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NAPLEX > Drug Allergies, ADRs And ADR reporting > Flashcards

Drug Allergies, ADRs And ADR reporting Flashcards

0
Q

List types of drug allergies or Hypersentivity rxns

A

Type 1

Type 2

Type 3

Type 4

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1
Q

What’s the difference btw SE and Adverse Drug Rxns (ADRs)?

A

SE are more common and gen less severe e.g. Orthostatic hypotension from Doxazosin

ADRs are KNOWN complications of a drug but are gen. rarer and more severe e.g. rash from Lamotrigine

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2
Q

What’s Type I rxn? (Drug allergies or Hypersentivity rxns)

A

Immediate (within 15-30 mins of exposure)

Severity can range from minor inconvenience to death

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3
Q

What’s Type II rxn? (Drug allergies or Hypersentivity rxns)

A

Mins to hours after exposure

E.g. Hemolytic anemia and Thrombocytopenia

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4
Q

What’s Type III rxn? (Drug allergies or Hypersentivity rxns)

A

Immune-complex rxns.

Occurs 3-10 hrs after exposure

E.g. Drug-induced lupus and serum sickness

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5
Q

What’s Type IV rxn? (Drug allergies or Hypersentivity rxns)

A

Delayed hypersensitivity rxns

Can occur 48 hrs to several weeks after exposure

E.g. PPD skin test for TB, which peaks at 48 hrs

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6
Q

What’s the most common drug rxn xterized as? What does it mean?

A

Type A = dose-dependent and predictable

E.g. Doxazosin is slowly titrated up to reduce severity of SE

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7
Q

What’s a type B drug rxn?

A

Idiosyncratic - means a particular pt has an independent peculiar rxn (or hypersensitivity) to the drug

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8
Q

Where should SEs, adverse events and allergies be reported to?

A

FDA’s MedWatch program

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9
Q

Are vaccine SE, ADRs and allergies reported to MedWatch program?

A

No!

Report to vaccine adverse drug rxns called VAERS

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10
Q

T/F? FDA conducts phase IV (post-marketing safety surveillance programs)?

A

True

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11
Q

T/F? Community-based adverse event reporting is critical?

A

True

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12
Q

Is reporting voluntary?

A

Yes

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13
Q

What’s a Naranjo Scale?

A

Validated causality assessment scale that can help pharmacists determine the likelihood that a drug caused by ADR

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14
Q

Characterizing an ADR?

A

What rxn occurred (mild rash, severe rash with blisters, trouble breathing)

When did it occur (about how old were you)

Can u use similar drugs in the same class (e.g. If they report allergy to penicillin, have they ever used Keflex)

Ask and include any food allergies and latex allergies in the pt record

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15
Q

How would u classify stomach upset/nausea?

A

Not a drug allergy

Better categorized as INTOLERANCE

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16
Q

How do deal with Photosensitivity?

A

Limit sun exposure

Use sunscreen that block UVA (causes aging, skin cancer) and UVB (causes sunburn)

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17
Q

What’s a broad-spectrum sunscreen?

A

Covers both UVA and UVB

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18
Q

List drugs most commonly associated with photosensitivity

A

Sulfa antibiotics

Tetracyclines

NSAIDs
Amiodarone
Chloroquine, Coal Tar, Cyclosporine 
Oral and topical retinoids
Phenothiazines, Psoralens
Quinidine
Fluoroquinolones
Tacrolimus, Topical fluorouracil
Diuretics, thiazides and loops
Metronidazole
St. John's wort
PDE-5 inhibitors
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19
Q

List drugs that are associated with severe skin rashes in SJS/TEN

A 
Sulfamethoxazole
Allopurinol 
CBZ, Oxcarbazepine
Phenobarbital
Ethosuximide
Lamotrigine
Phenytoin
Clopidogrel
Ticlopidine
Quinine
Abacavir
Nevirapine
Letrozole
Hydroxychloroquine
Piroxicam
Tetracyclines
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20
Q

List drugs that are associated with severe skin rashes in DRESS (drug rxn with eosinophilia and systemic sx)

A

Ethosuximide

Phenytoin

Tetracyclines

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21
Q

List drugs that are associated with severe skin rashes in TTP (Thrombotic Thrombocytopenic Purpura)

A

Clopidogrel

Sulfamethoxazole

Quinine

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22
Q

What’s the best way to treat SJS/TEN?

A

Stop offending agent ASAP

Pts should receive fluid/electrolyte replacement, wound care and pain meds

23
Q

What med can be used in SJS, but contraindicated in TEN?

A

Corticosteroids

24
Q

Whats DRESS?

