Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

AI Flashcards > Drug Allergy > Flashcards

Drug Allergy Flashcards

1
Q

Compare reactions between metabisulfite and ASA.

Metabisulfite causes bronchospasm in 5%of asthma patients.

A

Sulphite allergy

  • Non IgE mediated
  • Can be severe or life threatening asthma exacerbation
  • Sulphites are used as a preservative like dried fruit and wines
  • mgmt is avoidance of sulphites

ASA

  • ASA reactions are commonly part of a Samters triad and include nasal polyps, asthma and rhinitis as well as ASA sensitivity causing bronchoconstriction
  • diagnosis is with asa challenge
  • treatment is with asa desensitization
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

14 year old taking amoxil, gets a maculopapular rash. Differential diagnosis, investigation, limitations of investigations.

A

DDX

  • Viral exanthem (EBV, roseola, 5ths disease)
  • drug eruption
  • food allergy
  • CSU
  • insect bites
  • Rubella
  • TENS/ SJS
  • DRES

Invx - Penicillin skin testing, sIgE
Based on severity may consider BW

Limitation of testing
IgE sensitivity 45% when compared to skin testing
Skin testing PPV 100% and NPV 40-100%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is urticarial vasculitis?1

A
  • 5% of CIU
  • described as painful, tender, burning, or pruritic
  • lesions last 24-72 hours and resolve with purpura and hyperpigmentation
  • systemic involvement can occur but is rare (usually as arthralgia and myalgia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Name the three types of Urticarial vasculitis (UV)

A
  1. Normocomplementemic UV
  2. Hypocomplementemic UV
  3. Hypocomplementemic UV Syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How does glucagon work?

A
  • it has inotropic and chronotropic effects that are not mediated through B receptors

Adults - 1-5mg IV slow bolus over 5 minutes
Peds - 20-30 mcg/kg (max 1 mg) IV slow bolus over 5 minutes
Rapid administration of glucagon can induce vomiting, so should have airway protected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What investigations would you order for serum sickness and serum sickness like reaction?

A

CBC, Eos, Plt count, ESR/CRP, ANA, anti CCP, C3/C4, Cryoglobulins, C1q binding assay
Indirect and direct Coombs often positive if drug-induced hemolytic anemia

Can also do specific tests for immunocytotoxic thrombocytopenia and granulocytopenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What the difference between serum sickness and serum sickness like reaction

A

Difference between SSLR and True SS is in SSLRs:
Blood levels of complement are usually N
Renal/hepatic involvement rare (common in true SS)
Benign outcome, future courses of the medication are unlikely to lead to recurrence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is Multiple Drug Hypersensitivity Syndrome (MDH)?

A
  • Delayed hypersensitivity rxns to >2 structurally unrelated drugs
  • Initial rx: Usually severe exanthems or DRESS, associated with massive T cell activation
  • Subsequent rxn: To non-cross reactive drug, second specific T-cell sensitization takes place, leading to clinical manifestations which may be similar or different from initial
    Include: exanthema, erythroderma, DRESS, SJS, TEN, Hepatitis, agranulocytosis,
  • Timing can vary from weeks - months - years from initial rxn
  • Usually seen as complication of ongoing DRESS with recurrence of some DRESS symptoms over time
  • Can be chronic, with permanently activated T cells, and can have distant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Prevention of ADRs

A
  1. History to determine host factors
  2. Avoidance of cross-reactive drugs
  3. Use of predictive tests when available
  4. Prudent and proper describing of drugs frequently associated with reactions
  5. Use of oral drugs when possible
  6. Document ADR in patient’s medical record
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Metabisulfite reactions

A
  1. Skin - hives, swelling
  2. Resp - occur in pts with poorly controlled asthma
  3. Anaphylactic - extremely rare
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

ddx for serum sickness

A
  1. SSLR
  2. drug induced SLE
  3. reactive arthritis
  4. infectious mono
  5. rheumatic fever
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

testing in latex allergy

A

can do SPT with 0.001 - 1.0 mg/ml (highly sens and spec)

or can do sIgE (less sens 70%, but specific 95%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

ddx for cutaneous drug eruption

A
  1. general exanthem
  2. fixed drug eruption
  3. photo allergic reactions
  4. AGEP - acute gen. eczematous pustulosis
  5. drug induced sweet syndrome
  6. drug induced pemphigus
  7. linear igA bullous disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

skin testing in penicillin allergy

A
  • most reliable method, sIgE lacks accuracy
  • major and minor determinant should be used
  • neg pred value 100%
  • pos pred value 40-100%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

management of RCM allergy

A
  1. ensure study is essential
  2. ensure proper hydration
  3. use an alternation agent (non ionic)
  4. ~ Pre-medication with Pred 50 mg 13,7,1 hour prior to RCM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Mgmt of peri operative anaphylaxis (5)

