Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

16 Immuno > Adverse Reaction to Drugs > Flashcards

Adverse Reaction to Drugs Flashcards

1
Q

most common type of adr

A

type a: predictable

  • reaction ocurring in most normal patients given sufficient dose and duration of therapy
  • related to pharmacologic action of the drug
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

examples of type a adrs

A
  • overdose
  • toxicity (renal failure from aminoglycosides)
  • side effect: sedation from antihistamines
  • secondary/indirect effect: diarrhea from antibiotics
  • drug interaction: theophylline toxicity from erythromycin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

t/f type b adrs are dose dependent

A

false, not dose dependent and pts may react to very small amounts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

t/f type b adrs are unrelated to pharmacologic action of the drug

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

examples of type b adrs

A

intolerance, idiosyncratic reaction, drug allergy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is intolerance

A
  • undersirable pharmacologic effect at low and sub-therapeutic doses of the drug
  • no underlying abnormalities of metabolism, excretion, or bioavailability
  • ex. tinnitus with aspirin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is an idiosyncratic reaction

A
  • abnormal and unexpected effect
  • underlying abnormalities of metabolism, excretion, or bioavailability
  • ex. hemolysis with dapsone in g6pd deficiency
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is drug allergy

A
  • ige mediated drug allergy and pseudoallergic reactions

- anaphylactoid reaction (contrast)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

common manifestations of drug allergies

A
  • cutaneous rxns!!
  • maculopapular eruptions and urticaria
  • systemic reaction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

reactant, antigen, effector cells, and examples of type 1 ige mediated rxn

A

reactant: ige
antigen: soluble antigen
effector cells: mast cell activation
ex: allergic rhinitis, asthma, systemic anaphylaxis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

mechanism of type 1 rxn

A

production of ige from mast cells + recruitment of inflammatory cells
- repeated exposure: cross linking of ige molecules -> mast cell degranulation releasing histamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

reactant, antigen, effector cells, and examples of type 2 ige mediated rxn

A

reactant: igg
antigen: cell-associated antigen or matrix associated antigen
effector cells: fcr+ cells
ex: hemolytic anemia, thrombocytopenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

mechanism of type 2 rxns

A

antigens trigger the formation of antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

reactant, antigen, effector cells, and examples of type 3 ige mediated rxn

A

reactant: igg
antigen: soluble antigen
effector cells fcr+ cells
ex: serum sickness, arthus rxn, drug fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

mechanism of type 3 rxn

A

deposition of antigen-antibody complexes, complement activation, recruitment of leukocytes by complement products, release of enzymes and other toxic molecules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

immune reactant and effector cells of type iva

A

reactant: ifny, tnfa, th1
effector: macrophage activation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

immune reactant and effector cells of type ivb

A

4 fiBe 2 = b

reactant: il-5, il-4, il-13 (th2)
effector: eosinophils

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

immune reactant and effector cells of type ivc

A

reactant: perforin/granzyme b (ctl)
effector: t cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

immune reactant and effector cells of type ivd

A

reactant: cxcl-8, gm-csf (t cells)
effector: neutrophils

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

t/f the current paradigm is that antigens must be in multivalent form to elicit a specific immune response to activate immunopathologic mechanisms

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is the hapten hypothesis

A
  • haptens = chemically reactive small molecules
  • these undergo stable covalent binding to larger protein or peptides (hapten-carrier complexes)
  • the complexes can cause drug specific immune response

ez. penicillin

22
Q

what is the pro-hapten hypothesis

A
  • drug that is not chemically active becomes reactive after metabolism
  • reactive drugs bind to proteins/peptides to become immunogenic

ex. sulfa drugs

23
Q

what is the p-i concept

A
  • pharmacologic interaction with immune receptors

- drug binds directly to t cell receptor -> interacts with mhc receptor -> immune response

24
Q

when to suspect drug allergy

A
  • symptoms of PE compatible with immune drug reaction
  • definite temporal relationship
  • drug is associated with immune reaction
  • patient had previously received drug
  • no other clear cause for presenting manifestations
  • skin tests and/or lab findings are compatible with drug hypersensitivity
25
Q

drug related risk factors

A
  • nature of the drug (hapten concept, pro-hapten concept, danger concept, pharma interaction concept)
  • degree of exposure (dose, duration, frequency)
  • route of administration
  • cross sensitization
26
Q

host related risk factors

A
  • age, gender
  • genetic factors
  • atopy (for latex and radiocontrast)
  • hla-b 1502: carbamazepine
  • hla-b 5801: allopurinol
  • hla-b 5701: abacavir
  • concurrent medical illness
  • previous drug reaction
  • multiple allergy syndrome
27
Q

immediate type of symptoms

A

onset: 1-2 hrs
type: ige mediated (silent sensitization)
sx: urticaria, angioedema, bronchospasm, anaphylaxis

