Drug reactions

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  • 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.

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  • 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.

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  • Delayed hypersensitivity mechanisms directed by drug-specific T cells are probably the most important mechanisms in the etiology of the most common drug eruptions—morbilliform exanthems—and also of rare and severe forms such as hypersensitivity syndrome, acute generalized exanthematous pustulosis (AGEP), Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN). Drugspecific T cells have been detected in these types of drug eruptions. Contrary to what has been believed for years, the antigen is more often the native drug itself than its metabolites.

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  • Onychomadesis Onychomadesis is caused by temporary arrest of nail matrix mitotic activity. Common drugs reported to induce onychomadesis include carbamazepine, lithium, retinoids, and chemotherapeutic agents such as cyclophosphamide and vincristine. Paronychia Paronychia and multiple pyogenic granuloma with progressive and painful periungual abscess of fingers and toes are a side effect of systemic retinoids, lamivudine, indinavir, and anti-EGFR monoclonal antibodies (cetuximab, gefitinib).

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  • 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 any concerns.

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  • These reactions are characterized by one or more sharply demarcated, erythematous lesions, sometimes leading to a blister. Hyperpigmentation results after resolution of the acute inflammation. With rechallenge, the lesion recurs in the same (i.e., fixed) location. Lesions often involve the lips, hands, legs, face, genitalia, and oral mucosa and cause a burning sensation. Most patients have multiple lesions. Fixed drug eruptions have been associated with phenolphthalein, sulfonamides, cyclines, dipyrone, NSAIDs, and barbiturates.

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  • Allopurinol Together with sulfonamides and antiepileptics, allopurinol is one of the "usual suspects" that induce frequently mild maculopapular eruptions (in at least 3% of users) and may also cause more severe reactions including hypersensitivity/DRESS and SJS/TEN. Because of increasing utilization it is one of the most frequent causes of life-threatening reactions. Anti-HIV Medications In clinical trials, combinations of highly active antiretroviral treatments were frequently associated with ≥10% "drug eruptions.

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  • 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.

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  • Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Parkinsonism caused by adverse drug reactions: a case series...

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  • (BQ) Part 2 book "Illustrated synopsis of dermatology and sexually transmitted diseases" presents the following contents: Adverse drug reactions, autoimmune connective tissue diseases, sexually transmitted infections and hiv infection, nevi and skin tumors, cutaneous manifestations of internal diseases,...

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  • Five years have passed since the first edition of Principles of Clinical Pharmacology was published. The second edition remains focused on the principles underlying the clinical use and contemporary development of pharmaceuticals. However, recent advances in the areas of pharmacogenetics, membrane transport, and biotechnology and in our understanding of the pathways of drug metabolism, mechanisms of enzyme induction, and adverse drug reactions have warranted the preparation of this new edition.

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  • 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.

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  • This account is confined to therapy directed primarily at the skin. • Pharmacokinetics of the skin • Topical preparations:Vehicles for presenting drugs to the skin; Emollients, barrier preparations and dusting powders;Topical analgesics; Antipruritics; Adrenocortical steroids; Sunscreens • Cutaneous adverse drug reactions • Individual disorders: Psoriasis.Acne, Urticaria, Skin infections It is easy to do more harm than good with potent drugs, and this is particularly true in skin diseases.

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  • 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 Background 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.

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  • 5.3 II.5.3 Hair dyes by Kazuhiro Koyama and Takaaki Kikuno Introduction Nowadays, numerous kinds of hair dyes are being commercially available. Hair dyes are classified into “reactive hair dyes” with high toxicity and into “adhering hair dyes” with lower toxicity. The reactive hair dyes form a polymerized dye by oxidative reactions inside hair, while the adhering hair dyes only adhere to the outer surface of hair without chemical reaction. In view of poisoning, the reactive hair dyes are objects of interest and of analysis.

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  • Introduction: Oleander (Nerium oleander and Nerium indicum) is a relatively small evergreen tree of an Indian origin, and growing in Honshu, Shikoku, Kyushu and Okinawa islands in Japan. The plant contains cardiac glycosides in its leaves, stems and flowers and is known as one of poisonous plants; poisoning and fatal cases for domestic animals and humans due to ingestion of this plant were reported [1–6]. The main toxin of oleander is oleandrin. Oleandrin can be measured using cross-reaction of an immunoassay kit for digoxin [1], TLC [2], HPLC [7, 8] and LC/MS [3, 6].

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  • Compared with hydrophilic drugs not undergoing transport, lipophilic drugs are more rapidly taken up from the blood into hepatocytes and more readily gain access to mixed-function oxidases embedded in sER membranes. For instance, a drug having lipophilicity by virtue of an aromatic substituent (phenyl ring) (B) can be hydroxylated and, thus, become more hydrophilic (Phase I reaction, p. 34). Besides oxidases, sER also contains reductases and glucuronyl transferases. The latter conjugate glucuronic acid with hydroxyl, carboxyl, amine, and amide groups (p.

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  • 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.

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  • Natural photoprotection is provided by structural proteins in the epidermis, particularly keratins and melanin. The amount of melanin and its distribution in cells is genetically regulated, and individuals of darker complexion (skin types IV–VI) are at decreased risk for the development of acute sunburn and cutaneous malignancy. Other forms of photoprotection include clothing and sunscreens. Clothing constructed of tightly woven sun-protective fabrics, irrespective of color, affords substantial protection. Wide-brimmed hats, long sleeves, and trousers all reduce direct exposure.

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  • This book applies pharmacology to nursing practice, with the overall aim of enhancing patient care. The main focus of the book is adverse drug reactions, and the implications for patient monitoring. Adverse drug reactions account for around 4% of UK hospital admissions. Over 70% of these problems are avoidable (Pirmohamed et al. 2004): the monitoring of prescribed medications has long been a cause for concern (Royal College of General Practitioners 1985, DH 2000, Audit Commission 2001, Committee of Public Accounts 2006).

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