Corren Da

Front 1

Adverse Drug Rxn

Back 1

Noxious, unintended and undesired effect of drug at doses used for prevention, dx, and tx

Hint 1

Predictable - 80% of ADR, known PCOL effect of drug, dose dep, patient specific fxs.
Unpredictable- unrelated PCOL, occurs in susceptible individ, not dose dependent

Front 2

Unpredictable

Back 2

Drug intolerance, idiosyncratic, drug allergic rxns

Front 3

Immune mech of Drug Allergy

Back 3

Hapten hypothesis- small molecules result in sensitization
Prohapten hypothesis- SMX (not protein reactive) gains reactivity via metabolism (nitroso intermediate)

Hint 3

p-I intxn w/ immune receptors- direct intxn w/ immune receptors such as TCR or MHC

Front 4

Type I intxn - urticaria, angioedema, bronchospasm, anaphylaxis

Back 4

Type II intxn - cytotoxic, a/w hematopoetic presents as cytopenias

Hint 4

Type III- least common a/w drugs, serum sickness

Front 5

PSeudoallergic- resemble type I but involves mast cell activation: opiates, vancomycin, and RCM

Back 5

Drugs may also cause complement activation, bradykinin release, innate immune response

Hint 5

SJS/TEN- apoptosis in TEN is UNK, involves granzymes, granulysin, TNF and Fas-L

Front 6

DRESS- may be a/w drug specific T cells and reactivation of HHV 6

Back 6

AGEP- Type IVc delayed rxn ~ neutrophilic dermal rxn

Hint 6

Noncutaneous specific immune drug rxn- immune hepatitis nephropathies, MGN, pulm hypersiensitivity

Front 7

Risk fxs: LMW agents and polysacch, smaller drugs are haptens. Oral << IV. Higher dose and more freq admin --> greater sensitization

Back 7

Host risk: female, concurrent illness. Atopy a/w drug rxn incl IgE and non IgE

Hint 7

HLA B1502 ~ han chinese CBZ- SJS - recc genetic screening

Front 8

Allopurinol HLA B-5801 - HAN CHINESE, European, Japanese, SCAR

Back 8

Abacavir HLA B 5701- mult ethnicities - genetic screen; a/w fever, rash, malaise, GIT and resp symptoms

Hint 8

Exanthems- diffuse fine macules/papules ~ AminoPCN, AED, Sulfonamides

Front 9

Urticaria Angioedema- IgE, b lactam, onset w/n minutes

Back 9

Fixed drug eruptions- hyperpigmented plaques, Tet, NSAIDs, and CBZ

Hint 9

Pustules - Acneiform ~ steroids, sirolimus. AGEP: ABX, CCB

Front 10

Lichenoid- ACEI- furosemide, NSAIDs, PPI, imatinib (violaceous, polygonal plaques)

Back 10

Photodistributed
Eczematous photoallergic- HCTZ, quinidine

Hint 10

Phototoxic- Sulfonamides, Tet, Furosemide, FQ

Front 11

Bullous- Tense Furosemide, Vanc

Back 11

Flaccid blisters- Captopril, Penicillamine

Hint 11

Cutaneous lupus- HCTZ, ACEI, CCB

Front 12

Hematologic- Heme anemia, thrombocytopenia, granulocytopenia- PCN, quinine, sulfonamide

Back 12

Hepatic- Hepatitis, cholestatic jaundice- Sulfonamide, phenothiazine

Hint 12

Pulmonary- Nitrofurantoin, Bleomycin, MTX

Front 13

Renal - interstitial nephritis, MGN- PCN, Sulfonamide, Gold, Penicillamine, Allopurinol

Back 13

Anaphylaxis- IgE and non IgE dep rxns- beta lactam, monobactam

Hint 13

DRESS- cutaneous fever, eosinophilia, hepatic dysfn, LAD- AED, sulfonamides, Minocycline, Allopurinol

Front 14

SJS- fever, erosive stomatitis, ocular involvement, purpuric macules on face/trunk - Sulfonamides, AED, NSAIDs, lamotrigine, sertraline, pantoprazole, tramadol

Back 14

Serum sickness- urticaria, arthralgia, fever- a/w heterologous Ab, infliximab

Hint 14

SLE= hydralazine, procainamide, INH

Front 15

Vasculitis- cutaneous or viscer- hydralazine, PTU

Back 15

Exanthems- generalized MP eruption, pruritic, drug induced are pruritic, involves trunk, and spreads centrifugally many considered DTH. With resolution, scaling occurs (diff from epidermal detachment) -- does not evolve into anaphylaxis

Hint 15

Urticaria and angiodema- both IgE and non IgE MP lesion on sides of fingers/toes or serpiginous distribution along lateral aspect of soles specific for serum sickness

