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Which antibody is found in great numbers in a patients with allergies?
IgE
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What disease most commonly occurs with HIV?
Hepatitis C
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What does HIV primarily target?
CD4 Lymphocytes
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What are the 4 signs & symptoms of Systemic Lupus erythematosus?
- repeated miscarriages
- hepatitis
- pleural effusion
- butterfly rash
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What are 3 signs & symptoms of Rheumatoid Arthritis?
- morning stiffness
- swollen joints
- anorexia
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what blood levels should be drawn before & after IVIG administration?
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What test is used to confirm HIV?
Western Blot
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What immunity/response are tuberculin skin tests an example of?
T-cell mediated immune response
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How often should Peripheral venous cathetors be replaced?
72-96 hours
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Which type of immunity occurs in response to vaccines?
active immunity
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What 4 lab tests are used in the diagnoses of Rheumatoid Arthritis?
- Hepatic Panel
- Erythrocyte Sedimentation Rate
- Antinuclear antibody Titers
- C-Reactive Protein
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What 3 drugs cause drug induced systemic lupus erythematosus?
- Isoniazid
- Procainamide
- Hydralazine
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What antibody is the most common in the body?
IgG
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IVIG is administered over how much time?
2 to 4 hours
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T-Lymphocytes are produced and mature in what area of the body?
the thymus
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Autoimmunity
the normal protective immune response paradoxically turns against or attacks the body, leading to damage
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Hypersensitivity
when the body produces inappropriate or exaggerated responses to specific antigens
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Primary Immune Deficiencies
- deficiency results from improper development of immune cells or tissues
- it is usually congenital or inherited
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Secondary Immune Deficiencies
deficiency results from some interference with an already developed immune system usually acquired later in life
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What do neutrophils do?
They increase in response to a bacterial infection
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What is the function of Monocytes?
they function as phagocytic cells that engulf, ingest & destroy numbers of foreign bodies or toxins
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What do Basophils & Eosinophils do?
The increase as a response to an allergic reaction or a parasitic infection
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Acquired Immunity
Acquired during life-not at birth. Usually a result of prior exposure to an antigen through immunization or by contracting a disease
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What do Lymphocytes do?
they pla a major role in humoral & cell-mediated immune response
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What do lymphocytes consist of?
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What percent of lymphocytes are b-cells?
10-20% of lymphocytes
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What percent of lymphocytes are t-cells?
60-70% of lymphocytes
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B-Cells
- important for producing a humoral response
- during response they can transform themselves into plasma cells that maufacture antibodies
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T-Cells
important for producing a cellular immune response
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Suppressor T-Cells
Lymphocytes that decrease b-cell activity to a level at which the immune system is compatible with life
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Memory T-cells
Remembers contact with an antigen & mounts an immune response when in contact again
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Helper T-Cells
- Lymphocytes that attack foreign invaders (antigens) directly
- Usually classified as CD4
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Cytotoxic T-Cells
- Lymphocytes that lyse cells infected with a virus
- plays a role in graft rejectionUsually classified as CD8
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CD4 T-Cell Count
400-1600
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Natural Immunity
- Rapid, non-specific immunity present at birth
- Provides a broad spectrum defense against & resistance to infection
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What defense mechanism of determining "friend or "foe"?
natural immunity
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What activates an immediate immune response or develops an acquired immune response?
Natural Immunity
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What type of immunity produces an immune response to defend against re-exposure?
acquired immunity
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What does acquired immunity rely on?
the recognition of a specific foreign antigen
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what is the humoral response?
- response whre t-cells recognize foreign invader through the body
- t-cells report this to the lymph nodes
- characterized by the production of antibodies by b-cells in response to specific antigen
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In humoral immune response, what are b-cell responsible for?
sending out specific clones for that invader and then making memory cells to recognize that invader, causing a stronger response
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What type of lymphocyte is responsible fore the cellular immune response?
t-cells
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what do stem cells do in the cellular immune response?
they migrate from the bone marrow to the thymus gland wehre they develop into t-cells
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what is the function of t-cells in the cellular immune response?
- attack foreign invaders directly rather than producing antibodies like b-cells
- take back information on invader to lymph nodes & develop various t-cells to defeat invader
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When is the humoral immune response activated?
- anaphylaxis
- allergic hay fever
- asthma
- immune complex disease
- bacterial & some viral infections
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When is the cellular immune response activated?
- transplant rejection
- delayed hypersensitivity (TB rxn)
- tumor surveillance on destruction
- Viral, Fungal & parasitic infections
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What is the function of antibodies?
- get antigens to agglutinate in order to facilitate phagocytosis
- promote release of histamine
- get natural immune system to attack the invader
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What are antibodies?
large proteins called immunoglobulins
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How many types of antibodies can the body produce?
