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NAPLEX 2023 > Chapter 77: Drug Allergies & Adverse Drug Reactions > Flashcards

Chapter 77: Drug Allergies & Adverse Drug Reactions Flashcards

1
Q

What is an ADR

A

unintended pharmacologic effect

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2
Q

ADRs are categorized into which two types

A

Type A: predictable (most ADRs)
Type B: unpredictable

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3
Q

ADRs are different from medication erros because…

A

the drug is being administered correctly (dose, indication, etc) and someone then has an ADR

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4
Q

Type A reactions are dependent on

A

dose
account for 80% of ADRs

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5
Q

Type B reactions depend on ____ and include

A

patient specific factors (unrelated to pharmacologic mechanism)
- idiosyncratic reactions (e.g., SJS)
- pseudoallergic reactions (e.g., redman syndrome with rapid vanco infusion, itching after opioid administration)
- Drug intolerances (e.g., nausea with codeine)
- Drug allergies (immune mediated responses)

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6
Q

Type I allergic reactions occur how long after drug exposure

A

within 60 min

Ex) urticaria, bronchospasm, angioedema, anaphylaxis

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7
Q

Type II allergic reactions occur how long after drug exposure

A

Several days (5-8 days)

Ex) hemolytic anemia and thrombocytopenia

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8
Q

Type III allergic reactions occur how long after drug exposure

A

immune complexes ≥ 1 week

Ex) DILE

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9
Q

Type IV allergic reactions occur how long after drug exposure

A

48 hours to several weeks

Ex) SJS

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10
Q

REMS are developed by ____ and approved by ____ to ensure the benefits of the drug outweighs the risk

examples

A

Manufacturer
FDA

clozapine REMS, isotretinoin IPLEDGE

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11
Q

T/F: if a medication has a MedGuide, it only needs to be dispensed with the original Rx and it’s optional to dispense it with each refill

A

False - it must be dispensed with the original rx and each refill

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12
Q

When an ADR occurs, which scale can help determine the likelihood that a drug caused an adverse reaction

A

Naranjo Scale

0 = doubtful ADR; ≥9 = definite ADR

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13
Q

SE, adverse events and allergies should be reported to the ____

A

FDAs MedWatch program, which is called the FDA Adverse Event Reporting System (FAERS)

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14
Q

Post-marketing safety surveillance programs is also known as

A

Phase IV trials

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15
Q

upset stomach/nausea is ____

A

an intolerance, not an allergy

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16
Q

When dispensing medications that can cause photosensitivity, it is important to advise patients to use sunscreens that block both UVA and UVB, which are labeled as

A

Broad-spectrum

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17
Q

Drugs most commonly associated with photosensitivity

A 
Amiodarone
Diuretics (thiazide and loop)
MTX
Oral and topical retinoids
Quinolones
St. John's Wort
Sulfa antibiotics 
Tacrolimus
Tetracyclines
Voriconazole
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18
Q

What is TTP

A

a blood disorder in which clots form throughout the body

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19
Q

Key drugs associated with TTP

A

Oral P2Y12 inhibitors (e.g., Plavix)
Sulfamethoxazole

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20
Q

What is the key to treating SJS and TEN

A

stop the offending drug
then fluid and electrolyte replacement, woudn care, pain medications

21
Q

Which medications are CI in TEN, but may be used in SJS

A

Systemic steroids

22
Q

DRESS management

A

stop offending agent

23
Q

Anaphylaxis occurs within what time frame of drug exposure

A

seconds to minutes

24
Q

Treatment for anaphylaxis

A

Epinephrine injection +/- Benadryl +/- steroids +/- IV fluids

25
Q

Key drugs that are commonly associated with severe skin reactions

A 
Abacavir
Allopurinol
Carbamazepine
Ethosuximide
Lamotrigine
Modafinil
Nevirapine 
PCNs
Phenytoin
SMX
26
Q

Dose for EpiPen

A

1 mg/mL

27
Q

Where should EpiPen be injected

A

into the middle of the outer thigh

28
Q

At what angle should an EpiPen be injected

A

90 degree only

29
Q

How long should the EpiPen needle be held in place when injecting

A

3 seconds

30
Q

After removing the EpiPen needle, how long should you massage the area for

A

10 seconds

31
Q

T/F: to know you have injected the full amount of EpiPen, there should be no liquid in the device after using

A

False - there may be liquid remaining in the device after injection

32
Q

T/F: A second dose of EpiPen can be given in the opposite leg if needed prior to arrival of medical help

A

True

33
Q

T/F: EpiPen CANNOT be injected through clothing

A

False - it can

34
Q

On the NAPLEX, if a patient is allergic to PCNs, all PCN classes should be avoided, with the exception of:

A

Acute otitis media; use of a 2nd or 3rd gen cephalosporin in patients with non-severe PCN allergy (cefdinir, cefpodoxime, ceftriaxone, or cefuroxime)

35
Q

Which medication is considered safe in patients with PCN allergies

A

Aztreonam

36
Q

In which disease state should a pregnant person or a person with HIV & a PCN allergy be desensitized and still receive PCN

A

Syphilis - PCN G Benzathine (Bicillin LA)

37
Q

Which drugs/classes contain a warning or CI for use in patients with sulfa allergies

A 
Thiazide & loop diuretics
Sulfonylureas
Acetazolomide
Zonisamide
Celecoxib
Darunavir
38
Q

T/F: Sulfite or sulfate allergies cross react with sulfonamides

A

False - they do not cross react

39
Q

Contrast media used in CT scans can cause

A

Anaphylactoid reactions and delayed skin reactions

40
Q

Drugs to avoid with a peanut or soy allergy

A

Clevidipine
Propofol

41
Q

Patients who have true allergy to eggs should avoid which drugs

A

Clevidipine
Propofol
Yellow Fever vaccine

42
Q

T/F: if a severe reaction occurs to an influenza vaccine, regardless of which ingredient is suspected, the patient should not receive further doses of any influenza vaccine formulation

A

True

if egg allergy, no matter how severe, can get any flu vaccine indicated

43
Q

What is the most common drug allergy in the US

A

PCN allergy

44
Q

What is the goal of penicillin skin testing

A

To identify patients who are at the greatest risk of a Type I hypersensitivity reaction

45
Q

Skin testing only predicts what kind of reaction

A

IgE-mediated

46
Q

How is desensitization done

A

A very small dose of the medication is administered and the dose is increased in increments at regular time intervals up to the target dose

47
Q

What happens if doses are missed during desensitization

A

The drug-free period allows the immune system to re-sensitize to the drug and serious hypersensitivity reactions could occur with subsequent doses

48
Q

Desensitization should NEVER be attempted if an agent has previously caused which reactions

A

SJS or TEN

NAPLEX 2023 (88 decks)

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