Summarize that drugs enter the human body through various channels, causing reactions in organs and tissues, which is called drug reaction. Among the side effects of drugs, about 1/3 ~ 1/4 is related to the skin, so someone put forward the name of raciotns, a skin drug. Drug eruption or drug dermatitis (drug dermatitis) is more prominent in all skin and mucosal drug reactions. Therefore, this article focuses on drug eruption.
3 Diagnosis In view of the wide range of drug reactions, complex manifestations and many specificities, it is sometimes difficult to make a definite diagnosis. At present, the diagnosis of drug eruption is still based on clinical history, combined with rash manifestations and laboratory examination, excluding the possibility of other diseases, and making comprehensive analysis and judgment.
In laboratory examination, skin scratches and intradermal tests are often used to detect whether patients are sensitive to penicillin or iodide, which has certain value in preventing anaphylactic shock, but has little significance in preventing drug eruption. In vitro tests such as lymphocyte transformation test and radioactive allergen adsorption test (RAST) have been used to detect allergens, but they are only reliable for some drugs and can be used under certain conditions, which has certain reference value.
4 treatment measures (1) to remove the cause? Stopping all suspected pathogenic drugs is the first step that must be taken, and it is forbidden to tamper with the practice of not stopping taking drugs when there are signs of drug reaction.
(2) Support therapy? Give patients favorable conditions and avoid unfavorable factors, so as to successfully overcome their self-limited course of disease, such as bed rest, nutritious diet, maintaining suitable cold and warm environment, and preventing secondary infection.
(3) Strengthen excretion? Use laxatives and diuretics as appropriate to promote the excretion of drugs in the body.
(4) medication? Different measures should be taken according to the severity of the disease.
1. Mild cases? ① 1 ~ 2 oral antihistamines; ② Intravenous injection of vitamin C 1g, once a day; ③ Intravenous injection of 10% calcium gluconate or10% sodium thiosulfate 10ml for 1 ~ 2 days; ④ Externally apply calamine lotion, oscillating lotion or talcum powder containing camphor or mint several times a day to relieve itching, dissipate heat and diminish inflammation. Usually it can be cured in a week or so.
2. A case of a minor illness? Refers to a rash that is widespread and accompanied by fever. ① Bed rest; ② Application of the above drugs; (3) Prednisone, 20 ~ 30 mg per day, is taken 3 ~ 4 times, and generally can be fully recovered in about 2 weeks.
3. Serious cases? Include severe erythema multiforme, epidermolysis bullosa and systemic exfoliative dermatitis. The following measures should be taken immediately:
⑴ Corticosteroids: hydrocortisone 300~500mg, vitamin C3g, 10% potassium chloride 20 ~ 30ml, glucose solution 5 ~ 1000 ~ 20~30ml, slowly drip, once a day, and keep continuous drip for 24 hours until the body temperature returns to normal. If the rash subsides and the general condition is further improved, the oral dose of hormone will be gradually reduced. The principle is that each reduction is1/6 ~110 of the current daily dose, and each reduction needs to be observed for 3 ~ 5 days, and always pay attention to the rebound phenomenon in the reduction. The problem of dealing with severe drug eruption often lies in improper dosage or usage of hormone, such as too small initial dose or too fast reduction in the later stage.
⑵ Antihistamines: Two drugs are taken orally at the same time.
⑶ Infusion of fresh blood and plasma: 200 ~ 400 ml each time, 2 ~ 3 times a week, usually 4 ~ 5 times.
⑷ Antibiotics: Use appropriate antibiotics to prevent infection, but be careful. Patients with severe drug eruption are often in a state of high allergy, which is not only prone to drug cross-allergy, but also may cause multi-gene sensitivity, that is, allergic to drugs unrelated to the structure of the original sensitized drugs, causing new drug eruption.
