immune mediated diseases Flashcards by Julie T

HIV disease/AIDS
Cancer
Rheumatic diseases
Asthma

immune mediated diseases

How well did you know this?

Not at all

Perfectly

– Retrovirus that is implicated in development of AIDS
– Primary target is the CD4 lymphocyte (helper T cell)
– Causes cell death of CD4 T cells

hiv

How well did you know this?

Not at all

Perfectly

– Progressive impairment of the immune system by the
human immunodeficiency virus (HIV)
– A diagnosis is based on
• Low CD4 counts 5000 copies per ml
• The presence of one or more specific opportunistic infections or malignancies

aids

How well did you know this?

Not at all

Perfectly

• First appearance is unknown
– Central Africa
– First confirmed case was in the Congo in 1959
– Spread rapidly through heterosexual population
• High rate of extramarital sex
• Low rate of condom use
• High rate of gonorrhea
• Medical clinics reused needles to promote vaccinations

aids history

How well did you know this?

Not at all

Perfectly

• End of 2012: Living with HIV/AIDS
– 35.3 million people were living with HIV
• 2.3 million people became newly infected
• 1.6 million died of AIDS-related causes
• Nearly 1 in every 20 adults in Sub-Saharan Africa are living with HIV
(69% of all people with HIV)
• In the US, > 1.1 million people are living with HIV
– Almost 1 in 5 (18.1%) are unaware of their infection
• More than 25 million deaths over the past 3 decades

aids brief history

How well did you know this?

Not at all

Perfectly

• HIV is a retrovirus
– Attacks immune system, especially the helper T cells (CD4’s) and macrophages
– Transmitted by exchange of cell-containing bodily fluids, such as semen and blood
– Highly variable time between contracting virus and developing AIDS symptoms

how we get aids: virus

How well did you know this?

Not at all

Perfectly

-drug users, homosexual men, heterosexual population, transmission from mother to child

aids transmission

How well did you know this?

Not at all

Perfectly

• Acute HIV infection
– Within a week or so
– Mild early symptoms: Fever, sore throat, flu-like
symptoms
• 3 to 6 weeks
– Infection abates, asymptomatic period
• Amount of virus gradually rises: HIV Disease
– Immune system compromised
– Opportunistic infections (viruses and parasites) and malignancies, such as Kaposi’s sarcoma, occur
– Common symptom for women: Gynecologic infection

how hiv infection progresses

How well did you know this?

Not at all

Perfectly

• Actions taken to decrease morbidity and
mortality from disease
• Primary
– Avoid development of disease
• Secondary
– Early disease detection to prevent progression
and symptom development
• Tertiary
– Reduce negative impact of established disease

prevention

How well did you know this?

Not at all

Perfectly

• Taking measures to combat risk factors for
illness before an illness ever has a chance to
develop
• Two general strategies
– Employ behavior-change methods to alter
problematic behaviors
– Keep people from developing poor health habits in the first place

primary preverntion

How well did you know this?

Not at all

Perfectly

– Early detection/screening
– Teach patients behaviors to prevent spread of HIV
– Antiretroviral drug therapy to keep HIV disease from occurring

secondary prevention

How well did you know this?

Not at all

Perfectly

– Antiretroviral drug therapy and adherence training

– Cognitive behavioral therapy

tertiary prevention

How well did you know this?

Not at all

Perfectly

– Dramatically improved health of those with HIV
– Treatments are complex: combinations of drugs
– Adherence is critical
– Side effects unpleasant
– Adherence is variable

highly active antiretroviral therapy (HAART)

How well did you know this?

Not at all

Perfectly

• Test positive for HIV, not yet AIDS
– People live with a threatening event
– Live with uncertainty and fear
• Initial response
– Psychological distress
– Sharply curtail HIV risk-related behaviors
– Make positive changes in health
• Interventions that reduce depression are 
valuable

Psychosocial Impact of HIV

Infection

How well did you know this?

Not at all

Perfectly

– Major barrier to controlling spread of HIV:
Not disclosing HIV status
– Those who don’t disclose:
Less likely to use condoms
– \_\_\_ has benefits
• Positive health consequences
• More CD4 cells than non-disclosers 
• \_\_\_\_ of sexuality
– Also linked to HIV outcomes
– Remaining “in the closet” associated with
• Faster progression of HIV disease

disclosure

How well did you know this?

