Drug causes of disease Flashcards

Question

Drugs causing SCLE?

Answer 1

``` GATCH Griseofulvin, terbinafine ACEI TNFα inhibitors Ca channel blockers HCZ - Thiazides ``` ``` Also; NSAIDs Docetaxel, 5-FU + prodrugs IFN statins ```

Answer 2

``` Sumphasalazine turns skin yellow-orange The rest go shades of grey/brown/black/blue Amioderone Minocycline, doxycycline HCQ (antimalarials) Hydroxyurea clofazimine chlorpromazine, imipramine phenytoin Bismuth Silver (argyria), Gold Alkylating agents (cyclophosphamide etc) bleomycin, doxorubicin, danorubicin Antimetabolites - 5-fU, capecitabine, MTX, hydroxyurea OCP - melasma Iron injections - local hyperpigmentation or brown discolouration hydroquinone - ochronosis ``` Other chemo pigmentation rcns; Serpentine supravenous hyperpigmentation - 5-FU, Doxorubicin, Docetaxel, Vinorelbine, alkylating agents Mucosal hyperpigmenation – 5-FU, Busulfan, cyclophosphamide, hydroxyurea Nail hyerpigmentation – 5-FU (can cause transverse melanoncyhia), cyclophosphamide, Hydroxyurea, Daunorubicin, Doxorubicin, MTX, Bleomycin

Answer 3

``` BIG TOPS (TOP are most important) Beta blockers Itraconazole Griseofulvin TNFα inhibitors Oestrogens, testosterone Penicillamine Sulphonamides ```

Answer 4

``` Do My Pits Pus Today? Diltiazem Macrolides Penicillins/beta lactams Plaquenil Terbinafine and azole antifungals ```

Answer 5

Phenytoin Atorvatsatin Simvastatin

Answer 6

Mostly thiols - Captopril, Ramipril, Penicillamine, Gold, Piroxicam (Feldene, an NSAID) gold penny ram cap also propanolol

Answer 7

``` ABCD ROME (from ASM, 2014) ACEi B-blockers anti-Coagulants anti-Depressants Retinoids (acitretin>isotretinoin) OCP/hormones Minoxidil anti-Epileptics ```

Answer 8

``` DING 5alpha Dapsone Isoniazid NSAIDs Griseofulvin, Voriconazole 5-FU + prodrugs TNFα inhibitors ```

Answer 9

Griseofulvin | TNFα inhibitors

Answer 10

``` ‘Epileptic meds plus ABC’ Carbamazepine, Phenytoin, Sodium valproate ACEi, Allopurinol, Amitriptyline Beta-blockers, Benzodiazepines calcium channel blockers + many more in literature ``` Often single lesion can cause exfoliative erythroderma Drug-induced pseudolymphoma is almost always T cell predominant

Answer 11

``` 3C's and T-BAG toxins Chemo – 5FU, high dose MTX, doxorubicin, bleomycin. Starts 2-4 wks into chemo Colchicine CsA Thallium Bismuth Arsenic Gold ```

Answer 12

False | Lacquer chicken has triggered AGEP

Answer 13

melasma, spider naevi, pseudoporphyria, DLE, photosensitivity, pompholyx, acanthosis nigricans, urticaria, EM, contact derm to oestrogen creams or adhesive patches

Answer 14

``` common ABCD STAT ACEI – enalapril, lisinopril Beta blockers – atenolol, propanolol, labetolol, metoprolol Calcium channel blockers – verapamil, diltiazem, nifedepine Diuretics - Frusemide (+HCTZ) Statins – Simva, Prava, Lova TNFα blockers Antihistamines (H1 or H2), Anakinra Thalidomide, lenalidomide ``` ``` Uncommon HCTZ Carbamazepine Diazepam Bupropion Ganciclovir Darifenacin Sennosides (senna) onset after months-years of taking the drug Can mimic Interstitial granulomatous dermatitis or Palisaded neutrophilic and granulomatous dermatitis clinically and histologically ```

Answer 15

PHD TO BOOST (the) CV Penicillamine, Hydroxyurea, Diclofenac Tamoxifen, TNFα blockers, Benzalkonium Chloride Carbamazepine, cyclophosphamide, Vaccination (BCG) - Statins sometimes included but really just cause myositis

Answer 16

Women More prescribed meds Older age Immunosuppressed (esp immune mediated reactions – paradoxically) Malignancy AIDS Connective tissue disease – Sjogrens, SLE, RA

Answer 17

an expected drug reaction occurring to an exaggerated extent and at a lower dose than that expected to cause the reaction

Answer 18

A small molecule which can elicit an immune response but only when bound to a larger molecule esp a protein

Answer 19

a reaction that involves histamine release and resembles anaphylaxis but is not caused by IgE-mediated type 1 hypersensitivity reaction

Answer 20

