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54 Cards in this Set

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WHAT CELLS ARE INVOLVED IN NONSPECIFIC IMMMUNITY?
The phagocytes-->granulocytes & agranulocytes.
WHAT CELLS ARE INVOLVED IN SPECIFIC IMMUNITY?
The lymphocytes-->T cells & B cells.
WHERE ARE LYMPHOCYTES MADE?
The thymus and the bone marrow.
THYMUS=cell mediated-->T lymphocytes
BONE MARROW=humoral mediated-->B lymphocytes.
WHAT ARE MHC AND WHAT ARE THE TWO DIFFERENT KINDS OF MHC?
MHC are markers that determine which antigens an individual's B celss, T cells and macrophages can respond to. The different kinds of MHC are:
MHC I-markers that appear on all body cells and are the markers on all genes for SELF.
MHC II-markers that are found on B cells and macrophages responsible for presenting foreign antigens.
NOTE:
MHC I=SELF & MHC II=FOREIGN
WHAT ARE THE FOUR WAYS THE BODY RECOGNIZES AN ANTIGEN?
1.) Memory B cells can recognize a prototype of an antigen when it's present.
2.) T helper cells look for a class MHC II molecule (displayed by macrophage and B cells) on a NONSELF antigen.
3.) Cytotoxic T helper cells respond to MHC I class molecules found on all body cells.
4.) Some cytotoxic helper cells track down microbes while others become NKC(natureal killer cells).
WHAT ARE CYTOKINES?
-Cytokines are chemical communicator made of proteins.
-It posess multiple effects influencing production of other cytokines via cascade effects.
-Cytokines produced by lymphocytes are called LYMPHOKINES
-Cytokines produced by monocytes are called MONOKINES.
WHAT ARE INTERFERONS?
Interferons are cytokines secreted by cells invaded by viruses+others. It prevents viral replication and suppress malignant cell replication and tumor growth.
WHAT ARE INTERLEUKINS?
Interleukins are cytokines secreted by active WBCs that influence other WBCs.
WHAT ARE THE TWO TYPES OF INTERLEUKINS?
The two types of interleukins are:
IL-1=stimulates T cells to initiate immune response.
IL-2=released from active T cells to stimulate the production of more T cells and increase activity of B cells, cytotoxic cells and natural killer cells.
NOTE:
IL-1=stimulates T cells
IL-2=released from T cells to stimulate more T cells.
WHAT CELLS ARE INVOLVED IN NONSPECIFIC IMMMUNITY?
The phagocytes-->granulocytes & agranulocytes.
WHAT CELLS ARE INVOLVED IN SPECIFIC IMMUNITY?
The lymphocytes-->T cells & B cells.
WHERE ARE LYMPHOCYTES MADE?
The thymus and the bone marrow.
THYMUS=cell mediated-->T lymphocytes
BONE MARROW=humoral mediated-->B lymphocytes.
HOW DO T CELLS DEVELOP?
-T-cells first leave the thymus and are referred to as "naive" until their initial encounter with an antigen.
-Following antigenic stimulation, a single cell expands into a pool of cells, with some forming memory which will regain activity with repeated stimulation/exposure.
WHAT CELLS ARE INCLUDED IN THE T-CELL GROUP?
T-cells include the:
-cytotoxic T lymphocytes
-functional subsets of T cells characterized by their cytokine secretion profiles.
WHAT ARE CYTOTOXIC T CELLS AND HOW DO THEY FUNCTION?
Cytotoxic T cells are a type of lymphokine and has several modes of action:
-cytotoxic T cells respond to specific antigens/antibody complexes on plasma cells and kill on contact.
-cytotoxic T cells secrete messengers called lymphokines
-a subset of cytotoxic T cells are called Natural Killer Cells (NKC).
-cytotoxic cells also become suppressor T cells.
WHAT ARE NATURAL KILLER CELLS AND HOW DO THEY FUNCTION?
-Natural Killer Cells are a type of cytotoxic T cell.
-Unlike the regular cytotoxic T cell, NKC do not need to recognize a specific antigen.
-NKC recognize class MHC 1(self) proteins, so it targets tumor cells and protects against a variety of microbes.
-NKC spontaneously destroys malignant cells.
-NKS patrols the body & kills on contact by delivering bursts of letal lymphokines.
NOTE: Know that NKC patrols the body & kills on contact by delivering a burst of lethal lymphokines.
WHAT ARE B-CELLS AND HOW DO THEY DEVELOP IN THE BODY?
-B-cells are programmed to identify specific antigens.
-When B-cells reacts with it's specific antigen, it changes into a plasma cells which produce immunoglobulins.
