AP Summer > Allergies and Anesthesia > Flashcards

Allergies and Anesthesia Flashcards

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1
Q

Will add

A

Love you all

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2
Q

What is an allergy?

A

Reproducible adverse reaction to an extrinsic substance mediated by the immune system

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3
Q

What are the 4 types of allergic reactions?

A

Type 1: immediate
Type 2: cytotoxic
Type 3: immune complex
Type 4: delayed

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4
Q

What are some examples of type 1 reaction?

A
    • Atopy
    • Urticaria (hives)
    • Angioedema (swelling)
    • Anaphylaxis
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5
Q

What type of reactions occur because of hemolytic reactions or HIT ?

A

Type 2 (cytotoxic)

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6
Q

What are some examples of type 3 reaction?

A

Serum sickness

– reaction to an injection of foreign proteins

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7
Q

What are some examples of type 4 reaction?

A

Contact dermatitis

– skin reaction because of direct contact with a substance

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8
Q

What is anaphylaxis?

A

An exaggerated response to a foreign substance that is mediated by an antigen-antibody reaction

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9
Q

What is the onset of an anaphylactic reaction?

A

Minutes

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10
Q

What is it about an anaphylactic reaction that makes it unique?

A

It requires a previous exposure to antigen to have a reaction

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11
Q

What is the one most common feature of an anaphylactic reaction that makes it deadly?

A

Circulatory collapse

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12
Q

What is the incidence and mortality rates for an anaphylactic reaction?

A

1:5000

Mortality 6%

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13
Q

What is the mechanism of an allergic reaction?

A
    • Antigen causes stimulation of IgE antibodies
    • Antibodies fix to mass cells and basophils
    • 2nd exposure of antigen results in antibody binding onto mass cells/basophils
    • Binding stimulates degranulation and release of chemical mediators
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14
Q

What are the most common chemical mediators released from mass cells/basophils?

A
  • -Histamine
  • -Leukotriene
    • Prostaglandins
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15
Q

What does histamine release cause?

A
    • Increased capillary permeability
    • Peripheral vasodilation
    • Bronchoconstriction
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16
Q

What does leukotriene release cause?

A
    • Bronchoconstriction
    • Increased capillary permeability
    • Negative iontropy
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17
Q

What does prostaglandins release cause?

A
    • Bronchoconstriction

- - Vasodilation

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18
Q

What resembles anaphylaxis but is not mediated by the immune system and does not involve IgE antibodies?

A

Anaphylactoid reactions

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19
Q

With anaphylactoid reactions, what is the most often cause?

A

Pharmacologic

– Drug has direct action on mast cells/basophils to release large amounts of histamine

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20
Q

Can an anaphylactoid reaction occur on 1st exposure?

A

YES

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21
Q

T OR F

Anaphylactoid reactions clinically are indistinguishable from anaphylactic reactions and are equally life-threatening?

A

TRUE

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22
Q

What are some predisposing factors for anaphylactoid reactions?

A
    • Pregnancy
    • Youth (peds)
    • History of atopy
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23
Q

Under anesthesia, what are some clinical signs your patient is having some sort of reaction?

Study These Flashcards
A
    • Circulatory collapse
    • Pulmonary insults
    • Cutaneous signs
24
Q

What are some indications of circulatory collapse?

