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FD9 > 45 - Cutaneous Reactions to Drugs > Flashcards

45 - Cutaneous Reactions to Drugs Flashcards

1
Q

Exanthematous eruptions account for approximately _____% of skin reactions

A

95

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2
Q

Exanthematous eruptions typically starts on the

A

Trunk

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3
Q

Y/N: Pruritus is almost always absent in exanthematous eruptions.

A

No - present

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4
Q

Examples of drug-virus interaction

A

Infectious mononucleosis - aminopenicillin

HIV - sulfonamide antibiotics

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5
Q

Exanthematous eruption in conjunction with fever and internal organ inflammation

A

Hypersensitivity syndrome reaction or
Drug-induced hypersensitivity syndrome or
Drug reaction with eosinophilia and systemic symptoms

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6
Q

HSR occurs most frequently on _____ exposure

A

First

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7
Q

Often the presenting symptoms of hypersensitivity syndrome reaction

A

Fever

Malaise

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8
Q

Possible long-term complication of HSR

A

Immune-mediated thyroid dysfunction

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9
Q

When deep dermal and subcutaneous tissues are also swollen, the reaction is known as

A

Angioedema

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10
Q

Frequently unilateral and nonpruritic and lasts for 1-2 hours

A

Angioedema

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11
Q

Drug-induced IgE-mediated immediate hypersensitivity causes

A

Penicillin

Other antibiotics

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12
Q

Drug-induced non-IgE-mediated immediate hypersensitivity causes

A

NSAIDs

ACE inhibitors

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13
Q

Defined by the presence of fever, rash (usually urticarial) and arthralgias

A

Serum sickness-like reactions

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14
Q

Associated with an increased relative risk of serum sickness-like reactions

A

Cefaclor

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15
Q

Previous hormonal priming is a necessary prerequisite in

A

Acneiform eruptions

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16
Q

Do not affect prepubertal children

A

Acneiform eruptions

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17
Q

There is contradictory evidence for the benefit of _____ for prophylaxis for acneiform eruptions

A

Tetracyclines

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18
Q

AGEP is an acute febrile pustular eruption that occurs _____ hours after initiation of the implicated drug

A

24-48

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19
Q

In AGEP, sterile pustules are concentrated on the

A

Trunk

Intertriginous areas

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20
Q

Usual treatment necessary in most patient with AGEP

A

Discontinuance of therapy

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21
Q

Pseudoporphyria is a cutaneous phototoxic disorder that can resemble either _____ in adults or _____ in children

A

Porphyria cutanea tarda

Erythropoietic protoporphyria

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22
Q

Pseudoporphyria differs from porphyria cutanea tarda and erythropoietic protoporphyria by the presence of

A

Normal porphyrin levels

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23
Q

Drug-induced vs idiopathic linear IgA disease

A

Mucosal or conjunctival lesions are less common
Spontaneous remission occurs once offending agents is removed
Immune deposits disappear once the lesions resolve

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25
Q

Most frequently reported cause of drug-induced linear IgA disease

A

Vancomycin

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26
Q

Drug-induced vs idiopathic bullous pemphigoid

A 
Younger patients
May have positive Nikolsky sign
Lesions on normal-appearing skin
Target lesions on palns and soles
Involvement of the lower legs
Mucosal involvement
27
Q

FDE in women more commonly presenting with lesions on the ______, and men on the ______

A

Hands and feet

Genitalia

28
Q

FDE may exhibit _____, a sign of incipient blister formation

A

Epidermal wrinkling

29
Q

Most frequent culprits for FDE

A

NSAIDs
Acetaminophen
Antibioticso

30
Q

Drug-induced vs idiopathic lichen planus

A

Often appear initially as eczematous with a purple hue
Involve large areas of the trunk
Mucous membranes and nails are not involved

31
Q

Systemic symptons associated with drug-induced pseudolymphoma

A

Fever
Marked lymphadenopathy
Hepatosplenomegaly
Eosinophilia

32
Q

Y/N: Most patients with drug-induced lupus have no cutaneous findings of lupus erythematosus.

A

Yes

33
Q

Most common serologic abnormality in drug-induced lupus

A

Positivity for ANA with a homogeneous pattern

34
Q

Unlike in idiopathic lupus erythematosus, _____ are typically absent, whereas _____ are often present

A

anti-dsDNA

anti-ssDNA

35
Q

Causes of drug-induced lupus

A 
Hydralazine
Procainamide
Isoniazid
Methyldopa
Minocycline
36
Q

Most common drugs associated with SCLE

A

Terbinafine
Thiazide diuretics
Calcium channel blockers
Ranitidine

37
Q

Drug-induced dermatomysitis causes

A

Hydroxyurea
Penicillamine
HMG-CoA reductase inhibitors

38
Q

Drug-induced vasculitis represents approximately _____% of the acute cutaneous vasculitides

A

10

39
Q

Drug-induced vs other causes of vasculitis

A

Less progression to glomerulonephritis
Better outcomes
Require less immunosuppressive treatment

40
Q

Anticoagulant-induced skin necrosis develop in

A

Adipose-rich sites such as breasts, buttocks, and hips

41
Q

Incidence of anticoagulant-induced skin necrosis is higher in

A

Women, majority of whom are obese

42
Q

Treatment for neutrophilic eccrine hidradenitis

A

Colchicine

43
Q

Prophylactic treatment for neutrophilic eccrine hidradenitis

A

Dapsone

44
Q

New drugs started with the preceding 3 months are potential causative agents except in

A

Drug-induced lupus
Drug-induced pemphigus
Drug-induced cutaneous pseudolymphoma

45
Q

IgE-mediated; immediate-type immunologic reactions

A

Type 1

46
Q

Drug + cytotoxic antibodies cause lysis of cells such as platelets or leukocytes

A

Type II

47
Q

IgG or IgM antibodies formed to drug; immune complexes deposited in small vessels active complement and recruit granulocytes

A

Type III

48
Q

Cell-mediated immune reaction; sensitized lymphocytes react with drug, liberating cytokines, which trigger cutaneous inflammatory response

A

Type IV

49
Q

Type of reaction: Urticaria/angioedema

A

Type I

50
Q

Type of reaction: Petechiae resulting from thrombocytopenic purpura

A

Type II

51
Q

Type of reaction: Drug-induced pemphigus

A

Type II

52
Q

Type of reaction: Vasculitis

A

Type III

53
Q

Type of reaction: Urticaria

A

Type III

54
Q

Type of reaction: Serum sickness

A

Type III

55
Q

Type of reaction: Morbilliform exanthematous reactions

A

Type IV

56
Q

Type of reaction: Fixed drug eruption

A

Type IV

57
Q

Type of reaction: Lichenoid eruptions

A

Type IV

58
Q

Type of reaction: SJS-TEN

A

Type IV

59
Q

Patch testing has greater sensitivity if performed

A

Over a previously involved area of skin

60
Q

SCORTEN criteria is calculated within

A

First 24 hours of admission

61
Q

SCORTEN criteria

A 
Age older than 40 years
Urea < 10 mmol/L
Glucose > 14 mmol/L
Bicarbonate < 20 mEq/L
Heart rate > 120 bpm
Presence of malignancy
BSA > 10% at presentation
62
Q

SCORTEN mortality ranging from _____% (1 point) to _____% (5 points)

A

3.2

90

63
Q

Index of suspicion of drug induction in linear IgA disease should be higher in cases with

A

Only IgA and no IgG in the basement membrane zone

FD9 (108 decks)

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