Pathophys Exam 2

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Rx2013
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46282
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Pathophys Exam 2
Updated:
2010-10-31 13:50:28
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Infectious Disease
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Description:
Disorders of Human Immunity
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  1. disorder caused by the inability of the immune system to distinguish self antigens from foreign antigens.
    • autoimmune disorders
    • result in tissue damange
    • may affect any cell in the body
  2. common autoimmune disorders
    • type I diabetes
    • crohn's/ulcerative colitis
    • myasthenia gravis
    • multiple sclerosis
    • Hashimoto thyroiditis/graves disease
    • rheumatoid arthritis
    • lupus
  3. Etiology of autoimmune disorders
    • unknown
    • genetic suceptibility
    • environmental factors
  4. Most common autoimmune disorders
    • rheumatoid arthritis
    • thyroiditis
    • more common in women (estrogen stiumlates immune fx)
    • ~5% of the population of western coutnries
  5. Immune tolerance
    • ability of the immune system to distinguish self from non-self
    • Human leukocyte antigens
    • Accomplished by removing self reactive cells
  6. Proposed mechanisms of loss of self tolerance
    • loss of t cell anergy
    • release of sequestered antigens and epitope reading
    • molecular mimicry
    • superantigens
    • abnormal immunoregulatory mechanisms
  7. Clinical presentation of autoimmune disorders
    depends on the tissues damaged by immune response
  8. Diagnosis of an autoimmune disorder
    serological testing
  9. non pharmacological treatment of autoimmune disorders
    plasmaphoresis
  10. pharmacologic treatment of autoimmune disorders
    • immunosuppressive drugs
    • cordicosteroids, monoclonal antibodies
    • cyclophosphamide, azathioprine, tacrolimus
  11. disorders in which there is an inappropriate or excessive immune system response
    Hypersensitivity disorders
  12. IgE mediated hypersensitivity
    Type 1 hypersensitivity
  13. Antibody mediated hypersensitivity
    type II hypersensitivity
  14. complement mdiated hypersensitivity
    type III hypersensitivity
  15. cell mediated hypersensitivity
    type IV hypersensitivity
  16. cause of Type I hypersensitivity
    • allergens
    • IgE mediated
  17. hypersensitivity reactions represent about _____ of all adverse drug reactions.
    1/3
  18. ADRs affect _____ of hospitalized patients and more than ____ of the population
    • 10-20%
    • 7%
  19. Clinical presentation of systemic Type I hypersensitivity
    anaphylaxis
  20. clinical presentation of atopic type I reaction
    • sneezing, itching
    • watery nose/eyes
    • malaise, fatigue
    • headache
    • dermatitis
  21. non-pharmacologic treatment of Type I reactions
    • avoidance of antigen
    • airway maintenance
    • education and medical alert bracelet
  22. pharmacologic treatment for type I reactions
    • epinephrine
    • antihistamines/decongestants
    • corticosteroids and cromolyn
    • allergy shot desensitization
  23. mechanism of cromolyn
    stabilize mast cells
  24. Abnormality of immune system that renders a person susceptible to diseases normally prevented by the immune system
    immunodeficiency
  25. primary immunodeficiency
    congenital or inherited
  26. secondary immunodeficiency
    • aquired
    • HIV
  27. HIV infects
    • CD4 T Lymphocytes
    • Macrophages
    • Dendritic Cells
  28. AIDS is associated with
    • sever immunosuppression
    • opportunistic infections
    • malignancies
    • wasting
    • CNS degeneration
  29. Epidemiology of HIV/AIDS
    • ~40 million people worldwide
    • 2.9 million deaths in 2006
    • 50% of new infections in women and young people
    • Eastern europe and central asia
  30. Horizontal transmission of HIV
    fluid exchange
  31. Verticle transmission
    from mother to child
  32. time before symptoms of HIV occur
    1-3 months
  33. Steps of HIV infection of cells
    • 1. Binding to CD4 site
    • 2. Entry of virus into cell
    • 3. Reversetranscription of RNA from Virus
    • 4. DNA incorporated into host DNA
    • 5. DNA transcribed to mRNA
    • 6. Protease cleaves DNA
    • 7. New virus formed
    • 8. Virus buds off of cell
  34. The 4th stage where viral DNA is incorporated into the host DNA
    Provirus Stage
  35. Pathophysiology of HIV/AIDS
    • HIV replication leads to death of CD4 cells
    • CD4 count is depeleated
    • Pt. loses the ability to initiate an immune response
    • infection occurs in 3 stages over 8-12 years.
  36. Primary HIV/AIDS stage
    • occurs 1-4 weeks after exposure
    • lasts for 7-10 days
    • fever, fatigue, myalgias, sore throat, night sweats, GI issues, headache, rash, lymphadenopathy
  37. secondary HIV/AIDS stage (latency)
    • lasts around 10 years
    • no signs or symptoms
  38. tertiary stage of HIV/AIDS (overt)
    • CD4 count <200 cells/microL
    • opportunistic infections
    • CNS disorders
    • malignancies
    • wasting/metabolic disorders
  39. ELISA test
    • enzyme linked immunosorbent assay
    • detects HIV antibodies
    • high false positive rates
  40. Western blot assay
    • more specific than ELISA
    • used to confirm diagnosis
  41. AIDS is diagnosed when
    CD4 count is <200 and/or pt developes an AIDS defining illness
  42. Non-pharmacologic treatment of AIDS/HIV
    prevention
  43. NRTI
    Nucleoside/nucleotide reverse transcriptase inhibitors
  44. NNRTI
    non-nucleoside reverse transcriptase inhibitors
  45. PI
    • Protease Inhibitor
    • inhibits cleaving replicated proteins into new viruses
  46. FI
    • Fusion Inhibitor
    • prevents viral fusion with CD4 receptors
  47. INSTI
    • Integrase strand transfer inhibitor
    • blocks integration of DNA into host DNA
  48. Goal of HIV/AIDS therapy
    • reduce amount of virus in the body
    • inhibit or suppress viral replication
  49. HAART
    Highly active antiretroviral therapy
  50. 3 types of regimens for treatment of naive patients
    • NNRTI + 2 NRTI
    • PI + 2 NRTI
    • INSTI + 2 NRT

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