Drug reactions

Question 1

Type A

Answer 1

Any person at high enough dose

Predictable from pharm properties

Question 2

Type B

Answer 2

Hypersens or immune reaction
unpredictable who will get- except with HLA types
eg non immune HA in primiquine in G6PD def
AZA in G6PD def
aspirin and tinnitus

Question 3

Most likely to die from anaphylaxis caused by?

Answer 3

Drugs

Question 4

Association between latex allergy and…

Answer 4

It is recognised that many people who are allergic to latex are also allergic to fruits, particularly banana, pineapple, avocado, chestnut, kiwi fruit, mango, passion fruit and strawberry.

Question 5

If think have a beta lactam allergy, how useful is specific IgE?

(Talking about RAST to abx)

Answer 5

poor NPV–>cannot exclude and refer for specific skin test +/- challenge
If positivve–>confirm allergy, need medic alert

1. skin test
2. intradermal test
3. challenge with drug
   but if low pre test prob- direct to challenge

Question 6

Which abx can you not skin test?

Answer 6

Macrolides
QUinolones

skin irritants

Question 7

cross reactivity penicillin and cephalosporins

Answer 7

under 5%

Question 8

cross reactivity penicillins and carbapenems

Answer 8

under 1%

Question 9

cross reactivity penecillin and monobactams

Answer 9

zero percent

eg aztreonam

Question 10

Quinine induced thrombocytopaenia eg of what?

Answer 10

Type II mediated reaction

Question 11

HITS is an example of what?

Answer 11

Type II reaction

Question 12

Haemolysis from penicillin is from what type of reaction?

Answer 12

Type 2

Question 13

PTU
flecanide
amiodarone

leading to neutropaenia is an example of?

Answer 13

Type II reaction

Question 14

TEN/SJS higher risk with carbamazepine if what HLA?

Answer 14

HLAB * 1502

Question 15

Abacavir hypersensitivity associated with ?

Answer 15

HLA B5701

Question 16

Ab in drug induced lupus?

Answer 16

Anti histone Ab
mostly cutaneous lupus
Ipilimumab gives in 60% Also nivolumab, minocycline, INH, amiodarone

Question 17

Most common cause of anaphylaxis in anaesthetics?

Answer 17

NM blocking agents

Question 18

Childhood penicillin allergy, what is the chance that will be there in adulthood?

Answer 18

Under 10% but may be severe!

Question 19

SJS is what type reaction?

Answer 19

Type IV

Question 20

Can you get a type I response to drug several days into course?

Answer 20

No

Question 21

Is it the major or minor determinants ofbeta lactams that are the most isotype most of the time?

Answer 21

minor determinants

Question 22

In type 2 reactions, what cells clear the opsonised cells?

Answer 22

Macrophages

Question 23

How long after exposure is a type 2 reaction?

Answer 23

5-8 days

Question 24

Phenytoin skin reaction increase if:

Answer 24

HLA 1502

Question 25

Allopurinol rash increase risk if:

Answer 25

HLA *5801

Question 26

Abacavir HLA
Carbamazepine HLA
Phenytoin HLA
Allopurinol HLA

Answer 26

HLA B5701
Carbamazepine/pheny - HLA 1502
HLA 5801

Question 27

If testing for type 4 hypersensitivity rash, which bit of skin do you need to check>

Answer 27

The bit that was involved before