudoephedrine)
-What are Sympathomimetics and what do they cause
-Immediate relief of?
-What is the length of used for and consequence if used otherwise
-Adverse effects
Sympathomimetics – stimulants – cause vasoconstriction and reduction of mucous production
For immediate relief of nasal congestion – oral or intranasal
Short term-use only – rebound congestion if longer than 3-5 days (intranasal)
Adverse effects: oral – hypertension, anxiety, insomnia; intranasal – nasal irritation, rebound congestion, rarely systemic effects
Allergies
Decongestants
Restrictions on selling
- What is the main restriction on this drug
- single ingredient products contain?
- Where can they be found
Pseudoephedrine is used in manufacturing process of crystal meth – cant be sold as single ingredient in oral med
(difficult to isolate ephedrine if there is >1 ingredient)
Single-ingredient products now contain phenylephrine – not as potent
Pseudoephedrine is still available, but need to ask for it at the pharmacy (Schedule II)
Allergies: Nurses Role
- Document
- Correct product?
- Monitor what
- nasal dryness?
- Educate
- Assess?
Health history to identify triggers/antigens and previous therapy
Correct product = Prevention vs. treatment
Monitor anticholinergic effects, sedation, changes in vitals, urinary retention, effectiveness of product, stimulant adverse effects
Nasal dryness – humidifiers, saline drops, vaseline
Educate on short-term use of decongestants
Assess use of anti-histamines as sleep aids= sleep hygiene, etc.
Allergies Anaphylaxis -Response to what -How fast do symptoms appear -example
Fatal, hyper-response to an allergen (different from allergies/hay fever)
Symptoms within seconds or minutes
Itching, hives, tightness in throat or chest, difficulty breathing, facial swelling, non-productive cough and hoarse voice as larynx begins to close, rapid hypotension (with reflex tachycardia) and bronchoconstriction
Allergies Anaphylaxis Drug Epinephrine -Stimulate what -Does so via what and how 2 -Alleviates?
Stimulates both α and β adrenergic receptors
Via α–receptors: counters the high vascular permeability that occurs during anaphylaxis that leads to loss of intravascular fluid and hypotension
Via β–receptors: causes bronchial smooth muscle relaxation and relieves bronchospasm, dyspnea, and wheezing
Also alleviates pruritus, urticaria, and angioedema
Allergies Anaphylaxis: Outpatient Treatment -What is a epi-pen -Given when -What route
Epi-Pen® - epinephrine injection given an onset of symptoms
To be given on way to hospital – won’t resolve situation, just gives them more time
IM – give in large muscle in leg through clothing
Allergies Epinephrine Auto-Injectors -How many brands -Designed for -Variations of -Leave injector for how long -Injected where
Many brands now available
All designed for ease of use and clarity
Variations of “Remove cap and jab into top of thigh”
Leave injector in place for 5-15 seconds
To be injected ON WAY TO HOSPITAL
Anaphylaxis: Treatment in Hospital 6
-Oxygen
-More epinephrine
-IM or IV diphenhydramine
-Bronchodilator – salbutamol (β-agonist)
-Corticosteroids – both anti-inflammatory and immuno-suppressive effects
+ Comfort measures (traumatic experience)
Anaphylaxis: Monitoring and Nurse’s Role
- Document?
- Educate
- In hospital?
- support?
Health history to identify triggers/antigens
- Educate family on signs of anaphylaxis and what to do
- Educate proper use of epinephrine (EpiPen® or other) and follow-up
In hospital: vitals in response to treatment (hypertension, tachycardia, headache, dysrhythmias, edema, bronchoconstriction)
-Fight-or-flight response
Support for traumatic experience
Antibiotics
Bacterial Disease
-Bacteria cause disease by two mechanisms
Bacteria grows rapidly and causes disease by sheer numbers
Bacteria produce toxins that cause disease
E.g. botulinum toxin
Classification of Bacteria
-2 kinds
different antibiotics usually target either gram + or -
Gram-positive: have thick cell walls and retain purple gram-stain
Gram-negative: have thin cell walls and lose purple gram-stain
Classification of Bacteria Bacilli Cocci Spirilla Aerobic Anaerobic
Bacilli – rod-shaped
Cocci – spherical
Spirilla – spirals
Aerobic – bacteria that require oxygen to live and thrive
Anaerobic – bacteria that do not require oxygen to live and thrive
(some can live in both)
Antibiotics -target bacteria depending on? -Classified by? Bactericidal? Bacteriostatic?
