Certified Wound Care Nurse (CWCN) Practice Exam

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What is the most commonly implicated medication in patients with Toxic Epidermal Necrolysis?

Ciprofloxacin
Allopurinol
Ibuprofen
Penicillin

The correct answer is: Allopurinol

Toxic Epidermal Necrolysis (TEN) is a severe skin condition characterized by widespread detachment of the epidermis and mucosal surfaces. One of the critical aspects of managing TEN is recognizing potential drug triggers that can lead to this serious adverse reaction. Allopurinol, a medication commonly used to treat gout and certain types of kidney stones, is well-documented as one of the most implicated medications in causing Toxic Epidermal Necrolysis. This association has been supported by numerous case studies and pharmacovigilance reports, indicating that allopurinol can provoke a hypersensitivity reaction, leading to the severe skin damage seen in TEN. In contrast, while the other medications listed, such as ciprofloxacin, ibuprofen, and penicillin, can also cause adverse drug reactions, they are not as strongly associated with TEN compared to allopurinol. This delineation is essential for clinicians to keep in mind when reviewing a patient's medication history and considering the potential risks of drug reactions. Recognizing allopurinol as a significant offender helps guide practitioners in both identifying at-risk patients and taking appropriate measures to avoid prescribing it to individuals with a history of drug reactions or in cases where the risk of developing TEN is heightened.