RxPrep Drug Allergies & Adverse Drug Reactions

ADR

term that encompasses all unintended pharmacologic effects of a drug when it's administered correctly and used at recommended doses

adverse drug reaction

What does ADR stand for?

e

A rash with red/pinkish raised patches; patches have varied shapes and sizes

a) angioedema

b) erythema

c) morbilliform

d) pruritus

e) urticaria

hives

What's another term for urticaria?

d

Any rash or reaction that causes itching

a) angioedema

b) erythema

c) morbilliform

d) pruritus

e) urticaria

b

Redness on the skin from superficial capillaries, often due to inflammation

a) angioedema

b) erythema

c) morbilliform

d) pruritus

e) urticaria

a

Swelling caused by edema in the deeper dermal, cutaneous, and submucosal tissue

a) angioedema

b) erythema

c) morbilliform

d) pruritus

e) urticaria

c

Macular or maculopapular rash (or both) with 1-10 mm lesions and healthy skin between the lesions

a) angioedema

b) erythema

c) morbilliform

d) pruritus

e) urticaria

dose

ADRs are typically ________-related.

incorrectly

A medication error occurs when a medication is administered (correctly/incorrectly).

A

Predictable ADRs are known as type (A/B).

B

Unpredictable ADRs are known as type (A/B).

A

Type (A/B) ADRs are dose-dependent.

B

Type (A/B) ADRs are unrelated to the pharmacologic action of the drug and can be influenced by patient-specific factors.

A

Type (A/B) ADRs are most common.

A

Orthostatic hypotension with doxazosin and nephrotoxicity with aminoglycosides are examples of type (A/B) ADRs.

60 minutes

Immediate type B ADRs occur within ________ after exposure.

days to months

Delayed type B ADRs occur within ________ after exposure.

B

Drug allergies, drug hypersensitivity reactions, and idiosyncratic reactions are examples of type (A/B) ADRs.

allergies

Drug (allergies/hypersensitivity reactions) have a definite immune mechanism.

hypersensitivity reaction

clinically resembles a drug allergy but may or may not be immune-mediated

true

True or False: Drug hypersensitivity reactions do not always result in a contraindication to future administration.

idiosyncratic reaction

type B ADR that arises from genetic differences

a

Type ________ drug allergies are immediate.

a) I

b) II

c) III

d) IV

a

Type ________ drug allergic reactions are IgE-mediated, ranging from minor local reactions to severe systemic reactions.

a) I

b) II

c) III

d) IV

I

Urticaria, bronchospasm, angioedema, and anaphylaxis are examples of type ________ drug allergic reactions.

b

Type ________ drug allergic reactions are antibody-mediated.

a) I

b) II

c) III

d) IV

5-8 days

Type II drug allergic reactions usually occur ________ after exposure.

b

Hemolytic anemia and thrombocytopenia are examples of type ________ drug allergic reactions.

a) I

b) II

c) III

d) IV

c

Type ________ drug allergic reactions are immune-complex reactions.

a) I

b) II

c) III

d) IV

≥1 week

Type III drug allergic reactions usually occur ________ after exposure.

c

Serum sickness is an example of a type ________ drug allergic reaction.

a) I

b) II

c) III

d) IV

d

Type ________ drug allergic reactions are T cell-mediated.

a) I

b) II

c) III

d) IV

48 hours to weeks

Type IV drug allergic reactions usually occur ________ after exposure.

d

Stevens-Johnson syndrome is an example of a type ________ drug allergic reaction.

a) I

b) II

c) III

d) IV

Can you use similar drugs in the class?; Do you have any food allergies or a latex allergy?; How old were you when reaction occurred?; What reaction occurred?; When did reaction occur?

