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Dermatology > Drug Eruptions > Flashcards

Drug Eruptions Flashcards

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Dermatology Board Prep flashcards
1
Q

what mediates type 2 ‘allergic’ reactions

A

cytotoxic (cytotoxic t cells activated)

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2
Q

what skin symptoms are common with type 2 reactions

A

pemphigus and pemphigoid

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3
Q

what mediates type 3 reactions

A

immune complex mediated reaction

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4
Q

what skin symptoms are common with type 3 reactions

A

purpura/ rash

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5
Q

what mediates type 4 reactions

A

cell mediated delayed hypersensitivity reactions- T cell mediated

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6
Q

what skin symptoms are associated with type 4 reactions

A

erythema/ rash

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7
Q

are drug immunologically mediated reactions dose dependent

A

not dose dependent

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8
Q

what non allergic skin reactions can be caused by drugs

A 
eczema, 
drug- induced alopecia,
phototoxicity, 
skin erosions due to 5-fluorouracil, 
atrophy (steroids), 
psoraisis, 
pigmentation, 
cheilitis, 
xerosis
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9
Q

what is exanthematous, describe the pathophysiology ans symptoms

A

generalised symmetrical macropapular rash/ morbilliform/ macropapular

idiosyncratic, T cell mediated delayed (4-21 days after taking drug) type 4 hypersensitivity

mild and self limiting, itch and mild fever common

can progress to life threatening

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10
Q

what are the different presentations of drug eruptions

A 
exanthematous, 
urticarial,
papulosquamous,
pustular,
bullous,
pigmentation,
itch/pain,
photosensitivity
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11
Q

drug eruptions usually resolve when the drug is withdrawn, what are the exceptions to this rule

A

the half life of the drug, ability of the drug to be retained/ accumulate, cross reactions with similar class of drugs

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12
Q

what are the risks factors for drug eruptions

A

age (young adult/ elderly take more)
genetics (polymorphism in gene that metabolise drugs)
concomitant disease (immunosuppressed- HIV, cystic fibrosis)

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13
Q

name two drug types that commonly cause eruptions

A

B lactam compounds, NSAIDs

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14
Q

what is the most common type of drug reactions

A

exanthematous

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15
Q

what are the indicators of a potentially severe exanthematous drug eruption

A

involvement of mucous membrane and face

facial erythema and oedema

widespread confluent erythema

fever >38.5

skin pain

blisters, purpura, necrosis

lymphadenopathy, arthralgia

SOB, wheezing

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16
Q

what drugs are associated with exanthematous eruptions

A 
penicillins
sulphonamides 
erythromycin
streptomycin
allopurinol
anti-epileptics 
NSAIDs
chloramphenicol
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17
Q

does exanthematous skin reaction blanche

A

yes

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18
Q

does purpuric vasculitic reactions blanche

A

no

19
Q

describe a urticarial drug reaction

A

immediate IgE mediated hypersensitivity reaction after rechallenge with drug

OR

direct release of inflammatory mediators from mast cells on first exposure

20
Q

what drugs are associates with a urticarial drug reaction

A

rechallenge; B-lactam antibiotics, carbamepine

first exposure; aspirin, opiates, NSAIDs, muscle relaxants, vancomycin, quinolones

21
Q

what might urticaria that persists be

A

urticarial vasculitis

22
Q

what is the usual timeline for urticaria

A

comes and goes within hours, will be gone in 24 hours

23
Q

what can cause anceiform drugs reactions

A

glucocorticoids, androgens, lithium, isoniazid, phenytoin

24
Q

what can cause an acute generalised exanthematous pustulosis (AGEP)

A

rare, antibioticsm calcium channel blockers, antimalarials

25
Q

what can cause drug induced bullous pemphigoid

A

ace inhibitors, penicillin, furosemide

26
Q

what drug can cause a blistering rash in ring forms and why

A

vancomycin- linear decrease of IgE

27
Q

describe fixed drug eruptions

A

well demarcated round/ovoid plaques, red/purple-ish and painful affecting hands, genitalia, lips, oral mucosa and buttocks

28
Q

what happens to a fixed drug reaction when the drug is stopped

A

resolves with persistent pigmentation

29
Q

for fixed drug reactions what happens after resolutions if the drug is used again

A

will occur in exactly the same spot

30
Q

what often causes fixed drug reactions

A

treatment for (period) pain e.g paracetamol, NSAIDs

aslo tetracycline, doxycycline, carbamazepine

31
Q

name four severe cutaneous adverse drug reactions

A

steven-johnson syndrome (SJS)

toxic epidermal necrolysis (TEN)

drug reaction with eosinophilia and systemic symptoms (DRESS) - high fever, extensive symmetrical rash, facial oedema

acute generalised exanthemaout pustulosis (AGEP)

32
Q

what are the symptoms of SJS

A

generalised erythema and erosions of oral mucosae

33
Q

what are the acute phototoxic drug reactions

A

skin toxicity (photosensitivity),
system toxicity,
photodegradation

34
Q

what are the chronic phototoxic drug reactions

A

pigmentation,
photoaging,
photocarcinogenesis

35
Q

why do drugs cause photoxic drug reactions

A

7/10 drugs absorb light, cause hypersensitivity, are degraded producing photo products and oxygen radicals

36
Q

are phototoxic cutaneous drug reactions immunological

A

no

37
Q

what are the patterns of skin toxicity

A

immediate prickling with delayed erythema and pigmentation

exaggerated sunburn

exposed telangiectasia

delayed 3-5 days erythema and pigmentation

increased skin fragility- scarring and blistering

38
Q

what drugs are associated with phototoxicty

A 
antibiotics
thiazides 
chlorpromazine
NSAIDs
quinine 
antifungals
immunosuppressants 
(loads more)
39
Q

what are the common culprits of phototoxicity drug reactions

A

doxycycline, amiodarone, chlorpomazine, quinine

40
Q

what causes telangiectasia and angioemas on sun exposed sights

A

calcium antagonist phototoxicity

41
Q

what can proton pump inhibitors cause (phototoxicity)

A

sub acute cutaneous lupus

42
Q

can skin prick testing be used for type 2 and 3 reactions

A

no may trigger SJS, TEN and DRESS

43
Q

what is the management for drug reactions

A

discontinue drug if possible, use alternative

topical corticosteroids may be helpful

antihistamines if type 1 (or if itch)

Dermatology (23 decks)

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