Adverse Drug Reactions Flashcards
These are Immediate, IgE-mediated reactions,
Some cases also may be non-IgE-mediated through mast cell degranulation
Urticaria (hives)
Urticaria Lesions will usually migrate (individual lesions disappear within 24h but new ones appear elsewhere) until _____.
offending allergen is stopped
***Patients with urticaria are at increased risk for _____ with future exposure
anaphylaxis
Common drugs that result in Urticaria as an ADR
aspirin (ASA), penicillins
this is a Severe form of urticaria (hives penetrate deeper)
Angioneurotic Edema (Angioedema)
For Angioneurotic Edema (Angioedema) what is usually involved?
Lips, tongue, eyelids are commonly involved
Angioneurotic Edema (Angioedema) Can be fatal if involves the _____.
tongue, throat, larynx
Common drug that has Angioneurotic Edema (Angioedema) as an ADR is ____.
ACEIs (ace inhibitors)
patients must be warned to watch for swelling
How long does it take for angioedema to manifest?
May take weeks, months, or even years to manifest
Most severe form of immediate type I hypersensitivity
Anaphylaxis
characterisitcs of Anaphylaxis
Pruritus Urticaria Angioedema Laryngeal edema Wheezing N/V Tachycardia Sense of impending doom Allergic vasculitis
_____ are one of the leading causes of anaphylaxis
Drugs
five criteria for the classification of hypersensitivity vasculitis in a patient with vasculitis
- Age >16 years
- Use of a possible offending drug in temporal relation to the symptoms
- Palpable purpura
- Maculopapular rash
- Biopsy of a skin lesion showing neutrophils around an arteriole or venule
what is the most common cause of hypersensitivity vasculitis
drugs
Common drugs associated as cause for Hypersensitivity Vasculitis
- Minocycline
- Penicillins
- Cephalosporins
- Sulfonamides: includes antibiotics and several diuretics (loop and thiazide-type)
- Phenytoin
- Allopurinol
Chemicals or drugs that are ingested or applied to the skin promote a _______ when the individual is exposed to sunlight.
photosensitivity reaction
Two major types of photosensitivity reactions
Phototoxic (most common)
Photoallergic
these are Much more common than photoallergic-type reactions
Phototoxic
Phototoxic reaction Caused by absorption of _____ by drug which releases energy and directly damages cells
UV light
In severe cases of Phototoxic reactions, what may be seen?
vesicles or bullae
what drugs cause phototoxic reactions?
Tetracyclines (especially doxycycline) Thiazides Sulfonamides Fluoroquinolones NSAIDS (especially piroxicam and ketoprofen) Phenothiazines (e.g., chlorpromazine) Retinoids Griseofulvin Voriconazole Tar compounds St. John’s wort
A lymphocyte-mediated reaction caused by exposure to UVA is called a ____.
Photoallergic Reaction
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 _____.
contact dermatitis
in Photoallergic Reactions does the pt have to be previously exposed to the photoallergen to have a reaction?
yes,
As in other allergic contact dermatitis reactions, affected individuals must have been previously sensitized to the photoallergen
How are Photoallergic Reactions characterized?
Characterized by widespread eczema in the photodistribution: face; upper chest; and back of hands
are Photoallergic Reactions typically pruritic?
yes
Occasionally Photoallergic Reactions may become persistent and evolve into chronic ________, even after the offending drug or chemical has been discontinued
actinic dermatitis
Photoallergic Reactions Occur in most instances after exposure to_____ rather than systemic agents
topical
The most common topical agents responsible for photoallergic reactions are:
Sunscreens
Antimicrobial agents
NSAIDs
Fragrances
Systemic medications that can induce photoallergic reactions include:
Quinolones
Sulfonamides
Ketoprofen
Piroxicam
Drugs can cause acne-like lesions,
they Differ from true acne how?
No comedones Uniform appearance of lesions Location Age Recent drug exposure
Examples of drugs that cause Acneiform Reactions?
glucocorticoids, oral contraceptives, lithium, anabolic steroids
this disease is an Acute, immune-mediated condition characterized by the appearance of distinctive target-like lesions
Erythema Multiforme
Erythema Multiforme is often related to ____.
infections and sometimes drugs
Erythema multiforme with mucosal involvement
Erythema multiforme major
Erythema multiforme with no mucosal involvement
Erythema multiforme minor