A
  1. every effort should be made to identify the culprit
  2. History, review the record
  3. Review tests for mast cell stabilizers done at the time ie. tryptase
  4. if IgE mediated reaction is suspected then skin testing or sIgE
  5. for patient who require repeat ana, ensure: asthma is well-cx, avoid BB, avoid ACEi, verify baseline tryptase is not elevated, avoid histamine releasing drugs (morphine, vanco, NM blockers) if possible
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Two types of insulin reactions:

A
  1. Immediate: rapid sx, range from skin to systemic,
  2. Delayed (type 3 or 4) : occur 1 hour after, most cases several hours to days later, cutaneous, transient and resolve on their own
    a) indurated and subcut nodules at the site of injections (type 3)
    b) eczematous skin changes like contact derm (type 4)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

mgmt of insulin allergy

A
  1. change the insulin, sometimes its the additive like protamine (NPH contains protamine)
  2. use a GLP-1 receptor antagonist
  3. tx with AH and steroids
  4. desensitization to the desired insulin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

5 characteristic of DRESS

A
  1. eosinophilia
  2. visceral organ involvement
  3. skin rash
  4. lymphadenopathy
  5. atypical lymphocytosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

mgmt of DRESS (6)

A
  1. Identify and avoid the drug culprit
  2. Hydration
  3. Monitoring of organ dysfunction
  4. Steroids 0.5-1 mg/kg per day
  5. 2nd line cyclosporin, IVIG
  6. Avoid prescribing those drugs in the future
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Labs in UV

A
  1. histology: leukocytoclastic vasculitis
  2. elevated ESR
  3. Low C1q, C3, and C4
  4. ANA +
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

UV tx

A
  1. Anti histamines
  2. NSAIDs for arthralgias
  3. Steroids
    4.Dapsone - can be used in combination with steroids, usual dose is 50 mg PO OD and increase to 100 mg if needed
  4. Colchicine - used to treat the cutaneous manifestations of UV
  5. Hydroxychloroquine - can be used on combination with steroids
  6. Severe systemic disease:
    MMF, methotrexate, azathioprine, cyclosporin, rituxumb, anakinra, canakinumab, omalizumab
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

drugs that share the same side chain as amoxicillin

A
  1. cefadroxil
  2. cefprozil
  3. cefatirizine
  4. ampicillin
  5. Cephalexin
  6. Ceflacor
  7. Cefprozil
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Pen desensitization protocol

A

0.1 ml
0.2 ml
0.4 ml
0.8 ml
1.6 ml
3.2 ml
6.4 ml
15- 30 min interval between each step

25
Q

allopurinol desens protocol

A

there is a 28 day one and a rapid 2 day one

26
Q

insulin desens protocol

A

0.01 U reg
0.02 U
0.05 U
0.1 U
0.2 U
0.5 U
1U
2U
5U
30 mins between each step above then switch to NPH and give 10 U 60 mins after last dose of regular, and 10 U 12 hrs after previous dose

27
Q

acanthosis nigricans pathogenesis

A
  • increase in insulin growth factor 1, fibroblast growth factor and epidermal growth factor
  • increases in insulin stimulate keratinocytes and dermal fibroblasts which cause the plaque to form
28
Q

What are the potential allergic ingredients in the COVID vaccine?

A
  1. PEG (pfizer and moderna)
  2. Polysorbate (AZ and JJ)
  3. Tromethamine (moderna)
29
Q

what types of immune response to vaccines promote?

A

a humoral response

30
Q

what is needed for the success of a vaccine?

A
  1. infectious agent does not establish latency
  2. the infectious agent dose not undergo antigenic variation
  3. the infectious agent does not interfer with host immune response

HIV is difficult to vaccinate against because it establishes a latent infection and is highly variable due to gp120

31
Q

which type of injection give the strongest response?

A
  • subcutaneous injections elicit the strongest response bc they are taken up by langerhans cells and presented efficiently to the local lymph nodes
32
Q

two approved adjuvants for vaccines

A
  1. aluminium hydroxide gel - stimulates a B cell response

2. squalene - lipid formulation that triggers phagocytes

33
Q

what are the purified antigen subunit vaccines

A

tetanus

pneumococcus and H flu

34
Q

what are the non bronchodilator effects of b agonists

A
  1. mucociliary clearance
  2. inhibition of cholinergic neurotransmission
  3. inhibition of mediator release
  4. enhanced translocation of steroids receptor into nucleus by MAP kinases
35
Q

name some anticholinergic meds and how they work?