-An antigen-antibody complex is formed and activates a series of plasma proteins called complement.
-The complement proteins then destroy antigens.
WHAT ARE THE FIVE DIFFERENT COMPLEMENT IMMUNOGLOBULINS AND WHAT ARE THE FUNCTIONS OF EACH?
1.) IgG=kills bacteria
2.) IgA=viral protection in secretions, GI
3.) IgM=kills bacteria
4.) IgE=for allergy & wards off parasites*
5.) IgD=regulates cell activation
NOTE: IgGAMED
DURING ALLERGIC REACTION, WHICH CELLS SIGNALS THE ALLERGIC REACTION?
The eosinophils and basophils signal the allergic reaction. The allergic reaction is regulated by the immunoglobuline IgE.
DURING BACTERIAL INFECTION, WHICH MUST THE NURSE BE ALERT TO IN THE PATIENT'S LAB RESULTS?
During a bacterial infection, the nurse must be alert to the neutrophil levels because the mature cells could run out and result in a SHIFT TO THE LEFT(increased BANDS), meaning that the immature cells from the bone marrow are being used up.
WHICH CELL PRODUCES THE IMMUNOGLOBULIN COMPLEXES?
The B-cells are differentiated into the different immunoglobulin complexes.
DESCRIBE THE IgE Type 1 Hypersensitivity PROCESS/PATHWAY.
1.) The first time the allergy-prone person runs across an allergen such as ragweed, he or she makes large amounts of ragweed IgE antibody.
2.) The IgE molecules will then attach themselves to mast cells.
3.) The second time that person has a brush with ragweed, the IgE primed mast cells will release its powerful chemicals and the person will suffer the wheezing and/or sneezing, runny nose, watery eyes, and itching of allergy.
WHAT ARE THE THREE RELATIONSHIPS BETWEEN IMMUNE SYSTEM AND CANCER?
1.) Immune system can sometimes cause a spontaneous remissions in ptients with cancer.
2.) There is an increased incidence of cancer in immunosuppressed patients.
3.) It has been shown that there is presence of lymphoid infiltrates in solid tumors.
WHAT ARE SOME OF THE KNOWN AUTOIMMUNE DISEASES?
-Rheumatoid arthritis
-Systemic lupus erythematosus
-Type I diabetes mellitus
-Myasthenia gravis
-Graves' disease
-Multiple sclerosis
-Sjogren's syndrome
WHAT ARE THE DIFFERENT ETIOLOGIES OF AUTOIMMUNE DISORDERS?
-Genetics
-Viruses
-Environmental factors
-Drugs
-Sex hormones (more common in women)
-Multiple unknown causes
WHICH CELL PRODUCES THE IMMUNOGLOBULIN COMPLEXES?
The B-cells are differentiated into the different immunoglobulin complexes.
DESCRIBE THE IgE Type 1 Hypersensitivity PROCESS/PATHWAY.
1.) The first time the allergy-prone person runs across an allergen such as ragweed, he or she makes large amounts of ragweed IgE antibody.
2.) The IgE molecules will then attach themselves to mast cells.
3.) The second time that person has a brush with ragweed, the IgE primed mast cells will release its powerful chemicals and the person will suffer the wheezing and/or sneezing, runny nose, watery eyes, and itching of allergy.
WHAT ARE THE THREE RELATIONSHIPS BETWEEN IMMUNE SYSTEM AND CANCER?
1.) Immune system can sometimes cause a spontaneous remissions in ptients with cancer.
2.) There is an increased incidence of cancer in immunosuppressed patients.
3.) It has been shown that there is presence of lymphoid infiltrates in solid tumors.
WHAT ARE SOME OF THE CAUSES OR PATHOPHYSIOLOGIES IN AUTOIMMUNE DISEASES?
In general, autoantibodies are present in the many autoimmune diseases. Some of the pathophysiologies in autoimmune diseases are:
1.) Antibodies are directed against substances found in the cell's DNA, RNA and link up with SELF antigens.
2.) The MHC I(self) markers for self are no longer recognized as SELF and are seen as forein antigen.
3.) The immune complex set off inflammatory reactions.
4.) B-cells might be hyperactive while cytotoxic T suppressor cells may be underactive.
5.) T cell receptor may be defective or ineffective being capable of damagin own tissues.
WHAT ARE SOME OF THE NON-PHARMACOLOGIC TREATMENTS FOR AUTOIMMUNE DISEASE?
-Stress reduction
-Exercise to increase energy (low impact)
-Rest fo restorative functions
-Physical Therapy
-Massage therapy
-Vitamin/mineral supplements such as Vitamin C, Vitamin E and Glucosamine/Chondroitin
WHAT ARE SOME OF THE PHARMACOLOGIC TREATMENTS FOR AUTOIMMUNE DISEASES?
-NSAIDs + COX-2 inhibitors
-Corticosteroids
-Immunosuppresant agents
-Disease-modifying anti-rheumatic drugs (DMARDs)
-New biologic therapies
HOW DO GLUCOCORTICOIDS WORK?
-Glucocorticoids work by suppressing lymphocyte, inflammation and immune reactions.
-It is well-absored from the GI
-Hydrocortisone and prednisolone do not require hepatic metabolism to active form, which is why it's the short & intermediate-acting glucocorticoid drugs.
WHAT ARE THE THREE DIFFERENT CLASSES OF GLUCOCORTICOIDS?
1.) Short-acting=HYDROCORTISONE
2.) Intermediate-acting=PREDNISOLONE
3.) Long-acting=DEXAMETHASONE
WHAT ARE THE SHORT TERM ADVERSE EFFECTS OF GLUCOCORTICOIDS?
-Sodium retention=WEIGHT GAIN
-Hyperglycemia
-Adrenal suppression
-Mood changes
-Insomnia
-Stomach upset
NOTE: SHAMIS
DUE TO GLUCOCORTICOID'S EFFECT OF ADRENAL SUPPRESION, WHAT PRECAUTION MUST BE TAKEN?
The patient must be tapered off slowly from glucocorticoid therapy due to its effect of adrenal suppression which could result in secondary adrenocortical insufficiency. What happens is, if the glucocorticoid medication is abruptly withdrawn, the shrunken adrenal glands from prolonged glucocorticoid therapy will not be able to secrete sufficient glucocorticoids & symptoms of acute adrenocortical insufficiency will appear.
WHAT ARE THE LONG-TERM SIDE EFFECTS OF GLUCOCORTICOIDS?
-Muscle atrophies
-Thin skin
-Bone loss
-Peptic ulcers
-Weight redistributed (buffalo hump)
-Cataracts & glaucoma
(NOTE: Cushingoid signs & symptoms)
WHAT ARE THE DIFFERENT TYPES OF BIOLOGICAL THERAPY?
1.) Hematopoeitic growth factors (ANEMIA)
2.) Colony stimulating factors
3.) Cytokines
4.) Polyclonal/monoclonal antibodies
5.) Immune modulators
WHAT ARE THE VARIOUS WAYS BIOLOGICAL AGENTS WORK?
-Stimulates host defense cells by functioning as singaling systems mainly via cytokine responses.
-Stimulates growth of new cells from bone marrow.
-Disrupts host/tumor relationship by acting on tumor vasculature and nutrient supply.
-Used as immune suppresants
-Used concurrently to treat certain autoimmune disorders and cancers.
-It has potentially many exciting possibilities
HOW DO BIOLOGIC THERAPY UNDER COLONY-STIMULATING FACTOS WORK?
Colony-stimulating factors work by:
-increasing the numbers of various immune cells
-binding to receptors on specific progenitor cells in bone marrow
-produced by recombinant DNA technology which allows human protein to be engineered
WHAT ARE SOME OF THE CURRENT COLONY STIMULATING AGENTS AND HOW DO THEY WORK?
Some of the current colony-stimulating agents are produced recombinant granulocyte-macrophage that cause bone marrow to increase production of neutrophils.
1.) Pegfilgastrim (Neulasta) & Filgastrim (Neupogen)=works by returning cell-mediated immunity to the patient; used to shorten febrile neutropenia induced b myelosuppressive antineoplastic drugs; recombinantly engineered from E.coli bacteria.
2.) Neurogen=approved for adult myelogenous leukemia and for pats after bone marrow transplant.
3.) Sargramostim (Leukine)=works by producing more than one type of cell (neutrophil & monocytes); is recombinantly engineered granulocyte-macrophage from yeast cells; used after bone marrow transplant & in adults with acute myelogenous leukemia & non-Hodgkin's lymphoma.
WHAT ARE THE COMMON SIDE EFFECTS OF COLONY-STIMULATING FACTORS?
-Bone pain
-Risk for further leukemic progression
-Fever
-Allergic reactions, esp to pts sensitive to proteins derived from E.coli bacteria. (pt. can have respiratory distress.)
WHAT SIDE EFFECT CAN SOME PATIENTS HAVE TO SARGRAMOSTIM?
Sargramostim can cause capillary leak syndrome with peripheral edema and pleural effusion with SOB and hypotension.
WHAT IS CYTOKINE THERAPY AND HOW DOES IT WORK?
Cytokines are proteins released by WBCs in response to antigenic invasion.
