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Pharm 154* > Hives > Flashcards

Hives Flashcards

1
Q

What are hives?

A

Reddened, itchy welts that may be triggered by exposure to certain foods, medications, or other substances

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2
Q

What is the classic look of uticaria (hives)?

A

raised welts that move and change shapes
they are very itchy

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3
Q

What do we do when we see an atypical skin condition?

A

Refer to MD

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4
Q

What is the etiology of hives?

A

allergic and non-allergic

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5
Q

What are the allergic causes of hives?

A

Foods and drugs

Anything can cause hives and you can get a skin reaction

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6
Q

What are the non-allergic causes of hives?

A

foods, drugs
URTI (common in kids)
pressure/vibration
cold temperature
nerves

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7
Q

What is a common cause of rash in kids?

A

Virus or viral upper respiratory infection
Responsible for 40% of hive rashes
The virus causes the rash and not the drug
Hives last for 4-24 hours

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8
Q

True or False: Foods cause hives

A

False. An allergy to foods is pretty rare. 1% of hive sufferers

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9
Q

What is responsible for causing hives in the body?

A

High levels of histamine, can be due to stress

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10
Q

What medications cause hives?

A

The most common culprit are antibiotics

Heart medications (BB, ACEi, Diuretics, ASA)
Pain medication (NSAID, Muscle relaxers, Codeine, Morphine)
Radicontrast dye, Dextran, Quinine

Some of the above drugs cause histamine release from mast cells

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11
Q

Are hives caused by medications common?

A

No, only 10% of hives caused by meds

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12
Q

What is dermatographism?

A

An immunologic response to pressure applied to the skin
Local wheal-and-flare erythema followed by edema and itch
Begin within 5mins and persist for 15-30 minutes

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13
Q

What is the clinical presentation of hives?

A

Lesions can last 1-24 hours up to several days
Lesions change locations and move around
Very itchy
20% of the population have had it
Chronic form is 1%
Usually benign
Hives worse at night (due to lower cortisol)

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14
Q

How to tell if someone has hives?

A

It has to be itchy
Lesions cannot last for 24 hours in the same spot, otherwise it is something else

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15
Q

Are most hives allergy based?

A

No, the main cause is still URTI
Allergies are only 1-3% of cases and will last 1-2 weeks (antibiotic)

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16
Q

What is the clinical presentation of anaphylaxis?

A

Has a reaction in 2 body systems
Angioedema/swelling in the face, eyes, mouth
If left untreated can develop into life-threatening airway obstruction

17
Q

What are the treatments for hives?

A

Avoid the trigger (easier said than done)
2nd gen anti-He is KING
- try regular dosing for a few days up to 2 weeks
If no improvement after 2 weeks, then will need to see MD, where they will likely increase the dose by 2-4x
1st gen anti-He if the pt wants to sleep at night
oral steroid burst (for severe cases)

18
Q

What drugs do we avoid for hives?

A

Leukotriene antagonist

(singular, Montelukast)

19
Q

What is chronic spontaneous urticaria?

A

The recurrence of itchy wheals for at least 6 weeks
Affects up to 1% of the population
H1 antihistamines fail to work, even at high doses
Oral steroids are used to induce remission in 50% of cases

20
Q

What are the topical options to use alongside a 2nd gen Anti-He?

A

Clobetasone/ HC - can apply steroid, but playing catch up with the moving itch
Calamine
Cold pack

Menthol - maybe - it needs to be less than 1% to be antipruritic and cooling (more than 1% and it becomes a counter irritant)
Avoid the use of benadryl cream

21
Q

Allergic contact dermatitis, irritant contact dermatitis, and hives are all very common. How do you distinguish for hives?

A

Hives do not have blisters!

22
Q

Differentiate between allergic contact derm, irritant contact derm, and hives

A

Hives - rash appears within minutes of exposure and fades in minutes to an hour, does not necessarily need contact
Contact derm - needs to come in contact with allergen or irritant
irritant is more confined to the area of exposure, while allergic is more widespread on the skin
Allergic - rash can take up to 24-72 hours to appear, more itchy
Irritant - Immediate appearance, more painful than itchy

23
Q

What is the difference between hives and a rash?

A

Hives - raised, itchy bumps that can can be large or small. Red or same colour as skin
Rash - changes colour of skin . May cause the skin to look rough, scaly, or cracked. Iritated skin that hurts, but might not itch

Hives are a type of rash, but not every rash is caused by hives

24
Q

Is it necessary to ask about allergies for patients with cough in the real world? (part 2 of drug induced rashes)

A

No, this is only best practice for OSCE’s

25
Q

Is ibuprofen more likely to cause allergic or dermatologic incidence?

A

Likely not allergic (0.5%) where as derm is around 5% incidence (majority is maculopapular)

26
Q

How does an amoxicillin dermatologic condition present and how long does it take to manifest?

A

A morbilliform, erythematous, urticarial rash
Occurs after 3-14 days of therapy with amoxicillin
Most common with viral illnesses

27
Q

True of false:
Penicillin allergy can be resolved over time
People who believe that they have an allergy actually have an allergy
People with a penicillin allergy can tolerate penicillin-based antibiotics

A

True, usually after around 10 years
False
True

28
Q

The occurrence of Steven-Johnson syndrome is 3-4% with sulfas

A

False, this condition is ultra rare

29
Q

True of false:
Mild allergic reactions result in a skin rash
Skin rashes are a prerequisite for anaphylaxis

A

True
True

30
Q

What is required for an anaphylaxis reaction?

A

Allergic reaction in 2 systems

31
Q

How does anaphylaxis present itself?

A

Shortness of breath
Wheezing
Nausea/ vomitting
Lightheadedness/dizziness
Fast HR
Swelling of face, lips, tongue

32
Q

What are the ways to treat a drug allergy

A

Withdrawal of the drug - d/c drug tx
Anti-histamines - use second gens, can help a bit
Treatment of anaphylaxis requires immediate epinephrine

33
Q

What are the causes of morbilliform rashes? Hives?

A

Morbilliform rashes (measles, strep, sixth disease)
- drugs: antibiotics, NSAIDS, etc.

Hives (infxn, chemicals, latex)
- drugs (10%)
- foods (1%)

34
Q

What is a possible scenario for SJS?

A
  1. Infxn - UTI, bronchitis, ear infxn, etc.
  2. Prescribe an AB such as a sulfa AB
  3. Pt starts feeling better
  4. Then, pt gets sick again, flu-like sytmtoms w/ PAINFUL SKIN
  5. Lesions begin to form that are painful and don’t look like morbilliform or hives. SJS
35
Q

What is the incidence (%) of sulfa rashes?

A

3-4%

Pharm 154* (18 decks)

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