5. Local treatment: For patients with severe drug eruption, local treatment and nursing of skin and mucous membrane injury is very important, which often becomes the key to success or failure of treatment. In the early stage of acute phase, powder or calamine lotion can be used in large quantities to protect the skin, diminish inflammation and reduce swelling. If there is exudate, it can be wet-packed with normal saline or 3% boric acid solution, and replaced 4 ~ 6 times a day. After air drying, replace it with 0.5% neomycin and 3% sugar distillate, 1 ~ 2 times a day.
Conjunctiva and cornea are often involved and must be treated in time. Normal saline or 3% boric acid can be removed without washing. Triamcinolone acetonide acetate or hydrocortisone eye drops should be dropped once every 3 to 4 hours, and boric acid or hydrocortisone eye ointment should be dropped once every night to prevent blindness and conjunctival adhesion caused by corneal exfoliation. Mucosal injuries in the mouth and lips often hinder eating. You can gargle with compound borax solution several times a day, and apply mucosal ulcer ointment or Huang Zhu powder and tin powder. Nasal feeding can be used for people who can't eat.
[6] If accompanied by heart, lung, liver, kidney, brain and other organ damage, hematopoietic dysfunction, should be dealt with in time.
Once pay close attention to the balance of water and electrolyte; Give drugs such as adenosine triphosphate, coenzyme A, inosine and vitamin B6 as appropriate.
There is no doubt that the direct cause of drug reaction is of course drugs. According to the statistical data in 1960s, there are four main types of drugs causing drug eruption: sulfonamides (accounting for 2 1.6%), antipyretic and analgesic drugs (accounting for 14.3%), antibiotics (accounting for 12.3%) and sedative and hypnotic drugs (accounting for/kloc-0). According to the analysis of 4 cases of severe drug eruption in 1983 ~ 1992, the first four kinds of pathogenic drugs are antibiotics, anti-gout drugs (26 cases each, accounting for 25%) and antipyretic and analgesic drugs (20 cases, accounting for 19.2%) Cephalosporin is the main antibiotic. In recent years, there are many reports about furazolidone, thiazide drugs, non-steroidal anti-inflammatory drugs, isoniazid, p-aminosalicylic acid, chlorpromazine, carbazepine, immunosuppressants, anticancer drugs, serum biological products, Chinese herbal medicines, especially some Chinese patent medicines.
6 Pathogenesis The mechanism of drug reaction is quite complicated, including allergic, non-allergic or other special mechanisms.
(1) allergic? Most drug eruptions are related to this. The main basis is as follows: ① Almost all of them occur within the allowable dose of pharmacology; ② There is a certain incubation period; ③ Patients are only allergic to a certain drug or a certain kind of drug, with strong specificity; For people who are already allergic to a certain drug, if they use the same drug again, even a small amount will often lead to drug eruption recurrence; ⑤ Cross-allergy may occur when drugs with similar structures to sensitizing drugs are used; ⑥ Sensitizing drug skin test can get positive results; ⑦ Drug eruption caused by a small amount of drugs is mainly type I reaction, which can be desensitized in a short time; 8 Anti-allergic drugs, especially corticosteroids, are often effective.
Most chemical drugs are haptens, which must be combined with some protein components in tissues to form a total antigen (hapten carrier complex) to play a role. The antigenicity of drugs is related to their own chemical structure. It is generally believed that drugs with large molecular weight or benzene or pyrimidine core have strong antigenicity, such as penicillin G and its derivatives, polymers, long-acting sulfonamides, phenobarbital and compound aspirin, which are more common. However, drugs with weak antigenicity or no antigenicity, such as potassium chloride and sodium bicarbonate, rarely cause or do not cause drug eruption.
There are different types of drug allergic reactions, which can be manifested as any one of I to IV, and sometimes the same patient can have two types of reactions.
(2) No allergic reaction and others.
