1. MTB Step 3 - Anaphylaxis & Angioedema Flashcards
Cards Complete:
ANAPHYLAXIS
DEFINITION
What is the definition of Anaphylaxis?
Hypersensitivity / Allergic reaction that is potentially life-threatening.
- Type I Hypersensitivity
ANAPHYLAXIS
ETIOLOGY
What are the (3) Most Common causes of Anaphylaxis?
- Foods (e.g., peanuts, shellfish, etc.)
- Insect Stings / Bites (e.g., bees)
- Medications (e.g., penicillin, allopurinol, sulfa-containing drugs)
ANAPHYLAXIS
PRESENTATION
What are (2) Signs/Symptoms to look for with Anaphylaxis?
- Hemodynamic Instability (Hypotension + Tachycardia)
- Difficulty Breathing
ANAPHYLAXIS
TREATMENT
What is the 3-Drug Combination considered the Best INITIAL Treatment for Anaphylaxis?
- Epinephrine (IM) in a 1 : 1,000 conc.
- Corticosteroids
- H1 Inhibiting Antihistamines (e.g., Diphenhydramine, Hydroxyzine)
ANAPHYLAXIS
BASIC SCIENCE CORRELATE
- What is the Mechanism of Action (MOA) for Epinephrine used in Anaphylaxis?
- What is the Mechanism of Action (MOA) for Corticosteroids used in Anaphylaxis?
- Epinephrine will cause vasoconstriction through alpha-1 receptor stimulation. The beta-2 receptor stimulation effect dilates bronchi.
- Corticosteroids need 4–6 hours to work, and they increase vasoconstriction by up-regulating alpha-1 receptors. Steroids also inhibit leukotriene release.
ANGIOEDEMA
PRESENTATION
Angioedema is the Sudden Swelling of what (4) anatomical locations?
Face
Palate
Tonge
Airway
No Urticaria or Pruritis
ANGIOEDEMA
ETIOLOGY
What are (3) causes of Angioedema?
- Minor Trauma to the Face or Hands
- ACE Inhibitors
- C1 Esterase Inhibitor deficiency (Hereditary cause)
Question may describe patient hit in the face with a pillow or woodchips hitting the arm.
ANGIOEDEMA
PRESENTATION
Other than facial swelling, what are (3) more possible symptoms of Angioedema?
- No response to steroids
- Abdominal Pain
- Stridor
VISUALIZE: “NAS with Angioedema”
ANGIOEDEMA
DIAGNOSIS
What is the Confirmatory Diagnostic Test finding for Angioedema arising from C1 Esterase Inhibitor Deficiency (hereditary form)?
Low levels of C2 & C4
Chronically depleted levels of C2 & C4 in the complement pathway due to the Deficiency in C1 Esterase Inhibitors
ANGIOEDEMA
TREATMENT
What is the Best INITIAL Treatment for Hereditary Angioedema with Severe Laryngeal involvement?
C1 Inhibitor Concentrate
Recombinant C1 Inhibitor Concentrate is an alternative.
ANGIOEDEMA
TREATMENT
What are the (2) Drugs of Choice for Chronic Episodes of Hereditary Angioedema?
Ecallantide
(Ecallantide, an inhibitor of kallikrein, is the best initial therapy for angioedema. Ecallantide blocks bradykinin production.)
&
Icatibant
(Icatibant is a Bradykinin B2 Receptor antagonist)
ANGIOEDEMA
TREATMENT
What are (2) other medications that can be used for Chronic Hereditary Angioedema that have the Mechanism of Action (MOA) of Raising the C1 Esterase Inhibitor level (for unknown reasons)?
Danazol
&
Stanozolol
(both are Androgens)
ANGIOEDEMA
TREATMENT
What is the Treatment for Acute Episodes of Hereditary Angioedema?
Fresh Frozen Plasma (Infusion)
Antihistamines, Glucocorticoids, and Epinephrine are ineffective in acute episodes of hereditary angioedema. These therapies are the right answer for anaphylaxis, not C1 esterase inhibitor deficiency (hereditary angioedema).
ANGIOEDEMA
PROPHYLAXIS
What are (2) common types of procedures that can precipitate Angioedema in susceptible patients?
Surgical & Dental
The question will describe a person with a history of “sudden, nonpruritic swelling after surgery, especially of the face”
ANGIOEDEMA
PROPHYLAXIS
What are the (3) possible Prophylactic Treatments given to patients susceptible to Angioedema prior to Surgical or Dental procedures?
- Antifibrinolytics (e.g., Tranexamic Acid)
- Androgens (e.g., Danazol, Stanozolol)
- Infusions of C1 Esterase Inhibitor (Recominant or Plasma)
