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Phar 504 > Drug Allergies > Flashcards

Drug Allergies Flashcards

1
Q

What type of allergy is immediate in onset, delayed

A

Type 1/ type 2,3,4

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2
Q

Which allergic reaction is antibody mediated

A

Type 1

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3
Q

What are clinical features of Type 1 antibody reactions

A

Hives, itching, flusing, angioedema, hypotension, anaphylaxis

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4
Q

T/F: There is not a fever in type 1 allergy reactions

A

True

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5
Q

What is anaphylaxis, goals of therapy

A

acute, life-threatening allergic reaction involing multiple organ systems, anaphylactic shock

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6
Q

How often does Type 1 reactions causes problems for the skin, respiratory tract, GI, CV

A

80-90%, 70%, 40%, 35%

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7
Q

How quick is anaphylaxis

A

within 30 minutes of antigen exposure

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8
Q

T/F: Anigodema is only bilateral

A

False: Angioedema can be unilateral or bilateral

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9
Q

What type of angioedmea is a part of the type 1 allergic reaction

A

Mast-cell mediated

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10
Q

What are the criteria for having a type 1 allergic reaction

A

sudden skin or mucosal symptoms and signs, sudden respiratory symptoms and signs, sudden reduced BP or symptoms of end-organ dysfunction, sudden gastrointestinal symptoms

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11
Q

How many of the criteria is need to diagnose as a type 1 allergic reaction if the antigen is known, unkwown

A

2, 1

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12
Q

T/F; Skin manifestations must be present to be considered a type 1 allergic reaction

A

False: Skin manifestations is absent in 10 to 20% of the cases

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13
Q

Which allergic reaction is a cytotoxic reaction

A

Type 2

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14
Q

What causes a type 2 allergic reaction

A

Drug binds to surfaces of certain cell types and act as antigens

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15
Q

How long does it take for symptoms to occur in type 2 allergic reactions

A

1 week (can begin within hours if previously exposed)

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16
Q

What are clinical features of type 2 allergic reactions

A

hemolytic anemia, thrombocytopenia, leukopenia, neutropenia

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17
Q

What is heparin induced thrombocytopenia (HIT)

A

antibody initiates profound activation of platelets while, at the same time, initaiting their clearance by macrophages

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18
Q

What is a risk of HIT

A

low platelet count, blood clotting

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19
Q

Which allergic reaction is a immune-complex reaction

A

Type 3

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20
Q

What causes a type 3 allergic reaction

A

Free IgG or IgM binds to the drug to form free, soluble, circulating immune complexes that can percipitate into tissue causing an inflammatory response

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21
Q

When would Type 3 allergic reactions take place

A

after high dose, long term, or recurrent drug exposure

22
Q

How long does it take for a type 3 allergic reaction to take place

A

1 week or more

23
Q

What are the clinical features of type 3 drug allergies

A

Drug fever, vasculitits, serum sickness

24
Q

What are differences between drug fever and infectious fever

A

fever will stop upon discontinuation of drug and recur within hours of re-challenge, commonly high: 102-104, patients often do not realize they have a fever

25
Q

What cell type is usually present in only drug fever

A

Eosinophils

26
Q

Which allergic reaction is cell mediated/delayed

A

Type 4

27
Q

When do type 4 reactions take place

A

1-3 weeks

28
Q

What are dangerous diseases that can occur due to type 4 allergic reactions

A

Stevens-Johnsons syndrome and Toxic Epidermal Necrolysis

29
Q

What are indications of SJS and TENS, which is more dangerous

A

blistering and skin sloughing, TENS

30
Q

What is Drug Rash with Eosinophilia and Systemic Symptoms

A

severe drug reaction that involves widespread rash, fever, and single or multi organ failure

31
Q

What are organs affected by DRESS

A

Liver (80%), kidney, heart, lungs, muscle, pancreas

32
Q

T/F: DRESS has the unique feature of single or multi organ failure and not all cases are associated with eosinophilia

A

True

33
Q

When does aminopenicillin reaction occur

A

7 to 14 days after starting antibiotics

34
Q

What is common in lupus but not drug induced lupus

A

malar rash and discoid lesions, renal involvement, positive double stranded DNA antibodies

35
Q

T/F: A patient with positive anti-ds DNA and positive anti-histone antibodies likely has DILE

A

False: A patient with negative anti-dsDNA and postive anti-Histone antibodies likely has DILE

36
Q

What drugs cause DILE

A

slufas, hydralizine, isoniazaid, procainamide, phenytoin

37
Q

What are drugs that are started to be indicated for interstitial nephritis

A

PPIs

38
Q

Which drugs cause drug induced phototoxicity/photoallergy

A

tetracyclines, sulfonamides, voriconazole, amiodarone

39
Q

What is the most common cause of allergic drug reactions

A

Beta lactams

40
Q

T/F: Skin testing for an antibiotic test not the drugbut instead the metabolite

A

True

41
Q

What drug has cross reactivity to beta lactams

A

cephalosporins, carbapenam

42
Q

What type of aztreonam could have cross reactivity with beta-lactams

A

ceftazidime (identical side chain to that aztreonam)

43
Q

What is the drug that causes the 2nd most drug allergies, what part causes this

A

sulfonamides, arylamine side chain

44
Q

T/F: Beta lactams are the most common causes for SJS and TEN

A

False: Sulfonamide allergy is the most common cause of Steven-Johnson Syndrome and Toxic Epidermal Necrosis

45
Q

What causes Samter’s triad symptoms and cause type 1 reaction

A

Aspirin

46
Q

What are the sympotms of Samter’s triad

A

hypersensitivity reaction, ashtma exacerbations, and nasal polyps

47
Q

What drugs require HLA testing

A

Abacavir (all), carbamezapine, allopurinol, phenytoin

48
Q

What drugs can treat the symptoms of urticaria

A

H1 antihistamines, H2 antihistamines and glucoroticoids (severe or progressing)

49
Q

How is anaphylaxis treated

A

D/C suspected drug/antigen, IM injection of epinephrine, maintain 02 saturation over 92, lay patient down but keep legs raised, 0.9NaCl

50
Q

Wha drugs treat breathing problems

A

albuterol, Ipratropium

51
Q

How should corticosteroids be used in an allergic reaction

A

to prevent or minimize late phase reaction

52
Q

how much epinephrine should be given in anaphylaxis, refractory anaphylaxis

A

.3mg, 1-4 mcg

Phar 504 (34 decks)

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