Immune sys Interventions

Question 1

Corticosteriods are drug of choice for

Answer 1

Short term anti inflamm therapy

Question 2

Why aren’t steroids used long term

Answer 2

Significant adverse effects

Lymphocyte effect – reduce circulating lymphocytes
Monocyte effect – deplete body of monocytes and macrophages
Neutrophil effect – increase neutrophils in blood
Decrease production of prostaglandins and interleukins

Question 3

Long term adverse effects of corticosteroids

Answer 3

Osteoporosis
Cataract formation
Mental status changes
Fluid and salt retention
Hypertension
Hyperglycemia
Obesity
Adrenal atrophy

Question 4

Nursing considerations for assessing someone on immunosuppressants

Answer 4

Obtain complete health history including allergies and drug history
Obtain baseline laboratory values for complete blood cell count, electrolytes and liver enzymes
Obtain vital signs, especially temperature and blood pressure
Assess skin integrity, look for lesions and changes in skin colour

Question 5

Immunosupressants and BP

Answer 5

Fluid retention - HTN

Question 6

What to assess for immunosuppressant therapy

Answer 6

Assess renal function and liver function
Monitor vital signs with emphasis on body temperature and blood pressure
Monitor for possible adverse effects including leukopenia, hyperkalemia, hirsutism, sinusitis, gynecomastia, gingival hyperplasia
Monitor for signs and symptoms of infection
Ensure patient does not take grapefruit juice with cyclosporine in particular

Question 7

Nutritional therapy

Answer 7

Avoid salad bars and buffets
Avoid raw meat
Avoid soft cheeses
Wash fruits and vegetables
Beansprouts should be avoided

Question 8

Passive immunity

Answer 8

From your mum

Question 9

Active immunity

Answer 9

First exposure to pathogens that creates antibodies

Question 10

Hep B

Answer 10

Lives outside the body for a time

Vaccines are for individuals who are at risk of exposure to hepatitis B virus

Adverse effects: pain and inflammation at injection site, transient fever or fatigue, potential for hypersensitivity

Question 11

Biggest public health measure preventing death

Answer 11

Vaccines

Question 12

Herd immunity

Answer 12

If enough of a puplation is vaccinated, the rest of the population is safe

Question 13

Inflammation

Answer 13

Non-specific response to physical, chemical, traumatic, infectious, necrotic injury to tissue
Purpose of inflammation is to contain injury or destroy invading pathogens
Inflammation intended to be acute and local
Acute or chronic, but usually acute
Can last up to 10 days
Includes vascular and cellular phases

Question 14

Acute inflammation

Answer 14

Vascular phase related to actions of histamine and prostaglandins
Cellular phase associated with neutrophils

Question 15

Chronic inflammation

Answer 15

If inflammation cannot resolve injury or contain invading pathogen, inflammation can persist
Chronic inflammation is underlying problem of autoimmune disorders including lupus and rheumatoid arthritis
Associated with macrophages and lymphocytes

Question 16

Acute and chronic inflammation may include

Answer 16

febrile response
Body temperature over 38.8oC
Pulse over 90 beats/minute
WBC count over 12,000/mm3

Question 17

General principals for dealing with inflammation

Answer 17

Treat the underlying cause

Usually allowed to sef resolve, therefore, non pharm approaches are better

Drugs given via topical route cause fewer adverse effects than enteral route

Question 18

Non-steroidal anti inflam drugs

Answer 18

are the primary drugs for the treatment of mild to moderate inflammation
block inflammation by inhibiting cyclooxygenase (COX) the key enzyme in the biosynthesis of prostaglandins

prostaglandins promote inflammation

Question 19

COX 1 enzyme responsible for

Answer 19

Present in all tissues
Protective functions such as;
Reducing gastric secretion
Promoting renal blood flow
Regulating smooth muscle tone in blood vessels and the bronchial tree.

Question 20

COX 2 responsible for

Answer 20

Present only after tissue injury and promotes inflammation
Sensitizes pain receptors
Causes fever

Question 21

Three classes of NSAIDS

Answer 21

Salicylates (ie ASA)
Ibuprofen and ibuprofen-like drugs
COX-2 antagonists (ie celecoxib)

Question 22

Ibuprofen (NSAIDs)

Answer 22

Mechanism of action: to inhibit prostaglandin synthesis both COX-1 And COX-2

for musculoskeletal disorders such as rheumatoid arthritis and osteoarthritis, mild to moderate pain, reduction of fever, dysmenorrhea

Question 23

Adverse effects of NSAIDS

Answer 23

Possible GI bleed
Decreased kidney function
Interfere with mucosal protection in stomach

Question 24

COX-2 inhjibs

Answer 24

Indicated for mild to moderate pain and inflammation associated with RA and osteoarthritis, dysmenorrhea
Less GI bleeding and ulcer formation than with ibuprofen or aspirin
Celecoxib is widely used though there is an elevated risk of myocardial infarction and stroke

Question 25

Aspirin

Answer 25

Potent effect so the potential for bleeding must be carefully monitored. High doses may cause salicylism which includes symptoms of Tinnitus Dizziness Headache Sweating.