``` unpredictable response not due to immunological mechanism. Can be due to a genetic variation in the metabolism pathway of the drug e.g DRESS TEN Drug-induced lupus Drug reactions in HIV pts ```

Answer 21

F Fast acetylators some Mediterranean jews are slow acetylators

Answer 22

T occurs due to an acetylation metabolite of procainamide but slow acetylators more at risk or lupus-like syndrome overall

Answer 23

Hydralazine – lupus like syndrome Bactrim hypersensitivity in HIV pys Isoniazid – pellagra-like syndrome and peripheral neuritis Dapsone - haemolysis

Answer 24

– IgE mediated | – anaphylaxis, urticaria, angioedema

Answer 25

– Ab mediated | – petechiae in drug-induced thrombocytopenia e.g penicillins, quinine, sulphonamides

Answer 26

– immune complex mediated | – serum sickness, vasculitis, some urticarias

Answer 27

– delayed type hypersensitivty (cell mediated) | – exanthematous, lichenoid, FDE, ?SJS/TEN

Answer 28

risk of ANCA positive drug-induced lupus | check ANCA if symptomatic

Answer 29

specific vancomycin infusion reaction where there is flushing and may be angio-oedema AKA ‘red neck syndrome’

Answer 30

1-3 weeks typically but can be longer most often within 6 weeks SJS/TEN is same time period Serum-sickness like reaction is same time period

Answer 31

Up to 3 weeks | contrast to mins-hrs after last dose for true urticarial and anaphylactic reactions

Answer 32

1st episode 1-2 wks after starting drug | subsequently 8hr - 24 hrs

Answer 33

T AKA Morbiliform or Maculopapular drug eruption Most common type of drug eruption pt usuallly has low grade fever

Answer 34

T | but can be up to 6 weeks

Answer 35

often indistinguishable; Drug eruption usually favoured in adults Viral exanthem usually favoured in kids Drug rcn more polymorphic; – often confluent areas on trunk; macules, papules or urticarial lesions on limbs, can be purpuric lesions on lower legs/feet - Can involve palms and soles, can be mainly flexural, often spares face - Can be scarlatiniform on trunk - Can be rubelliform - Can be annular plaques or atypical targetoid lesions Drug rcn more likely to be itchy Eos in blood favours drug - viral infcn may have high lymphocytes or sometimes neuts Biopsy sometimes helps - in drug; Mild superficial perivascular lymphocytic infiltrate Eos in 30% Lichenoid in 50%

Answer 36

Facial oedema and eosinophilia – think DRESS (however onset usually later; 14-40 days) Mucosal involvement and dusky lesions – think early SJS/TEN – look for Nikolsky sign Toxic erythemas – exclude on basis of Hx and clinical features - Scarlet fever - Toxic shock syndrome - Acute GvHD - Kawasaki disease Still’s disease

Answer 37

F If drug is very important and there is no substitute you can try to 'treat through' Be cautious in case it is in fact evolving TEN or DRESS May progress to erythroderma if drug not stopped

