Thursday, March 11, 2010

Stevens-Johnson syndrome

Stevens-Johnson syndrome - Acute
Rahul Soman, M. Pharm


 

Definition  

Acute, eruptive skin disorder that occurs in response to a variety of antigenic stimuli


 

Medical History  

* Anticonvulsant use

* Beta-Lactam use

* NSAID use

* Sulfonamide use

* Mycoplasma pneumonia

* Pediatric (0-18 years) , Herpesvirus infection

* Pediatric (0-18 years) , Complication due to vaccination

* Systemic lupus erythematosus

* HIV infection

* Genetic predisposition


 

Findings  

* Conjunctivitis

* Cough

* Disorder of mucous membrane

* Fever

* Genital ulcer

* Headache

* Oral lesion

* Skin lesion

* Upper respiratory infection

* Anorectal lesion

* Esophageal erosions

* Finding of lacrimation

* Lesion of eye structure

* Malaise

* Myalgia

* Pain in throat

* Vomiting


 

Tests  


 

Initial evaluation of Stevens-Johnson syndrome  

* Electrolytes measurement, serum

* Urinalysis

* Creatinine measurement, serum


 

Suspected pneumonia  

* Plain chest X-ray: The presence of alveolar infiltrates on chest x-ray, in combination with suggestive clinical features, establishes the diagnosis of pneumonia .


 

Suspected Stevens-Johnson syndrome  

* White blood cell count: A WBC count less than 9,000/mm3 is a common finding in Stevens-Johnson syndrome, noted within 72 hours of the appearance of skin lesions .


 

Initial evaluation of Stevens-Johnson syndrome if infection is suspected  

* Bacterial culture, Skin lesion sample


 

Initial evaluation of Stevens-Johnson syndrome if sepsis is suspected  

* Blood culture


 

Initial evaluation of Stevens-Johnson syndrome .  

* Blood urea nitrogen measurement


 

Suspected Stevens-Johnson syndrome  

* Biopsy of skin: Biopsy in Stevens-Johnson syndrome reveals superficial dermal perivasculitis , minimal dermal infiltrate, and full-thickness epidermal necrosis .


 

Differential Diagnosis  

* Toxic epidermal necrolysis - Acute

* Kawasaki disease - Acute

* Fixed drug eruption

* Varicella-zoster virus infection

* Epidermolysis bullosa

* Impetigo - Acute

* Bullous pemphigoid

* Pemphigus vulgaris


 

Treatment  


 

Drug Therapy  


 


 

Stevens-Johnson syndrome  


 

METHYLPREDNISOLONE SODIUM SUCCINATE  


 


 


 

Acute pain  


 

ACETAMINOPHEN/OXYCODONE HYDROCHLORIDE  

Adults: Oxycodone 5 to 20 mg/acetaminophen 325 to 1,000 mg orally every 4 hours as needed (maximum 4 g acetaminophen/day)

Pediatrics: 0.05 to 0.15 mg/kg of the oxycodone ingredient orally every 4 hours as needed


 

HYDROCODONE BITARTRATE/ACETAMINOPHEN  

Adults: Hydrocodone 5 to 20 mg/acetaminophen 325 to 1,000 mg orally every 4 hours as needed (maximum 4 g acetaminophen/day)

Pediatrics (2-13 years): 0.27 mL/kg (0.135 mg/kg hydrocodone and 9 mg/kg acetaminophen) orally every 4 hours as needed (maximum 6 doses/day)


 

ACETAMINOPHEN/CODEINE PHOSPHATE  

Adults: Codeine 15 to 60 mg/acetaminophen 325 to 1,000 mg orally every 4 hours as needed (maximum 360 mg codeine and 4 g acetaminophen/day)

Pediatrics (3-6 years): 5 mL (12 mg codeine/120 mg acetaminophen per 5 mL) orally every 6 to 8 hours as needed

