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MSK/Derm > SM 261: Drug Reactions and Blistering Disorders > Flashcards

SM 261: Drug Reactions and Blistering Disorders Flashcards

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Dermatology Board Prep flashcards
1
Q

How are drug induced skin reactions classifed?

A

By timing: immediate ( < 1hr) vs delayed ( > 6hr)

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2
Q

What is an immediate drug induced reaction?

A

A reaction that occurs less than 1 hour of the the last administered dose of a drug

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3
Q

What are examples of immediate drug induced reactions?

A

Angioedema, Urticaria (hives), and Analphylaxis

AUA

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4
Q

What is a delayed drug induced reaction?

A

A reaction occuring after 6 hours of the last administered dose of a drug

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5
Q

What are examples of delayed drug induced reactions?

A

Exanthemous Eruptions, Fixed Drug Eruptions, Systemic Reactions, and Vasculitis

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6
Q

What is a Urticarial drug reaction?

A

An immediate drug reaction that can occur with or without angioedema

Caused by NSAIDs and Opiates

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7
Q

What drugs can cause Utricaria without Angioedema?

A

NSAIDS and Opiates

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8
Q

What drugs can cause Utricaria with Angioedema?

A

ACEi

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9
Q

What should a complete drug history involve?

A

The 7 I’s of drug use:

Instilled
Inhaled
Ingested
Inserted
Injected
Incognito
Intermittent
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10
Q

What is the most important factor in determining if a rash is medication-related?

A

Timing, based off of a drug timeline

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11
Q

What are risk factors for drug reactions?

A

Female, prior history of reaction, recurrent exposure, HLA type, HIV/EBV

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12
Q

What does EBV predispose a reaction to?

A

Aminopenicillins

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13
Q

What is an Exanthematous Drug reaction?

A

A reaction that is limited to the skin, with erythematous macules and papules initially appearing on the trunk and spreading centrifugally to the extremities in a symmetric fashion around 7-10 days after a drug

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14
Q

When does an Exanthematous drug reaction occur and when does it end?

A

7 - 10 days after starting the dug, and lasts 2-3 days after stopping

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15
Q

If someone is having an Exanethematous drug reaction, is it ever OK to continue giving the drug?

A

Yes, if the eruption is not too severe and the medication cannot be substituted

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16
Q

What are long term effects of an Exanthematous drug reaction?

A

None

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17
Q

What is the treatment for an Exanthematous drug reaction?

A

Steroids + antihistamines

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18
Q

What should you do if a patient presents with a rash and facial edema?

A

Order a CBC and LFT’s - possible Eosinophilic reaction known as DRESS

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19
Q

What is DRESS?

A

Drug Reaction with Eosinophilia and Systemic Symptoms; macular exanthem + centrofacial swelling + fever/malaise that begins 3 weeks after starting a drug and lasts many weeks after a drug is stopped

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20
Q

When does an DRESS occur and when does it end?

A

DRESS occurs 3 weeks after starting a drug and lasts several weeks after a drug - potentially fatal

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21
Q

What are long term effects of DRESS?

A

Possibly fatal, depending on the organ systems involved in the systemic reaction

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22
Q

How should a patient with DRESS be managed?

A

Consider severity of reaction + involved organs: order CBC, LFT, BUN/Creatinine and review medications

Stop all suspect medications and discontinue non-essential medications

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23
Q

What is the treatment for mild DRESS?

A

Stop all suspect medications; if mild, use topical steroids and antihistamines, if severe, use systemic steroids

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24
Q

What is the treatment for severe DRESS?

A

Stop all suspect medications; begin systemic steroids and gradually taper

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25
Q

What is Erythema Multiforme?

A

A self-limited but recurrent disease with the onset of papular “target” lesions occurring over 24 hours in acrofacial sites (face/hands/feet)

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26
Q

What are the two types of Erythema Multiforme?

A

Erythema Multiforme Major and Erythema Multiforme Minor

27
Q

What does Erythema Multiforme Minor look like?

A

Papular target lesions with little or no mucosal involvement or systemic symptoms

28
Q

What does Erythema Multiforme Major look like?

A

Papular target lesions with severe mucosal involvement and systemic symptoms that develop in < 24hours

29
Q

Which drug usually causes Erythema Multiforme?

A

HSV and Mycoplasma Pneumoniae, not a drug reaction

30
Q

Does Erythema Multiforme progress to Toxic Epidermal Necrolysis?

A

Typically, no

31
Q

What reactions are part of the Epidermal Necrolysis Spectrum?

A

Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

32
Q

What are SJS and TEN?

A

Both are rare, potentially fatal cutaneous reactions to drugs characterized by mucocutaneous tenderness, erythema, and skin erosion

33
Q

Compare SJS and TEN?