A

Can include a variety of skin eruptions as well as systemic sx (fever, hepatic dysfxn, renal dysfxn, lymphadenopathy)

25
Q

Tx of DRESS

A

Stop offending agent, but sx may actually get worse

26
Q

Tx of TTP?

A

Plasma exchange

27
Q

Which drugs cause the most drug allergies?

A

Penicillins and Sulfonamides

28
Q

What may cause a type I rxn?

A

Previous exposure to drug

29
Q

How may a rxn without breathing difficulty be treated?

A

Can be treated by simply stopping the offending drug

30
Q

What can be used to counteract the histamine release that causes itching, swelling and rash?

A

Antihistamines

31
Q

What may be used to decrease swelling?

A

Steroids and sometimes NSAIDs

32
Q

What may be needed in severe swelling?

A

Steroid injection

33
Q

What may be used if pt shows pt is wheezing or has other signs of trouble breathing to reverse bronchoconstriction?

A

Epinephrine

34
Q

S/sx of Anaphylaxis?

A

Swelling with to without Urticaria

Bronchoconstriction, difficulty breathing, pulmonary edema

Light headedness or dizziness, confusion

Nausea, vomiting

Sudden drop in BP, with or without loss of consciousness

Shock, with possible organ damage

35
Q

How to treat anaphylaxis?

A

Call 911 or go to ED right away

Receive Epinephrine inj +- IV fluids

36
Q

What shouldn’t be done to pts head when experiencing anaphylaxis?

A

Don’t put a pillow under their head

37
Q

What should a pt that has experienced anaphylaxis and is at future risk always have on them?

A

EpiPen

EpiPen Jr

Adrenaclick

Auvi Q

38
Q

What should be included in such pts emergency kit?

A

EpiPen, EpiPen Jr, Adrenaclick, Auvi Q

Diphenhydramine tablets (25mg x 2)

Emergency contact info

39
Q

How much epinephrine is in EpiPen, EpiPen Jr, Adrenaclick, Auvi Q?

A

0.3mg of epinephrine in all, except EpiPen Jr that contains 0.15mg

40
Q

Once a pt has injected EpiPen, EpiPen Jr, Adrenaclick, Auvi Q, what should they do to injection site?

A

Rub the area where the med entered the skin

41
Q

How do u use the EpiPen etc and antihistamine?

A

Inject EpiPen first

Then use diphenhydramine (2 x 25mg) next

42
Q

List drug classes that cause allergic rxns

A

Beta Lactam Allergy

Sulfa Allergy

Opioid Allergy

Breathing difficulties and NSAIDs

Peanut/Soy Allergy

Egg Allergy

43
Q

T/F? Anyone who’s allergic to penicillins should avoid the entire grp of beta-lactam antibiotics, unless they have been specifically evaluated for this problem?

A

True

44
Q

What’s the relationship btw penicillin allergy and Cephalosporins/ Carbapenems?

A

People with a hx of penicillin allergy have a small risk of having an allergic rxn to a cephalosporin or Carbapenems.

T4, it’s prudent to avoid ALL beta lactams on the exam if a pt had a stated allergy, unless there’s no alternative agent

45
Q

What med is most commonly reported with sulfa allergies?

A

Sulfamethoxazole (in Bactrim, Septra)

46
Q

If a patient has sulfa allergy, what other meds should be avoided?

A

Sulfapyridine

Sulfadiazine

Sulfisoxazole

47
Q

If a pt has a sulfa allergies, what meds can still be given to them (bcuz they don’t cross-react), but tell them to watch out for signs of sulfa allergies?

A

“Non-arylamine” Sulfonamides e.g,

Thiazides diuretics

Loop diuretics

Sulfonylureas

Acetazolamide

Zonisamide

Celecoxib

48
Q

Relationship btw Sulfites or Sulfate allergies and Sulfonamide?

A

Sulfites or Sulfate allergies DO NOT cross react with a Sulfonamide

49
Q

T/F? In opioid allergy, safety is the bottom line, so it’s best to avoid use, but if u use it, monitor pt?

A

True

50
Q

Sx of drug allergies in NSAIDs?

A

Pt will experience:

Urticaria
Angioedema
And occasionally anaphylaxis

T4 avoid ALL NSAIDs use, if previous NSAID rxn

51
Q

Relationship btw peanut and soy allergy?

A

Peanuts and Soy are in the same family and can have cross-reactivity

52
Q

List drugs to avoid in pts with peanut allergy

A

Clevidipine (Cleviprex)

Propofol (Diprivan)

Progesterone in Prometrium

53
Q

List drugs to avoid in pts with egg allergy

A

Clevidipine (Cleviprex)

Propofol (Diprivan)

Influenza vaccine

54
Q

Name the seasonal flu vaccine that’s made without eggs, t4 can be used in egg allergy?

A

Flublok

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