NAPLEX: Pharmacy Foundations Part 2 → ↑ ↓ Exam 100% Correct Answers

Type A adverse drug reaction (ADR) -ANSWER- = predictable → dose-dependent + related to pharmacological actions of the drug Type B adverse drug reaction (ADR) -ANSWER- = unpredictable → NOT dose-dependent + can be influenced by patient-specific factors -allergies (immune mediated response) -pseudoallergic reactions (itching after opioid admin, vanco infusion reaction) -drug intolerances (N/V) -idiosyncratic reactions (SJS) Type I Reaction -ANSWER- → type of drug allergy IgE-mediated → immediate (within 60 min) Type II Reactions -ANSWER- → type of drug allergy Antibody-mediated → occurring several days (5-8) after exposure Type III Reaction -ANSWER- → type of drug allergy Immune complex reaction → at least 1 week post exposure Type IV Reactions -ANSWER- → type of drug allergy Cell-mediated or delayed hypersensitivity → 48 hours to several weeks after drug exposure (SJS) Drugs that are commonly associated photosensitivity -ANSWER- -Amiodarone -thiazide & loop diuretics -Methotrexate -retinoids -quinolones -St. John's Wort -Sulfa antibiotics -Tacrolimus -tetracyclines -Voriconazole Drugs that are commonly associated with TTP -ANSWER- TTP = thrombotic thrombocytopenic purpura -oral P2Y12 inhibitors (clopidogrel) -sulfamethoxazole Drugs that are commonly associated with severe skin reactions -ANSWER- Severe skin reaction →→→ can be LIFE THREATENING SJS = Stevens-Johnson Syndrome TEN = Toxic epidermal necrolysis DRESS = drug reaction with eosinophilia and systemic symptoms -abacavir -allopurinol -carbamazepine -ethosuximide -lamotrigine -modafinil -nevirapine -penicillins -phenytoin -sulfamethoxazole Beta-lactam allergy -ANSWER- On NAPLEX exam → if patient is allergic to any beta-lactam → avoid other beta-lactams unless no other acceptable alternative Sulfa Allergy -ANSWER- Reported sulfa allergy → avoid... -sulfasalazine -thiazide diuretics -loop diuretics -sulfonylureas -acetazolamide -zonisamide -celebrex -darunavir (Prezista) "Sulfite" or "sulfate" allergies DO NOT cross react with a "sulfa" allergy Peanut and soy allergies -ANSWER- Drugs contraindicated with a soy allergy: -clevidipine (Cleviprex) -propofol (Diprivan) Egg Allergy -ANSWER- Drugs to avoid: -clevidipine (Cleviprex) -propofol -yellow fever vaccine Drugs that have non-linear kinetics -ANSWER- → saturable kinetics (rate of metabolism becomes saturated at higher doses) -phenytoin -theophylline -voriconazole Pharmacogenomic testing -ANSWER- HLA = human leukocyte antigen → HLA-B (+) HLA-B → do NOT use drug Abacavir genomic testing -ANSWER- -test ALL patients prior to initiating HLA-B*5701 → positive → fatal hypersensitivity reaction Abacavir combo drugs → Triumeq, Epzicom Allopurinol genomic testing -ANSWER- -consider testing high risk patients (Korean, Han, Thai) HLA-B*5801 → positive → risk of SJS → stop drug at 1st sign of allergic rxn/rash HLA-B*1502 genomic testing -ANSWER- -carbamazepine -oxcarbazepine -phenytoin -fosphenytoin -test all Asian patients prior to starting carbamazepine → optional for other agents Positive → SJS and TEN KRAS mutation -ANSWER- -cetuximab (Erbitux) + other EGFR inhibitors Positive KRAS mutation → DO NOT use this drug → ineffective cancer treatment in this mutation HER2 Gene expression -ANSWER- -Traztuzumab (Herceptin) → + other HER2 inhibitors Drug class requires OVER expression of HER2 to be efficacious Negative HER2 → DO NOT use drug → tumors do not respond to therapy Azathioprine genomic testing -ANSWER- TPMT = thiopurine methytransferase ↓ TMPT activity →→→ ↑ risk of life-threatening myelosuppression