Derm FINAL Exam: Lam Drug-Induced Skin Rxns

4 types of immunologically mediated reactions:

• _____: Immediate in onset and mediated by IgE and mast cells/basophils (urticaria, ANGIOEDEMA and ANAPHYLAXIS)

Type I

4 types of immunologically mediated reactions:

• _____: delayed in onset and caused by IgG-mediated cell destruction (HEMOLYSIS, THROMBOCYTOPENIA, and/or PURPURA)

Type II

4 types of immunologically mediated reactions:

• _____: delayed in onset and caused by IgG:drug immune complex deposition and complement activation (VASCULITIS, SERUM SICKNESS and urticaria)

Type III

4 types of immunologically mediated reactions:

• _____: delayed in onset and T-cell mediated hypersensitivity (CONTACT dermatitis, exanthematous RXNS, and photoallergic RXNS)

Type IV

ADEs: _____ Reactions

• Allergic/immune reactions

  • Type I (_____) hypersensitivity

  • Type II (_____) hypersensitivity

  • Type III (_____) hypersensitivity

  • Type IV (_____) hypersensitivity

Type B, immediate, cytotoxic, immune-complex, delayed

Classification of Drug-Induced Skin Reactions

• Acute

  • _____ eruptions

  • _____, _____ and _____

  • _____ syndrome

  • _____ and _____ (TEN)

  • _____-induced skin necrosis

  • Drug-Induced _____

  • _____-like reaction

  • _____

Erythematous, Uticaria, angioedema, anaplylaxis, Hypersensitivity, SJS, Toxic Epidermal Necrolysis, Warfarin, Vasculitis, Serum sickness, Photosensitivity

Classification of Drug-Induced Skin Reactions

• Chronic

  • Drug-induced _____ and drug-induced _____

lupus, acne

What Is Human Leukocyte Antigen (HLA)?

• HLA class I: _____, _____, and _____

HLA-A, HLA-B, HLA-C

Pharmacogenetics: Gene – Drug Examples

• _____: _____ (Ziagen®), _____ (Zyloprim®), _____ (Tegretol®)

• CYP_____

• _____, CYP_____

HLA-B, Abacavir, Allopurinol, Carbamazepine, 2D6, VKORC1, 2C9

Chronic Types of Drug-Induced Skin Reactions

• Drug-induced lupus: _____, _____

• Drug-induced acne: _____ (_____)

hydralazine, procainamide, lithium, dose-related

Corticosteroid ADRs Mnemonic: “GLUCOCORTICOids”

• G = Glaucoma

• L = Lunacy (psychiatric manifestations: mood swings)

• U = peptic Ulceration

• C = Cushing’s syndrome

• O = Osteoporosis

• C = Cataracts

• O = Opportunistic infections

• R = Retention of Na+ (esp. for mineralcorticoids)

• T = Telangiectasia

• I = Insulin resistance (hyperglycemia)

• C = Causes muscle weakness or wasting

• O = grOwth retardation

KNOW

Summary – Key Takeaways

• Advise patients about drugs that are _____

  • _____ allergic reactions

  • _____ hypersensitivity

  • _____ allergic reactions

• Pharmacogenetic testing _____ to drug initiation

  • _____: HLA-B*5701 screening

  • _____: HLA-B*5801 screening (Han Chinese and Thai descent; Koreans with stage 3 or worse CKD)

  • _____: HLA-B*1502 screening (Han Chinese, Singaporeans, Malaysians, Thai, Filipino)

• Consider _____ for urticaria

• Manage high fevers with _____ vs. _____ or an _____

• _____ to reduce inflammation

cross-reactive, penicillin, phenytoin, sulfonamide, prior, Abacavir, Allopurinol, Carbamazepine, 2nd Gen AHs, APAP, ASA, NSAID, topical or systemic corticosteroids