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)
2
Q
Urticaria Lesions will usually migrate (individual lesions disappear within 24h but new ones appear elsewhere) until _____.
A
offending allergen is stopped
3
Q
***Patients with urticaria are at increased risk for _____ with future exposure
A
anaphylaxis
4
Q
Common drugs that result in Urticaria as an ADR
A
aspirin (ASA), penicillins
5
Q
this is a Severe form of urticaria (hives penetrate deeper)
A
Angioneurotic Edema (Angioedema)
6
Q
For Angioneurotic Edema (Angioedema) what is usually involved?
A
Lips, tongue, eyelids are commonly involved
7
Q
Angioneurotic Edema (Angioedema) Can be fatal if involves the _____.
A
tongue, throat, larynx
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
9
Q
How long does it take for angioedema to manifest?
A
May take weeks, months, or even years to manifest
10
Q
Most severe form of immediate type I hypersensitivity
A
Anaphylaxis
11
Q
characterisitcs of Anaphylaxis
A
Pruritus Urticaria Angioedema Laryngeal edema Wheezing N/V Tachycardia Sense of impending doom Allergic vasculitis
12
Q
_____ are one of the leading causes of anaphylaxis
A
Drugs
13
Q
five criteria for the classification of hypersensitivity vasculitis in a patient with vasculitis
A
- 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
14
Q
what is the most common cause of hypersensitivity vasculitis
A
drugs
15
Q
Common drugs associated as cause for Hypersensitivity Vasculitis
A
- Minocycline
- Penicillins
- Cephalosporins
- Sulfonamides: includes antibiotics and several diuretics (loop and thiazide-type)
- Phenytoin
- Allopurinol
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
17
Q
Two major types of photosensitivity reactions
A
Phototoxic (most common)
Photoallergic
18
Q
these are Much more common than photoallergic-type reactions
A
Phototoxic
19
Q
Phototoxic reaction Caused by absorption of _____ by drug which releases energy and directly damages cells
A
UV light
20
Q
In severe cases of Phototoxic reactions, what may be seen?
A
vesicles or bullae
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
22
Q
A lymphocyte-mediated reaction caused by exposure to UVA is called a ____.
A
Photoallergic Reaction
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
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
25
How are Photoallergic Reactions characterized?
Characterized by widespread eczema in the photodistribution: face; upper chest; and back of hands
26
are Photoallergic Reactions typically pruritic?
yes
27
Occasionally Photoallergic Reactions may become persistent and evolve into chronic ________, even after the offending drug or chemical has been discontinued
actinic dermatitis
28
Photoallergic Reactions Occur in most instances after exposure to_____ rather than systemic agents
topical
29
The most common topical agents responsible for photoallergic reactions are:
Sunscreens
Antimicrobial agents
NSAIDs
Fragrances
30
Systemic medications that can induce photoallergic reactions include:
Quinolones
Sulfonamides
Ketoprofen
Piroxicam
31
Drugs can cause acne-like lesions,
| they Differ from true acne how?
```
No comedones
Uniform appearance of lesions
Location
Age
Recent drug exposure
```
32
Examples of drugs that cause Acneiform Reactions?
glucocorticoids, oral contraceptives, lithium, anabolic steroids
33
this disease is an Acute, immune-mediated condition characterized by the appearance of distinctive target-like lesions
Erythema Multiforme
34
Erythema Multiforme is often related to ____.
infections and sometimes drugs
35
Erythema multiforme with mucosal involvement
Erythema multiforme major
36
Erythema multiforme with no mucosal involvement
Erythema multiforme minor
37
Erythema multiforme major
| Lesions usually with erosions or bullae involving_______.
oral, genital, and/or ocular mucosae
38
what is an ADR
general term referring to untoward reaction
39
what is a Drug allergy?
ADR resulting from specific immunologic response
40
what is an Adverse cutaneous reaction
reaction with manifestations in skin
41
Drug reaction examples of Overdose
```
Hepatic failure (acetaminophen)
Metabolic acidosis (aspirin)
```
42
examples of drug side effects
Nausea, headache (with methylxanthines)
Oral thrush or vaginal candidiasis (with glucocorticoids)
Nephrotoxicity (with aminoglycosides)
43
examples of secondary or indirect effects of a drug
Diarrhea due to alteration in GI bacteria after antibiotics
| Phototoxicity (with doxycycline or thiazide diuretics)
44
example of Drug interactions
Macrolide antibiotics increasing theophylline, digoxin, or statin blood levels
45
example of drug intolerance
Tinnitus after a single aspirin tablet
46
examples of Idiosyncrasy• (pharmacogenetics)
```
G6PD deficiency: Hemolytic anemia after antioxidant drugs (eg, dapsone)Δ
TMPT deficiency: Toxicity during azathioprine therapyΔ
Pseudoallergic reaction (with NSAIDs)
```
47
examples of Immunologic drug reactions (allergy)
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
example of type I drug allergy
Anaphylaxis
Angioedema
Bronchospasm
Urticaria (hives)
49
example of type II drug allergy
Hemolytic anemia
Thrombocytopenia
Neutropenia
50
example of type III drug allergy
Serum sickness
| Arthus reaction
51
example of type IV drug allergy
Contact dermatitis, some morbilliform reactions, severe exfoliative dermatoses (e.g., SJS/TEN), interstitial nephritis, drug-induced hepatitis, other presentations
52
General Approach to Drug Reactions
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
Most common type of drug reaction manifested in skin (~90% of all drug rashes)
Exanthematous (morbilliform or maculopapular)
54
Exanthematous (morbilliform or maculopapular) Is believed to be what type of drug allergy (I,II,III,IV?)
