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1
(Quality Conference) 4/2556
...
17 2556 13.00 - 15.00 .
7
:
Quality Conference ..
.
1. Contrast media Iopromide (Ultravist), Iohexol (Omnipaque), Iobitridol
(Xenetix)
2. Phenytoin (Dilantin)
3. Antibiotic Ceftriaxone, Clindamycin, Meropenem, Vancomycin,
Amoxicillin+clavulanic acid (Augmentin, Cavumox), Dicloxacillin
4. NSAIDs Ibuprofen
2
1. Amoxicillin Amoxicillin + clavulanic acid (Augmentin, Cavumox),
Amoxicillin, Dicloxacillin
2. Ibuprofen Naproxen, Ibuprofen
3. Tramadol Tramadol, Tramadol + paracetamol (Ultracet)
Beta-lactams
Beta - lactams
1.1 Penicillins: cillin
Penicillin V: Pener
Dicloxacillin: Dicloson, Dorox, GPODiclox
Penicillin G: PenG Sodium, Retarpen
Cloxacillin: Cloxalin
Amoxicillin: Moximo, Ibiamox
Ampicillin + Sulbactam : Sulbaccin, Unasyn
Amoxicillin + Clavulanic: Cavumox,
Ranclav, Augmentin, Curam
Piperacillin+Tazobactam: Astaz-P , Tazocin
Penicillins Penicillins
3
1.2 Cephalosporins 4 generation 1st generation
Cephalexin : Keflex, Sialexin, Toflex
Cefazolin : Zefa M.H.
2nd generation
Cefaclor: Distaclor
Cefminox: Meicelin
Cefuroxime : Zinnat, Zinnacef, Furoxime, Magnaspor
Cefoxitin: Cefoxin
3thgeneration
Ceftriaxone : Rocephin, Cef-3, Cef-zon, Ceftrex
Ceftibuten: Cedax
Ceftazidime : Fortum, Zeftam M.H.
Cefixime: Cefspan, Sixime
Cefdinir: Omnicef, Samnir
Cefotaxime:Clarforan, Claraxim
Cefoperazone+Sulbactam: Sulperazone, Bacticep
4
4th generation
Cefipime: Maxipime, Cefamax
Cephalosporins
Penicillin Cephalosporins 1st & 2nd generation generation
1.3 Carbapenems : penem
Imipenem: Tienam
Ertapenem: Invanz
Doripenem: Doribax
Meropenem : Penem M.H., Meronem
5
ImipenemMeropenem Ertapenem,
Doripenem Carbapenem
Penicillins Carbapenems 2
9.2 -11%
1.4 Monobactam
Penicillin Cephalosporin
Cephalexin (Sialexin, Keflex), Cefazolin (Zefa M.H. ) Cefaclor (Distaclor)
Penicillins Anaphylactic
reaction, Steven Johnson Syndrome, Toxic Epidermal Necrolysis (TEN), DRESS
Beta lactam
Sulfa
Sulfa Sulfonamide antibiotics
Sulfonamide Sulfa Sulfa
8% ADR
Sulfa Sulfa
2 Cephalosporins
sulfonamide
Sulfonamide 2
2 Sulfonamide
6
sulfonamides
Sulfonamide
1. Sulfonamide antibiotics
Sulfapyridine (Sulfasalazine; Salazopyrin EN)
Sulfadiazine
Sulfamethoxazole (Bactrim)
2. Sulfonamide non-antibiotics
Loop diuretics
- Furosemide (Lasix) - Torsemide (Unat)
Thaizide diuretics - - Hydrochlorothaizide (HCTZ) - - Indapamide (Natrilix)
Carbonic anhydrase inhibitors - Acetazolamide (Diamox) - Dorzolamide (Cozopt) - Brinzolamide (Azopt,Azagra)
Cox-II inhibitors - Celecoxib (Celebrex) - Parecoxib (Dynastat)
Sulfonylureas - Chlorpropamide (Diabenese) - Glibenclamide (Daonil)
- Glipizide (Minidiab)
- Gliclazide (Diamicron)
- Glimeperide (Amaryl)
Others - Topiramate (Topamax) - Dapsone - Zonisamide (Zonigrane)
7
: Sulfa Sulfonamide antibiotic
2 Cephalosporins
Sulfonamide non-antibiotics Sulfa
Sulfonamide non-antibiotic Sulfa
(Cross reactivity of antiepileptic drug)
Drug hypersensitivity syndrome (DHS)
drug reaction with eosinophilia and systemic symptoms (DRESS)
DHS DRESS
47.4 % (aromatic antiepileptic drug)
Drug hypersensitivity syndrome (DHS) drug reaction with eosinophilia and
systemic symptoms (DRESS)
- 38-40
- (mp rash)
- 1
- 2 .
