6- Drug Eruptions Flashcards

1
Q

Thought to be important inducers of ADRs

A

Th1 cells

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2
Q

Most common form of adverse cutaneous drug reaction

A

Exanthem

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3
Q

Occurs within the first 2 weeks of treatment or even up to 10 days after it has been stopped

Lesions tend to appear proximally esp in groin or axilla

Prominent pruritus

A

Exanthem (morbiliform or maculopapular reactions)

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4
Q

Most common cause of exanthematous drug eruption

A

Antibiotics- penicillin TMP SMX

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5
Q

Characteristic features of drug induced hypersensitivity syndrome

A

Fever
Rash
Internal organ involvement

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6
Q

7 major classes of medications that are implicated in DIHS

A
ALANA MD
Anticonvulsants 
Long acting sulfonamides
Allopurinol 
Nevirapine
Abacavir
Minocycline 
Dapsone
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7
Q

Morbiliform rash with follicular accentuation

Facial edema, fever, internal organ involvement

Rash developing late and lasts for >2 weeks

A

DIHS/DRESS

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8
Q

Adverse prognosticators in DIHS

A
Tachycardia
Leukocytosis
Tachypnea
Coagulopathy
Thrombocytopenia 
GI bleeding
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9
Q

Most common anticonvulsant causing DRESS (drug reaction with eosinophilia and systemic symptoms)

A

Carbamazepine

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10
Q

DRESS begins how many days after intake of anticonvulsant?

A

30-40 days

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11
Q

After intake of phenytoin etc
Low grade fever pharyngitis
Morbiliform skin eruption with marked facial and neck edema

Begins in trunk and face spreading centrifugally

Elevated LFTs

A

Anticonvulsant hypersensitivity Syndrome

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12
Q

What drug is considered a safe alternative for px sensitive to aromatic anticonvulsant

A

Valproate

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13
Q

Usual starting dose for systemic corticosteroid treatment for anticonvulsant hypersensitivity Syndrome

A

1-1.5 mg/kg/day

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14
Q

Allopurinol hypersensitivity Syndrome usually occurs in patients with

A

Preexisting renal failure

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15
Q

Minocycline hypersensitivity usually occurs in patients deficient in

A

Glutathione S-transferase

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16
Q

Morbiliform eruption that heals with desquamation is most characteristic of this drug

A

Dapsone

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17
Q

The term bullous drug reaction usually refers to a drug reaction in:
A. Erythema multiforme
B. SJS
C. TEN

A

A

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18
Q

Reactivation of this virus can be seen in SJS/TEN

19
Q

Most common drug to cause SJS/TEN

20
Q

SJS/TEN in children is most commonly caused by

A

Sulfonamides
Antiepileptics
Acetaminophen

21
Q

Most common mucosal surfaces eroded in SJS

A

Oral mucosa

Conjunctiva

22
Q

Mucosal involvement usually not found in:
A. SJS
B. TEN

23
Q

Histo:
Lymphocytic infiltrate at dermoepidermal junction with necrosis of keratinocytes

Cellular necrosis out of proportion to the infiltrate

24
Q

Poor prognostic factor in SJS that is not included in SCORTEN

A

Respiratory involvement

25
HIV infected patients are at increased risk of developing adverse drig reactions esp if TH cell count is
Between 25 and 200
26
6 or fewer lesions occur | Recur at the same site with each exposure to medication
Fixed drug eruption
27
Most common sites affected in fixed drug eruption
Oral and genital mucosa
28
Begins as red patch that soon evolves to an iris or target lesion similar to EM that may blister and erode
Fixed drug eruption
29
Lesions in genital and oral mucosa in fixed drug eruption manifest as
Erosions
30
Pathognomonic of FDE (histo)
Normal stratum corneum | Chronic dermal changes- papillary dermal fibrosis and deep peri vascular pigment incontinence
31
Drugs that can cause FDE
NSAID- paracetamol naproxen oxicams mefenamic acid (predilection for lips) Genital- sulfonamides TMP SMX
32
Risk of developing FDE has been linked to this human leukocyte antigen
HLA B22
33
Most common culprit of nonpigmented FDE
Pseudoephedrine hydrochloride
34
Provocation test can be performed to confirm FDE but must be delayed at least _______
2 weeks from last eruption
35
Oral provocation test should have ___% of the standard dose
10
36
Patch provocation test should have ___% of the standard dose
10-20
37
Sudden onset, fever, facial edema Scarlatiniform — >100 nonfollicular pustules Mucous membrane involvement common but only affects one surface and is nonerosive Self limited- 15 days
Acute generalized exanthematous pustulosis (AGEP) | Pustular drug eruption
38
Frequently associated drugs in AGEP
``` Ampicillin/ amoxicillin Quinolones Hydroxychloroquine Sulfonamide Terbinafine Imatinib Diltiazem ```
39
Histo: Marked papillary edema Neutrophil clusters in dermal papillae Perivascular eosinophils
AGEP
40
Most common drugs in non immunologic urticaria
Aspirin and NSAIDS
41
Immunologic urticaria is most often associated with
Penicillin and related B lactam antibiotics
42
Angioedema is a known complication of the use of
ACE inhibitors and Angiotensin 2 antagonists
43
Drugs in photosensitive drug reactions
``` NSAIDs TMP SMX Thiazides Sulfonylureas Quinine quinidine Phenothiazine Tetracycline ```