Drug Induced Dermatologic disorder

Card Set Information

Author:
twinklemuse
ID:
62670
Filename:
Drug Induced Dermatologic disorder
Updated:
2011-02-13 00:05:12
Tags:
Drug Induced Dermatologic disorder
Folders:

Description:
Drug Induced Dermatologic disorder
Show Answers:

Home > Flashcards > Print Preview

The flashcards below were created by user twinklemuse on FreezingBlue Flashcards. What would you like to do?


  1. Why do you have to know the severity of dermatological disorder?
    To let patient know whether to go to doctor or ER and how fast
  2. Hyperpigmentation.
    Mild/mod skin reaction or severe?
    mild/mod
  3. Photosensitivity.
    Mild/mod skin reaction or severe?
    mild/mod
  4. Alopecia.
    Mild/mod skin reaction or severe?
    mild/mod
  5. Skin-necrosis
    Mild/mod skin reaction or severe?
    mild/mod
  6. Purple toe syndrome
    Mild/mod skin reaction or severe?
    mild/mod
  7. Maculopapular eruption.
    Mild/mod skin reaction or severe?
    mild/mod
  8. Urticaria
    Mild/mod skin reaction or severe?
    mild/mod
  9. Angioedema
    Mild/mod skin reaction or severe?
    mild/mod
  10. Anaphylaxis
    Mild/mod skin reaction or severe?
    mild/mod
  11. Fixed drug eruption
    Mild/mod skin reaction or severe?
    mild/mod
  12. Vasculitis
    Mild/mod skin reaction or severe?
    mild/mod
  13. Acute generalized exanthematous pustulosis
    Mild/mod skin reaction or severe?
    mild/mod
  14. Systemic lupus erythematosus
    Mild/mod skin reaction or severe?
    mild/mod
  15. Erythema multiforme
    Mild/mod skin reaction or severe?
    severe
  16. Stevens Johnson Syndrome
    Mild/mod skin reaction or severe?
    severe
  17. Toxic Epidermal Necrolysis
    Mild/mod skin reaction or severe?
    severe
  18. When the patient comes to pharmacy and presents a skin reaction, what are two important questions to ask?
    • Have you changed anything recently?
    • What medications do you take (i.e. herbal, OTC)
  19. Drug induced dermatologic disorder is more frequent in ___ (older/younger) adults.
    older
  20. It is very important to check previous history when assessing skin reaction. T or F
    very True
  21. List the route of administration in order of the one that most quickly induces skin reaction to the list.
    • topical > IV > PO
    • this does not mean "likely". we are talking about "quickly".
  22. If you have been on one drug for a long time, it is less likely to induce a disorder. T or F
    • False
    • i.e.) angioedema can occur years after the initiation of ACEI therapy
  23. If you are immunocompromised, your ability to react to antigenic material and induce reaction will increase.
    T or F
    • False
    • if you are immunocompromised, less likely to have a reaction.
  24. What are top three drugs associated with photosensitivity?
    • FQ
    • Sulfonamide
    • tetracycline
  25. Diuretics can cause photosensitivity.
    T or F
    T
  26. NSAIDS do not cause photosensitivity.
    T or F
    • F
    • they do cause
  27. Exacerbation or induction of skin disease.
    Immunologic or nonimmunologic?
    non-immunologic
  28. Photosensitivity
    Immunologic or nonimmunologic?
    non immunologic
  29. Pigmentary changes
    Immunologic or nonimmunologic?
    non immunologic
  30. Hair changes
    Immunologic or nonimmunologic?
    non immunologic
  31. Nail changes
    Immunologic or nonimmunologic?
    non immunologic
  32. Lipodystrophy
    Immunologic or nonimmunologic?
    non immunologic
  33. An example of exacerbation of dermatologic disease.
    NSAID can exacerbate ____ _______.
    plaque psoriasis.
  34. An example of exacerbation of dermatologic disease.
    Lithium can exacerbate ___ ____.
    plaque psoriasis
  35. An example of exacerbation of dermatologic disease.
    Beta blockers can exacerbate ___ ____.
    plaque psoriasis
  36. An example of exacerbation of dermatologic disease.
    ACE inhibitor can exacerbate _____ _____.
    plaque psoriasis
  37. An example of exacerbation of dermatologic disease.
    Antimalarial can exacerbate ___ ____.
    PUSTULAR (not plaque) psoriasis
  38. An example of induction of dermatologic disease.
    Glucocorticoids can induce ___.
    acne
  39. An example of induction of dermatologic disease.
    Androgen can induce ___.
    What is an example of androgen containing medication?
    • acne
    • contraceptive
  40. An example of induction of dermatologic disease.
    Lithium can induce ___.
    • acne
    • (could worsen it)
  41. An example of induction of dermatologic disease.
    D penicillamine can induce ____.
    pemphigus (autoimmune disease, skin blister)
  42. An example of induction of dermatologic disease.
    Captopril and ACEI can induce ___.
    pemphigus (autoimmune disease, skin blister)
  43. An example of exacerbation of dermatologic disease.
    Minocycline can exacerbate ___
    subacute SLE
  44. An example of exacerbation of dermatologic disease.
    Thiazide can exacerbate ___
    subacute SLE.
  45. SLE could be confused with roseasea.
    SLE (if drug induced) happens to ___.
    Roseasea happens in _____.
    • SLE: anyone
    • Roseasea: older women
  46. As a pharmacist, if you see an underlying skin disorder (i.e. psoriasis), what should you do?
    monitor/evaluate medications to see if any of them would exacerbate the condition.
  47. Photosensitivity reacts and it is treated a lot like ____.
    sunburn
  48. Mechanism of photosensitivity is almost always _____.
    phototoxicity, not photoallergy
  49. Phototoxic reactions resemble sunburn and can occur with ___ (first, subsequent) exposure to a drug.
    first
  50. Is phototoxicity immune mediated?
    • it is NOT immune mediated
    • Photoallergy is immune mediated (Type IV cell mediated)
  51. Is phototoxicity immune mediated?
    • it is NOT immune mediated
    • Photoallergy is immune mediated (Type IV cell mediated)
  52. How does the onset of phototoxicity and photoallergy compare?
    • phototoxicity is immediate
    • photoallergy is delayed (because this is allergy)
  53. How does the potential for pigmentary change compare between phototoxicity and photoallergy?
    • pigmentary change is HIGH in photoTOXICITY.
    • pigmentary change is LOW in photoALLERGY
  54. Is there a potential for cross reactivity in phototoxicity? How about in photoallergy?
    • Phototoxicity: nope
    • Photoallergy: yep
  55. Do you still get persistent light reaction upon d/c of drug for phototoxicity? How about photoallergy?
    • phototoxicity: nope
    • photoallergy: yep
  56. Do TCAs cause photosensitivity?
    Yes
  57. Phenothiazines cause photosensitivity. T or F
    T
  58. Sulfonylurea do not cause photosensitivity. T or F
    • False
    • they do cause
  59. Benzodiazepines can cause photosensitivity. T or F
    True
  60. Amiodarone can cause photosensitivity and pigmentation change. What else would you concern if this happens?
    • Amiodarone is often used with warfarin.
    • Pigmentation change (purple) maybe due to bruise from warfarin.
  61. How do you treat photosensitivity?
    • Remove the drug or UV radiation
    • Use high potency sunscreens (SPF 15-45) that block UVA, UVB (avoid product that has PABA)
    • Treat the reaction as a sunburn (i.e. aloe, pain medication)
  62. Topical or systemic corticosteroids may alleviate photosensitivity.
    T or F
    • False
    • effective ONLY in photoallergy
  63. Antihistamines are effective in photosensitivity reaction.
    T or F
    • FALSE
    • effective only in photoallergy
    • DEFINITELY avoid topical antihistamine (i.e. benadryl cream) because could be more irritating
  64. Pigmentation change
    oral contraceptive?
    where?
    • melasma (darkening of skin)
    • typically face
  65. Pigmentation change
    minocycline, gold salts, silver, iron?
    blue gray
  66. Pigmentation change
    Amiodarone?
    purple
  67. Pigmentation change
    Anti cancer regimen?
    various changes
  68. Pigmentation change
    Busulfan?
    mucous membrane
  69. Pigmentation change
    zidovudine?
    nails
  70. Pigmentation change
    beta carotene?
    • orange tinge
    • typically on palms and soles
  71. Is alopecia reversible upon drug discontinuation?
    Yes
  72. Alopecia most commonly affects where?
    scalp
  73. Alopecia diagnosis is difficult because it may be due to underlying disease, such as? (list 4)
    • Thyroid disease (hypothyroidism)
    • Infections
    • Anemia
    • Trauma
  74. why does alopecia happen?
