Advanced Immunity, Inflammation & Infection + Advanced Special Groups Flashcards Preview

PA40333 - MO > Advanced Immunity, Inflammation & Infection + Advanced Special Groups > Flashcards

Flashcards in Advanced Immunity, Inflammation & Infection + Advanced Special Groups Deck (23)
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1
Q

What are the TWO main categories of changes that happen to the body during surgery?

A

Hormonal –> Corticotrophin (ACTH) levels increase (increasing cortisol), and growth hormones inhibits glucose uptake/use whilst insulin secretions are decreased, so blood glucose will raise (hence the need for sliding scales)

The thyroid also has an increased activity, increasing the body temperature

Metabolic –> An increase in catabolic (breaking down) enzymes, meaning there’s an increase in glucose, AAs and fatty acids

Water and electrolyte levels are also often disturbed

2
Q

What is the Triad of anaesthesia?

And what drugs would be used pre-op and peri-operatively?

A

Analgesia, Amnesia and Muscle Relaxant

Pre-op –> Anxiolytics (midazolam), antibiotics (broad spectrum), steroids and GI protection

Peri-op –> Propofol/Thiopental or gas with O2/N2O mix for induction)

Opitates, propofol IV (not in those with egg allergies) and O2/N2O mix gas (maintenance)

Switch to Oxygen, neostigmine (muscle relaxant) and anti-cholinergenics like atropine (end)

3
Q

For most surgeries, what would you do if the patient was on the following medication?

Anticoagulants

Anti-platelets

Cardiac meds

Steroids

Insulin

Oral Contraceptives

Tamoxifen

MAOIs

Lithium

A

Anticoagulants –> Wafarin (stop 5 days before) and DOACs (2 days before)

Anti-platelets –> Stop 2 days before

Cardiac meds –> Stop unless they’re protective for other reasons

Steroids –> Keep

Insulin –> Can give long acting in the morning, but then put on a sliding scale (oral hypoglycaemics are okay)

Oral Contraceptives –> Hold (but dependent on the patient)

Tamoxifen –> Continue

MAOIs –> Dependent on what it’s being used

Lithium –> Keep

4
Q

What are the following procedures?

Apendictectomy

Hemi-colectomy

Para-thyroidectomy

Oophorectomy

Laprotomy

Laproscopy

A

Apendictectomy –> removal of the appendix

Hemi-colectomy –> removal of half of the colon

Para-thyroidectomy –> removal of the parathyroid gland

Oophorectomy –> removal of the ovaries

Laprotomy –> open the front of the GI tract

Laproscopy –> same as above but not opening, using instruments and cameras instead

5
Q

What are the 4 main things that occur as a result of Sepsis, which make it so severe?

A

Hypovolaemia

Hypoperfusion at a cellular level

Cell Death

Organ Dysfunction

All this is due to the inflammatory response that is produced from the causative agent

6
Q

What are the 9 Red Flags of Sepsis?

A

AVPU of V, P or U (so not too with it)

Acute confusion

RR over 25 per min

Needs oxygen to keep sats above 92%

HR over 130 per min

Systolic BP under 90mmHg (or a drop of 40 from normal)

Not passed urine in the last 18hrs

Non-blanching rash

Recent chemotherapy (last 6 weeks)

7
Q

What are the Sepsis 6?

A
8
Q

What is an ART regime?

A

Triple therapy used to treat HIV

Contains two NRTIs (non-reverse transcriptase inhibitors), known as the backbone, and a third drug

9
Q

What is Tenofovir Alafenamide (TAF)?

A

A salt of tenofovir (an NRTI) with increased solubility and reduced side effects

This is ideal as the drug is nephrotoxic, so we want to give as little as possible

10
Q

Does Lamivudine (an NRTI) need to be dose adjusted in an AKI?

A

YES

11
Q

Which drug, given after a TIA, is most problematic when the patient is on HIV treatment?

A

Clopidogrel

This is because it’s a pro-drug that is metabolised by CYP enzymes, which will effect the levels of most HIV drugs!

12
Q

If Dolutegravir (a protease inhibitor) is given to patient whilst being treated for TB and HIV, what should be done to the dose?

A

Dose should be increased by 50% due to the AUC being decreased by the TB treatment (usually change from 50mg OD –> BD)

Important to not alter the TB treatment, but the HIV treatment instead!

13
Q

What’s the difference between PEP and PrEP?

A

PEP –> Post Exposure Prophylaxis

A 28 day course of drugs taken after exposure to prevent HIV. Can’t have 48hrs between doses as then the entire regimen won’t work

PrEP –> Pre-Exposure Prophylaxis

ART therapy that can be taken daily (like the pill). Shouldn’t be given if you have HepB, as it increases liklihood of sex without a condom (riskier sex)

14
Q

What is the ‘mismatch’ for this patient wanting to get a kindey transplant?

A

1-0-2

1 –> From A

0 –> From B

2 –> From DR

15
Q

What is the main ‘induction agent’ for immunosuppresion for kidney transplants?

Why are the other 2 possible agents not often used?

A

Basiliximab (IL-2 inhibitor)

Binds and inhibits IL-2 on T cells

20mg given 2 hours prior to surgery, and then 20mg 4 hours after

Cant use Almetuzumab or ATG as they can only be used once due to the body creating antibodies against them!

16
Q

What are Calcineurin Inhibitors (CNI’s)?

A

Tacrolimus (1st line) and Ciclosporin –> Used for maintainence immunosuppresion

These inhibit calcineurin activity, thus preventing T cell proliferation

These have specific brands! You cannot switch them!

Tacrolimus –> Needs to be given on an empty stomach, and is metabolised in the gut so D+V will increase active levels

Levels are increased by macrolides and decreased by rifampicin

Ciclosporin –> Should be diluted with juice or squash before administration due to horrible taste

17
Q

Which form of Mycophenolate Mofetil is the pro-drug form?

A

Mycophenolate sodium

Mycophenolate acid is the enteric coated version (so needs less than Mofetil, with a conversion ratio of acid 720mg : 1g Mofetil)

18
Q

What 3 types of prophylaxis is given to high risk patients after kidney transplants?

A

PCP Prophylaxis –> Co-trimoxazole

CMV Prophylaxis –> Aciclovir and Valganciclovir

TB Prophylaxis –> Isoniazid and Pyridoxine

19
Q

What are the 2 main interventions that are done when a kidney is rejected?

A

Pulsed methylprednisolone

ATG is given –> Which causes a cytokine storm

Should be given with hydrocortisone and chlorphenamine

20
Q

In RA, why would we want to taper people off of drugs that have got them into remission?

A

Cost

Side Effects

Convienience (mabs can be hard to store and administer)

Prevent cummulative toxicity

21
Q

In RA, what was found when comparing biologics treatment cessation and treatment tapering?

A

Stopping is worse than continuing the drug

Tapering off is probably just as good as continuing the drug….so you might as well do that! (But this is dependent on the patient)

The deeper/longer the patient is in remission for, the less likely they are to flare up when the dose is reduced

22
Q

What are the 7 most common signs of sepsis?

A

High/low temperature

Slurred speach/confusion

Extreme shivering/muscle pain

Passing no urine in a day

Severe breathlessness (blue lips)

“I feel like I might die” –> Feeling dreadful

Skin mottled or discolured

23
Q

In RA, why is dose optimisation at an inappropriate time a bad idea?

A

As it cause an RA flare

This makes getting control of the the RA afterwards much harder