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ALLERGY
ALLERGY
64
Nursing
Graduate
07/13/2011

Additional Nursing Flashcards

 


 

Cards

Term
What are 2 types of immunity?
Definition

Innate

Acquired

Term

Innate immunity

Phagocytosis of bacteria, etc by _______

Destruction of swallowed organisms by _______

Resistance of ____to invasion

Chemical compounds in blood which destroy _____

Name 4 of these chemical compounds

Definition

Phagocytosis of bacteria, etc by WBCs & tissue macrophages

Destruction of swallowed organisms by stomach acid & digestive enzymes

Resistance of skin to invasion

Chemical compounds in blood which destroy foreign organisms or toxins

 

lysosymes

basic polypeptides

complement complex

natural killer lympocytes

 

(Ron didn't seem to interested in this type of immunity)

Term

*Acquired immunity involves humoral & cell mediated responses.

Humoral=__-cell immunity

Cell mediated=__-cell immunity

Definition

Humoral=B-cell immunity

Cell mediated=T-cell immunity

Term

Antigens

 

Protein or large ___ unique to a specific toxin or organism

Usually of a ____ molecular weight

Antigenicity requires __________ molecular groups (epitopes) on the ______

 

Definition

Protein or large polysaccharide unique to a specific toxin or organism

Usually of a high molecular weight

Antigenicity requires regularly recurring molecular groups (epitopes) on the surface

Term

Acquired immunity requires the presence of ____

These are present in greatest numbers in the _____, but also what 4 other areas?

 

see slide 4 for pic/lymphocyte dvpt

Definition

Acquired immunity requires the presence of lymphocytes

These are present in greatest numbers in the lymph nodes

 

spleen

submucosal tissue of GI tract

thymus

bone marrow

Term

What is the primary mechanism in organ transplant rejection?

 

Where does B-cell production take place in mid fetal life? After that?

Definition

T cell immunity

 

 

liver

then later bone marrow

Term

An antigen reacts with ___ or ___ & activates them.

 

T/F: T-cells have surface receptor proteins & the whole cell reacts, whereas B-cells have antibodies & only the antibody reacts.

 

Definition

An antigen reacts with T-cells or B-cells & activates them.

 

True

(B-cells have thousands of antibodies on their surface)

Term

What is initiated by activation of T or B cells by antigen?

 

What amplifies this process?

Definition

Initiates extremely rapid reproduction of that specific T or B cell, resulting in a "clone" of that particular cell.

 

Macrophages-attack & liberate antigenic matter; secrete interleukin-1, which causes more reproduction of lymphocytes

Helper T cells-secrete lymphokines; very imp in B cell immunity

Term

Plasma Cell Antibody Formation

 

Dormant _____ + specific antigen→

enlarge to form _____→

some of lymphoblasts differentiate to form _____→

plasmablasts divide to form _______

 

What do plasma cells produce?

 

How long does this process continue?

Definition

Dormant B cells + specific antigen→

enlarge to form lymphoblasts

some of lymphoblasts differentiate to form plasmablasts

plasmablasts divide to form plasma cells

 

Bcellslymphoblastsplasmablastsplasma cells

 

Plasma cells produce Gamma Globulin Antibodies

 

Continues for days to weeks or until plasma cell dies

Term

Following activation of B lymphocytes, some of the lymphoblasts form new _____ rather than plasma cells.

 

 

Definition
Following activation of B lymphocytes, some of the lymphoblasts form new memory B-lymphocytes rather than plasma cells.
Term

What do memory B-cells do until they are activated?

 

What does a subsequent exposure to a specific antigen produce?

Definition

circulate throughout the body but remain dormant until activated by the same antigen

 

produces a much more rapid, pronounced, & sustained response

Term

Anitbodies are either what 2 kinds of proteins?

 

These account for ~20% of _____

Each antibody is _____ for a particular antigen

What are 5 classes of antibodies?

Which class is the largest # of antibodies?

Which class is involved in allergy & is only a small % of all antibodies?

 

Definition

gamma globulins or immunoglobulins (Ig)

 

These account for ~20% of plasma proteins

Each antibody is specific for a particular antigen

 

IgA, IgD, IgE, IgG, IgM 

 

largest #: IgG

allergy: IgE

 

Term

What are 4 ways in which the invading organism is inactivated (antibody mechanisms)?

Briefly describe each.

