Drug Allergy Interview

Exercise 1

Objectives:

1. To conduct an interview with a patient admitted in a hospital

regarding any drug or food allergy.

2. To be able to identify from patients history what are possible indications of the presence of
allergy.

3. To prepare an allergy card.

4. To fill out allergy sheet properly.

Procedure:

1. Secure an allergy sheet. Conduct an allergy interview with 5 people

you know.
2. Prepare guide questions before hand and politely inquire from patient any presence of
allergy in the past history and present history.
3. Prepare the allergy card in a ½ index card. Put necessary information of patient allergy on
food using blue ballpen and red ballpen for any drug allergy.
4. Be sure to place this card on the first page of the patient’s medical chart for the doctor to
see.
Questions:

1. What is allergy? What are the possible causes of allergy?

- Allergies are an immune response triggered by allergens some ordinarily harmful
substances such as medication, pollen, bee venom or food.
2. Give mechanism of action of any drug used to alleviate allergy.
- Antihistamines are used to relieve or prevent the symptoms of colds, hay fever and
allergies. They block histamine w/c is released by the body when we are exposed to
harmful substances that cause allergic reactions.
3. Discuss the different types of hypersensitivity reactions.
- Type I: reaction mediated by IgE antibodies.
- Type II: cytotoxic reaction mediated by IgG or IgM antibodies.
- Type III: reaction mediated by immune complexes.
- Type IV: delayed reaction mediated by cellular response.
4. What is the drug of choice for anaphylactic shock caused by drug allergy? Illustrate the
mechanism of action.
- Epinephrine is the drug of choice for treating anaphylaxis

5. Describe or illustrate the mechanism of action of prednisone in blocking the production of

IGE.

6. Submit the following:

a. Patient drug profile
b. Filled allergy sheet
c. ½ index allergy card
 MEDICATION PROFILE

Patient Number: 1 Date:

Patient Name: Age: Sex:
Address:
Allergies:

Date Name of Dose Route Started on Stopped on

Drug

Patient Number: 2 Date:

Patient Name: Estrella Esquijo Age: 32 Sex:F
Address: Palattao, Naguilian, Isabela
Allergies: Antibiotic

Date Name of Dose Route Started on Stopped on

Drug

Patient Number: 3 Date:

Patient Name: Age: Sex:
Address:
Allergies:

Date Name of Dose Route Started on Stopped on

Drug

Patient Number: 4 Date:

Patient Name: Age: Sex:
Address:
Allergies:

Date Name of Dose Route Started on Stopped on

Drug
 Patient Number: 5 Date:
Patient Name: Age: Sex:
Address:
Allergies:

Date Name of Dose Route Started on Stopped on

Drug

Recorded by:

Checklist for Drug Allergy Interview

Interviewer will ask the patient the particular drugs he has been allergic to under such
category:

Antibiotics Analgesics, Anti- Sulfas Local X-ray Dyes for others

antipyretics rheumatics Anesthetic IVP, IV
s Cholangiogram,
others
Patient 1
Patient 2
Patient 3
Patient 4
Patient 5

1.
 Drug Interaction
Exercise 2

Objectives:

1. To classify the drugs that is commonly causing interaction.

2. Identify the object drug and the precipitant drug.

Procedure:

1. Prepare a clean sheet of paper. Look at the drug and fill up the table below what is being
asked for.
2. Identify the pharmacologic classification of the drugs given.

3. Choose which between the drugs are the object drug and the precipitant drug.

4. Indicate the potential adverse effect of the object drug.

Drug Object drug Precipitant drug Drug Potential ADR

Interaction

1. food, amoxicillin Amoxicillin Food(grapefruit Enzyme Increase risk of

capsule capsule juice) induction toxicity

2. acyclovir,
cyclosporine

3. phenytoin, Corticosteroid Phenytoin Enzyme

corticosteroid induction

4. rifampicin, Hypoglycemic Rifampicin Enzyme Decrease

hypoglycemic induction efficacy of
plasma levels

5. barbiturates, TCA barbiturates Enzyme

TCA induction

6. erythromycin, carbamazepine erythromycin Enzyme Toxicity of

carbamazepine inhibition object drug

7. Enzyme
chloramphenicol, inhibition
paracetamol
 8. theophylline, theophylline phenytoin Enzyme
phenytoin induction

9. alcohol, Alcohol Cimetidine Enzyme Increase blood

cimetidine inhibition level of object
drug

10. corticosteroid, Corticosteroids nortriptyline Enzyme

nortriptyline induction

11. doxycycline, Cyclosporine Doxycycline Enzyme

cyclosporine induction

12. coumarins phenylbutazone Enzyme Increase

phenylbutazone, inhibition anticoagulant
coumarins activity

13. probenecid, Methotrexate probenecid Elevated

methotrexate plasma levels of
acidic drugs
risks of toxin
reactions

14. ASA, penicillin

15. naloxone,
opioid analgesic

Questions:

