Adverse Drug Reactions Flashcards
(130 cards)
1
Q
What SERIOUS ADRs are associated with Triptans?
A
Coronary artery Vasospasm Transient MI MI Ventricular Tachycardia/Fibrillation HTN
2
Q
What are more COMMON ADRs associated with Triptan use?
A
Paresthesias Fatigue Flushing Chest Tightness Swelling
3
Q
What is St. Anthony’s Fire?
What class of HA treatment medications is it associated with?
A
Associated with Ergotamines
Sx include...... Headache Emesis Diarrhea Gangrene
4
Q
Why is life-threatening ischemia associated with erogtamines?
A
When administered with CYP3A4 inhibitors (such as macrolides) it increases ergot levels leading to an increased risk of ischemia
5
Q
What COMMON ADRs are associated with ergotamines?
A
Nausea Emesis Abdominal Pain Weakness Parethesias Myalgia Diarrhea Chest Tightness
6
Q
Does Butorphanol have addictive properties?
A
Yes
7
Q
What COMMON ADRs are associate with Butorphanol?
Remember: This is a partial opioid agonist
A
Somnolence Dizziness Nausea Emesis Nasal Congestion Insomnia Respiratory Depression
8
Q
What COMMON ADRs are associated with Fiorinal/Fioricet?
A
Nausea
Drowsiness
Dizziness
Abdominal Pain
9
Q
If Fiorinal or Fioricet are overused (more than 2x weekly) what an occur?
A
Rebound-Headache from withdrawal
10
Q
What ADRs are seen with IV metoclorpamide use for headache treatment?
A
Akathisia
Drowsiness
11
Q
Why should you use PA-free formulations of butterbur?
A
Because the PA forms are associated with Hepatoxicity
12
Q
What psychiatric warnings are associated with interferon beta?
A
Depression
Suicidal Ideation
13
Q
What organotoxicity is associated with Interferon Beta?
A
Hepatotoxicity
14
Q
Is CHF a potential warning of interferon beta?
A
Yes
15
Q
What COMMON ADRs are seen with interferon Beta?
A
Flu-like Symptoms (Fever, mayalgia)
Insomina
Injection Site Reaction
Edema
16
Q
Can you see HTN with Interferon Beta?
A
Yes
17
Q
What can be given prior to injection of Interferon Beta to prevent the flu-like reaction?
A
Acetaminophen/Ibuprofen
30 minutes prior
18
Q
What post-injection reactions are seen in Glutiramer Acetate?
A
Flushing Chest Pain Palpitations Anxiety Urticaria Throat Constriction
19
Q
Can a patient undergoing Glatiramer Acetate injections for MS treatment have Lipoatrophy or skin necrosis at the injection site?
A
Yes
20
Q
What organotoxicity is associated with Mitoxantrone?
What should be done to monitor this?
A
Cardiotoxicity
Need Baseline LVeF
Repeat before each dose
21
Q
What can be seen when Mitoxantrone is used for leukemia?
A
Myelosuppression
22
Q
T/F: Secondary AML is seen with Mitoxantrone use
A
True
23
Q
What are COMMON ADRs seen with Mitoxantrone?
A
Nausea
Alopecia
Menstrual Changes
UTI / URI
24
Q
An MS patient presents complaining of a her urine now appearing a “blue-green” color…..
What medication is likely the culprit?
A
Mitoxantrone
25
Progressive Multifocal Leukoencephalopathy is associated with what MS medication?
Natalizumab
26
Would you expect to see leukopenia or leukocytosis with Dimethyl Fumarate?
Leukopenia
27
What ADRs are associated with Dimethyl Fumarate?
Flushing, Redness (Due to it's metabolite)
Rash
N/V/D
Abdominal Pain
28
What organotoxicity is NEWLY associated with Dimethyl Fumarate?
Hepatotoxicity
Normalizes after stopping medication
29
First-dose bradycardia is associated with what MS medication?
Fingolimod
EKG prior to dosing and monitor 6 hours after dose
30
Varicella Zoster is associated with what MS medication?
Fingolimod
31
Is Fingolimod associated with increased or decreased mortality?
Increased
32
What COMMON ADRs are associated with Fingolimod?
```
Headache
Influenza
Diarrhea
Back Pain
Abnormal LFTs
Cough
```
33
Is Teriflunomide teratogenic?
Yes
34
What organotoxicitiy is associated with teriflunomide?
