What are the types of granulocytes?
Neutrophils, basophils, eosinophils
What canmonocytes differentiate into?
dedritic cells and macrophages
What are the main functions of neutrophils?
first responders; induce inflammation and vasodilation, lysosomal enzymes for degranulation
What are the main functions of basophils?
inflammation and allergies, histamine, leukotrienes, serotonin, heparin, induce inflammation and vasodilation.
What are the main 4 functions of monocyets?
1. repair/remodel2. present antigens3. produce cytokines4. destroy pathogens
What are the main functions of NK cells?
kill infected cell, kill altered self or cancer cell, produce cytokines that influence the adaptive response that follows innate response
What types of cells are part of the adaptive immune response?
B and T lymphocytes
Where are B and T cells located?
lymphoid tissues and blood
B-cells are what time of immunity? What to B-cells evolve into?
Humoralplasma cells-> antibody release into blood and tissue
T-cells are what type of immunity?
cell mediated immunity
What are the major functions of Helper T cells 1?
cell-mediated immunity pathway, secretes TNF and IFN gamma, delwayed hypersensitivity
What are the functions of helper 2 T cells?
2 drive B-cell proliferation, secretes IL 4, 5, 13
What are the functions are Helper 17 T cells?
promote inflammation and secrete IL-17
What are the functions of regulatory T cells?
control specific immune response, prevents autoimmunity
What are the function to cytotoxic T-cell?
destroy target foreign cells by lysis, role in destruction fo cancer cells, complex microbes, virus infected cells and graft rejection
What is the main function fo IgM Ab?
produced by B-cells: primary response, MAC formation, Ab-pathogen complexes that are engulfed
What are the main functions of IgG Ab?
IgG1/3 good at complement fixation, IgG1 goof at ACC by NK cells, Fc receptors enhance phagocytosis by macrophages
Which cells release histamine?
neutrophils, basophils and mast cells
Which cells produce leukotrienes?
Basophils/mast cells
What type of cells could trigger histamine release indirectly?
Eosinophils
What cells are professional phagocytes?
Neutrophils and monocytes
List and describe the steps of phagocytosis.
Chemotaxis, Adherence (opsonization), ingestion (pseudopods extend), digestion (phagolysosome, residual body discharged)
Main functions of C3a
binds to mast cells to release histamine. causes vasodilation, increased permeability, and inflammation
Main functions of C5a
chemotaxis attracts phagocytes, leads to complement fixation
Complement fixation components
C 5-9: cytolysis through MAC
C3b functions
phagocytosis through opsonization.
What are interferons?
antiviral proteins that barely affect the host cell
How are interferons produced?
By fibroblasts in connective tissue, lymphocytes and macrophages.
Explain how alpha and beta INF work.
produced by host cells. INF diffuses into uninfected cells where it binds to uninfected cellular receptors inducing mRNA for antiviral proteins. AVPs destroy virus multiplication and protein synthesis and IFN also induces phagocytosis by activation of NK cells
INF alpha and beta are produced by .....
host cells-infected cells
INF gamma is produced by
T cells
List the types of immune responses in B-cell antibodies and how they work.
1. Virus and toxin neutralization-> prevents pathogen-host binding2. opsonization->phagocytosis3. complement fixation and the formation of the MAC-> phagocytosis or lysis4. ADCC-? NK-induced apoptosis
Are are antigens that are exogenous processed? (toxins, bacteria)
Ag taken up by APC, process, presented with MHC Class II, recognized by CD4+ T-cells
Antigens that are endogenous are synthesized within APC, presented in association with MHC Class 1, and recognized by what type of cells?
cytotoxic cells
What substance/mediator is released by T-cells and induces inflammatory response?
IFN-gamma
What mediator binds to mast cells and induces histamine release?
Complement subunit C3a
What are the 5 signs of acute inflammation and their causes?
rubor- redness caused by increased circulation and vasodilationcalor- heat caused by increased blood flowtumor-swelling caused by fluid escaping into tissuesdolor-pain caused by stimulation of nerve endingsloss of function
List the acute mediators
Histamine, nitric oxide, kinins, prostaglandins, leukotrienes, fibrin, plasmin, cytokines, complement cascade, inflammasome
What is inflammasome?
