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PSA > Drug allergy and anaphylaxis > Flashcards

Drug allergy and anaphylaxis Flashcards

1
Q

what are the 2 ways mast cells can be activated in drug allergy reactions?

A

Via immunoglobulins - IgE
Direct activation - aspirin, contrast media

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2
Q

where can an allergy history be taken from?

A

patient
carer
GP
community pharmacist
care home
medical notes
summary care record

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3
Q

how do you take a drug allergy history?

A

all current meds and recent changes including OTC and injections

generic name for drug suspected of causing reaction

exact signs, symptoms and severity of reaction

when reaction occurred

how long before reaction drug was taken

whether the allergy is a first hand recollection

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4
Q

what 5 things should be documented on the drug chart about an allergy?

A

generic name of drug
relevant non-drug allergies
nature of reaction
signature
Date

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5
Q

what are 5 allergic symptoms?

A

itch
urticaria
hypotension
angioedema
wheeze

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6
Q

what are 4 rashes that can be caused by non-allergic drug reactions?

A

morbilliform rash (like measles)
Erythema multiform (urticarial)
fixed drug eruptions
photosensitivity

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7
Q

what 4 antibiotics are betalactams?

A

penicillins
cephalosporins - cefalexin, cephotaxime
carbapenems - meropenem, impenem
monobactams - aztreonam

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8
Q

what beta-lactam antibiotic is safe in penicillin allergy?

A

Aztreonam

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9
Q

what beta lactams can be prescribed with caution in those with penicillin allergy?

A

3rd generation cephalosporins - cefazidime, ceftriaxone
carbapenems - Meropenem - 1% of penicillin allergies have allaergy to carbapenems

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10
Q

How long should a patient be observed for after anaphylaxis?

A

6-12 hours

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11
Q

what is the dose of adrenaline given to adults and children >12 in anaphylaxis?

A

500 micrograms IM

0.5ml of 1 in 1000

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12
Q

what are 4 conditions that increase risk of drug allergy?

A

HIV
EBV
CMV
CF

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13
Q

what medications may patients with chronic urticaria or mastocytosis be sensitive to?

A

NSAIDs
opioid analgesics

drugs with histamine releaseing properties liek atracurium

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14
Q

what medications are high risk for allergies?

A

beta lactam antibiotics
neromuscular blocking agents
radiocontrast media
NSAIDs
High molecular weight starches

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15
Q

are women or men more at risk of drug allergies?

A

women

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16
Q

what are 7 medications that commonly cause allergic reactions?

A

chlorhexidine
opioids
Antimicrobials
NSAIDs
plasma expanders
muscle relaxants
radiocontrast media

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17
Q

what are 4 ways allergies should be identified in hospital?

A

red wrist band
documentation on drug chart
documentation in notes
documentation in electronic system

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18
Q

what antihistamine is usually used in mild allergic reactions?

A

Chlorphenamine

Mild = no evidence of systemic reaction

19
Q

what is the definition of anaphylaxis?

A

a serious systemic hypersensitivity reaction that us usually rapid onset and may cause death. Characterised by potentially life threatening compromise in airway breathing or circulation

20
Q

what scale can be used to assess the severity of allergic reaction?

A

Sampson severity score

21
Q

what would be a grade 1 sampson reaction?

A

localised pruritus, flushing urticaria, angioedema

oral pruritus, tingling or mild lip swelling

22
Q

what is a grade 3 sampson reaction?

A

grade 2 skin signs - pruritus, angioedema, urticaria

oral signs + repetitive emesis

rhinorrhoea, congestion, sensation of throat tightness or itch

tachycardia (increase >15 BPM)

change in activity + anxiety

22
Q

what would be a grade 2 sampson reaction?

A

generalised pruritus, flushing urticaria, angioedema

grade 1 signs + nausea/vomiting

nasal congestion/sneezing

change in activity leve

22
Q

what is stage 4 sampson reaction?

A

skin signs

Oral signs, vomiting + diarrhoea

congestion, throat tightness, barking cough, difficulty swallowing, cyanosis, wheeze, SOB

Dysarrythmia/mild hypotension

light headed, feeling of pending doom

23
Q

what is a stage 5 sampson score?

A

skin signs

loss of bowel control

respiratory arrest

severe brady, hypotesion, cardiac arrest

LOC

24
Q

what is the dose of adrenaline given in children aged 6-12 in anaphylaxis?

A

300 micrograms

0.3ml 1 in 1000

25
Q

what is the dose of adrenaline given in children 6 months to 6 years in anaphylaxis?

A

150 micrograms

0.15ml of 1 in 1000

26
Q

what is the dose of adrenaline given to children <6 months in anaphylaxis?

A

100-150 micrograms

0.1-0.15ml of 1 in 1000

27
Q

when should a second dose of adrenaline be given if needed?

A

after 5 minutes

28
Q

what medication can be given to treat skin symptoms of anaphylaxis once patient is stable?

A

non-sedating antihistamine e.g. certirizine

29
Q

what is the dose of certirizine for an adult or child over 12?

A

10mg OD PO

30
Q

what is the dose or certirizine for a child aged 2-5?

A

1.5mg BD PO

31
Q

what is the dose of certirizine for a child aged 6-11?

A

5mg BD PO

32
Q

what antihistamine can be given IV or IM?

A

chlorpheniramine

33
Q

what other medications can be given in anaphylaxis to help with breathing?

A

INH or IV salbutamol

ipratropium, amiophylline, magnesium

34
Q

what are 2 complications of IV adrenaline?

A

life threatening arrhythmias
hypertension

35
Q

what is the usual dose of adrenaline in an autoinjector for an adult?

A

300 micrograms

36
Q

what is the follow up for a patient after anaphylaxis?

A

Prednisolone for 3 days
Non-sedating antihistamine for 3 days - as per trust guidelines
Medical allert band
Document allergy
Communicate with GP
warn patient is available over counter
give info leaflet
prescribed 2 adrenaline autoinjectors
report drug reaction via yellow card scheme

37
Q

when should patient with anaphylaxis be referred to specialist?

A

all severe reactions - anaphylaxis, SJS
Reactions during or after anaesthesia
when future management may be complicated by unnecessary avoidance of medications

38
Q

what are the guidelines on use of adrenaline autoinjectors?

A

carry two at all times
call ambulance after every use
lie down and raise legs after administration
do not leave alone

39
Q

what are the 3 adrenaline autoinjecters available in the uk?

A

epipen
emerade
jext

40
Q

when should mast cell tryptase samples be take?

A

ASAP after reaction

1-2 hours later - no longer than 4 hours later

At 24 hours

41
Q

how long should patients be observed for after anaphylaxis?

A

6-12 hours - adults or >16 years

42
Q
A

PSA (8 decks)

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