Pediatrics (7-12 years): 10 mL (12 mg codeine/120 mg acetaminophen per 5 mL) orally every 6 to 8 hours as needed


 

MORPHINE SULFATE  

Adults: 2 to 10 mg IV every 5 to 10 minutes titrated to effect OR 10 mg IM or subQ every 3 to 4 hours as needed

Pediatrics: 0.1 to 0.2 mg/kg subQ, IM, or IV every 2 hours as needed (maximum 15 mg/dose)


 

HYDROMORPHONE HYDROCHLORIDE  

Adults: 1 mg IV every 10 minutes titrated to effect OR 1 to 2 mg subQ or IM every 3 to 4 hours as needed

Pediatrics: 10 to 20 mcg/kg IV every 3 to 4 hours as needed


 

FENTANYL  

Adults: 1 mcg/kg IV slowly every 3 to 5 minutes titrated to effect

Pediatrics: 0.5 to 1 mcg/kg IV every 30 to 60 minutes as needed


 


 

Fever  


 

ACETAMINOPHEN (Related toxicological information in ACETAMINOPHEN-ACUTE, ACETAMINOPHEN-REPEATED SUPRATHERAPEUTIC)  

Adults: 650 to 1,000 mg orally every 4 to 6 hours as needed (maximum 4 g/day)

Pediatrics: 10 to 15 mg/kg orally or rectally every 4 to 6 hours as needed (maximum 5 doses or 4 g/day)

Neonates: 10 to 15 mg/kg orally or rectally every 6 to 8 hours as needed


 


 

Risk of thrombosis due to immobility  


 

Heparin  

Adults: 5,000 units subQ every 8-12 hours


 

ENOXAPARIN SODIUM  

Adults: 40 mg subQ once a day for up to 14 days


 

DALTEPARIN SODIUM  

Adults: 5000 international units subQ once daily for 12-14 days


 


 

Hyperglycemia  


 

INSULIN HUMAN REGULAR  


 


 

Procedural Therapy  


 

Suspected or known drug-induced rash with severe manifestations  

* Recommendation to stop drug treatment: Prompt cessation of the suspect drug(s) is essential in patients with a severe drug eruption .


 

Bullous eruption in Stevens-Johnson syndrome, toxic epidermal necrolysis, and staphylococcal scalded skin syndrome  

* Wound care, Epidermolysis: Bullous eruptions with epidermolysis require meticulous skin care with protection of exposed, eroded areas and prevention of secondary infection .


 

Conjunctivitis due to a mucocutaneous disorder such as Stevens-Johnson syndrome and toxic epidermal necrolysis  

* Eye care management: Meticulous eye care is essential to lessen or prevent permanent ophthalmic complications in Stevens-Johnson syndrome and toxic epidermal necrolysis .


 

Dehydration  

* Intravenous fluid replacement: Intravenous fluid replacement is indicated for patients with dehydration when oral replacement cannot be accomplished .


 

Prevention and treatment of pulmonary complications due to Stevens-Johnson syndrome and toxic epidermal necrolysis  

* Respiratory therapy: Respiratory therapy is necessary to reduce and treat pulmonary complications of Stevens-Johnson syndrome and toxic epidermal necrolysis .


 

Stomatitis  

* Mouth care management: Oral mucosal lesions are treated with analgesics, soothing mouth rinses, topical anesthetics, a soft diet, and avoidance of spicy or acidic foods .


 

Stevens-Johnson syndrome with oral mucous membrane involvement  

* Nasogastric feeding: In patients with mucosal lesions that interfere with oral intake, a nasogastric tube may be used to maintain fluid balance and nutritional support .


 

Stevens-Johnson syndrome in young children and in patients with acute urinary retention or difficulty voiding  

* Insertion of catheter into urinary bladder: A urinary catheter may be necessary in young children to monitor fluid balance and in patients with urinary retention or difficulty voiding .