1. Explain what will happen to an antihypertensive patient taking MAOIs if he/she consumed
wine and cheese.
2. List the drugs that can cause ototoxicity due to drug interaction.
3. What is SLE?
4. List 20 drugs (each category) that are contraindicated/ monitored for the following:
(a) pregnant women,
(b) CKD/Renal Diseases, and
(c) Liver diseases

Category Drug Potential Adverse Monitoring

Effect Procedure (if
in case, that
the drug is
needed in
therapy)
Pregnant 1. Aminoglycosides(Amikacin, Fetus: Do not use in
women Gentamicin and Tobramycin) ototoxicity/deafness pregnancy not
unless the
benefit
outweighs the
risk of fetus
2. Macrolides Fetus:
cardiovascular
abnormalities and
cleft palate w/
Clarithromycin
3. Tetracycline’s Fetus: Not
hypospadias(1st recommended
trimester only), in pregnancy
inguinal hernia,
limb hypoplasia,
cleft palates
4. Clindamycin Increase in neonatal
infection and low
birth weight seen w/
vaginal preparation
5. Metronidazole(Flagyl) Spontaneous Safe for use
abortions, low birth only in 2nd and
weight babies and 3rd trimester
carcinogenic
possibilities
6. Sulfamethoxazole (SMX)/ Fetus: SMX: Not
jaundice, hemolytic recommended
anemia and possibly in pregnancy
kernicterus
7. trimethoprim (TMP) Fetus: TMP: neural Not
tube defects(NTD), recommended
oral clefts, cardiac in pregnancy
defects & urinary
tract defects
8. Warfarin (coumadin) Birth defects
9. Nitrofurantoin(Macrobid) Fetus: hemolytic
anemia
10. Carbamazepine(Tegretol) Cardiac effects,
mild mental
retardation
11. ACEI Renal damage
12. Barbiturates Neonatal
dependence
13. Fosphenytoin(Cerebryx) Congenital
malformations,
 cardias effects
14. Lamotrigine(Lamictal) Frequency of major Human data
defects among 1st suggest low
trimester risk; adjust
dose to
maintain
clinical
response
15. Phenobarbital(Luminal Congenital defects, Risk during at
sodium) hemorrhage at birth lowest
effective level
16. Phenytoin(Dilantin) Fetus: congenital Maintain
abnormalities, lowest level
hemorrhage at birth, required to
neurodevelopment prevent
abnormalities seizures in
Maternal: folic acid order to lessen
deficiency risk of fetal
anomalies
17. Chloramphenicol Gray baby
syndrome
18. ciprofloxacin Miscarriage
19. Codeine Withdrawal
symptoms
20. clonazepam Withdrawal
symptoms
 Patient Diagnosis: Signs and Symptoms
Exercise 3

Objective:

1. To distinguish between signs and symptoms in assessing a patient.

2. To list key signs and symptoms of common diseases.
3. To provide illustration on how conducting physical assessment.

A. SIGNS AND SYMPTOMS

Procedure:
1. Answer the questions given to facilitate table given.
2. Identifying the signs and symptoms presented by diseases below. Answer concisely and
clearly. Use a dash(-) or asterisk(*) in listing your answers. Write your answers in a clean sheet
of paper.
3. Take a picture of your answers or scan them.
4. Submit to my email with subject name: SURNAME, EXERCISE 3A

Name:
Activity title: EXERCISE 3A
Date Submitted:

Diseases Signs Symptoms

1. Peptic Ulcer Disease
2. Crohn’s Disease
3. Ulcerative Colitis
4. Acute Kidney Injury
5. CKD & End-Stage Renal Disease
6. Hypertension
7. Coronary Heart Disease
8. Dyslipidemia
9. Asthma
10. COPD
11. Parkinson’s Disease
12. Schizophrenia
13. Anxiety
14. Epilepsy
15. UTI
16. TB
17. HIV
18. Hyperthyroidism
19. DM 1, DM 2, DM 3
20. Anemia
 21. Leukemia
22. Lymphoma
23. Rheumatoid Arthritis
24. Osteoporosis
25. Gout and Hyperuricemia
26. Constipation and Diarrhea
27. Liver Disease
28. Arrythmias
29. Thrombosis
30. Insomnia
31. Eczema
32. Psoriasis
33. Prostate Disease
34. Infective meningitis
35. Glaucoma

B. VITAL SIGNS AND PHYSICAL ASSESSMENT

Procedure:
1. Below are lists of Physical Assessments in evaluating patients upon interview. Act the
physical assessment and document your actions.
2. The documented pictures must be compiled in (1) Microsoft word file/WPS (whichever is
applicable).
3. If the material to conduct the activity is not available to you, you may use any object or
substitute to show how the procedure is being done.
4. Submit to my email with subject name: SURNAME, EXERCISE 3B
5. Format for file contents:

Name:
Activity title: EXERCISE 3B
Date Submitted:

1. Physical Assessment: _________________

Picture
sample
Physical Assessment Activity:

1. Taking body temperature, height and weight

2. Auscultation
3. Palpation of extrajugular vein
4. Percussion of stomach (show position of hands in tapping)
5. Inspection of tonsils
6. Testing for skin turgor
7. Patient draped and sitting (pharmacy student facing)
8. Patient draped and sitting (pharmacy student to right and back)
9. Patient draped and supine (physician to the right)
10. Test for lid lag

Questions:

1. What is a sign? A symptom?

2. Give 5 examples of symptoms that are expressed by patients that may be as chief compliant or
as a response to concurrent medications.

3. Give 5 examples of practices in listing the signs during history taking from patients.

4. What is a disease?

5. What is a syndrome?

6. Draw the Sprague stethoscope. Label and indicate the use of its parts.
 Diet and Modification List

Exercise 4

1. Provide the recommended diet for the following disorders:

a) Gastritis
b) Peptic ulcer
c) Vomiting
d) Diarrhea
e) Cirrhosis with hepatic insufficiency/ encephalopathy
f) Stable cirrhosis patient
g) Hepatitis
h) Gallbladder disease
i) Hyperlipidemia
j) Hypertension/CHF/MI/CAD/Atherosclerosis
k) Acute renal disease
l) Chronic renal disease
m) Kidney stones
n) Nephrotic syndrome
o) COPD
p) TB
q) Cancer
r) Food sensitives
s) Obesity, overweight
t) Stroke
u) Underweight
2. Give the 10 Diet Modification and food lists.
 Case Studies
Exercise 5

Procedure: Answer the case comprehensively.

A7-year-old girl is seen in the hospital pediatric outpatient clinic. She is known to have cystic
fibrosis and has had several exacerbations in the past which have been treated with flucloxacillin.
On this visit she is stable, but a report of sputum culture received two days after the clinic shows
a growth of P.aeruginosa.

Questions
1. What treatment should be started?
2. What other options are available? One week later, you receive a telephone call from
the parents that she has become unwell and they suspect she has another chest infection.
3. What agents might be appropriate in treating the infection?

Case Studies
Exercise 6

Procedure: Answer the case comprehensively.

A 72-year-old man with a known history of COPD presents to the hospital accident and
emergency department with increasing breathlessness. He has a cough productive of cream
coloured sputum which is normal for him. He has not noticed an increase in purulence or
volume. Chest X-ray showed hyperinflated lungs but no focal consolidation, and a diagnosis of
acute exacerbation of COPD was made.

Questions
1. How should this patient be managed?
2. What investigations would inform the diagnosis?

Case Studies
Exercise 7

Procedure: Answer the case comprehensively.

A 70-year-old man who is a lifelong non-smoker presents to his GP with recurrent chest
infections.He has been experiencing a cough productive of sputum which is occasionally blood-
stained for several months. He also complains of increasing breathlessness.He has had no relief
from several courses of antiblotics.Chest examination is unremarkable.The following day the
local microbiology laboratory reports the presence of acid-fast bacilli in the sputum.