28
Q

delayed type of symptoms

A

onset: >6 hours to weeks
type: t cell or igg mediated
sx: exanthems (bullous, maculopapular, acute generalize exenthematous pustulosis)

29
Q

danger s/sx in delayed type reaction

A
  • extensive, confluent infiltrated exanthema
  • bullae, pustules
  • (+) nikolsky’s sign: the very thin top layer of skin will shear off, leaving skin pink and moist, and usually very tender
  • erythroderma
  • painful skin
  • mucosal affection
  • facial edema
  • lymphadenopathy
  • constitutional symptoms

read figure 10

30
Q

immediate rxn laboratory tests

A
  • serum tryptase (6 hours)
  • serum histamine (elevated, 1 hour)
  • skin prick and intradermal tests (ige rxns)
31
Q

delayed rxn laboratory tests

A
  • cbc
  • liver function tests
  • serum creatinine
  • urine microscopy and dipstick
  • crp
32
Q

more common epilepsy drug that causes hypersensitivity rxn

A

phenytoin

  • anticonvulsant hypersensitivity syndrome
  • drug reaction with eosinophilia and systemic symptoms
33
Q

antibiotic agents that cause hypersensitivity

A
  • beta lactams
  • haptens
  • cross reaction with penicillins and cephalosporins
  • cause maculopapular exanthema > urticaria > anaphylaxis > sjs
34
Q

mechanisms of radiocontrast media hypersensitivtiy

A

anaphylactoid: direct mast cell activation, complement activation, not ige-mediated

delayed type IV reactions

35
Q

risk factors for rcm hypersensitivity

A
  • female
  • asthma
  • cvd
  • prior rxn to rcm
36
Q

t/f neuromuscular blocking agents can cause hypersensitivity reactions

A

true

37
Q

what is widal or samter’s triad

A

underlying asthma, sinusitis, or nasal polyposis

read other nsaid phenotypes!

38
Q

diagnosis for nsaid hypersensitivity reactions

A
  • inhalational lysine aspirin challenge
  • oral aspirin drug provocation test
  • search for alternative by dpt
39
Q

miscellaneous syndromes for hypersensitivity

A

read

40
Q

manifestation of erythema multiforme

A

target lesions:

  • erythematous central papule that may blister
  • edematous middle ring
  • erythematous outer ring

early treatment can prevent progression to sjs

41
Q

manifestation of sjs and ten

A
  • blisters and mucosal or epidermal detachment resulting from full thickness epidermal necrosis
42
Q

spectrum of nikolsky’s sign or epidermal detachment

A
  • <10% total body = sjs
  • 10-30% = sjs-ten
  • > 30% = ten
43
Q

treatment for sjs and ten

A

sjs: steroids
ten: fluid and electrolyte management, nutritional support, infection control, pain management, ivig

44
Q

what is drug fever

A
  • caused by release of pyrogens from phagocytes following engulfment of igg complexes and stimulation of t cells
  • 7-10 days after therapy
  • variable fever pattern
  • no more fever after 48 hrs of stopping drug
45
Q

what is dress

A
  • maculopapular eruption mimicking exanthematous drug rash, but may progress to exfoliative erythroderma
    • multiorgan failure
  • mortality rate of 10%
46
Q

what is red man syndrome

A
  • infusion related reaction to vancomycin
47
Q

treatment for adrs

A
  • identify and stop suspected drugs
  • antihistamines, im epinephrine, systemic corticosteroids, high dose ivig
  • emollients and skin care, hydration and prevention of superinfection
48
Q

indications for inpatient care

A
  • angioedema, anaphylaxis
  • severe skin reactions (bullous drug eruption, em/sjs/ten)
  • systemic symptoms
  • possibly >1 drug
49
Q

indications for outpatient care

A
  • urticaria/maculopapular rash
  • fixed drug eruption
  • drug allergy without systemic symptoms
50
Q

when to refer to allergist

A
  • uncertain whether reaction was drug allergy
  • uncertain which drug (reevaluation and testing)
  • desensitization, hepatitis

16 Immuno (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions