APA 2 - Immune System Flashcards by Mark Next

Immune system begins at approximately _____

6 weeks of age

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Functions of immune system

support, protect, vitalize functions, maintain homeostasis

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The non-specific or _______ system provides defense against a very large number of ______

innate / pathogens

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foreign substances

antigens

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_____ _______ immunity involves immune cells directed at elimination or destruction of pathogen cells.

cell-mediated

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_____ ______ comprises different antibodies and proteins, such as complement, that can directly or in concert with cellular immunity orchestrate cell injury and destruction.

humoral immunity

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Primary defenses against bacterial invasion

integument, phagocytosis, killer T c ells, respsonses (sneezing, tearing, coughing, sweating, body temp, normal flora)

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Passive immunity includes antibodies (activated T cells) given to provide protection and this usally happens by ______ and can last ___ to ____

transfusion / hours to weeks

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Acquired or _______ immunity is accomplished by destruction of organisms and toxins by ______ and specific lymphocytes

adaptive / antibodies

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No innate immunity exists with ______ immunity

acquired

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With acquired immunity, resistance is developed after entrance to _________. At that point, antigens interact with lymphocytes to form ________. These are prodcued by __ lymphocytes and called _________ which has MEMORY

body / antibodies / B / immunoglobulins (IG)

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Humoral branch consists of B-lymphocytes which originate in ____ ___ and _____ _____

bone marrow and plasma cells

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Cell-mediated branch has T-lymphocytes which originate in ____ ___ and mature in the _______

bone marrow / thymus

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Vaccinations are used to produce ______ ______

acquired immunity

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______ _______ is immunity from serum antibodies produced by plasma cells. More specifically, someone who has never been exposed to a specific diesease can gain humoral immunity through administration of __________ from someone who has been exposed, and survived the same disease.

humoral immunity / antibodies

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Humoral refers to the bodily fluids where these free-floating serum antibodies bind to antigens and assit with _______

elimination

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Cell-mediated immunity can be acquired thorugh __ _______ from someone who is immune to the target disease or infection. Cell-mediated refers to the fact that the response is carried out by _______ cells

T-cells / cytotoxic

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Review Slides 9 and 10

Now

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______ immunity is where a pathogen is deliberately administered to an individual for the sole purpose of stimulating the immune system. After repeat exposure, _____ immune system is able to provide a quicker and more efficient response. Example vaccines

active / adaptive

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_______ __________ is where a person receives another person’s _______ to help fight or prevent certain infectious diseases. Protection is immediate but short _______.

passive immunity / antibodies / lived

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Fetus during pregnancy from mother via IgG

passive immunity

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IgA via breast milk

passive immunity

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Rh immune golbulin (RhoGAM) to Rh-negative mothers to prevent their immune system from developing antibodies to a fetal Rh antigen

passive immunity

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Components of the Nonspecific Human Immune system

mononuclear cells, polymorphonuclear cells, eosinophils, neutrophils, basophils, mast cells, natural killer cells, platelets, B-lymphocytes, T-lymphocytes, plasma cells

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Review slide 13

cells

Granulocytes

neutrophils, basophils, eosinophils

Granulocyte order of number

neutrophils > eosinophils > basophils

Most numerous WBC's, 6 hour half life, fight bacteria and fungal infection

neutrophils

least common granulocyte, involved in hypersensitivity reactions, release histamine, leukotrienes, cytokines and prostaglandinds, and stimulate smooth muscle contraction (bronchospasm)

basophils

Heavy in GI (parasites), respiratory , and urinary mucosa

eosinophils

Agranulocytes

monocytes and lymphocytes

phagocytosis, release cytokines, present pieces of pathogens to T-lymphocytes

Monocytes

B-lymphocytes

humoral immunity and produce antibodies

T-Lymphocytes

cell-mediated immunity (DOES NOT produce antibodies)

A pathogen is deliberately administered to an individual for the sole purpose of stimulating the immune system. Repeat exposure, the adaptive immune system is able to provide a quicker and more efficient response (vaccines)

Active Immunity

Inflammation in both innate and acquired immunity

localized vasodilation, increased blood flow, increased capillary permeability, extravasation of plasma proteins (complement and coagulation factors), c hemotaxic movement of leukocytes to site of injury

