inflammation Flashcards
1
Q
inflammation
A
immunologic defence against tissue injury, infection or allergy
2
Q
function of inflammatory response
A
restitution of normal, functioning cell after injury
fibrous repair when restitution of functioning cells is impossible
3
Q
injuries that cause inflammation
A
mechanical, thermal, electrical, chemical, radiation, biological assault
4
Q
steps of inflammatory response (8)
TVSIMEMR
A
- tissue injury - release of chemical mediators
- vasodilation + increase blood flow
- swelling + retraction of endothelial cells
- increased vascular permeability + leakage of small plasma proteins
- movement of immune response cells to injury site
- exudate formation
- movement of glucose + oxygen to injury site
- release of chemical repair factors from endothelial cells
5
Q
populations at greatest risk
A
very young
very old
uninsured
6
Q
exposure to secondhand smoke
A
smoke irritates eyes and mucous membranes of respiratory tract. irritation causes inflammation
7
Q
excessive exposure to sun
A
results in sun burn (thermal injury)
8
Q
exposure to infection
A
infection always accompanied by inflammation
9
Q
rheumatoid arthritis
A
inflammation of joints and surrounding tissues
10
Q
first line of defence is?
A
innate immunity (natural) physical, mechanical, biochemical barriers
11
Q
second line of defence is?
A
inflammatory response
12
Q
third line of defence is?
A
adaptive immunity (acquired)
13
Q
physical barriers
describe
line of defence
A
1st line of defence - skin - lining of gastrointestinal, genitourinary, respiratory tract > sloughing of cells > coughing and sneezing > flushing - urine > vomiting > mucous and cilia
14
Q
epithelial cell-derived chemical barriers
describe
line of defence
A
1st line of defence
- secrete saliva, tears, earwax, sweat and mucous
- antimicrobial peptides
- normal microbiome
15
Q
inflammatory response
describe
line of defence
A
nonspecific
regulated by chemical mediators
16
Q
what materials cause inflammatory response
A
infection, tissue necrosis, ischemia, trauma, physical/chemical injury, foreign bodies, immune reaction
17
Q
local manifestations of inflammatory response
A
redness, heat, swelling, pain, loss of function
18
Q
inflammatory response
vascular
A
vasodilation
increased vascular permeability and leakage
WBC adherance to inner wall of vessels
19
Q
goals of inflammation
A
prevent/limit infection or further damage
limit/control immune response
initiate adaptive immune response
initiate healing
20
Q
list three protein systems
A
complement
clotting
kinin
21
Q
complement system
A
produces biologically active fragments that recruit phagocytes, activate mast cells and destroy pathogens
22
Q
activation of C3 and C5
A
most important to complement system
opsonins
chemotactic factors
anaphylatoxins
23
Q
pathways of complement system
CAL
A
classical: antigen-antibody reaction
alternative: bacterial endotoxin
lectin: independent of antibody
24
Q
clotting system
A
forms blood clots at an injured/inflamed site
25
what do blood clots do
prevents spread of infection
localizes micro organisms and foreign bodies
stops bleeding
framework for repair/healing
26
main substance in clotting system
insoluble protein - fibrin
27
pathways of clotting system
extrinsic: activated by tissue factor
intrinsic: factor XII
28
kinin system
activate and assist inflammatory cells
29
primary kinin
bradykinin
30
what does the kinin system do
cause dilation o blood vessels and smooth muscle contraction, induces pain, increase vascular permeability
31
cellular components of inflammation
| EPL
erythrocytes
platelets
leukocytes
32
types of leukocytes
granulocytes
monocytes
lymphocytes
33
cellular receptors of inflammation
bind a large spectrum of antigens
| different receptors recognize specific molecules
34
types of receptors
| PPDTCSN
- Pattern recognition receptors (PRRs)
- Pathogen-associated molecular patterns (PAMPs)
- Damage-associated molecular patterns (DAMPs)
- Toll-like receptors (TLRs)
- Complement receptors
- Scavenger receptors
- NOD-like receptors (NLRs)
35
what are cytokines responsible for
activating other cells and regulating inflammatory response
36
cytokines can be either
pro-inflammatory (induce)
| anti-inflammatory (inhibit)
37
types of cytokines
| CITI
chemokines
interleukins
tumor necrosis factor-alpha
interferon
38
chemokines synthesized by
| pro or anti
different cells in response to pro-inflammatory cytokines
39
chemokines induce
chemotaxis to promote phagocytes and wound healing
40
examples of chemokines
- monocyte/macrophage chemotactic proteins
- macrophage
inflammatory response
- neutrophils
41