Not at all

Perfectly

• Education
• Health Beliefs and AIDS Risk-Related Behavior
– One must perceive oneself as capable of controlling risk-related activity
– Behaviors become integrated into ‘sexual styles

Interventions to Reduce the

Spread of HIV/AIDS

How well did you know this?

Not at all

Perfectly

• Targeting IV Drug Use
– Needle exchange programs
• Cognitive-Behavioral Interventions
– Decrease distress among HIV+ individuals
– Buffer psychological/immunologic consequences
– Improve surveillance of opportunistic infections
• HIV Prevention Programs
– School-based interventions about safe sex
– Communication & condom use skills
– Target behaviors associated with high-risk sex
(alcohol, drugs)
– Target norms (monogamy, abstinence)

Interventions to Reduce the

Spread of HIV/AIDS

How well did you know this?

Not at all

Perfectly

• HIV disease/AIDS is now a chronic disease
– Employment
• Men with HIV continue working
• Unemployed may not return to work
– Fear and prejudice
• Many have an intense fear of AIDS
• Many blame the victims for their disease: Especially gay and IV drug users
• Coping Skills
– Coping effectiveness training
– Perceived control &amp; self-efficacy
• Social Support

Coping with HIV+ Status and Aids

How well did you know this?

Not at all

Perfectly

• HIV-infected gay men
– Rapid course of disease for those with more
stress
– Slower course of disease with more social support
• Negative beliefs about self
– Correlated with decline in helper T cells
• Finding meaning and optimism associated
with better outcomes
• Writing interventions promoting optimistic
thinking about the future
– Led to greater reported adherence to medication
– Less distress from side effects

Psychosocial Factors that Affect its Course

How well did you know this?

Not at all

Perfectly

-set of >100 diseases
- all result from dna dysfunction
• Neoplastic growth
– Rapid cell growth and proliferation (unlimited)
– Cancerous cells provide no benefits to body
– Cancerous cells sap the body’s resources
• Neoplastic cells may be:
– Benign
– Malignant

cancer

How well did you know this?

Not at all

Perfectly

remain localized and usually less threatneing

benign neoplastic cells

How well did you know this?

Not at all

Perfectly

more dangerous; invade and destroy surrounding tissue and may metasasize

malignant neoplastic cells

How well did you know this?

Not at all

Perfectly

– Carcinomas
– Sarcomas
– Leukemias
– Lymphoma

malignant growths of cancer

How well did you know this?

Not at all

Perfectly

Cancers of the epithelial tissue

* Skin, stomach lining, mucous membranes, etc.

carcinomas(malignant)

How well did you know this?

Not at all

Perfectly

* Cancers of the connective tissue | * Bone, muscles, cartilage, etc.

sarcomas(malignant)

* Cancers of the blood cells | * Stem cells, white blood cells

leukemias(malignant)

* Cancer of the lymphatic system | * Rarer

lymphoma(malignant)

* Many cancers are species-specific * Develop in different ways in different species * Many cancers have long/irregular growth cycles * High within-species variability

why is cancer hard to study

many cancers have genetic basis and some are ethnically linked – Overall, African-Americans have a 40-50% greater incidence of and mortality from cancer than do European Americans – Hispanic Americans, Asian Americans, and Native Americans have lower rates than African- and European-Americans – Most differences are attributable to • Access in medical care • Adherence to treatment • Knowledge • Attitudes about cancer • Socioeconomic status

cancer risk factors beyond control

– U.S. Anglo men > bladder cancer rates – U.S. Anglo men > malignant melanoma rates – U.S. Hispanic women > cervical cancer – African American men > prostate cancer – Japanese Americans > stomach cancer – Chinese Americans > liver cancer – African American women > mortality breast cancer

