Antibiotci Allergy Flashcards
(194 cards)
1
Q
Hypersensitivity reaction types
A
D
2
Q
Type 1
Immune mediator
Mechanism
Timing of onset
HSRS
Testing ‘ verification methods
A
D
3
Q
Type 2
Immune mediator
Mechanism
Timing of onset
HSRS
Testing ‘ verification methods
A
D
4
Q
Type 3
Immune mediator
Mechanism
Timing of onset
HSRS
Testing ‘ verification methods
A
5
Q
Type 4
Immune mediator
Mechanism
Timing of onset
HSRS
Testing ‘ verification methods
A
E
6
Q
Drug antigen bind and cross link IgE on allergic cell which results in degranulation
A
S
7
Q
Drug antigen specific igG bind antigen on the cell surface or matrix and activated phagocytosis cell
A
D
8
Q
Drug antigen specific IgG bind to soluble antigen forming complexes that activate complement and phagocytic cell
A
D
9
Q
Drug antigen specific t lymphocyte receptor bind to drug antigen and activate t lymphocyte with effector cell including macrophage, eosinophils and or cytotoxic t lymphocyte
A
D
10
Q
Minuet to hours
A
D
11
Q
Days to week
A
D
12
Q
Combo testing
A
D
13
Q
Complement level
A
D
14
Q
Prolonged drug challenge
A
D
15
Q
Type A:
A
D
16
Q
Type B:
A
E
17
Q
pharmacologically predictable, dose-dependent, non-
immune-mediated, and less influenced by genetic factors
A
D
18
Q
pharmacologically unpredictable, non-dose-dependent and
often immune-mediate
A
E
19
Q
being caused by mechanisms of
action other than the intended primary pharmacologic mechanism of action of the drug.
A
X
20
Q
The off-target can be:
A
E
21
Q
Most delayed reactions begin
after six hours and typically after days of treatment
A
D
22
Q
Directly attributable to vasoactive mediators released by mast cells
and basophils
A
D
23
Q
Attributable to anti-body
mediated cell destruction
A
F
24
Q
Due to inflammation in response
to AG-AB complex
A
C
25
Activation of T-cells
E
26
Urticarial rash
D
27
Pruritus, flushing
W
28
Angiodema of face, extremities or
laryngeal tissue
E
29
Wheezing, Bronchospasm, rhinitis
S
30
• GI symptoms, hypotension
W
31
Anaphylaxis
E
32
Hemolytic anemia
D
33
Thrombocytopenia
E
34
Neutropenia
R
35
Serum sickness
D
36
Vasculitis
D
37
Arthus reaction
D
38
Contact dermatitis
E
39
Maculopapular (including
morbilliform) eruptions
D
40
SDRIFE — "Symmetrical drug-
related intertriginous and flexural
exanthem"
D
41
Acute generalized exanthematous
pustulosis — AGEP
E
42
Drug fever
D
43
Stevens-Johnson syndrome/toxic
epidermal necrolysis (SJS,TEN)
D
44
Drug-induced hypersensitivity
syndrome — DiHS, also called
DRESS
D
45
The signs and symptoms of most pseudoallergic reactions are similar
to IgE-mediated (immediate) allergic reactions
W
46
Both can involve urticaria, angioedema, or anaphylaxis due to mast cell
degranulation.
E
47
Anaphylaxis is likely when any one of the three criteria is fulfilled
D
48
Evaluation of patients with penicillin allergy
C
49
Allergy history:
W
50
Skin testing for immediate reaction
E
51
Is a bioassay that detects the presence of allergen-specific IgE on the surface of a patient's cutaneous
mast cells.
W
52
Skin testing
Mechanism
Indication
Safety
Contraindicated
D
53
Mast cell activation results in a positive skin test, which is a transient "wheal-and-flare" reaction
within 15 to 20 minutes from application of the allergen.
W
54
Most rapid, sensitive, and cost-effective testing modality for identifying penicillin-sensitized patients
W
55
High risk for an anaphylactic reaction to testing,
D
56
Have experienced a recent anaphylactic event,
C
57
Taking medications that may interfere with the treatment of anaphylaxis, or
F
58
Have certain skin conditions.
E
59
Skin testing
Procedure
D
60
Two methods of skin testing for IgE-mediated disorders:
C
61
performed following negative prick/puncture tests and are approximately 100- to
F
62
should be performed first, and if negative, intradermal tests should
D
63
The minimal reagents required are:
E
64
Positive and negative controls,
D
65
The major determinant (penicilloyl-polylysine [PPL]) and
R
66
The minor determinant penicillin G.