1. Toxic effect? Most of them are caused by excessive doses, such as the inhibition of the central nervous system caused by large doses of barbiturates; Bone marrow suppression or liver damage caused by nitrogen mustard and Baixuening; Toxic reactions caused by the absorption of pesticides 1059 and 1605.
2. pharmacological action? Such as drowsiness caused by antihistamines; Corticosteroids cause euphoria; Facial flushing caused by nicotinic acid.
3. light sense? After taking chlorpromazine and sulfanilamide, sun exposure can cause dermatitis in exposed parts. According to its mechanism, there are two kinds of photosensitivity reaction and phototoxicity reaction.
4. The destruction of the enzyme system? For example, Darren Ding Can causes oral ulcers by interfering with the absorption and metabolism of folic acid; 13 cis-vitamin A acid can change lipid metabolism and cause xanthoma; Isoniazid can affect the metabolism of vitamin B6 and cause polyneuritis.
5. settlement? Reactions caused by the deposition of drugs or their products in special tissues, such as the deposition of heavy metal salts such as bismuth, mercury, silver and lead on gums, the deposition of arsenic on skin (pigmentation and keratinization), and the yellowing of skin caused by adipine.
6. Special local * * * effect? For example, aspirin can directly corrode gastric mucosa, causing gastric bleeding and gastric ulcer; Sulfanilamide crystals block renal tubules, renal pelvis and catheter, causing dysuria, hematuria, oliguria and even urinary closure.
7. flora imbalance? The normal flora in the human body can adapt to each other in the process of years of co-evolution. Some flora can inhibit the overgrowth of other flora, and some flora can synthesize vitamin B and vitamin K for health needs of the body. In a word, there is contradiction and unity between microorganisms and between microorganisms and organisms. However, if antibiotics, corticosteroids or immunosuppressants are used for a long time or in large quantities, these balances will be broken. For example, the application of broad-spectrum antibiotics often leads to the infection of conditional pathogens.
8. Teratogenesis and carcinogenesis? Some drugs may have teratogenic and carcinogenic effects after long-term use, such as thalidomide and tretinoin.
(3) What are the influencing factors? In addition to the drug itself and its possible pathogenesis as a direct pathogenic factor mentioned above, the following factors often play a role in the occurrence and development of drug reactions.
1. Drug use
⑴ Abuse: It is mostly due to doctors' poor grasp of the principles of drug use, and they give drugs at will. Some drug reactions are caused by patients' ignorant application of self-provided drugs or self-purchased drugs.
⑵ Misuse: The doctor prescribed the wrong medicine, or the pharmacy prescribed the wrong medicine, or the patient took the wrong medicine. Of course, these are all accidental events.
⑶ Suicide by taking medicine: This is a rare phenomenon.
⑷ Dosage: Excessive dosage can lead to serious or even death. However, drug reactions can sometimes occur at normal doses, which is related to the different absorption, metabolism and excretion rates of drugs by different individuals, especially for elderly patients.
5] medication course; For acute diseases, the medication time is generally not long, even if the drugs used are very toxic, their harm may be less. Chronic diseases, especially cancer patients, take anticancer drugs for a long period of time, which often leads to drug accumulation and toxicity. Of course, some drugs, such as sleeping pills and sedatives, can also cause drug addiction if they are used repeatedly for a long time to gossip.
[6] Too many kinds of drugs: For people with allergic systems, the more kinds of drugs are commonly used, the more opportunities there are for reactions. This may be due to the cross-reaction or synergy between drugs.
(7) Administration route: It is generally believed that drug injection is more likely to cause reactions than oral administration. The surname rate of drug reaction after absorption of topical ointments with strong antigenicity, such as sulfonamides and tetracycline ointments, is also much higher than that of oral ointments. For a long time, it has been reported that excessive absorption of drugs during wet application of boric acid solution for external use led to infant death. Drugs taken by pregnant or lactating women may enter the fetus or baby and cause reactions.