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A
    • Profound Vasodilation secondary to decreased SVR
    • Profound hypotension that difficult to fix
    • Tachycardia
    • Pulmonary vasoconstriction / HTN
    • End result, cardiac arrest
25
What are some of the pulmonary insults that can present?
- - Wheezing (heard throughout chest) - - Severe bronchospasm - - Increased PIP - - Laryngeal edema and/or stridor - - Pulmonary edema - - Acute respiratory failure / hypoxia
26
What are some of the signs you can see on the skin?
- - Uticaria (hives) - - Flushing - - Periorbital edema - - Perioral edema
27
What are the basics once a reaction has been identified?
- - Reactions vary in severity and clinical manifestations - - IMMEDIATE recognition and treatment is a must - - AVOID worst case scenario: DEATH
28
What are treatment options/plan of care once a reaction has been identified?
- - Stop administration of antigen - - 100% O2 and PPV - - Discontinue volatile agents - - Intravascular volume expansion - - Epinephrine - - If needed, external cardiac massage (chest compressions)
29
When giving intravascular volume expanders, is it better to give colloids or crystalloids?
-- Colloids | because of increased capillary permeability colloids stay in vascular longer
30
What is the dose for giving intravascular volume expanders?
20 mg/kg boluses | Total: 1-4 L
31
What dose of epi do you administer?
1:10,000 @ 0.1 mL/kg IV == repeat dose every 3-5 min doubling the 2nd dose
32
How does epi help in treating anaphylactic shock?
- - B2 agonist effect relaxes bronchial smooth muscle | - - A agonist effect vasoconstricts blood vessels
33
Once patient has stabilized, what are some secondary treatment options? - - Drug and dose - - What it treats/does/is in parentheses
- - Diphenhydramine 0.25-1 mg/kg (Antihistamine) - - Hydrocortisone 8 mg/kg (Corticosteroid) - - Albuterol ( Inhaled bronchodilator) - - Aminophylline (Bronchospasm) - - Bicarb (as needed for acidosis) - - Inotrope infusion as needed for BP
34
What are some immediate post-op management goals after a reaction?
- - Admit to ICU - - Clotting screen and blood gases - - Airway evaluation before extubation
35
What are the different types of skin test available for reactions?
- - Intradermal - - RAST (radioallergosorbent test) - - ELISA (enzyme linked immunosorbent assay)
36
What is difference in RAST and ELISA?
- - RAST tests patient serum against specific IgE antibodies | - - ELISA measures antigen specific antibodies
37
What are some common offenders of causing reactions in the OR?
- - Muscle relaxants (most common) - - Induction drugs - - LA - - Opioids - - Antibiotics - - Latex - - Halothane and others
38
What are 2 most common muscle relaxants to cause reactions?
- - Succ | - - Atracurium
39
T OR F | There is a cross reactivity between sux and ND muscle relaxants?
TRUE
40
What is the unique thing with reactions and induction drugs?
Anaphylaxis may occur even after previous uneventful drug exposure
41
Do the barbiturates cause reactions?
Very rare, but when they do occur very life threatening
42
Are patients truly allergic to propofol?
Not likely, most likely due to other allergies (egg, soy, etc)
43
What is true with LA(local anesthetics) and reactions?
True allergic reactions rare | Most reactions are just adverse effects
44
Are esters or amides more likely to cause the reaction?
Esters because they are metabolized by PABA
45
What is the main opioid reaction we are concerned with?
Morphine | causes direct histamine release along with arterial and venous dilation
46
What is the only class of drug that brings about true anaphylaxis reactions?
Antibiotics
47
What is the cross sensitivity of PCN and cephalosporins (ancef)?
1-2% | but still err on side of caution
48
Vancomycin produces which type of reaction?
- - Produces both | - - However anaphylactoid most common and causes redman's syndrome
49
What is the only anaphylactic reaction that has delayed onset?
Latex
50
What is the time frame before you will begin to see symptoms?
30-40 min after exposure
51
What are the high-risk patient populations that may have cross sensitivity to latex?
- - Spina bifida | - - Healthcare workers
52
Halothane has a direct correlation to what adverse outcome?
Hepatitis
53
What are some allergic symptoms brought on by halothane?
--Eosinophilia --Rash --Fever (Prior exposure to halothane increases these risks)
54
What are other things that can cause a reaction?
- - Blood products (around 3%) - - IV Contrast - - Protamine - - High risk patient population (allergy to seafood, diabetic)
55
T OR F | True anaphylaxis is rare when given anesthetic agents
TRUE
56
T OR F | Anaphylactoid reactions occur much more commonly?
TRUE
57
What is the key to preventing death when your patient has a reaction?
- - Have a high index of suspicion - - Prompt recognition - - Aggressive treatment
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