What are 5 questions to ask to determine whether an ADR is an intolerance or a drug allergy?

intolerances

Drug (allergies/intolerances) are less serious complaints, such as nausea or constipation.

allergies

Drug (allergies/intolerances) are an immune system response and range from mild to severe.

c

When dispensing medications that can cause photosensitivity, it's important to advise the patient to limit sun exposure and to use sunscreen that blocks ________ radiation.

a) UVA

b) UVB

c) both A and B

amiodarone, diuretics, methotrexate, quinolones, retinoids, St. John's wort, sulfa drugs, tacrolimus, tetracyclines, voriconazole

What 10 drugs/classes are most commonly associated with photosensitivity?

thrombotic thrombocytopenic purpura

blood disorder in which clots form throughout the body; clotting process consumes platelets and leads to bleeding under the skin and the formation of bruises and dots on the skin; can be fatal

plasma exchange

What is used to treat thrombotic thrombocytopenic purpura?

clopidogrel, sulfamethoxazole

What 2 drugs commonly cause thrombotic thrombocytopenic purpura?

d

Raised spots

a) ecchymosis

b) hematoma

c) macules

d) papules

e) petechiae

f) purpura

c

Flat spots

a) ecchymosis

b) hematoma

c) macules

d) papules

e) petechiae

f) purpura

d

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

a) hematoma

b) macules

c) papules

d) purpura

e

Purpura that's pinpoint in size

a) ecchymosis

b) hematoma

c) macules

d) papules

e) petechiae

a

Purpura that forms a large bruised area

a) ecchymosis

b) hematoma

c) macules

d) papules

e) petechiae

b

A collection of blood under the skin due to trauma to a blood vessel, resulting in blood leaking into the surrounding tissue

a) ecchymosis

b) hematoma

c) macules

d) papules

e) petechiae

f) purpura

stopping offending drug

A drug hypersensitivity or allergic reaction without breathing difficulty can sometimes be treated by ________.

antihistamine

What drug class used to treat a hypersensitivity or allergic reaction counteracts itching, swelling, and rash?

systemic steroids; NSAIDs

________, and sometimes ________, can be used to decrease swelling due to hypersensitivity or allergic reactions.

epinephrine

What drug is used to reverse bronchoconstriction if the patient is wheezing or has other signs of trouble breathing due to a hypersensitivity or allergic reaction?

opioids

________ can cause a non-IgE-mediated release of histamine from mast cells in the skin, causing itching and hives.

vancomycin

________, when infused too rapidly, can cause a direct release of histamine from cutaneous mast cells, causing flushing, hives, and sometimes hypotension.

human leukocyte antigen

What does HLA stand for?

HLA alleles

For some drugs, the presence of specific ________ increases the risk of delayed-type hypersensitivity syndromes.

B*5701

Patients positive for HLA-________ are at an increased risk for abacavir hypersensitivity, a syndrome presenting with fever, malaise, GI or respiratory symptoms, and rash.

drug reaction with eosinophilia and systemic symptoms

What does DRESS stand for?

Stevens-Johnson syndrome

What does SJS stand for?

toxic epidermal necrolysis

What does TEN stand for?

DRESS, SJS, TEN

What are 3 severe cutaneous adverse reactions that can be caused by drugs?

allergies

DRESS, SJS, and TEN are categorized as delayed (allergies/hypersensitivities).

allopurinol, amoxicillin, ampicillin, carbamazepine, ethosuximide, lamotrigine, nevirapine, phenytoin, sulfamethoxazole, sulfasalazine, vancomycin

What are 11 drugs most commonly associated with DRESS, SJS, and TEN?

TEN; SJS

Systemic steroids are contraindicated with (SJS/TEN), but may be used for (SJS/TEN), though the benefit is controversial.

false

True or False: A history of SJS/TEN to a medication is not a contraindication to receiving it again.

1 hour

Anaphylaxis is a severe, life-threatening allergic reaction that usually happens within ________ of drug exposure, and involves multiple organs.

anaphylaxis

Generalized urticaria, swelling of the mouth and throat, difficulty breathing or wheezing sounds, severe GI symptoms, and hypotension are symptoms of ________.

epinephrine injection ± diphenhydramine ± steroids ± IV fluids

What does the typical treatment for anaphylaxis include?

single-use epinephrine auto-injector

What should patients carry after they've had an anaphylactic reaction?

