drug allergies and ADR Flashcards
ADR vs Errors
ADR:
effects from a drug that was admin correctly. ADRs are typically dose-related; risk increase w/ higher dose/reduced clearance
Med Error:
something wrong occurred, such as giving a med dose to a wrong pt.
Type A vs Type B
type a: predictable
- dose-dependent, known pharmacological action, most common
type b: unpredictable
- not dose-dependent, unrelated to the pharmacological actions, pt-specific factors such as: allergies (immune-mediated response), pseudoallergic reaction (itching after admin of opioids, vanco infusion), idiosyncratic (SJS)
drug allergy types
Type I reaction
- IgE-mediated and immediate (within 60min of drug exposure) Ex: bronchospasm, angioedema, anaphylaxis
Type II reaction
- antibody-mediated, occurring several days (5-8) days after drug exposure Ex: hemolytic anemia, thrombocytopenia
Type III reaction
- immune-complex reaction occurring >=1 weeks after drug exposure Ex: drug-induced lupus erythematosus
Type IV reactions
- cell-mediate or delayed hypersensitivity, occurring anytime from 48 hrs to several weeks after drug exposure Ex: SJS
boxed warning
risk of death or permanent disability
contra, warning and precautions
contra: cannon be used in pt. the risk will outweigh any possible benefit
warnings and precautions: serious reactions that can result in death, hospitalization, medical interventions, disability or teratogenicity (raloxifene warning for VTE)
Adverse reaction
undesirable, uncomfortable or dangerous effects
REMS
risk evaluation and mitigation strategies (REMS)
required by FDA, developed by manufacturer and approved by FDA to usner the benefits of a drug outweigh the risk
EX: clozapine REMS, isotretinoin iPLEDGE program
Med guide
FDA-approved pt handouts that detail a drug’s important Adverse event in non-technical language
dispensed w/ original prescription and each refill
not necessary in hospitals
SE, and AE and allergies should be reported to
FDA’s MedWatch program, which si called the FDA Adverse Event Reporting System (FAERS)
phase IV trails (post-markering safety surveillance programs)
stomach upset/Nausea
should not be reported or on pt profile, do not bother w/ it because this is not an allergy. more of an intolerance. intolerance document in electronic medical record is different than allergies
Intolerance
are less serious complains, such as nausea or constipation. since the drug bothers the pt it should be avoided if possilbe
allergies e
immune system response and range from mild (pruritus) to severe (anaphylaxis)
present: facial swelling, bronchoconstriction, sever drop in BP, weakness, fever, severe rash
photosensitivity
Use brad-spectrum sun screen both UVA and UVB
Key drugs associated w/ photosensitivity
- amiodarone
- diuretics (thiazide and loop)
- Methotrexate
- oral and topical retinoids
- quinolones
- st. john’s wort
- sulfa antibiotics
- tacrolimus
- tetracyclines
- voriconazole
thrombotic thrombocytopenic purpura
blood disorder clotes form throughout the body TTP
key drugs
- oral p2y12 inhibitors (e.g. clopidogrel)
- sulfamethoxazole
Steven johnson syndrome, toxic epidermal necrosis, drug reaction w/ eosinophilia and systemic symptoms
SJS, TENS, DRESS
severe skin reaction key drugs
- Abacavir
- Allopurinol
- Carbamazepine
- Ethosuximide
- Lamotrigine
- Modafinil
- Nevirapine
- Penicillins
- Phenytoin
- Sulfamethoxazole
anaphylaxis tx
immediate emergency care
911 +
epi +/- diphenhydramine +/- steroids +/- IV fluids
epi is 1/1000 so 1mg/ml, in doses of .3mg (adult dose) .15mg (peds)
EpiPen admin steps
- remove from carrying case and pull off the blue safety release
- keep thumb fingers and hand avey from the orange (needle) end of the device
- inject into the middle of the outer thigh at a 90 degree angle
- hold the needle firmly in place while counting to three
- remove the needle and massage the area for 10 seconds
- after the injection, the orange tip will extend to cover the needle, if needed is visible, it should not be reused
all epi auto-injectors
- it is normal to see liquid remaining in the device after injecting
- call for emergency help, because additional care may be needed
- a second dose (in the opposite leg) may be given, if needed, prior to the arrival fo medical help
- refrigeration is not required
- all products can be injected through clothing
- check the device periodically to make sure the med is clear and not expired
penicillin allergy
avoid at all cost on the NAPLEX, no exception!
read carefully
only situation ok is acute otitis media for peds, 2nd or 3rd generation cephalosporin in pt with a non-severe penicillin allergy.
peanuts and soy
are in the same family, can have cross-reactivity
contra w/ soy allergy include clevidipine (cleviprex) and propofol (diprivan)
eggs allergy
true allergy eggs, they can not use clevidipine, propofol, and yellow fever vaccine.
flublok and flucelvax quadrivalent contain no egg protein— if a severe reaction occurs regardless of the which ingredient.. pt should not receive further doses of influenza vax
penicillin skin testing
true allergy in the past, but over time antibodies can wane. the test is to identify pt who are great risk of type I hypersensitivity reaction
skin test only predicates an IgE-mediate reaction. regardless of the skin test, pt should not be re-challenged w/ an agent that caused SJS or TENs
induction of drug tolerance
desensitization
- recommended in prego pt w/ syphilis
- slowly, stepwise process, very small doses of medication and incrementally increased to a target dose. done in a medical setting w/ emergency care.
- if doses are missed, drug-free period allows for the immune system to re-sensitize…
desensitization does not “cure” the pt of an allergy and the reaction should not be removed form pt’s medical record.