(8) Cross-allergy: Many drugs with similar structures, such as sulfonamides containing * * * and "aniline" nuclei, procaine, p-aminosalicylic acid, etc., can cause the same reaction, which is called cross-allergy. This reaction can occur about 10 hour after the first administration, and the incubation period does not exceed 4 ~ 5 days.
Repeated use of sensitizing drugs: If a patient is allergic to a drug and uses it repeatedly in the future, a more serious reaction may occur. The repeated use of sensitizing drugs is usually due to: ① the doctor's negligence and ignorance of the patient's past drug reaction history; ② The patient didn't take the initiative to tell the doctor about his drug allergy history; (3) using drugs that can cause cross-allergy; ④ Individual patients with drug eruption who are in a highly sensitive state are prone to allergic reactions to originally insensitive drugs.
⑽ unclean syringes: unclean syringes, needles, syringes, medicine bottles, leather tubes, etc. It may cause adverse reactions by bringing some pyrogens into the body.
2. Physical condition
⑴ Sex: Both men and women can have surnames, but there are slightly more men than women (3∶2). Because of gender differences, estrogen and griseofulvin can cause male development, while androgen can cause female patients to be masculine.
⑵ Age: Children are more sensitive to anesthetics and more tolerant to general drugs than adults. Children's allergic reactions to drugs are also rare.
⑶ Specific reaction: Abnormal reaction to drugs without immune mechanism. The reasons for it were not known
⑷ Genetic factors: such as the potential danger that atopic patients have a serious reaction to penicillin drugs.
5. Allergy or allergic constitution: Most drug reactions occur in some patients with allergic constitution. The pathogenesis of allergic diseases has been discussed before.
7 Pathological changes Histopathological changes caused by drug reactions are mostly similar to those caused by non-drugs, lacking specificity and having no diagnostic value, and are omitted here.
Since the founding of New China, due to the rapid development of medical and health undertakings, the variety of new drugs has been increasing, and the opportunities for patients to use drugs have been increasing. Therefore, the drug reaction also increased significantly. According to the statistics of dermatology in our school in 10 years after the founding of the People's Republic of China, the number of refractory drug eruption in 1958 increased from 1949 to 1.2%, which increased by 12 times. Statistics from several major hospitals in Shanghai show that drug eruption has increased from 0.5% of 200,000 newly diagnosed patients in dermatology to 1954 and then to 1.2% of 280,000 patients in dermatology, which is basically consistent with the former. Recently, the dermatology department of our school counted 380,000 newly diagnosed patients from 1982 to 1986, and the proportion of drug eruption patients rose to 2.37%. 1983 ~ 199 1 year, among the 24 18 inpatients in the dermatology department of Huashan Hospital of our school, 208 patients had pre-medication conditions, accounting for 8.6%. In the past, drug reactions were more common in cities. In recent years, due to the popularization of medicine, drug reactions are more common in rural areas. Due to the wide application of traditional Chinese medicine, the drug reactions caused by traditional Chinese medicine have also increased. In fact, almost everyone has access to one kind or another of drugs in his life, so almost everyone may have a drug reaction under certain circumstances. With the increasing variety of drugs, the types and manifestations of drug reactions have changed accordingly. Most drugs are given by doctors, so drug reactions are mainly iatrogenic diseases. If doctors can be cautious about the time of medication, drug reactions may not be completely avoided, but they can certainly be greatly reduced.
Clinical manifestations can involve various systems and organs, from the whole body to the local area, due to drug reactions. This section only discusses some typical drug eruptions and several special types of drug reactions.
