Pharmacology Seizure meds #5

Question

A patient takes lamotrigine for seizure control and comes to the clinic reporting muscle pain and fatigue. The nurse should complete a focused assessment on which of the following priority findings that are present in Steven Johnson Syndrome (SLS)? Select all that apply.

Answers

  1. Reports of muscle pain
    • Rationale:

      This answer is correct because muscle pain is associated with Steven Johnson Syndrome (SJS). Additional symptoms include blisters on the neck and face, peeling skin, red-purple spots, fatigue, fever, sun sensitivity, sore throat, cough, itching, and dizziness. These symptoms should be reported immediately especially when taking medications associated with SJS because this condition is a medical emergency, with severe, life-threatening consequences. Treatment must be immediate and the condition may be fatal.

  2. Dizziness
    • Rationale:

      This answer is correct because dizziness is associated with Steven Johnson Syndrome (SJS). Additional symptoms include blisters on the neck and face, peeling skin, red-purple spots, fatigue, fever, sun sensitivity, sore throat, cough, muscle pain, and itching. These symptoms should be reported immediately, especially when taking medications associated with SJS because this condition is a medical emergency, with severe, life-threatening consequences.

  3. Splinter hemorrhages
    • Rationale:

      This answer is not correct because splinter hemorrhages are most related to underlying conditions of bacterial endocarditis, rheumatoid arthritis, malignancies, lupus, and diabetes. These dark red-brown lines seen in the nail groove do not usually cause pain but are not related to SJS.

  4. Blisters on neck and face
    • Rationale:

      This answer is correct because dizziness is associated with Steven Johnson Syndrome (SJS). Additional symptoms include blisters on the neck and face, peeling skin, red-purple spots, fatigue, fever, sun sensitivity, sore throat, cough, muscle pain, and itching. These symptoms should be reported immediately, especially when taking medications associated with SJS because this condition is a medical emergency, with severe, life-threatening consequences.

  5. Loss of taste
    • Rationale:

      This answer is incorrect. Upper respiratory illness may alter taste, but loss of taste is not a symptom of SJS.

Overview

Steven Johnson Syndrome (SJS) is a side effect of lamotrigine, an anti-seizure medication. SLS symptoms include reports of muscle pain, dizziness, and blisters on the neck and face.

Explanation

Steven Johnson syndrome (SLS) may present with muscular pain, and lesions on mucous membranes, and blisters on neck and face. Mucotaneous lesions may occur anywhere on the body including the palms of hands and soles of felt. Fever and fatigue occur; however, dizziness is not a specific characteristic that determines SLS. SLS is an inflammatory condition classified as an immune-complex-mediated hypersensitivity that is a variant of bullous erythema multiforme. A common cause is adverse reactions to drugs. Treatment must be immediate and the condition may be fatal.

Learning Outcomes

Steven Johnson Syndrome (SJS) is a serious, yet rare, skin and mucous membrane disorder which is commonly associated with an infection or medication reaction. SJS is an inflammatory condition classified as an immune-complex-mediated hypersensitivity that is a variant of bullous erythema multiforme. Symptoms include: 

  • Skin symptoms: blisters on the neck and face, peeling skin, red-purple spots
  • Whole body symptoms: fatigue, fever, muscle pain
  • Other: sun sensitivity, sore throat, cough, itching, dizziness

These symptoms should be reported immediately because SJS is a medical emergency, with severe, life-threatening consequences.

Test Taking Tip

Remember, just because something is rare, it does not mean it is insignificant. Research highly tested conditions and often rare, but life-threatening or highly unusual conditions or symptoms can surprisingly make “the list” of highly tested subjects.

Video Rationale