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Rx Prep > Drug Allergies and ADRs - Quiz 2 > Flashcards

Drug Allergies and ADRs - Quiz 2 Flashcards

1
Q

What is an ADR?

A

Unintended pharmacologic effects of a drug that was administered

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2
Q

That are the types of ADRs?

A

Predictable (Type A)
Unpredicatable (Type B)

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3
Q

What is a type a reaction?

A

Dose dependent with a knonw pharmacologic properties
* Most common side effects

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4
Q

What is a type b reaction?

A

Not dose-dependent are unrelated to the pharmacologic actions that are influenced by patient-specific facotors
* Can be immediate or delayed

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5
Q

What are the types b reactions?

A
  1. Drug allergies
  2. Drug hypersensitivity reactions
  3. Idiosyncratic reactions
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6
Q

What are the types of drug allergies?

A

Type I-Immediate
Type 2-Delayed
Type 3 - Delayed
Type 4 - Delayed

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7
Q

What is Type 1 allergy? Examples?

A

IgE mediated: uticaria, bronchospasm, angioedema, anaphylaxisis

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7
Q
A
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8
Q

What is TYpe 2 allergy? Examples?

A

Antibody-mediated usually occuring 5-8 dyas after exposure: hemolytic anemia, thrombocytopenia

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9
Q

What is Type 3 allergy? Examples?

A

Immune complex rx occuring ≥1 wks after exposure: serum sickness

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10
Q

What is Type 4 allergy? Examples?

A

T cell mediated occurring 48hrs to wks after exposure: SJS

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11
Q

What is the difference between intolerance and allergy?

A

Intolerance: less serious complaints (N/constipation)
* Stomach upset without hypersensitivity sx

ALlergies: an immune system response and range from mild to severe

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12
Q

Counseling points of photosensitivity?

A

Use broad spectrum sunscreen that blocks both UVA and UVB

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13
Q

What are drugs that cause photosensitivity?

A
  1. Amiodarone
  2. Diuretics (Thiazides and loops)
  3. Methotrexate
  4. PO and topical retinoids
  5. Quinolones
  6. St Johns wort
  7. Sulfa drugs
  8. Tacrolimus
  9. Tetracyclines
  10. Voriconazole
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14
Q

What is Thrombotic thrombocytopenic purpura?

A

Blood disorder where clots form throughout the body

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15
Q

Drugs that cause TTP?

A
  1. PO P2Y12 inhibtiors: Clopidogrel
  2. Sulfamethoxazole
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16
Q

What are papules?

A

Raised spots

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17
Q

What are macules

A

Flat spots

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18
Q

What are purpura?

A

Red/purple skin spots (lesions) due to bleeding under the skin

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19
Q

What is Petechiae?

A

Pinpoint rash

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20
Q

What is ecchymosis?

A

Large bruised area

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21
Q

What is hematoma?

A

A collection of blood under the skin due to trauma or injury

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22
Q

How do you quickly identify if a patient has an allergy?

A

Med ID bracelet

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23
Q

How can you immediately treat an allergic reaction?

A
  1. Stopping the offending drug
  2. Antihistamine to stop itching, swelling, and rash
  3. Systemic sroids and NSAIDs for swelling
  4. Epinephrine for bronchoconstriction
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24
Q

Example drugs that mimic drug allergies?

A

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

25
Q

What is the allele that causes delayed type hypersensitivity syndrome?

A

HLA-B*5701

26
Q

Drug that affects the HLA allele?

A

Abacavir

27
Q

Types of severe cutaneous ADRs?

A
  1. SJS
  2. TEN
  3. DRESS
28
Q

Drugs that can cause severe cutaneous ADRs?

A
  1. Allopurinol
  2. AMoxicillin
  3. Ampicillin
  4. Carbamazepine
  5. Ethosuximide
  6. Lamotrigine
  7. Nevirapine
  8. Phenytoin
  9. Sulfamethoxazole
  10. Sulfasalazine
  11. Vancomycin
29
Q

Signs of SJS and TENS?

A

Epidermal detachment and skin loss mimicking 3rd degree burns

30
Q

What medication should be avoid when treating SJS?

A

Systemic steroids

31
Q

What is DRESS? Tx?

A

Skin eruptions accompanied by systemic sx: stop offending dru

32
Q

What is anaphylaxis?

