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Miscellaneous Topics > Apex- WBCs and hypersensitivty reactions > Flashcards

Apex- WBCs and hypersensitivty reactions Flashcards

1
Q

Anaphylaxis causes degranulation of: (Select 2):

-neutrophils
-monocytes
-basophils
-mast cells

A

mast cells and basophils

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2
Q

what does it mean when a cell degranulates?

A

it releases cytotoxic contents from it’s storage vesicles

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3
Q

Match:
Neutrophils, Basophils, Eosinophils

Immune defense agaisnt parasites, allergic reactions, immune defense

A

Neutrophils = immune defense
Basophils = allergic response
Eosinophils = immune defense agaisnt parasites

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4
Q

Which one provides humoral immunity vs cellular immunity- T lymphocytes bs B

what’s the differene?

A

B = humoral
T= cellular

B-lymphocytes: Humoral immunity > produces antibodies (B : B cells, antiBodies)
T-lymphocytes: cell-mediated immunity > does NOT produce antibodies

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5
Q

What is the most abundant type of WBCs

what are they responsible for?

A

Neutrophils (keepin everything neutral)

immune defense - fight bacterial and fungal infections

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6
Q

What specific receptor does epi act on to help in treating anaphylaxis?

A

Binds to BETA-2 receptor on the cell membranes of basophils and mast cells and prevents their degranulation (releasing of their contents into circulation)

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7
Q

Why might someone with a bad viral ilness not have elevated WBC count?

what could you specifically look at on CBC with diff

A

Bc neutrophils make up 60% of WBCs and they fight bacterial and fungal infections

monocytes are the ones that fight viral infections

monocytes

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8
Q

What do natrual killer cells do

A

limit the spread of tumor and microbial cells

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9
Q

Why might someone say to avoid opioids in somone with cancer?

A

bc opioids reduce the function of natural killer cells which help limit the spread of tumor and microbial cells (concern for cancer recurrance or spread)

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10
Q

Match Each type of hypersensitivity reaction with its BEST example: Tyypes 1-4:

Serum sickness after snake bite
ABO incompatability
Anaphylaxis
Graft-vs-host reaction

A

1- Anaphlyaxis (1st is the worst)
2- ABO incompatability (2 bloods mixing)
3- Serum sickness after snake bite
4- Graft vs host reaction

  1. Immediate hypersensitivity
  2. antibody mediated
  3. immune complex mediated
  4. delayed
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11
Q

Match each type of hypersensitivity reaction : types 1-4

-immune complex mediated
-antibody mediated
-delayed
-immediate hypersensitivty

A
  1. immediate hypersensitivity
  2. antibody mediated
  3. immune complex mediated
  4. delayed

  1. anaphylaxis and extrinsic asthma
  2. ABO incompatability and HIT
  3. snake venom reaction
  4. contant dermatitis, graft-vs-host
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12
Q

What type of hypersensitivty reaction:
anaphylaxis

A

1

immediate hyperesensitivty

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13
Q

What type of hypersensitivty reaction:
Extrinsic asthma

A

1

immediate hypersensitivty

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14
Q

What type of hypersensitivty reaction:
HIT

A

2

antibody mediated

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15
Q

What type of hypersensitivty reaction:
ABO-incompatability

A

2

antibody mediated

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16
Q

What type of hypersensitivty reaction:
snake-venom reaction

A

3

immune complex mediated

17
Q

What type of hypersensitivty reaction:
contact dermatitis/steven johnson

A

4

delayed

18
Q

What type of hypersensitivty reaction:
graft-vs-host disease

A

4

delayed hypersensitivity

19
Q

3 ways epi works to treat anaphylaxis

A

1- prevents degranulation of mast cells and basophils
2- provides CV support
3- dilates the airways

1- beta 2 receptors on basophils and mast cells
2- beta 1 receptors
3- beta 2 receptors

20
Q

What are the 3 most common culprits for periop allergic reactions

A
  1. NMBs - SUX*
  2. Latex
  3. Antibotics (beta-lactams most common)

beta lactams = PCN, ampicilin, and cephalosporins

21
Q

Differene between Anaphlyactic and anaphylactoid reactions

why doesnt it really matter

A

anaphylaxis- requires prior sensitization or cross reactivity
anaphylactoid - no prior exposure is needed

bc they both degrade mast cells and basophils and tx is the same

22
Q

What 3 things are released when mast cells and basophils degranulate?

A
  1. Histamine & Arachidonic acid metabolites:
  2. leukotrienes
  3. prostaglandins
23
Q

3 effects of histamine 1 receptor
2 effects on histamine 2 receptor

A

H1 = vasodilation, increased vascular permeability, smooth muscle contraction ( not VSM)
H2 = cardiac stimulation (tachycardia) and gastric acid secretion

24
Q

pt bronchospasms- what 2 things would you notice first

A
  1. drop off in ETCO2
  2. high PIPS

followed by your sat plummeting

25
Q

What type of hypersensitivity is IgE mediated

A

Type 1- Immediate hypersensitivty

Angigen + antibody interaction in a pt previously sensitized to the antigen

anaphylaxis + extrinsic asthma

26
Q

What type of hypersensivity reaction is IgG mediated

A

Type 2- antibody mediated

IgG and IgM antibodies bind to the cell surfaces or extracellular regions and activate the complemnt cascase

ABO-incompatabilty, HIT

27
Q

What type of hypersensivitity reaction is IgM mediated?

A

Type 2- Antibody mediated reaction

IgG and IgM antibodies bind to the cell surfaces or extracellular regions and activate the complemnt cascase

ABO- incompatability and HIT

28
Q

What type of hypersensivity reaction is tissue rejection?

A

Type 4- delayed

29
Q

Type 4 hypersenisitivity reactions are delayed for at least how long following exposure?

A

12 hours

contact dermatitis, graft-host, tissue rejection

30
Q

Epi dosing for anaphylaxis:

-what to start with for hypotension vs CV collapse

A

5-10mcg for hypotension
0.1-1mg for CV collapse

take 0.1mg epi (100mcg/ml)
-dilute in 20ccs 5mcg/ml

if you only have 1mg vials:
-take 0.5cc (500mcg/ml)
-dilute it in 20mls = 25mcg/ml (25 x 2 = 50 [add the zero in from the 20] = 500mcg)
-take 2ccs (50mcg) and dilute it in 5mls

31
Q

How much hydrocortisone are you going to give in anaphylaxis and why

A

250mg to prevent the delayed release of inflammatory compounds

no immediate effect

32
Q

Anaphylactic steps

A

*discontinue offending agent
1. 100%fio2
2. epi (start with 5-10mcg) - dilute 0.1mg in 20ccs for 5mcg/ml
3. open fluids
4. H1 and H2 blockers (block the effects of histamine)
5. albuterol for bronchospasm
6. vasopressin for refractory hypotension (1-2unit bolus, gtt is 0.01unit/min start)
7. hydrocortisone 250mg to prevent delayed rlease of inflammatory substances

H1- vvasodilation, vascular permeability, smooth musccle relaxation
H2- cardiac stimulation (tachycardia) and gastric acid secretion

33
Q

Groups of people at high risk for latex allergy (4)

A
  1. spinabifida/myelomeningocele
  2. atopy (allergic to everything)
  3. heatlhcare workers
  4. allergy to fruits: banana, kiwi, mango, papaya, pinepple …… & tomato lol

Miscellaneous Topics (11 decks)

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