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Derm/Ophth > Drug-Induced Derm > Flashcards

Drug-Induced Derm Flashcards

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Dermatology Board Prep flashcards
1
Q

circumsised flat lesoins of any shape or size that differ from surroundings bc of their color

A

macules

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2
Q

small, raised lesions (pimple)

A

papules

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3
Q

multiple, well defined red macules of varying size that blanch upon pressure and are thus a result of inflammatory vasodilation

A

drug eruption

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4
Q

palpable, solid, round, or ellipsoidal lesions

A

nodules

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5
Q

technical term for blisters.

A

vesicles and bullae (bullae are >0.5cm diameter)

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6
Q

rounded or falt-topped papules or plaques that are evanescent (disappear quickly)

A

wheals

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7
Q

exanthematous + fever

A

hypersensitivity syndrome reaction (DRESS)

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8
Q

blistering and no fever

A

fixed drug eruption

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9
Q

urticarial and no fever

A

urticaria/angioedema (IgE-mediated, hives etc.)

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10
Q

exanthematous and no fever

A

simple maculopapular eruption

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11
Q

pustular and fever

A

AGEP

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12
Q

pustular and no fever

A

acneiform

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13
Q

blistering and fever

A

SJS/TEN (uh oh land)

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14
Q

urticarial and fever

A

serum sickness-like

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15
Q

maculopapular rash
onset
offset
causative drugs

A 
exanthematous and no fever
most common type of drug -induced dermatologic condition
trunk, arms, and upper back
onset at 7-10 days of drug initiation
resolves in 7-14 days of d/c drug

penicillins/cephalos
sulfonamides
anticonvulsants

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16
Q

DRESS
definition
s/sx
offending agents

A 
exanthematous eruption + 
fever, lymphadenopathy, eosinophilia, multi-organ involvement (kidney liver and lungs), facial edema, >50% of body surface area
onset at 1-6wks post-initiation of drug
offending agents: 
allopurinol #1
sulfonamides
anticonvulsants (barbituates, phenytoin, carbamazepine, lamotrigine)
dapsone
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17
Q

DRESS

patho

A

T cell activation and proliferation
reactivation of latent human herpes virus-6
exact patho is unknown

18
Q

allopurinol-induced DRESS

risk factors

A 
excessive allopurinol dose
renal dysfxn
concominant thiazide diuretic
HTN
asian ethnicity
HLA-B*58:01
19
Q

DRESS treatment

A

d/c offending drug
avoid starting new medications
avoid beta lacs
valproic acid is a good alternative anti-epileptic
fluid, electrolyte, and nutrition management
organ involvement?
no = high potency topical steroids BID-TID x 1wk
yes = systemic corticosteroids 0.5-2mg/kg/d prednisone equivalents, tapered over 8-12 weeks

20
Q

what are some high potency steroids

A 
clobetasol 0.05%
fluocinonide 0.1%, 0.05%
betamethsasone dipropionate augmented 0.05%
halobetasol 0.05%
halcinonide 0.1%
betamethsasone dipropionate 0.05%
triamcinolone cream or ointment 0.5%
desocimethasone 0.05%
21
Q

what are medium to low potency steroids

A 
triamcinolone cream or ointment 0.1%
mometasone 0.1%
triamcinolone lotion 0.1%
hydrocortisone valerate 0.2%
betamethasone valerate 0.1%
desonide 0.05%
triamcinolone 0.025%
hydrocortisone 1%
22
Q 
urticaria and no fever
s/sx
offending agents
onset
tx
A 
type 1 HS rxn (IgE mediated)
can be 1st sign of anaphylactic rxn
hives, priuritic red raised wheals, angioedema, swelling of mucous membranes
onset in minutes to hours
agents:
penicillins and related ABX
sulfonamides
ASA
Opiates
Latex
tx: Benadryl
23
Q 
urticaria plus fever 
s/sx
onset
resolution
offending agents
tx
A 
serum sickness-like rxn
not a true serum sickness
urticaria, fever, arthralgias
onset at 1-3 weeks after starting drugs
sx resolve within 1-2 weeks
agents: 
penicillins/cephalos
sulfonamides
24
Q

Blistering with no fever (fixed drug eruption)
s/sx
onset
offending agents

A 
simple eruptions with priuritic, erytheatous, raised lesions that can blister
onset in minutes to days
skin hyperpigmentation can last for months
agents: 
TTCs
barbituates
sulfonamides
codeine
phenolphthalein
APAP
NSAIDs
25
Q

SJS/TEN
definition
s/sx
onset

A

rare, severe, life-threatening, acute mucocutaneous disorders
painful bullous formation with systemic s/sx
fever, HA, respiratory sx, mucous membrane involvement, flu-like sx,
skin lesoins spread rapidly and cause epidermal, necrosis, detachment and sloughing
onset within 1-2 weeks of exposure

26
Q

SJS/TEN patho
risk factors
concerns

A

cytotoxic t cell activation, keratinocyte apoptosis mediated by granulysin or fas ligand
RF: HIV infection, lupus (SLE), malignancy, UV light or radiation therapy, genetic factors (HLA-B*15:02)
concerns: fluid loss, electrolyte imbalance, hypotension, secondary infection

27
Q

SJS/TEN offending agents

A 
sulfonamides
penicillins
antoiconvulsants
NSAIDs (-oxicams)
allopurinol
28
Q

acute phase of SJS/TEN s/sx

A 
fluid loss and electrolyte imbalance
severe pain
hypovolemic shock and associated AKI
bacteremia
hypercatabolic state
insulin resistance
pulmonary dysfunction requiring mechanical ventialtion
GI dysfunction (poor po intake)
mulitple organ dysfunction syndrome (MODS)
29
Q

SJS/TEN treatment

A

withdraw offending drug
check cross-reacting drugs (penicillins ands eulfas)
supportive care (pain management, fluids, electrolytes, nutrition)
wound care (topical antiseptics: chlorhexidine, silver nitrate, silver sulfadiazine (CI is SJS from sulfa), gentamicin)
ophthalmology consult (artificial tears or oint, CS/antimicrobial drops)

30
Q

SJS/TEN tx options

A

systemic CS
IVIG
Cyclosporine
Thalidomide

31
Q 
steroids for SJS/TEN
dosing
use
risks
take home
A

prednisone 1-2mg/kg/d for 3-5d if started w/in 1st 24-48h sx onset!!
risks: infection, inc protein catabolism, dec wound healing
take home: generally avoided unless early course and no current infection, dont use if TEN (>30% covered)

32
Q

SJS #1 COD

A

infection

33
Q 
IVIG for SJS/TEN
dosing
use
risks
take home
A

1g/kg/d x3d w/in 24-48h sx onset may be beneficial
risks: does not target underlying patho, cost, BBW AKI and thromboembolic events, hemolysis, infusion rxn, hypervolemia)
take home: generally not used unless severe disease and early course
BUT, #1 choice bc doesnt inc risk infxn

34
Q 
Cyclosporine for SJS/TEN
dose
use
risks
take home
A

3-5mg/kg/d has been shown to delay progression of SJS/TEN but s limited
risks: normal SE (HTN, renal injury)but is limited byshort course of therapy
take home: generally not used, second line if pt is intolerant of IVIG

35
Q

Thalidomide for SJS/TEN

use

A

DO NOT USE

36
Q

hyperpigmentation

caused by…

A

phenytoin- inc melanin
TTCs, silver, mercury, antimalarials - direct deposition
amiodarone (skin, liver, lungs and thyroid toxicity)

37
Q

photosensitivity
causes
prevention

A 
sulfonamides
TTCs
Amiodarone
coal tar
*use 30 SPF, avoid sun exposure
38
Q

general management of DIDD

A

dc offending drug
avoid cross-reacting drugs
supportive care
consider short course of systemic CS for more severe manifestations

39
Q

sulfonamides cross react with…

A 
loop diuretics
thiazide diuretics
sulfonylureas
sulfasalazine
dapsone
40
Q

crossreactivity btwn penicillins and cephalos

A

1-2%

Derm/Ophth (5 decks)

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