Definition

1. Agglutination: bound together in a clump

2. Precipitation: antigen-antibody complex becomes too large & precipitates out

3. Neutralization: antibodies cover all the toxic sites of the antigenic substance

4. Lysis: attack cellular membranes & rupture the cells

Term

The complement system consists of _____ present in plasma, many are ______

 

___ of these are primary importance

 

 

 

Normally ____, but activated mainly by the _____ pathway

Definition

The complement system consists of ~20 proteins present in plasma, many are enzyme precursors

11 of these are primary importance

The complement system helps or “complements” the ability of antibodies and phagocytic cells to clear pathogens from an organism. It is part of the immune system called the innate immune system that is not adaptable and does not change over the course of an individual's lifetime. However, it can be recruited and brought into action by the adaptive immune system.

 

Normally inactive, but activated mainly by the Classical pathway

Term

Describe the 4 steps of the "Classical Pathway"

 

What is the result of complement activation?

Definition

1. antigen-antibody rxn occurs

2. a reactive site on the antibody becomes "uncovered" & binds w/ protein C1

3. The activated proenzyme C1 sets in motion a cascade of rxns

4. Produces marked amplification

 

 "attack, disable & destroy invading cells"

Term

What stimulates the "classical" pathway?

"alternative" pathway?

 

Which pathway is more common?

Definition

Classical:

IgG or IgM (transfusion rxns)

plasmin

 

Alternative:

lipopolysaccharides (endotoxin)

radiographic contrast media*

drugs

membranes

vascular graft material

latex

 

classical more common

Term

On antigen exposure the specific clone of T-cells ___ & is ____

 

These T-cells recirculate in the body for ___ to ____

 

Definition

On antigen exposure the specific clone of T-cells proliferates & is released

 

These T-cells recirculate in the body for months to years

Term

Memory T cells are formed in a process analogous to memory B-cell formation

 

What do the memory T-cells do until a subsequent exposure to that specific antigen?

 

What does activation of memory T cells result in?

Definition

they remain dormant

 

results in a more rapid & pronounced effect on subsequent exposure

Term

When do T-cells react to antigens?

 

Name 3 antigen-presenting cells.

Definition

Only when they are bound to specific MHC proteins on the surface of antigen-presenting cells

 

macrophages

B-lymphocytes

dendritic cells

Term
What are MHC proteins & what do they do?
Definition

majory histocompatibility complex

 

carry antigen proteins degraded in antigen-presenting cells to the cells surface

Term

What cells are the most numerous of the T-cells?

 

Definition
helper T-cells
Term

What role do helper T-cells play?

 

Helper T-cells do this via production & secretion of _______ which act on: (2)?

Definition

major regulator of virtually all immune fcn

 

via production & secretion of lymphokines which act on:

other immune systems

bone marrow

Term

Helper T-cells cause:

Stimulation of growth & proliferation of ___ & ___ 

Stimulation of B-cell ___, ___, ___ & ___ secretion

Accumulation & activation of_____

_____ feedback (_____) of helper T-cells

Definition

Stimulation of growth & proliferation of cytotoxicsuppressor T-cells

Stimulation of B-cell growth, proliferation, plasma cell formation, & antibody secretion

Accumulation & activation of macrophages

Positive feedback (stimulation) of helper T-cells

Term

Cytotoxic "killer" T-cells

___ proteins on their surface bind w/specific antigen

___(____) secreted, which puncture the attacked cell

____ substances released into attacked cell

Attacked cell ____&____

Cytotoxic "killer" cell moves away to ____ & later ____ other cells

 

Definition

Receptor proteins on their surface bind w/specific antigen

Perforins (hole forming proteins) secreted, which puncture the attacked cell

Cytotoxic substances released into attacked cell

Attacked cell swells & dissolves

Cytotoxic "killer" cell moves away to circulate & later attack other cells

Term
Besides specific antigen, what other 3 things do "killer" T-cells attack?
Definition

normal tissue cells w/viral particles entrapped in them

cancer cells

transplanted tissue

Term
What 2 things are suppressor T-cells important in?
Definition

regulation "suppression" of the cytotoxic & helper T-cells

limiting the immune system's ability to attack the host

Term

What does tolerance of acquired immunity mean?

What does most tolerance result from?

Definition

recognition of "host" tissues as distinct from invading organisms

 

most tolerance results from "preprocessing"of lymphocytes to destroy the ones that would attack the host

 

Term

What happens in failure of tolerance?

 

What happens to this w/age?

 

What are 4 examples of this?

Definition

destruction of body tissues releases "self-antigens" which may activate T-cells or antibodies

 

increases w/ age

 

rheumatic fever

some glomerulonephritis

myasthenia gravis

SLE

Term

Name 3 types of immunizations & describe them

 

Definition

Killed: dead organism, but antigenic material remains

Chemically treated: no longer toxic, but antigenic material intact

Live-attenuated: cultured in special media or passed thru animals until mutated enough that it won't cause disease, but still antigenic

Term

What is passive immunity?