interleukins produced by
macrophages and lymphocytes in response to stimulationof PRRs or other cytokines
many types
42
examples of interleukins
IL-1 proinflammatory
| IL-10 anti-inflammatory
43
tumour necrosis factor-alfa secreted by
macrophages in response to PAMP and toll-like receptor recognition
44
tumour necrosis factor-alfa induces
fever
| acts as endogenous pyrogen
45
tumour necrosis factor-alfa increases
synthesis of inflammatory serum proteins
46
tumour necrosis factor-alfa causes
muscle wasting and intravascular thrombosis
47
high levels of tumour necrosis factor-alfa can be
lethal
48
interferons protect against
viral infections
49
interferons produced and released by
virally infected host cells in response to viral DS RNA
50
types of interferons
IFN-a and INF-b:
induce production of antiviral proteins
IFN-y:
increase microbiocidal activity of macrophages
51
mast cells
cellular bags of granules located in the
| loose connective tissues close to blood vessels
52
mast cells contain
histamine, cytokines, and chemotaxic factors
53
mast cells release
degranulation
| synthesis
54
mast cell degranulation
release of the contents of mast cell granules
55
mast cells synthesis
new production and release of mediators in response to stimulus
56
mast cell degranulation
| histamine
-vasoactive amine
causes temporary, rapid constriction of large blood vessels and dilation of postcapillary venules
- retraction of endothelial cells lining the capillaries causing increased vascular permeability
57
mast cell degranulation
| receptors
H1 and H2
58
H1 receptor
pro-inflammatory
| present in smooth muscle cells of the bronchi
59
H2 receptor
anti-inflammatory
present on parietal cells of the stomach mucosa
induces the secretion of gastric acid
60
leukotrienes
product of arachidonic acid from mast cell membranes
| similar effects to histamine in later stages
61
prostaglandins
similar to leukotrienes (induce pain)
| aspirin and some NSAIDS block synthesis of prostaglandins
62
platelet-activating factor
similar to leukotrienes and platelet activation
63
types of phagocytes
```
neutrophil
eosinophil
basophil
monoctye/macrophage
dendritic
```
64
neutrophils
- polymorphonuclear neutrophils (PMNs)
- predominate in early inflammation
- ingest bacteria, dead cells and cellular debris
65
eosinophils
- mildly phagocytic
| - defence against parasites and regulation of vascular mediators
66
basophils
- least prevalent granulocytes
| - primary role unknown
67
monocytes and macrophages
monocytes in bone marrow>circulation>migrate to inflammatory site>become macrophages
arrive 24 hours after neutrophils
68
dendritic cells
peripheral organs and skin
| migrate through lymph to interact with T lymphocytes to generate acquired immune response
69
phagocytosis
process by which cells ingest and dispose of foreign material
70
margination
adherence of leukocytes to endothelial cells in the walls of capillaries
71
diapedesis
emigration of cells through the endothelial junctions
72
5 steps of phagocytosis
- adherence
- engulfment
- phagosome
- fusion with lysosomal granules
- destruction of target
73
natural killer cells
recognize and eliminate cells infected with viruses
74
local manifestations results of acute inflammation
vascular changes and corresponding leakage of circulating components into the tissue
75
examples of local manifestations of acute inflammation
heat, swelling, redness, pain, loss of function
| exudative fluids
76
serous exudate
watery exudate
indicates early inflammation
ex - blister fluid
77
fibrinous exudate
thick, clotted exudate
indicates more advanced inflammation
ex - pneumonia
78
purulent exudate
pus
indicates bacterial infection
ex - cyst or abscess
79
hemorrhagic exudate
contains blood
| indicates bleeding
80
systematic manifestations
fever
leukocytes
increased plasma protein synthesis
81
fever caused by
exogenous and endogenous pyrogens
| act directly on hypothalamus
82
leukocytes
increased number of circulating leukocytes (WBC)
83
increased plasma protein synthesis
acute phase reactants
84
examples of acute-phase reactants
- C-reactive protein
- fibrinogen
- haptoglobin
- amyloid
- ceruloplasmin
85
what is chronic inflammation characterized by
pus formation, supperation
| incomplete wound healing
86
other causes of chronic inflammation
- high lipid and wax content of a micro organism
- ability to survive inside macrophage
- toxins
- chemicals, particulate matter or physical irritants
87
characteristics of chronic inflammation
- dense infiltration of lymphocytes and macrophages
- granuloma formation
- epithelioid cell formation
- giant cell formation
88
hypersensitivity def.
