Allergic and Hypersensitivity Reactions to Antibiotics (Nursing)

00:01 Now, another group of drugs that is ridiculously known for allergic reactions are antibiotics.

00:07 So, just about any of the antibiotics can cause an allergic sign.

00:11 What we want you to be aware of is what does an allergic reaction look like in a patient? Well, take a look at the photo that we provided for you.

00:19 That doesn’t look that intense, does it? But here’s the deal.

00:23 If your patient is on a new medication and they develop a rash, you need to immediately stop the medication, okay? Don’t kind of look at it or watch it, so whether you’re taking the NCLEX test question or in real practice, if your patient is taking a new medication and develops a rash, they have this signs of an allergic reaction, itching, rash, or hives, stop the medication immediately, okay? Because we don’t want to risk the patient continuing the medication treatment plan and then ending up in big trouble.

00:53 Well, I know that the hives and the itching is uncomfortable, nobody wants to have that, but here’s the problem, a simple hive or rash can progress to full blown anaphylaxis.

01:05 The worst case scenario for anaphylaxis is cutting off the airway, so we don’t want that, obviously.

01:12 So, we want to be ultraconservative in practice and when you’re taking NCLEX questions, and when you’re with live patients, you want to make sure if they’re showing you any signs of allergy, stop the medication, remove it from the patient, and contact the healthcare provider.

01:27 Again, we talked about the kind of meds that most likely do this are antibiotics and even some ACE inhibitors.

01:33 Now, I want to talk to you about ACE inhibitors and angioedema.

01:39 Why am I talking that way? Because that’s a sign of angioedema.

01:44 That means, my lips swells, my tongue swells, the oral mucous membranes are the first ones usually to be involved.

01:53 Angioedema can become life threatening.

01:56 Now, we might be able to treat it.

01:57 Sometimes people have angioedemous reaction to just a food allergy.

02:01 I was with students one time on a trip and she was a single mom, she had a great babysitter for her kid, and she was looking to go out and have some fun after we had dinner, but she got something on the pizza that started to bother her and she said, “You know what? I think I’m having problems.” She opened up her mouth and I said, “Stick out your tongue,” and she had a double-decker sized tongue.

02:24 So, we quickly ran and got her some antihistamines to try to deal with that situation.

02:29 That was a minor situation we were able to resolve it, but you need to be vigilant and know that could have progressed to a really, really big problem.

02:38 So, for drug-induced angioedema, I want you to have in mind that it’s the swelling in the deep layers of the skin and other tissues.

02:47 Particularly, where we are most concerned about is going to be someplace that’s going to block your airway.

02:52 Now, that might also have an itchy raised rash that goes along with it, but most of all, think of angioedema as being your tongue and you talk really, really funny.

03:02 Now, here’s a picture of a more appropriate and professional representation of angioedema, but keep in mind that it’s an allergic reaction usually to a medication— can also happen to a food—but we’re focusing on medications.

03:15 It’s an allergic reaction to a medication.

03:18 It can occur with a new medication or even in the course of treatment.

03:23 Now, the types of meds that we see this most often with, although it is rare, are ACE inhibitors, and ACE inhibitors are drugs that we use to treat high blood pressure like enalapril or lisinopril, and we’ll teach you as you go along the way those generic names can be your friend.

03:38 When you see enalapril or lisinopril, most ACE inhibitors end in –pril, right.

03:45 So, we’ll give you those tips and strategies to help you try and sort out all the sort of drug names— I know you’re probably already starting to feel overwhelmed with.

03:54 So, drug-induced angioedema—one group is ACE inhibitors and we use that to treat high blood pressure, and the other one is angiotensin-2 receptor blockers.

04:06 Yeah, we call those ARBs instead of having to say angiotensin-2 receptor blockers.

04:10 That’s a mouthful.

04:12 We usually just call them ARBS, so when you see that wording, that shortened, you know that’s what it is.

04:17 So angiotensin-2 receptor blockers, or ARBS, like losartan, valsartan, olmesartan, those are also used to treat high blood pressure.

04:28 So, stop and review what are the most likely drugs to cause angioedema? Two groups.

04:38 What type of disease are we trying to treat with those groups of medication? Great! Hopefully, you are able to remember without looking at your notes that ACE inhibitors and ARBs are likely to cause angioedema and we use them to treat hypertension.

04:57 Okay, so here’s another really nasty thing.

05:00 When we say erosive esophagitis risk, you may think, “You know, I’ve had a sore throat before.

05:07 It’s not the end of the world.” Oh, no! No, no, no, no, no.

05:10 That is not what erosive esophagitis is.

05:13 Erosive esophagitis is so painful, you want to cry every time you think about swallowing your own spit.

05:20 I promise it is excruciating type of pain.

05:24 So, you don’t want to eat, you don’t want to drink, you don’t want to do anything because every time it just hurts.

05:30 Now, it can even get as bad as it can cause you nausea, vomiting, or indigestion.

05:35 I mean, what possible reason, what possible medication would be worth risking this? Well, here’s the deal.

05:42 If we educate our patients not to take the meds at night or to lie down after they take them, they won’t develop erosive esophagitis, so this is all on us.

05:52 And, I can’t tell you how many patients I have met or students that I’ve had in nursing school that wish they would have been taught this because they had to go through the experience of erosive esophagitis because nobody took the time to educate them.

06:05 Now, what’s the deal about not taking it at nighttime? Well, you would be amazed at how many people, you know, you brush your teeth every night, they might take their birth control at night.

06:16 So, if they have a medication that they take one time a day, sometimes they take it at night, so if you put a patient on these medications we’re going to talk about in just a minute, they may end up taking those at night if they didn’t know.

06:28 So, if you want to avoid erosive esophagitis, teach your patients they cannot lay down, and particularly you don’t want to take them at night because we usually lay down at night, after they take these medications.

06:41 Now, you see a picture of what esophagitis looks like there.

06:43 We just can’t give you a feel for how painful it is.

06:48 Take our word for it, but that picture cannot do it justice to say what it feels like to actually have it.

06:54 Now, let’s talk about some of the medications you want to be sure that you educate your patient don’t lay down and don’t take it at night after you take this medication.

07:03 So, doxycycline which is an antibiotic, tetracycline that’s another antibiotic, clindamycin another (you got it) antibiotic, and look at that last one—bisphosphonates.

07:15 Now, we use that to treat osteoporosis, so women are the ones who predominately take this medication.

07:21 You know, let’s start looking at a theme we have here.

07:25 What group of medications was most likely to cause an allergic reaction? Well, across the board allergic reactions, antibiotics.

07:33 What are the ones that are most likely to cause erosive esophagitis? Yeah.

07:37 Some of these specific antibiotics.

07:39 So, you want to keep in mind grouped information together will help your brain remember it.

07:44 So, these 3 antibiotics plus bisphosphonates are medications that we give to patients to help them slow down the bone loss they’re experiencing.

07:54 Remember, you have the ability to make sure your patient never has to go through this if you just simply educate them on why they shouldn’t lay down or take the medication at night.