A patient was seen in the emergency department after sustaining a fractured leg and multiple abrasions in a bicycle accident. Eight hours after discharge the patient is admitted in anaphylactic shock. The nurse would suspect which drugs prescribed for the initial injury as implicated in this reaction?

Question

1. A cephalosporin antibiotic
2. A topical antibiotic for use on abrasions
3. An NSAID for minor pain
4. An opioid analgesic for more severe pain
5. Normal saline wash for abrasions

Answer 1

1,3,4
Rationale 1: Antibiotics such as penicillin and cephalosporins cause high risk for allergic reaction.
Rationale 2: It would be rare for a patient to have anaphylaxis to a topical antibiotic.
Rationale 3: NSAIDs may be implicated in the development of anaphylaxis.
Rationale 4: Opioid analgesics are often implicated in the development of anaphylaxis.
Rationale 5: Normal saline does not cause allergic reactions.

Global Rationale: Antibiotics such as penicillin and cephalosporins cause high risk for allergic reaction. NSAIDs and opioid analgesics may be implicated in the development of anaphylaxis. It would be rare for a patient to have anaphylaxis to a topical antibiotic or normal saline.