Drug Allergies & Adverse Drug Reactions

Question 1

Adverse drug reactions are….

Answer 1

effects from a drug when it is administered correctly

ADR are typically dose related, severity inc with higher doses/reduced clearance

Question 2

2 types of ADR

Answer 2

Type A = predictable
Type B = unpredictable

Question 3

Type A reactions

Answer 3

dose dependent
most common, 85% of ADRs

Question 4

Type B reactions

Answer 4

not dose dependent
can be influence by pt specific factors

immediate = 60 min after exposure
delayed = days/months after exposure

Question 5

Types of Drug allergies

Answer 5

Type I = immediate = IgE mediated

Type II = delayed, antibody mediated 5-8 days after exposure

Type III = delayed, immune-complex reactions, > 1 week after exposure

Type IV reactions = delayed, T cell mediated, 48hrs - wks after exposure

Question 6

Drugs associated with photosensitivity

Answer 6

Amiodarone
Thiazide/Loop Diuretics
Methotrexate
Oral/topical retinoids
Quinolones
St Johns Wort
Sulfa Drugs
Tacrolimus
Tetracyclines
Voriconazole

Question 7

Drugs most commonly associated with severe cutaneous adverse reactions (SJS,TEN,DRESS)

Answer 7

allopurinol
Amoxicillin
Ampicillin
Carbamazepine
Ethosuximide
Lamotrigine
Nevirapine
Phenytoin
Sulfamethoxazole
Sulfasalazine
Vanco

Question 8

Beta-lactam allergy info

Answer 8

if allergic to one penicillin, assumed to be allergic to others

cephalosporins/carbapenems structurally related, small risk of cross reactivity

** for Naples purposes, beta-lactam allergy = avoid all of them **

Question 9

Sulfa allergy info

Answer 9

most common with Bactrim
avoid sulfasalazine/sulfadiazine in pts w/ allergy

some drugs have CI/warnings but dont usually cross react (thiazide/loop diuretics, acetazolamide, sulfonylureas, zonisamide, celecoxib)

Question 10

drugs contraindicated with soy allergy

Answer 10

Clevidipine = Cleviprex
Propofol = Diprivan

Question 11

Drugs contraindicated with egg allergy

Answer 11

Clevidipine = Cleviprex
Propofol = Diprivan
Yellow fever vaccine

Question 12

Which flu vaccine contain no egg

Answer 12

Flublok
Flucelvax

Question 13

Desensitization dosing

Answer 13

slowly increase from very small dose up to target dose to give med if no other options

if miss a dose, would have to restart

has to be done in medical setting

Question 14

Naranjo Scale ADR

Answer 14

> 9 = definite ADR
5 - 8 = probable ADR
1 - 4 = possible ADR
0 = doubtful ADR

Question 15

What does boxed warning indicate

Answer 15

risk of death or permanent disability from the drug

Question 16

Contraindications indicate that….

Answer 16

drug cannot be used in the patient
risks outweigh the benefit

Question 17

Risk evaluation and mitigation strategies

Answer 17

required by FDA for some drugs

developed by the manufacturer and approved by the FDA to ensure benefits outweigh risks of drug

Question 18

Medication guides

Answer 18

FDA approved patient handouts that detail drugs important adverse events

should be dispensed with original prescription and with each refill