F
67
Following negative skin test results, the absence of allergy should be confirmed with a ........
R
68
Do not perform any pencillin allergy testing if there is history of pencilllin associated
D
69
Blistering rash
D
70
Nephritis
D
71
Hepatitis
E
72
Fever
F
73
Joint pain
S
74
The reaction was cutaneous
S
75
The reaction had feature of IgE / immediate
S
76
The patient unstable or compromised hemodynamics or respiratory status or pregnancy with low risk allergy history
D
77
Skin testing: Delayed reaction
F
78
Patch testing:
F
79
Intradermal testing with delayed readout:
E
80
Drugs to be used in patch testing are mixed into petrolatum or 0.9 percent saline, applied to a small area of
skin under occlusion for 48 hours, and then removed.
F
81
The site is examined 48 to 96 hours after placement.
F
82
This type of testing should only be performed if a commercially available injectable form of the drug is
available.
F
83
The concentration used should be known to be non-irritating, and a prick test should be performed initially
to assure there is no immediate response
F
84
A positive result consists of erythema and induration at the site, and the site is examined at 24 to 48 hours
after placement
D
85
Test Dosing (Or Graded Challenge)
Indications
Contraindications
D
86
Indicated to exclude immediate allergic reactions.
K
87
The purpose of a test dose is to expose the patient to a small amount of drug, followed by a period of
close observation, in case there is a reaction.
I
88
used to exclude allergy to the medication in question, and is most appropriate for
a patient who is unlikely to be allergic to that drug.
F
89
should not be performed in a patient with a positive response in a prior drug
allergy test (skin or in vitro).
J
90
only when immediate allergy to the tested antibiotic is judged to be
unlikely after careful consideration of the details of the past reaction.
F
91
Patients with mild past reaction to penicillin that lacked features of an IgE-mediated allergy.
F
92
Patients with mild past reaction to penicillin that occurred more than 10 years ago, even if it
involved hives or angioedema,
F
93
In contrast, if a patient's history is vague but some element of it suggests a serious IgE-mediated
reaction (eg, "My mother said that I could not breathe"), then the more cautious approach of
performing a
D
94
does not modify the allergic response to the drug or prevent recurrent
reactions. Therefore:
F
95
Graded challenge to the suspect drug is contraindicated in patients
with the following types of reactions:
V
96
Blistering dermatitis (eg, Stevens-Johnson syndrome, toxic epidermal necrolysis)
F
97
Sloughing of the skin
C
98
Severe generalized hypersensitivity reactions involving internal organs (drug-induced
hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms)
F
99
Milder dermatoses with mucous membrane lesions (eg, erythema multiforme)
F
100
The starting dose is usually 1/10th of the full dose, but could be higher or lower,
depending on the route of administration, clinical stability of the patient, and level of
certainty that the patient is not allergic to the drug.
D
101
usually 1/4th or 1/10th of
the full dose
V
102
Low risk history:
F
103
Moderate risk history
F
104
High-risk history
F
105
Isolated nonallergic symptoms (eg, gastrointestinal symptoms) or
F
106
Patients solely with a family history of a penicillin allergy,
F
107
pruritus without rash,
U
108
remote (>10
years) unknown reactions without features suggestive of an IgE- mediated reaction
Y
109
Low risk history:
Action :
For patients with nonallergic symptoms or a family history:
For patients with other low-risk histories, such as pruritus without rash or remote (>10 years)
unknown reactions without features suggestive of an IgE-mediated reaction:
I
110
Amoxicillin can be prescribed,
V
111
However, patient preference may dictate whether a direct oral amoxicillin challenge is performed under medical
observation first.
O
112
direct oral amoxicillin challenge under medical observation should be performed
U
113
urticaria or other pruritic
rashes or reactions with features of IgE-mediated reactions (eg, swelling), but not
anaphylactic reactions
I
114
patients receiving supplemental oxygen
F
115
compromised cardiac function,
9
116
pregnant patients
I
117
Moderate risk history
Actions
F
118
Skin test and amoxicillin challenge
F
119
Patients with positive skin test are allergic to penicillin and should not be challenges.
F
120
Negative skin test can be followed by oral amoxicillin challenge
I
121
High-risk history
Action
K
122
Patients with a history of high-risk reactions, including anaphylaxi
D
123
positive
penicillin skin testing results
U
124
recurrent penicillin reactions,
F
125
hypersensitivities to multiple β-lactam
antibiotics, should be evaluated by specialists.