(1) allergic drug eruption? This is the most diverse and common type of drug eruption. According to its incubation period, occurrence and development, rash manifestations and prognosis, it can be divided into at least 10 subtypes, such as erythema fixum, erythema scarlet fever, erythema measles, erythema urticae, erythema multiforme, erythema nodosum, pityriasis rosea, purpura, epidermolysis bullosa and so on. They have the following similarities: ① There is a certain incubation period, usually 4-20 days, with an average of 7-8 days. If you are allergic, you can get sick within 24 hours, with an average of 7-8 hours. The shortest is only a few minutes, and the longest is no more than 72 hours; ② Most patients have sudden onset, and may have symptoms such as chills, discomfort and fever first. ③ The rash occurred and developed, except for the fixed erythema, the others were generalized and distributed symmetrically as usual; (4) It is often accompanied by systemic reactions with different degrees of severity, which are not obvious in light cases, and headache, chills and high fever may occur in severe cases; ⑤ The course of disease is self-limited, ranging from one week to less than one month. ⑥ The prognosis of epidermolysis bullosa is serious, and all others are good. Here are several representative subtypes.
1. Fixed erythema (fixed rash)? It is the most common drug eruption, accounting for 22% ~ 44% of drug eruption. Among 909 cases of drug eruption in undergraduate course, 3 18 cases were in this form, accounting for 34.98%. The common pathogenic drugs are sulfonamides (long-acting sulfonamides are the first), antipyretic and analgesic drugs, tetracyclines and sedative and edematous patches, which are round or oval with clear edges. In severe cases, there are one or more blisters or bullae on the spots. The number of erythema varies from one to several, and the distribution is asymmetric. It can occur anywhere, often at the junction of skin and mucosa such as lips and external genitalia, and often causes erosion due to friction. If it recurs, it usually still occurs in the same place, completely or partially overlapping with the pigment spots left by the last time, and it is often enlarged and enlarged compared with the last time. Local skin lesions can be accompanied by itching, and those with extensive skin lesions have different degrees of fever. After erythema subsides, it often leaves bright purple-brown spots, which do not disappear for many years and have diagnostic value. A few purple-free edematous erythema will soon fade away, leaving no trace. Individual cases may be accompanied by erythema multiforme, urticaria or measles.
2. scarlet fever-like erythema? Rash occurs suddenly, often accompanied by chills, fever (above 38℃), headache and general malaise. The rash begins with large and small erythema and develops from the face, neck, trunk, upper limbs to lower limbs. It can spread all over the body in 24 hours, with symmetrical distribution, edema, bright red and fading when pressed. In the future, the rash will increase, expand and merge with each other, which can involve the whole skin, similar to scarlet fever. However, the patients are generally in good condition and have no other manifestations of scarlet fever. The rash developed to * * *, and the redness gradually disappeared, followed by extensive desquamation. After the body temperature, the scales gradually become thinner, and like pityriasis, the skin returns to normal. The whole course of disease does not exceed one month, and there is generally no visceral damage. If the rash is similar to measles, it is called pityriasis rosea-like drug eruption; I am an analogy.
3. Severe erythema multiforme? This is a severe bullous erythema multiforme. In addition to skin damage, the mucous membrane of eyes, mouth and external genitalia is seriously damaged, with obvious chyle and exudation. Often accompanied by chills and high fever. It may also be complicated with bronchitis, pneumonia, pleural effusion and kidney damage. Eye damage can lead to blindness. This type of drug eruption is more common in children. However, it must be pointed out that this syndrome is sometimes not caused by drugs.
4. Bullous epidermal necrolysis drug eruption? This is the first drug eruption we saw in China from 65438 to 0958. It is rare in clinic, but it is quite serious. The onset is urgent, and the rash spreads all over the body within 2 ~ 3 days. At first it was bright red or purplish red spots. Sometimes it starts with erythema multiforme, and then it expands and merges into a large brown-red film. In severe cases, mucosa is involved at the same time, which can be described as a piece of skin. Loose bullae appear in a large area, forming many parallel wrinkles 3 ~ 10 cm long, which can be pushed from one place to another. The epidermis is extremely thin, which can be broken with a little friction, showing obvious acantholysis phenomenon. The whole body is often accompanied by a high fever of about 40℃. In severe cases, stomach, intestine, liver, kidney, heart, brain and other organs may be involved at the same time or successively. I have seen a patient who died of this disease, and the wall of the nasal feeding tube was densely covered with exfoliated mucosa. The course of the disease is self-limited, and the rash usually begins to subside after 2 to 4 weeks. If there are serious complications or serious involvement of some important organs, or due to improper handling, you can die in about 2 weeks.
The total number of white blood cells in blood is more than10×109/l (10000/mm3), neutrophils account for about 80%, and the absolute count of eosinophils is 0 or very low. Pathological anatomy of severe death cases showed: ① Epidermal atrophy was obvious, spinous cells only had 1 ~ 2 layers or even disappeared completely, intercellular and intracellular edema, dermal congestion and edema, peritubular cell infiltration, collagen fiber breakage and pregnancy. Oral mucosal lesions are similar to skin. ② Lymph node enlargement, medullary hyperplasia, endothelial mucosa hyperplasia and cortical follicle atrophy. ③ Liver slices were yellow and red, with congestion and pregnant hepatocytes. Microscopic examination showed severe congestion in the center of the upper lobe of the foot, and the remaining hepatocytes were fatty and free. The boundary between liver parenchyma and manifold is unclear, some hepatocytes are blurred, and some are necrotic, dissolved and absorbed. ④ The renal section was swollen and the capsule was everted. Microscopic examination showed that the blood vessels were congested, the convoluted duct was turbid and swollen, and there was focal infiltration mainly formed by lymphocytes and monocytes in the cortical stroma ⑤ Neurons in the gray matter of the brain show various degeneration, neurons in the occipital lobe show watery degeneration and swelling, and satellite cells are occasionally seen. Focal hyperplasia of basal nucleus and microglia. ⑥ Myocardial interstitial edema, diffuse mild round cell infiltration.
Epidermolysis bullosa drug eruption has many similarities with toxic epidermal necrolysis reported by Lyell( 1956). The latter skin lesions like burns, no blisters, obvious local pain, no obvious damage to internal organs, and frequent recurrence. But some people think they may be the same disease.
(2) Other types of drug eruptions and drug reactions? The reason is not completely clear. There are many kinds, mainly the following:
1. Systemic exfoliative dermatitis? It is one of the more serious drug eruption types, and its severity is second only to epidermolysis bullosa. In the era when corticosteroids were not used, its mortality rate was very high. Because of the large dosage or long course of treatment, this kind of drug eruption may be complicated with certain toxic reactions on the basis of allergic reactions.
This type of drug eruption is not common. According to the incomplete statistics of our department, 909 cases of drug eruption in 1949 ~ 1958 accounted for 2.53%, and 4 cases of drug eruption in1975 accounted for 7.9%. 1983 ~ 1992, 104 cases, 23 cases, accounting for 22%. Because the condition is serious, if you don't save it in time. Will lead to death.
This disease is characterized by a long incubation period, often exceeding 20 to 20 days; The course of the disease is long, usually at least one month. The whole course of disease can be divided into four stages: ① Precursor stage, characterized by transient rash, such as symmetrical erythema confined to chest, abdomen or thigh, conscious itching, or fever, which is a warning symptom. At this time, drug withdrawal can avoid the onset. ② In the eruption stage, it can gradually develop from the face down, or start as an acute attack, and then spread to the whole body quickly or slowly in the form of a rash. * * * When the rash breaks out, the whole body skin is bright red and swollen, and the facial edema is obvious, often accompanied by exudation and scab, accompanied by chills and fever. Some patients may have visceral damage such as liver, kidney and heart. The total number of white blood cells in peripheral blood is mostly increased, generally between15×109 ~ 20×109/l (15000 ~ 20000/mm3). ③ Exfoliation period, which is the characteristic manifestation of the disease. The redness and swelling of the rash began to subside, and then it took the form of scales to large pieces of desquamation. In the morning, you can cover scales with sheets, wear gloves and socks, and fall off repeatedly for one to several months. Hair and nails often fall off at the same time. ④ In the recovery period, the scale-like desquamation becomes chaff-like, and then gradually disappears, and the skin returns to normal. Since the application of glucocorticoid, the course of disease can be significantly shortened and the prognosis can be greatly improved.
2. Short-term antimony dermatitis? This is a mild toxic dermatitis seen in the treatment of schistosomiasis japonica by short-term intravenous injection of potassium antimonate in China in the 1950s. Its characteristics are as follows: ① the prevalence rate is high, generally above 30% ~ 40%, and some can be as high as 60% ~ 70%; ② The incubation period is short, and all patients get sick within 2 ~ 3 days after starting treatment; (3) All the antimony broke out after the dose reached 0.3g; ④ More common in summer; ⑤ The rash is symmetrically distributed on the face, neck, back of hand and finger extension surface, occasionally seen in the chest and abdomen, like prickly heat, dense but not fused, with slight inflammatory reaction, mild itching or burning sensation, and some cases have systemic symptoms such as fever; ⑥ The course of disease is self-limited. Even if the drug is not stopped, the rash will disappear spontaneously within 3 ~ 5 days, accompanied by chaff-like desquamation; ⑦ Re-treatment recurs occasionally. No complications and sequelae were found. Histochemical examination showed that there was no significant difference in antimony content between rash and normal skin (both about 2.5μg/dl). Histopathology is similar to contact dermatitis and has no specificity.
3.*** Proliferative? It is mostly caused by long-term use of levo-iodine and bromide. The incubation period is usually about one month. We have seen two cases of mushroom-like proliferative granuloma, about 3 ~ 4 cm in diameter, which are scattered irregularly on the basis of erythema-like drug eruption all over the body and feel quite firm, mainly occurring in the trunk. After symptomatic treatment, it gradually subsided in about 3 weeks.
4. Lupus erythematosus-like reaction? Since the discovery that hydralazine can cause lupus erythematosus-like reactions in the early 1960s, more than 50 drugs such as penicillin, procainamide, isoniazid, p-aminosalicylic acid, phenylbutazone, methylthiouracil, reserpine, metronidazole and oral contraceptives have been known to cause such reactions. The main clinical manifestations are joint pain, myalgia, multiple serositis, pulmonary symptoms, fever, lymphadenopathy of liver and spleen, cyanosis of limbs and rash. The difference between this disease and real lupus erythematosus is that it is caused by fever, tubular urine, hematuria and azo. After the symptoms disappear, the laboratory positive can last for months or even years.
5. Fungal reaction? Due to the application of a large number of antibiotics, corticosteroids and immunosuppressants, the environmental balance in the body is often disturbed, the flora is out of balance, and fungal case reactions are produced, which are manifested as candida albicans, Aspergillus or dermatophytes infection. The first two may have gastrointestinal tract, lung or other visceral infections, or may involve multiple organs at the same time. It is not uncommon to find serious systemic fungal infection in autopsy before the death of immunosuppressants. It is worth noting that some patients with dermatophytosis, due to the application of the above drugs, make the pathological range of dermatophytosis more extensive, and it is not easy to treat, even if cured, it is easy to relapse, which makes it difficult to prevent and treat tinea.
6. Corticosteroid type reaction? If the hormone is used in large doses for a long time, it will often cause a variety of adverse reactions and even lead to death. The main side effects are: ① secondary bacterial or fungal infection: the most common; ② Gastrointestinal tract: "steroid ulcer", even complicated with bleeding and perforation; ③ Central nervous system: euphoria, excitement, dizziness, headache, insomnia, etc. ④ Cardiovascular system: palpitation, hypertension, thrombosis, arrhythmia, etc. ⑤ Endocrine system: Cushing's syndrome, osteoporosis, diabetes, cortical hypofunction and growth inhibition of children; ⑥ Skin: acne, hirsutism, telangiectasia, ecchymosis, skin atrophy, etc. ⑦ Eyes: blurred vision, elevated intraocular pressure, cataract and glaucoma.