A complex of proteins that get activated when PAMPS and PRR interact, which causes an inflammatory response that releases interleukin I and creates pored that cause cell death- pyroptosis
List healing/anti-inflammatory mediators
cytokines and interleukines, antioxidant enzymes, phosphatases and kinases, high levels of cAMP, Lipoxins
Describe Type I Hypersensitivity
IgE mediate, systemic anaphylaxis, hay fever, asthma, food allergies, eczema
Type II hypersensitivity
IgG/M mediated, cytotoxicity. blood transfusion reactions, autoimmune hemolytic anemia
Type III hypersensitivity
Immune complex mediated. serum sickness, systemic lupus erythematosus, rheumatoid arthritis
Type IV hypersensitivity
cell mediated. contact dermatitis, tubercular lesions, graft rejection, SJS/TEN
What are the similarities between asthma and COPD?
both are characterized by chronic inflammation, inflammatory mechanism is different
Contrast asthma and COPD
Asthma: airway hyper-responsiness, bronchoconstriction, reversible, IgE Abs, histamine and leukotrienes, T hlper 2 cellsCOPD: emphysema and fibrosis, irreversible and progressive. mediators are neutrophils, macrophages, T helper 1 and cytotoxic cells
What are the mediators involved in smoking?
neutrophils and macrophages
Describe chronic bronchitis
increased mucus, narrowing airways leads to cough, sputum, dyspena, scarring and decreased respiratory function
Describe emphysema
alveoli walls are collapse by the inflammation, decreased airflow and decreased respiratory function
What lab values would be observed on a patient suffering from an acute asthma attack?
eosinophilia and basophilia
Describe prevalence of tobacco use in general.
Males more prevalent than women, about 14% of adults are current smokers
Identify health related consequences of smoking tobacco/
Cancer, pulmonary diseases, cardiovascular disease, reproductive effects, other
List examples of compounds in tobacco that can cause harm
carbon monoxide, hydrogen cyanide, ammonia, benzene, formaldehyde, nicotine, nitrosamine, leaf, cadmium
describe the health risks associated with second-hand smoke in infants.
increased risk for sudden infant death syndrome, acute respiratory infections, ear problems, sever asthma, respiratory symptoms and slowed lung growth
What are the types of responses to acute inflammation?
2 main responses- vascular and cellularVascular: dilation of arterioles, venules and capillaries, increase permeability and edemaCellular: increase blood viscosity, margination of WBC in endothelium wall, diapedesis of WBC into tissue, plasma cells into antibodies, activation of fibroblast leads to fibrin, collagen formation
What are the responders to acute inflammation?
Neutrophils, macrophages, monocytes
What is Pulmonary Ventilation
breathing: moving air to and from the exchange surfaces of the lungs alone the respiratory passageways- includes inspiration and expiration
external respiration
providing an extensive surface area for gas between air and circulating blood
internal respiration
exchanges gases between the bloodstream and tissue
chemical sensation
detecting odors by olfactory receptors in the superior portion of the nasal cavity
phonation
producing sounds for speaking and singing
What does the upper respiratory system consist of?
nose, nasal cavity, paranasal sinuses, pharynx
What does the lower respiratory system consist of?
larynx, trachea, bronchus, bronchioles, and alveoli
Describe in main terms external respiration
exchange of gas between lungs, blood, and environment. includes gas diffusion. Blood arriving in pulmonary capillaries has decreased PO2 and increased CO2. After diffusion between the alveolar mixture and pulmonary capillariers, PO2 increases and CO2 decreased (O2 enters blood and CO2 leaves)- ends up higher O2 in alveolus
explain internal respiration
oxygen transport form lung to tissue. O2 diffuses into interstitial fluid, CO2 diffuses from tissues into blood
Define Ventilation
reduces friction, allows volume of lungs to change with volume of thoracic cavity, from intrapleural fluid
Sympathetic nervous symptoms causes bronchioles to ...
bronchodilation, increase airflow
parasympatetic nervous system causes bronchioles to
contrict, reduces air flow
List the 3 types of alveolar cells and their functions
Pneumocytpes I- gas difusion, most numerous, very thin'pneumocytes type II- surfactant to prevent collapsealveolar macrophages- to phagocyte
describe the physiology of cystic fibrosis
thick mucus cannot be transported-incfections
Forced vital capacity
maximal volume of inspiration as fast as possible
forced expiratory volume in 1 second
maximal amount of air that can forcefully exhale in 1 second
tidal volume
volume of air moved during normal breathing
inspiratory capacity
maximum volume that can be inspired
expiratory reserve volume
maximal amount of air that can be expired from lungs
forced vital capacity
total amount of air exhaled during FEV test
functional residual capacity
volume of air remaining in the lungs after a normal tidal volume expiration
List examples of compounds in tobacco smoke that can cause harm
...
