NSG 325 Module 6aReview of immune systemHumoral immunity (antibody)AntibodiesAntigenRememberNCLEX questionNCLEX questionSuppression of immune systemAction of immuno-suppression drugsCyclosporinePrednisoneHistaminesAnti-histaminesAllergic responseAntihistiminesDiphenhydramine (Bendadryl)PromethazineIV phenerganComparison Benadryl & PromethazineOther antihistaminesNCLEX QuestionNCLEX QuestionAnti-inflammatory MedicationsEffects of COX 1 and COX 2Anti-inflammatory medicationsFirst generation NSAIDsIndicationsAdverse effectsKetorolacCelecoxib (Celebrex)Acetaminophen (Tylenol)Comparison of NSAIDsAHA statement on COX inhibitorsGlucocorticoidsGlucocorticoids AKA CorticosteroidsPharm effectIndicationsAdverse effectsIV formsSpecial considerationsRheumatoid arthritisMedicationsMethotrexateSulfasalazine (Azulfidine)Etanercept (Enbrel)NSG 325Module 6aHappy Columbus Day!ImmunityAnti-inflammatory drugs10/14/2013Review of immune system•Cell mediated immunity- activation of phagocytes, antigen-specific cytotoxic T-lymphocytes and release of cytokines (not antibody)•Humoral immunity or antibody mediated immunity-antibodies in body fluids or humorsHumoral immunity (antibody)Antibodies•Produced by B lymphocytes•Immunoglobins •IgA-GI tract, lungs secretions•IgD-surface of B cells•IgE-Mast cells (release of histamine)•IgG-major antibody in blood•IgM-first responder (Spleen)Antigen•Cause an immune response•Self antigen•Should not make you sick•Foreign antigen•Cause for attack!!!Remember•Immune system protects us from invaders•Virus•Bacteria•Fungi•Parasites•Cancer cells•Sometimes the immune system runs amok and attacks itself (autoimmune diseases)NCLEX questionA client develops an anaphylactic reaction after receiving morphine sulfate. The nurse should plan to institute what actions? Select all that apply. 1. Administer oxygen2. Quickly assess the client’s respiratory status. 3. Document the event, interventions, and client’s response. 4. Leave the client briefly to contact a health care provider. 5. Keep the client supine regardless of blood pressure readings6. Start an intravenous infusion of D5W and administer a 500 mL bolusNCLEX questionA client develops an anaphylactic reaction after receiving morphine sulfate. The nurse should plan to institute what actions? Select all that apply. 1. Administer oxygen2. Quickly assess the client’s respiratory status. 3. Document the event, interventions, and client’s response. 4. Leave the client briefly to contact a health care provider. 5. Keep the client supine regardless of blood pressure readings6. Start an intravenous infusion of D5W and administer a 500 mL bolusSuppression of immune system•Necessary for organ transplants•Prevent rejection•Used to treat autoimmune diseasesAE:Increased risk for infectionIncreased risk of cancerAction of immuno-suppression drugs Most common drugs are SteroidsCyclosporinTacrolimus Cellcept (Mycophenolate)Note: RAMethotrexateAzathioprine (immuran)Cyclophosphamide(Cytoxan)Cyclosporine•Common immunosuppressant•Kidney•Liver•Heart•Can be given PO or IV•Drug level is monitored for effectiveness•Nephrotoxic- up to 75% of patients (monitor BUN and creatinine)•Increased risk of infection-74% of patients on medication get infection•Many drug-drug interactionsPrednisone•High dose decrease immune response•IV, PO•Used to treat:• allograft rejection•Asthma•RA (Rheumatoid arthritis)•SLE (systemic lupus erythematous)•MS (Multiple Sclerosis)HistaminesAnti-histamines•Histamine- two types we will concentrate on•H1 found in smooth muscles and endothelium and CNS tissue:•Causes vasodilatation, increased capillary permeability, broncho-constriction, itching, pain, secretion of mucus, sleep and appetite suppression•H2 located in parietal cells and vascular smooth muscle cells •Causes vasodilatation and stimulates gastric secretionAllergic response•Mediated by histamine (H1)•Mild allergic response (i.e. seasonal allergies)•Rhinitis•Itching•Localized edema•Severe allergic response (Anaphylaxis)Antihistimines•Blocks H1 receptors (not release of histamine)•Inhibits dilatation of arterioles and venules•Prevents flushing•Inhibits capillary bed permeability•Decreases edema•Blocks H1 receptors in sensory nerves•Decreases itching and pain•Blocks H1 receptors in mucous membranes•Decreases mucous productionDiphenhydramine (Bendadryl)•PO, IV•Indication: allergic symptoms caused by histamine response, anaphylaxis, insomnia, motion sickness, cold•AE: drowsiness/sedation (can develop tolerance), dry mouth.•Interaction: with CNS depressants. •Caution use in elderly and those with liver impairmentPromethazine•Antihistamine, anti-emetic, sedative/hypnotic•Blocks histamine, inhibitory effect of the chemoreceptor trigger zone in the medulla, effects dopamine in CNS. Anticholinergic effects. CNS depression•PO, PR, IV•IV can cause SEVERE tissue damage!!AE: Respiratory depression, confusion, depression, neuroleptic malignant syndrome, sedationCaution use in elderlyIV phenerganComparison Benadryl & PromethazineDrug Route Onset Peak DurationBenadryl PO 15-60 minutes 2-4 hours4-8 hoursBenadryl IV Rapid Unknown4-8 hoursPromethazine PO 20 minutes Unknown4-12 hoursPromethazine PR 20 minutes Unknown4-12 hoursPromethazine IV 3-5 minutes Unknown 4-12 hoursOther antihistamines•New meds (second generation) are less sedating, but not available IV•Examples: Allegra, Zyrtec, Claritin, ClarinexNCLEX QuestionA client calls the nurse in the emergency department and states that he was just stung by a bumble bee while gardening. The client is afraid of a severe reaction because the client’s neighbor experienced such a reaction 1 week ago. Which nursing actions should the nurse take?1. Advise the clients to soak the site in hydrogen peroxide. 2. Ask the client if he ever sustained a bee sting in the past.3. Tell the client to call an ambulance for transport to the emergency department. 4. Tell the client not to worry about the sting unless difficulty with breathing occurs.NCLEX QuestionA client calls the nurse in the emergency department and states that he was just stung by a bumble bee while gardening. The client is afraid of a severe reaction because the client’s neighbor experienced such a reaction 1 week ago. Which nursing actions should the nurse take?1. Advise the clients to soak the site in hydrogen peroxide. 2. Ask the