SM_261a: Drug Reactions and Blistering Disorders Flashcards Preview

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Flashcards in SM_261a: Drug Reactions and Blistering Disorders Deck (33)
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1

Drug-induced skin reactions can be ____ or ____

Drug-induced skin reactions can be immediate or delayed

 

  • Immediate: occurs < 1 hour after last administed dose - urticaria, angiodema, anaphylaxis
  • Delayed reactions: occurs after 1 hour but usually > 6 hours - exanthematous eruptions, fixed drug eruption, systemic reactions (DRESS, SJS, TEN), and vasculitis

2

Urticaria can be caused by ____, while angiodema can be caused by ____

Urticaria can be caused by NSAIDs/opiates (pain meds), while angiodema can becaused by ACE inhibitors

 

 

(most urticaria is not drug-related)

3

Urticaria is described as a ____

Urticaria is described as a wheal

 

(edematous pink plaque that branches)

4

____, ____, and ____ are the most common delayed adverse drug reactions

Exanthematous, drug-induced hypersensitivity syndrome (DRESS), and epidermal necrolysis (Stevens-Johnson, toxic epidermal necrolysis) are the most common delayed adverse drug reactions

5

Reactions to aminopenicillins occur most commonly in patients with ____

Reactions to aminopenicillins occur most commonly in patients with EBV infection

6

This is an ____ drug reaction

This is an exanthematous drug reaction

 

(rapidly erupting rash that may have specific diagnostic features of infectious disease, classic in measles)

7

Morbiliform rash is associated with ____

Morbiliform rash is associated with measles

 

 

(other exanthems are rubella, roseola infantum / sixth disease / exanthem subitum which is caused by HHV-6)

8

Exanthematous drug eruption lesions initially appear on the ____ and spread ____

Exanthematous drug eruption lesions initially appear on the trunk and spread centrifugally to the extremities in symmetric fashion

 

(erythematous macules and papules)

9

Exanthematous drug reaction resolves ____ and is treated with ____, ____, and ____

Exanthematous drug reaction resolves in a few days to a week after medication is stopped and is treated with topical steroids, oral antihistamines, and reassuranc

10

Patient with facial edema; diffuse rash; and elevated WBC, eosinophils, and ASTs has ___

Patient with facial edema; diffuse rash; and elevated WBC, eosinophils, and ASTs has drug-induced hypersensitivity syndrome (DRESS)

11

Drug induced hypersensitivity syndrome / drug reaction with eosinophilia and systemic symptoms (DRESS) is a ___ with ____ symptoms and ____ involvement that appears in the ___ week of treatment

DRESS is a skin eruption with systemic symptoms and internal organ involvement that appears in the 3rd week of treatment

 

(>70% of patients have eosinophils, 

12

Medications implicated in DRESS include ___, ___, ___, ___, ___, and ___

Medications implicated in DRESS include allopurinol, antibiotics, anti-TB drugs, anticonvulsants, NSAIDs, and anti-HIV drugs

13

Approach to patient with suspected DRESS is ____

Approach to patient with suspected DRESS is stopping / substituting all suspected medications and discontinuing non-essential medications

 

  • If not severe, can use topical steroids and systemic antihistamines
  • If severe, start systemic steroids (prednisone) and gradually taper - steroids are indicated for nephritis and impending organ failure

14

Erythema multiforme is characterized by ____ that favor ____, ____, and ____

Erythema multiforme is characterized by target lesions that favor palms, soles, and face

15

Preceding ____ are the most common precipitating factors of erythema multiforme, not usually ____

Preceding HSV or Mycoplasma pneumoniae infection are the most common precipitating factors of erythema multiforme, not usually a drug reaction

16

This is ____ due to ____

This is erythema multiforme due to Mycoplasma

17

This is ____

This is epidermal necrolysis 

 

(includes Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis)

18

Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis are characterized by mucocutaneous ____ and ____ and ____

Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis are characterized by mucocutaneous tenderness and erythema and extensive skin erosion

19

Stevens-Johnson Syndrome / Toxic Epidermal Necrosis results from ____

Stevens-Johnson Syndrome / Toxic Epidermal Necrosis results from extensive necrosis and detachment of the epidermis 

20

Stevens-Johnson Syndrome / Toxic Epidermal Necrosis occur ____ days after initiation of drugs such as ____, ____, and. ____

Stevens-Johnson Syndrome / Toxic Epidermal Necrosis occur 7-21 days after initiation of drugs such as sulfa, anticonvulsants, and NSAIDs

21

Stevens-Johnson Syndrome / Toxic Epidermal Necrosis clinical findings include ____,  ____,  ____, and  ____

Stevens-Johnson Syndrome / Toxic Epidermal Necrosis clinical findings include systemic signs, eruption initially symmetric and distributed on the face / upper extremities / proximal extremities, initial lesions characterized by dusky red to purpuric macules (atypical targets), and blistering of dark center of atypical target lesions

22

Stevens-Johnson Syndrome / Toxic Epidermal Necrosis is treated initially by ____

Stevens-Johnson Syndrome / Toxic Epidermal Necrosis is treated initially by early recognition and withdrawal of the offending drugs

23

Describe clinical features that warn of potentially severe drug reaction

Clinical features that warn of potentially severe drug reaction

  • Systemic: fever, internal organ involvement, lymphadenopathy
  • Cutaneous: evolution to erythroderma, prominent facial involvement ± edema or swelling, mucous membrane involvement, skin tenderness / blistering / shedding, purpura

24

Blister forms from ____

Blister forms from separation of cells either in epidermis or at dermal / epidermal junction

25

Intraepidermal blisters are ____, while subepidermal blisters are ____

Intraepidermal blisters are flaccid and easily broken, while subepidermal blisters are tense and usually intact

 

 

(Nikolsky sign: epidermal separation induced by lateral pressure to edge of blister or normal appearing skin - characteristic for intraepidermal blisters)

26

Dermatitis herpetiformis is caused by ____, is the skin version of ____, and is treated with ____ and ____

Dermatitis herpetiformis is caused by gluten sensitivity, is the skin version of Celiac disease, and is treated with gluten-free diet and dapsone

 

 

(associated with gastric atrophy, thyroid disease, small bowel lymphoma)

27

Dermatitis herpetiformis results from ____ and is caused by deposition of ____ in the ____, triggering a ____

Dermatitis herpetiformis results from immunologic response to chronic stimulation of gut mucosa by dietary gluten and is caused by deposition of IgA in the papillary dermis, triggering an immunologic cascade

28

Pemphis vulgaris is when ____ result in ____

Pemphis vulgaris is when autoantibodies against desmogleins in demsomosomes result in superficial bullae and erosions

 

(flaccid and easily ruptured bullae on skin and mucous memrbanes, IF shows IgG to Dsg3 ± Dsg1, treated with immunosuppression, complication of sepsis)

29

Pemphigus vulgaris involves ____ and is ____ on immunofluorescence

Pemphigus vulgaris involves intraepithelial split just above the basal keratinocytes and is +IgG on immunofluorescence

30

Pemphigus foliaceous is more ____ than pemphigus vulgaris

Pemphigus foliaceous is more superficial than pemphigus vulgaris

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