chapter 9+11


Tamoxifen

  • Hormone modulator

  • For breast cancer

  • Slows down hormonal process to slow cancer

  • Gi tract liver urine

  • Adverse effects: MENOPAUSE, HOTFLASHES


Hydroxurea

  • Antimetabolite

  • Treats leurkemia and some others

  • Inhibits dna synthesis 



What is inflamation

  • Wall off injured area

  • Prevent spread of injury

  • Bring body’s defenses to needed area

  • Like a mosquito bite

  • Can be local or systemitcic

  • Acute or chronic

    • Acute: rapid, 

    • Chronic: 


Itis

  • meaning inflmation



Acute inflammation

  • Rapid onset, terminates quickly

  • Phases

    • Increased vascular permeability

    • Cellular chemotaxis

    • Systemic response



5 signs of inflammation

  • Rubor (redness)

  • Tumor (swelling)

  • Calor (heat)

  • Dolor (pain)

  • Loss of function (function laesa)



Vascular permeability

  • Yes



Exudates- fluid 

  • Serous/transudate

    • Clear

  • Serosanous

    • Bit of blood and cell debrive

  • Fibrinous

    • Sticky post surgery 

  • Catarhhal

    • Runny nose cloudy and mucus

  • Purulent

    • Green yellow gross

    • Big infection 

    • Pus


Abcesses

  • Localized walled off collection of purulent exudate


Effusions

  • Ueaj



Cellular chemotaxis

  • Chemical agents from wbcs 

  • Attratch wbcs and platelets

  • Margination

    • WBC block off area

    • Release inflammatory mediators




Inflamtory mediators

  • Promote or inhibit inflammation

  • Cytokines

    • Gewe

  • Chemokines

    • Proteins that attract leukocytes


Acute phase proteins

  • Liver rpduces in response to cytokines

  • C reactive protein

    • CRP

    • Marks foreign material for phagoctyosis

    • Activates complement system

    • Stimulates other inflammatory cytokines

    • elevations= active inflammation

  • High sensitive CRP

    • Increased risk for myocardial infarction (MI)

  • Fibrinogen

    • Binds to red blood cells

    • Enthrocyte sedimentation rate (ESR)

