What is leukocytosis?
an increase in the number of white cells in the blood, especially during an infection.
What is neutrophilic leukocytosis?
is an abnormally high number of neutrophils (a type of white blood cell) in the blood. Neutrophils help the body fight infections and heal injuries. Neutrophils may increase in response to a number of conditions or disorders.
What is the specific cellular MOA for prednisone?
-Glucocorticoids diffuse across the membrane of the cell, bind with a specific receptor and then enter the nucleus and interact specifically with DNA
What is the MOA of prednisone in the body?
-Anti-inflammatory effects: inhibits production of almost ALL cytokines and pro inflammatory mediators --Inhibit innate immunity--suppresses phagocytic function of neutrophils and macrophages, causes neutrophilic leukocytosis --Decrease the number of circulating T cells -with chronic administration, decrease in IgG and IgA
What is the MOA of prednisone?
-anti-inflammatory --inhibit phagocytosis (neutrophils and macrophages) --cause neutrophilic leukocytosis --decrease # circulating T cells --with chronic admin, decrease IgA and IgG
Why would you use prednisolone ?
--used alone or in combo with other agents for a wide variety of medical conditions involving an undesirable immunologic response
What undesirable immunologic responses do you use prednisolone for?
-prophylaxis for prevention of rejection of transplanted organ -autoimmune disease -inflammatory disorders -allergic conditions -malignancies
What is the cushingoid appearance?
round moon face, buffalo hump, big belly also giving them cortisol so patient tends to gain weight
What is atherosclerosis?
is a disease in which plaque (plak) builds up inside your arteries.
What are the prednisolone adverse effects? (11 things)
1. skin thinning and purport 2. cushingoid appearance 3. weight gain 4. HTN 5. HDL --> may lead to atherosclerosis 6. GI= gastritis, ulcers, may initially increase appetite (then later on will decrease b/c of gastritis) 7. osteoporosis 8. neuropsychiatric (initially euphoria/insomnia, can lead to depression, mania or psychosis) 9. Hyperglycemia --> leading to DM 10. Hypothalamic-pituitary-adrenal-insufficiency 11. Heightened risk of typical and opportunistic infections
What do you need to monitor with these patients? 3 all time, 2 long term
1. Blood pressure 2. Lipids (b/c of HDL) 3. CMP (BG b/c of DM) Long term: 1. DEXA scan (bone density) 2. Ophthalmic exam (glaucoma, cataracts)
What are the specific questions you will need to address in the patient instructions? 4 questions
How to take it When to take it What to watch for When to go to the ED
When should patient take prednisone?
Take with food because of GI upset, take in morning and noon because of insomnia
What should the patient watch for when taking predisone short term?
HTN-- monitor BP BG--if diabetic watch BG Psychosis --strange behavior or voices-->immediate help Follow up closely
What should you tell the patient to watch for if on long term prednisone?
HTN, BG, Psychosis, close follow up and: Osteoporosis Check lipids because of HDL Hypothalamic pitiitary renal insufficiency glaucoma and cataracts
When should the patient go to the ED?
Chest pain, SOB, HTN, pounding headache, psychosis
What is the concern with hypothalamic-pituitary-adrenal-insufficiency?
Giving puts corticosteroids surpasses the bodies action to make them. If pt gets sick, trauma, their adrenal glands will not produce cortisone or mount a response so you have to give them some or they will die
What is Cyclosporine?
What is tacrolimus?
What is sirolimus?
What is azathioprine (Imuran)?
What is cyclophosphamide(cyc)?
What is pneumocysistis? And pneumocystis jirovecii?
Pneumocysistis is a parasitic protozoan that can cause fatal pneumonia n peple affected with immunodeficiency diseases.
Pneumocystic jerovecii is a FUNGAL infection of the lungs
When are combined immunodeficiences termed "severe"?
When they lead to early death from overwhelming infection, typically within the first year of life
What is lymphadenopathy?
a palpable enlargement of the lymph node
What is lymphocytosis?
Lymphocytosis is an increase in the number or proportion of lymphocytes in the blood
What is thrombocytopenia?
deficiency of platelets in the blood. This causes bleeding into the tissues, bruising, and slow blood clotting after injury
Hypogammaglobulinemia, XLA, Burtons
When is it diagnose, what gender is it found it, and what is the pathophysiology?
(x or y linked, does it affect B and or T cells?)
Diagnosed in infants
Mostly in males unless dad is affected and mom is a carrier and/or affected
mutant tyrosine kinase
virtual absence of B cells
ALL immunoglobulins are decreased
T-cell is still fine
What is the clinical presentation of XLA, Burtons, hypogammaglobulinemia?
--reccurant, PYROGENIC, bacterial infections such as otitis media, sinusitis, and pneumonia from: Streptococcus pneumoniae, Haemophilus influenzae
--may have absence of tonsils and lymph nodes
--may have failure to thrive
--serious skin infections, abcesses, pneumonia
What is the treatment for XLA, burtons, hypogammaglobulinemia? What does this treatment help with? What should you check with these patients during treatment and how should you counsil?
--replacement of immunoglobulin by:
IVIG (IV IgG) or Sub Q IgG (SCIG, IGSC)
Treatment helps with decreasing the number and intensity of infections
Check levels of IgG to see how treatment is going
Council on blood transfusions