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Autonomic Pharm > Toxins and Drug reactions > Flashcards

Toxins and Drug reactions Flashcards

1
Q

Tetrodotoxin

A

Source: pufferfish
Action: highly potent, binds fast VG-Na+ channels in cardiac/nerve tissue (prevent depolarization)
Symptoms: nausea, diarrhea, paresthesias, weakness, dizziness, loss of reflexes
Tx: supportive

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2
Q

Ciguatoxin

A

Source: reef fish (barracuda, snapper, moray eel)
Action: opens Na+ channels (depolarization)
Symptoms: nausea, diarrhea, perioral numbness, hot and cold reversal, bradycardia, heart block, hypotension
Tx: supportive

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3
Q

Histamine (scombroid poisoning)

A

Source: spoiled dark-meat fish (tuna, mahi-mahi, mackerel, bonito)
Action: bacterial histadine carboxylase converts histadine to histamine
*Frequently misdiagnosed as fish allergy
Symptoms: mimics anaphylaxis–acute burning of mouth, flushing of face, erythema, urticaria, itching (may progress to bronchospasm, angioedema, hypotension)
Tx: antihistamines, albuterol/epinephrine if needed

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4
Q

Beers criteria

A

> 50 meds that should be avoided in elderly

  • anticholinergics, antihistamines, antidepressants, benzos, opioids = increased risk of delirium, sedation, falls, constipation, urinary retention
  • A-blocks = increased risk of hypotension
  • PPIs = increased risk of C. Diff
  • NSAIDs = increased risk of GI bleeding
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5
Q

Acetaminophen tx

A

N-acetylcysteine (replenishes glutathione)

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6
Q

AChE inhibitors, organophosphate tx

A

Atropine > pralidoxime

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7
Q

Antimuscarinic/anticholinergic tx

A

Physostigmine

Control hyperthermia

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8
Q

Arsenic tx

A

Dimercaprol

Succimer

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9
Q

Benzo tx

A

Flumazenil

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10
Q

B-block tx

A

Atropine

Glucagon (increase fat and glucose)

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11
Q

CO tx

A

100% o2

Hyperbaric o2

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12
Q

Copper tx

A

Penicillamine

Trientine

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13
Q

Cyanide tx

A

Nitrite + thiosulfate

Hydroxocobalamin

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14
Q

Digitalis (digoxin) tx

A

Anti-dig Fab fragments

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15
Q

Heparin tx

A

Protamine sulfate

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16
Q

Iron tx

A

Deferoxamine
Deferasirox
Deferiprone

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17
Q

Lead tx

A

EDTA
Dimercaprol (like arsenic)
Succimer (like arsenic)
Penicillamine (like copper)

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18
Q

Mercury tx

A

Dimercaprol
Succimer
(Like arsenic, lead)

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19
Q

Methanol, ethylene glycol (antifreeze) tx

A

Fomepizole > ethanol

Dialysis

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20
Q

Methemoglobin tx

A

Methylene blue

Vitamin C

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21
Q

Opioids tx

A

Naloxone

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22
Q

Salicylates tx

A

NaHCO3 (alkalinize urine)

Dialysis

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23
Q

TCAs tx

A

NaHCO3

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24
Q

Warfarin tx

A 
Vitamin K (delayed effect)
FFP (immediate)
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25
Q

Cause coronary vasospasm

A

Amphetamines
Cocaine
Ergot alkaloids
Sumatriptan

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26
Q

Cause cutaneous flushing

A 
Vancomycin
Adenosine
Niacin
Nitrates
CCBs
Echinocandins
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27
Q

Cause dilated cardiomyopathy

A

Anthracyclines (doxorubicin, daunorubicin)

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28
Q

Cause torsades de pointes

A 
Antiarrhythmics
Antibiotics (macrolides)
Antipsychotics (haloperidol)
Antidepressants (TCAs)
Antiemetics (ondansetron)
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29
Q

Cause adrenocortical insufficiency

A

HPA suppression secondary to glucocorticoid withdrawal

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30
Q

Cause DI

A

Lithium

Demeclocycline

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31
Q

Cause hot flashes

A

Tamoxifen

Clomiphene

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32
Q

Cause hyperglycemia

A 
Tacrolimus 
Protease inhibitors
Niacin
HCTZ
Corticosteroids
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33
Q

