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2ND YR DERM > DRUGS > Flashcards

DRUGS Flashcards

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Dermatology Board Prep flashcards
1
Q

what percentage of adverse drug reactions are cutaenous?

A

30%

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2
Q

name Type 1 immunologically mediated reactions

A
  • anaphylactic reactions
  • urticaria
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3
Q

name type II immunologically mediated reactions

A
  • cytotoxic reactions
  • pemphigus and pemphigoid (blictering etc.)
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4
Q

name type III immunologically mediated reactions

A
  • immune complex mediated reactions
  • purpura rash
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5
Q

name type IV immunologically mediated reactions

A
  • cell mediated delayed hypersensitivty reactions
  • T cell mediated can result in erythema/rash
  • not dose dependent
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6
Q

name some non-immunological reactions

A
  • can be does dependant
  • eczema
  • drug induced alopecia
  • phototoxicity etc.
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7
Q

give some risk factors for drug eruptions

A
  • age
  • gender
  • genetics
  • concomitant disease (HIV, EBV, CMV)
  • immune factors
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8
Q

what are the most common rash presentations?

A
  • exanthematous, morbilliform, maculopapular (75-95%)
  • urticarial
  • papulosquamous/pustular/bullous
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9
Q

who should be especially considered when suspecting a cutaneous drug eruption?

A

patients taking medication who suddenly develops a symmetrical skin eruption

  • usually stops when drug is withdrawn
  • ability of drugs ability to accumulate/be retained in tissue plays a role
  • may cross react with a similar class of drug
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10
Q

name risk factors in drugs that may cause eruptions?

A
  • chemical makeup e.g.
    • beta lactam
    • NSAIDS
    • high molecular weight drugs can cause this
  • route of administration
  • dose
  • half life
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11
Q

what is acute generalised exathematous pustulosis? (AGEP)

A
  • small red or whit epustules
  • with pruritus and mildn fever
  • over 90% of cases are drug induced
  • usually takes 1-3 weeks for rash to develop, shorter if sensitised already
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12
Q

what should be done if suspected acute generalised exanthematous pustulosis?

A
  1. culture blood and take skin biopsy
  2. stop causative drug (most often antibacterial)
  3. prescribe an emollient
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13
Q

what type of hypersensitivity is AGEP?

A

type IV T cell mediated delayed type hypersensitivity

  • can progress to a life threatening reaction
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14
Q

what can a severe AGEP reaction be indictaed by?

A
  • facial erythema and oedema
  • fever above 38.5
  • skin pain
  • dyspnoea and arthralgia
  • blisters etc.
  • drugs (e.g. penicillins, erythromycin, streptomycin, allopurinol)
  • most often drugs are antibacterial
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15
Q

name the two causes of urticarial drug eruptions?

A
  • IgE meduated hypersensitivity reaction type I
    • after rechallenge with drug
  • direct release of inflammatory mediators from immediate degranulation of mast cells on exposure (on first exposure)
    • more triggered by streotypical drigs e.g. aspirin, opiates, NSAIDS, msucle relaxants, vancomycin
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16
Q

name two types of pustular or bullous drug eruptions

A
  • acneiform (papules and pustules resembling acne)
  • acute generalised exanthomatous pustulosis
17
Q

which drugs can trigger acneiform like rash?

A
  • common with glucocorticoids which triggers steroid acne
  • androgens, lithium, isoniazid, phenytoin
18
Q

which drugs can trigger AGEP?

A
  • use of antibiotics
  • calcium channel blockers
  • anti-malarials
19
Q

what causes drug induced bullous pemphigoid?

A
  • ACE inhibitors
  • penicillin
  • furosemide
20
Q

what are fixed drug eruptions?

A
  • well demarcated round/ovoid plaques
  • red/painful
  • found in the hands/genitalia/lips and occasionally oral mucosa
  • usually just one big red mark
  • can reoccur on the same site on re-expousre to drugs
  • usualy muld and one single lesion
  • can also present as…
    • eczematous lesions
    • papules
    • vesicles
    • urticaria
21
Q

name the adverse drug reactions that cause life threatening cutaneous reactions with overlapping features caused by drugs such as:

  • sulfonamides
  • aminopenicillins
  • anti-epileptics
  • NSAIDs
  • allopurinol

some patients may develope more severe underlying problems e.g. AIDS

A

stevens johnson syndrome AND toxic epidermal necrolysis

22
Q

what are some severe drug reactions to look out for?

A
  • drug reaction with eosinophilia and systemic symptoms (DRESS)
  • Acute generalised exanthomatous pustulosis (AGEP)
23
Q
  • non-immunological skin reaction that is caused by the reaction to sunlight (UVA)
  • caused by a drug making the individual more photosensitive
  • can also be brought on by SLE (lupus) or immunosuppression
  • most will affect the patient through a glass window
A

phototoxic drug reactions

24
Q

name the two types of phototoxic drug reactions?

A

ACUTE

  • skin toxicity
  • systemic toxicity
  • photodegradation

CHRONIC

  • pigmentation
  • photoaging
  • photo carcinogenesis
25
Q

what investigations can be carried out for cutaneous drug eruptions?

A
  • history ad physical exam
  • phototesting
  • biopsies
  • patch and photopatch tests (for suspected contact dermatitis)
  • skin prick (for type 1 reaction for suspected allerguc reactions watch for anaphylaxis)
  • skin testing is not indicated for serum sickness reaction type 3 or T cell mediated (can trigger conditions)
26
Q

management of cutaneous drug eurptions?

A
  • discontinue drug and use alternative
  • topical corticosteroids
  • anti-histamines (if type 1/symptoms of itch)
  • allergy bracelets useful for some drugs
27
Q

common cutaneous drug eruptions?

A

2ND YR DERM (6 decks)

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