5 types
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IgG
- appears in interstitial fluid
- Major role in blood & tissue infections
- Crosses the placenta
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IgA
- appears in body fluids
- protects
against respiratory GI & GU infectionsprevents absorptions of antigens from food- passess to newborn in breast milk
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IgM
- in intravascular serumfirst Ig produced in response to bacterial/viral infection
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IgD
influences B-Cell differentiation
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IgE
- takes part in allergic & hypersensitivity reactionscombats parasitic infections
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What are stem cells?
blank cells that can be engineered to become various types of cells
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where are stem cells found in large quantities?
- umbilical cord blood
- aborted fetal tissue
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Deficiency/Excess of what nutrients impari the Immune System?
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What Immunoglobulin mediates allergic reactions?
IgE Antibodies
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Where is IgE mainly located?
Respiratory & GI mucosa
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What does IgE do?
Triggers mast cells to release chemical mediators such as histamine, serotonin & kinins
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What does the production of antigen specific IgE require?
Active communication between macrophages, T-cells & b-cells
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What is the 5 step process of IgE in an allergic reaction?
- 1.) allergin is absorbed through respiratory, GI tract or skin
- 2.) Macrophgae process antigen & presents it to t-cell
- 3.) T-cell influences b-cell
- 4.) B-cell mature into allergen specific IgE plasma cells
- 5.) IgE plasma cells synthesize & secrete antigen specific IgE antibodies
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Where are primary chemical mediators found?
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What are primary chemicals mediators commonly referred to?
immediate hypersensitivity response
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What are the 4 primary chemical mediators?
- Histamine
- Eosinophil chemotactic factor of anaphylaxis
- Platelet aggregating factor
- Prostaglandins
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Secondary Chemical Mediators
inactive precursors that are formed or released in response to primary mediators
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What are 3 secondary chemical mediators?
- leukotrienes
- bradykinin
- serotinin
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What is the most severe form of hypersensitivity?
anaphylactic (type 1) hypersensitivity
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What are the signs & symptoms of anaphylactic (type 1) hypersensitivity?
they are determined by the amount of the allergen, mediator released, sensitivity of target organ & route
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When does anayphylactic (type 1) hypersensitivity occur?
typically occurs on re-exposure to an antigen
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When does cytotoxic (type 2) hypersensitivity occur?
- Occurs when system mistakenly identifies a normal constituent of the body as foreign
- Ex. Rh Hemolytic disease of the newborn
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What is cytotoxic (type 2) hypersensitivity associated with?
- several disorders such as:
- -myasthenia gravis
- -goodpasture syndrome
- -blood transfusion reaction
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What is immune complex (type 3) hypersensitivity?
- Reaction that involves immune complexes that are formed when antigens bind to antibodies
- Complexes are cleared from circulation by phagocytic action
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Which hypersensitivity reaction are joints & kidneys particularly susceptible?
Immune Complex Hypersensitivity (Type 3)
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When does Delayed-Type (type 4) hypersensitivty occur?
24-72 horus after exposure
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What mediates delayed-type (type 4) hypersensitivity?
sensitized t-cells
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anaphylaxis
immediate reaction between a specific antigen and an antibody that results in rapid release of IgE
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What are the most common medications that can cause anaphylaxis?
- penicillin
- contrast dyes
- IV anesthetics
- NSAIDS
- Opiods
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What are the most common foods that cause anaphylaxis?
- peaches
- shellfish
- fish
- milk
- eggs
- wheat
- soy
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What are the signs & symptoms of Mild Anaphylaxis?
- warmth
- sensation of fullness in mouth & throat
- Nasal congestion
- puritis
- sneezing
- tearing of the eyes
- periorbital edema
- ** S/sx occur w/i 2 hrs
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what are the signs & symptoms of moderate anaphylaxis?
- flushing
- warmth
- anxiety
- itching
- bronchospasm
- dyspnea
- cough
- wheezing
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what are the signs & symptoms of severe anaphylaxis?
- abrupt reaction with all previous signs & symptoms plus:
- -cyanosis
- -hypotension
- -dysphagis
- -nausea, vomiting, diarrhea
- -seizures
- -cardiac arrest
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What are teh 8 ways to manage anaphylaxis?
- oxygen
- epinephrine
- antihistamines
- intubation
- corticosteroids
- IV Fluids
- Epi Pen
- CPR
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What are the signs & symptoms of allergic Rhinitis?
- clear watering nasal drainage
- itching of throat
- headache
- hoarseness
- dry cough
- pain over sinuses
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What medications treat allergic rhinitis?
- antihistamines
- mast cell stabilzers
- corticosteroids
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What type of hypersensitivity reaction is contact dermatitis?
type 4 delayed hypersensitivity
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what type of hypersensitivty reaction is atopic dermatitis?
type 1 immediate hypersensitivity
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what is the treatment of atopic dermatitis?
- corticosteroids
- antihistamines
- immunosuppresive agents
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What are teh signs & symptoms of atopic dermitits?