Clinical manifestations of inflammation

erythema, localized edema, pain

Antibodies are gamma globulins called _______. Each antibody is specific for a particular _______; this characteristic is caused by its unique structural organization of amino acids in the variable portions of both the light and heavy chains.

immunoglobulins / antigen

Antibodies act mainly in two ways to protect the body against invading agents:

1. by direct attack on the invader 2. by activation of the "complement system" that then has multiple means of tis own for destroying the invader

There ____ general classes of antibodies

five (IgG, IgM, IgA, IgE, IgD)

With allergies, antibodies attach to ____ ____ and _____

mast cells and basophils

With Allergies, antibodies attaching to mast cells and basophils initiate change which:

release histamines and other substances, lead to abnormal response, vary in presentation and magnitude, urticaria, hay fever-like symptoms, asthma, anaphylaxis

H3 receptors occur at _________ sites and inhibit the release of a variety of _______

presynaptic / neurotransmitters

Type I hypersensitivity

anaphylaxis

Type II hypersensitivity

antibodies specific to antigens attach to cell surface. Example is cytotoxic (autoimmune hemolytic anemia)

Type III hypersensitivity

Immune complex disease. Antibodies bind antigens and release enzymes that cause tissue damage (SLE, rheumatoid, glomerulonephritis)

Type IV hypersensitivity

Delayed sensitivity (contact dermatitis, graft rejection) CELL MEDIATED

Type I immune reactant

IgE

Type II immune reactant

IgG

Type III immune reactant

IgG

Type IV immune reactant

TH1, TH2 cells, CTL

Type I initiation time

2-30 min

Type II initiation time

5-8 hr

Type III initiation time

2-8 hr

Type IV initiation time

24-72 hr

Anaphylaxis is ____ mediated and releases potent meidators like mast cells and basophils

IgE

With anaphylaxis, hypotension is secondary to _____ ____ ______

increased capillary permeability (50% fluid shift)

Anaphylaxis requires ______ _______

prior exposure

Anaphylactoid is caused by mediator release from mast cells and basophils and is not ______ mediated

IgE

Anaphylactoid can happen with ____ exposure

first

rocuronium is indicated in ____ % of anaphylactic reactions related to periop

60%

other reasons for anaphylaxis

latex 15%, ABX 5-10%, opiods <5%

read slide

29 now

Standard non-life threatning treatment epii

epinephrine 100-500 mcg subq or IM repeat 15 min (adult) children epi is 10mcg/kg-500mcg max q15 min x2, then q4hrs

standard treatment with benadryl

1-2 mg/kg or 25-50 mg IV

Treatment of anaphylaxis

airway maintenance, 100% 02, Epi 50-100 mcg IV or more, fluids and glucagon if on beta-blocker, CPR, pressors, fluids, bronchodilators, H1 and H2 antagonists, corticosteroids

Mild transfusion reaction

hives and pruritis

Fetal hemolytic reaction

usually from ABO incompatibility where antibodies destroy donor cells and bad things happen (DIC, renal failure, death). This is masked with anesthesia and will have cardiovascular instability, hypotension, fever, hemoglobinuria, bleedeing diathesis **TREAT IMMEDIATELY

Latex allergy high risk factors

Health care workers, neural tube defects, multiple surgeries, spina bifida, genitourinary tract defects and allergies to bananas, kiwi, mangos

What type of reaction is a latex allergy usually manifested as?

Type IV: Dermatitis AND Type I: Anaphylaxis

Latex reactions in the AWAKE patient

itchy eyes, generalized pruritis, SOB, faintness, feeling of impending doom, nausea, vomiting, abdominal cramping, diarrhea, wheezing

Latex reactions in the ANESTHETIZED patient

taachycardia, HTN, Wheezing, Bronchospasm, Cardiopulmonary arrest, flusing, facial edema, laryngeal edema, urticaria

Insufficient or limited response to antigens superseded by a self-reactive state that is inadequate and dysfunctional. Alterations in response to insult cause body to attack itself. May proliferate (anemias, arthritis, adreanl dysfunction, thyroid dysfunction, platelet aberrations)

Autoimmude disease

With ______, the immune system plays important role to reject and resist. It is variable with cell type and immune resposne.

