Drug Hypersensitivity Flashcards Preview

Pharmacology (5th year) > Drug Hypersensitivity > Flashcards

Flashcards in Drug Hypersensitivity Deck (35):
1

Examples of Type 1 reactions

- allergic rhinitis
- asthma
- systemic anaphylaxis
(mast cell activation)

2

Examples of Type 2 reactions

Some drug allergies (penicillin)
(FcR cells)

3

Examples of Type 3 reactions

Serum sickness
(FcR cells, complement)

4

Examples of Type 4a reactions

- Tuberculin reaction
- contact dermatitis
(macrophage activation

5

Examples of Type 4 b reactions

- chronic asthma
- maculopapular exanthema
(eosinophils)

6

Examples of Type 4c reactions

- contact dermatitis
- maculopapular and bullous exanthema
- hepatitis
(T cells)

7

Examples of Type 4 d reactions

- acute generalised exanthematous pustulosis
- Behcet disease
(neutrophils)

8

Mechanism and examples of Type 1 drugs

(IgE- mediated, immediate reaction)
- beta-lactam antibiotics
- neuromuscular blockers

9

Mechanism and examples of Type 2 drugs

(IgG/M- mediated cytotoxic)
- heparin
- methyldopa

10

Mechanism and examples of Type 3 drugs

(IgG/M-mediated immune complexes)
- beta-lactams
- quinidine
- procainamide

11

Mechanism and examples of Type 4a drugs

(Th1 cells activate monocytes via IGN-G and TNF-a)
- topical antibiotics and antihistamines
- local anaesthetics

12

Mechanism and examples of Type 4b drugs

(Th2 cells drive eosinophilic inflammation - IL-5,4,13)
- Rifampicin
- pyrazinamide
- INH

13

Mechanism and examples of Type 4c

(CD41/81 cytotoxic T cells kill targets with perforin)
- Neviropine
- abacavir
- rifampicin
- pyrazinamide
- INH
- carbamazepine
- sulfonamides

14

Mechanism and examples of Type 4d

(T cells recruit and activate neurophils)
- sulfonamides
- tetracyclines
- cephalosporins
- penicillins
- hydroxychloroquine
- NSAIDs
- azoles

15

How does a small molecule induce an immune reaction?

Stimulate innate immune system
- bind to proteins and stimulate cells of IIS

Stimulate specific immune system
- couple to carrier protein to form hapten-protein complex
- complex is precessed by APCs
- modified proteins can induce a humoral immune system by stimulating B cells

16

Drugs that cause majority of adverse reactions

- antibiotics
- general anaesthesia
- ACE-I
- asprin/ NSAIDS
- local anaesthetics
- radio-contrast media

17

Classification of NSAID hypersensitivity

- asprin-exacerbated respiratory disease
- urticaria exacerbated cutaneous disease
- multiple NSAIDS-induced urticaria/ angioedema
- Single NSIADS IgE allergy
- Single NSAIDS T cell reaction (Non-immediate)

18

Discuss ACE-I associated angioedema

- vasodilatory effect due to bradykinin
- not immune-related

19

SCAR reactions
(severe cutaneous adverse drug reactions)

- mobilliform eruptions
- SJS and TEN
- drug rash with eosinophilia and systemic symptoms
- Lichenoid drug eruptions
- AGEP

20

Reactions with Rif

- DRESS, LDE, SJS/TEN
- DILI
- AIN
- anaphlyactoid urticaria/ angioedema

21

Reactions with INH

- DRESS, LDE, SJS/TEN
- DILI

22

Reactions with pyrazinamide

- SJS/TEN, DRESS
- DILI

23

Reactions with ethambutol

- DRESS, SJS/TEN

24

Reactions with fluoroquinolones

Anaphylactoid

25

Reactions with ethionamide

DRESS, SJS/TEN

26

Agents responsible for DILI

- antimicrobials
- dietary supplements
- lipid lowering agents
- antineoplastic drugs
- NSAIDS
- psychotropics
- immunosuppressants

27

Common antimicrobials causing DILI

- amoxil/ calvulanate
- INH
- nitrofurantoin
- Co-trimox
- minocycline
- ciproflox
- azithro

28

How do genetics play a role in DILI?

- N-acetyltransferase 2 and CYP2E polymorphisms associ with anti-TB DILI
- cytokine polymorphisms associ with diclofenac DILI
- HLA associations with Co-amoxyclav DILI

29

Main categories of acute renal failure

- tubular necrosis
- interstitial nephritis
- acute glomerulonephritis

30

Causes of AIN

- antibiotics
- Rif
- herbal/traditional meds
- NSAIDS
- duiretics
- allopurinol
- phenytoin

31

Histological findings in AIN

- intersitial oedema
- diffuse interstitial infiltrate of inflammatory cells (T-cells and eosinophils)

32

AIN pathogenesis

Immunologically mediated hypersensitivity reaction to an antigen

33

Clinical manifestations for drug induced AIN

- rash
- joint pain
- eosinophilia
- eosinophiliuria

34

Features of Rif-induced AIN

- occurs when reintroduced
- not associated with eosinophilia
- flu-like symptoms, flank pain, hypertension, oliguria, ARF
- can also see acute tubular necrosis

35

Treatment of drug-related AIN

- cessation of drug (usually resolves in a few days)
- if not:
- renal biopsy
- high dose prednisone