Allergies & Anaphylaxis Flashcards
Clinical criteria of ANAPHYLAXIS include:
Urticaria, gen itching or flushing or edema of lips/ tongue/ uvula/ skin developing over mins-hrs & assoc w at least 1 of the ff:
1_______ OR
2______ OR
3_______
1 Resp distress/ hypoxia
2 Hypotension
3 Assoc sx of organ dysfx (syncope, hypotonia/ incontinence)
Clinical criteria of ANAPHYLAXIS include:
2 or more s/sx that occur after allergen exposure:
1 _____
2_____
3_____
4_____
1 Skin/ mucosal involvement
2 Resp compromise
3 Hypotension or assoc sx
4 Persistent GI cramps/ vomiting
Mediator responsible for vasodilation and inc vascular permeability, HR, cardiac contraction & glandular secretion
Histamine
Mediator causing bronchoconstrictor, pulmo and coronary vasoconstrictor & peripheral vasodilator
Prostaglandin D2
Mediator producig bronchoconstriction, increase in vascular permeability and promote airway remodeling
Leukotrienes
Potent bronchoconstrictor and increases vascular permeability
Platelet activating factor
Serum tryptase is recommended for diagnosing anaphylaxis. TRUE or FALSE?
FALSE. Diagnosis of anaphylaxis is CLINICAL.
1st priority in anaphylaxis
Securing airway
Gastric lavage is NOT recommended for foodborne allergens. TRUE or FALSE?
TRUE
Epinephrine ia a mixed a & b receptor agent. B1 stimulation increses HR. B2 provides bronchodilation. A1 receptor stimulation does what?
Reduces mucosal edema & treats hypotension
If relapse occurs, repeat IM epinpehrine every __ mins.
5-10
Epi IM dose for adults
0.3 -0.5 mg (1:1000 dilution)
Epi IV bolus for adults
100 mcg over 5-10 mins; max: 0.1 mg in 10 mL NS and infuse over 5-10 min
Epi IV infusion for adults
Start 1 mcg/min (mix 1 mg in 500 mLNS and infuse at 0.5 mL/min)
H1 antihistamine
Diphenhydramine 25-50 mg IV SIVP or via IM
H2 antihistamine that should NOT be used for px who are elderly, have multiple comorbidities, haverenal or heaptic impairment
Cimetidine
H2 antihistamine prolonging metabolism of B blocker use (may prolong anaphylactic state)
Cimetidine
For px taking B blockers w hypotension refractory to Epi and fluids, what IV med should be used every 5 mins until hypotension resolves
Glucagon 1 mg IV ff by 5-15 mcg/min infusion (pedia: 50 mcg/kg)
S/E of glucagon use
N/V
Hypokalmeia
Dizziness
Hyperglycemia
IV crystalloid bolus in adults w hypotension
1-2 L PNSS/ PLR
IV crystalloid bolus in pedia w hypotension
10-20 mL/kg
Epi should be diluted and given over __ mins and should be stopped immediately if dysrhythmias or chest pain occurs
5-10 mins
Corticosteroid in adults
Methylprednisolone 80-125 mg IV
Hydrocortisone 250-500 mg IV
Corticosteroid in pedia
Methylprednisolone 2 mg/kg (max: 125 mg)
Hydrocortisone 5-10 mg/kg (max: 500 mg)
LTRA is NOT effective for tx of anaphylaxis. TRUE or FALSE?
TRUE
After initial IV corticosteroid dose, px may continue orally as outpatient for ___ days
3-5 days w/o tapering required
How many puffs of salbutamol MDI should be given if px w bronchospasm?
4-6 puffs repeated q20 mins PRN
2.5-5 mg nebulized
How many puffs of ipratropium Br MDI should be given if px w bronchospasm?
4-6 puffs repeated q20 mins PRN
250-500 mcg nebulized
If bronchospasm is refractory to MDI, what IV med can be given?
MgSO4 2 g over 20 mins
pedia dose: 25-50 mg/kg IV over 20 mins
Healthy px who remain sx-free after an __ hrs can be discharged (<5% of incidence)
1-6 hrs
Rx for MGH px
Diphenhydramine 25-50 mg PO x 3-5 days
Prednisone 40-60 mg PO OD or 20-30 mg PO BID x 3-5 days
Drug that is a common trigger for angioedema
ACE inhibitors
ACE-inhibitor induced angioedema is NOT IgE mediated. TRUE or FALSE?
TRUE
Which among the ff drugs is NOT effective in ACEI-induced angioedema?
A. Icatibant, braydkinin 2 antagonist
B. C1 esterase inhibitor
C. Eccalantide, a kallikrein inhibitor
C. Eccalantide
Px w angioedema should be observed for ___ hrs before discharge
12-24 hrs
Autosomal disorder characterized by C1 esterase inhibitor deficiency
Hereditary angioedema (type I: low lvl; type II: dysfx enzyme)
Autosomal disorder characterized by C1 esterase inhibitor deficiency
Hereditary angioedema (type I: low lvl; type II: dysfx enzyme)
A C4 level
30%
Usual trigger for hereditary angioedema
Minor trauma
Alternative for C1 esterase inhibitor
1-2 u FFP
IgE mediated allergic rxn after consuming red meat containing mammalian oligosaccharide
Mammalian meat allergy/ alpha-gal allergy
Epinehrine, antihistamines and corticosteroids are effective tx in hereditary angioedema. TRUE or FALSE?
FALSE
