2.1 Cs Exam5: Drug Reactions

Front 1

What Rx cause Fixed drug eruption?

Back 1

Tetracycline, sulfanamides, barbituates

Front 2

What Rx cause Pigmentation?

Back 2

Minocycline, antimalarials, bleomycin

Front 3

__________ Rxn:

-photodistributed erythema, scaly annular eruption, psoriasiform eruption that appears about 7 weeks after starting medication

-+ ANA

Back 3

Subacute Lupus-like Rxn

Front 4

What Rx cause subacute lupus-like sx?

(sx will improve 6-12 wks after removing agent)

Back 4

antihypertensives (Hydrochlorothorothiazide, ACE I, Ca blockers), Terbinafine, HMC CoA reductase I, INF-alpha

Front 5

_______________Rxn:

-fever, musculoskeletal sx, pleuropulmonary involvement, & weight loss that may occur > 1 yr after starting medication

-+ ANA (may persist up to yr after removing offending agent)

(NO cutaneous involvement)*

Back 5

Systemic Lupus-like Rxn

Front 6

What Rx cause systemic lupus-like sx?

(sx will resolve 4-6 wks after removing agents)

Back 6

procainamide, hydralazine, minocycline, isoniazid, penicillamine

Front 7

What Rx cause serum sickness-like sx?

Back 7

cefaclor, minocycline

Front 8

What Rx cause Pemphigus-like sx?

Back 8

Captopril, penicillamine

Front 9

What Rx cause Photosensitivity?

Back 9

doxycycline, thiazide, sulfonylureas

Front 10

MC drug hypersensitivity rxn

-acute, puritic, lasts weeks even after stopping drug

-diffuse papular erythemic rash (looks like measles)

Tx?

Back 10

Morbilliform eruption

Tx: systemically

Front 11

What Rx cause Morbilliform eruption?

Back 11

antibiotics & calcium channel blockers

(amoxicillin, codeine, opiates)

(starts on trunk & spreads to limbs & neck symmetrically)

Front 12

Patient started a new drug 2-6 weeks ago & presents w/ flu-like sx, fever, widespread rash (exanthema) & exfoliative dermatitis (erythroderma), & edema. Dx?

Tx?

Back 12

Drug Hypersensitivity Syndrome

Tx: remove offending agent**

Front 13

Erythroderma or exfoliative dermatitis is also characteristic of ________________, an inflammatory skin disease w/ erythema & scaling

Back 13

Red man syndrome

Front 14

What systemic features would you expect to see in a pt w Drug hypersensitivity syndrome?

Back 14

cervical lymphadenopathy/pharyngitis

atypical lymphocytosis w/ eosinophila

hepatotoxicity (abnormal LFTs)

Front 15

What drugs are the MC agents responsible for Drug hypersensitivity syndrome?

Back 15

aromatic anticonvulsants (phenytoin, phenobarbital, carbamazipine)

sulfonamide antibiotics (thiazides, furosemide, sulfonylureas)

minocycline

Front 16

What drug causes Blue Lunula?

Back 16

Minocycline

(Minocycline-induced hyperpigmentation--> causes slate/blue pigmentation & brown hyperpigmentation (esp on ant legs))

Front 17

A pt presents w/ high fever, "toxic" appearance, widespread erythema, & non-follicular small sterile pustules a few days after starting a new drug. Dx?

What could the drug be?

Back 17

Acute Generalized Exanthematous Pustulosis

Rx: beta-lactam antibiotics, Terbinafine, Itraconazole, Macrolide

Front 18

Erythema multiforme major

Steven-Johnson Syndrome

Toxic Epidermal Necrolysis

All cause what?

Back 18

Severe cutaneous adverse reactions (SCAR)

(usually w/i a month of onset of therapy)

Front 19

_____________ is characterized by target lesions on the distal extremities. Lesions reoccur w/ recurrent HSV infections.

Pts are put on chronic acyclovir or valcyclovir.

Back 19

Erythema Multiforme Major (if minor- less severe usually not d/t drugs)

Front 20

_________ is a severe form of Erythema multiforme. Skin starts to slough & pt develops mucosal, ocular, & genital erosions (very severe). May be caused by TMP-SMX (bactrim).

Back 20

Steven-Johnson Syndrome (SJS)

Front 21

________ is a severe form of SJS, characterized by mucosal erosions, more diffuse areas of sloughing & upper respiratory prodrome (fever, pharyngitis, conjunctivitis) These pts must go to burn center!

What is the MC drug to cause this?

Back 21

Toxic Epidermal Necrolysis (TEN)

MC d/t Sulfonamides

Front 22

In addition to aggressive supportive (Burn Unit) care, TEN patients also need to be put on what meds?

Back 22

systemic corticosteroids

plasmaphoresis

IV Immunoglobulins (IVIG)

Front 23

What are some of the potential adverse effects of systemic corticosteroids?

Back 23

-increased BP (usually mild)

-Osteonecrosis (in long-term, 2 months +)

-peptic ulcer dz (if dose is 1g +)