Auvi-Q, EpiPen, Symjepi

What are 3 brand names for single-use epinephrine auto-injectors?

1; 1:1000

EpiPens are generally available as epinephrine ________ mg/mL, previously labeled as ________.

2 diphenhydramine 25 mg tablets

Along with an EpiPen, what should a patient's emergency kit contain in the event there's no tongue/lip swelling?

orange

Which end is the needle end of an EpiPen, blue or orange?

3 seconds; 10 seconds

After administering an EpiPen, the needle should be held in place for ________, then the area should be massaged for ________.

true

True or False: A second dose of a single-use epinephrine auto-injector may be administered in the opposite leg, if needed, prior to the arrival of medical help.

false

True or False: Single-use epinephrine auto-injectors must be stored in a refrigerator.

true

True or False: All single-use epinephrine auto-injectors can be injected through clothing.

aspirin, beta-lactams, biologics, heparin, NSAIDs, opioids, radiocontrast media, sulfa

What are 8 drugs commonly associated with allergic reactions?

eggs, peanuts, soy

What are 3 food products commonly associated with allergic reactions?

false

True or False: Patients allergic to a particular beta-lactam are not typically presumed to be allergic to others in the class.

true

True or False: On the NAPLEX, beta-lactams should be avoided with a stated allergy to another beta-lactam.

acute otitis media

In ________, the American Academy of Pediatrics recommends a 2nd- or 3rd-generation cephalosporin in patients with a non-severe penicillin allergy due to the toxicities and decreased efficacy of alternative therapies in children.

aztreonam

What beta-lactam is considered safe in patients with an immediate-type penicillin allergy?

beta-lactam

What drug class can cause a delayed-onset mild rash that's not a contraindication to receiving the drug again or drugs from similar classes?

skin test

For immediate-type penicillin allergic reactions, a(n) ________ can assess risk of using it again.

false

True or False: Allergy skin testing should be performed for severe cutaneous adverse reactions.

cephalosporins

Many ________ can be safely tolerated in patients with a mild penicillin allergy.

cefdinir, cefpodoxime, ceftriaxone, cefuroxime

What 4 cephalosporins can be used to treat acute otitis media in patients with an allergy to penicillin/amoxicillin?

sulfamethoxazole

What sulfa drug is most commonly associated with allergic reactions?

sulfadiazine, sulfasalazine

Other than sulfamethoxazole, what are 2 sulfa drugs that should be avoided in patients with a sulfa allergy?

acetazolamide, celecoxib, darunavir, loop diuretics, sulfonylureas, thiazide diuretics, zonisamide

The package labeling for what 7 drugs/classes contain warnings or contraindications for use in patients with a sulfa allergy, although they usually don't cross-react with a sulfamethoxazole allergy?

true

True or False: Sulfite or sulfate allergies do not cross-react with sulfonamides.

angioedema, urticaria; respiratory

Aspirin and NSAIDs can cause many different types of hypersensitivity reactions, the most common being ________, ________, and those that are ________ in nature.

c

Radiocontrast media can cause ________ hypersensitivity reactions.

a) immediate

b) delayed

c) both A and B

peanuts, soy

What 2 food products are in the same family and can have cross-reactivity?

clevidipine, propofol

What 2 drugs are contraindicated with a soy allergy?

clevidipine, propofol, yellow fever vaccine

What 3 drugs cannot be used in patients with a true egg allergy?

false (ACIP states patients even with severe allergic reactions to eggs can receive any indicated inactivated vaccine)

True or False: Patients with any allergic reaction to eggs cannot receive influenza vaccines.

Flublok, Flucelvax

What 2 influenza vaccines contain no egg protein and are options in patients with a severe egg allergy?