- itching
- scratching
- excessive dryness
- inflammation & hyperreactivity of the skin
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What type of hypersensitivity reaction is dermatitis medicarmentosa?
type 1 immediate hypersensitivity
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What type of hypersentivity reaction is a latex allergy?
- type 1 immediate hypersensitivity *anaphylaxis*
- Type 4 delayed hypersnsitivity
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Autoimmune Disease
immune complexes build up & are deposited into synovial tissue or other organs, triggering inflammatory reaction (the body attacks itself)
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What are common autoimmune disorders?
- rheumatoid arthritis
- osteoarthritis
- systemic lupus erythematous
- scleroderma
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When is the Erythrocyte Sedimentation rate Increased?
in conditions involving inflammation
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when is the hematocrit decreased?
in chronic inflammation or anemia
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When is the RBC decreased?
- Rhematoid Arthritis
- Systemic Lupus Erythematous
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When is the WBC decreased?
systemic lupus erythematus
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What diagnostic test is postive with many autoimmune disorders?
antinuclear antibody (ANA)
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When is the rhematoid factor positive?
-
What does a positive C-reactive protein indicate?
active inflammation
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When are IgA, IgM & IgG levels increased?
in people with autoimmune disorders
-
What disease are human leukocyte antigen levels present?
- In patients with:
- -ankylosing spondylitis
- -reiters syndrome
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Where does rheumatoid arthritis occurs?
synovial tissue
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What does rheumatoid arthritis do?
destroys cartlidge and bone resulting in loss of articular surface, joint motion, muscle elasticity & ctonractile power lost
-
what is early rheumatoid arthritis mediation treatment?
- salcylates
- NSAIDS
- Disease modifying antirhematic drugs (DMARDs) ex. Plaquenil, axulfidine
- Immunosuppresives ex. methotrexate & cytoxan
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what is moderate rheumatoid arthritis medication treatment?
immunomodulators ex. humira, enbrel, & remicade
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What is medication treatment for advanced/erosive rheumatoid arthritis?
- corticosteroids
- immunosuppressive
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What does rheumatoid arthritis frequently attack?
- wrist
- hands
- elbows
- shoulders
- knees
- ankles
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What are the signs & symptoms of rheumatoid arthritis?
- edema
- pain
- swelling
- warmth
- erythema
- joint stiffness in the morsning lasting more than 30 min.
- bilateral & symmetrical
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What doea an x-ray show in rheumatoid arthritis patients?
- Bony erosion
- narrowed joint space
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What needs to be monitored with immunosuppresive therapy?
- assess for:
- -bone marrow suppression
- -GI ulcerations
- -Skin rashes
- -alopecia
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What labs need to be done for rheumatoid arthritis client on immunosuppressive therapy?
- CBC
- Liver enzymes
- Creatinine q 2-4 wks
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what is tested before administering immunomodulators?
test for TB first
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What are patients at an increased risk for with remicade?
- increased risk for infection
- **withhold meds if fever exhists**
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How is remicade administered?
IV over 2hrs or more
-
How should Rheumatoid arthritis patients eat?
small frequent meels high in protein, vitamins & iron
-
What are 2 self-injectable immunomodulators?
-
Systemic Lupus Erythematous
- increaed autoantibody result from t-cell suppression leading to immune complex depostion & tissue damage
- inflammation stimulates antigens, which stimulate additional antibodies & reptition of cycle
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What are the vascular s/sx of systemic lupus erythmatous?
- inflammation of arterioles
- Purpric lesios on fingertips, elbow, toes, forearms & hands
-
What are the musculoskeletal s/sx of systemic lupus erythemouts?
- arthalgia
- joint swelling
- tenderness
- pain on movement
- morning stiffness
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What are the skin s/sx of systemic lupus erythematous?
- polycystic lesions
- chronic rash
- butterfly rash on face
- oral ulcers
-
What are the renal system lupus erythematous complications?
affects glomeruli resulting in renal failure
-
What are the cardiovascular systemic lupus erythematous complications?
- pericarditis
- possible myocarditis with pleural effusions
-
What neurological complications occur with systemic lupus erythematous?
- wide spread neurological involvement
- seizures
- *psychosis
- *Depression
-
What diagnostic test are done for systemic lupus erythematous?
- positive ANA
- CBC to assess for anemia, thrombocytopenia, leukocytosis/leukopenia
- serum creatine & urinalysis to assess kidney damage
-
What are 5 mediations that can cause drug-induced System Lupus Erythematous?
- apresoline
- procainamide
- thorazine
- INH
- Some Seizure Medications
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What are 3 types (categories) of SLE medications?
- corticosteroids
- antimalarial meds
- immunosuppressive
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What is the window period for HIV sero-conversion?
up to 12 weeks
-
What diseases are caused by a T-Cell deficiency?
thymus hypoplasia (DiGeorge syndrome)
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