6- Drug Eruptions

Question 1

Thought to be important inducers of ADRs

Answer 1

Th1 cells

Question 2

Most common form of adverse cutaneous drug reaction

Answer 2

Exanthem

Question 3

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

Answer 3

Exanthem (morbiliform or maculopapular reactions)

Question 4

Most common cause of exanthematous drug eruption

Answer 4

Antibiotics- penicillin TMP SMX

Question 5

Characteristic features of drug induced hypersensitivity syndrome

Answer 5

Fever
Rash
Internal organ involvement

Question 6

7 major classes of medications that are implicated in DIHS

Answer 6

ALANA MD
Anticonvulsants 
Long acting sulfonamides
Allopurinol 
Nevirapine
Abacavir
Minocycline 
Dapsone

Question 7

Morbiliform rash with follicular accentuation

Facial edema, fever, internal organ involvement

Rash developing late and lasts for >2 weeks

Answer 7

DIHS/DRESS

Question 8

Adverse prognosticators in DIHS

Answer 8

Tachycardia
Leukocytosis
Tachypnea
Coagulopathy
Thrombocytopenia 
GI bleeding

Question 9

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

Answer 9

Carbamazepine

Question 10

DRESS begins how many days after intake of anticonvulsant?

Answer 10

30-40 days

Question 11

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

Answer 11

Anticonvulsant hypersensitivity Syndrome

Question 12

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

Answer 12

Valproate

Question 13

Usual starting dose for systemic corticosteroid treatment for anticonvulsant hypersensitivity Syndrome

Answer 13

1-1.5 mg/kg/day

Question 14

Allopurinol hypersensitivity Syndrome usually occurs in patients with

Answer 14

Preexisting renal failure

Question 15

Minocycline hypersensitivity usually occurs in patients deficient in

Answer 15

Glutathione S-transferase

Question 16

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

Answer 16

Dapsone

Question 17

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

Answer 17

A

Question 18

Reactivation of this virus can be seen in SJS/TEN

Answer 18

HHV-6

Question 19

Most common drug to cause SJS/TEN

Answer 19

TMP-SMX

Question 20

SJS/TEN in children is most commonly caused by

Answer 20

Sulfonamides
Antiepileptics
Acetaminophen

Question 21

Most common mucosal surfaces eroded in SJS

Answer 21

Oral mucosa

Conjunctiva

Question 22

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

Answer 22

B

Question 23

Histo:
Lymphocytic infiltrate at dermoepidermal junction with necrosis of keratinocytes

Cellular necrosis out of proportion to the infiltrate

Answer 23

TEN/SJS

Question 24

Poor prognostic factor in SJS that is not included in SCORTEN

Answer 24

Respiratory involvement

Question 25

HIV infected patients are at increased risk of developing adverse drig reactions esp if TH cell count is

Answer 25

Between 25 and 200

Question 26

6 or fewer lesions occur | Recur at the same site with each exposure to medication

Answer 26

Fixed drug eruption

Question 27

Most common sites affected in fixed drug eruption

Answer 27

Oral and genital mucosa

Question 28

Begins as red patch that soon evolves to an iris or target lesion similar to EM that may blister and erode

Answer 28

Fixed drug eruption

Question 29

Lesions in genital and oral mucosa in fixed drug eruption manifest as

Answer 29

Erosions

Question 30

Pathognomonic of FDE (histo)

Answer 30

Normal stratum corneum | Chronic dermal changes- papillary dermal fibrosis and deep peri vascular pigment incontinence

Question 31

Drugs that can cause FDE

Answer 31

NSAID- paracetamol naproxen oxicams mefenamic acid (predilection for lips) Genital- sulfonamides TMP SMX

Question 32

Risk of developing FDE has been linked to this human leukocyte antigen

Answer 32

HLA B22

Question 33

Most common culprit of nonpigmented FDE

Answer 33

Pseudoephedrine hydrochloride

Question 34

Provocation test can be performed to confirm FDE but must be delayed at least _______

Answer 34

2 weeks from last eruption

Question 35

Oral provocation test should have ___% of the standard dose

Answer 35

10

Question 36

Patch provocation test should have ___% of the standard dose

Answer 36

10-20

Question 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

Answer 37

Acute generalized exanthematous pustulosis (AGEP) | Pustular drug eruption

Question 38

Frequently associated drugs in AGEP

Answer 38

``` Ampicillin/ amoxicillin Quinolones Hydroxychloroquine Sulfonamide Terbinafine Imatinib Diltiazem ```

Question 39

Histo: Marked papillary edema Neutrophil clusters in dermal papillae Perivascular eosinophils

Answer 39

AGEP

Question 40

Most common drugs in non immunologic urticaria

Answer 40

Aspirin and NSAIDS

Question 41

Immunologic urticaria is most often associated with

Answer 41

Penicillin and related B lactam antibiotics

Question 42

Angioedema is a known complication of the use of

Answer 42

ACE inhibitors and Angiotensin 2 antagonists

Question 43

Drugs in photosensitive drug reactions

Answer 43

``` NSAIDs TMP SMX Thiazides Sulfonylureas Quinine quinidine Phenothiazine Tetracycline ```