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(Quality Conference) 4/2556

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17 2556 13.00 - 15.00 .

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Quality Conference ..

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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)

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2. ADR sticker

3. ADR report summary

4.

5. Removable ADR sticker/IPD chart

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6. Wrist band

7.

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2.

3.

4.

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