A

Both involve extensive necrosis and detachment of the epidermis and mucosal surfaces, but SJS is < 10% of body surface area and TEN is > 30% of body surface area with overlap in between

34
Q

Are SJS and TEN emergencies?

A

Yup

35
Q

When are SJS and TEN more dangerous?

A

Greater skin involvement, increasing age, and comorbids

36
Q

When do TEN and SJS occcur?

A

7 - 21 days after starting a drug

37
Q

What causes SJS and TEN?

A

Extensive death of Keratinocytes via apoptosis mediated by Fas-FasL signalling

38
Q

How are SJS and TEN managed?

A

Stop the drug, and supportive care

39
Q

What drugs are high risk for SJS/TEN?

A

NSAIDS, Sulfa antibiotics, and Anticonvulsants

40
Q

How does SJS present?

A

Fever and myalgia 1-3 days before skin changes, skin changes initially on the face and upper trunk symmetrically, dusky red to purpuric macules (atypical targets) which coalesce and involve mucous membranes

41
Q

What areas are initially involved in SJS?

A

Face and upper trunk and proximal extremities: symmetric, erythematous dusky red to purpuric macules

42
Q

What are complications of SJS?

A

Corneal damage, fluid/electrolyte problems, and secondary injection

43
Q

Why should you consult Optho for SJS?

A

Corneal damage

44
Q

What are systemic warning signs of a potentially severe drug reaction?

A

Fever, malaise, etc. and Lymphadenopathy

45
Q

What are cutaneous warning signs of a potentially severe drug reaction?

A

Erythroderma, facial involvement + swelling, mucous membrane involvement, and purpura

46
Q

What is a Vesicle?

A

A blister that forms from cells separating in the Epidermis or at the Epidermal/Dermal layer

47
Q

How can intraepidermal and subepidermal blisters be differentiated?

A

Intraepidermal blisters are flaccid and easily broken; Subepidermal blisters are tense and intact

48
Q

What is the Nikolsky sign?

A

Epidermal separation caused by lateral pressure to edge of blister/normal-appearing skin = intraepidermal blister

49
Q

What is Dermatitis Herpetiformis?

A

The skin version of Celiac, caused by gluten sensitivity: causes pruritic papulovesicles on extensor sufaces, buttocks and back

50
Q

What causes Dermatitis Herpetiformis?

A

Deposition of IgA on the Papillary Dermis leading to neutrophil recruitment in response to dietary gluten allergy

51
Q

What causes the immune reaction in Dermatitis Herpetiformis?

A

Genetic predisposition for gluten sensitivity + diet high in gluten = formation of IgA to gluten Transglutaminase, which cross reacts with epidermal Transglutaminase

52
Q

If the IgA in gluten allergy is directed against Gluten Transglutaminase, why does it effect the skin?

A

IgA cross-reacts with Epidermal Keratinocyte Transglutaminase, leading to the deposition of IgA on the skin and causing Dermatitis Herpetiformis

53
Q

What causes Pemphigus Vulgaris?

A

IgG Autoantibodies to Desmogleins resulting in superficial Bullae

54
Q

Who does Pemphigus Vulgaris effect?

A

People in their 50’s - 60’s

55
Q

What is the treatment to Pemphigus Vulguars?

A

Immunosuppression

56
Q

What type of antibody does Pemphigs Vulgaris use, and where does it effect the skin?

A

IgG targeted against Epidermal Desmosomes

57
Q

What is Bullous Pemphigoid and what does it target?

A

Bullous Pemphigoid are autoantibodies to the hemidesmosome, resulting in deep, tense bullae on flexoral surfaces

58
Q

Who does Bullous Pemphigoid effect?

A

The Elderly

59
Q

How is Bullous Pemphigoid treated?

A

TDAP: Tetracycline, Dapsone, Azathioprine, Prednisone

60
Q

Where in the dermis does Bullous Pemphigoid split skin?

A

Subepidermally, since it targets the Hemidesmosome

61
Q

What are Porphyrias?

A

A group of inherited disorders resulting from deficiencies in heme biosynthesis enzymes

62
Q

What is Porphyria Cutanea Tardia and how does it present on skin?

A

A disorder caused by decreased activity of Uroporphyrinogen Decarboxylase that causes photosensitvity and skin fragility with blistering in sun-exposed sites

63
Q

What disease is associated with Porphyria Cutanea Tardea?

A

Liver disease such as alcoholism and Hepatitis C

64
Q

How is Porphyria Cutanea Tardia diagnosed?

A

Urine porphyrins and pink fluorecent urine under Woods light

MSK/Derm (46 decks)

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