Hepatotoxicity
35
Other than hepatotoxicity and teratogenicity, what serious ADRs are associated with Teriflunomide?
Neuropathy
Bone MArrow Supressions
Hyperkalemia
Transient Renal Failure
36
What ADRs are associated with Dantrolene?
Drowsiness
Dizziness
Malaise
Diarrhea
37
What ADRs are associated with Nudexta?
N/V/D
| Cough
38
What lab needs to be monitored in patients on Levodopa?
LFTs
39
What ADR is seen commonly in patients who are on Levodopa long-term?
Dyskinesia (Choreiform Movements)
40
What is the "on-off" effect of Levodopa?
What medication class is used to "smooth" this out?
Off - Akinesia
On - Dyskinesia
This is due to fluctuations in Levodopa concentrations
Dopamine Receptor Agonist
41
What ADRs are associated with Levodopa?
Nausea
Anorexia Hypotension
Confusion
Insomnia
42
What psychiatric like syndrome is associated with Levodopa?
Schizophrenic-like syndrome
43
What ADRs are associated with Dopamine Receptor agonists?
```
Anoreaxia
hypotension
Nausea
Emesis
Hallucinations
Sedation
```
44
Are cardiac arrhythmias a possible ADR of dopamine receptor agonists?
Yes
45
When Ergot DRA (Bromocriptine, Cabergoline) are used at Parkinson's doses, what is a potiental ADR?
Cardiovulvopathy
46
Which Non-Ergot DRA is associated with sudden somnolence?
Rotigotine (Transdermal)
Patients on this should not drive
47
What may occur if metoclopramide is given with a DRA or Levodopa?
This makes it hard to distinguish what?
Tardive Dyskinesia
In Parkinson's patients this would make it hard to distinguish if this was a side effect of metoclopramida or worsening Parkinson's
48
If Selegiline or Rasagiline where given to a cocaine abuser, what may occur?
Fatal Hyperthermia
49
Selegiline blocks MAO-A at high doses.....
What ADR may be seen if this occurs?
HTN Crisis
50
What potential organtoxicity is seen in patients on Talcapone?
Hepatootoxicity
51
A Parkinson's patients presents complaining of an orange discoloration to his urine.....
What class of medication is likely the culprit?
COMT Inhibitors
Talcapone
Entacapone
52
What COMMON ADRs are associated with COMT inhibitors?
Diarrhea
Abdominal Pain
Orthostatic Hypotension
Sleep Disturbance
53
What ADRs are associated with Amantadine?
CNS (Restlessness, Depression, Insomnia, Agitation, Hallucinations, Seizures)
54
What dose of Amantadine is potentially fatal?
1 gram
55
What ADRs are associated with Trihexyphenidyl and Benzotrpine?
```
Dry Mouth
Lack of Diaphoresis
Urinary Retention
Constipation
Drowsiness
Confusion
```
56
What ADRs are associated with Pimavanserin?
```
Peripheral Edema
Nausea
Confusion
Hallucinations
Constipation
Gait Changes
```
57
What ADRs are associated with Safinamide?
Dyskinesia
Falls
Nausea
58
T/F: Retinopathy is associated with Safinamide
True
59
Is a patient on Safinamide more likely to experience hypotension or hypertension?
HTN
60
What ADRs are common amongst all Cholinesterase Inhibitors?
N/V/D
61
Which Cholinesterase Inhibitor is associated with muscle cramps?
Donepezil
62
Which Cholinesterase Inhibitors are associated with weight loss?
Rivastigmine
| Galantamine
63
T/F: Rivastigmine is associated with Hepatotoxicity
False
64
What ADRs are associated with Memantine?
```
Agitation
Diarrhea
Insomnia
Dizziness
Headache
Hallucinations
```
65
Overdose of Pyridostigmine is associated with what crisis?
How is this tested?
How would this crisis be treated?
Cholinergic Crisis
Tesilon Test (Endrophonium)
If Weakness worsens = Cholinergic Crisis which is treated with atropine
If weakness improves = Myasthenia Crisis
66
What COMMON ADRs are seen with pyridostigmine?
```
Rash
N/V/D
Increased Salivation
Increased Bronchial Secretion
Miosis
Diaphoresis
```
67
Riluzole can show an elevated in what lab value?
LFTs
68
What are pulmonary side effects of Riluzole?
