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Integ Exam 1 > Drug Reactions Lecture > Flashcards

Drug Reactions Lecture Flashcards

1
Q

Common drugs

A 
Penicillin
Sulfonamides
Barbiturates
Anticonvulsants
Insulin preps
Local anesthetics
Iodine preps
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2
Q

Prevalence and characteristics

A

1-5% experience cutaneous drug eruptions
No correlation with the diagnosis or underlying illness
Women&raquo_space; men
Occur with previously tolerated drugs
Overlooked or misdiagnosed
Non-immunologic in nature (due to direct toxic effect on skin tissue or direct action to release histamine from mast cells and do not involve antibodies or T cells directly

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3
Q

Non-immunologic in nature means?

A

Due to direct toxic effect on skin tissue or direct action to release histamine from mast cells
Do NOT involve antibodies or T cells directly

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4
Q

Immune mediated allergic reactions

A

Drug-protein interactions may be mediated by metabolic enzymes and are processed by langerhans cells in skin (presented to T cells which produce TH1 or TH2 response)

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5
Q

Type 1 Gell-Coombs Classification

A

Classic immediate hypersensitivity - anaphylaxis

    • Antibody: IgE mediated on mast cells and basophils
  • Minutes to one hour
  • Life-threatening
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6
Q

Type II Gell- Coombs Classification

A

Cytotoxic antibody reaction

  • Antibody: IgE or IgM interacts with complement system resulting in cell lysis
  • Within several hours
  • Caused by drugs, food, emotions, environment
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7
Q

Type III Gell- Coombs Classification

A

Immune complex reaction

- Ige or IgM antibodies formed against drug to form an immune complex –> inflammation

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8
Q

Type IV Gell Coombs Classification

A

Delayed hypersensitivity reaction

  • Sensitized T cells –> CYTOKINES and inflammation
  • Late time course
  • Drug induced skin rashes, cell mediated reactions (no antibodies)
  • Stop ASAP, improves rapidly
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9
Q

Type V Gell Coombs Classification

A

Autoimmune response

- Antibody is produced and binds to some receptor in the body (self-antigen binding)

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10
Q

Type I Drugs

A

Epinephrine
Diphenhydramine (H1 blocker)
Hydrocortisone
Bronchodilators, IV fluids, and H2 antagonists
- Usually antihistamine and steroids
- 15% are H2 so just a H1 blocker wouldn’t do the job

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11
Q

Type II or III Drugs

A

H1 and H2 blocker (doxepin)

Hydrocortisone

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12
Q

Type IV Drugs

A

Mild and topical agents

- Oral antihistamine or corticosteroids

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13
Q

Exanthem

A

Rash
May be maculopapular, morbilliform, erythematous
- 2-3 days after drug admin
- Treated with an antihistamine, wet dressing or systemic corticosteroids
- Disappears after drug termination (2-4 days)
- Type IV

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14
Q

Urticarial eruptions

A

Hives
Treat with H1 and H2 blockers or systemic corticosteroids
Clear in 1-2 days

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15
Q

Fixed drug reaction

A

Oval lesion
Reoccur 30 minutes to 8 hours after rechallenge
Drugs not effective
Lesion heal 7-10 days after termination

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16
Q

Photosensitive

A

Senstivity to sun
Phototoxic: within hours of exposure
Photoallergic: within 1-2 days
Discontinue drug use

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17
Q

Alopecia

A

Toxic reaction

Interferes with normal growth phases of the hair

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18
Q

Acneiform eruptions

A

Acne like lesions, usually on neck, chest or back
2-4 week onset
Uniform size and symmetrical distribution

19
Q

Erythema Nodosum

A

Red PAINFUL nodules
Discontinue drug
Heals over 2-3 weeks after termination

20
Q

Exfoliative dermatitis

A

Severy with erthema and abundant flaky desquamation (skin sloughs)
Loss of fluids
Treat with fluids, steroids, pain meds and antibiotics

21
Q

Toxic Epidermal Necrolysis (TEN)

A 
Life threatening
Medicated by cytotoxic T cells
30% mortality
Discontinue drug use, use corticosteroids, antihistamines, fluids and antibiotics
Severe pain
Intensity: 1-3 days
>30% of body
22
Q

Stevens-Johnson Syndrome

A 
Life threatening
Mediacted by cytotoxic T cells
Mortality rate 5-18%
Symptoms: maculopapular bullae, vesicles, hemorrhagic lesions in the mouth, lips and conjunctiva
Mild pain
Intensity: 7-15 days
<10% of body
23
Q

Macule

A

Circumscribed, flat lesion of any shape or size

Differing from surrounding skin due to color

24
Q

Papule

A

Small solid elevated lesion

25
Q

Plaque

A

A mesa-like elevated lesion occupying a relatively large area in comparison to height

26
Q

Hives

A

Urticarial lesion

27
Q

Nodule

A

Palpable, solid round or ellipsoidal lesion

28
Q

Vesicle

A

Small, circumscribed, fluid-filled blister

29
Q

Bullae

A

Large vesicle

30
Q

Angioedema

A

Sudden appearance of edematous areas of skin, mucous membranes and occasionally viscera
Of immune or unknown origin

31
Q

Morbilliform

A

Multi-shaped red flat rash resembling measles

32
Q

Erthema

A

Presence of a red color

33
Q

Exanthem

A

Rash or eruption of the skin

34
Q

Urticaria

A

Vascular reaction of skin marked by transient slightly elevated patches that are redder or paler than surround skin –> intense itching

35
Q

First generation H1 antagonists

A

Hydroxyzine, chlorpheniramine, diphenhydramine, cyproheptadine

  • Pass the BB –> CNS sedation
  • Help sleep but not good if you need to be alert
36
Q

Second generation H1 Antagonists

A

Loratadine and cetirizine

Do not penetrate CNS, non-sedating but metabolized by 3A4 and 2D6

37
Q

H2 Antagonists

A

Cimetidine, ranitidine, famatidine, nizatidine

- Cimetidine has many interact

38
Q

Cimetidine

A

Many interaction

Disturb kidney function and drug metabolisms

39
Q

leukotriene Receptor Antagonists

A

Block LT1 receptor to reduce inflammation and itching
Zafirlukast
Montelukast

40
Q

Antidepressants

A

Tricyclic antidepressants (increase NE and dopa)
Antihistamic and anticholinergic sedating properties
Mood-elevating effects
Doxepin, topical cream

41
Q

Oral or Parenteral steroids

A

Hydrocortisone: anaphylaxis
Methyprednisolone: more severe reactions
Prednisone: milder conditions
- Alter gene expression and direct receptor mediated effects
- Decreased response to sun, chemical, mechanical, infectious and immunological stimuli
- Decrease lots

42
Q

Withdrawal of therapy adverse effects

A

Flare underlying disease

Acute adrenal insufficiency due to long term suppresion of hypothalamic-pituitary acis

43
Q

Metabolic/organ system dysfunction

A

Continued use at higher levels = disorders develope

44
Q

Antimetabolites

A

Folic acid analog used to inhibit DHFR and reduce immunocompetent cells of skin
- Avoid interaction with other folate antagonists and co-admin with aspirin or NSAIDs

Integ Exam 1 (7 decks)

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