Anaphylaxis Flashcards by Sam Myers

Briefly describe Anaphylaxis

systemic hypersensitivity rxn
serious allergic rxn
rapid in onset
could cause death

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What % of anaphylaxis presents skin irritation?

80-90 %

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Urticaria

Hives

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Describe the pathophysiology of an immunologic anaphylaxis rxn

during initial exposure an individual will transform IgE antibodies to an antigen
when individual is exposed to antigen, it binds to IgE antibodies
this triggers release of vasoactive and inflammatory mediators from mast cells and basophils
ALSO RELEASES HISTAMINE
leads to potential development of urticaria, angioedema, bronchospasm, hypotension, GI symptoms

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When do symptoms usually occur after exposure?

30 mins (but could happen hours after)

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angioedema

swelling

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bronchospasm

difficulty breathing

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hypotension

drop in BP

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3 categories of human anaphylaxis

immunologic (IgE mediated rxns)
non immunologic (identical rxns that are not immunologically mediated)
idiopathic (unknown cause)

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understand clinical criteria

ok man

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What are the 3 types of potential patterns of anaphylactic rxns?

uniphasic (1 phase)
biphasic (2 phases - symptoms reappear)
protracted (severe rxn that lasts for more than 24 hrs)

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What is recommended for Pt’s after they use an epipen?

seek medical attention

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Describe examples of a cutaneous rxn to anaphylaxis

hives/welts
itching
flushed/redness of the skin
swelling

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Describe examples of a respiratory rxn to anaphylaxis

throat or chest tightness
difficulty breathing
wheeze
cough
swelling of tongue, lips, uvula, palate
itching of throat
itchy nose, congestion, runny/sneezing nose

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Describe examples of GI rxn to anaphylaxis

difficulty/pain swallowing
nausea/vomitting
abdominal cramping
diarrhea

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Describe examples of cardiovascular rxn to anaphylaxis

hypotension (drop in BP)
chest pain
dysrhythmias (abnormal rhythm of the heart)

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List a few other common rxns to anaphylaxis

*See pg 2/7 in notes

lightheadedness
dizziness
sweating
feeling of doom lol
uneasiness
headache

etc
etc

**children may display sudden behavioural changes

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Give examples of common triggers of anaphylaxis

foods
drugs
insect stings
latex

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List the 3 key parts of treatments for anaphylaxis in the community setting

CPR (if breathing is affected)
epinephrine (inj immediately and repeat in 10 mins if required)
seek medical attention

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What schedule are epinephrine auto injectors?

schedule 2 (don’t need an Rx, but held behind counter and require pharmacist consultation)

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Describe the MOA (mechanism of action) of epinephrine auto injectors

acts on alpha and beta-adrenergic receptors
leads to restoration of respiratory and cardiovascular function by:

-relaxing bronchial smooth muscle (helps open airways)

-vasoconstriction to stop the vasodilation causing hypotension in anaphylaxis
(increase BP back to normal)

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Where is the recommended administration of an epipen?

intramuscularly in the mid to outer part of thigh

Describe the action and duration of epipens?

rapid onset

short duration

When should pt’s feel improvement after injection of epinephrine?

5-10 mins

Why do we inject into the thigh?

-great blood supply

What is the dose for the adult epipen?

0.3mg/dose

What is the dose for the epipen jr?

0.15mg/dose

Are there any contraindications of epinephrine?

no absolute contraindications

What are a few common adverse effects of epinephrine?

- anxiety - tremors - pallor - tachycardia (increase HR)

What is the acronym for what to watch for when expecting an allergic rxn?

FAST Face - hives, itching, redness, swelling of face, lips, or tongue Airway - restricted speaking, swallowing, or breathing Stomach - stomach pain, vomiting, diarrhea Total body - hives, itching, swelling, weakness

____ hives are present for less than 6 wks

acute

____ hives are recurrent with signs and symptoms recurring most days of the week, for six weeks or longer

chronic

Describe the appearance of hives

- smooth - can be elevated - discolored itchy!

What can cause hives?

- allergic rxns - infections - illnesses - exposure to sun, heat, cold, or water - exercise - stress - contact w chemicals - scratching the skin

Recommended treatment for acute urticaria?

oral anti-histamines

Describe general treatment of insect bites and stings (5)

- remove insect/stinger - ice to reduce swelling - clean area well - non-Rx oral anti-histamines - non-Rx topical steroid to relieve inflammation and itching

Describe the 6 OTC treatment options for insect bites and stings

- topical corticosteroids - oral antihistamines - skin protectants - topical anesthetics - topical antihistamines - topical counterirritants

What is the difference between an anesthetic and an analgesic?

Anesthetic: induces insensitivity to pain Analgesic: relieves pain

What do counterirritants do?

-depress cutaneous receptors resulting in relief of itching and irritation due to anesthetic

Do topical anesthetics have a short or long duration?

short (between 15 and 45 mins)

List some examples of topical anesthetics

benzocaine lidocaine pramoxine

What risk do topical anesthetics pose?

hypersensitivity rxn and systemic absorption/toxicity

T or F: drugs ending in "caine" are less common to pose a hypersensitivity risk than drugs with a different ending

false | -more common

How do topical antihistamines work?

They cause an anesthetic effect by DEPRESSING CUTANEOUS RECEPTORS to relieve pain and itching

What is more effective usually: oral or topical anesthetics

oral

Give an example of a topical antihistamine

topical diphenhydramine (benadryl)

What do skin protectants do?

reduce inflammation and irritation

Give 2 examples of skin protectants

zinc oxide | calamine

What are the 2 oral treatments for insect bites and stings

- analgesics (pain relief) | - oral antihistamines (relief of itching, inflammation and pain)

Give examples of oral analgesics (4)

- acetaminophen - ASA - naproxen - ibuprofen

Antipruritic

anti-itch

explain how topical corticosteroids works

Produce antipruritic and anti-inflammatory actions that can prevent or suppress development of edema, capillary dilation, swelling and tenderness

Edema

fluid collection

Discuss the 5 monitoring parameters

- pain/fever - itching - swelling/redness - signs of infection - anaphylactic rxn