Question 26

Assessments in NSAIDs

Answer 26

Assess for changes in pain, reduction in temperature and inflammation Monitor for bleeding Assess for gastrointestinal bleeding, hepatitis, nephrotoxicity, hemolytic anemia

Question 27

Aspirin is dangerous for babies bc

Answer 27

It can cause Ryes syndrome

Question 28

Systemic Glucocorticoids

Answer 28

are anti-inflammatory drugs that can suppress severe cases of Inflammation suppress histamine release inhibit the synthesis of prostaglandins by COX-2 suppress certain functions of phagocytes and lymphocytes

Question 29

Prednisone

Answer 29

Synthetic glucocorticoid to treat inflammation Long term therapy may result in cushings syndrom (Moonface, abdom obesity) Increases risk for infection Used for autoimmune disease)

Question 30

Long term use for systemic glucocorticoids

Answer 30

Consider alternate day therapy plan Signals adrenal cortext to continue producing steroids CANNOT be stopped abruptly - can can cause adrenal shut down and adrenal crisis when glucocorticoid is withdrawn

Question 31

Why cant glucocorticoids be stopped abruptly

Answer 31

can cause adrenal shut down and adrenal crisis when glucocorticoid is withdrawn

Question 32

Antipyretic Drugs

Answer 32

Fever is a normal part of body’s defense against invading pathogens Prolonged fever is dangerous and can be life-threatening Acetaminophen and NSAIDs are most commonly used drugs to reduce fever

Question 33

Why does acetaminophen not work for inflammation

Answer 33

Acetaminophen does not have anti-inflammatory properties; has different adverse effects than NSAIDs

Question 34

How does acetaminophen work and what for

Answer 34

Mild to moderate pain Osteoarthritis of the hip or knee Dysmenorrhea Dental procedures Headache and myalgia Fever

Question 35

How does acetaminphen work

Answer 35

Mechanism of action Inhibits COX activity in CNS but not in rest of body Antipyretic action may be due to action at hypothalamus

Question 36

Serious adverse effects

Answer 36

Hepatotoxicity, acute liver failure Renal failure Pancytopenia

Question 37

Routes of Acetaminophen

Answer 37

PO PR

Question 38

Two categories of allergy drugs

Answer 38

Preventors and relievers

Question 39

Histamine receptors

Answer 39

H1 (related to allergy response) Found on smooth muscle cells, vascular endothelium Stimulation of H1 receptors promote vasodilation and increased permeability of blood vessels, consistent with vascular phase of inflammation H2 Found in stomach on parietal cells Stimulation of H2 receptor triggers release of HCl by parietal cells

Question 40

H1 recepor antagonist

Answer 40

H1 receptor antagonists block histamine receptors associated with inflammation

Question 41

Benadryl uses

Answer 41

Hypersensitivity Type I allergic reaction Allergic rhinitis, URT and GI allergies Skin rashes, irritations, urticarias, angioedema Antiemetic for vertigo and motion sickness Antitussive Insomnia (hypnotic agent) Parkinson’s disease Hypersensitivity Type I allergic reaction Allergic rhinitis, URT and GI allergies Skin rashes, irritations, urticarias, angioedema Antiemetic for vertigo and motion sickness Antitussive Insomnia (hypnotic agent) Parkinson’s disease

Question 42

Trade name for diphenhydramine

Answer 42

Benadryl

Question 43

Adverse effects of benadryl

Answer 43

Increased HR, pupil dilation, urinary retention, constipation, hallucinations (high doses

Question 44

What should be monitored for benadryl pts

Answer 44

Monitor vital signs and monitor ECG for possible dysrhythmias Monitor for vision changes, especially with patients that have narrow angle glaucoma Monitor neurological status and LOC, especially with patients with seizure history (and older adults)

Question 45

Flonase (fluticansone)

Answer 45

Intranasal glucocorticoids

Question 46

Intranasal glucocorticoids uses

Answer 46

Seasonal and perennial allergic rhinitis

Question 47

Mech of action for intranasal glucocorticoids

Answer 47

Inhibits histamine release by mast cells Prevents macrophage accumulation Reduces leukotriene release

Question 48

Adverse effects for decongestants

Answer 48

Few Dry nasal passages Repound congestion

Question 49

Anaphylaxis

Answer 49

Overwhelming allergic response that is life threatening Skin, respiratory and Cardiovascular Flushing, then cold, clammy with shock Sense of dis-ease/foreboding Angioedema (welts/swelling) and hives Difficulty breathing as throat swells and bronchi constriction

Question 50

Epinephrine mech of action

Answer 50

Non-specific adrenergic agonist with action at alpha1, beta1 and beta2 receptors which increased blood pressure and open airway Alpha1 – vasoconstriction Beta1 – increased HR, force of contraction Beta2 – bronchodilation Adverse effects Hypertension, dysrhythmias are a risk so careful monitoring is crucial`