Drug Reactions and Urticaria Flashcards
Chinese/SE Asian patients may develop SJS/TEN if they have HLA-B* ______ and you give them carbamazepine
HLA-B*1502
White/Hispanic people may develop DRESS (Drug Related Eosinophilia with Systemic Symptoms) if they have HLA-B*______ and you give them abacavir
HLA-B*5701
Chinese/Taiwanese/Thai patients may develop SJS/TEN if they have HLA-B*_________ and you give them Allopurinol
HLA-B*5801
What is this:
Severe form of immune reaction in the skin that leads to a widespread eruption of tender lesions, especially bullae and target lesions. Skin and mucous membranes are involved
SJS
Two types of epidermal necrolysis drug reactions
SJS
TEN (Toxic Epidermal necrolysis)
If someone has an immediate reaction to a drug (less than 1 hour after taking it), what kind of symptoms might you expect
Urticaria
Angioedema
Anaphylaxis
Does allergy testing help us determine if someone will have a drug reaction?
No, only works with Penicillin
True or False:
HIV+ patients have higher rates of skin reactions to sulfas
True
Morbilliform means:
Measles like eruption
Widespread, symmetric erythematous macules and papules on the trunk and extremities
What is the most common type of cutaneous drug eruption
Exanthematous
(Limited to the skin
Appear on trunk and spread to extremities in a symmetric fashion
Erythematous macules and infiltrated papules
Pruritus and mild fever possible
Appear >2 days after drug has been started and persists for several days after stopping)
If someone develops an exanthematous drug reaction, can they keep taking the drug that caused it?
Yes, as long as the eruption is not too severe and the medication cannot be substituted
How do you treat an exanthematous drug eruption?
Topical steroids
Oral antihistamines
Reassurance
What kind of drug reaction is this:
“Characterized by the formation of a SOLITARY erythematous patch or plaque that will recur at the same site with re-exposure to the drug”
Fixed drug eruption
difference between SJS and TEN
SJS is less than 10% body surface area
TEN is over 30% body surface area
What is it called if someone has necrosis and detachment of the epidermis and mucosal surfaces due to a drug reaction, and it covers 20% of their body surface area?
SJS/TEN
True or Fasle:
SJS and TEN are emergencies
True
Let’s see the drugs at highest risk of causing SJS and TEN
Sulfas
Allopurinol
Tetracyclines
Anticonvulsants (carbamazepine, Lamotrigine, phenobarbital, phenytoin)
NSAIDS
(SATAN 😈)
True or false:
The first symptom of SJS or TEN is always skin lesions
False.
Often preceded by fever, headache, rhinitis, or myalgia by 1-3 days
Which is worse with SJS and TEN:
Pain or Itching
Pain
SJS and TEN lesions evolve to become:
Flaccid blisters, which spread with pressure and break easily
Can SJS or TEN make you blind
Yes
If someone has SJS or TEN, do you need to stop all non-life-sustaining drugs
Yes
If someone has SJS or TEN that involves >25% surface area, they need to be treated where?
Burn center
HLA-B*1502 is associated with what
Southeast Asian patients on carbamazepine