examples of ethnic differences with risk factors

``` • Age(Strongest risk factor) • Environment: – Exposure occurs at work or home – Radiation – Asbestos – Radon – Pesticides – Motor exhaust – Chemicals[ Arsenic, benzene, chromium, nickel, vinyl chloride, etc] ```

risk factors for cancer

poor diet and tobacco use– Lung, breast, head and neck cancers – Additive or synergistic effect with • Socioeconomic level, occupation, ethnicity, building materials of home, birth control pills

cancer Behavioral Risk Factors

• Carcinogenic foods – Natural foods aren’t necessarily safer than ones with preservatives – Spoiled food causes stomach cancer – Dietary fat is risk factor for colon and breast cancer – High cholesterol is risk factor for testicular cancer – Preserved/charred/smoked meats are a risk factor for colorectal cancer – Salt-cured meats are a risk factor for stomach cancer – Obesity and diet receive a lot of attention as risk factors for colorectal cancer and many others

Foods That May Cause Cancer

– Haven’t identified specific foods or nutrients – Beta-carotene • Form of vitamin A in sweet potatoes and carrots – Vitamin C, Folate, Calcium – Selenium • Trace element found in grains and grain-fed meats – Flavonols • Product of plant metabolism and antioxidants • Apples, onions, garlic, scallions, leeks, tea, string beans, broccoli, green peppers, blueberries – Water

Protective foods

``` – Healthy diet and weight control • High fiber • High in fruits, vegetables, whole grains, low-fat dairy products, fish, poultry • Low in red meat, refined grains – Vitamin and mineral supplements ```

protective foods

• Alcohol – Cancers of the tongue, tonsils, esophagus, pancreas, breast, and liver – Synergistic effect with smoking • Sedentary lifestyle • Ultraviolet light exposure – Cumulative exposure and occasional severe sunburn are risk factors for skin cancer – Especially important for light-skinned, fair-haired, blue-eyed people

Behavioral Risk Factors

– AIDS-related carcinomas • Kaposi’s sarcoma • Non-Hodgkin’s lymphoma – HPV infection and cervical and head & neck cancers – Early age at first intercourse and large number of partners • Cancers of the cervix, vagina, ovary, prostate

sexual behavior risk factor

``` • Negative emotionality & tendency to repress or deny emotions • Uncontrollable stress & feelings of helplessness • Other, weaker risk factors – Experience of serious loss – Low level of social support – Chronic depression – Negative emotional states – A “fighting spirit” – Life events – Fatalistic view of the world – Active coping style ```

psychosocial risk factors

• Psychological stress – Adversely affects ability of NK cells to destroy tumors – NK cells activity is important in survival rates for certain cancers, such as breast cancer • Ways that patients cope with cancer stress – Associated with inflammatory processes (IL-6) that play a role in tumor progression

Stress and Coping

``` Approximately 68% of cancer victims live at least 5 yearsafter their diagnosis • Surgery • Radiation • Chemotherapy • Hormonal treatments • Immunotherapy ```

Cancer Treatments

``` • Coping with physical limitations – Pain and discomfort – Downregulation of immune system,vulnerability to other disorders – Fatigue • Treatment-related problems – Cosmetic problems:Surgical removal of organs – Body image concerns – Use of prosthesis – Conditioned nausea and immune suppression ```

Adjusting to Cancer

``` • Intermittent and long-term depression • Restriction of usual activities • Issues involving social support cancer because it increases their own risks • Marital and sexual relationships • Psychological adjustment( PTSD) • Self-presentation ```

Cancer: | Psychosocial Issues

amount of psychological problems (with the exception of depression) experienced by cancer patients Is significantly less than people suffering from psychiatric disorders • Finding meaning in cancer • Optimism associated with better outcomes

coping with cancer

• Pharmacologic Interventions center on – Nausea /vomiting, eating difficulties, emotional disorders, pain • Cognitive-Behavioral interventions focus on – Stress, pain, appetite control, side effects – Distraction, relaxation & guided imagery helps coping with chemotherapy – Also Mindfulness-based stress reduction interventions & Exercise – Enhance social support • Psychotherapeutic interventions involve – Meeting psychosocial and informational needs – Individual, family, or group • Support groups

cancer interventions

• Autoimmunity: A condition in which the body produces an immune response against its own tissue constituents – Most prevalent autoimmune disorder – means “inflammation of a joint” • Three major forms – Rheumatoid, osteoarthritis, gout