- Many are believed to be T-cell-mediated (type IV)
55
Common drug that cause exanthematous (morbilliform or maculopapular)
antibiotics and sulfonamides
56
how long does it take Exanthematous (morbilliform or maculopapular) to develop?
- Usually develop within 5-14 days
57
characteristics of Exanthematous (morbilliform or maculopapular)
- Erythematous macules and papules (rarely pustules/bullae) that usually involve the trunk and proximal extremities
58
photoallergic rxns are typically _____, eczematous eruptions in sun-exposed areas of skin that develop ______ hours after sun exposure
Typically pruritic, eczematous eruptions in sun-exposed areas of skin that develop 24 to 48 hours after sun exposure
59
difference in incidence between phototoxicity and photoallergy
phototoxicity- high
| photoallergy- low
60
difference in the amount of agent required for photosensitivity between phototoxicity and photoallergy
phototoxicity- large
| photoallergy- small
61
difference in onset after exposure to photosensitize and light between phototoxicity and photoallergy
phototoxicity- minutes to hours
| photoallergy- 24 hours or more
62
difference in requirements for prior exposure between phototoxicity and photoallergy
phototoxicity- no
| photoallergy- yes
63
difference in clinical characteristics between phototoxicity and photoallergy
phototoxicity- exaggerates sunburn
| photoallergy- acute, subacute, or chronic dermatitis
64
difference in distribution between phototoxicity and photoallergy
phototoxicity- exposed skin only
| photoallergy- exposed skin- may spread to unexposed skin
65
difference in pigmentary changes between phototoxicity and photoallergy
phototoxicity- frequent
| photoallergy-unusual
66
Fixed Drug Eruption is caused exclusively by ___
drugs
67
appearance of fixed drug eruptions
- Erythematous lesions of various types (nodules, bullae, etc.) commonly on genitals and face
68
how long does it take fixed drug eruptions to occur?
- Occur usually within minutes to about 10 hours after exposure
69
do fixed drug eruptions occur in the same location each time or in different locations?
Occur in same location each time, hence “fixed”
70
when do fixed drug eruptions resolve?
- Generally resolve after offending drug stopped but may have chronic hyperpigmented area of skin
71
drug examples that cause fixed drug eruptions
antibiotics, anti-inflammatory agents, oral contraceptives
72
characteristics of Erythema Nodosum
Erythematous, tender nodules usually with flu-like symptoms (fever, arthralgias)
73
are drugs the only cause of Erythema Nodosum
NO
| - Drugs not only cause
74
drug examples that cause Erythema Nodosum
***oral contraceptives***, analgesics, sulfonamides
75
what is Exfoliative Dermatitis (Erythroderma)
A severe and potentially life-threatening condition that presents with diffuse erythema and scaling involving ≥90 percent of the skin surface area
76
Most common causes ofExfoliative Dermatitis/ erythroderma
exacerbation of a preexisting inflammatory dermatosis, hypersensitivity reactions to drugs, and cutaneous T-cell lymphomas
77
Drugs are responsible for approximately__ percent of Exfoliative Dermatitis/erythrodermas
20%
78
some drugs that can cause Exfoliative Dermatitis (erythrodermas)
allopurinol, penicillins, barbiturates, gold salts, arsenic, and mercury
79
how do patients typically present with Exfoliative Dermatitis (erythrodermas)
- 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
Extracutaneous symptoms of Exfoliative Dermatitis (erythrodermas)
fever or hypothermia, peripheral edema, and tachycardia
81
when does scaling occur in Exfoliative Dermatitis (erythrodermas)
two to six days after the onset of erythema and may become prominent
82
what is SJS and TEN
- Severe mucocutaneous reactions usually triggered by medications that is characterized by extensive necrosis and detachment of the epidermis
83
is SJS or TEN less severe?
SJS
84
SJS/TEN occurs at higher rates in individual infected with ____.
HIV
85
what triggers SJS/TEN
- Medications are leading trigger usually within 1-2 months of initiating therapy
86
medications with a strong association of causing SJS/TEN
allopurinol, carbamazepine, lamotrigine, meloxicam, phenobarbital, phenytoin, sulfamethoxazole
- Some association: amox/amp, a-mycin/c-mycin/e-mycin, ceftriaxone/cefadroxil, cipro-/levofloxacin, doxycycline
87
What is DRESS
Drug reaction with eosinophilia and systemic symptoms (DRESS)
88
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)
DRESS
89
when does reaction typically occur with DRESS
- In most patients, the reaction begins two to six weeks after the initiation of the offending medication
90
initial symptoms of DRESS
- Fever (38 to 40°C [100.4 to 104°F]), malaise, lymphadenopathy, and skin eruption are the most common initial symptoms
91
Frequently reported drugs causing DRESS:
```
Ð Allopurinol
Ð Carbamazepine
Ð Lamotrigine
Ð Phenytoin
(know above 4)
Ð Sulfasalazine
Ð Vancomycin
Ð Minocycline
Ð Sulfamethoxazole
```
92
how is DRESS diagnosed?
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