    • disturbance of the hair growth cycle
    • can be immediate or delayed depending on which part of cycle is interrupted
  75. What are treatment option for alopecia? Provide counseling points as well
    • avoid drugs that cause it (if necessary, use lowest possible dose)
    • minoxidil topical solution (+/- tretinoin): 2% for women, 5% for men
    • counseling: upon d/c of minoxidil (+/- tretinoin), you will lose hair all over again within 3 months
  76. Finasteride may be used for drug induced alopecia in men. T or F
    • F
    • NOT effective
  77. Which antihypertensive drug may cause alopecia?
    beta blocker
  78. Which anticonvulsant drug may cause alopecia?
    • carbamazepine
    • valproate
  79. Antidepressant may cause alopecia. T or F
    • T
    • could also be due to underlying disease so be careful
  80. Antithyroid drug does not cause alopecia. T or F
    • False
    • whenever body senses the removal of thyroid, alopecia may occur
  81. Oral contraceptive does not cause alopecia. T or F
    • F
    • change of hormone occurs with contraceptive so it may directly affect alopecia
  82. Interferons may cause alopecia. T or F
    T
  83. Warfarin induced skin necrosis occurs predominantly in ____ (male/female).
    female
  84. How fast does warfarin-induced skin necrosis occur?
    • between 3rd and 10th day of treatment
    • usually with initializing therapy
    • fairly early
    • mostly in in-patient setting
  85. May begin with localized skin tingling, pain, sensation of pressure then well-demarcated erythematous lesions usually progress to purpuric and hemorrhagic areas
    warfarin induced skin necrosis
  86. Warfarin induced skin necrosis has lesions in what kind of tissues?
    • areas of subcutaneous fatty tissue
    • common area: breasts, thigh, buttock, penis
  87. Warfarin induced skin necrosis is related to warfarin dose. T or F
    • F: unrelated to warfarin dose
    • but seems to happen more with a higher dose of warfarin
  88. Clinical course of warfarin induced skin necrosis will subside upon discontinuation of warfarin. T or F
    • False
    • you would be lucky...
  89. Warfarin induced skin necrosis is associated with ____ deficiency. This leads to _____ in microvasculature.
    • protein C/S deficiency
    • coagulation/thrombosis
  90. Purple toe syndrome is a rare complication of which drug?
    warfarin
  91. Purple toe syndrome lesions typically develops _____ weeks after initiation of drug.
    • 3-8 weeks
    • due to warfarin
  92. Sudden onset of bilateral discoloration on the toes and side of feet
    Affected area is cold and tender to touch What is this?
    purple toe syndrome
  93. How do you treat warfarin induced skin necrosis?
    • discontinue anticoagulation therapy immediately.
    • MUST initiate IV heparin when d/c warfarin
  94. If warfarin induced skin reaction is found early, what additional therapy can you consider?
    vitamin K may be initiated
  95. Once warfarin induced skin necrosis occurs, you cannot use warfarin again.
    T or F
    • False
    • re-initiation of warfarin at lower doses has been well documented
    • initiation phase is most sensitive: start low and slow
    • testing for protein c/s deficiencies may be warranted.
  96. How can you prevent warfarin induced skin reaction?
    • fully heparinize patient to therapeutic aPTT before starting warfarin
    • avoid large loading dose of warfarin
  97. Maculopapular eruption
    Immunologic or nonimmunologic?
    • immunologic
    • mild-mod
  98. Urticaria
    Immunologic or nonimmunologic?
    • immunologic
    • mild/mod
  99. Angioedema
    Immunologic or nonimmunologic?
    • immunologic
    • mild-mod
  100. Anaphylaxis
    Immunologic or nonimmunologic?
    • immunologic
    • mild/mod
  101. Fixed drug eruption
    Immunologic or nonimmunologic?
    • immunologic
    • mild/mod
  102. Vasculitis
    Immunologic or nonimmunologic?
    • immunologic
    • mild/mod
  103. Acute generalized exanthematous
    Immunologic or nonimmunologic?
    • immunologic
    • mild/mod
  104. Pustulosis
    Immunologic or nonimmunologic?
    • immunologic
    • mild/mod
  105. Systemic lupus erythematosus (SLE)
    Immunologic or nonimmunologic?
    • immunologic
    • mild/mod
  106. Exanthematous/morbiliform reaction is also known as _____ _____.
    maculopapular reaction
  107. Most common drug induced skin reaction?
    maculopapular reaction
  108. What reaction is this?
    Nonspecific lesions, measles like in presentation
    Erythematous, pruritic
    Symmetrical, maybe flat or raised
    vesicles may be present
    Often start on trunk, areas of pressure or trauma
    maculopapular rash
  109. Maculopapular rash typically happens __ week after initiation of drug.
    ~1week
  110. If on drug rechallenge, maculopapular rash occurs sooner. T or F
    • T
    • this is an immunologic based reaction
  111. Maculopapular rash generally does not fade within a feww days after discontinuation on offending agent. T or F
    • F
    • it does fade upon d/c
  112. What are some drugs that cause maculopapular rash?
    • sulfa antibiotic
    • penicillin (especially aminopenicillin)
    • NSAIDs
    • carbamazepine
    • phenytoin
    • barbiturates
    • gold salts
    • allopurinol
  113. How do you treat maculopapular reaction?
    • withdraw causative drug if possible
    • symptomatic relief: tepid or cool water bath or compress
    • systemic antihistamine for itchy lesions
  114. what would you do for a severe type of maculopapular reaction?