Questions
1. What is the likely diagnosis?
2. What are the next steps in the management of this patient?

Case Studies
Exercise 8

Procedure: Answer the case comprehensively.

A woman in her mid-2Os is diagnosed as having sputum smear-negative pulmonary TB.

Although she initially takes her anti-TB drugs, she does not attend follow-up clinics and her
condition deteriorates. Her primary care doctor collects a sputum sample from her and persuades
her to attend the chest clinic. The sputum smear is now positive and it is found she has continued
to work, despite being advised not to do so.

Questions
1.What type of treatment regimen should be offered to this patient?
2. Who should be involved in planning this treatment regimen, and what arrangements
should be put in place to ensure this works?
3. Should the patient's work contacts be screened?

Case Studies
Exercise 9

Procedure: Answer the case comprehensively.

A man in his 40s is referred to a chest physician with a cough productive of sputum and a fever.
A chest x-ray indicates bilateral pneumonia with apical involvement. A sputum smear reveals the
presence of acid, alcohol-fast bacilli. His physician considers that TB is the most likely clinical
diagnosis. This is subsequently confirmed microbiologically. The patient does not comply with
treatment and needs to be admitted to hospital, but refuses. There are indications he might be
disruptive if admitted into hospital.

Questions
1. What form of TB does this patient have?
2. What can be done to compel his admission to hospital?
3. Which groups of healthcare staff should be involved in arrangements for his admission
to hospital?
 Case Studies
Exercise 10

Procedure: Answer the case comprehensively.

Ms A is a 21-year-old UK-born pharmacy student who presented to her primary care doctor with
a rash, swollen glands and flu-like illness.A presumptive diagnosis of swine flu was made. She
was given a course of oseltamavir (Tamiflu®) and her symptoms largely resolved over the
following 2 weeks.Two months later,her male partner attended his dentist for a routine check up
and was found to have oral candidiasis. He had no obvious predisposing factors and his dentist
thus suggested that he have an HIV test, which was positive. As a result of this, Ms A was
advised to have a test and was subsequently found to be HIV positive too, with a CD4 count of
420 cells/mm3 and a plasma HIV RNA (viral load) of 610,000 copies/mL. One year after her
diagnosis, Ms A has had two consecutive CD4 counts below 350 cells/mm3 (the latest being
310) and a viral load of 50,000-95,000 copies/mL. She is advised to start antiretroviral therapy
and plans to do this in a few weeks as soon as she has finished her final exams. She currently
takes no medication and uses condoms for contraception/ sexually transmitted infection
prevention. You are part of the multidisciplinary team which will recommend the regimen to be
offered/prescribed.

Questions
1. What is the most likely diagnosis for the illness Ms A initially presented with to her,
primary care doctor?
2. What baseline investigation results would you need to inform your choice of
antiretroviral therapy?
3. What would you do if there was a need to start therapy urgently and these results were
not available?
4. Assuming all results were normal, which antiretroviral therapy regimen would you
suggest and why?
5. What are the main counselling points to discuss with Ms A when she starts
antiretroviral therapy?

Case Studies
Exercise 11

Procedure: Answer the case comprehensively.

Mr FT,a 67-year-old retired bank manager, has COAG in both eyes and a history of herpes
simplex infection of theright eye. His IOP has been controlled on timolol eye drops 0.5% twice a
day in each eye which he tolerates well.At this appointment, the optometrist working in the
hospital's clinic noted an increased IOP in the right eye and deterioration in the visual field in
that eye.She feels that Mr FT requires an additional ocular hypotensive agent in his right eye and
asks the ophthalmologist in the clinic for an opinion.

Question

1. What treatments should the ophthalmologist consider for Mr FT?

Case Studies
Exercise 12

Procedure: Answer the case comprehensively.

Mrs TM is a 36-year-old married lady who has type 1 diabetes. She undertook a home pregnancy
test because she was feeling particularly nauseated in the mornings and her period was late. The
test was positive confirming that she was pregnant. However, at 8 weeks, she experienced
vaginal bleeding and abdominal pain. She attended the Accident & Emergency
department,where a miscarriage was confirmed. Upon questioning,it was discovered that she had
been taking folic acid 400 μcg daily for the previous 6 months but had not received any pre-
conception diabetes care. Her most recent HbA, sem 7.3%(56mmol/mol). Her regular
medications are ramipril 10mg daily, simvastatin 40mg daily, insulin glargine at night and
insulin aspart three times daily with meals.

