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Block 2 Pharmacology > Adverse Drug Reactions > Flashcards

Adverse Drug Reactions Flashcards

1
Q

These are Immediate, IgE-mediated reactions,

Some cases also may be non-IgE-mediated through mast cell degranulation

A

Urticaria (hives)

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2
Q

Urticaria Lesions will usually migrate (individual lesions disappear within 24h but new ones appear elsewhere) until _____.

A

offending allergen is stopped

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3
Q

***Patients with urticaria are at increased risk for _____ with future exposure

A

anaphylaxis

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4
Q

Common drugs that result in Urticaria as an ADR

A

aspirin (ASA), penicillins

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5
Q

this is a Severe form of urticaria (hives penetrate deeper)

A

Angioneurotic Edema (Angioedema)

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6
Q

For Angioneurotic Edema (Angioedema) what is usually involved?

A

Lips, tongue, eyelids are commonly involved

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7
Q

Angioneurotic Edema (Angioedema) Can be fatal if involves the _____.

A

tongue, throat, larynx

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8
Q

Common drug that has Angioneurotic Edema (Angioedema) as an ADR is ____.

A

ACEIs (ace inhibitors)

patients must be warned to watch for swelling

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9
Q

How long does it take for angioedema to manifest?

A

May take weeks, months, or even years to manifest

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10
Q

Most severe form of immediate type I hypersensitivity

A

Anaphylaxis

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11
Q

characterisitcs of Anaphylaxis

A 
Pruritus
Urticaria
Angioedema
Laryngeal edema
Wheezing
N/V
Tachycardia
Sense of impending doom
Allergic vasculitis
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12
Q

_____ are one of the leading causes of anaphylaxis

A

Drugs

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13
Q

five criteria for the classification of hypersensitivity vasculitis in a patient with vasculitis

A
  1. Age >16 years
  2. Use of a possible offending drug in temporal relation to the symptoms
  3. Palpable purpura
  4. Maculopapular rash
  5. Biopsy of a skin lesion showing neutrophils around an arteriole or venule
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14
Q

what is the most common cause of hypersensitivity vasculitis

A

drugs

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15
Q

Common drugs associated as cause for Hypersensitivity Vasculitis

A
  1. Minocycline
  2. Penicillins
  3. Cephalosporins
  4. Sulfonamides: includes antibiotics and several diuretics (loop and thiazide-type)
  5. Phenytoin
  6. Allopurinol
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16
Q

Chemicals or drugs that are ingested or applied to the skin promote a _______ when the individual is exposed to sunlight.

A

photosensitivity reaction

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17
Q

Two major types of photosensitivity reactions

A

Phototoxic (most common)

Photoallergic

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18
Q

these are Much more common than photoallergic-type reactions

A

Phototoxic

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19
Q

Phototoxic reaction Caused by absorption of _____ by drug which releases energy and directly damages cells

A

UV light

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20
Q

In severe cases of Phototoxic reactions, what may be seen?

A

vesicles or bullae

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21
Q

what drugs cause phototoxic reactions?

A 
Tetracyclines (especially doxycycline)
Thiazides
Sulfonamides
Fluoroquinolones
NSAIDS (especially piroxicam and ketoprofen)
Phenothiazines (e.g., chlorpromazine)
Retinoids
Griseofulvin
Voriconazole
Tar compounds
St. John’s wort
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22
Q

A lymphocyte-mediated reaction caused by exposure to UVA is called a ____.

A

Photoallergic Reaction

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23
Q

in Photoallergic Reaction, it is Postulated that the absorbed radiation converts the drug into an immunologically active compound that is then presented to lymphocytes which causes a reaction identical to _____.

A

contact dermatitis

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24
Q

in Photoallergic Reactions does the pt have to be previously exposed to the photoallergen to have a reaction?

A

yes,
As in other allergic contact dermatitis reactions, affected individuals must have been previously sensitized to the photoallergen

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25
Q

How are Photoallergic Reactions characterized?

A

Characterized by widespread eczema in the photodistribution: face; upper chest; and back of hands

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26
Q

are Photoallergic Reactions typically pruritic?

A

yes

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27
Q

Occasionally Photoallergic Reactions may become persistent and evolve into chronic ________, even after the offending drug or chemical has been discontinued

A

actinic dermatitis

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28
Q

Photoallergic Reactions Occur in most instances after exposure to_____ rather than systemic agents

A

topical

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29
Q

The most common topical agents responsible for photoallergic reactions are:

A

Sunscreens
Antimicrobial agents
NSAIDs
Fragrances

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30
Q

Systemic medications that can induce photoallergic reactions include:

A

Quinolones
Sulfonamides
Ketoprofen
Piroxicam

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31
Q

Drugs can cause acne-like lesions,

they Differ from true acne how?

A 
No comedones
Uniform appearance of lesions
Location
Age
Recent drug exposure
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32
Q

Examples of drugs that cause Acneiform Reactions?