Answer 38

``` All Bloody Scarlet + toxins Allopurinol, Ampicillin/penicillins Barbiturates, Carbamazepine, Phenytoin Sulphasalazine, Sulphonamides Arsenic, Gold, Mercury, Lithium + many more listed ```

Answer 39

F 2 specific meanings. Either; vancomycin infusion reaction where there is flushing and may be angio-oedema Or; chronic erythroderma in old men of unknown aetiology often with palmoplantar keratoderma, dermatopathic LNs and high IgE ?actinic reticuloid/ chronic light reactors

Answer 40

F | second most common after exanthematous

Answer 41

1. Allergic/immunological (inc anaphylaxis) - type 1 response 2. Non-allergic/non-immunological (inc anaphylactoid) – direct mast cell degranulators and other, unknown mechanisms (pseudoallergens) 3. Serum-sickness like reaction w/ urticarial rash (type 3 immune rcn) 4. Urticarial vasculitis (usually also type 3 immune rcn)

Answer 42

Chronic urticaria or angio-oedema e.g. ACE inhibitors | Exacerbation of chronic urticaria despite not being the original cause (esp pseudoallergens) e.g. Aspirin, NSAIDs

Answer 43

Mainly antibiotics; Penicillins, cephalosporins, sulphonamides, tetracyclines (esp mino) biologics radiocontrast media

Answer 44

T have resucitation equipment ready Useful test but limited by availability of preparations

Answer 45

Vancomycin, opiates, atrocurarium, polymixin, dextran, Iodine radiocontrast dye (alcohol and strawberries also release histamine)

Answer 46

Aspirin, NSAIDs, ciprofloxacin, phenylbutazone

Answer 47

``` UV Makes Noisy Fun in the CBD MTX NSAIDs Fluoxetine Cimetidine Biologics Diltiazem ```

Answer 48

drug reaction of unclear aetiology. May involve immune-complex deposition similar to true serum-sickness May think of as a more acute form of urticarial vasculitis starts 1-3 weeks after exposure urticarial (or sometimes morbilliform) rash w/ lesions which may last >24hrs and may be tender and resolve with bruising, fever, oral oedema, lymphadenopathy, symmetrical arthralgia, myalgias, mild proteinuria

Answer 49

``` drugs; Penicillins (inc amoxicillin), Cephalosporins (esp cefclor), sulphonamides, tetracyclines, ciprofloxacin, NSAIDs, carbamazepine, phenytoin, propanolol, allopurinol, barbiturates, bupropion, thiouracil Radiocontrast media Infection (esp HepB or C) Vaccinations (Hep B and tetanus toxoid) rarely foods ```

Answer 50

ACE inhibitors - 1-2 per 1000 pts prescribed ACEI - can occur after first dose or after years Other are; ARIIBs Penicillins - 2nd most common after ACEIs NSAIDs radiocontrast media monoclonal Abs,

Answer 51

T always consider this before ascribing reaction to drug entirely e.g. acquired C1q esterase inhibitor deficiency

Answer 52

F | Higher risk if black or Hx of idiopathic angio-oedema

Answer 53

penicillin

Answer 54

Classification – systemic drugs - Phototoxicity (most common for systemic agents) - Photoallergy (rare for systemic agents) - Drug-induced photosensitive dermatosis e.g. lupus, pellagra, porphyria - Drug induced UV-recall eruption Classification – topical drugs - Phototoxic contact dermatitis (rare for topical agents) - Photoallergic contact dermatitis (Most common for topical agents); includes Riehls melanosis

Answer 55

F | Phototoxic drug reactions cause an exaggerated sunburn like reaction

Answer 56

psoralens, OCP, tetracyclines and fluoroquinolones

Answer 57

Unusual for topicals - photallergy more common True phototoxicity should be due to UVR-activation of drug e.g. coal tar also medical dyes such as fluorescin or methylene blue Photosensitivity to topicals is often due to thinning and inflammation of skin e.g. efudix and topical retinoids Most contact photosensitizers are foods and plants

Answer 58

T | if drug has short half life

Answer 59

F clinical and histo usually more eczematous like allergic contact dermatitis and can be bullae or vesicles. Sometimes lichenoid = lichenoid photodrug allergy

Answer 60

T remember same list of 'photosensitizers' esp sulpha drugs and thiazides

Answer 61

T | photoallergic contact dermatitis

Answer 62

T Typically due to fragrances containing bergapten fragrance Bergapten is 5-methoxypsoralen and is found in the fragrance Bergamot oil as well as other fruits and plants e.g. figs (Ficus carica), celery (Apium graveolens), lemon oil, Tromso palm (H laciniatum), Queen Anne's lace (Ammi majus), and giant Russian hogweed (H mantegazzianum)

Answer 63

F | Oxybenzone (a benzaphone sunscreen) is most common topical photoallergen

Answer 64

PIP | Pellagra – isoniazid, phenytoin

Answer 65

MTX piperacillin, tobramycin, vancomycin, ciprofloxacin Docetaxel with or without cyclophopshamide, paclitaxel, etoposide, suramin, sorafenib

Answer 66

'wear ANKLE chains in Her Majesties Prison' Hydralazine Minocycline Propylthiouracil + cocaine - causes ANCApos (in >80%) vasculitis that mimics WG and can have facial midline destructive lesions

Answer 67

Cytotoxic drugs – BM suppression induced purpura Bleomycin – thrombocytopenia Aspirin – platelet inhibition Heparin – see later re HITTs Warfarin – increased INR tPA assoc w/ painful purpura TMP-SMX (bactrim) can cause an acral purpuric eruption similar to the papular-purpuric glove and socks syndrome Numerous other drugs can cause thrombocytopenia or altered coagulation causing purpura

Answer 68

T in 80% also seen in 25% of non-drug vasculitis

Answer 69

Variant of lichenoid drug eruption Red-purple papules and plaques Histo shows lichenoid drug eruption with granulomatous histiocytic infiltrate with multinucleated giant cells. Usually but not always a drug induced reaction pattern esp to antibiotics, ACE inhibitors, beta blockers, statins and NSAIDs.

Answer 70

1 month to 3 years after starting drug

Answer 71

F usually 1-4 months but up to 2 years if due to gold

Answer 72

older ave age of onset - 65 for drug, M=F Generalized distribution; often spares classic LP sites often photodistributed mucosa usually spared Not typical LP appearance; Can look more eczematous/psoriasiform/pityriasiform usually no Wickham's striae hyperpigmentation very uncommon in drug rcn

Answer 73

Lichenoid Drug; Lichenoid infiltrate w/ Civatte bodies high up in epidermis May have eos and/or plasma cells May extend to deep vascular plexus May be parakeratosis May be some spongiosis LP; Lichenoid reaction Mild inflammation confined to papillary dermis w/out parakeratosis rarely eos or plasma cells (but presence of eos doesn’t=drug)

Answer 74

F Can use EDTA or dimercaprol (=BAL-British Anti-Lewisite) - used for gold, arsenic, mercury and lead poisoning and Wilsons disease

Answer 75

Carbamazepine

Answer 76

F | Classified as endogenous as not due to something contacting the skin

Answer 77

An eczematous reaction to an oral drug due to prior contact sensitization to the drug or to a cross reacting chemical Often first or most severely affects site of prior ACD Often symmetrical E.g; phenothiazines (parabens ACD) Gentamicin (neomycin ACD) Disulfiram (thiuram ACD) Can be Baboon syndrome e.g. mercury, nickel, penicillins

Answer 78

T | Kind of systemic contact-type dermatitis medicamentosa

Answer 79

ACD occurring to a substance in topical form after initial sensitization to the drug taken orally E.g. penicillin, methyldopa, allopurinol, indomethacin, sulphonamides, gold, quinine, clonidine, chloramphenicol, bleomycin

Answer 80

``` Neutrophilic eccrine hidradenitis + PASH PG AGEP Sweets Halogenodermas (bromoderma, iododerma, fluoroderma) ```

Answer 81

``` F v rare G-CSF or GM-CSF most common Can be Isotretinoin Possibly; MTX AZA hydralazine ```

Answer 82

T | may be because many due to G-CSF in neutropenic chemo patients (given to try to reverse the neutropenia)

Answer 83

Fever - classical feature AKI - next most common Liver - cholestatic or hepatitic picture, can be hepatomegally or steatosis Lungs – hypoxia w/ bilat effusions Rare multiorgan dysfunction–can be DIC and death

Answer 84

``` Chemo drugs Typically follows chemo esp cytarabine for AML – onset 1-2 weeks after chemo MTX, cyclophosphamide, anthracyclines, 5FU, bleomycin, vinca alkaloids, imatinib sites of bleomycin injection Rare causes; G-CSF (esp in HIV), paracetamol In Behcets strep, staph, gram neg bacilli, HIV ```

Answer 85

Erythematous papules and plaques on trunk and extremeties and face Can be linear, annular, targetoid or polymorphic, can be purpuric and pustular

Answer 86

Eccrine glands show vacuolar degeneration in secretory and ductal cells sparing acrosyringium Neutrophilic infiltrate May see some eccrine squamous syringometaplasia (squamous metaplasia of cuboidal epithelial cells of eccrine ducts)

Answer 87

stop drug if drug cause resolves in days-weeks steroids orally if severe dapsone

Answer 88

T | Non-aromatics usually don’t; sodium valproate, topiramate, Gabapentin, levetiracetam, ethosuximide, tiagabine

Answer 89

F | cell-mediated

Answer 90

face, lips, hands, feet, genitals can be intraoral trunk rare

Answer 91

F Usually at exactly same site and sometimes at additional sites but may be a refractory period when readministration doesn’t cause a reaction

Answer 92

F | means many typical lesions of FDE

Answer 93

``` SCANT Sulphonamides esp TMP-SMX Cacium channel blockers Aspirin NSAIDs inc ibuprofen Tetracyclines ```

Answer 94

F clinical and histo the same always think of drugs as many reported drug causes e.g. CAAVVE – Captopril, Ampicillin, Amioderone, Vanc, Voltaren, Epileptics Resolves in 2-5 wks after stopping drug

Answer 95

F | up to 10% of pemphigus cases in developed countries

Answer 96

T esp if penicillamine cause; perilesional direct IF negative in up to 10% of penicillamine induced pemphigus Sometimes indirect IF also negative – 30% of penicillamine cases but is more often posiitve the same frequency as sporadic forms

Answer 97

T | captopril, Ramipril, penicillamine, gold, Piroxicam (Feldene, an NSAID)

Answer 98

A drug allergy rash without systemic symptoms which may be called baboon syndrome. Most often due to antibiotics or contrast media Criteria are ; Exposure to a systemic drug but not chemo agent – can occur after initial or repeated dose Sharply demarcated area of gluteal/perianal area and/or V-shaped erythema of genital/ inguinal area At least one other flexural site involved Symmetrical No systemic signs or symptoms

Answer 99

Systemic contact type dermatitis Baboon syndrome | Toxic erythema of chemotherapy

Answer 100

Anticonvulsants – phenytoin, carbamazepine, phenobarbital, mephenytoin, valproate, trimethadione Antipsychotics – chlorpromazine, promethazine ACEIs and ARIIBs Allopurinol Imatinib Ibuprofen/NSAIDs Starts weeks – years after starting drug; mostly in first 7 weeks Completely resolves within weeks of stopping drug, sometimes takes months

Answer 101

Lesions on skin are solitary or multiple and can be localized or widespread Red-violet papules, plaques or nodules Can present as erythroderma – looks like Sezary syndrome Often lymphadenopathy

Answer 102

Histo Dense lymphocytic infiltrate in dermis mimics lymphoma Can be band-like and mimic MF Mainly T cells, usually polyclonal Nuclei may look atypical with cerebriform outline Can be epidermotropism and Pautrier-like microabscesses Features which help distinguish from true lymphoma; spongiosis, apoptotic keratinocytes, papillary dermal oedema, eos in epi, RBCs

Answer 103

F | clinical and histo mimics these - always consider drug and try to stop meds

Answer 104

Due to reduced protein C function causing coagulation and ischaemic infarcts inc risk if hereditary protein C deficiency (protein C and S are vit K-dependent and are inhibited by warfarin more quickly than the anticoagulant effect esp protein C as short half life) 1 in 10,000 warfarin pts Esp pts in 50s-60s F:M = >4:1 Usually starts 2-5 days after starting drug Starts as pain then red, painful plaques esp breast, thighs, buttocks Turn into haemorrhagic blisters and necrotic ulcers or eschar Stop warfarin Reverse with vitamin K Give heparin to anticoagulate (as still need anticoagulation) Can give intravenous protein C concentrates or activated protein C

Answer 105

F | Due to cholesterol emboli due to anticoagulation – not limited to warfarin alone

Answer 106

F antibody mediated; binding of antibodies to heparin and platelet factor 4 to form PF4/heparin complexes (HIT complexes) which stimulate platelet aggregation and consumption 5-30% of pts who develop HIT-IgG Abs will develop clinical HIT(T)S

Answer 107

F | can be UFH or Lmolwt Heparin

Answer 108

F Don’t use warfarin/Coumadin as can precipitate limb gangrene due to initial prothrombotic effects can give dabigatran, danaparoid, lepirudin, argatroban

Answer 109

T | but high risk if less than 100 days ago

Answer 110

T | skin lesions are macular purpura with central necrosis and retiform extensions at the margins

Answer 111

Nicorandil, penicillamine, gold, phenylbutazone, captopril, phenindione, piroxicam, phenobarbitol and topical bleach (sodium hypochlorite) Foscarnet can cause penile urethra ulceration by contact toxicity as excreted

Answer 112

F most often anagen effluvium, rarely TE e.g. Antimetabolites, vinca alkaloids, alkylating agents, topoisomerase inhibitors also arsenic, gold, bismuth NB - most non-chemo drug alopecia is due to acute or chronic telogen effluvium Bisulfan causes characterisitic irrevrsible hairloss

Answer 113

