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Stack #212945
Drug Fever
| Question | Answer |
|---|---|
| Drug fever is a diagnosis of ______ | exclusion |
| Fever attributed to a drug when (2 things) | -fever coincides with administration and end with discontinuation of the drug___-no other cause of fever is detected |
| Most commonly the result of a ______rxn | hypersensitivity |
| Fever usually occurs in ____ days after drug admin and declines after ____ days after DC | 5-10 and 48-72 |
| MOA of drug fever | 1) Drug binds receptors on WBC__2)WBC excretes pyrogens that stimulates the hypothalamus__3)Hypothalamus secretes prostaglandins, NE, 5-HT, and cAMP which changes body temp set pt :: leading to fever |
| 5 General MOA of drug Fever | 1) Administration-Related__2)Pharmacologic Rxn__3)Alteration of thermoregulatory system__4)Idiosyncrasy__5)Hypersensitivity |
| Fever from Drug Administration can be due to (4 answers) | 1)Exogenous pyrogens or endotoxin contaminants is IV sol.__2)Drugs that act as exogenous pyrogens__3)Phlebitis__4)Sterile abscesses from IM injections |
| Drugs that act as exogenous pyrogens | Bleomycin (blenoxane), vaccines, Amphotericin |
| Two examples of fever from therapeutic action of drug | 1)JArisch-Herxheimer Rxn and Syphillis (spirochites)__2)Antineoplastics-endogenous pyrogens released from malignant cells |
| Describe Jarisch-Herxheimer Rxn | occurs when lrg amt of toxins released into body as bacteria (typically Spirochetal bacteria) die, due to antibiotic treatment or rapid detoxification. death of bacteria and associated release of endotoxins occurs faster than body can remove toxins |
| Altered Thermoregulatory Mechanism of Drug Fever-- 3 MOA and drug examples for each | 1) decreased sweating (anticholinergics)__2)Vasoconstiction (catecholamines and pressors)__3)inc production of heat or inc metabolism (levothyroxine) |
| Idiosyncratic Drug Fever Reactions- 2 ex of | Malignant Hyperthermia and Neuroleptic Malignant Syndrome (NMS) |
| Malignant Hyperthermia | ___inc heat production, inc muscle rigidity, assoc w/ anesthetics, poss genetic defect that causes inc release of calcium, mortality up to 64% |
| NMS associated with this type of drug | antipsychotics that block and deplete dopamine which :: affect dopaminergic pathways in the hypothalamus and disrupt thermoregulatory center, associated w/ short AND longterm use |
| NMS is exacerbated with the use of these drugs | benzatropine and other anticholinergics. (also cogentin) |
| ____ may be seen in the setting of withdrawal of levodopa in pt w/ Parkinsons | NMS |
| Classic Features of NMS | hyperthermia (>105, muscle rigidity, autonomic dysfunction (tachycardia, labile bp, dyspnea), changes in MS, myonecrosis/myoglobinemia, rapid dehydration, renal failure, cardiovascular collapse, mortality if untreated |
| NMS Treatment | Stop agent, Give: skeletal muscle relaxants (IV dantrolene), +/- Dopa agonist (bromocriptine), external cooling, fluid resucitation, correct electrolyte imbalances |
| If pt still needs NMS after initial tx | 1) wait at least 2 wks before resuming tx__ 2)use lower potency drugs__3)avoid concominant lithium and dehydration |
| Most Common mechanism of Drug Fever | Hypersensitivity |
| Drug fever due to hypersensitivity occurs_____ | after induction period of about 5-10days, readministration of drug accelerates fever |
| Hypersensitivity drug fever may be accompanied by_____ | rash, eosinophilia, or other s/s of allergy (RARELY is fever the only manifistation) |
| Drugs most commonly implicated in Drug Fever due to Hypersensitivity | PCN, Cephalosporins, sulfas, vancomycin, streptomycin, methyldopa, phenytoin, iodides, isoniazid, quinidine, procainamide |
Created by:
stormesk
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