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DERM > wk 2 2 Cutaneous Drug Eruptions > Flashcards

wk 2 2 Cutaneous Drug Eruptions Flashcards

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Dermatology Board Prep flashcards
1
Q

hypersensitivity type I (anaphylactic) may lead to what effect on skin

A

uticaria

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2
Q

type 2 (cytotoxic) leads to what effect on skin

A

blistering (pemphigus/pemphigoid - look like these, auto-iimmune blistering)

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3
Q

ype 3 (immune-complex) can cause what efrct on skin

A

purpura/rash

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4
Q

type 4 (delayed) causes what effect on skin

A

erythema/rash

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5
Q

in immune reactions, there is not a dose-dependant for reaction

A

true

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6
Q

examples of non-immunological reactions in skin

A 
eczema
drug induced alopecia
phototoxicity
skin erosion (topical 5-flurouracil) 
atrophy 
psoriasis
pigmentation 
cheilitis, xerosis 
(can be dose dependent)
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7
Q

drug induced skin condition most typically present as

A 
morbilliform 
exanthematous (symmetrical) 
uticaria 
pigmentation 
itch/pain
photosensitivity
(blistering more rare)
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8
Q

risk factors for drug eruptions

A

age - young adults>infants, elderly

gender
-females

genetics

concomitant disease

  • Viral INfections
  • CF

Immune status

  • prev drug reaction
  • positive skin test
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9
Q

B-lactam compounds and NSAIDS are more likely to cause drug eruptions

A

true

High mol. weight/ hapten-forming drug also

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10
Q

which route is likely to cause skin eruptions

A

topical

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11
Q

most common type of drug skin eruption

A

exanthematous drug eruptioons

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12
Q

exanthematous is a type __ hypersensitivity reaction

A

4

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13
Q

t/f exanthematous are mild and self limiting

A

true

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14
Q

pruritis is unlikely with exanthematous

A

false
v common
mild fever also common

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15
Q

time frame from taking first drug to developing skin conditions

A

4-21d

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16
Q

exanthematous skin eruptions can be indicated by

A 
skin pain 
oedema 
involvement of mucous membrane and face
high feveer ( >38.5)
Dyspnoea, wheezing 
widespread confluent erythema  
lymphadenopathy, arthalgia
17
Q

examples of dugs associated with exanthematous eruptions

A 
penicillins
erythromycin 
allopurinol 
NSAIDS
chloramphenicol 
anti-epileptics (carbamazepine, phenytoin) 
sulphonamides 
streptomycin
18
Q

uticarial drug reactions are usually an ____ __ ___ reactioin

A

immediate IgE mediated

can also be direct release of inflam mediators from mast cells (aspirin, opiates,NSAIDS,muscle relaxants, Vanco, Quinolones)

19
Q

t/f uticaria is blanching and mobile

A

true

gone within 24hrs

20
Q

if longer than 24hrs, consider

A

uticaria vasculitis

21
Q

pustular/ bullous drug eruptions can occur when using

A

glucocorticoids
androgens, lithium (no blackheads) , isoniazid, phenytoiin
(these cause acneiform)

22
Q

acute generalised exanthematous pustylosis (AGEP) can occur when using

A

antibiotics
Ca blockers
Antimalarials

23
Q

pemphigoid

A

auto-immune blistering disease

24
Q

drug-induced bullous pemphigoid can occur due to 3

A

ace inhibitors
penicillin
furosemide

25
Q

vancomycin can trigger linear IgA disease t.f

A

true

26
Q

fixed drug eruptions can be described as

A

well demarcated round plaques

27
Q

fixed drug eruptions are usually not painful

A

false

red, painful

28
Q

fixed drug eruptions always occur in the same spot

A

true

29
Q

4 severe cutaneous drug reavtions include

A

stevens-johnson syndrome (SJS)
toxic epidermal necrolysis (TEN)
drug reaction with eosinophilia and systemic symptoms (DRESS)
acute generalised exanthematous pustulosis (AGEP)

30
Q

DRESS causes

A

high fever, usually on infections ward

31
Q

TEN patients require treatment as if they are a

A

burns patient

32
Q

explain phototoxicity

A

drug in skin, absoorbs light (UVA), produces oxygen radicals leading to damage

33
Q

t/f phototoxic cutaneous drug reactions is an immunological skin reaction

A

false

34
Q

presentation of skin phototoxicity

A 
immediate prickling with delayed erythema/pigmentation (chlorpromazine, amiodarone) 
exaggerated sunburn (quinine, thiazides, demeclocycline)  
exposed telangiectasia (Ca blockers)  (broken blood vesels) 
incr skin fragility (nalidixic acid, tetra naproxen, amiodarone)
35
Q

important qs in histoyry

A 
detailed description of reaction 
timing of onset/ prev exposure
why on drug 
comprehensive drug history
prev history of drug reaction
36
Q

common drugs causing cutaneous eruptions

A

doxy
amiodarone (acneiform)
chlorpromazine (sunburn)
quinine (pigmentation, itching)

37
Q

investiigations

A

history/physical super important

phototesting

biopsy

patch and photopatch tests (type IV)

skin prick tests for specific drugs (for type I)

skin testing not indicated for serum sickness reaction (typeIII) or for T cell mediated (TypeIV) (potentially trigger SJS,TEN,DRESS)

38
Q

management for drug eruptions

A

discontinue drug if possible/ use alternative
topical corticosteroids may be useful

antihistamines if Type I/itch

allergy bracelets

drug adverse effects - reported via yellow card scheme

DERM (8 decks)

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