Drug Allergies and ADRs - Quiz 2 Flashcards
What is an ADR?
Unintended pharmacologic effects of a drug that was administered
That are the types of ADRs?
Predictable (Type A)
Unpredicatable (Type B)
What is a type a reaction?
Dose dependent with a knonw pharmacologic properties
* Most common side effects
What is a type b reaction?
Not dose-dependent are unrelated to the pharmacologic actions that are influenced by patient-specific facotors
* Can be immediate or delayed
What are the types b reactions?
- Drug allergies
- Drug hypersensitivity reactions
- Idiosyncratic reactions
What are the types of drug allergies?
Type I-Immediate
Type 2-Delayed
Type 3 - Delayed
Type 4 - Delayed
What is Type 1 allergy? Examples?
IgE mediated: uticaria, bronchospasm, angioedema, anaphylaxisis
What is TYpe 2 allergy? Examples?
Antibody-mediated usually occuring 5-8 dyas after exposure: hemolytic anemia, thrombocytopenia
What is Type 3 allergy? Examples?
Immune complex rx occuring ≥1 wks after exposure: serum sickness
What is Type 4 allergy? Examples?
T cell mediated occurring 48hrs to wks after exposure: SJS
What is the difference between intolerance and allergy?
Intolerance: less serious complaints (N/constipation)
* Stomach upset without hypersensitivity sx
ALlergies: an immune system response and range from mild to severe
Counseling points of photosensitivity?
Use broad spectrum sunscreen that blocks both UVA and UVB
What are drugs that cause photosensitivity?
- Amiodarone
- Diuretics (Thiazides and loops)
- Methotrexate
- PO and topical retinoids
- Quinolones
- St Johns wort
- Sulfa drugs
- Tacrolimus
- Tetracyclines
- Voriconazole
What is Thrombotic thrombocytopenic purpura?
Blood disorder where clots form throughout the body
Drugs that cause TTP?
- PO P2Y12 inhibtiors: Clopidogrel
- Sulfamethoxazole
What are papules?
Raised spots
What are macules
Flat spots
What are purpura?
Red/purple skin spots (lesions) due to bleeding under the skin
What is Petechiae?
Pinpoint rash
What is ecchymosis?
Large bruised area
What is hematoma?
A collection of blood under the skin due to trauma or injury
How do you quickly identify if a patient has an allergy?
Med ID bracelet
How can you immediately treat an allergic reaction?
- Stopping the offending drug
- Antihistamine to stop itching, swelling, and rash
- Systemic sroids and NSAIDs for swelling
- Epinephrine for bronchoconstriction
Example drugs that mimic drug allergies?
Opioids: non-IgE-mediated release of histamine from mast cells in the skin -> itching and hives
Vancomycin: ifused too rapidly can cause a direct release of histamine -> slowing the infusion rate is required
What is the allele that causes delayed type hypersensitivity syndrome?
HLA-B*5701
Drug that affects the HLA allele?
Abacavir
Types of severe cutaneous ADRs?
- SJS
- TEN
- DRESS
Drugs that can cause severe cutaneous ADRs?
- Allopurinol
- AMoxicillin
- Ampicillin
- Carbamazepine
- Ethosuximide
- Lamotrigine
- Nevirapine
- Phenytoin
- Sulfamethoxazole
- Sulfasalazine
- Vancomycin
Signs of SJS and TENS?
Epidermal detachment and skin loss mimicking 3rd degree burns
What medication should be avoid when treating SJS?
Systemic steroids
What is DRESS? Tx?
Skin eruptions accompanied by systemic sx: stop offending dru
What is anaphylaxis?
Severe, life-threatening allergic reaction that usually happens within 1 hr
Sx that often accompanies anaphylaxis?
- Uticaria
- Swelling in mouth and throat
- Difficulty breathing or wheezing
- Severe GI sx
- Hypotension
What is the tx for anaphylaxis?
- Immediate emergency medical care
- Epinephrine inj
- Diphenhydramine\
- Steroids
- IV fluids
Epinephrine
EpiPen, Auvi-Q
What is the available EpiPen strength? Pediatric dose?
1mg/mL
Pediatric: 0.15 mg
When should Benadryl be taken for anaphylaxis?
2x25mg tablets when there is no tongue and lip swelling
Counseling points for EpiPen?
- Remove from carrying case and pull off the blue safety release
- Keep thumb, fingers, and hand awat from the orange end of device
- To inject jab the orange end in the missle of the outer thigh at a 90 degree angle
- Hold the needle firmly in place for 3 seconds
- Remove needle and massage area for 10 seconds
- After injection, the orange tip will extend to cover the needle. It would not me reused if needle is exposed
COunseling for Symjepi?
- Pull of the cap, holding the syringe
- Inject in the middle of out thigh, hold needle firmly for 2 seconds and massage area for 10
- After inj, slide the safety guard out over the needle
Counseling for Auvi-Q
- Pull off the outer case, that follow voice instructions
- Hold needle firmly in place on the thigh for 5 seconds
Counseling for all epinephrine auto injector?
- Normal to see liquid remaining in device after injection
- Call for emergency help because additional care may be needed
- 2nd dose may be required, given on the opposite leg
- Refrigeration is not required
- Can be injected through clothing
- Check expiration dates
When would a penicillin allergy be disregarded?
Syphillis and pregnant use penicillin desensitization
What ABX is used for those with penicillin allergies due to lack of cross tolerance?
Aztreonam
Drugs that should be avoid with Sulfa allergies?
Sulfasalazine and sulfadiazine
- Bactrim
- Thiazide, loops
- Sulfonylureas
- Acetazolamide
- Zonisamide
- Celecoxib
- Darunavir
Allergic rx that are caused by NSAIDs and aspirin?
- Respiratory
- Uticaria/angioedema
Drugs that contain peanuts and soy?
- Clevidipine (Cleviprex)
- Propofol (Diprivan)
- Progesterone (Prometrium)
Drugs that should be avoided with egg allergies?
- Clevidipine
- Propofol
- Yellow fever vaccine
- Influenza vaccine
Flu vaccines that do not have eggs?
Flublok and Flucelvax
Who qualifies for the penicillin skin test? Component of test?
To identify patients who are at greatest risk of type 1 hypersensitivity rx
PrePen, possitive control (histamine), negative control (saline)
Who should not get skin tested?
SJS or TEN
What is desensitization? Does it cure allergies? CI?
No, patients are given a very small dose and incrementally increasing dose to therapeutic target
If dose was missed, patient would re-sensitize and have a serious hypersentivity rxs
CI: SJS or TEN
What is the assessment used to assess ADR causality?
Naranjo Scale
* ≥9 -> definite
* 0 -> doubtful
What entitity are ADRs reported to?
FDA Adverse Event Reporting System (FAERS or FDA MEDWATCH)
What can be initiated by the FDA to collect data on ADRs and drug safety?
Phase IV trials
What is a BBW?
A risk of death or permanent disability
What is the difference between CI and warning/precaution?
CI: risk that outweighs any possible benefit
Warning: Can cause serious reactions including hospitalization, medical intervention, disability or teratogenicity
WHat is REMS?
Developed by the maufacturer and approved by the FDA to ensure the benefits of a drug outweigh the risk
What drugs have REMS?
- Clozapine
- Isotretinoin
Are MedGuides FDA approved?
Yes