 

How long does this last?

Definition

T-cells or antibodies from another person or animal transfused

 

Confers immunity for hrs to wks

Term
What are 4 types of allergic rxns? What mediates each?
Definition

Type I (classic allergic rxn)

IgE mediated

involves mast cells & basophils

 

Type II

IgG, IgM and complement

 

Type III

tissue damage via immune complex formation or deposition

 

Type IV

T-cell mediated delayed hypersensitivity

Term

What type of allergic rxn is anaphylaxis?

What mediates this?

 

What is tryptase?

 

 

Definition

Immediate Type I hypersensitivity rxn

IgE mediated release of active substances

(many different vasoactive substances are released; see slide 28 for full list)

 

Tryptase is a diagnostic marker that distinguishes b/n anaphylaxis & anaphylactoid rx

(released in anaphylaxis)

Term

What are 3 major systems affected by anaphylaxis?

What are s/s of each?

Definition

Skin: urticaria

 

Respiratory system: bronchospasm & upper airway edema

 

CV system: vasodilation, changes in inotropy, incr capillary permeability

(some pts lose 1/2 their intravascular vol d/t capillary permeability; if you see an unexpected drop in BP, think anaphylaxis)

Term

Anaphylaxis time frame

Typically _____

May be delayed ____

Rarely delayed _____

Timing unpredictable following _____

 

Severe symptoms may recur ___ later, requiring several hours of ________

Definition

Typically immediate

May be delayed 2-15 min

Rarely delayed 2.5 hrs

Timing unpredictable following oral admin

 

 

Severe symptoms may recur 6-8 hrs later, requiring several hours of close observation

 

(1st wave of symptoms-caused by vasodilation & feeling of impending doom, quickly followed by 2nd wave as cascade of mediators amplifies the rxn)

Term

What is the definitive diagnosis of anaphylaxis?

When does it have to be measured?

Definition

plasma tryptase concentrations

measure w/in 1-2 hrs of rxn

 

 

 

 

Term

What is the gold standard for definitive identification of causative antigen?

 

What are 2 other tests?

Definition

Skin testing-use preservative free, diluted antigen; pt can have anaphylaxis rxn during test, so need trtmt nearby

 

RAST & ELISA

Term
*What are 3 immediate goals for anaphylaxis treatment?
Definition

Correct hypotension & hypoxemia

Replace intravascular vol

Inhibit further degranulation & release of vasoactive mediators

Term

What is the #1 treatment for anaphylaxis?

What are 4 other treatments?

Definition

#1=Epi

 

fluid resuscitation

B2 agonists

corticosteroids

antihistamines?

Term

*When should epi be given for anaphylaxis?

How does it help?

Definition

Early & as needed

 

correction of hypotension

relaxation of bronchial smooth muscle

restoration of membrane permeability

-decr release of vasoactive mediators

Term

Why do we use B2 agonists in anaphylaxis?

 

T/F: Antihistamines are effective following release of vasoactive mediators

Definition

reversal of bronchospasm

 

F: Antihistamines are ineffective following release of vasoactive mediators

but might still give them if anticipate ongoing rxn (ongoing mast cell degranulation)

Term

What are the effects of corticosteroids in anaphylaxis?

When might they be particularly useful?

Definition

enhances effect of B-agonist drugs

inhibition of arachidonic acid release & subsequent production of leukotrienes & prostaglandins

 

may be particularly useful following activation of the complement cascade

Term

T/F: Treatment of anaphylactoid rxn is identical to anaphylaxis rxn

 

T/F: The s/s of anaphylactoid rxn are clinically distinguishable from anaphylaxis

 

 

Definition

true

 

False!!!

clinically indistinguishable

only way to distinguish is with plasma tryptase test

Term

Is anaphylactoid rxn mediated by IgE?

 

How is anaphylactoid rxn produced?

Definition

No

 

produced by activation of:

blood coagulation & fibrinolytic systems

kinin-generating sequence

complement cascade

Term

What drug is responsible for most fatal anaphlactic rxns in general population?

 

 

 

 

Definition

PCN

 

 

Term

What is intolerance?

 

What is an idosyncratic rxn?

Definition

undesirable effect at low drug dose

 

 

undesirable effect independent of dose administered

Term
In order of highest incidence to lowest, name 3 substances that attribute to actual anaphylaxis or anaphylactoid rxns during anesthesia
Definition

MR

latex

antibiotics

Term

Why is there a high incidence of anaphylaxis rxns w/ MRs?

 

Why might you see anaphlyaxis on 1st exposure to MR?

