Anti-Inflammatory Flashcards
(114 cards)
1
Q
A network of tissues and organs that help get rid the body of toxins, waste, and other unwanted materials
A
Lymphatic System/Lymphoid System
2
Q
Primary function is to transport lymph - a fluid containing infection fighting white blood cells, all throughout the body
A
Lymphatic System/Lymphoid System
3
Q
It consists of lymphoid cells, tissues, and organs such as tonsils, spleen, thymus, and lymph nodes
A
Lymphatic System/Lymphoid System
4
Q
It is the first line of protection/defense from pathogen
A
Nonspecific Defenses (First Line of Defense)
5
Q
Serves as barriers to microbes or environmental hazards
A
Nonspecific Defenses (First Line of Defense)
6
Q
Unable to distinguish one type of threat from another and the response or protection is the same regardless of the pathogen
A
Nonspecific Defenses (First Line of Defense)
7
Q
Physical barriers
Phagocytes
Natural killer cells
Complement systems
Fever
Interferons
Inflammation
A
Nonspecific Defenses (First Line of Defense)
8
Q
The most important nonspecific defenses
A
Inflammation
9
Q
Like epithelial lining of the skin, respiratory and gastrointestinal mucous membranes that are potential entry points from pathogen
A
Physical barriers
10
Q
Line of defense that is particular to a certain threat
A
Second Line of Defense (Specific Defense)
11
Q
A specific defense may act against only a single species of bacteria and be ineffective against all others
A
Immune response
12
Q
Foreign agents that elicit an immune response against all others
A
Antigen
13
Q
What are the strongest antigens?
A
- Foreign proteins such as those present on the surface of pollen grains
- Bacteria
- Nonhuman cells
- Viruses
14
Q
The primary cell of the immune response that interacts with an antigen
A
Lymphocytes
15
Q
It is initiated when an antigen encounters a type of lymphocytes known as B cell
A
Humoral Immunity
16
Q
Primary function is to secrete antibodies specific to the antigen that initiated the challenge
A
Plasma Cells
17
Q
It is a condition of being able to resist a particular disease
A
Immunity
18
Q
Antibodies that are circulating through the body
A
Immunoglobulins
19
Q
Physically interacts with the antigen to neutralize it or mark the foreign agent for destruction by other cells of the immune response
A
Immunoglobulins
20
Q
Biological agents used to stimulate the immune system
A
Vaccines
21
Q
What is the goal of a vaccine administration?
A
To prevent serious infections by life threatening pathogens
22
Q
Administer a modified, harmless microorganism or its toxoid to the client so that an immune response occurs in the following weeks or months
A
Vaccinations or Immunizations
23
Q
Most required follow up vaccinations called _________ to provide sustained protection
A
Boosters
24
Q
Measures the amount of antibody produced after the vaccines has been administered to know the effectiveness of most vaccines
A
Titer
25
Two types of Immunity
Active Immunity
Passive Immunity
26
Immunity achieved through the administration of vaccines
The clients immune system is stimulated to produce antibodies by exposure to the antigen or a vaccine
Active Immunity
27
Occurs when performed antibodies are transferred from one person to another
Passive Immunity
28
Maternal antibodies cross the placenta and provide protection for the fetus and newborn. What type of immunity is this?
Passive Immunity
29
Examples of Selected Vaccines
Bacillus Calmette Guerin (BCG)
Hepatitis B Vaccine
Tetanus Toxoid
Measles Vaccine
30
Vaccines that provide Passive Immunity
Hepatitis B Immunoglobulin (IM)
Rabies Immunoglobulin (IM)
Tetanus Immune Globulin (IM)
31
Administered months or years after the initial vaccine
Booster vaccine
32
Stimulate the immune system to maintain enough memory cells to mount a rapid response to an antigen
Booster vaccine
33
Common Side Effects of Vaccines
Redness and discomfort on the site of injection
Fever
Anaphylaxis
34
A type of reaction where it is uncommon but has a severe effect and considered as a common side effect of vaccines
Anaphylaxis
35
1. Prior to administration, assess for
any risk based precautions such as
pregnancy, diabetes, heart disease,
renal failure and various other
serious and debilitating conditions
and provide education on the
importance of receiving
vaccinations.
