Drug Reactions Flashcards
name the five types of drug reactions
exanthematous fixed drug reaction stephen johnson syndrome drug induced hypersensitivity syndrome or drug related eosnophilia with systemic symptoms
what type of drugs are people with EBV susceptible to reaction with?
penicillins
what type of drugs are people with HIV susceptible to reaction with?
sulfonamides
describe the exanthematous drug reaction on the skin
widespread symmetric erythematous macules and papules
where on body does exanthematous drug reaction occur?
trunk and extermities
when does exanthematous drug reaction usually start?
usually between 8-11 days after starting drug
what two things to give for treatment of exanthematous drug reaction?
topical steroid and antihistamines
describe how fixed drug eruption appears on the skin
solitary erthematous patch or plque that often has central bulla
name the four drug classes common for fixed drug eruptions
NSAIDs
tetracyclines
metronidazole
sulfonamides
where on body do fixed drug eruptions usually occur?
mouth genitals face and acral areas
how does fixed drug eruption look after healing?
dark brown macule with violet hue
when do fixed drug eruptions appear? how long after drug?
about a day
what is treatment for fixed drug eruption?
steroid ointment if not eroded and abx cream if eroded
what three things do patients with drug induced hypersensitivity syndrome present with
fever
facial swelling
macular exanthem
what do a high percentage of patiens with drugs induced hypersensitivity syndrome have?
eosinophilia
where does rash appear with drugs induced hypersensitivity syndrome?
macular rash on trunk and extremities
how long after drug do you get drugs induced hypersensitivity syndrome?
usually around 3rd week but can be anywhere from 1-12 weeks
name the five drugs classes common for drugs induced hypersensitivity syndrome?
allopurinol abx NSAIDs abacavir (HIV) anticonvulsants
what two abx lead to drugs induced hypersensitivity syndrome?
penicillin and sulfonamides
what other organs can be involved in drugs induced hypersensitivity syndrome?
liver
kidney and bone marrow
what is treatment for mild drugs induced hypersensitivity syndrome?
topical steroids with anti histamines
what is treatment for severe drugs induced hypersensitivity syndrome?
prolonged systemic steroid with slow taper
describe what happens in the skin with stephens johnson syndrome or toxic epidermal necrolysis
eryhtematous irregularly shaped dusky red macules that start to coalesce and skin sloughs off
name the five drug classes involved in SJS/TEN (SATAN)
sulfonamides allopurinol tetracyclines anticonvulsants NSAIDs
what other symptoms are there in SJS/TEN?
fever headache and myalgias
what is the Nikolsky sign?
skin detaches with lateral pressure in SJS/TEN
name three common complications with SJS/TEN
corneal damage
bacteremia/sepsis
mucous membrane stenosis/scarring
what drug reaction can involve the mucus membranes?
SJS/TEN
what is treatment for SJS/TEN
remove meds consult derm and send to burn
when does SJS/TEN onset?
within 8 weeks after start of offending drug
what is another reaction that commonly is confused with SJS/TEN?
erythema multiforme
what happens in erythema multiforme?
painful erythematous targetoid papules and oral ulcerations
where does erythema multiforme occur more? what about SJS/TEN?
erythema multiforme more in acral extremities
SJS more in trunk
both in mouth
what is erythema multiforme related to ?
HSV…may occur in flares
how to treat erythema multiforme?
topical steroids for mild and systemic for severe
