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T&D 1 exam 2 > Drug Allergies > Flashcards

Drug Allergies Flashcards

1
Q

Risk factors

A
  • chemical structure
  • Molecular weight
  • route of administration
  • Dose, duration of therapy, repeated exposure to drug
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2
Q

Immunogenic compoud

A

Hapten/carrier

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3
Q

molecular mass required for immunogenicity

A

greater than 10,000 daltons

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4
Q

binding between Hapten and carrier

A

covalent

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5
Q

what must occur for drug to form a hapten/carrier conjugate

A

be chemically reactive

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6
Q

what if the drug is not intrinsically reactive, how can it be activated?

A
  • Biotransformation

- Photoactivation

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7
Q

what does complete antigen mean?

A

macromolecular drugs that do not require binding to invoke an immune response

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8
Q

Gell and Coombs classification

A

I. Anaphylactic - IgE mediated (

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9
Q

Fatal anaphylaxis

A

Asphyxia due to laryngeal edema or cardiovascular collapse

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10
Q

Serum sickness

A

syndrome due to soluble circulating immune complexes (Ag excess)

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11
Q

Presents with fever, malaise, lymphadenopathy

Morbilliform skin eruptions

onset is a week - 2 wks post exposure

A

Serum sickness

  • cephalosporins (ceflacor)
  • antivenin (equine serum)
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12
Q

may be due to release of factors or direct pharmacologic effects on tissues (eg w/ chemo)

High variable temperature pattern (spiking)

prompt resolution after removal of causative drug

A

Drug fever

Amphotericin B
Antimicrobials

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13
Q

Rigors, fever, and hypotension after use of TCN, Doxy, Pen G for treatment of spirochetal and bacterial infections, Louse Borne relapsing fever or Tick borne refractory fever

A

Jarisch-Herxheimer Reaction

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14
Q

JHR happens due to

A

sudden release of bacterial components from injured and or killed bacteria

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15
Q

Drug induced SLE

  • drug characteristics?
  • Sex distribution?
  • Which drugs?
  • When does it typically resolve?
A
  • Hydrazine/Amino group linked to an aromatic ring
  • Equal
  • HIPP: Hydralazine, Isoniazid, procainamide, phenytoin (also quinidine and penicillamine)
  • 3-6 mos
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16
Q

Onset - several mo after beginning drug

Fever, malaise, rash, Arthralgias, myalgias, mucosal ulcers, pulmonary involvement

A

Systemic Lupus erythematosus

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17
Q

Fever, rash, eosinophilia

proteinuria, hematuria, eosinophiluria

A

Interstitial Nephritis

  • Anti staphylococal PCN
  • Cephalosporins
  • Sulfonamides
  • Cimetidine
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18
Q

Mechanisms for Interstitial nephritis

A
  • Humoral: Ab to a drug - basement membrane complex

- Cell mediated

19
Q

Eosinophilia, fever, rash, granulomas on biopsy

  • eliminated kidney as the problem

which drugs caused the problem?

A

Hepatic Hypersensitivity reaction/ toxic hepatitis

  • Erythromycin
  • PCN
20
Q

How does Hepatic Hypersensitivity reaction/ toxic hepatitis induce autoimmune reaction

A
  • drug acts as a hapten

- may not be inherently toxic to the liver

21
Q

Palpable purpuric lesions

in lower extrimities

A

Vasculitis

22
Q

Vasculitis is characterized by

A

inflammation and necrosis of blood vessels

23
Q

Dermatologic reactions - Mild vs Sever. which is common?

A

Mild is most common

Mild:

  • Pruritis
  • Maculopapular rash
  • Urticaria/Angioedema
  • Fixed drug reactions
  • Phototoxic

Severe:

  • Toxic epidermal necrolysis (TENs)
  • Stevens-Johnson Syndrome (SJS)
24
Q

Symmetrical, flat red rash - small confluent bumps
itchy
Begins in back/extremities
Not seen on palms and soles

A

Maculopapular/Morbilliform Rash

early/late onset depends on sensitization

PCN, antibiotics, anticonvulsants

25
Q

Pruritic, edematous wheals with surrounding erythema

Dermatographism

A

Urticaria/Angioedema

26
Q

Angioedema is found specifically found

what type of drug typically causes this issue

A

facial (esp mouth) and periorbital

ACE inhibitors

27
Q

What causes urticaria

A

Histamine release from mast cells in dermis causing blood plasma to leak out of small BV

28
Q

Common agents that cause Urticaria/Angioedema

A

Antibiotics, NSAIDs, Anticonvulsants (eg: phenytoin)

29
Q

Dark red or violet lesion that is single or multiple edematous that reappears in the same location if drug is reinitiated

A

Fixed Drug eruptions

30
Q

Common agents that cause fixed drug eruptions

A

Antibiotics: PCN, TCN, Cipro, Bactrim

NSAIDs, Quinidine, Sulfonamides

31
Q

Immediately post treatment after short exposure to sunlight

A

Phototoxicity

32
Q

Activated by long wavelength sunlight
- urticarial, eczematous papulovesicular, or exudative eruptions

Hapten formed with UV light + drug

A

Photoallergy

33
Q

Common Agents that cause phototox/allergy

A 
TCN
Carbamazepine
Griseofulvin
Coal Tar derivatives
OCs
34
Q

Topical treatment of preexisting dermatosis causes a new rash to develop. The rash becomes erythematous, indurated, and vesicular

A

Eczematous Contact Dermatitis

35
Q

Concentric (target) lesions that look like “bulls eye”

A

Erythema multiforme

36
Q

Severe variant of erythema multiforme

A

Stevens Johnson Syndrome

37
Q

Mucosal and conjunctival edema

High fever, myalgias, arthralgias with conjunctival scarring that can lead to blindness

A

Stevens Johnson syndrome

38
Q

Common agents that cause stevens johnson

A

Sulfas
Anticonvulsants
NSAIDs

39
Q

Erythematous rash that progresses to large flaccid bullae

epidermis sloughs and exposes raw dermis - equivalent to 2nd degree burn

A

Toxic Epidermal Necrolysis

Steven Johnsons that covers more than 30% of the body

40
Q

Most dermatologic rxns are due to

A

Antibiotics
Anticonvulsants
NSAIDs

41
Q

scale used for management of ADR

A

Naranjo Scale

42
Q

Drug induced autoimmunity

A
  • SLE
  • Hemolytic anemia
  • Renal interstitial nephritis
  • Hepatic hypersensitivity
43
Q

Pulmonary reactions

A
  • rhinitis/asthma

- Acute infiltrate/chronic fibrotic pulmonary rxn (Nitrofurantoin)

44
Q

Aplastic anemia is usually seen with

A

chloramphenicol

T&D 1 exam 2 (10 decks)

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