Questions
1. Why should women of childbearing age be offered advice about pregnancy?
2. What blood glucose targets should Mrs TM have been advised to aim for before and
after conceiving?
3. Was she taking appropriate dietary supplements prior to conception?
4. What advice should she be given with respect to her regular medication?

Case Studies
Exercise 12

Procedure: Answer the case comprehensively.

Mr LG is a 47-year-old man with type 2 diabetes.He has recemly had basal insulin (insulin
detemir) added into his other diabeten medicines:metformin modified release 1 g twice a day and
gliclazide 80mg twice a day. He complains of waking witha headache and feeling 'groggy' and
unrested in the morning.Hi recent blood glucose readings have generally been very good
although his before breakfast readings are 10-13mmol/L.He is worried because he is feeling
worse since he started insulin, even though his blood glucose levels are much improved.He has
made an appointment with his primary care doctor. His primary care doctor suspects nocturnal
hypoglycaemia may be causing his recent symptoms.
 Questions
1. What is nocturnal hypoglycaemia?
2. Why might nocturnal hypoglycaemia cause raised blood gluctase levels in the
mornings?
3. How can the diagnosis of nocturnal hypoglycaemia be confirmed?
4. How should it be treated?

Case Studies
Exercise 13

Procedure: Answer the case comprehensively.

A 33-year-old woman has been diagnosed with endometriosis having presented with severe
dysmenorrhoea. She has visited the gynaecology clinic to discuss treatment options but is very
concerned about her fertility. She does not wish to conceive at the present time but would
certainly plan to try for a baby in the next couple of years.

Questions
1. What effect does endometriosis and its treatment have on fertility?
2. What treatment options could be considered?

Case Studies
Exercise 14

Procedure: Answer the case comprehensively.

Mr TH is a 50-year-old, slightly over-weight (95 kg) male who presents with an extremely
painful big toe. He states that the pain started suddenly in the early hours of the morning and that
he cannot even bear to put a sock over his foot. He can think of no recent trauma to his foot. He
has no other symptoms and there is no previous significant medical history apart from high blood
pressure for which he takes bendroflumethiazide (2.5mg in the morning). On examination, the
toe is red, hot, swollen and extremely painful on palpation. The patient also has an elevated
blood pressure of 150mm/95 mmHg. On questioning about his weekly alcohol intake, he states
thathe usually does not exceed 21 units/week, but that it was a friend's 50th birthday party
recently and he might have had considerably more to drink than usual. Blood results show a
slightly raised C-reactive protein, other parameters are normal including renal function; however,
his serum urate is slightly raised (390μmol/L). A diagnosis of acute gout is made.

Questions
1. What initial therapy would you recommend to treat the patient's acute attack of gout?
2. What risk factors could have contributed to the acute attack?
3. Should this patient be placed on therapy to prevent further attacks?
4. What lifestyle and dietary advice would you give to the patient to assist in preventing further
attacks?

Case Studies
Exercise 15

A 56-year old Hispanic woman presents to her medical practitioner with symptoms of fatigue,
increase thirst, frequent urination, and exercise intolerance with SOB of many month’s duration.
She does not get regular medical care and is unaware of any medical problems. Her family
history is significant for obesity, diabetes, blood pressure,and coronary artery disease in both
parents and several siblings. She is not taking any medications. Five of her six children had a
birthweight of over 9 pounds. Physical examination reveals a BMI (body mass index) of 34,
blood pressure of 150/90 mm Hg, and evidence of mild peripheral neuropathy. Laboratory tests
reveal a random blood sugar of 261 mg/dL; this is con-firmed with a fasting plasma glucose of
192 mg/dL. A fasting lipid panel reveals total cholesterol 264 mg/dL,triglycerides 255 mg/dL,
high-density lipoproteins 43 mg/dL, and loW-density lipoproteins 170 mg/dL. What type of
diabetes does this woman have? What further evaluations should be obtained? How would you
treat her diabetes?

2. Fill up the table below: Identify the bioavailability of insulin after SQ injection

Onset Peak Duration

Short-acting (R)
Intermediate (N)
Long-acting (L)