 

How long can a person remain sensitized after developing antibodies?

 

Antibodies to MR may also cross-react w/ what?

Definition

IgE antibodies to quaternary or tertiary ammonium ions

 

Quaternary & tertiary ammonium ions are contained in many cosmetics & OTC drugs

 

up to 30 yrs

 

ammonium ions of neostigmine & morphine

Term

With what class of MRs might you see histamine release from direct mast cell degranulation (non-immune mediated)?

 

Name 3

Definition

Benzylisoquinolinium NDPMRs

 

mivaurium

atracurium

curare

Term

Is anaphylaxis common w/ barbs?

 

What about opioids?

Definition

rare, more common in atopic individuals

 

very rare, but morphine may cause direct release of histamine

Term

Anaphylaxis & propofol

 

have occured following ___ or ___exposures

higher risk in pts ____ to other drugs

high incidence of ______

Definition

have occured following  1st or subsequent exposures

higher risk in pts allergic to other drugs

high incidence of bronchospasm

Term

Do ppl have anaphylactic rxns more often w/ amide or ester LAs? Why?

What can be causative in both classes of LAs?

 

Definition

Esters-more common d/t metabolism of PABA

 

preservatives:

methyparaben & proplyparaben

Term
Cross-senstivity w/ halothane should be least likely w/ which IA? Why?
Definition

desflurane

decr metabolism

Term

With protamine, anaphylaxis is more common in which 3 types of pts?

 

Besides anaphylaxis, what else can protamine cause?

Definition

seafood allergy

diabetic using protamine-containing insulin

following vasectomy

 

may also cause direct histamine release & activate complement cascade

Term

Which ABX most commonly causes anaphylaxis?

Which ABX has a rare incidence of causing anaphylaxis? When can this incidence be incr?

 

What 3 blood & vol expanders cause anaphylaxis?

 

What is the #1 cause of anaphylactoid rxn? why?

Definition

most common: PCN

rare: cephalosporins; minimally incr w/ PCN allergy

 

blood, dextran, hespan

 

Radiocontrast media: iodine containing

Term

Life-threatening periop allergic drug rxns are reported w/ most all anesthetic drugs, except which 2?

 

 

Definition

BZDs

Ketamine

Term

*What is the primary manifestation of anaphylaxis in an anesthetized pt?

When does it typically occur?

Exception?

Definition

CV collapse

 

typically occurring w/in 5-10 min of drug exposure

 

exception: latex allergy might take ~ 30 min

Term
Name 5 populations at risk for latex allergy
Definition

Hx of multiple surgical procedures

[congenital urinary tract anomolies & *Myelomeningocele (spina bifida)]

Health care providers

Occupational exposure

Hx of atopy, hay fever, rhinitis, asthma, or excema

Hx food allergy

Term

What is a diagnostic procedure for Type IV latex rxn?

for Type I?

 

Definition

Type IV: patch testing

 

Type I

serologic testing-RAST, EAST, ELISA

skin prick testing (gold standard)

Term
What are 5 routes of exposure to latex?
Definition

skin or mucous membranes

 inhalation

ingestion

parenteral injection

wound inoculation

Term
What are 3 types of latex allergy rxns?
Definition

irritant contact dermatitis

 

Type IV (contact) hypersensitivity

 

Type I (IgE mediated) hypersensitivity

 

Term

Type IV latex rxn

aka ____ type hypersensitivity

occurs over ___

___ mediated

limited to _____

Definition

aka delayed type hypersensitivity

occurs over ~24hrs

Cell mediated

limited to site of contact

Term

Type I (IgE mediated) latex rxn

 

T/F: this is a true allergic rxn

 

Does this type of rxn have localized or systemic effects?

Definition

True

 

Localized and/or systemic effects

Term

When should you schedule surgery for a pt w/ latex allergy?

 

Is prophylaxis in latex-sensitive pt always successful in prevention?

 

What is a problem with prophylaxis in these pts?

 

What 3 drugs would you use for prophylaxis?

 

see slide 52 for treatment of latex allergy

Definition

1st case of the day

 

not universally successful

 

may attenuate early immune response, leaving anaphylaxis as the 1st sign

 

H1 blocker-diphenhydramine

H2 blocker-ranitidine

Glucocorticoid-methylprednisolone

*Dr Anderson says go for it cause it wont hurt anything

Term

Tx of Type IV Latex allergy is ______ & ______.

 

Tx of Type I reactions depends on what?

 

 

Definition

avoidance

steroids

 

whether the reaction is localized or systemic

rhinitis = antihistamines

hives = antihistamines and systemic steroids

anaphylaxis = as discussed before

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