Drug Allergies, ADRs And ADR reporting Flashcards
List types of drug allergies or Hypersentivity rxns
Type 1
Type 2
Type 3
Type 4
What’s Type I rxn? (Drug allergies or Hypersentivity rxns)
Immediate (within 15-30 mins of exposure)
Severity can range from minor inconvenience to death
What’s Type II rxn? (Drug allergies or Hypersentivity rxns)
Mins to hours after exposure
E.g. Hemolytic anemia and Thrombocytopenia
What’s Type III rxn? (Drug allergies or Hypersentivity rxns)
Immune-complex rxns.
Occurs 3-10 hrs after exposure
E.g. Drug-induced lupus and serum sickness
What’s Type IV rxn? (Drug allergies or Hypersentivity rxns)
Delayed hypersensitivity rxns
Can occur 48 hrs to several weeks after exposure
E.g. PPD skin test for TB, which peaks at 48 hrs
What’s the most common drug rxn xterized as? What does it mean?
Type A = dose-dependent and predictable
E.g. Doxazosin is slowly titrated up to reduce severity of SE
What’s a type B drug rxn?
Idiosyncratic - means a particular pt has an independent peculiar rxn (or hypersensitivity) to the drug
Where should SEs, adverse events and allergies be reported to?
FDA’s MedWatch program
Are vaccine SE, ADRs and allergies reported to MedWatch program?
No!
Report to vaccine adverse drug rxns called VAERS
T/F? FDA conducts phase IV (post-marketing safety surveillance programs)?
True
T/F? Community-based adverse event reporting is critical?
True
Is reporting voluntary?
Yes
What’s a Naranjo Scale?
Validated causality assessment scale that can help pharmacists determine the likelihood that a drug caused by ADR
Characterizing an ADR?
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
How would u classify stomach upset/nausea?
Not a drug allergy
Better categorized as INTOLERANCE
How do deal with Photosensitivity?
Limit sun exposure
Use sunscreen that block UVA (causes aging, skin cancer) and UVB (causes sunburn)
What’s a broad-spectrum sunscreen?
Covers both UVA and UVB
List drugs most commonly associated with photosensitivity
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
List drugs that are associated with severe skin rashes in SJS/TEN
Sulfamethoxazole Allopurinol CBZ, Oxcarbazepine Phenobarbital Ethosuximide Lamotrigine Phenytoin Clopidogrel Ticlopidine Quinine Abacavir Nevirapine Letrozole Hydroxychloroquine Piroxicam Tetracyclines
List drugs that are associated with severe skin rashes in DRESS (drug rxn with eosinophilia and systemic sx)
Ethosuximide
Phenytoin
Tetracyclines
List drugs that are associated with severe skin rashes in TTP (Thrombotic Thrombocytopenic Purpura)
Clopidogrel
Sulfamethoxazole
Quinine
What’s the best way to treat SJS/TEN?
Stop offending agent ASAP
Pts should receive fluid/electrolyte replacement, wound care and pain meds
What med can be used in SJS, but contraindicated in TEN?
Corticosteroids
Whats DRESS?
Can include a variety of skin eruptions as well as systemic sx (fever, hepatic dysfxn, renal dysfxn, lymphadenopathy)
Tx of DRESS
Stop offending agent, but sx may actually get worse
Tx of TTP?
Plasma exchange
Which drugs cause the most drug allergies?
Penicillins and Sulfonamides
What may cause a type I rxn?
Previous exposure to drug
How may a rxn without breathing difficulty be treated?
Can be treated by simply stopping the offending drug
What can be used to counteract the histamine release that causes itching, swelling and rash?
Antihistamines
What may be used to decrease swelling?
Steroids and sometimes NSAIDs
What may be needed in severe swelling?
Steroid injection
What may be used if pt shows pt is wheezing or has other signs of trouble breathing to reverse bronchoconstriction?
Epinephrine
S/sx of Anaphylaxis?
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
How to treat anaphylaxis?
Call 911 or go to ED right away
Receive Epinephrine inj +- IV fluids
What shouldn’t be done to pts head when experiencing anaphylaxis?
Don’t put a pillow under their head
What should a pt that has experienced anaphylaxis and is at future risk always have on them?
EpiPen
EpiPen Jr
Adrenaclick
Auvi Q
What should be included in such pts emergency kit?
EpiPen, EpiPen Jr, Adrenaclick, Auvi Q
Diphenhydramine tablets (25mg x 2)
Emergency contact info
How much epinephrine is in EpiPen, EpiPen Jr, Adrenaclick, Auvi Q?
0.3mg of epinephrine in all, except EpiPen Jr that contains 0.15mg
Once a pt has injected EpiPen, EpiPen Jr, Adrenaclick, Auvi Q, what should they do to injection site?
Rub the area where the med entered the skin
How do u use the EpiPen etc and antihistamine?
Inject EpiPen first
Then use diphenhydramine (2 x 25mg) next
List drug classes that cause allergic rxns
Beta Lactam Allergy
Sulfa Allergy
Opioid Allergy
Breathing difficulties and NSAIDs
Peanut/Soy Allergy
Egg Allergy
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?
True
What’s the relationship btw penicillin allergy and Cephalosporins/ Carbapenems?
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
What med is most commonly reported with sulfa allergies?
Sulfamethoxazole (in Bactrim, Septra)
If a patient has sulfa allergy, what other meds should be avoided?
Sulfapyridine
Sulfadiazine
Sulfisoxazole
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?
“Non-arylamine” Sulfonamides e.g,
Thiazides diuretics
Loop diuretics
Sulfonylureas
Acetazolamide
Zonisamide
Celecoxib
Relationship btw Sulfites or Sulfate allergies and Sulfonamide?
Sulfites or Sulfate allergies DO NOT cross react with a Sulfonamide
T/F? In opioid allergy, safety is the bottom line, so it’s best to avoid use, but if u use it, monitor pt?
True
Sx of drug allergies in NSAIDs?
Pt will experience:
Urticaria
Angioedema
And occasionally anaphylaxis
T4 avoid ALL NSAIDs use, if previous NSAID rxn
Relationship btw peanut and soy allergy?
Peanuts and Soy are in the same family and can have cross-reactivity
List drugs to avoid in pts with peanut allergy
Clevidipine (Cleviprex)
Propofol (Diprivan)
Progesterone in Prometrium
List drugs to avoid in pts with egg allergy
Clevidipine (Cleviprex)
Propofol (Diprivan)
Influenza vaccine
Name the seasonal flu vaccine that’s made without eggs, t4 can be used in egg allergy?
Flublok
What’s the difference btw SE and Adverse Drug Rxns (ADRs)?
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
