Which of the following drugs is associated with the reaction of Stevens-Johnson syndrome?

Appeared in: SJH Nursing Officer - 2019

Explanation

Carbamazepine (CBZ) is an anticonvulsant medication strongly associated with severe cutaneous adverse reactions (SCARs), including Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN).
The reaction is a delayed-type (Type IV) hypersensitivity response.
There is a significant genetic predisposition linked to the HLA-B*1502 allele, particularly in individuals of Asian descent, making screening crucial in these populations before initiating therapy.
SJS is a medical emergency characterized by fever, a painful rash, and mucosal involvement, which can progress to skin detachment.

Why Other Options Were Wrong

Option B: Quinidine is not primarily associated with SJS. Its classic toxicity is cinchonism.
Option C: Isoniazid's main adverse effects are hepatotoxicity and peripheral neuropathy.
Option D: Procainamide is classically associated with Drug-Induced Lupus Erythematosus (DILE), not SJS.

Related Visual

Clinical Relevance

Nursing practice connection: Knowing Adverse drug reactions, specifically Stevens-Johnson Syndrome (SJS) helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Recognizing SJS is a critical nursing responsibility. Early signs include non-specific flu-like symptoms followed by a painful rash. Immediate reporting is essential.
The cornerstone of management for SJS/TEN is the immediate withdrawal of the suspected causative agent. This single action is the most important factor in improving prognosis.
Patient education is vital. Nurses must teach patients starting high-risk drugs like carbamazepine to seek immediate medical attention if they develop any rash, blisters, or sores in the mouth.

How to Approach the Question

First, identify the key concept in the question stem: 'Stevens-Johnson syndrome'.
This is a factual recall question from pharmacology, requiring knowledge of specific, severe adverse drug reactions.
Systematically review each option, recalling the most common and serious side effects associated with it.
For CBZ (Carbamazepine), recall its strong association with SJS/TEN, a well-documented and frequently tested fact.
For the other options (Quinidine, Isoniazid, Procainamide), recall their own classic toxicities (cinchonism, hepatotoxicity/neuropathy, and drug-induced lupus, respectively) to confirm they are incorrect.
Select the drug with the strongest and most established link to SJS.

Concept Tested & Keywords

Concept Tested: Adverse drug reactions, specifically Stevens-Johnson Syndrome (SJS).
Stem keywords: drugs, reaction, Stevens-Johnson syndrome
Lead-in keywords: Which
Negative lead-in flag: false

Question ID

QGhdab3f_cRrM9V657IptI

Reference Book

E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) pp. 7899-7901, 10679-10681

E6 Pharmacology Nursing Lilley 11e Part 2 p. 92-94

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