-Cytokine therapy enhances and accelerates the inflammatory and specific responses that will destroy invading antigen.
-Cytokine therapy has proinflammatory with anti-viral, anti-proliferative, and anti-neoplastic properties.
WHAT ARE SOME OF THE CURRENT CYTOKINE AGENTS USED?
Cytokine agents for Cytokine Therapy are generally Interferons and Interleukins produced by activated lymphocytes.
WHAT ARE THE COMMON SIDE EFFECTS OF CYTOKINE THERAPY?
-Dizziness, confusion, lethargy
-Flu-like symptoms
-Anorexia, nausea
-Depression and suicidal ideation
-Bone marrow depression
-Increased liver enzymes
**NOTE: The above can result in -risk for infection, -risk for injury, -altered nutrition less than body requirements.
WHAT IS POLYCLONAL/MONOCLONAL ANTIBODIES AND WHAT ARE THEY USED FOR?
Note: Only monoclonal antibodies used now. Monoclonal antibodies are used to react with specific tumor receptor sites for diagnosis and treatment of malignancy.
NAME SOME OF THE COMMON MONOCLONAL ANTIBODY AGENTS (Specific to what's already been mentioned in class)?
1.) For treatment of RA:
-infliximab (Remicade)=for tx of RA, binds to TNF & unlike other monoclonal antibodies, it has no anti-tumor function.
-adalimumab (Humira)
2.) For antiplatelet:
-Abciximab (Reopro)-binds to GPIIb/IIIa on human platelets to help prevent platelet aggregation.
3.) For treatment of breast cancer:
-trashuzumab (Herceptin)=recombinant DNA-derived humanized monoclonal antibody for tx of breast cancer in those who has over expression of HER2 protein.
WHAT ARE IMMUNE MODULATORS AND HOW DO THEY WORK?
-Immune modulators act directly on function of T & B cells and can either stimulate or suppress the immune response
-Those that act as suppressants block the normal effects of the immune system; therefore, it is BENEFICIAL FOR ORGAN TRANSPLANTATION AND IN AUTOIMMUNE DISEASE.
HOW DOES TNF (TUMOR NECROSIS FACTOR) PLAY A ROLE IN RA PATHOGENESIS?
TNF is a cytokine that stimulates other cytokines-interleukins(IL) and causes massive inflammatory response. TNF also inhibits some bone formation, induces resorption and stimulates secretion of protein-degrading enzymes to destroy joints.
WHAT ARE THE PHARMACOLOGIC TREATMENTS FOR RA?
-NSAIDS & COX-2 inhibitors
-Corticosteroids=Prednisone & NI: monitor wt, glucose & osteoporosis
-DMARDs=slows the progression of the disease.
Example:
1.) Methotrexate(Rheumatrex)=most widely used because of LONG-TERM EFFICACY; may add other DMARDs to regimen to increase efficacy and reverse debilitating effects of RA. S/E: oral ulcers, nausea, anorexia, increase risk for infection--must monitor CBC
**NOTE: Methotrexate is an anti-cancer drug that lowers immune function.
2.) Leflunomide(Arava)=used w/ Methotrexate; its a cytostatic agent & an immunosuppressant that inhibits synthesis of pyrimidine required for proliferation of Tcells; also inhibits IL1 and TNF alpha. S/E: skin rash, abd pain, diarrhea, nausea, reversible alopecia--must monitor for increased LFTs.
WHAT PRECAUTION SHOULD BE TAKEN FOR A PATIENT WHO IS ON PHARMACOLOGIC TREATMENT SPECIFICALLY "BIOLOGIC THERAPY" FOR RA?
Nurse must note that all RA Biologic Therapy drugs are not recommended for patients with latent TB and has history of cancer malignancy because it can cause increased risk for infection.
WHAT IS THE MODE OF ACTION OF etanercept (Enbrel)?
Etanercept (Enbrel) is a TNF-alfpha blocker. During RA increased inflammation, immune system counteracts with its own anti-inflammatory agents. One is a receptor for TNF which this drug binds to and inactivates the excess TNF-alpha.
WHICH TNF BLOCKER FOR TREATMENT OF RA IS NOT USED WITH OTHER TNF BLOCKERS?
Adalimumab (Humira) is given by SQ and not concurrently with other TNF blockers.
WHICH DRUG FOR TREATMENT OF RA UNDER THE BIOLOGIC THERAPY IS NOT A TNF BLOCKER?
Anakinra (Kineret) because it is an interleukin 1 (IL1) receptor antagonist. The MOA is to augment the diminished levels of naturally occuring IL1 as a counterbalance to the detrimental effects of IL1 activity in bone resorption, erosion and and joint cartilage destruction.