    short course of systemic corticosteroid
  115. What is the first indicator of anaphylaxis?
    urticaria
  116. How fast does urticaria occur? (in other words, what is the acute onset?)
    12-36 hours
  117. How fast does urticaria resolve?
    within 1-3 days
  118. What is this reaction?
    Raised, well defined, pruritic, erythematous wheals (HIVES) lesions
    systemic symptoms of fever, lymphadenopathy, joint swelling, arthralgia
    urticaria
  119. How do you treat urticaria?
    • identify offending agent and discontinue
    • antihistamine
  120. Which drugs cause urticaria?
    • aspirin, NSAIDs, penicillin
    • but virtually all drugs
    • * remember that urticaria happens quickly so patient might have just started the drug
  121. How fast does anaphylaxis begin?
    • within 30 minutes to 2 hours
    • late phase reactino can be seen 6-8 hours later
  122. How long should observe a patient who may have anaphylaxis?
    12 hours
  123. What are most common drugs that cause anaphylaxis? (list 3)
    • NSAIDs
    • penicillin
    • aspirin
  124. What is this condition?
    urticaria, angioedema, pruritus
    abdominal pain, NVD
    dyspnea, wheezing
    hypotension, tachycardia, arrhythmia
    anaphylaxis
  125. fatality can result from ___ (also known as laryngeal edema) or cardiovascular collapse.
    aspyxia
  126. What is this condition?
    painless, nonpruritic, nonpitting, and well circumscribed area of edema due to increased vascular permeability
    angioedema
  127. Angioedema involved swelling of ___ (shallow/deeper) tissue
    deeper
  128. What is the treatment of angioedema?
    withdraw causative drug
  129. What is this condition?
    painful burning sensation first then pruritis then then discoloration
    erythematous, hyperpigmented, round/oval lesions
    change in color (pale red to dusky red)
    gray brown hyperpigmented spot persists
    fixed drug eruption
  130. During fixed drug eruption, where does the recurrence eruption upon re-exposure occur?
    exact location as the previous reaction
  131. Once the fixed drug eruptions go away, the colored lesions will subside as well. T or F
    • F
    • gray brown hyperpigmented spot persists
  132. Fixed drug eruption can occur in any location, but most common in oral mucosa and genitalia. T or F
    T
  133. Does fixed drug eruption go away upon drug discontinuation?
    Yes but could still get eruptions randomly. They seem to have mind of their own...
  134. How do you treat fixed drug eruption?
    • remove offending agent, avoid in future
    • cool water compress
    • bleaching cream for hyperpigmentation
    • systemic corticosteroids and antihistamine can be used but they have minimal effect
  135. NSAIDs are associated with fixed drug eruption. T or F
    T
  136. Fixed drug eruption can caused by an excipient, such as ____.
    food/drug dyes
  137. Barbiturates can cause fixed drug eruption. T or F
    T
  138. Oral contraceptives do not cause fixed drug eruption. T or F
    False
  139. Sulfonamides can cause fixed drug eruption. T or F
    T
  140. What is this condition?
    purpuric papules (itchy little dots)
    typically lower extremities
    organ involvement can be life threatening
    vasculitis
  141. When is the onset of vasculitis?
    7-21 days after drug administration
  142. If on drug rechallenge, when is the onset of vasculitis?
    • less than 3 days after
    • which is much faster than 7-21 days for the first exposure
  143. Does vasculitis resolve after drug withdrawal?
    • Yes
    • leads to rapid resolution
  144. What can you give if vasculitis leads to a life threatening situation?
    give systemic steroids
  145. Is vasculitis has a high percentage of drug induced etiology?
    • no
    • only ~10%
  146. What is this condition?
    acute pustular eruption
    fever and numerous small pustules
    burning, itching rash
    widespread edematous erythema
    acute generalized exanthematous pustulosis
  147. Does acute generalized exanthematous pustulosis have a high percentage of drug induced etiology?
    • yes
    • more than 90%
  148. What are some drugs that cause acute generalized exanthematous pustulosis?
    • aminopenicillin
    • diltiazem
    • antimalarial
  149. What is the onset of acute generalized exanthematous pustulosis?
    <2 days after drug administration
  150. What should you do when acute generalized exanthematous pustulosis happen?
    • withdraw drug
    • may use systemic antihistamine for pruritis
  151. How fast does acute generalized exanthematous pustulosis resolve?
    less than 15 days
  152. erythema multiforme
    immunologic or nonimmunologic?