Front 16

Complement activation may also result in urticaria/angioedema

Back 16

Fixed drug eruptions- w/n 1-2 weeks, may recur w/ subsequent exposure...eczematous lesions, often round, demarcated, elevated plaques (prediliction - lips, hands, genitalia) OCCURS w/ CBZ, NSAIDs, TETracycline

Hint 16

Eczemaous Rxs- SDRIFE) Symm Drug Related Intertriginous Flexural Exantema post systemic exposure w/ demarcated erythema buttocks/thigh

Front 17

Exfoliative derm- may be a/w systemic symptoms

Back 17

Photoallergic- w/n days of drug and UV exposure- vs photoxic a/w w/n min-hrs of sunlight exposure ~ a/w vesicles

Hint 17

Drug ind cutaneous lupus- a/w eruptions in photodistrib (erythema or annular scaly plaques)

Front 18

Lichenoid rxns w/ Furosemide, ACE-I, GOLD, PPI, Imatinib, NSAIDS (akin to Lichen planus)

Back 18

Pustular drug eruptions- several cutaneous drug rxns- a/w pustules, occurs w/ GC, androgens, lithium, phenytoin, and INH, Sirolimus

Hint 18

AGEP- erytehma/edema in intertriginous areas on face, fine non follicular sterile pustules; a/w fever, neutrophilia (eosinophilia). AGEP w/ ABX will occur w/n a few days, AGEP from CCB post few weeks

Front 19

Drug ind Sweet's - fever, painful nodules, plaques/pustules - GCSF- sulfonamides, and minocycline

Back 19

Drug ind pemphigus- a/w thiol grp (captopril)

Hint 19

Drug induced BP (ACEI, Furosemide, PCN, Sulfasalazine)

Front 20

Linear IgA bullous dx- VAnc is most common

Back 20

EMM- targetoid lesions ~ to SJS, symmetric, acral, mucosal less severe and extensive occ mainly post HSV. , often benign

Hint 20

SJS, TEN, and DRESS may also present w/ vesicular or bullous lesions

Front 21

Purpura and petechiae stgmata of vasculitis

Back 21

AGEP - a/w erythemia in intertigionsous areas or face, then non follicular sterile pustules develp, fever, neutrophilia, 1/3 cases a/w eosinophilia - often implicated ABX and CCB

Hint 21

AGEP 2- T cell mediated, drug specific CXCL8, good progrnosis, resolution w/n days of drug discontinuation

Front 22

SJS - <10% BSA, TEN > 30%

Back 22

Clinical features of SHS/TEN - a/w mucous membrane erosions, target lesions, epidermal necrosis w/ detachment- may be preceded w/ fevers, cough, malaise

Hint 22

Blisters of SJS/TEN are flaccid and +ve Nikolsky's sign

Front 23

High risk drugs for SJS/TEN incl sulfonamide, Ceph, CBZ, phenytoin, and oxicam NSAIDs

Back 23

Other high risk for SJS/TEN incl lamotrigine, nevirapine, sertraline, protonix, and tramadol

Hint 23

DRESS- a/w fever, eosinophilia (most not all), hepatic/renal dysfn, LAD. Cutaneous a/w MP exanthems, facial edema may be diffuse, extremity and genital edema may also occur; hypoT in up to 42% of pts.

Front 24

Meds implicated in DRESS- Sulfonamide, AED, Allopurinol, Minocycline, Dapsone, Abacavir, Sulfasalazine, NSAID, Vancomycin, NSAIDs

Back 24

DRESS- atypical a/w 2-8 weeks, may worsen post d/c. HHV6 reactivation detected in pts w/ DRESS

Hint 24

Drug induced vasculitis- PTU, Hydralazine, Allopurinol, Phenytoin, MTX. Some a/w ANCA, long latency

Front 25

CSS (Churg) a/w LKTI, ICS,

Back 25

Systemic DILE- a/w hypocomplement, antihistone Ab > 90%, a/w INH, esp w/ Procainamide and Hydralazine. Also seen w/ INH, methlydopa, Chlorpromazine

Hint 25

Serum sickness a/w PCN, sulfonamides, thiouracils, phenytoin. Monoclonal Ab. Sxs may last as long as weeks, tx w/ steroids, anti-H, sometimes NSAIDs (esp Cefaclor) in peds

Front 26

May occur w/o immune complex and just EM, arthralgias w/ w/o fever

Back 26

Immun nephropathy a/w fever, rash, arthralgias, peripheral eos. also see MGN (allopurinol) and renal vasculitis

Hint 26

NSAID, antidepressants, Sulfonamides a/w allergic hepatitis. Hepatitis and cholestasis may occur. May take mos to resolve post d/c