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Bolognia Book Club > Chapter 22 - Drug Reactions > Flashcards

Chapter 22 - Drug Reactions Flashcards

1
Q

This substance, which is often used by dermatologists to treat erythema nodosum and sporotrichosis, can cause halogenoderma.

A

Saturated solution of potassium idodide (SSKI)

*Note: “KI” is the chemical abbreviation for potassium idodide

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2
Q

What inflammatory infiltrate is typically present in halogenoderma?

A

Neutrophilic

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3
Q

This neutrophilic drug reaction, which is often confused with Sweet’s syndrome, is likely due to a toxin insult to the eccrine glands.

A

Neutrophilic eccrine hydradenitis (NEH)

*Note: NEH is most commonly seen in patients with acute myelogenous leukemia receiving cytarabine

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4
Q

Activation of which two viruses might be linked to the pathogenesis of DRESS?

A

HHV 6 and HHV7

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5
Q

True or false: facial edema is a characteristic feature of DRESS.

A

True

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6
Q

What is the most common cause of mortality associated with DRESS?

A

Fulminant liver failure

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7
Q

What is the first-line therapy for DRESS?

A

Systemic steroids (topical steroids can be used alone in mild cases)

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8
Q

Fixed drug eruptions (FDE) can occur anywhere on the body, however certain sites are more commonly involved. These include:

A

The lips, face, hands, feet, and genitalia

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9
Q

What drug most commonly causes the non-pigmented variant of FDE?

A

Pseudoephedrine

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10
Q

What drugs are most commonly implicated in FDEs?

A

Sulfonamides, NSAIDs, barbiturates, tetracyclines, and carbamazepine

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11
Q

What drug is most commonly associated with drug-induced linear IgA bullous disease? What group of drugs is next most commonly associated?

A
  • Vancomycin
  • Beta lactam antibiotics
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12
Q

True or false: pseudolymphoma (i.e. drug induced lymphoma) tends to have a biologically aggressive course, and typically meets the diagnostic criteria for Non-Hodgkin’s lymphoma.

A

False; it has a benign biological behavior and does not satisfy the criteria for non-Hodgkin lymphoma

*Note: complete recovery typically occurs several weeks after withdrawing the drug

**Note: pseudolymphoma can simulate either a T- or B-cell lymphoma.

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13
Q

True or false: DRESS often recurs when the systemic steroid used to treat it is withdrawn. Thus, a long slow taper is typically necessary.

A

True

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14
Q

True or false: drug-induced alopecia always causes anagen effluvium.

A

False; it can produce either telogen or anagen effluvium

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15
Q

Do chemotherapy drugs cause an anagen or telogen effluvium?

A

Anagen effluvium

* This explains the more rapid onset of alopecia that typically occurs with chemotherapy (anagen effluvium occurs within 2-3 weeks of drug exposure, while telogen effluvium occurs within 2-4 months of drug exposure)

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16
Q

True or false: anti-convulsants, beta-blockers, lithium, and retinoids can all cause telogen effluvium.

A

True!

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17
Q

Other than chemotherapy drugs, list three other drugs that can cause an anagen effluvium.

*This is a tough one!

A

Bismuth, gold, and thallium

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18
Q

True or false: it’s a myth that patients with straight hair can sometimes regrow curly hair after chemotherapy.

A

False! This is not a myth. Sometimes patients with straight hair can regrow curly hair.

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19
Q

What is a potential complication of patients with psoriasis who are receiving chemotherapy?

A

Necrosis of the psoriatic plaques

20
Q

Give examples of drugs that can cause psoriasis with a short, intermediate, and long latency period (i.e. how soon after giving the drug the psoriasis occurs).

A
  • Short: terbinafine and NSAIDs
  • Intermediate: antimalarials and ACE inhibitors
  • Long: lithium and β-blockers
21
Q

Other than corticosteroids, list two drugs that are associated with acneiform eruptions.

A

Androgens and lithium

22
Q

True or false: chloroquine and sunitinib are two drugs that can lead to lightening, or complete depigmentation of the hair.

A

True

23
Q

What changes does 5-FU typically cause in the nails?

A

Horizontal melanonychia

23
Q

What pigmentary changes can the drug sunitinib induce on the hair?

A

Either ligtening OR darkening of the hair

24
Q

List the seven drugs most commonly implicated in drug-induced hyperpigmentation of the skin.

A
  1. Minocycline
  2. Antimalarials
  3. Amiodarone
  4. Oral contraceptives
  5. Imipramine
  6. Chemotherapeutic agents
  7. Clofazimine

*Image: amiodarone-induced hyperpigmentation

25
Q

What drug is most commonly implicated in pseudoporphyria?

A

Naproxen

26
Q

True or false: immunosuppressed patients have an increased risk of immunologically mediated adverse drug reactions (ADRs).

A

True; although this seems paradoxical, they have a 10 - 50 time increased risk of immunologically mediated ADRs

27
Q

What is the difference between anaphylaxis and an anaphylactoid reaction?

A
  1. Anaphylaxis = Ag binds to IgE on surface of mast cells, basophils, degranulation, release histamine
  2. Anaphylactoid = non-immunologic release of histamine +/- inflammation
28
Q

For patients who have ACEi-induced angioedema, can you substitute with an ARB? Why?

A

No, is a different class of drugs but receptor antagonist are still associated with angioedema

29
Q

What are some histologic differences between AGEP and pustular psoriasis?

A
  1. AGEP = superficial dermal edema, vasculitis, eosinophil exocytosis, keratinocyte necrosis
  2. Pustular psoriasis = acanthosis
30
Q

What are the most common visceral involvement and leading cause of death in DRESS?

A

Liver, hepatitis

Fulminant

~10%

31
Q

At what CD4 count do you commonly see increased susceptibility to drug reactions

A

100-400/mm3

32
Q

What are the types of immunologic reactions according to Gell-Coombs classification?

A

IgE dependent (type I)

  • Urticaria, Angioedema, Anaphylaxis

Cytotoxic (type II) [Ab vs. fixed Ag]

  • Thrombocytonpenia –> petechiae

Immune-complex dependent (type III)

  • Vasculitis, Serum-sickness, Urticaria

Cell-mediated, delayed type (type IV)

  • Exanthamatous, Fixed, Lichenoid drug erruption
  • SJS
    TEN
33
Q

What are the clinical manifestations of anaphylaxis?

A
  • Urticaria
  • Angioedema
  • Tachycardia
  • Hypotension
34
Q

Where is the pathology in leukocytoclastic vasculitis (what vessels)?

A

Postcapillary venules

35
Q

What is the primary lesion in AGEP?

A

non-follicular sterile pustules

36
Q

AGEP must be differentiated from acute pustular psoriasis of Von Zumbusch. How?

A
  1. AGEP = Acute
  2. AGEP = drug history present
37
Q

What percentage of Sweet’s syndrome is drug-induced?

A

<5%

  1. All-trans-retinoic acid
  2. G-CSF (stimulate neutrophil differentiation)
  3. GM-CSF (stimulate neutrophil proliferation)
38
Q

True or False: neutrophilia is present in drug-induced Sweet’s syndrome

A

False

39
Q

What is the most common drug that causes neutrophilic eccrine hidradenitis?

A

Cytarabine (AML Rx)

40
Q

What toxic anticonvulsant metabolite DRESS patients cannot detoxify?

A

Arene oxide

41
Q

What are the four types of fixed drug eruptions?

A
  1. Localized
  2. Generalized
  3. Non-pigmented
  4. Linear
42
Q

Flagellate linear hyperpigmentation is caused by what drug?

A

Bleomycin

43
Q

True or Flase: in drug-induced systemic LE, ds-DNA antibodies are typically present.

A

False; Anti-histone antibodies are usually elevated (in 95% of patients)

44
Q

True or Flase: Abrupt cessation of mitotic activity of stem cells of the hair matrix occurs in Telogen Effluvium

A

False

This occurs in Anagen Effluvium

Bolognia Book Club (29 decks)

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