      • Measures active inflmation

      • Inflammation 

        • Blood cells will stick togteher= sink together 



Systemic responses in acute inflammation

  • Fever

  • Lymphadenopathy/swollen lymph nodes

  • Anorezia

  • Sleepy

  • Lethargy

  • Anemia

  • Weight loss

    • Most signs due to chemical mediators

      • Pyrogens tnf alpha 

      • Drugs to reduce inflammation target these signals


Fever

  • Pyogens cause fever

    • Wbcs and microgranism releases signals causing prostaglandins to reset temp

    • High temps = wbc efficiency

    • Reye’s syndrome

      • No aspirin for teens and kids

  • Shivering to increase temp

  • Sweating to reduce temps during breaks



Histamine

  • Basophils platelets and mast cells

  • Systemic effects

    • Arteriolar vasodilantion

    • Large artery vasocondstirction

    • Increased permeability of venules

  • Etc: sneezing runy noses pharngeal irritations in upper respiratory tract



ANY ANTIBIOTIC THAT U GIVE THAT GIVES REACTION ON SKIN = VERY BAD ALWAYS STOP AND TELL PROVIDER 



Outcomes of acute inflammation

  • Complete resolution

  • Healing of connective tissues

    • Cell regen

  • Chronic persistent inflammation

    • Resolution does not occur

    • Extensive tissues damage occurs


CHronic inflammation

  • Persistent infection like virus, TB, syllisis

  • Hypersensivtes like lupus and RA

  • Toxic agents like black lung

  • Atheroscleriousis

    • Chronic inflam disease



DIfferences

  • Chronic has more monocytes, lymptoctes and macrophages

  • Constant cytokine realse damages tissues

  • Granuloma formation

  • T and b cells amplify and perpetuate

  • Can autoimmune



Wound healing 

  • Four stages

    • Hemostasis

      • Exposed collagen attacts platetes

      • Secrete inflam mediators

      • Vasoactive amines cause vasocstriction

    • Inflamtion

    • Proliferation, granulation tissue formation angioegesis apittheization

      • Start remodaling

    • Wound contraction and remodeling



Types of intentions

  • Primary intention

    •  clear wound edges

    • No missing tissues

    • No gap

  • Secondary intention

    • Extensive tissue loss

    • Granulation adn fibrotic tissue formation

    • Long healing time with wound contraction

    • Scarring

    • Big gash 

  • Tertiary intention

    • Missing large amount of deep tissues

    • Cleaned, left open

    • Temp packing with gauze

    • Lots of scarring, skin graft

    • Pressure ulcers and severe burns


eschar 

  • Dead tissue that sheds or falls off

  • Crusty


Debriefing

  • Removing necrotic tissues

  • Promotes reepithelialization



Factors that effect wound healing

  • Need good nutrient

    • Positive nitrogen balances

  • Blood flow and oxygen deliver

    • Hyperbaric chamber

  • Immune strength

  • Infection

    • BIGGEST DELAY

  • Foreign bodies

  • Mechanical factors



Dysfunctional wound healing

  • Wound rupture

    • High tension

    • Ab wall and coughing

  • Wound dihescene

    • Closed wound edges open and rupture

    • Pysch woman opening her hytroextromy

  • Wound evisecerion

    • Internal tissues and organs protruding from open wound

  • Needs protection with sterile saline moistened dressing


Keloid formation

  • Hyperplastic eptiyhteiation leading to big scar

Contracture 

  • Shrinking wound

  • Limits mobility


Stricture

  • Narrowing of open area

  • Like esophagus 


FIstula

  • Abnormal connection between two sections

  • Trachesogeal fistula


Adhesion

  • Weird bands of internal scar tissue that limit mobilbity




Disorders of the immune system

  • Antigens

  • Immunodeficiency

  • Hypersensitivity disorders

  • Innate immunity

  • Adaptive immunity


ACTIVE VS PASSIVE IMMUNITY U MUST KNOW



Types of hypersensitivity

  • 1 allergic reaction after introduction

    • IGs mast cells give rise to histamine

    • Allergy results

    • Allergic rhinitis

      • Runny noses

      •  watery eyes

      • Post nasal drip cough

  • 2cytotoxic

    • Antibodies target cells

  • 3 immune complex disorders

    • Complex disorders with ig

    • Organ 

  • 4 delayed

    • Posion ivy


Autoimmune

  • Can’t distinguish between the surface markers on self and foreign cells

  • Body develops autoantibodies

  • Autoantibodies attack body’s own tissues, causing organ dysfunction



Lupus (SLE)

  • Chronic inflamoatory disease

  • Causes are a lot

  • Pathophis- autoantibodies all over very despoities in tissues and organs

  • Great eliminator

  • Symptoms

    • Butterfly rash

    • Joint inflam

    • musculoskeletal system

    • Acute skin lesions

    • Renal involvement

      • Creatinine levels

    • Pulmonary involvement

    • Cardiovascular disease

    • Central and peripheral nervous system

  • Excerbations and remissions



Rheumatoid arthritis

  • Chronic autoimmune disease

  • Cause can be genetic age or female

  • Pathophysiology

    • Immune system attacks synovial tissues

    • Inflammation leads to the destruction of joint structure

    • Hypertrophy in joints

  • High levels of Rheumatoid factor (RF) an antibody

  • Always eepy


HIV treatments include….



DMARDS- disease-modifying antirheumatic drugs

  • Given early in disease

  • Adverse effects can be fatal

  • Contraindicated in acute infections and cancer

  • Tumor necrosis factor (TNF) blockers

    • TNF ^^^ = time to block

    • Decrease local effects of tnf

  • Black box warnings

  • Risk for serious infections demylinating disorders,, MI heart failure

  • Other DMARDs used when patients do not respond to conventional therapy or sued to directly disease pain in joints r/t arthritis

  • No vaccines for them



Etanercept

  • Must teach them to give themself sub cutetanous 

  • Are for rheumatoid arthritis