医科大学精品课件:Drug eruption.ppt
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- 医科大学精品课件:Drug eruption 医科大学 精品 课件 Drug
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1、Drug Eruption,Liangchun Wang Department of Dermatology, Sun Yat-Sen Memorial Hospital 15.10.16,Adverse Drug Reactions,Over 2 MILLION serious ADRs yearly 100,000 DEATHS yearly ADRs 4th leading cause of death ahead of pulmonary disease, diabetes, AIDS, pneumonia, accidents and automobile deaths Nursin
2、g home patients ADR rate350,000 yearly,Drug eruption,Gastrointestinal tract events 22.1% (colchicine) Electrolyte/renal 16.7% (Amphotericin B, Cyclosporin A) Hemorrhagic 12.7% (warfarin) Metabolic/endocrine 9.5% (corticosteroid) Dermatologic (skin) /allergic 7.9%,Medical administration pathways that
3、 induce drug eruption,Ingestants: substances that enter the body by mouth Inhalants: the allergen is breathed in through the nose or mouth Injected: enter the body through puncture Contact Allergies: enter the body through the skin,Pathogenesis,Type A:,Nonimmunologic mechanisms -sometimes predictabl
4、e,Over dose Cumulative toxicity Drug-drug interactions Exacerbation of disease Pharmacological side effects,Type A:,Idiosyncratic with a possible immunologic mechanism-unpredictable,DRESS TEN/SJS- allopurinol /HLA-B*5801; Carbamazepine/ HLA-A*3101 Drug reaction in the setting of HIV infection Drug i
5、nduced lupus,Type B:,Response by the patients to the drug or its metabolite Four types of hypersensitivity,Type I hypersensitivity,Type I hypersensitivity,Systemic Anaphylaxis (Allergic shock) Anaphylactic shock drug allergy, e.g. penicillin toxin from bee, seafood Localized Anaphylaxis: Breathe tra
6、ct allergy: allergic rhinitis, allergic asthma Digest tract allergy (food) Skin allergy: urticaria, angioedema,Type II hypersensitivity,Red cells: Penicillin, chloropromazine, phenacetin Granulocytes: Quinidine, amidopyrine Platelets: sulphonamides, thiazides,Type II hypersensitivity,Infusion reacti
7、on Neonate hemolysis(Rh blood group antigen) Drug reactions hemolytic anemia, thrombocytopenic purpura , granulocytopenia Graves disease,Type III hypersensitivity,Characterized by fever, chills, skin rash,Type III hypersensitivity(2),Type IV hypersensitivity,Clinical manifestation,The most frequent
8、cutaneous patterns: exanthemas urticarial eruptions/angioedema fixed drug eruptions Acneiform eruptions Photosensitivity,Bullous drug reactions: Erythema multiforme SJS v. TEN (life threatening),Most common form of adverse cutaneous eruption Lesions first appear proximally - especially groin and axi
9、lla, generalizing within 1-2 days Pruritus: usual, prominent, a distinguishing factor from a viral exanthem Occur first 2 weeks of tx but may occur later Most common cause: Antibiotics, especially semi-synthetic penicillin & sulfamethoxazole /trimethoprim,Exanthemas,Differential diagnosis (DDx),Vira
10、l eruption,Presentation: wheals, angioedema, or part of severe anaphylactic reactions with bronchospasm, laryngospasm, or hypotension Types: Nonimmunologic Aspirin and NSADS are the most common cause. They alter prostaglandin metabolism, enhancing degranulation of mast cells. Immunologic Most common
11、ly associated with penicillin and related beta-lactam antibiotics Skin test: penicillin exposure Cross reaction with cephalosporins,Urticaria,DDx,Papular urticaria,urticaria,A complication of ACE inhibitors Dose dependent, dose resolve ACE users: one episode; a 10x risk of a second episode , more se
12、vere. Mechanism :Blocking of kinkiness II by ACE inhibitors may increase tissue kinin levels?,Angioedema,Fixed drug eruption,Unknown pathogenesis Variant: Nonpigmented fixed drug eruption Large, tender, often symmetrical erythematous plaques Resolve completely weeks, Recur on re-ingestion of offendi
13、ng drug Pseudoephedrine by far most common.,Variant: pigmented fixed drug eruption Unknown pathogenesis Present anywhere on body (50% occur on oral and genital mucosa) Presentation: Six or less lesions occur, typically one. A red patch an iris or target lesion (EM) blister & erode. Postinflammatory
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