altered immunological response to an antigen that results in disease or damage to the host
89
allergy
hypersensitivity
| deleterious effect of hypersensitivity to environmental antigens
90
autoimmunity
disturbance in immunological tolerance of self-antigens
91
4 types of immune mechanisms
type I IgE mediated
type II tissue specific
type III immune complex-mediated
type IV cell-mediated
92
type I
against environmental antigens
| histamine release from mast cell degranulation
93
type I
| IgE binds to
Fc receptors on surface of mast cells
94
type I manifestations
| GI allergy
nausea, vomiting, diarrhea, abdominal pain
95
type I manifestations
| skin
urticaria (hives)
96
type I manifestations
| mucosa allergens
conjunctivitis, rhinitis,
| asthma
97
type I manifestations
| lung allergens
bronchospasm, edema, thick secretions
98
type II
specific cell or tissue is the target of an immune response
99
type II
| five mechanisms
1. cell destroyed by antibodies and complement
2. cell destruction through phagocytosis
3. soluble antigen enter circulation and deposit on tissues
4. antibody-dependent cell -mediated cytotoxicity
5. target cell malfunction
100
type III mediated by
immune complex
101
type III antigen-antibody
complexes formed in circulation
| later deposited in vessel walls or extravascular tissues
102
type IV mediated by
cell-mediated hypersensitivity
103
what do type IV not invlove
antibodies
104
strain
stretching injury
105
strain involves
muscle/tendons
106
strain caused by
mechanical overload
107
sprain involves
ligaments
| incomplete or completely torn
108
pain and swelling resolve faster in in sprain or strain
strain
109
sprain caused by
irregular or excessive movement of a joint
110
symptoms of sprain
```
pain
rapid swelling
heat
disability
discolouration
limited function
```
111
sprain strain treatment
anti-inflammatory analgesics
| gradual return to activity
112
RICE
rest
ice
compression
elevate
113
osteoarthritis characterized by
- loss+damage of articular cartilage
- inflammation
- new bone formation in joint
- subchondral bone chanes
- variable degrees of mild synovitis
- thickening of joint capsule
114
prevalence of ____ increased with age
osteoarthritis
115
risk factors of osteoarthritis
- increased age
- joint trauma
- long-term mechanical stress
- obesity
116
manifestations of osteoarthritis
```
pain
stiffness
enlargement of joint
tenderness
limited motion
muscle wasting
partial dislocation
deformity
```
117
conservative treatment of osteoarthritis
exercise and weight loss
drugs (analgesics and anti-inflammatory)
nutritional supplements
118
surgical treatment of osteoarthritis
used to improve joint movement, correct deformity or malalignment, or create new joint with artificial implants
119
prostaglandins
lipids that promote inflammation and are found in all tissues
120
cyclooxygenase
key enzymes in the biosynthesis of prostaglandins
121
two forms of cyclooxygenase
cyclooxygenase-1
| cyclooxygenase-2
122
cyclooxygenase-1
| location
all tissues
123
cyclooxygenase-1
| function
protects against gastric mucosa, support kidney function, promote platelet aggregation
124
cyclooxygenase-1
| inhibited by medications
undesirable:increase risk for gastric bleeding and kidney failure
125
cyclooxygenase-2
| location
all sites of injury
126
cyclooxygenase-2
| function
mediates inflammation, sensitizes pain receptors, mediates fever in brain
127
cyclooxygenase-2
| inhibited by medications
desirable: results in suppression of inflammation
128
NSAIDs
nonsteroidal anti-inflammatory drugs
129
NSAIDs action
inhibit cyclooxygenase->blocking inflammation
130
NSAIDs drug of choice for
mild to moderate pain, inflammation, fever
131
properties of all NSAIDs
antipyretic
analgesic
anti-inflammatory
132
use of NSAIDs
```
relief of:
mild/moderate headache
myalgia
neuralgia
arthralgia
post-op pain
arthritis pain
treatment of gout and hyperuricemia
```
133
celecoxib (celebrex®)
NSAID cyclooxygenase inhibitor
134
adverse effects of NSAIDS
```
heartburn to severe GI bleeding
acute kidney injury
noncardiogenic pulmonary edema
altered hemostasis
hepatotoxicity
skin eruption
tinnitus
```
135
tinnitus
hearing loss
136
misoprostal
prevents GI bleed
| synthetic prostaglandin E1 analogue that inhibits gastric acid secretion
137
NSAIDs nursing considerations
```
take with food/milk
avoid alcohol
assess for GI bleed
monitor I&O
no children
```
138
glucocorticoids action
suppresses histamine release and inhibits syntheses of prostaglandins by inhibiting COX-2
139
glucocorticoids released by
adrenal cortex
| natural hormone
140