Decreased lung function
| PNA
69
T/F: Vertigo is an associated ADR with Riluzole
True
70
What ADRs are associated with Edaravone?
Anaphlyaxis
Bruising
Gait Disturbance
71
What psychiatric ADRs are seen with tetrabenazine?
Depression
| SI
72
What is the MAXIMUM DAILY DOSE of Acetaminophen for adults?
Pediatrics (< 12 y.o.)
Adults: 4 grams daily
Peds: 5 doses of 50/75 mgs/kg
73
T/F: Acetaminophen is the leading cause of liver failure in the USA
True
74
At what dose does acetaminophen become hepatotoxic?
Fatal?
Hepatotoxic: 10 - 15 grams
Fatal: >20 g
75
P450 2E1 _______ (inducers/inhibitors) may result in acetaminophen toxicity.
Inducers
76
Consuming what in combination with acetaminophen could lead to toxicity?
Alcohol
77
Acetaminophen toxicity leads to metabolism of what toxic metabolite?
NAPQI
78
Acetaminophen has the potential to be toxic to which organs?
Liver
Renal (ATN)
Heart
Pancreas
79
```
Nausea
Emesis
Acidosis
AMS
Elevated PT/INR
```
..... Are all Sx of what?
Acetaminophen OD
80
Asymptomatic
Normal LFTs
No Liver Injury
......Is what stage of acetaminophen OD?
Stage 1
81
```
72-96 Hours
Hepatic Failure
Encephalopathy
AST/ALT > 10,000
Potentially Fatal Stage
```
......Is what stage of acetaminophen OD?
Stage 3
82
24-36 Hours
AST > 1,000
RUQ Pain / Hepatomegaly
Increase PT, BUN, sCr
......Is what stage of acetaminophen OD?
Stage 2
83
What stage of acetaminophen OD is considered recovery?
Stage 4
84
What side effects are associated with N-acetylcysteine, especially the IV administration?
```
Anaphylaxis:
Urticaria
Flushing
N/V
Bronchospasms (Potetially Fatal)
```
85
Why are NSAIDs associated with renal ischemia?
In what conditions does this risk increase?
Because they inhibit prostaglandins which help to maintain renal blood flow
CHF
CKD
Cirrhosis
86
Why should NSAIDs be avoided in the 3rd trimester of pregnancy?
May prematurely close PDA
87
What ADRs are COMMONLY associated with NSAIDs?
```
Nausea
Dyspepsia
Abdominal Pain
Flatulence
Diarrhea
```
88
What GI risks are associated with NSAID use?
What are examples of medications that can be used to reduced this risk?
Peptic Ulcers
GI Bleeding
Naproxen/Esomeprozole
Ibuprofen/Famotidine
ASA/Omeprazole
Mistoprostol
89
What is the MOST COMMON ADR associated with Mistoprostol?
What are additional ADRs?
DIARRHEA
Nausea
Abdominal Pain
90
Why is Mistorporstol Pregnancy Category X?
Abortifacient Effect
| Teratogenicity
91
Should NSAIDs be used for pain control following cardiac surgery?
No
92
What renal effects can be seen in patients using NSAIDs?
What patients at at increased risk for these?
Renal Insufficiency
Hyperkalemia
Renal Papillary Necrosis
CHF
CKD
Elderly
Medications (Diuretics, ACEi, Cyclosporine)
93
What class of ABx should be avoided with NSAIDs due to increase renal risks?
Aminoglycosides
94
How is an ASA OD treated?
Sodium Bicarbonate
95
Which NSAID has....
1. Increased risk of cardiac events
2. Increased liver toxicity
3. More likely to have GI toxicity
Diclofenac
96
If a patient is chronically using Piroxicam, what type of exam should be preformed periodically?
What labs?
Eye Exams
CBC
Renal Function
hepatic Function
97
Do you need to dose adjust Celcoxib in patients with renal impairment?
Hepatic Impairment?
Renal: No
Hepatic:
Decrease by 50%
98
What ADRs are commonly associated with Opioids?
```
Sedation
Lethargy
Respiratory Depression
Nausea
Emesis
Pruritis
Urticaria
Bronchospams
```
99
What is the TRIAD of opioid OD?
What is the antidote?
1. Miosis
2. LOC
3. Respiratory Depression
Antidote: Naloone (Narcan)
100
Other than the ADRs associated commonly with all opioids......