A

glucocorticoids, oral contraceptives, lithium, anabolic steroids

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33
Q

this disease is an Acute, immune-mediated condition characterized by the appearance of distinctive target-like lesions

A

Erythema Multiforme

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34
Q

Erythema Multiforme is often related to ____.

A

infections and sometimes drugs

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35
Q

Erythema multiforme with mucosal involvement

A

Erythema multiforme major

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36
Q

Erythema multiforme with no mucosal involvement

A

Erythema multiforme minor

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37
Q

Erythema multiforme major

Lesions usually with erosions or bullae involving_______.

A

oral, genital, and/or ocular mucosae

38
Q

what is an ADR

A

general term referring to untoward reaction

39
Q

what is a Drug allergy?

A

ADR resulting from specific immunologic response

40
Q

what is an Adverse cutaneous reaction

A

reaction with manifestations in skin

41
Q

Drug reaction examples of Overdose

A 
Hepatic failure (acetaminophen)
Metabolic acidosis (aspirin)
42
Q

examples of drug side effects

A

Nausea, headache (with methylxanthines)
Oral thrush or vaginal candidiasis (with glucocorticoids)
Nephrotoxicity (with aminoglycosides)

43
Q

examples of secondary or indirect effects of a drug

A

Diarrhea due to alteration in GI bacteria after antibiotics

Phototoxicity (with doxycycline or thiazide diuretics)

44
Q

example of Drug interactions

A

Macrolide antibiotics increasing theophylline, digoxin, or statin blood levels

45
Q

example of drug intolerance

A

Tinnitus after a single aspirin tablet

46
Q

examples of Idiosyncrasy• (pharmacogenetics)

A 
G6PD deficiency: Hemolytic anemia after antioxidant drugs (eg, dapsone)Δ
TMPT deficiency: Toxicity during azathioprine therapyΔ
Pseudoallergic reaction (with NSAIDs)
47
Q

examples of Immunologic drug reactions (allergy)

A

Anaphylaxis from beta-lactam antibiotics
Photoallergy with quinidine
Immune-mediated thrombocytopenia (with heparin)
Serum sickness (with antivenom preparations)
Vasculitis (with phenytoin)
Stevens-Johnson syndrome (with trimethoprim-sulfamethoxazole)
Drug-induced hypersensitivity syndrome (with allopurinol in HLA-B*58:01 individuals)Δ

48
Q

example of type I drug allergy

A

Anaphylaxis
Angioedema
Bronchospasm
Urticaria (hives)

49
Q

example of type II drug allergy

A

Hemolytic anemia
Thrombocytopenia
Neutropenia

50
Q

example of type III drug allergy

A

Serum sickness

Arthus reaction

51
Q

example of type IV drug allergy

A

Contact dermatitis, some morbilliform reactions, severe exfoliative dermatoses (e.g., SJS/TEN), interstitial nephritis, drug-induced hepatitis, other presentations

52
Q

General Approach to Drug Reactions

A

Step 1: Recognize that problem may be drug-related
Step 2: Identify the agent
Step 3: Stop offending agent
Step 4: Determine severity (i.e. triage situation)
Step 5: Treat sequelae/supportive care
Step 6: Educate patient on what has happened and future risk

53
Q

Most common type of drug reaction manifested in skin (~90% of all drug rashes)

A

Exanthematous (morbilliform or maculopapular)

54
Q

Exanthematous (morbilliform or maculopapular) Is believed to be what type of drug allergy (I,II,III,IV?)

A
  • Many are believed to be T-cell-mediated (type IV)
55
Q

Common drug that cause exanthematous (morbilliform or maculopapular)

A

antibiotics and sulfonamides

56
Q

how long does it take Exanthematous (morbilliform or maculopapular) to develop?

A
  • Usually develop within 5-14 days
57
Q

characteristics of Exanthematous (morbilliform or maculopapular)

A
  • Erythematous macules and papules (rarely pustules/bullae) that usually involve the trunk and proximal extremities
58
Q

photoallergic rxns are typically _____, eczematous eruptions in sun-exposed areas of skin that develop ______ hours after sun exposure

A

Typically pruritic, eczematous eruptions in sun-exposed areas of skin that develop 24 to 48 hours after sun exposure

59
Q

difference in incidence between phototoxicity and photoallergy

A

phototoxicity- high

photoallergy- low

60
Q

difference in the amount of agent required for photosensitivity between phototoxicity and photoallergy

A

phototoxicity- large

photoallergy- small

61
Q

difference in onset after exposure to photosensitize and light between phototoxicity and photoallergy

A

phototoxicity- minutes to hours

photoallergy- 24 hours or more

62
Q

difference in requirements for prior exposure between phototoxicity and photoallergy

A

phototoxicity- no

photoallergy- yes

63
Q

difference in clinical characteristics between phototoxicity and photoallergy

A

phototoxicity- exaggerates sunburn

photoallergy- acute, subacute, or chronic dermatitis

64
Q

difference in distribution between phototoxicity and photoallergy

A

phototoxicity- exposed skin only

photoallergy- exposed skin- may spread to unexposed skin

65
Q

difference in pigmentary changes between phototoxicity and photoallergy

A

phototoxicity- frequent

photoallergy-unusual

66
Q

Fixed Drug Eruption is caused exclusively by ___

67
Q

appearance of fixed drug eruptions

A
  • Erythematous lesions of various types (nodules, bullae, etc.) commonly on genitals and face
68
Q

how long does it take fixed drug eruptions to occur?