    • immunologic
    • severe
  153. Stevens johnson syndrome
    immunologic or nonimmunologic?
    • immunologic
    • severe
  154. toxic epidermal necrolysis
    immunologic or non immunologic?
    • immunologic
    • severe
  155. What is this condition?
    localized typical targets or raised atypical tragets, particularly on extremities
    bull's eye lesion
    possible nonspecific prodromal symptoms
    erythema multiforme (EM)
  156. Erythematous multiforme can be drug induced but most likely an ___ ____.
    • infectious agent
    • particularly herpes simplx virus
  157. The disease that causes EM often do not lead to SJS and TEN. T or F
    • F
    • most likely variants of the same disease
  158. How fast does erythema multiforme resolve? How about complete healing?
    • 4-5 days
    • completely healing in 2-4 weeks (new lesions may appear during this time)
    • post-inflammatory hyperrpigmentation can occur
  159. How do you treat erythema multiforme?
    • withdraw drug
    • symptomatic relief: antihistamine, tap water compress, 1/2 strength hydrogen peroxide gargles for oral lesions
  160. What do you tell patient if you suspect erythema multiforme?
    if the lesions seem to get worse, go to ER!
  161. What is this condition?
    extensive mucosal and conjunctival edema, erosions
    systemically high fever, myalgia, vomit, diarrhea, arthralgia
    necrotic lesions
    purpuric macules
    SJS
  162. What is the onset of SJS?
    typically begins within 4 weeks of initial drug exposure
  163. What is the % of epidermal detachment in SJS?
    ~10%
  164. What are the complications of SJS?
    • Eye: keratitis, conjunctival scarring, blinding
    • pneumonia
    • dehydration (due to skin loss)
    • esophagitis (due to the effect on alimentary canal)
  165. How do you treat SJS?
    • rapidly identify and withdraw the causative agent
    • anti-inflammatory and/or immunosuppressive treatment: corticosteroids, immunoglobulins, plasmapheresis/hemodialysis, cyclophosphamide, cyclosporine, thalidomide
  166. What are supportive treatment of SJS?
    • remove loose sheets of detached skin
    • cover erosions: very painful
    • supportive care for ocular involvement and respiratory tract
    • alimentation (maybe enteral nutrition)
    • think about systemic absorption when using topical antibacterial or antiseptic
  167. What is this condition?
    erythema and extensive detachment of the epidermis
    prodromal state with nonspecific symptoms are common (fever, cough, sore throat, pyrexia, myalgia)
    involves more lower layers
    toxic epidermal necrolysis
  168. What is the acute onset of cutaneous manifestation for TEN?
    1-3 days
  169. What is the prognosis of TEN?
    • dependent upon patient age, extent of skin involvement, concurrent disease adn complication
    • high mortality in the beginning but 3% if you pass 3-4 days
  170. TEN's clinical picture may seem similar to ____ _____ burn.
    2nd degree
  171. What are complications of toxic epidermal necrolysis?
    • these are all rather common
    • fluid and electrolyte imbalance
    • septicemia (very high risk)
    • corneal ulceration
    • conjunctivitis
    • systemic involvement
  172. How do you treat toxic epidermal necrolysis?
    • immediate identification and removal of causative agent
    • treat like a burn patient
    • empirical use of short course systemic corticosteroids (controversial): early administration may stop further immunologic injury but it does not reverse programmed death
    • symptomatic treatment: IVIG, fluid/electrolyte maintenance, infection, ocular, aggressive nutrition support
  173. What drug pops into your head when you think SJS and TEN?
    lamotrigine!
  174. What should you counsel when you dispense lamotrigine?
    • if you get rash, go to physician immediately
    • this may be nothing but it may be something
    • counsel upon your FIRST TIME DISPENSING
  175. What drugs cause SJS/TEN?
    • LANCOPS
    • lamotrigine
    • allopurinol
    • nevirapine
    • carbamazepine
    • oxicam NSAIDs
    • phenytoin
    • sulfa antibiotic
  176. If you have erythema multiforme, can you rechallenge the drug?
    NO
  177. If you have SJS or TEN, can you rechallenge the drug?
    NO

What would you like to do?

Home > Flashcards > Print Preview