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OU Pt Assessment Spring 2018 > Physical Effects of Meds > Flashcards

Physical Effects of Meds Flashcards

1
Q

mechanism of drug-induced urticaria, rash, or allergy

A
  • IgE-mediated, Type I reaction

- Hypersensitivity

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2
Q

Which medications can cause drug-induced urticaria, rash, or allergy?

A
  • Penicillin, ampicillin, amoxicillin, and related antibiotics
  • Sulfonamides
  • Carbamazepine and several antiepilelptic drugs (AEDs)
  • Allopurinol
  • Monoclonal antibodies
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3
Q

characteristics of drug-induced rash / allergy

A

Morbilliform (AKA exanthematous; appears maculopapular)

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4
Q

Warning signs (red flags) for a more severe reaction of a drug-induced urticaria, rash, or allergy

A
  • Pain
  • Facial edema
  • Blisters or epidermal detachment
  • Fever
  • Involvement of the mucous membranes
  • Painful erythema
  • Shortness of breath or wheezing
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5
Q

What does DRESS stand for?

A

Drug Rash with Eosinophilia and Systemic Symptoms

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6
Q

DRESS characteristics

A
  • Morbilliform rash with red flag symptoms

- need immediate evaluation -> ER

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7
Q

common medications that cause DRESS

A
  • AEDs – carbamazepine, lamotrigine, phenytoin
  • Sulfonamides – sulfamethoxazole, sulfasalazine
  • Other antibiotics – vancomycin, minocycline, dapsone
  • Allopurinol
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8
Q

timing of DRESS to occur

A

2-6 weeks of drug initiation

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9
Q

mortality rate of DRESS

A

5-10%

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10
Q

management of DRESS

A
  • Stop medication and avoid it in the future (further administration can cause a more severe reaction)
  • Antihistamines +/- corticosteroids often used to help symptoms resolve
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11
Q

What are conditions that consists of a series of mucocutaneous reactions with extensive necrosis and epidermal attachment?

A
  • Erythema multiforme (EM)
  • Stevens-Johnson Syndrome (SJS)
  • Toxic Epidermal Necrolysis Syndrome (TENS)
  • TENS/EM/SJS
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12
Q

What is the mechanism of TENS/EM/SJS?

A
  • T-lymphocyte-mediated immune reaction
  • Leads to widespread apoptosis of keratinocytes
  • Considered a type IV extreme cutaneous reaction
  • Primarily caused by medications
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13
Q

EM

A
  • Maculopapular rash +/- vesicles occurring on the trunk
  • Accompanied by target lesions on hands or forearms; presence of the target lesions puts pt at higher risk for SJS and TENS
  • Typically has an infectious cause but can be medication-related
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14
Q

SJS

A
  • Also known as EM major

- Vesicular and bullous lesions of mucous membranes (e.g. mouth, eyes, GI tract)

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15
Q

TENS

A
  • Widespread epidermal necrosis
  • Resembles 3rd degree burns
  • 20-30% mortality rate
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16
Q

common medications that cause EM

A
  • NSAIDs
  • AEDs
  • Antibiotics Sulfonamides
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17
Q

common medications that cause SJS

A
  • Allopurinol
  • AEDs
  • Antibiotics Sulfonamides
  • Oxicam NSADs (meloxicam, piroxicam)
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18
Q

common medications that cause TENS

A
  • Allopurinol
  • AEDs
  • Antibiotics Sulfonamides
  • Oxicam NSADs (meloxicam, piroxicam)
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19
Q

triage considerations of TENS/EM/SJS

A
  • Immediate evaluation – ED
  • Early diagnosis, withdrawal of offending agent, supportive care offer best chance at recovery
  • Any of the three manifestations indicates the medication should never be used again
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20
Q

What does skin color blue-gray indicate?

A

possible cause of amiodarone or tricyclic antidepressants

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21
Q

What does hyperpigmentation indication?

A
  • melanin sensitivity

- possible cause of chemotherapeutic agents, hormones, prostaglandin agonists (bimatoprost, latanaprost)

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22
Q

What does jaundice indicate/

A
  • Hyperbilirubinemia

- possible cause of Atazanavir

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23
Q

Triage considerations of skin pigmentation changes

A
  • Refer to prescribing provider
  • Not life-threatening, more of a cosmetic issue
  • Adherence can be affected
  • Reversal of pigment changes can take months
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24
Q

characteristics of tardive dyskinesia

A
  • Intermittent hyperkinetic involuntary movements
  • Typically involve face, tongue, eyelids, or limbs
  • Difficult to define temporal relationship as timing often delayed
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25
Q

mechanism of tardive dyskinesia

A

Acetylcholine deficiency combined with dopamine receptor sensitivity

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26
Q

common medications that cause tardive dyskinesia

A
  • Antipsychotics: Typical (e.g. haloperidol) > atypicals (e.g. risperidone)
  • Metoclopramide
27
Q

triage considerations for tardive dyskinesia

A
  • Occurs at a rate of about 20-40%
  • Difficult for patients to have to live with
  • Direct patient to prescribing provider; can provide recommendations
28
Q

recommendations for drug-induced tardive dyskinesia

A
  • Dose reduction
  • Addition of a benzodiazepine
  • Switch to an agent with less risk (e.g. atypical antipsychotic)
29
Q

characteristics of pulmonary symptoms

A

most common are

  • SOB
  • cough
30
Q

mechanism of pulmonary symptoms

A
  • Oxidant injury
  • Immune-mediated
  • Drug mechanism-mediated
31
Q

common medications that cause pulmonary symptoms

A
  • Beta blockers – drug induced bronchiole constriction
  • ACEI or ARB – cough only
  • Cytotoxic agents typically cause the most severe effects
32
Q

triage considerations for pulmonary symptoms

A
  • Refer to PCP if non-severe symptoms; ED if severe (assess the patient)
  • Often a diagnosis of exclusion – everything else is ruled out before meds are suspected
  • Assess via dose reduction or drug discontinuation
33
Q

characteristics of angioedema

A
  • Swelling of dermis and subcutaneous tissue, development of wheals; typically non-pruritic
  • Wheals forming in mouth and pharynx can cause airway obstruction
34
Q

mechanism and common causes of angioedema

A
  • Most commonly IgE-mediated mast cell activation – opioids, NSAIDs, aspirin
  • ACEI – inhibition of kinin metabolism
  • CCBs – histamine-release
35
Q

triage considerations of angioedema

A

immediate attention -> ER

36
Q

characteristics of peripheral edema

A

swelling of lower extremities

37
Q

mechanism of peripheral edema

A
  • Increased hydrostatic pressure from pre-capillary dilation (CCBs cause arterial vasodilation) and post capillary constriction
  • Thiazolidinediones and NSAIDs – increased sodium reabsorption in kidneys; more commonly an issue in those with pre-existing heart disease
38
Q

common medications that cause peripheral edema

A
  • DHP CCBs
  • Vasodilators – hydralazine, minoxidil
  • Thiazolidinediones – pioglitazone, rosiglitazone
  • NSAIDs
39
Q

triage considerations of peripheral edema

A
  • A benign effect; cosmetically an issue but not an indicator of a systemic danger
  • Diuretics not needed
  • Be sure to assess the whole patient
    • Other symptoms of fluid retention (e.g. weight gain, SOB, orthopnea) indicates another process is going on
    • Often drug-induced edema is a diagnosis of exclusion
40
Q

Gynecomastia characteristics

A

breast enlargement in males

41
Q

mechanism of Gynecomastia

A
  • Enhanced estrogen activity

- Inhibition of testosterone action or production

42
Q

common medications of Gynecomastia

A
  • Most have either an effect on sex hormones or a steroid-like structure
  • Enhanced estrogen activity – estrogens, anabolic steroids
  • Inhibition of testosterone – spironolactone, megestrol, efavirenz, ketoconazole, phenytoin
43
Q

triage considerations for Gynecomastia

A
  • Refer to prescribing provider
  • Not systemically harmful
  • Patient can report chest pain; use patient assessment skills to discern
  • Typically resolves a few days after treatment discontinuation
44
Q

alopecia characteristics

A

hair loss

45
Q

common medications that cause alopecia

A 
- variable mechanisms 
handout.
- Chemotherapeutic agents
- AEDs
- Hormones
- Statins
46
Q

triage considerations for alopecia

A

Can be reversible with treatment discontinuation

47
Q

hair growth mechanism

A
  • Hirsutism – often related to androgenic stimulation of hormone sensitive hair follicles
  • Hypertrichosis – a specific pattern of hair growth along the temporal regions and forehead
48
Q

common medications that cause hair growth

A
  • Hirsutism: anabolic steroids, contraceptives, testosterone

- Hypertrichosis: Minoxidil (aka Rogaine®), Phenytoin, Cyclosporine

49
Q

common medications (and mechanisms) that cause musculoskeletal effects

A
  • Diuretics – cramping can result from electrolyte imbalances
  • Statins – typically affects larger muscles (e.g. back, leg muscles)
  • Fluoroquinolones – can lead to tendon rupture; typically Achilles tendon
50
Q

triage considerations for musculoskeletal effects

A
  • Diuretics – check BMP, treat as needed
  • Statins – assess whether myalgia, myositis, or rhabdomyolysis; will need prescribing provider intervention
  • Fluoroquinolones – discontinue
51
Q

characteristics of Gingival hyperplasia

A

overgrowth of gum tissue

52
Q

common medications that cause Gingival hyperplasia

A
  • CCBs
  • Phenytoin
  • Cyclosporine
53
Q

triage considerations for Gingival hyperplasia

A
  • Prevention and reduction can be accomplished with good oral hygiene
  • Cosmetic issue but can also lead to increased risk of infection
  • Not reflective of systemic disease
54
Q

mechanism of Gingival hyperplasia

A

proliferation of epithelial keratinocytes, fibroblasts, and collagen

55
Q

characteristics of skin necrosis

A

Cutaneous infarction

56
Q

mechanism of skin necrosis

A
  • Precipitous fall in protein C (anticoagulant)
  • Promotion of hypercoagulable state
  • Thrombosis occurs in the cutaneous microvasculature
57
Q

common medications that cause skin necrosis

A
  • Warfarin

- Injection site reactions: Heparin, Interferon

58
Q

triage considerations of skin necrosis

A

immediate treatment -> ER

59
Q

skin necrosis: warfarin

A
  • Usually starts between 3 and 5 days after initiation

- Tends to occur in higher-fat areas (breasts, buttocks, abdomen)

60
Q

characteristics of Petechiae

A

Small red/purple spots caused by bleeding under the skin; typically do not blanche

61
Q

mechanism of Petechiae

A
  • Usually indicates a hemotologic abnormality (often thrombycytopenia)
  • Caused by a medication or underlying disease process
  • Must evaluate both possibilities
62
Q

common medications that cause Petechiae

A
  • Heparin
  • Antiplatelet medications
  • NSAIDs
  • Chemotherapeutic agents
  • Beta lactam antibiotics, linezolid
  • AEDs
63
Q

triage considerations for Petechiae

A

Not immediately life-threatening but warrants quick workup – immediate PCP or urgent care/ED if unavailable

OU Pt Assessment Spring 2018 (10 decks)

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