What additional ADRs are associated with Morphine?
Orthostasis
| Constipation
101
Can you give fentanyl to a patient with a codeine allergy?
Yes
102
What organotoxicity is associated with Meperidine (Demerol)?
Is this reversible with Naloxone?
Neurotoxicity (Anxiety, Tremors, Seizures)
No!
103
What organotoxicities are associated with Propoxyphene?
Neurotoxicity
| Cardiotoxicity
104
What cardiac arrhythmia is associated with Methadone?
Torsades
105
What ADRs are associated with Naloxone (Narcan)?
Headache
Myalgia
Hypertension
Withdrawal
106
Tramadol has a high risk for what at the recommended and increased doses?
This risk is increased with what class of medications?
Seizures
```
Increased risk with....
SSRIs
TCAs
Opioids
MAOIs
```
107
T/F: There is an increased suicide risk associated with Tramadol
True
108
Is Serotonin syndrome associated with Tramadol?
Yes
109
What has a higher risk of respiratory distress....
Morphine or Tramadol?
Morphine
110
Tapentadol is potentially fatal when taken with what?
Alcohol
111
What are THREE signs of Opioid Abuse?
1. Early Refills
2. Requesting higher doses
3. Prescriber Hoping
112
```
Withdrawal Sx (treating with other medications
Taking larger doses than prescribed and taking for longer
Impairment in social and occupational settings
```
....are all symptoms of opioid ________
Dependence
113
What are Sx of opioid withdrawal?
When would these onset?
```
Mood Liability
Chills
Diaphoresis
Nausea / Diarrhea
Rhinoorhea
Dilated Pupils
Insomnia
```
Onset 8-16 hours after last dose peaking in 2-4 days
114
Is opioid withdrawal life threatening?
No
115
How is opioid withdrawal treated?
Detoxification either through tapering or reversing medications (Naltrexone)
Can also use clonidine, NSAIDs, anti-diarrheals, muscle relaxants
116
What SERIOUS ADRs are associated with Milnicipran?
Common ADRs?
Serious:
SI
Serotonin Syndrome
HTN
Tachycardia
Common:
N/V
Constipation
headache
Hyperhidrosis
117
What ADRs are associated with cyclobenzaprine (Flexeril)?
Remember this has anticholinergic activtiy?
Dry Mouth
Constipation
Urinary Retention
Dry Eyes
118
Trnasient Quadriplegia is associated with what muscle relaxant?
What are additional ADRs?
Carisoprodol (Soma)
```
Drowsiness, Vertigo
Depression
Syncope
Hypotension
N/V
```
119
Is there a withdrawal syndrome seen with Carisoprodol (Soma)?
What are the Sx?
how is it treated?
Yes, onsets 3 days after abrupt sesation
Sx.....
```
Insomnia
Anxiety
Muscle Twitching
Incoordination
N/V
Anorexia
```
Treatment: Benzodiazapines + Anti-psychotics
120
Metaxalone (Skelaxin) is associated with what THREE serious ADRs?
Leukopenia
Hemolytic Anemia
Jaundice
121
What ADRS are associated with Baclofen?
```
Drowsiness
Dizziness
Fatigue / Wekaness
Nausea
Emesis
Confusion
```
122
What type of ADRs are seen with Orphenadrine (Norflex)?
Anticholinergic:
```
Dry Mouth
Urinary Retention
Tachycardia
Mydriasis
N/V
```
123
What medication is associated with idiosyncratic hepatotoxictiy?
Chlorzoxazone
124
T/F: Glucosamine Sulfate may have some impact on insulin resistance
True
125
Ziconotide is associated with what types of ADRs?
What additional ADRs?
Neuropshychiatric
Additional:
Dizziness
Ataxia
Somnolence
Nausea
126
Is intrathecal Baclofen associated with hypertonia or hypotonia?
Hypotonia
127
What ADRs are associated with PO Menthol use?
Topical?
Oral:
Heartburn, Nausea, Emesis
Topical:
Irritation
Dermatitis
128
Why should camphor be avoided orally?
It can become toxic leading to seizures and respiratory failure
129
Capsaicin is associated with a worsening cough when taken with what class of antihypertensives?
ACEi
130
What ADRs are associated with Capsaicin when taken orally?
Topically?
Oral:
GI Discomfort
Diaphoresis
Flushing
Topical:
Burning, Stinging, Erythema
