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29 Cards in this Set
- Front
- Back
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1 to ____ percent of hospitalized patients experience cutaneous drug reactions.
Which drugs are most common? |
1-20%
Most common drugs: antibx, anticonvulsants |
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Alopecia and excessive purpura are _________ drug reactions to which drug types?
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Alopecia - chemotx
Excessive purpura - anticoags Both are NONALLERGIC drug rxns |
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What is the Jarisch-Herxheimer phenomenon?
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Indirect drug-induced effect caused by rxn to bacterial endotoxins liberated by destruction of organisms
Syx (fever, LAD, arthralgias, transient macular or urticarial eruption) disappear w/continued tx |
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Allergic reactions are NOT _________.
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Dose-dependent
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What are the fours types of cutaneous drug reactions (I-IV)?
Examples of each. |
Type I: IgE immediate hypersens (urticaria, edema, anaphylaxis, pruritis)
Type II: Cytotoxic (hemolytic anemia, autimmune blistering) Type III: Immune complex: palpable purpura, vasculitis Type IV: delayed hypersens--MHC presentation, etc--exanthematous drug rash, contact dermatitis |
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What drugs are most likely to cause exanthematous drug eruption?
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A TEAM
Abx (amoxicillin, ampicillin, sulfa drugs, cephalosporins) Anticonvulsants Allopurinol |
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Exanthematous drug eruption:
Treatment |
Discontinue suspected drug
Topical corticosteroids (consider desensitization if offending drug is necessary for tx) |
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What is the triad of drug hypersensitivity syndrome?
Offending drugs? |
Fever, Rash, Systemic Syx
DRESS: Drug Reaction with Eosinophilia and Systemic Syx (occurs 1-8 weeks after drug exposure) Drugs include: Anticonvulsants (phenytoin, carbamazepine, phenobarb), sulfas, allopurinol, minocycline |
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Facial swelling is the hallmark feature of __________.
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Drug Hypersensitivity Syndrome
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Systemic involvement of Drug Hypersensitivity Syndrome.
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Hepatitis
Nephritis Pneumonitis Myocarditis Encelphalitis Hypothy Colitis |
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Urticarial Allergic Drug Eruption:
Hallmark sign Offending drugs |
Hallmark: pink wheals, discrete or confluent
Drugs: salicylates, ***NSAIDs***, IV constrast dye |
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What defines complex urticarial drug eruptions?
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Generalized urticaria w/anaphylaxis, angioedema, serum sickness, vasculitis
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Events allowing a photoallergic drug reaction to occur.
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UV light converts drug into immunologically active compound (photoallergen) that induces immune response.
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This type of lesion is an urticarial, oval patch with a cigarette paper-like scale.
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Erythema annulare centrifugum (EAC)
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Causes of erythema annulare centrifugum-like cutaneous drug reaction.
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More often assocd w/infection or underlying neoplasm
Can be due to barbiturates, captopril, labetalol, clinidine, PCN, salicylates |
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How do acneiform drug reactions differ from true acne?
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No comedones!
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This lesion manifests as palpable purpura and ulcerations.
Type of allergy reaction? |
Leukocytoclastic Vasculitis (LCV)
a type III reaction |
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Fixed Drug Eruption occurs when ______.
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REPEATED drug exposure at SAME site; can have multiple
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Vacuoles along the epidermis (on histologic examination) is indicative of _____.
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Fixed drug eruption
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This lesion appears as tender erythematous nodules on the anterior shins.
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Erythema Nodosum
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This lesion appears as multiple violet, flat-topped, pruritic, polygonal papules and/or plaques.
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5 P's = Lichenoid drug eruption
Lichen = 'stuck to' |
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This lesion appears as widespread (EVERYWHERE) erythema and scaling WITHOUT blisters.
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Exfoliative Erythroderma
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This skin lesion exhibits leukocytosis with elevated neutrophils, renal failure, and hypocalcemia.
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Acute Generalized Exanthematous Pustulosis
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How does acute generalized exanthematous pustulosis differ from pustular psoriasis?
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Pustules in pustular psoriasis will coalesce. Pusules in AGEP are monogamous.
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Pathophysiology of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis.
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SJS/TEN = most feared mucocutaneous reaction
Cell-mediated cytotoxic rxn against keratinocytes leads to apoptosis. Skin dies and sheds. Dermis is exposed. Lose water, heat, iron. Die of sepsis. |
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SJS vs TEN
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SJS: 2>mucosal surfaces involved (oral mucosa always involved), less than 10% skin blistering
TEN: >30% skin blistering, don't necessarily have mucosal involvement (usually do) |
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What is a Nikolsky sign and what is it diagnostic of?
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Nikolsky sign: press laterally on skin and it sloughs off (because it's dead)
If poz Nikolsky sign-->SJS/TEN |
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This skin lesion occurs almost exclusively with herpes simplex or mycoplasm infection.
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Erythema multiforme
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Treatment protocol for SJS/TEN.
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-Burn Unit Intensive Care
-D/C suspected drug -D/C corticosteroids -IV Immunoglobulin if within 48-72 hours (prevents Fas-Fas ligand interaction to prevent cell death) -Optho consult |
