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Dermatology > 1: Drug Reactions > Flashcards

1: Drug Reactions Flashcards

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Dermatology Board Prep flashcards
1
Q

Define urticaria

A

Leakage of fluid from capillaries and small venules

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2
Q

Define angioedema

A

Localised swelling of dermis, subcutaneous and submucosal tissue due to leakage of fluid in the interstitium

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3
Q

What are 5 causes of urticaria

A
  1. Food
  2. Bites
  3. Infection
  4. Medications
  5. Contact - latex
  6. Hereditary
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4
Q

Where is swelling in urticaria

A

in the superficial dermis - which raises the epidermis

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5
Q

How will urticaria present clinically

A

wheal

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6
Q

What is angioedema

A

swelling of the dermis and deeper subcutaneous tissue

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7
Q

How will angioedema present

A

swelling of the tongue and lips

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8
Q

What is anaphylaxis

A

oedema of the face and larynx. Associated with bronchospasm and hypotension

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9
Q

What is the typical progression of anaphylaxis

A

Starts with urticaria, may progress to angioedema and then anaphylaxis

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10
Q

What is the main mediator of urticaria and angioedema

A

Histamine release from mast cells

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11
Q

How is urticaria managed

A

Anti-histamine

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12
Q

How is angioedema managed

A

Corticosteroids

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13
Q

What is a drug eruption

A

adverse cutaneous reaction to medication

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14
Q

What is a simple drug eruption

A

cutaneous reaction resolves once drug is ceased

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15
Q

What are two types of possible drug eruption

A
  • Urticarial

- Exanthematous

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16
Q

What is a type I hypersensitivity reaction

A

IgE mediated

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17
Q

Give an example of a type I hypersensitivity reaction

A

Urticaria, Angioedema, Anaphylaxis

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18
Q

What is a type II hypersensitivity reaction

A

Cytotoxic reaction

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19
Q

What causes type II hypersensitivity reactions

A

IgM and IgG antibodies

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20
Q

What is a Type III hypersensitivity reaction

A

Immune-Complex mediated hypersensitivity reaction

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21
Q

What is a type IV hypersensitivity reaction

A

Delayed Hypersensitivity reaction

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22
Q

What mediates a type IV hypersensitivity reaction

A

T lymphocytes

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23
Q

What is erythema multiforme

A

Hypersensitivity reaction commonly triggered by infection

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24
Q

What is a typical distinguishing feature of erythema multiforme

A

there is NO (repeat NO) mucosal involvement

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25
Q

Explain the relationship between Steven Johnson syndrome and Erythema multiforme

A

Use to think steven Johnson was a severe form of erythema multiforme - now know that is different and they are separate entities.

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26
Q

What age group does erythema multiforme occur in

A

20-40 years

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27
Q

What is the most common cause of erythema multiforme

A

Infection

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28
Q

What infection causes 50% of erythema multiforme

A

HSV

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29
Q

What medications may cause erythema multiforme

A
  • Phenytoin
  • Barbituates
  • Salphonamides
  • NSAIDs
  • Penicillin
30
Q

What lesions are pathognomic of erythema multiforme

A

Target Lesions

31
Q

Explain the presentation of erythema multiforme

A

Acute onset erythematous macules, progress to papules and after a few days target lesions will appear

Target lesions = dark inner circle, pale surrounding circle and dark erythematous ring

32
Q

Which areas does erythema multiforme tend to affect first

A

Hands, Feet, Back and then the trunk

33
Q

How is erythema multiforme managed

A

Stop medication

Treat infection

34
Q

What is Steven Johnson Syndrome

A

Immune-mediated skin reaction with blistering of the skin and significant epidermal detachment

35
Q

What is the most common cause of Steven Johnson Syndrome

A

Medications

36
Q

What percentage of SJS is caused by medications

A

80%

37
Q

What medications can cause SJS (5)

A 
Corticosteroids 
ART
Anti-epileptics 
Allopurinol
Sulphonamides 
Sulfasalazine
38
Q

What infections may cause SJS (3)

A
  • Mycoplasma
  • CMV
  • Herpes
39
Q

In which individuals is there a higher risk of SJS

A

HIV

40
Q

How long after medication does prodrome of SJS usually start

A

1-3W

41
Q

What is the prodrome phase of SJS

A
  • High fever >39
  • Malaise
  • Myalgia
42
Q

How does the cutaneous aspect of SJS present

A
  1. Painful erythematous purpuric macules
  2. Formation of bullae
  3. Full-Thickness epidermal necrosis and sloughing
43
Q

What sign is positive in SJS

A

Nikolosky’s sign

44
Q

What is Nikolosky’s sign

A

On touching epidermis it will slough off

45
Q

What is a key differentiating feature between erythema multiforme and SJS

A
  • Erythema multiforme: NO mucosal involvement

- SJS: Mucosal involvement

46
Q

How will mucosal involvement in SJS present

A
  • Stomatitis, Chelitis, Oral Ulcers, Odynophagia
  • Urethritis
  • Conjunctivitis
47
Q

What type of hypersensitivity reaction is SJS

A

Type 4

48
Q

What mediates type 4 hypersensitivity reactions

A

Cytotoxic T cells

49
Q

Explain pathophysiology of SJS

A
  • Cytotoxic T cells raise an immune response to epidermal cells causing necrosis and sloughing
  • Sloughing of the epidermis can lead to dehydration. Also impedes barrier function resulting in bacterial superinfection
50
Q

What is on the same spectrum as SJS

A

TEN

51
Q

How do SJS and TEN differ

A

Depending on % body area affected

52
Q

What percentage of surface area affected indicates SJS

A

<10%

53
Q

What percentage of surface area affected indicates SJS and TEN

A

10-30%

54
Q

What percentage of surface area affected indicates TEN

A

> 30%

55
Q

Explain management for SJS

A
  1. Remove cause
  2. Antibiotics for infection
  3. Cleanse wounds, irrigate with chlorhexidine, greasy emollient, apply non-adherent dressing
  4. IV fluids
  5. Daily ophthalmology and oral review
56
Q

What prognostic score is used for SJS

A

SCORTEN

- calculate in first 24h

57
Q

What is ophthalmological complication of SJS

A

keratoconjunctivitis sicca

58
Q

What is toxic epidermal necrolysis

A

Life-threatening skin disorder caused by immune-mediated reaction to medications

59
Q

What most commonly causes TEN

A

Medications

60
Q

Aside from drug reactions that cause 80% of TENS, what is the second most common cause

A

HSV

61
Q

List common drugs that can cause TENS (PPCANS)

A 
Penicillin
Phenytoin
Carbamezapine
Allopurinol
NSAIDs
Sulphonamide
62
Q

What is a risk factor for TENS

A

HIV

63
Q

How long after drug ingestion does pro-drome of TENS present

A

1-3W

64
Q

What are the prodromal features of TENS

A

Fever >39
Malaise
Lymphadenopathy
Myalgia

65
Q

Explain the cutaneous manifestation of TEN

A

Painful-erythematous macules/papules. Then blisters. Will separation of epidermis

66
Q

Explain the mucosal manifestation of TEN

A

Oral: pharyngitis, chelitis
Conjunctivitis
Urethritis

67
Q

What is another feature of TEN

A

Shock

68
Q

What type of hypersensitivity reaction is TEN

A

type IV

69
Q

What % of body area is affected in TEN

A

> 30%

70
Q

What % mortality of TEN

A

30

Dermatology (6 decks)

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