A
  1. Ipratropium
  2. Tiotropium

They work by inhibiting cholinergic response which causes bronchoconstriction. They bind to M1, M2 and M3 muscurinic receptors to compete with Ach and leads to bronchodilation

36
Q

how does theophylline work?

A
  1. PDE inhibition
  2. adenosine receptor antagonism
  3. anti inflammatory effects
37
Q

IVIG dosing

A

400-600 mg/kg every 3-4 weeks
trough level goal of 7-8

for SCIG dosing - multiply the IVIG dosing by 1.37 and divide by 4 and give once weekly

for Hizentra multiply the IV dose by 1.53 and divide by 4 and give once weekly

38
Q

How does the UAS7 work?

A

based on itch (0-3)
based on number oh hives (0, 1-6, 7-12, >12) each day for 7 days
provides a score of 42

39
Q

MOA of methotrexate

A
  • inhibits dihydrofolate reductase and thymidylate synthase - inhibits DNA synthesis
  • reduces production of TNFa, IFN y, IL-1, IL-6, IL-8
  • must check a CBC q4-6 weeks
40
Q

MOA of azathiopurine

A
  • inhibits purine synthesis, which inhibits T cell growth and function
41
Q

MOA of MMF

A
  • inhibits purine synthesis, interfers with the ab/ag interactions
  • inhibits neutrophil chemotaxis and phagocytosis
  • interfers with IL-1, TNFa, INGy, and IL-6
42
Q

MOA of cylophosphamide

A
  • alkylating agents which cross links DNA and RNA inhibiting cell division
  • causes T and B cell lymphopenia
43
Q

MOA of colchicine

A

binds to microtubules to prevent activation, degranulation, migration and proliferation of neutrophils

44
Q

MOA of calcineurin inhibitors

A
  1. cyclosporin- make a complex with cyclophillin
  2. tacrolimus binds FK binding protein
  3. Sirolimus binds mTOR
45
Q

meds that have a suppressant effect on SPT

A
  1. AH - loratidine (7days)
  2. intranasal azelastine
  3. TCAs and tranquilizers (doxepin and imipramine)
46
Q

SPT is 100% diagnostic for the following foods and results

A

7 mm for egg - sIgE > 7
8 mm for milk - sIgE> 14
8 mm for peanuts - sIgE>15

47
Q

SPT sensitivity and specificity for inhalant allergies

A

85-87% and specificity 79-86%

48
Q

how does BAT work?

A
  • measures release of histamine from basophils incubated with allergen
  • when well characterized allergens are used the test is similar in accuracy to skin testing
49
Q

adjuncts used in AIT

A
  1. aluminum
  2. CPG (tolamba)
  3. MPL
  4. Calcium phosphate
50
Q

what is an effective dose of major allergen in AIT

A

5-20 mcg

51
Q

rule of 2s for systemic reactions in AIT

A

0.2% of injections
2% of patients
2% severe
and 1 in 2 million injections cause fatality

52
Q

what is the efficacy of Grasstek?

A

22% relative difference in daily symptom score

53
Q

what is the efficacy of oralair?

A

rhinitis total score improved by 27% compared to placebo group
29% reduction in rescue medication use

54
Q

efficacy of ragwitek?

A

26% relative difference in total symptom score

17% in daily symptoms score

55
Q

explain pathophysiology of serum sickness

A
  • type III reaction
  • usually caused by protein antigen which meets ab and forms complex, which normally is cleared by phagocytes
  • when excess immune complexes form they deposit in tissues and trigger the inflammatory response
  • leading to arthritis, arthralgias and fever
  • complement is activated and releases cytokines which cause urticaria
56
Q

causes of SSLR

A
  1. venom or rabies
  2. mabs
  3. insect stings
  4. vaccines
  5. antibiotics - pen, amox, TMP-SMX
57
Q

invx in SSR

A
  1. CBC - neutropenia and reactive lymphocytes
  2. ESR and CRP
  3. UA - look for mild protienuria
  4. LFTs and BUN Cr
  5. complement can be low is severe cases
  6. skin biospy rarely needed - would show mild infiltrate with lymphocytes and histiocytes, IIF shows IgM and Cr
58
Q

full name for Pre Pen

A

Penicillinoly polylysine

59
Q

vaccine allergy administration protocol

A
  1. SPT and ID testing
  2. If positive proceed with vaccine administration in graded doses protocol
    - 0.05 of 1:10 dilution
    - 0.05 full strength
    - 0.1 full strength
    - 0.15 full strength
    - 0.2 full strength

AI Flashcards (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions