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PHM 604- Dermatology and Glaucoma > Drug-Induced Dermatology > Flashcards

Drug-Induced Dermatology Flashcards

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Dermatology Board Prep flashcards
1
Q

What should you always ask a patient when they come into the pharmacy and they have a rash?

A

Do you have a fever?

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2
Q

Four categories of cutaneous drug eruptions

A

Exanthematous, urticarial, blistering, pustular

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3
Q

Types of exanthematous reactions

A

Maculopapular rash and DRESS (drug reaction with eosinophilia and systemic symptoms)

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4
Q

Types of urticarial reactions

A

Urticaria/angioedema and serum sickness-like syndrome

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5
Q

Types of blistering reactions

A

Fixed drug eruption and SJS, TEN, SJS/TEN

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6
Q

When does a maculopapular rash start?

A

7-10 days after drug initiation

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7
Q

When does a maculopapular rash resolve?

A

Within 7-14 days of D/C

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8
Q

Drug causes of a maculopapular rash

A

Penicillins, cephalosporins, sulfonamides, anticonvulsants

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9
Q

Treatment of a maculopapular rash

A

Kids: can continue taking med as long as the rash isn’t itchy and doesn’t have a fever

Adults: switch to a non-penicillin

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10
Q

DRESS symptoms

A

Exanthematous eruption, plus fever, lymphadenopathy around the site of the rash, hematologic abnormalities (eosinophilia), MULTIORGAN INVOLVEMENT (lungs, liver, kidneys)

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11
Q

When does DRESS occur? (onset of action)

A

Starts 1-6 weeks after starting drug, average onset is 2-3 weeks

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12
Q

Drug causes of DRESS

A

ALLOPURINOL
Sulfonamides
Anticonvulsants (phenobarbital, phenytoin, carbamazepine, lamotrigine)
Dapsone

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13
Q

How long does it take to recover from DRESS?

A

6-8 weeks, can be relapse/remission in some cases

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14
Q

DRESS treatment

A

Withdraw offending drug
Avoid starting new meds (avoid beta-lactams)
Fluid and electrolyte management, nutrition

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15
Q

What anticonvulsant can you switch a patient to if they have DRESS and the culprit is another anticonvulsant (lamotrigine, carbamazepine, phenobarbital, phenytoin, etc.)

A

Valproic acid

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16
Q

If there IS organ involvement, what med can you give for treatment of DRESS

A

Systemic corticosteroids: 0.5-2mg/kg/day of prednisone equivalents, tapered down over 8-12 weeks

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17
Q

If there is NO organ involvement, what meds can you give for DRESS

A

High potency topical steroids BID-TID x1 week

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18
Q

Super high potency steroids

A

Clobetasol 0.05%*
Flucinonide 0.1%
Betamethasone dipropionate augmented 0.05%
Halobetasol 0.05%

19
Q

High potency steroids

A 
Flucinonide 0.05%
Halcinoninde 0.1%
Betamethasone diproprionate 0.05%
Triamcinolone 0.5%
Desoximetasone 0.05%
20
Q

Risk factors for DRESS caused by allopurinol

A

Excessive dose, renal dysfunction, concomitant thiazide diuretic, HTN, Asian ethnicity (HLA-B*58:01 allele)

21
Q

Urticaria is what type of hypersensitivity reaction?

A

Type I

22
Q

Symptoms of urticaria

A

Hives, pruritic red raised wheals, sometimes angioedema and swelling of mucous membranes

23
Q

Time of onset of urticaria

A

Minutes-hours

24
Q

Drug causes of urticaria

A 
Penicillins and related ABX
Sulfonamides
ASA
Opiates
Latex
25
Q

Urticaria treatment

A

Stop offending drug and avoid it/drug class in the future

26
Q

Serum-sickness like reaction signs/symptoms

A

Urticaria, fever, arthralgias

27
Q

Onset of serum sickness-like reaction

A

1-3 weeks

28
Q

Drug causes of serum sickness-like reaction

A

Penicillins/cephalosporins

Sulfonamides

29
Q

Treatment of serum sickness-like reactions

A

Will go away on its own in 1-2 weeks

30
Q

Fixed drug eruption signs and symptoms

A

Eruptions with pruritic, erythematous, raised lesions that can blister

Occur in the same place every time the drug is given

31
Q

Onset of fixed drug eruption

A

Within minutes-days

32
Q

Drug causes of fixed drug eruption

A 
TTCs
Barbituates
Sulfonamides
Codeine
Phenolphthalein
APAP
NSAIDs
33
Q

Treatment of fixed drug eruption

A

Resolves within days of D/C

34
Q

Signs and symptoms of SJS, TEN, SJS/TEN

A

Painful bullous formation with systemic signs and symptoms like fever, headache, respiratory symptoms, body-wide mucous membrane involvement

Lesions spread rapidly and cause epidermal, necrosis, detachment, and sloughing

35
Q

Onset of SJS, TEN, SJS/TEN

A

7-14 days

36
Q

Risk factors for SJS, TEN, SJS/TEN

A

HIV, lupus, malignancy/cancer, UV light/radiation therapy, HLA-B*15:02 gene in Asian patients

37
Q

Drug causes of SJS, TEN, SJS/TEN

A 
Sulfonamides (Bactrim)
Penicillins
Anticonvulsants
-oxicam NSAIDs
Allopurinol
38
Q

SJS, TEN, SJS/TEN complications

A

Fluid loss, electrolyte imbalances, hypotension, secondary infections (caused by staph and MRSA)

Treat with topical wound care and topical ABX

39
Q

SJS, TEN, SJS/TEN complications that require pharmacotherapy

A

Fluid loss, electrolyte imbalance, severe pain, hypovolemic shock and associated AKI, BACTEREMIA, hypercatabolic state, insulin resistance, pulmonary dysfunction requiring ventilation, GI dysfunction, multiple organ dysfunction syndrome

40
Q

SJS, TEN, SJS/TEN treatment

A

Withdraw offending drug and check for cross-reacting ones
Pain management, fluid/electrolytes/nutrition
Topical wound care: chlorhexidine, silver nitrate, silver sulfadiazine, gentamicin
Ophthalmology consult: artificial tear drops or oinment, corticosteroids/antimicrobial combo for more severe cases

41
Q

Meds for SJS, TEN, SJS/TEN

A

Systemic corticosteroids: first line; may be effective in early treatment but increases immunosuppression and infection risk

IVIG: first line; no increased infection risk but has a BBW of thromboembolism and AKI

Cyclosporine: use if IVIG fails

Thalidomide: NEVER`

42
Q

Sulfa ABX and sulfa non-ABX cross-reactivity

A

Cross-reactivity is minimal; if the patient has a mild sulfa ABX allergy they can still take the sulfa non-ABX. If severe, they should avoid sulfa drugs entirely

43
Q

PCNs and cephalosporins cross-reactivity

A

Cross-reactivity is minimal; look at the side chains of each and compare. The more similar it is, the more likely there is cross-reactivity

44
Q

Cross-reactivity between PCNs and cephalosporins is greater with what generations of cephalosporins?

A

First and second generations

PHM 604- Dermatology and Glaucoma (9 decks)

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