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👩🏼‍⚕️ ANDREWS' DISEASES OF THE SKIN 13TH EDITION > 6- Drug Eruptions > Flashcards

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

A

HHV-6

19
Q

Most common drug to cause SJS/TEN

A

TMP-SMX

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

A

B

23
Q

Histo:
Lymphocytic infiltrate at dermoepidermal junction with necrosis of keratinocytes

Cellular necrosis out of proportion to the infiltrate

A

TEN/SJS

24
Q

Poor prognostic factor in SJS that is not included in SCORTEN

A

Respiratory involvement

25
Q

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

A

Between 25 and 200

26
Q

6 or fewer lesions occur

Recur at the same site with each exposure to medication

A

Fixed drug eruption

27
Q

Most common sites affected in fixed drug eruption

A

Oral and genital mucosa

28
Q

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

A

Fixed drug eruption

29
Q

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

A

Erosions

30
Q

Pathognomonic of FDE (histo)

A

Normal stratum corneum

Chronic dermal changes- papillary dermal fibrosis and deep peri vascular pigment incontinence

31
Q

Drugs that can cause FDE

A

NSAID- paracetamol naproxen oxicams mefenamic acid (predilection for lips)

Genital- sulfonamides TMP SMX

32
Q

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

A

HLA B22

33
Q

Most common culprit of nonpigmented FDE

A

Pseudoephedrine hydrochloride

34
Q

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

A

2 weeks from last eruption

35
Q

Oral provocation test should have ___% of the standard dose

A

10

36
Q

Patch provocation test should have ___% of the standard dose

A

10-20

37
Q

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

A

Acute generalized exanthematous pustulosis (AGEP)

Pustular drug eruption

38
Q

Frequently associated drugs in AGEP

A 
Ampicillin/ amoxicillin 
Quinolones
Hydroxychloroquine
Sulfonamide
Terbinafine
Imatinib
Diltiazem
39
Q

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

A

AGEP

40
Q

Most common drugs in non immunologic urticaria

A

Aspirin and NSAIDS

41
Q

Immunologic urticaria is most often associated with

A

Penicillin and related B lactam antibiotics

42
Q

Angioedema is a known complication of the use of

A

ACE inhibitors and Angiotensin 2 antagonists

43
Q

Drugs in photosensitive drug reactions

A 
NSAIDs
TMP SMX
Thiazides
Sulfonylureas
Quinine quinidine 
Phenothiazine
Tetracycline

👩🏼‍⚕️ ANDREWS' DISEASES OF THE SKIN 13TH EDITION (32 decks)

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