Antibiotics target certain bacteria depending on if they are:
- Gram positive or negative
- Bacilli, cocci, or spirilla
- Aerobic or anaerobic
Antibiotics are classified either by their structure or their mechanism of action
Bactericidal – drugs that KILL the bacteria
Bacteriostatic – drugs that slow down the growth of the bacteria, allowing the body’s immune system to dispose of the bacteria
Antibiotic Resistance
(Bacteria multiply increasing chance of mutation)
-Mutations give what
-if antibiotic doesn’t destroy mutated bacteria?
Some mutations may give bacteria a benefit over others of the same species – antibiotic resistant properties
If the antibiotic doesn’t destroy these mutated bacteria, it will replicate, passing on the beneficial traits = resistant to the previous antibiotic
Activities that Promote Resistance 3
Examples: MRSA (methicillin-resistant staphylococcus aureus), VRE (vancomycin-resistant enterococcus)
Not completely finishing a course of antibiotics – some bacteria are left over even after symptoms disappear
Not a high enough dose of antibiotics – does not reach high enough of a concentration to get rid of all bacterial cells
Using an antibiotic when it is not indicated – every time an antibiotic is used, there is an increased chance of resistance due to exposure
Spectrum of Antibiotics 2
Broad-spectrum antibiotics: drugs that are effective against a wide variety of bacteria
(Prescribed empirically (according to experience) when we don’t know specific pathogen)
Narrow-spectrum antibiotics: drugs that are effective against very specific microorganism or restricted group
(Prescribed when pathogen is clear from a C & S, or symptoms, or type of infection)
Culture & Sensitivity (C & S)
Ideal situation and real life situation
Ideal situation:
-A patient comes in with an infection, we swab the infected area, grow it in a culture, and test it with classes of antibiotics to find out what it is sensitive to, then prescribe that agent in an appropriate way
Real life:
- We prescribe an agent right away (usually broad-spectrum, empirically prescribed), order a C & S, then change the antibiotic or dose if needed according to results
- Unfortunately, because it is done after the fact, there are instances where C & S results are not reviewed, therefore inappropriate and ineffective treatment can occur
Superinfections
- What kind of infection
- When does this happen and what antibiotic causes this
- Normal flora does what
- what creates an opportunity of super infection
A secondary infection
When an antibiotic also kills bacteria in the normal flora of our body (most commonly skin, lungs, GI and urinary tract)
(Broad spectrum antibiotics are more likely to do this than narrow spectrum)
Normal flora has useful purposes such as aiding in digestion and fighting pathogens through competition for nutrients
Absence of normal flora + tiny amount of remaining pathogen = opportunity for superinfection
Signs of Superinfections
- what is the sign
- Common SS
Another infection during or immediately after antibiotic therapy
- May be a different site of infection (Yeast infection after treating an upper respiratory tract infection - URTI)
- Common sites: GI tract, genitourinary tract
Common: diarrhea, blood or pus in stool, cramping, abdominal pain, bladder pain, painful and frequent urination, signs of vaginal infection (yeast or bacterial)
Probiotics
- What antibiotics cause diarrhea
- Do probiotics work
- When do you give
- What do susceptible pts use
Any/every antibiotic (especially given orally) has potential to cause diarrhea, due to disruption of normal flora = does not ALWAYS lead to superinfection
Maybe! (i.e. some products have shown evidence in preventing diarrhea)
Don’t give at exact same time as antibiotic dose – separate as much as possible
If patient is more susceptible (regularly gets diarrhea from antibiotics – assess with med history), can use probiotics to prevent diarrhea
Choosing an antibiotic
We consider? 8
-C & S
-Site of infection
Immune system status of patient (bactericidal or –static more appropriate?)
-Kidney and liver function
-Dosage forms available
-Variables affecting absorption, distribution, metabolism and elimination of antibiotic
-Patient allergies or intolerances
-Ease of administration and adherence issues