- AST/ALT
- (nephropathy)
- eosinophil 1,500 /.
- Barbiturates Phenobarbital, Primidone , Mephobarbital
- Benzodiazepines Clonazepam, Clorazepate, Diazepam, Lorazepam
- Hydantoins Phenytoin, Fosphenytoin, Mephenytoin, Ethotoin
8
- Others Carbamazepine, Oxcarbazepine, Valproic acid, Lamotrigine,
Topiramate, gabapentin, etc
Aromatic ring
Arene oxide
Aromatic
aromatic ring metabolite arene oxide
aromatic antiepileptic drug
40 - 58% carbamazepine aromatic
(P
9
aromatic Antiepileptic drug (AED)
non-aromatic antiepileptic drug
Topamax Topiramate Depakine (Valproate sodium)
Gabapentin sandoz, Neurontin (Gabapentin) Keppra (Levetiracetam)
Pruritus, Rash, MP rash, Urticaria
closely observe
Carbamazepine aromatic Antiepileptic drug (AED)
Anaphylaxis, Drug hypersensitivity, Drug rash with
eosinophilia and systemic symptoms (DRESS), Steven Johnson Syndrome, Toxic Epidermal
Necrolysis consult allergy Grade challenge
Desensitization
10
NSAIDs (Cross hypersensitivity of NSAIDs)
NSAIDs 2
1. Immediated type
2. Delayed type
1. Immediated type
NSAIDs Immediated type Urticaria,
Angioedema, Anaphylaxis
Immediated type 2
1.1 Pseudoallergy
IgE
1.2 True allergy urticaria, angioedema
anaphylaxis
11
Pseudo allergy True allergy
Pseudo allergy True allergy
Urticaria, Angioedema, Anaphylaxis
Urticaria, Angioedema, Anaphylaxis
Cox I (PGE2 )
(IgE)
Cox I
NSAIDs Cox I
NSAIDs /
NSAIDs 7
1 Salicylic acids
Cardiprin 100 Aggrenox
B-aspirin Ascot
2 Indol and indene acetic acids
Indomed Clinoril
12
3 Hetero acetic acids
Voltaren Voltaren SR Dosanac
Ketalac Voltaren
4 Arilpropionic acids
Synflex, Napxen, Napxen Loxonin
Nurofen Heidi 200 mg 400 mg
5 Fenamates
Ponstan Idarac
6 Oxicams
Feldene-D Tilcotil, Seftil
13
Feldene, Flamic Mobic, Melcam
7 Cox II inhibitor
Celebrex Arcoxia
Dynastat
1.1 NSAIDs Pseudoallergy Cox I
PGE2 (PGE2 Mast cell stabilizer) Histamine
Mediators Cox I
14
1.2 NSAIDs True allergy
NSAIDs True allergy
(IgE) 1 >1
NSAIDs True allergy
NSAIDs
2. Delayed type
NSAIDs Deleyed type MP rash, Fixed
drug eruption, DRESS, Drug hypersensitivity syndrome, SJS, TEN
True allergy
Fixed drug eruption
Oxicams NSAIDs
NSAIDs NSAIDs
15
NASIDs 2
1. Immediated type 2
1.1 Pseudo allergy
1.2 True allergy
NSAIDs
True Pseudo allergy NSAIDs >1
NSAIDs Cox I Cox II inhibitor
Cox I Cox II ( 4%)
NSAIDs 1 >1 NSAIDs
2. Delayed type True allergy
NSAIDs
:
1. (Adverse drug reaction: ADR card)
16
2. ADR sticker
3. ADR report summary
4.
5. Removable ADR sticker/IPD chart
17
6. Wrist band
7.
..
1.
2.
3.
4.
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