In recent years, with the emergence of a large number of new drugs, the concept of "new drug eruption" was put forward in the 1980 s, which made people have a further understanding of drug reactions. Almost all new drugs will cause various drug reactions. There are many kinds of β -lactam antibiotics, and all kinds of cephalosporins and penicillins can cause macula or macula. Cytotoxic drugs can cause alopecia, urticaria, toxic green skin necrosis, photosensitive dermatitis and stomatitis. There are many kinds of new anti-rheumatic drugs, which can cause photosensitive dermatitis, urticaria, purpura, maculopapular rash, stomatitis and so on. Rifampicin, D- chloramphenicol and captopril can cause maculopapular rash, urticaria and erythematous pemphigus (deciduous type). Long-term use of beta blockers, such as oxprenolol, oxynolol, proproanolol, etc., may lead to psoriasis-like rash, and some patients may be accompanied by hyperkeratosis of palms and soles, eczema, lichenoid rash and other types of hirsutism, which may also reverse male hair loss and may also cause StevensJohnson syndrome.
10 prevention because of the high incidence of drug reactions, great harm, and serious cases can lead to death, it is of great significance to pay attention to prevention. If doctors don't give drugs casually and patients don't abuse drugs, drug reactions can be greatly reduced.
1. Make a definite diagnosis before taking the medicine, and don't besiege with multiple drugs before the condition is unclear, thinking that there will always be one drug that will have an effect and easily lead to unnecessary drug reactions.
2. The ingredients, properties, indications, contraindications, side effects and compatibility contraindications of the drugs used should be thoroughly familiar with and mastered to avoid abuse, misuse or multi-purpose of one drug.
3. Before taking the medicine, the patient should be asked in detail whether he has a history of drug allergy, especially those with allergies. For those who have had drug allergic reactions, attention should be paid to the occurrence of cross-sensitivity or multi-source barnyard grass allergic reactions.
4. Medication should be planned, the dosage should not be too large, the variety should not be too much, the time should not be too long, and regular observation should be made, especially the use of drugs with certain toxicity, such as immunosuppressants and anticancer drugs. , should be closely observed, and should always check the blood picture.
5. When some organs have dysfunction, they are often intolerant of some drugs. For example, patients with kidney disease need to use heavy metal drugs with caution.
6. During medication, attention should be paid to some warning symptoms or intolerance, such as itchy skin, erythema or fever. Once it appears, consider stopping the drug immediately.
7. Anyone who has had allergic reactions to drugs should be issued with a drug taboo card, indicating the name and reaction type of allergic drugs for reference during the follow-up visit.
8. The national pharmaceutical administrative department must strengthen drug management. Before drugs are put on the market, they must undergo strict inspection to ensure the quality of drugs.
Acupoint Yang-flushing combined with Gu, Xue Hai and Sanyinjiao has the function of strengthening the body resistance and detoxifying, and is mainly used for the drug reaction of Hibernating Ling. Literature review: classic acupuncture A and B: exogenous heat of typhoid fever, flexion. ...
Ear point system therapy. It can be used for acupuncture, electroacupuncture, drug injection or resection, and acupuncture anesthesia. Clinical operation, with ears. ...
Side by side time. Frequent moxibustion at this acupoint can prevent influenza. In summer, direct moxibustion or drug smearing on Shu Fei can enhance human immunity. Compatibility of Shouwaishu points: Shu Fei ...
It is compatible with Gu, Shu and Sanyinjiao, and has the function of strengthening the body resistance and detoxifying. It is mainly used to treat the drug reaction of Hibernating Ling. Literature review: classic acupuncture A and B: exogenous heat of typhoid fever, flexion. ...
Ghost leg
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