Describe the economic and health benefits of quitting tobacco
circulation improves, walking becomes easier, lung function increases, lung cilia regain normal function, ability to clear mucus is increased, lung cancer decreased
list the 7 forms of tobacco
cigarrettes, smokeless, pipes, cigars, e cigs, clove cigarettes, bidis, hookah
How much nicotine is delivered by a cigarette?
1-2 mg
Describe the potential health risks from electronic cigarettes
propylene glycol may cause respiratory irritation and increase risk for asthma; glycerin may cause lipoid pneumonia on inhalation; carcinogenic substances; impaired cardiovascular function and offspring; emissions
About how much nicotine is delivered by a Juul pod? Puff Bar? Suoirin?
-41 cigs-50 cigs-90 cigs
Decribe the absorption of nicotine
pH dependent. In acidic media, poorly absorbed because ionized. In alkaline media readily absorbed. At physiologic pH 31% is nonionized and absorbed.
Describe the distribution of nicotine.
reached the brain within 10-20 seconds, higher concentration in arterial than venous
Describe the metabolism of nicotine
10-20% excreted unchanged in the urine; 70-80% cotinine is metabolized and excreted in urine and 10% in other metabolites is metabolized and excreted
describe the excretion of nicotine
half life of nicotine is 2 hours, cotinine is 16 hours, excretion through kidneys and breast milk
Describe the pharmacodynamics of nicotine
Nicotine binds to receptors in the brain or other sites throughout the body. In the CNS, creates pleasure, arousal, improved task performance, and anxiety relief. cardiovascular system causes increased heart rate, increased cardiac output, increased BP, coronary vasocontriction and cutaneous vasocontriction
What is the dopamine reward pathway and its role in nicotine addiction?
Nicotine enters the brain, stimulation of nicotine receptors in ventral tegmental area, dopamine released in nucleus accumbens and prefrontal cortex.
What are symptoms of nicotine withdrawal and describe the general timeframe for appearance, peak, and resolution.
1 week: irritability, anger, anxiety, difficulty concentrating, restlessness, depressed, insomnia, impaired task performance6 months: increased appetite, weight gain, cravings
Describe the drug interaction between smoking and caffeine and be able to advise a patient on how to adjust caffein consumption when quitting.
Constituents in tobacco smoke induce CYP1A2 enzymes, which metabolize caffeine. When a patient quits, caffeine levels increased about 56%. Advise patients to decrease nicotine intake by half.
Which patients are most at risk when using combined hormonal contraceptives while smoking?
women who are 35 and older AND smoke at least 15 cigarettes a day are at significantly elevated risk for: serious cardiovascular events like stroke, myocardial infarction, and thromboembolism.
What are some nonpharmacologic methods for quitting tobacco?
cold turkey, unassisted tapering, assisted tapering, formal cessation programs, acupuncture therapy, hypnotherapy and massage therapy.
Explain the different components of the central nervous system and peripheral nervous system
Central- brain and spinal cordPeripheral: sensory (afferent) neurons; motor (efferent) neurons, ANS
What are the components of the ANS and its functions?
sympathetic and parasympatheticfunctions: involuntary and inconscious, referred to as vegetative or visceral functions like heart pupillary dilation and contraction, secretions, smooth muscles or airways and blood vessels
Describe the sympathetic nervous system
Sweat glands, cardiac and smooth muscle glands, renal vascular smooth muscle, fight or flight
parasympathomimetic
cholinergicANS- mimic Acetycholine effects of parasympathetic NS. (contriction of pupil, decreased HR and blood pressure, increased urine production). These drugs can be used for underactive bladder
parasympatholytic
anticholinergic, reduced activity of the parasympathetic NS. used for drying of secretions, anti-diarrhea, prevention of bed wetting
sympathomimetic
adrenergic.increases effects of sympathetic activity by mimicking endogenous compound. (dilation of pupil, increased secretions, vasocontriction and vasodilation of blood vessels in heart, secretion of E and NO, increased airway diameter, increase respiratory rate, decrease urine production)
sympatholytic
decreases effects of sympathetic NS, anti-adrenergic (heart rate decrease with less force)
Cholinergic
causes lacrimation, salvation, urination and defecation. Mimic acetycholine effects on parasympathetic system (decreased HR, contraction of smooth muscles, increase secretions)
Muscarinic
type of cholinergic receptor found in smooth muscle, cardiac muscle, and glands
nicotine
type of cholinergic receptor found in neuromuscular end plate, skeletal muscle, and Autonomic ganglion cells