``` T also; Combing Cheeks Makes Pam Angry • Corticosteroids • Cyclosporin • Minoxidil • Phenytoin • Androgens ```

Answer 114

cyclosporine, phenytoin, minoxidil, diazoxide, corticosteroids, androgens, penicillamine, psoralens, streptomycin Also Bimatoprost (lumigan, latisse) eye drops which cause eyelash growth trichomegaly of eyelashes also caused by EGFR inhibitors (long, thick, rigid hairs)

Answer 115

Reversible greying in red/blonde haired people

Answer 116

darkening, lightening, curling, kinking

Answer 117

thinning, fragility, onycholysis, onychoschizia, nail shedding, onychomadesis, ingrowing nails, periungual granulation tissue, paronychia

Answer 118

yellow discolouration + onycholysis + photo-onycholysis | Psoralens cause same things

Answer 119

CsA, nifedipine, phenytoin, felodepine, verapamil, diltiazem

Answer 120

bilateral red swollen ears due to Cytarabine

Answer 121

AKs – 5-FU, capecitabine, pentostatin Seb Ks – Cytarabine, Taxanes DSAP – 5-Fu + prodrugs, Taxanes

Answer 122

T Acquired cutaneous adherence can also be caused by retinoids

Answer 123

sclerosis and hyperpigmentation along the vein following IV infusion - 5-FU, Doxorubicin, Docetaxel, Vinorelbine, alkylating agents

Answer 124

distinct subtype of acral ertyhema (HFS) 5-10% ot pfts on taxanes e.g. Docetaxel, Paclitaxel Erythematous plaques on dorsal hands, achilles tendons and malleoli (not palms and soles like in other drugs so nota cause of PPK) + often have associated nail toxicity – onycholysis, Beau lines, nail melanosis, subungual haemorrhage, paronychia.

Answer 125

Eg. Cetux, pmab, erlotinib, gefitinib 'EGFR makes(MEK) a fast car' (rhymes) - if you have a fast car you get 'MPH PRIDE' Mucositis Photosensitivity Hair changes eg hypertrichosis, hirsuitism, trichomegally of eyelashes + Alopecia (androgenetic or rarely scarring) Papulopustular eruption Regulatory changes in hair Itching Dryness Easy breaking nails (brittle) + paronychia + onycholysis + pyogenic granulomas NB; MEK inhibitors have same side effects eg. Seletanib, trametinib

Answer 126

Eruptions (75%) squamoproliferative lesions - kAs, SCCs, verrucal keratoses photosensitivity KP-like reaction, seb derm-like eruption, Grover’s hyperkeratotic hand-foot reaction, panniculitis, melanocytic lesions, vitiligo Cymotrichous (wavy hair)