2. Assess recent laboratory blood tests
because vaccines are
contraindicated to
immunosuppressed clients.
3. Answer all the questions and concerns of clients and family members regarding the benefits and risk of vaccines
Nursing Considerations for Vaccines
36
1. Practice reliable contraception for 3
months after administration of
vaccines.
2. Maintain immunization records and
bring to health care appointments
during visits for immunizations
3. Keep all scheduled appointments
for additional vaccinations
4. Advise the client or care provider of
the side effects may include pain at
injection site, fever and soreness
5. Immediately report shortness of
breaths and allergic reaction.
Client Health Teaching: Vaccines
37
The 2nd branch of immune response that involves lymphocytes
T Cells
38
Give the 2 major types of T Cells
Helper T Cells
Cytotoxic T Cells
39
Has a CD4 receptor
Particularly important because they are responsible for activating most other immune cells, including B cells
Helper T Cells
40
A glycoprotein found on the surface of immune cells such as T helper cells, monocytes, macrophages, and dendritic cells
CD4
41
Has a CD8 receptor
Travels throughout the body, directly killing certain bacteria, parasites, virus infected cells, and cancer cells
Cytotoxic T Cells
42
It is a transmembrane glycoprotein that serves as a co-receptor for the T cell receptor (TCR)
CD8 (Cluster of Differentiation 8)
43
Hormone like proteins that regulate the intensity and duration of the immune response and mediate cell to cell communication
Cytokines
44
Enumerate the specific cytokines being released when activated by T Cells
Interleukins
Gamma interferon
Perforin
45
Cytokines secreted by leukocytes and macrophages that have been infected by a virus
Interferons (IFNs)
46
Slow spread of viral infection and enhance the activity of existing leukocytes
It also has an antiviral, anti-cancer, and anti-inflammatory properties
Interferons (IFNs)
47
Its action includes modulation of immune functions such as increasing phagocytosis, and enhance cytotoxic activity of T cells
Interferons (IFNs)
48
It consists of two different formulations: Beta 1a and Beta 1b
Primarily reserved for the treatment of severe multiple sclerosis
Interferon Beta
49
Another class of cytokines - it synthesizes primarily by lymphocytes, monocytes, and macrophages that enhance the capabilities of the immune system
Interleukins
50
It stimulates cytotoxic T cells activity against tumor cells, increased B cells, and plasma cell production and promotion of inflammation
Interleukins
51
Derived from T helper lymphocytes - promotes the proliferation of both T lymphocytes and activated B lymphocytes
Interleukin 2
52
Approved for the treatment of metastatic renal carcinoma
Aldesleukin
53
Derived from the bone marrow cells
Interleukin 11
54
A growth factor with multiple hematopoietic effects
Interleukin 11
55
It has the ability to stimulate to platelet production in immunosuppressed clients
Oprelvekin (Neumega)
56
Used to stimulate the production of B cells, T cells, and macrophages in clients with colon cancer
Levamisole (Ergamisol)
57
1. Prior to starting a client on these
drugs, conduct a thorough
assessment including a complete
health history, present signs and
symptoms, allergy and medical
health history.
2. Assess for the presence and or
history of the following diseases or
disorders; chronic hepatitis, AIDS
related Kaposi’s sarcoma etc.
3. Assessment of infections and cancer
verifies the needs for this drugs.
4. Immunostimulants are
contraindicated for clients with renal
or liver disease and pregnancy
5. Before starting the therapy, obtain
the results of lab test including a
complete CBC, electrolytes, renal
function and liver enzyme to provide
baseline data
6. Measure vital signs and body weight in the initial assessment and throughout the treatment regimen to monitor progress
Nursing Considerations: Immunostimulants
58
7. Used interferon alfa-2b (Intron A)
with caution in clients with hepatitis,
other than hepatitis C, leukopenia,
and pulmonary disease, promotes
development of leukemia because
of bone marrow suppression.
