Page 1813 - Hall et al (2015) Principles of Critical Care-McGraw-Hill

1282 PART 11: Special Problems in Critical Care

1. Patient develops a
possible adverse drug
reaction

2. Review of medical history, records,
physical exam, and clinical tests support
the occurrence of a drug-induced
reaction

No 4. Nonimmune adverse event,(eg, toxicity,
3. Drug- side effect, drug interaction), idiosyncrasy,
induced hyper- intolerance or pseudoallergic effect of the drug
sensitivity/
immunologic
reaction
suspected 4a. Management:
Modify dose (for toxicity, side effect, or drug
interactions)
Alternative drug
Yes Consider slow graded challenges
Consider prophylactic regimens before
administration (if shown to be effective)
Patient education
5. Perform
appropriate Not available
confirmatory tests,
if available

Available

8. Does test have
6. Tests No
positive high negative
predictive value?
Yes
Yes No

10. Patient may be allergic
7. Diagnosis of drug 9. Patient not
with negative drug-specific
hypersensitivity/immunologic allergic to the or nonspecific confirmatory
reaction confirmed drug
tests

7a. Management:
Anaphylactic reactions require prompt emergency treatment
Avoid drug if possible
Consider desensitization or graded challenge before administration
Consider prophylactic regimen before administration (if shown to be effective)
Future prudent use of drugs
Future use of drug could cause nonanaphylactic, life-threatening reaction (eg, Stevens-Johnson,
Churg-Strauss), thus absolutely contraindicated
Patient education

FIGURE 129-4. Algorithm for the management of adverse drug reactions. Adapted with permission from Executive summary of disease management of drug hypersensitivity: a practice
parameter. Joint Task Force on Practice Parameters, the American Academy of Allergy, Asthma and Immunology, the American Academy of Allergy, Asthma and Immunology, and the Joint
Council of Allergy, Asthma and Immunology. Ann Allergy Asthma Immunol. December 1999;83(6 pt 3):665-700.

in susceptible individuals (10%-15%) a few days after administration T lymphocytes. These include the four mechanisms identified in the
or with re-exposure, and are independent of dose. Type B comprises Gell and Coombs classification: immediate, cytotoxic, immune complex,
drug intolerance, idiosyncratic reactions, and allergic or hypersen- and delayed hypersensitivity. 8
sitivity reactions. Allergic reactions can be categorized further into Type I (immediate) hypersensitivity reactions are mediated by immu-
those that are mediated by drug-specific antibodies or drug-specific noglobulin (Ig) E antibodies specific to the causative drug, found on

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