Cancer

________ decrease ciliary action and cause increased risk for infection

hypnotics

Anesthesia agents can ______ the immune system as it relates to nonspecific host resistance mechanisms

depress

Inhalation agents, opiods, and regional anesthesia have _______ or controversial effects on immune system

negligible

_________ can have transient alteration of lymphocyte and killer T cell activity

epidurals

Surigical site infection occurs at or near a surgical incision within _____ days of the procedure or ___ year(s) from the implant

30 days / 1 year

The _______ immune system Is activated during surgery. Tissue damage and blood loss leads to a sterile systemic ______ ______. The DAMPs released promote neutrophil and macrophage migration to site.

innate / inflammatory response

As it relates to surgical site infection, T cell levels _______ which correlates with procedure duration and blood loss. ___________ surgery is associated with decreased immune suppression. ________ ________ is associated with depression of the immune system and increased risk of SSI. Hyperglycemia and _____ also contribute.

decrease / laparoscopic / blood transfusion / hypothermia

Retrovirus invades cell-mediated branch of immune system. Transmission through blood and certain body fluids. Usually on many drugs and little evidence to support different anesthetics.

HIV/ AIDS

NNRTIs __________ CYP450 system

induce

Cardiovascular abnormalities with HIV

abnormal EKG (50%) and pericardial effusion (25%)

Common comorbidities with HIV

wasting syndrome, peripheral neuropathies, platelet instability (splenectomy), non-hodkins lymphoma and kaposi's

Two major concerns with HIV

infectioin of patient and infection of YOU

Most common opportunistic infection with HIV/AIDs

pneumocystic carinii

Chronic inflammatory disease with production of ANA

SLE

Presentation of SLE

polyarthritis and dermatits, malar rash in 1/3 of patients, renal dz in >50% of patients which is most common cause of death and 10-20% of them will require dialysis

Treatment of SLE

corticosteriods, antimalarial, immunosuppressants

Having a dx of SLE carries a higher risk of

seizures, stroke, dementia, neuropathy, psychosis, pericardial effusion (tamponade rare)

What exacerbates SLE

infection, pregnancy, surgical stress, drugs

Drugs that exacerbate SLE (if patient over 80)

procanimide, hydralazine, captopril, enalapril, isoniazid, methyldopa, d-penicillamine

Anesthesia implications for someone with SLE

Prone to PE, pneumonitis, alveolar hemorrhage, pulmonary HTN, restrictive disease

With SLE, 1/3 of patients exhibit what?

cricoarytenoid arthritis and RLN palsy

Someone with SLE may require_________

corticosteroids

With SLE, Cyclophosphamide which is used to treat lupus nephritis, it may cause problems ______ LA and succinylcholine because it inhibits ______ ______

ester / plasma cholinesterase

Collagen vascular disease that is characterized by inflammation, vascular sclerosis, fibrosis of skin and organs

scleroderma

Sleroderma progression

injury to the vascular endothelium, vascular obliteration and leakage of proteins into the interstitial space, tissue edema and lymphatic obstruction due to the protein leakage, tissue fibrosis

Review slide 57

Scleroderma

Anesthetic implications of scleroderma

may require fiberoptic intubation, bleeding with airway manipulation, chronic HTN (contracted vascular volume), GERD (hypotonis of LES), corneal abrasion (prone to dry eyes), pulmonary HTN (avoid acidosis and hypoxemia)

Advantages of regional anesthesia with Scleroderma

peripheral vasodilation and post op pain control

Characterized by cellular hyperplasia in synovium, infiltration by lymphocytes, plasma cells and fibroblasts AND articular cartilagtge eventually completely destroyed

Treatment for RA

corticosteroids, methotrexate, immunosuppressants, NSAIDS

Anesthetic considerations with RA

steroid supplement, cyclophsphamide inhibits plasma cholinesterase and NSAIDS interfere with platelet function

Airway considerations with RA

neck extension restricted, antlantoaxial subluxation, TMJ, Laryngeal joints with edema and laryngeal swelling, consider glidescopoe or fiberoptic

APA 2 - Immune System Flashcards

(106 cards)