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Allergic & Pseudoall

Allergic & Pseudoallergic Drug Rxns

QuestionAnswer
allergic and pseudoallergic rxns comprise how much reported adverse drug rxns 24%
how many basic types of drug allergy categories 4
observed rxn in immunologically mediated drug rxns do not resemble pharmacologic effect
type of manifestation is similar to what with immunologically mediated drug rxns similar to those seen with other allergic reactions (anaphylaxis, urticaria, serum sickness)
between the first exposure to the drug and the reaction to the drug is what?? lag time
after the drug as been dc'd, what happens with the rxn Resolved
What can treat the adverse clinical signs and symptoms Rash in limited areas - topical corticosteroid oral/iv antihistamine refractory/severe rxn - systemic corticosteroid burst
Type I - immune response IgE
Type II - Immune response IgG
Type III Immune Response IgG and IgM
Type IV Immune Response IVa - Th1 Cytokines, IVb - Th2 Cytokines, IVC- cytotoxic T cells, IVd-T cells
Clinical Sx Type 1 anaphylaxis, urticaria
Clinical Sx Type II hemolytic anemia, thrombocytopenia blood dyscrasias
Clinical Sx Type III Vasculitis, serum sickness, lupus
Clinical Sx Type IV a-tuberculin rxn, eczema b-maculopapular & bullous exanthema c-same as b also eczema, pustular exanthema d-pustular exanthema
Potential causative drugs Type I b-lactams - pcns, cephs, carbapenems non-b-lactams- sulfonamides, vanco others-insulin, heparin
Potential causative drugs Type II quinidine, methyldopa, pcns, heparin
Potential causative drugs Type III pcns, sulfonamides, radiocontrast agents, phenytoin
Potential causative drugs Type IV B-lacatams, sulfonamides, phenytoin
Pseudoallergic Drug Rxns clinically resemble immediate HSN allergic rxns but lack an immune basis
pathophysiology of pseduoallergic drug rxns unknown - considered subtype of idiopathic rxns
w/ readministration of the drug what happens w/the reaction rxn remains constant -whether mild or severe and are dose-related
opiate pseudoallergic drug rxn stimulate mast cell release directly, pruritis, urticaria, and occasionally mild wheezing - pretreat w/antihistamines
radiocontrast media pseudoallergic drug rxn serious, immediate pseudoallergic rxns
anaphylaxis acute, life-threatening allergic raxn w/MULTIPLE organ systems
Clinical Presentation anaphylaxis - what systems cutaneous rxn, respiratory dysfunction, cardiovascular complications, gi disturbances
clinical presentations anaphylaxis - cutaneous rxn flushing, pruritis, urticaria, angioedema
clinical presentations anaphylaxis - respiratory dysfunction SOB, tightness of throat or chest, etc
clinical presentations anaphylaxis - CV complications HOTN, syncope, altered mental status, CP, dysrhythmia
clinical presentations anaphylaxis - GI disturbances N/V/D
grading of anaphylaxis mild - skin/subq tissues only moderate- respiratory, CV, Gi involvement severe- hypoxia, HOTN, disordered CNS fxn
Biphasic response of anaphylaxis initial rxn - 30min-2h after antigen exposure 6-8hrs after antigen exposure anaphylaxis may return
how long do you observe pt after anaphylactic rxn greater than or equal to 12 hours
pathophysiology of anaphylaxis prior exposure ->IgE formation->Secondary ag exposure ->Crosslink IgE on mast cells and basophils -> release stored inflammatory mediators ->vasodilation ->increased vascular permeability
IgE-mediated Antigens Antibiotics MC, other meds, foods
what position should you place pt w/anaphylaxis in trendelenburg
monitor VS when q2-5 min, stay w/pt
other anaphylaxis management epinephrine, diphenhydramine or ranitidine, treat HOTN, hydrocortisone, may use glucagon
when would you use glucagon for anaphylaxis management refractory cases not responding to epinephrine because bb is complicating management
when would you use ranitidine IV prn may need to use w/diphenhydramine for H2 receptors
chronic anaphylaxis management trigger avoidance, immunotherapy, post-trigger self treatment, ID bracelet
post-trigger self treatment includes what Epi-Pen, Ana-Kit
Created by: ashleylafontaine
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