Answer 127

E.g. Sorafenib, sunitinib, pazopanib, vandetanib Grade 1 – painless mild changes. Rx: emollients, keratolytics, gel/foam shoe inserts Grade 2 – painful changes limiting instrumental ADLs. Rx: as for grade 1 + potent TCS for 7-10 days and consider 50% dose reduction Grade 3 – severe pain and limits self-care ADLs. Rx: as per grade 2 + local antiseptic baths + stop drug for at least 1 week and restart when HFSR toxicity grade 0/1

Answer 128

``` F AE profile than single agent therapy but regular derm check ups still recommended Much lower SCC risk Much lower verrucal keratosis risk Much lower Grover’s disease risk Increased folliculitis Other AEs at similar rates ```

Answer 129

F | same as EGFR inhibitors

Answer 130

Mouth ulcers Inflammatory eruptions – common. Can be morbilliform, eczematoid or acneiform. Erythematous follicular pustules and papules most common. Onset first 2 wks. Trunk>limbs>face. Variable histo. Onset, course + Rx similar to EGFR inhibitor rash. Others – nail toxicity esp paronychia, pyogenic granuloma-like lesions, alopecia, facial hypertrichosis, poor wound healing, pruritus, xerosis, oedema, vasculitis.

Answer 131

alopecia (60%) - usually mild | dysguesia (up to 75%) - treat w/ zinc

Answer 132

Autoimmune dermopathy (40%) is most common immune side effect, followed by colitis. Pruritis in 30% or fewer, morbilliform eruption in 10-50% Vitiligo-like melanoma-associated hypopigmentation – portends good prognosis Rarely – prurigo nodularis, lichenoid exanthems, papulopustular eruptions, pyoderma-gangrenosum-like ulcerations, photosensitivity, XRT recall, DRESS, TEN Also; diarrhoea/colitis, pruritus/dermatitis, endocrine problems/hypophysitis, hepatitis, neuritis, death (esp from severe colitis) Symptoms mainly dose-dependent and resolve after Rx

Answer 133

F | common but more so if CD4 count between 100-400

Answer 134

Inflammatory eruptions Hyperkeratotic hand-foot skin reaction (HFSR) stomatitis hair changes genital eruptions eg psoriasifrom rash Uncommon; seb-derm like facial rash, yellowing of skin, facial oedema, pyoderma gangrenosum-like lesions, eruptive naevi, hyperkeratotic squamoproliferative lesions like in BRAF inhibitors, asymptomatic nail splinter haemorrhages, acute folliculitis, dryness, photosensitivity

Answer 135

Sulphur drugs – co-trimoxazole, sulphonamides Allopurinol Tetracyclines Anticonvulsants - barbiturates, phenytoin, lamotrigine, carbamazepine NSAIDs - esp COX2 + oxicams

Answer 136

``` Classically associated with penicillin treatment of early syphilis Also seen in; Borreliosis/erythema chronicum migrans (penicillin or minocycline) Leptospirosis Onchocerciasis (diethylcarbamazine) Strongyloides (thiabendazole) Q fever Bartonellosis & cat scratch disease Brucellosis Tularaemia Typhoid fever Trypansomiasis ```

Answer 137

Ingesting large amounts of iodine inhibits iodination of thyroglobulin in the thyroid and thyroid hormone levels are reduced. Can occur when using potassium iodide Patients on KI may also get an iodide goitre

Answer 138

Phenytoin | the 'pyt' in both words is very similar

Answer 139

Phenytoin, cyclosporine, EGFR inhibitors oral or topical minoxidil systemic or topical corticosteroids topical latanoprost

Answer 140

``` GP VACKS Grovers of folliculitis PPK, Panniculitis, Photosensitivity Vitiligo, Verrucal keratoses, Verruca vulgaris AK, Acneiform rash, Alopecia Cysts, Cymotrichous (wavy hair) Keratosis Pilaris SCC ```

Answer 141

Psoriasis Dariers HS

Answer 142

Ethacrynic acid Unlike the other loop diuretics, ethacrynic acid is not a sulfonamide and thus, its use is not contraindicated in those with sulfa allergies

Answer 143

penicillin, beta lactams, allopurinol, barbiturates, codeine, quinidine, mercury, indandiones

Drug causes of disease Flashcards

(178 cards)