Drug Induced Skin Reactions

Question 1

Drug reactions can be 1 or 2.

Answer 1

1. immediate reactions

2. delayed reactions

Question 2

Immediate reactions occur less than 1 of last administered dose and include 2, 3, 4. Delayed reactions occur after 5, usually more than 6 and occasionally 7. They include 8, 9, 10, 11

Answer 2

1. one hour
2. urticaria
3. angioedema
4. anaphylaxis
5. 1 hour
6. 6 hrs
7. weeks to months after start of administration
8. exanthematous eruptions
9. fixed drug eruptions
10. systemic reactions
11. vasculitis

Question 3

The only allergy testing used in drug induced reaction is 1, which is useful due to 2 mediated 3 allergy.

Answer 3

1. penicillin
2. IgE
3. penicillin

Question 4

The most important data in determining if a rash is medication related is 1. For exanthematous eruptions, initiation of medication is often 2 before rash, though may be much shorter in 3

Answer 4

1. timeline
2. 7-10 days
3. repeated exposures

Question 5

Risk factors for drug reactions are being 1, prior 2, recurrent 3, 4 type, and certain 5

Answer 5

1. female
2. hx of drug rxn
3. drug exposure
4. HLA (Han Chinese and SJS/TEN with allopurinol)
5. disease states (sulfa drugs and AIDS pt, EBV pt with aminopencillin)

Question 6

Physical exam of 1 drug induced reaction shows widespread, 2, 3 on 4 and 5 in 6 fashion. This is the most common of all cutaneous drug eruptions and is limited to the 7. They subside 8 after stopped using the drug, treat with 9 if needed.

Answer 6

1. exanthematous
2. erythematous
3. macules and papules
4. trunk
5. extremities
6. symmetric
7. skin
8. 2-3 days
9. antihistamine

Question 7

Fixed drug eruptions is characterized by formation of 1 that will 2 at the 3 with 4. The lesion can be 5 with 6, and is non 7. They are very commonly elicited by drugs such as 8, 9, 10.

Answer 7

1. solitary erythematous patch or plaque
2. reoccur after 30min-8hrs after drug ingestion
3. same site
4. re-exposure
5. perfectly round/sharply demarcated erythematous macule
6. bullae
7. scaly
8. phenophthalein (laxatives)
9. NSAIDs
   10 sulfonamides

Question 8

Drug Reaction with Eosinophila and Systemic Symptoms (DRESS) are characterized by 0 eruptions with 1 and 2 involvement. Typical signs and symptoms are 3, 4, 5, 6, 7, 8. >70% have 9.

Answer 8

0. morbiliform skin eruptions
1. systemic symptoms (fever)
2. internal organ involvement
3. macular exanthem
4. erythematous centrofacial swelling
5. fever
6. malaise
7. lymphadenopathy

Question 9

DRESS have signs and symptoms beginning at 1 after start of medication or after 2. It’s distinguished therefore from the exathematous drug eruptions which occurs 3. Signs and symptoms may 4 after 5 of drug treatment with fatality rate up to 10%. Classically due to medications such as 6 and 7

Answer 9

1. 3rd week
2. increasing dose
3. sooner (7-10 days)
4. persist
5. cessation
6. anti epileptics
7. sulfa drugs

Question 10

SJS/TEN happens where 1 detaches from the 2 and are acute life threatening event, distinguished baed on the 3 involved, TEN covering more than SJS

Answer 10

1. epidermis
2. mucosal surfaces
3. Body Surface Area 10%, 10-30%, >30%

Question 11

The drugs associated with the highest risks are __

Answer 11

SATAN: sulfa, allopurinol, tetracyclines, anticonvulsants, NSAIDS

Question 12

Symptoms of SJS/TEN clinically begin within 1 after onset of drug exposure with 2, 3, 4, all of which may precede cutaneous lesions by 5. There is positive 6 sign and could additionally have 7 involvement

Answer 12

1. 8 weeks
2. fever
3. HA
4. Rhinitis
5. 1-3 days
6. Niklesky sign
7. Mucosal

Question 13

Complications of SJS/TEN include 1, 2, 3, 4; Treatment is ___

Answer 13

corneal damange, fluid and electrolyte problems, nutritional problems, secondary infections
Tx: withdraw from offending drug and supportive care