Harrison's Internal Medicine Chapter 56. Cutaneous Drug Reactions
CUTANEOUS DRUG REACTIONS: INTRODUCTION
Cutaneous reactions are among the most frequent adverse reactions to drugs. Every physician will see patients suffering from them. Most are benign, but a few can be life-threatening. Prompt recognition of severe reactions, drug withdrawal, and appropriate therapeutic interventions can minimize toxicity.
Untoward cutaneous responses to drugs can arise as a result of immunologic or nonimmunologic mechanisms. A variety of adverse reactions result from mechanisms that do not involve an immunologic process. Drug reactions are a public health problem because of their frequent occurrence, occasional severity, and impact on the use of medications. The skin is among the organs most often affected by adverse drug reactions. The list of conditions that can be triggered by medications includes nearly all dermatologic diseases.
When a new veterinary medicinal product is
launched into widespread use, adverse drug reactions
may become apparent. These may be seen in
the treated animal patients, in exposed users or as
adverse effects on the environment. Additionally,
they may manifest as excess residues of the drug
in food of animal origin. As a consequence, legislation
and regulatory approaches have developed
across the globe to address these issues and to
ensure that the continued safety of these products
can be monitored and, where necessary,
that regulatory actions can be pursued to assuage
Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Possible life-threatening adverse reaction to monovalent H1N1 vaccine...
(BQ) The best and easiest way to learn essential information about the top 300 drugs. Every card includes: Generic and common name, class, dosage forms, approved dose and indications, off-label use, contraindications, adverse reactions, drug interactions,...
(BQ) Part 2 book "Nelson’s pediatric antimicrobial therapy" presentation of content: Preferred therapy for specific parasitic pathogens, alphabetic listing of antimicrobials, antibiotic therapy for obese children, antibiotic therapy for patients with renal failure, adverse reactions to antimicrobial agents,...
Adverse Drug Effects
premature breakdown of red blood cells (hemolysis) in subjects with a glucose6-phosphate dehydrogenase deficiency. The discipline of pharmacogenetics deals with the importance of the genotype for reactions to drugs. The above forms of hypersensitivity must be distinguished from allergies involving the immune system (p. 72). Lack of selectivity (C). Despite appropriate dosing and normal sensitivity, undesired effects can occur because the drug does not specifically act on the targeted (diseased) tissue or organ.
Sulfonamides Antibacterial sulfonamides have a rather high risk of causing cutaneous eruptions and are among the drugs most frequently implicated in SJS and TEN. The combination of sulfamethoxazole and trimethoprim frequently induces adverse cutaneous reactions in patients with AIDS (Chap. 182). Desensitization is often successful in AIDS patients with morbilliform eruptions but is not recommended in AIDS patients who manifested erythroderma or a bullous reaction in response to their earlier sulfonamide exposure.
Cutaneous reactions are among the most frequent adverse reactions to drugs. Every physician will see patients suffering from them. Most are benign, but a few can be life-threatening. Prompt recognition of severe reactions, drug withdrawal, and appropriate therapeutic interventions can minimize toxicity. This chapter focuses on adverse cutaneous reactions to drugs other than topical agents; it covers their incidence, patterns, and pathogenesis and provides some practical guidelines on treatment, assessment of causality, and future utilization of drugs.
We must be daring and search after Truth; even if we do not succeed in finding her, we shall at least come closer than we are at present (Galen AD 130-200)
SYNOPSIS (CONTINUED) Surveillance studies and the reporting of spontaneous adverse reactions respectively determine the clinical profile of the drug and detect rare adverse events. Further trials to compare new medicines with existing medicines are also required.These form the basis of cost-effectiveness comparisons.
Though alternative methods of controlling insects, rodents,
insect pests, pathogens, microbes and weeds have been developed, pesticides could
not be replaced. The prosperous role of pesticides in the management of insect pests
and diseases is indisputable. However, its nature of non selective toxicity towards
other organisms and deposition in the environment warrants the legislation of usage.
Pesticide use raises a number of environmental concerns.
Background Definitions Causation: degrees of certainty Pharmacovigilance and pharmacoepidemiology Classification Causes Allergy in response to drugs Effects of prolonged administration: chronic organ toxicity Adverse effects on reproduction
Cur'd yesterday of my disease I died last night of my physician.1 Nature is neutral, i.e. it has no 'intentions' towards humans, though it is often unfavourable to them.
I hope that the reader will find these chapters useful to get new perspectives on some
of the current topics and issues in membrane trafficking, and to get a sense on the
diversity of approaches and experimental systems that are used in this field.
Finally, I would like to thank all the people associated with the production of this
book. First, the authors themselves for taking the time to prepare their chapters in a
timely manner and in a format filled with technical details and novel and exciting
concepts. It is not an easy task, and I sincerely thank them for their efforts.
Most books about drugs fall into one of two categories—
they either focus on basic pharmacology, rich with information
about pharmacokinetics and pharmacodynamics,
or they address pharmacotherapeutics with an emphasis on
conditions and indicated treatments. Th e former provides
in-depth information that, unfortunately, is often detached
from actual practice, making it diffi cult for a reader to
retain and later use.
content decreased (Agblevor et al. 1994). The equivalents of chlorine per equivalent of alkali or
alkaline earth metals increased from 3.4 to 8.5 during this filtration. This suggests that the
residual inorganics may be present as chlorides and that much of the chlorine may be in solution.
Chloride ions in solution will have an adverse effect on corrosion of many metals, including
stainless steels such as SS304.
Compared to coal and many crude oils, biomass has a low sulfur content.
tive driving skills and other tasks requiring precise sensorimotor coordination will be impaired. Triazolam (t1/2 of elimination ~1.5–5.5 h) is especially likely to impair memory (anterograde amnesia) and to cause rebound anxiety or insomnia and daytime confusion. The severity of these and other adverse reactions (e.g., rage, violent hostility, hallucinations), and their increased frequency in the elderly, has led to curtailed or suspended use of triazolam in some countries (UK).
Allergic diseases are an adverse reaction of the immune system against otherwise innocuous
substances and are characterized by their high complexity. Patients can be asymptomatic or
their involvement could be as severe as asthma. The complex nature of the phenotypes
involved seems to point to genetic and environmental factors implication.
Familiar aggregation or genetic implication in the development of these diseases is well
reported, and experts seem to agree that atopic diseases affect homozygotic twins more than
dizigotic twins (Ownby, 1990, Duffy et al., 1990)....
Diagnosis and Treatment of Adverse Drug Reactions The manifestations of drug-induced diseases frequently resemble those of other diseases, and a given set of manifestations may be produced by different and dissimilar drugs. Recognition of the role of a drug or drugs in an illness depends on appreciation of the possible adverse reactions to drugs in any disease, on identification of the temporal relationship between drug administration and development of the illness, and on familiarity with the common manifestations of the drugs.
In addition to family planning services, the WHP offers preventive health screening
services. For many women, the periodic family planning visit may be their only point of contact
for preventive care and screening. An analysis of patients at family planning centers found that
the majority (62%) considered the center their usual source of care and that poor (73%) and
uninsured (75%) women were even more likely to depend on the centers as their usual source of