arthritis

• Crippling form of arthritis believed to result from an autoimmune process – Usually attacking small joints of hands, feet, wrists, knees, ankles, and neck • Primarily affects :40-70 age group/ Women • Main complications are Pain, limitations in activities, need to be dependent on others • Depression

rheumatoid arthritis

– Development of disease • Negative life events (in the past 2 years) may precede disease onset – Aggravation of disease • Increases in interpersonal stressors in the previous week predicts increases in disease activity • Better spousal relationships buffer the effects of interpersonal stress on RA • Following a hurricane, RA patients were classified in later stages of disease and had more flares than compared to before the hurricane • Mediated by immune system

rheumatoid arthritis stress

``` – Aspirin, NSAIDs & Cox-2 inhibitors to relieve inflammation and pain – Rest – Supervised exercise • Cognitive-behavioral interventions – Enhancement of perceived self-efficacy – Optimism – Relapse prevention strategies • Juvenile RA appears between 2 and 5 years ```

rheumatoid arthritis treatment

• Form of arthritis that results when the articular cartilage (smooth lining of a joint) begins to crack or wear away because of overuse of a particular joint – May also result from injury or other causes – Usually affects weight-bearing joints – Common among athletes and the elderly – More common in women • Treatment – Keeping weight down, exercise, aspirin (NSAIDs), steroids

Osteoarthritis

``` • A form of arthritis produced by a buildup of uric acid in the body (kidneys can’t excrete the acid) – More prevalent in men than in women – Uric acid build up produces crystals that become lodged in the joints – Most commonly affected area - big toe • Blood supply cannot carry away crystals ```

gout

``` – Avoid alcohol and certain foods; maintain proper weight, exercise, fluid intake; no aspirin since it slows uric acid removal – Untreated, gout can be deadly ```

gout treatment

``` Untreated can lead to – Kidney disease – High blood pressure – Coronary heart disease – Stroke • Triggers – Foods – Stress – Infections – Some antibiotics – Diuretics ```

gout

alcohol, anchovies, sardines in oil, fish roes, herring, yeast, organ meat, meat extracts, concomme, gravies

gout: purinecontaining foods to be avoided

hearts , herring, mussels, yeast, smelt, sardines, sweetbreads

foods high in purines

• High fat foods and foods containing trans fat (partically hydrogenated vegetable oils) • Drink plenty of fluids/water, exercise and maintain a healthy body weight. Diets designed for quick or extreme weight loss can increase uric acid levels in the blood and worsen symptoms.

other food to avoid when have gout

• More severe allergic reaction • Triggers – Dust, dander, pollens, mold, fungi – Animal dander, cockroaches – Respiratory infections, smoke, other air pollutants --perfume – Stress or exercise • Produce bronchial spasms & hyperventilation • Muscle constriction, swelling, & inflammation of airtubes → ↑mucus → bronchiole obstruction → ↓O & ↑CO2

asthma

``` • Dramatic increase in past 20-30 years • 1 in 10 children may have ___ • Reasons are not fully known – >130 million worldwide have it – More in industrialized countries – More in urban than rural areas – Paradoxical Issue: Correlation: Children with lots of childhood infectious diseases are LESS LIKELY to develop allergies • Improved hygiene → ↑allergies? ```

asthma

– Traditional view • Allergic reaction to substances in environment – Genetic vulnerability • Diathesis-stress model • Genetic vulnerability for immune system to overreact to certain environmental agents if exposed – Hygiene hypothesis • Result of cleanliness • Immune systems haven’t been exposed to many allergens so when exposed overreact – Refinement of hygiene hypothesis • Combines it with diathesis-stress and people are either sensitized or protected

asthma theories

• Trouble breathing or can’t breathe – Associated with fear and anxiety • Frequent attacks leads to decreases in self efficacy for management of the disease • Can cause respiratory failure and death

Asthma Attacks

– Patient needs to be active in management – Track Peak Expiratory Flow Rate and identify warning range – Take preventive medications • Usually anti-inflammatory corticosteroid inhalers • Adherence is a problem – Use emergency inhalers when you have an attack • Bronchodilators

develop management plan for asthma

immune mediated diseases Flashcards

(60 cards)