Cause hypothyroidism

A

Lithium
Amiodarone
Sulfonamides

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34
Q

Cause SIADH

A

Carbamazepine
Cyclophosphamide
SSRIs

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35
Q

Cause acute cholestatic hepatitis, jaundice

A

Erythromycin

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36
Q

Cause diarrhea

A 
Acamprosate
Acarbose
Cholinesterase inhibitors
Colchicine
Erythromycin
Ezetimibe
Metformin
Misoprostol
Orlistat
Pramlintide
Quinidine
SSRIs
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37
Q

Cause focal to massive hepatic necrosis

A

Halothane
Amanita phalloides
Valproic acid
Acetaminophen

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38
Q

Cause hepatitis

A 
Rifampin
Isoniazid
Pyrazinamide
Statins
Fibrates
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39
Q

Cause pancreatitis

A 
Didanosine
Corticosteroids
Alcohol
Valproic acid
Azathioprine
Diuretics (furosemide, HCTZ)
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40
Q

Cause pill-induced esophagitis

A 
Bisphosphonates
Ferrous sulfate
NSAIDs
Potassium chloride
Tetracyclines
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41
Q

Cause pseudomembranous colitis

A

Ampicillin
Cephalosporin
Clindamycin
Fluoroquinolones

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42
Q

Cause agranulocytosis

A 
Clozapine
Carbamazepine
PTU
Methimazole
Colchicine
Ganciclovir
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43
Q

Cause aplastic anemia

A 
Carbamazepine
Methimazole
NSAIDs
Benzene
Chloramphenicol
PTU
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44
Q

Cause direct Coombs, positive hemolytic anemia

A

Methyldopa

Penicillin

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45
Q

Cause DRESS (drug rxn with eosinophilia and systemic symptoms)

A

Allopurinol
Anticonvulsants
Antibiotics
Sulfa drugs

  • potentially fatal delayed hypersensitivity rxn. Latency period (2-8 weeks) followed by: fever, morbilliform skin rash, frequent multi organ involvement
  • Tx: withdrawal of agent, corticosteroids
46
Q

Cause gray baby syndrome

A

Chloramphenicol

47
Q

Cause G6PD hemolysis

A 
Isoniazid
Sulfonamides
Dapsone
Primaquine
Aspirin
Ibuprofen
Nitrofurantoin
48
Q

Cause megaloblastic anemia

A

Hydroxyurea
Phenytoin
Methotrexate
Sulfa drugs

49
Q

Cause thrombocytopenia

A

Heparin

50
Q

Cause thrombotic complications

A

OCPs, hormone replacement, SERMs

51
Q

Cause fat redistribution

A

Protease inhibitors

Glucocorticoids

52
Q

Cause gingival hyperplasia

A

Phenytoin
CCB
Cyclosporine

53
Q

Cause hyperuricemia

A 
Pyrazinamide
Thiazides
Furosemide
Niacin
Cyclosporine
54
Q

Cause myopathy

A 
Statins
Fibrates
Niacin
Colchicine
Daptomycin
Hydroxychloroquine
Interferon-alpha
Penicillamine
Glucocorticoids
55
Q

Cause osteoporosis

A 
Corticosteroids
Depot medroxyprogesterone
GnRH agonists
Aromatase inhibitors
Anticonvulsants
Heparin
56
Q

Cause photosensitivity

A

Tetracyclines
Sulfonamides
Amiodarone
5-FU

57
Q

Cause Stevens-Johnson syndrome

A

Anti-epileptic drugs (esp. lamotrigine)
Allopurinol
Sulfa drugs
Penicillin

58
Q

Cause SLE-like syndrome

A 
Sulfa drugs
Hydralazine
Isoniazid
Procainamide
Phenytoin
Etanercept
59
Q

Cause teeth discoloration

A

Tetracyclines

60
Q

Cause tendonitis/rupture/cartilage damage

A

Fluoroquinolones

61
Q

Cause cinchonism

A

Quinidine
Quinine

-Tinnitus, hearing/vision loss, psychosis, cognitive impairment

62
Q

Cause Parkinson-like syndrome

A

Antipsychotics
Reserpine
Metoclopramide

63
Q

Cause seizures

A 
Isoniazid (vitamin B6 deficiency)
Bupropion
Imipenem/cilastatin
Trauma doll
Enflurane
64
Q