No comments:

Post a Comment

SYSTEM BASED CLASSIFICATION OF DISEASES

SYSTEM BASED CLASSIFICATION OF DISEASES

Bone and Joint Diseases

  1. Gout and Hyperurecemia
  2. Osteoarthritis
  3. Rheumatoid Arthritis
  4. Acute coronary Syndroms

Cardiovascular Diseases

  1. Arrhymias
  2. Cardiopulmanary Resuscitation
  3. Heart Failure
  4. Hypertension
  5. Hyperlipidemia
  6. Ischemic Heart Diseases
  7. Shock
  8. Stroke
  9. Venous Thromboembolism

Dermatrologic Diseases

  1. Acne
  2. Psoriasis
  3. Skin Disorders and Cutaneous Drug Eruptions

Endocrine Diseases

  1. Cirrhosis
  2. Portal Hypertension

Gastrointestinal Diseases

  1. Irritable Bowel Syndrome
  2. Constipation
  3. Diarrhea
  4. Gastroesophagal Reflux Disease
  5. Hepatitis, Viral
    1. Hepatitis A
    2. Hepatitis B
    3. Hepatitis C
  6. Nausea and Vomiting
  7. Pancreatitis
  8. Peptic Ulcer disease

Gynecologic and Obstetric Diseases

  1. Contraception
  2. Hormone therapy

Hematologic Diseases

  1. Anemia
    1. Megaloblastic Anemia

i. Megaloblastic Anemia due to Folate Deficiency

ii. Megaloblastic Anemia due to Vitamine B12 Deficiency

    1. Sickle Cell anemia
    2. Hemolytic Anemia
    3. Iron Deficiency Anemia
    4. Aplastic Anemia
    5. Iron Deficiency Anemia

Infectious Diseases

  1. Central Nervous System infections
  2. Endocarditis
  3. Fungal infections, Invasive
  4. Gastrointestinal Infection
  5. HIV / AIDS
  6. Intra-Abdominal Infection
  7. Respiratory Tract infections, Lower
  8. Respiratory Tract infections, Upper
  9. Sepsis and Septic Shock
  10. Sexually transmited Diseases (STD)
  11. Skin and soft tissue infection
  12. Tuberculosis
  13. Urinary tract infection and prostatitis

Neurologic Diseases

  1. Epilepsy
  2. Headache
    1. Migraine
    2. Cluster Headache
  3. Pain management
  4. Parkinson’s Diseases
  5. Status epilepticus

Nutritional Diseases

  1. Enteral Nutrition
  2. Obesity
  3. Parentaral Nutrition

Onchologic Diseases

  1. Breast cancer
  2. Colorectal Cancer
  3. Lung cancer
  4. Lymphomas
  5. Prostate cancer
  6. Cervical Cancer
  7. Esophageal Cancer
  8. Gastric Cancer
  9. Head and Neck Cancer
  10. Lung Cancer
  11. Ovarian Cancer
  12. Pancreatic Cancer
  13. Primary bone Cancer
  14. Primary Brain cancer
  15. Testicular Cancer
  16. Thyroid Gland Cancer
  17. Urinar Bladder cancer
  18. Uterine Cancer

Ophtalmic Diseases

  1. Glaucoma

Psychiatric Diseases

  1. Alzhimer’s Diseases
  2. Anxiety Disease
  3. Bipolar Diseases
  4. Depressive diseases
  5. Schizophrenia
  6. Sleep Diseases
  7. Substance-Related Diseases

Renal Diseases

  1. Acid base Diseases
  2. Acute renal Failure
  3. Chronic Renal Failure
  4. Drug Dosing in renal insufficiency
  5. Electrolyte Homeostasis

Respiratory Diseases

  1. Allergic Rhinitis
  2. Asthma
  3. Chronic Obstructive Pulmonary Diseases

Urologic Diseases

  1. Benign Prostatic, Hyperplasia
  2. Erectile Dysfunction
  3. Urinary Incontinence