U
126
If penicillin is required immediately for optimal patient care, a .... procedure may be pursued.
L
127
is reserved for scenarios in which penicillin or a penicillin-related drug is superior to
alternative antibiotics.
I
128
induction of tolerance procedure, is used in the context of a history of an IgE- mediated
hypersensitivity reaction (HSR) or a positive skin test.
Y
129
procedure uses gradual steps (often 12-step protocols) to build temporary tolerance to a drug by rendering
effector cells (e.g., mast cells, basophils) less reactive in a controlled setting that does not cause overt
anaphylaxis.
8
130
Desensitization
Indication
O
131
had elevated tryptase during the initial reaction (indicating mast cell activation),
I
132
strongly suspected to have an immediate-type drug allergy based on clinical history
D
133
whom there are no acceptable alternate drugs.
F
134
Desensitization
Contraindication
Safety
S
135
never attempted in patients with histories of reactions involving
significant skin desquamation, such as Stevens-Johnson
syndrome or toxic epidermal necrolysis
Y
136
Erythema multiforme and diffuse erythroderma with desquamation
U
137
drug reaction with eosinophilia and
systemic symptoms/drug-induced hypersensitivity syndrome (DRESS/DiHS),
I
138
acute generalized exanthematous pustulosis (AGEP), serum sickness
reactions, nephritis, hepatitis,
G
139
Cross reactivity between B lactam antibiotics
U
140
Amoxicillin has side chain that are identical to
K
141
Ampicllin has side chain that are identical to
S
142
Cefadroxil
D
143
Cefprozil
S
144
Cefatrizine
D
145
Cefaclor
S
146
Cephalexin
S
147
Cephradine
D
148
Cephaloglycin
D
149
Loracarbef
S
150
Management of Drug Challenge Reactions
O
151
Not tolerance
D
152
Serious type of delayed
D
153
Past reaction was mild without feature of IgE
D
154
Past reaction did have feature of IgE
S
155
Treatment
Immediate
Delayed
Not allergic
D
156
Drugs for anaphylaxis reaction
V
157
Emergency management of anaphylactic reaction in adults
F
158
I’m epinephrine
D
159
Oxygen
D
160
Normal saline rapid bolus
D
161
Albuterol ( salbutamol )
D
162
H1 antihistamine
D
163
H2 antihistamine
L
164
Diphenhydramine
D
165
Famotidine
P
166
Methylprednisolne
D
167
Glucagon
D
168
Sulfonamide
Reaction
Treatment
D
169
O
170
Medications in the nonantimicrobial group do not contain ... groups and are associated only rarely with
hypersensitivity reactions.
.
171
not a sulfonamide but can cause hypersensitivity reactions similar to those caused by sulfonamides
V
172
Dapsone
S
173
fever and morbilliform rash, sometimes accompanied by organ involvement, beginning one to two weeks after the start of therapy.
9
174
serum sickness-like reactions and immunoglobulin (Ig)E-mediated allergic reactions.
O
175
Highly associated with the rare blistering reactions Stevens-Johnson Syndrome (SJS) and toxic epidermal
necrolysis (TEN).
I
176
There is minimal evidence of cross-reactivity between the antimicrobial sulfonamides and the nonantimicrobial
sulfonamides.
P
177
the only safe approach if a patient describes symptoms consistent with any type of blistering dermatitis or diffuse erythroderma
I
178
Flouroquinolone
L
179
The two most common types of hypersensitivity reactions to fluoroquinolones
O
180
Cross-reactivity among the fluoroquinolones for this type of reaction appears to be low
V
181
suggest identifying a safe alternative using a graded challenge with a fluoroquinolone, other than the one that caused the reaction
D
182
Patch testing is not useful
G
183
There is evidence of cross-reactivity
D
184
Vancomycin
C
185
Vancomycin infusion reaction VIR:
P
186
Flusing, erythema, pruritus for the upper body usually
P
187
Prevented by administering the drug at rates ≤10 mg/minute (or 1 gram over
more than 100 minutes).
P
188
patients who require higher infusion rate (above 10 mg/minutes or 1 g over
hour): antihistamine premid (can combine anti H1 + H2)
P
189
Vancomycin
Mild
Moderate
Sever
F
190
Macrolide
D
191
Aminoglycoside
S
192
Tetracycline
D
193
Clindamycin
S
194
Metronidazole
D
