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IOS 9 Exam 2
Skin Disorders-drug induced
| Question | Answer |
|---|---|
| Cirteria for immunologic drug reactions | small %, rxn does not resemble drug intent, manifestation simular to allergic rxn, lag time between first exposure of drug and reaction, reaction reproduced with small doses, reaction produced with simular drugs, eosinophilia, reaction resolve after dc |
| Immunologic reactions | Require activation of host innate pathway, dependant of size, dose, route, individual sensitivity, metabolites, based on esposure, 4 types |
| Type I reaction | IgG mediated immediate -30 minutes anaphylaxis |
| Type II reaction | Cytotoxic reaction a drug reacts with tissue to cause drug antibody complex-PCN hemolytic anemia |
| Type III reaction | Complex and antigen-antibody complexes in blood, and can deposit in vessels to cause serum sickness 6+ daylater |
| Type IV reactionDrug antigen come into contact with T-cells to stimulate the release of inflammatory cell mediators | Delayed hypersensitivity-Contact sensitivity lympocyte mediated |
| Maculopapular eruptions | Drug induced skin reaction appears on the trunk or area of pressure. Measles like "morbilliform" appearance, vesicles Can appear early hours -3 days or late 9 days later |
| Maculopapular eruptions associated with drugs... | PCS, benzodiazepines, carbamezepins, |
| Management of maculopapular eruptions | D/C drug, Cool water baths/compresses, oral antihistamines or topical corticosteroids (itch), if svere short course steroids |
| Urticaria | Primary lesion is a wheal, a flesh-colored to pink, well circumscribed plaque caused by dermal edema; itchy! May progress to angioedema |
| Drugs that cause Urticaria | ACEi, ASA, NSAIDS, H2 blockers, Omeprazole, PCN |
| Urticaria management | D/C medication, PO antihistamines, Doxepin if unresponsive, TOPICALS ARE NOT USEFUL |
| Fixed Drug eruption presentation | Erythematous or hyperpigmented lesions, round or oval, usually unsymptomatic, ODD but will go away and reappear in same location |
| Fixed-Drug Eruption drugs that cause | Carbamazepines, Sulfonamindes, NSAIDS, Tetracyclines, DIGoxin, Phenophthaline |
| Fixed-Drug Eruption management | D/C medication and do not readminister, cool compress or bleaching creams for hyperpigmentation, can try oral antihistamines or corticosteroids |
| Photosensitivity | Can be phototoxic or photoallergic; resembles a sun burn timing only distinguishing factor |
| Phototoxic | Occurs within 30 minutes to few hours- 1st exposure there is tissue damage |
| Photoallergy | Delayed hypersensitivity 1-14 days- UV+ drug creates a hapten |
| Medications associated with photosensitivity | Tetracyclines, doxycycline, sulfonyluraeas, furosimide, thiazides, NSAIDS, Amiodarone, Carbamazepine, oral contraceptives |
| Management of photosensiticity | D/C drug, Aloe vera, soothing lotions, Avoid sun, use sunscreen and photoallergic patient can try topical antihistamines or corticosteroids |
| Erythema multiforme | Self-limiting lesion is approximately 1cm dull-red macule or papule with a central area of blistering or hemorrhage |
| Stevens Johnsons syndrome | <10% of skin from mucus membranes is shed |
| TENS | A detachment greater than 30%. Full-thickness epidermal necrosis is observed on pathological examination. |
| Drug hypersensitivity usually occurs | 1/3000 persons, during first prolonged course of drug (1-6 weeks up to 2-3 months into therapy) Prodome can mimic URTi, skin lesions follow in 85% of patients |
| PCN cross reactivity | Prior to 1980 thought to occur about 10-20% current theory 4% |
| Sulfonamides reactions | Type I and Type II reaction, occurs because of the arylamine group form reactive intermediate |
Created by:
liza001
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