glucocorticoids helps control inflammatory response by
stabilizing cell membranes of inflam cells (lysosomes). decreases migration if WBC into already inflamed areas
141
prednisone
Apo-Prednisone
| glucocorticoids prototype
142
glucocorticoids routes
inhaled or injected
143
glucocorticoids inhaled
control of steroid-responsive bronchospastic states
144
glucocorticoids nasal admin
manage allergic rhinitis and prevent recurrence of polyps after surgical removal
145
glucocorticoids topical
used in management of inflammation of eye ear skin
146
methylprednisolone sodium succinate
most common injectable glucocorticoid
147
hydrocortisone sodium succinate and dexamethasone sodium succinate
second most common injectable glucocorticoids
148
glucocorticoids - prednisone
| action
potent anti-inflam: short acting systemic corticosteroid
149
glucocorticoids - prednisone
| contraindications
active untreated infections, lactation, hypersensitivity to alcohol, bisulfate or tartrazine (food additive)
150
glucocorticoids - prednisone
| dosage
5-60 mg/day
| week to a month
151
glucocorticoids - prednisone
| adverse effects
depression, euphoria, headache, personality change, psychosis, restlessness, increased intraocular pressure, increased BP, peptic ulcers, anorexia, nausea, vomiting, delayed wound healing, increased blood glucose, decreased potassium, weight gain, osteoporosis, moon face
152
acetaminophen
Tylenol
pain reliever
max dose 4g/24 hrs
153
opioid analgesic
Ultram (tramadol)
- extended release
- synthetic - similar to morphine
- considered weak
- binds to receptors in brain responsible for transmitting pain signals and inactivates them
- manage moderate to severe pain
154
Ultracet or Tramacet
contains acetaminophen
155
viscosupplementation
- injected like cortisone
- available OTC oral supplement
- ex synvisc, orthovisc
156
eczema
"atopic dermatitis"
- inflam condition
- chronic (relapse and exacerbation)
- non contagious
- genetic predisposition
- eviron trigger
- immune dysregulation
- disturbance to epidermis
- stress
157
eczema manifestations
```
dry skin
itching
erythema
papules
infiltration
```
158
eczema therapy
```
symptomatic
emollients
oil bath
topical moisturizer
anti-inflam
UV therapy
topical antifungal
systemic antibiotics
severe: systemic immunosuppressives (cyclosporine)
```
159
anaphylaxis
most severe hypersensitivity
occurs within minutes of exposure
systemic or cutaneous
160
desensitization
reduce the severity of allergic reaction
| can cause anaphylaxis
161
antihistamines
drugs that directly compete with histamines for receptor sites
162
properties of antihistamines
antihistaminic
anticholinergic
sedative
163
histamine antagonists
H1 and H2
164
H1 antagonist examples
ex: chloropheniramine, fexofenadine (Allegra®), loratadine (Claritin®), cetirizine
(Reactine®), desloratadine (Aerius®),
diphenhydramine (Benadryl®)
165
H2 antagonist examples
cimetidine, ranitidine (Zantac®),
| famotidine (Pepcid AC®), nizatidine (Axid®)
166
H2 antagonists used to
reduce gastric acid in peptic ulcer disease
167
Diphenhydramine hydrochloride
```
traditional antihistamine (Benadryl)
acts both peripherally and centrally
```
168
Diphenhydramine hydrochloride also has
anticholinergic and sedative effects
169
anaphylaxis pharmacotherapy
symptomatic
| support cardiovascular system and prevent further hyper-response
170
what does an epipen do
rapidly reverse hypotension
171
what is in an epipen
epinephrine
| andrenergics
172
common diagnostic tests
| lab
```
CBC
WBC with differential
CRP
ESR
serological test to detect specific antibodies or viruses
```
173
common diagnostic test
| radiographic
MRI
CAT
PET scan
colonoscopy
174
CBC
complete blood count
175
WBC
white blood cell
176
CRP
C-reactive protein
177
ESR
erythrocyte sedimentation rate
178
MRI
magnetic resonance imaging
179
CAT
Computerized Axial Tomography
180
PET
positron emission tomography
181
pregnancy risk category for medications
| A
adequate
well controlled studies
not shown risks to fetus
182
pregnancy risk category for medications
| B
no adequate well controlled studies in women
| studies in animals not found risks to fetus
183
pregnancy risk category for medications
| C
no adequate well controlled studies in women
animal studies found harmful effect on fetus
or not studied in women or animals
caution advised, benefits may outweigh risks
184
no adequate well controlled studies
| D
clear risk to human fetus
| benefits may outweigh risks for pregnant women with serious condition
185
no adequate well controlled studies
| X
clear evidence that medication causes abnormalities in fetus