A
  • Occur usually within minutes to about 10 hours after exposure
69
Q

do fixed drug eruptions occur in the same location each time or in different locations?

A

Occur in same location each time, hence “fixed”

70
Q

when do fixed drug eruptions resolve?

A
  • Generally resolve after offending drug stopped but may have chronic hyperpigmented area of skin
71
Q

drug examples that cause fixed drug eruptions

A

antibiotics, anti-inflammatory agents, oral contraceptives

72
Q

characteristics of Erythema Nodosum

A

Erythematous, tender nodules usually with flu-like symptoms (fever, arthralgias)

73
Q

are drugs the only cause of Erythema Nodosum

A

NO

- Drugs not only cause

74
Q

drug examples that cause Erythema Nodosum

A

oral contraceptives, analgesics, sulfonamides

75
Q

what is Exfoliative Dermatitis (Erythroderma)

A

A severe and potentially life-threatening condition that presents with diffuse erythema and scaling involving ≥90 percent of the skin surface area

76
Q

Most common causes ofExfoliative Dermatitis/ erythroderma

A

exacerbation of a preexisting inflammatory dermatosis, hypersensitivity reactions to drugs, and cutaneous T-cell lymphomas

77
Q

Drugs are responsible for approximately__ percent of Exfoliative Dermatitis/erythrodermas

78
Q

some drugs that can cause Exfoliative Dermatitis (erythrodermas)

A

allopurinol, penicillins, barbiturates, gold salts, arsenic, and mercury

79
Q

how do patients typically present with Exfoliative Dermatitis (erythrodermas)

A
  • Patients typically present with erythematous patches that increase in size and coalesce into a generalized bright red erythema with occasional islands of sparing
  • The skin feels warm to the touch and dry
  • Patients appear uncomfortable, shiver, and complain of feeling cold
80
Q

Extracutaneous symptoms of Exfoliative Dermatitis (erythrodermas)

A

fever or hypothermia, peripheral edema, and tachycardia

81
Q

when does scaling occur in Exfoliative Dermatitis (erythrodermas)

A

two to six days after the onset of erythema and may become prominent

82
Q

what is SJS and TEN

A
  • Severe mucocutaneous reactions usually triggered by medications that is characterized by extensive necrosis and detachment of the epidermis
83
Q

is SJS or TEN less severe?

84
Q

SJS/TEN occurs at higher rates in individual infected with ____.

85
Q

what triggers SJS/TEN

A
  • Medications are leading trigger usually within 1-2 months of initiating therapy
86
Q

medications with a strong association of causing SJS/TEN

A

allopurinol, carbamazepine, lamotrigine, meloxicam, phenobarbital, phenytoin, sulfamethoxazole

  • Some association: amox/amp, a-mycin/c-mycin/e-mycin, ceftriaxone/cefadroxil, cipro-/levofloxacin, doxycycline
87
Q

What is DRESS

A

Drug reaction with eosinophilia and systemic symptoms (DRESS)

88
Q

name disease:
A rare, potentially life-threatening, drug-induced hypersensitivity reaction that includes:
o Skin eruption
o Hematologic abnormalities (eosinophilia, atypical lymphocytosis)
o Lymphadenopathy
o Internal organ involvement (liver, kidney, lung)

89
Q

when does reaction typically occur with DRESS

A
  • In most patients, the reaction begins two to six weeks after the initiation of the offending medication
90
Q

initial symptoms of DRESS

A
  • Fever (38 to 40°C [100.4 to 104°F]), malaise, lymphadenopathy, and skin eruption are the most common initial symptoms
91
Q

Frequently reported drugs causing DRESS:

A 
Ð	Allopurinol
Ð	Carbamazepine
Ð	Lamotrigine
Ð	Phenytoin
(know above 4)
Ð	Sulfasalazine
Ð	Vancomycin
Ð	Minocycline
Ð	Sulfamethoxazole
92
Q

how is DRESS diagnosed?

A

Diagnosis is based upon the combination of clinical features:

  • History of drug exposure, cutaneous findings, systemic findings (such as fever, lymphadenopathy, and visceral involvement)
  • Laboratory findings

Block 2 Pharmacology (13 decks)

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