Side Effects And ADRs Flashcards
Type II hypersensitivity reaction
Occurs minutes to hours after exposure
Type I hypersensitivity reaction
Immediate within 15 to 30 minutes of exposure
Type III reaction
Immune complex reaction
Example is drug-induced lupus
Type IV reactions
Delayed hypersensitivity reaction that occurs anywhere from 48 hours to several weeks after exposure
Example is a PPD skin test for tuberculosis
Where to report adverse drug reactions
FDA med watch program
Phase 4 post marketing surveillance
Observes the drug in the general population to identify any safety and efficacy issues
What occurs if the FDA determines there are too many side effects associated with a drug already released?
They may ask for the package insert or labeling to be changed
An example was in 2008 the FDA required Tamiflu to change it’s pediatric labeling to indicate precautions about hallucinations confusion and other strange behavior
How do you know if the drug was to blame?
Use the naranjo scale with patients
The higher the score the more likely the drug caused the event
Photosensitivity
Examples of drugs that cause this are sulfa antibiotics, tetracyclines, NSAIDs, topical retinoids ,fluroquinolones, tacrolimus, cyclosporine (immune suppressant drugs)
Patient should avoid sun during high exposure times and should use broad-spectrum sunscreen
Severe skin rashes
SJS (Steven Johnson)/ TEN(toxic epidermal necrosis): sulfamethoxazole, allopurinol, carbamazepine, oxcarbazepine, phenytoin, Plavix
DRESS: ethosuximide, phenytoin, tetracyclines
TTP(thrombotic thrombocytopenic purpura): Plavix, sulfamethoxazole, quinine, ticlopidine
What to do for severe skin rash reaction?
Stop the offending agent as soon as possible
Give fluid, electrolytes, wound care, and pain medication
Corticosteroids can be used and Steven Johnson syndrome but are contraindicated in toxic epidermal necrolysis
Anaphylaxis
Can give antihistamines steroids NSAIDs steroid injections or epinephrine depending on the reaction
Signs and symptoms of anaphylaxis include swelling, bronchoconstriction, lightheadedness or dizziness, nausea vomiting, decrease blood pressure, shock
What should patients carry that have previously had an anaphylactic reaction
Epinephrine diphenhydramine and emergency contact information (epi 0.3mg adults and 0.15mg children)
After an epinephrine injection the area should be rubbed to make the medication enter the skin
Beta-lactam allergy
Avoid all penicillins cephalosporins and carbapenems
Drugs associated with sulfa allergies
Sulfamethoxazole, sulfadiazine, sulfisoxazole, thiazide diuretics, loop diuretics, sulfonylureas Acetazolamide, zonisamide, and celecoxib