8. Interferon alfa-2a (Roferon-A) should
be used with caution in clients with
cardiac disease, herpes zoster, and
recent exposure to chicken pox.
9. Keep client well hydrated during
pharmacotherapy
10. Use of immunostimulant can lead to
the development of
encephalopathy; therefore assess for
changes in mental status.
11. Be specially vigilant for signs and
symptoms of depression and
suicidal ideation
Nursing Considerations: Immunostimulants
59
1. Practice reliable contraception and
notify your health care provider if
pregnancy is planned or suspected.
2. Avoid the use of corticosteroids
because this hormones reduce the
drug’s antitumor effect
3. Liver, endocrine or neurological
adverse effects that occurs during
therapy may be permanent
4. Avoid alcohol use, because it may
induce a disulfiram (Antabuse)
reaction
Client Health Teaching: Immunostimulants
60
5. Keep all scheduled appointments
and laboratory visits for testing
6. Immediately report symptoms of
nausea or stomatitis.
7. Immediately report hematuria,
petechiae, tarry stools, bruising,
fever, sore throat, jaundice, dark colored urine, clay colored stool, feeling of sadness and nervousness
8. Used non alcoholic mouthwashes to treat stomatitis
Client Health Teaching: Immunostimulants
61
Drugs used to inhibit the immune response
Immunosuppressants
62
Used for clients receiving transplanted tissues or organs
This agents may be prescribe for severe cases of rheumatoid arthritis or other autoimmune diseases
Immunosuppressants
63
Examples of Immunosuppressants
Glucocorticoids
Antimetabolites
Antibodies
Calcineurin inhibitors
64
Potent inhibitors of inflammation
Treatment of asthma and arthritis
Glucocorticoids
65
Examples of Glucocorticoids
Prednisone
Betamethasone
Dexamethasone
66
Inhibits aspects of lymphocyte replication
Antimetabolites
67
Examples of Antimetabolites
Silorimus (Rapamune)
Azathiprine (Imuran)
68
Binding to the intracellular messenger calcineurin
Cyclosporine (sandimmune , neoral)
69
It simply disrupts the T cell function
Tacrolimus (prograft)
70
Value in treating psoriasis, inflammatory disorder of the skin
Calcineurin inhibitors
71
1. When providing care for the clients
taking immunosuppressants,
complete a through health
assessment, including, the presence
of history of organ transplant or
grafting and verify the need for the
drugs.
2. Immunosuppressants are
contraindicated in clients with
leukemia, metastatic cancer, active
infection renal or liver disease or
pregnancy.
3. These drugs should be use with
cautions in clients who have
pancreatic or bowel dysfunction,
hyperkalemia, hypertension and
infection.
4. Obtain vital signs and results of lab
testing, including CBC, electrolytes
and liver profile, to provide baseline
data and reveal any abnormalities
Nursing Considerations: Immunosuppressants
72
5. Superinfection may occur, causing
an increase in white blood cell count
due to dampen effect of immune
system.
6. Monitor vital signs, especially
temperatures, and blood testing for
indications of infection
7. Carefully monitor the degree of
bone marrow suppression
(thrombocytopenia and leukopenia)
because the adverse effect can be
life threatening
8. Monitor patients who are taking in
Azathioprine (imuran) for the development of secondary malignancies; also inform the client of this possible side effects
Nursing Considerations: Immunosuppressants
73
1. Take antibiotics as prescribed by
your physician to prevent infection.
2. Keep all scheduled laboratory visits
for hematology studies.
3. Avoid exposure to individuals with
infection and other situations in
which there is a high risk of
infection.
4. Immediately report alopecia,
increased pigmentation, arthralgia
respiratory distress, edema, nausea,
vomiting, paresthesia, fever, blood
in the urine, black stool, feeling of
sadness
Client Health Teaching: Immunosuppressants
74
Give the 2 Classifications of Inflammation
Acute Inflammation
Chronic Inflammation
75
Caused by minor physical injury
Has a short duration, ranging from few hours to few days
8-10 days are normally needed for the symptoms to resolve and for repair to begin
Acute Inflammation
76
Signs of Acute Inflammation
Swelling
Pain
Warmth
Redness of the affected area
Loss of function
77
Inflammation of prolonged duration, usually weeks to months and even years
Chronic Inflammation
78
The response is characterized predominantly by lymphocytes and macrophages, tissue repair, such as healing, fibrosis and granular tissue formation, all of which may occur simultaneously
Chronic Inflammation
79
Most anti-inflammatory drugs are: specific or non specific?
Most of it are non specific
80
Allergic rhinitis, anaphylaxis, chron's disease
Ankylosing spondylitis, contact dermatitis
Glomerulonephritis, hashimoto's thyroiditis
Peptic ulcers, rheumatoid arthritis
Systemic lupus erythematosus (SLE)
Ulcerative colitis
Common disease that have an anti-inflammatory component that may benefit from anti-inflammatory pharmacotherapy
81
Examples of Chemical mediators of inflammation
Histamine
Leukotrienes
Bradykinin
Complement
Prostaglandins
82
What are the fundamental steps in acute inflammation?
1. Vasodilation - redness and heat
2. Vascular permeability - edema
3. Cellular infiltration - pus
4. Thrombosis - clots
5. Stimulation of nerve ending - pain
83
Key chemical mediator of inflammation
Histamine
84
It is stored primarily within mast cells located in the tissue spaces under epithelial membranes such as the skin, bronchial tree, digestive tract, and along blood vessels
Histamine
85
A life threatening allergic response that may result in shock and even death
Anaphylaxis
86
Give the 2 Histamine Receptors
H1 Receptors
H2 Receptors
87
Present in the smooth muscles of the vascular system, bronchial tree, and the digestive tract
H1 Receptors
88
Stimulation of these receptors results in itching, pain, edema, vasodilation, bronchoconstriction, and the characteristic symptoms of inflammation and allergy
H1 Receptors
89
Present primarily in the stomach and their stimulation results in the secretion of large amounts of hydrochloric acid
H2 Receptors
90
Drug of choice for the treatment of mild to moderate inflammation
Available as OTC or over the counter drugs
NSAIDs
91
Have analgesic, antipyretic, and anti-inflammatory properties such as aspirins and ibuprofen, the newer COX-2-inhibitors
NSAIDs
92
Acts by inhibiting the synthesis of prostaglandin
Block inflammatory by inhibiting cyclooxygenase (COX)
NSAIDs
93
It is the key enzyme in the biosynthesis of prostaglandins
Cyclooxygenase (COX)
94
Are lipids found in all tissues that
have potent physiological effects, in
addition to promoting inflammation,
depending on the tissue to which
they are found.
Prostaglandinds
95
2 Forms of COX
Cyclooxygenase - 1 (COX-1)
Cyclooxygenase - 2 (COX-2)
96
Present in all tissues and serves as protective functions such as:
- reducing gastric acid secretion
- promoting renal blood flow
- regulating smooth muscle tone in blood vessels and in the bronchial tree
Cyclooxygenase - 1 (COX-1)
97
It is present only after tissue injury and serves to promote inflammation
Cyclooxygenase - 2 (COX-2)
98
These are the first generation NSAID drugs
Aspirin and Ibuprofen
99
These drugs both block COX-1 and COX-2
Aspirin and Ibuprofen
100
Their inhibition reduces inflammation, the inhibition of COX-1 results in undesirable effects such as bleeding, gastric upset, and reduced kidney function
Aspirin and Ibuprofen
101
Binds to both COX-1 and COX-2 enzymes
Changing their structures and preventing them from forming inflammatory prostaglandins
Aspirin
102
Often a drug of choice for treating mild inflammation
Aspirin
103
It has also protective effects on the
cardiovascular system and is taken
daily in small doses by millions of
people to prevent abnormal clot
formation and strokes.
Aspirin
104
1. Large doses of aspirin that are
needed to suppress severe
inflammation may results in high
incidence of adverse effects,
especially on the digestive system
which includes:
- Increasing gastric acid
secretion and irritating the
stomach lining
- Epigastric pain, heartburn
- Bleeding due to ulceration
2. Because of its anticoagulant effect,
potential for bleeding must be
monitored.
3. High doses of aspirin may produce
Salicyclism, a syndrome that
includes symptoms such as tinnitus,
dizziness, headache, and excessive
sweating.
Adverse Effects of Aspirin
105
Developed as alternatives to aspirin
Like aspirin, they exhibit their effects through inhibition of both COX-1 and COX-2 although the inhibition by these drugs is reversible
Ibuprofen (Motrin, Advil)
106
This is given to clients with significant pre-existing renal impairment for pain or fever
Acetaminophen
107
Treatment of choice for moderate to severe inflammation
Selective COX-2 Inhibitors
108
Celecoxib (Celebrex)
Aside from its anti-inflammatory indications, this is also used to reduce the number of colorectal polyps in adults
109
1. NSAIDs may be used for their
analgesic, antipyretic and anti
inflammatory effects.
2. NSAIDs are primarily metabolized by
the liver, they should not be given to
clients with liver dysfunction it could
lead to hepatic failure
3. Assess clients for bleeding
disorders, peptic ulcer disease, CHF,
fluid retention, hypertension, renal
disease and use of use of diuretics,
lithium, anticoagulants, herbal
supplements, alcohol and cigarettes,
NSAIDs may be contraindicated in
these clients.
4. Obtain baseline kidney and liver
function test and CBC prior to
initiation of NSAIDs therapy.
5. Monitor bleeding time with long
term administration
6. Assess for changes in pain (intensity,
frequency and type) and reduction
in temperature and inflammation to
determine effectiveness.
Nursing Considerations: NSAIDs
110
7. Assess for gastrointestinal bleeding,
hepatitis, nephrotoxicity, hemolytic
anemia and salicylate toxicity.
8. Assess for the common side effects
may include tinnitus, abdominal
cramping and heartburn
9. Use cautiously in elderly clients because of the potential for increase bleeding
10. Use may be cautioned in pregnancy
and lactation, depending on a
specific drugs
11. Use ibuprofen with caution in infants
younger than 6 months, and
naproxen with caution in children
younger than 2 years old.
12. Aspirin is contraindicated in
pediatric clients younger than 18
years old. This is especially critical if
the child has varicella or influenza
infections because of the possibility
of developing
Nursing Considerations: NSAIDs
111
A rare, though serious disorder characterized by an acute increase in intracranial pressure and massive accumulation of lipids in the liver
Reye's Syndrome
112
What are the intracranial pressure?
headache, blurred vision, feeling less alert than usual, vomiting, changes in behavior, weakness or problems with moving and talking and lack of energy or sleepiness
113
1. Take NSAIDs with food or milk to decrease
GI upset.
2. Read the labels OTC drugs, carefully,
because may maintain aspirin or other
salicylates (example: excedrin and
pepto-bismol)
3. Avoid alcohol use
4. Report signs of bleeding such as prolonged
bleeding from injury, gingivinal bleeding,
dark stools or urine, and increase in severity
or frequency of bruising.
Client Health Teaching: NSAIDs
114
5. Do not take aspirins and other NSAIDs
together, because the NSAID effects may
decreased.
6. Optimal effects from the NSAID therapy
may not be experienced for 1 to 3 weeks
7. Aspirin - generally contraindicated to below
18 years old - Reye’s syndrome
Client Health Teaching: NSAIDs