Cause tardive dyskinesia

A

Antipsychotics

Metoclopramide

65
Q

Cause Fanconi syndrome

A

Cisplatin
Ifosfamide
Expired tetracyclines
Tenofovir

66
Q

Cause hemorrhagic cystitis

A

Cyclophosphamide

Ifosfamide

67
Q

Cause interstitial nephritis

A 
Penicillins
Furosemide
NSAIDs
PPI
Sulfa drugs
68
Q

Cause pulmonary fibrosis

A 
Methotrexate
Nitrofurantoin
Carmustine
Bleomycin
Busulfan
Amiodarone
69
Q

Cause antimuscarinic effects

A

Atropine
TCAs
H1-blockers
Antipsychotics

70
Q

Cause disulfiram-like reactions

A 
1st-generation sulfonylureas
Procarbazine
Certain cephalosporins
Griseofulvin
Metronidazole
71
Q

Cause nephrotoxicity/ototoxicity

A 
Aminoglycosides
Vancomycin
Loop diuretics
Cisplatin
Amphotericin B
72
Q

Sulfa drugs

A 
Sulfonamide antibiotics
Sulfasalazine
Probenecid
Furosemide
Acetazolamide
Celecoxib
Thiazides
Sulfonylureas

-Allergies = fever, UTI, Steven-Johnson syndrome, hemolytic anemia, thrombocytopenia, agranulocytosis, acute interstitial nephritis, urticaria

73
Q

Cytochrome P450 inducers

A

-Increase metabolism = decreased drug

Chronic alcohol use
St. John's wort
Phenytoin
Phenobarbital
Nevirapine
Rifampin
Griseofulvin
Carbamazepine
74
Q

Cytochrome P450 substrates

A

Anti-epileptics
Theophylline
Warfarin
OCPs

75
Q

Cytochrome P450 inhibitors

A

-Decrease metabolism = increased drug

Sodium valproate
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Acute alcohol abuse
Chloramphenicol
Erythromycin (macrolides)
Sulfonamides
Ciprofloxacin
Omeprazole
Metronidazole
76
Q

-azole

A

Ergosterol synthesis inhibitor

77
Q

-bendazole

A

Antiparasitic/antihelminthic

78
Q

-cillin

A

Transpeptidase (penicillin-binding protein)

79
Q

-cycline

A

Protein synthesis inhibitor

80
Q

-ivir

A

Neuraminidase inhibitor

81
Q

-navir

A

Protease inhibitor

82
Q

-ovir

A

DNA polymerase inhibitor

83
Q

-thromycin

A

Macrolide antibiotic

84
Q

-ane

A

Inhaled general anesthetic

85
Q

-azine

A

Typical antipsychotic

86
Q

-barbital

A

Barbiturate

87
Q

-caine

A

Local anesthetic

88
Q

-etine

A

SSRI

89
Q

-ipramine -triptyline

A

TCA

90
Q

-triptan

A

5-HT agonist

91
Q

-zepam-zolam

A

Benzodiazepine

92
Q

-chol

A

Cholinergic agonist

93
Q

-curium -curonium

A

Nondepolarizing paralytic

94
Q

-olol

A

BB

95
Q

-stigmine

A

AChE inhibitor

96
Q

-terol

A

B2 agonist

97
Q

-zosin

A

Alpha1 antagonist

98
Q

-afil

A

PDE5 inhibitor

99
Q

-dipine

A

Dihydropyridine CCB

100
Q

-pril

A

ACE inhibitor

101
Q

-sartan

A

Angiotensin 2 receptor blocker

102
Q

-statin

A

HMG-CoA reductase inhibitor

103
Q

-xaban

A

Direct factor Xa inhibitor

104
Q

-dronate

A

Bisphosphonate

105
Q

-glitazone

A

PPAR-gamma activator

106
Q

-prazole

A

PPI

107
Q

-prost

A

Prostaglandin analog

108
Q

-tidine

A

H2-antagonist

109
Q

-tinib

A

Tyrosine kinase inhibitor

110
Q

-tropin

A

Pituitary hormone

111
Q

-ximab

A

Chimeric monoclonal Ab

112
Q

-zumab

A

Humanize monoclonal Ab

Autonomic Pharm (4 decks)

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