A

Severe, life-threatening allergic reaction that usually happens within 1 hr

33
Q

Sx that often accompanies anaphylaxis?

A
  1. Uticaria
  2. Swelling in mouth and throat
  3. Difficulty breathing or wheezing
  4. Severe GI sx
  5. Hypotension
34
Q

What is the tx for anaphylaxis?

A
  1. Immediate emergency medical care
  2. Epinephrine inj
  3. Diphenhydramine\
  4. Steroids
  5. IV fluids
35
Q

Epinephrine

A

EpiPen, Auvi-Q

36
Q

What is the available EpiPen strength? Pediatric dose?

A

1mg/mL

Pediatric: 0.15 mg

37
Q

When should Benadryl be taken for anaphylaxis?

A

2x25mg tablets when there is no tongue and lip swelling

38
Q

Counseling points for EpiPen?

A
  1. Remove from carrying case and pull off the blue safety release
  2. Keep thumb, fingers, and hand awat from the orange end of device
  3. To inject jab the orange end in the missle of the outer thigh at a 90 degree angle
  4. Hold the needle firmly in place for 3 seconds
  5. Remove needle and massage area for 10 seconds
  6. After injection, the orange tip will extend to cover the needle. It would not me reused if needle is exposed
39
Q

COunseling for Symjepi?

A
  1. Pull of the cap, holding the syringe
  2. Inject in the middle of out thigh, hold needle firmly for 2 seconds and massage area for 10
  3. After inj, slide the safety guard out over the needle
40
Q

Counseling for Auvi-Q

A
  1. Pull off the outer case, that follow voice instructions
  2. Hold needle firmly in place on the thigh for 5 seconds
41
Q

Counseling for all epinephrine auto injector?

A
  1. Normal to see liquid remaining in device after injection
  2. Call for emergency help because additional care may be needed
  3. 2nd dose may be required, given on the opposite leg
  4. Refrigeration is not required
  5. Can be injected through clothing
  6. Check expiration dates
42
Q

When would a penicillin allergy be disregarded?

A

Syphillis and pregnant use penicillin desensitization

43
Q

What ABX is used for those with penicillin allergies due to lack of cross tolerance?

A

Aztreonam

44
Q

Drugs that should be avoid with Sulfa allergies?

Sulfasalazine and sulfadiazine

A
  1. Bactrim
  2. Thiazide, loops
  3. Sulfonylureas
  4. Acetazolamide
  5. Zonisamide
  6. Celecoxib
  7. Darunavir
45
Q

Allergic rx that are caused by NSAIDs and aspirin?

A
  1. Respiratory
  2. Uticaria/angioedema
46
Q

Drugs that contain peanuts and soy?

A
  1. Clevidipine (Cleviprex)
  2. Propofol (Diprivan)
  3. Progesterone (Prometrium)
47
Q

Drugs that should be avoided with egg allergies?

A
  1. Clevidipine
  2. Propofol
  3. Yellow fever vaccine
  4. Influenza vaccine
48
Q

Flu vaccines that do not have eggs?

A

Flublok and Flucelvax

49
Q

Who qualifies for the penicillin skin test? Component of test?

A

To identify patients who are at greatest risk of type 1 hypersensitivity rx

PrePen, possitive control (histamine), negative control (saline)

50
Q

Who should not get skin tested?

A

SJS or TEN

51
Q

What is desensitization? Does it cure allergies? CI?

A

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

52
Q

What is the assessment used to assess ADR causality?

A

Naranjo Scale
* ≥9 -> definite
* 0 -> doubtful

53
Q

What entitity are ADRs reported to?

A

FDA Adverse Event Reporting System (FAERS or FDA MEDWATCH)

54
Q

What can be initiated by the FDA to collect data on ADRs and drug safety?

A

Phase IV trials

55
Q

What is a BBW?

A

A risk of death or permanent disability

56
Q

What is the difference between CI and warning/precaution?

A

CI: risk that outweighs any possible benefit
Warning: Can cause serious reactions including hospitalization, medical intervention, disability or teratogenicity

57
Q

WHat is REMS?

A

Developed by the maufacturer and approved by the FDA to ensure the benefits of a drug outweigh the risk

58
Q

What drugs have REMS?

A
  1. Clozapine
  2. Isotretinoin
59
Q

Are MedGuides FDA approved?

A

Yes

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