Common Pharm AE/CI

Question 1

Antibiotics

Answer 1

AE: nausea; diarrhea; rash; yeast infections; fever

Intxns: decrease efficacy of OCPs, penicillins increase methotrexate levels

Common allergies:

• Penicillins
• Beta-lactams (-cillin and ceph/cef-)

Question 2

Anti-asthma (non steroid)

Answer 2

Nervous feeling; sweating; nausea; vomiting

Question 3

Antihistamines

Answer 3

Drowsiness; insomnia; weakness

Question 4

NSAIDs

Answer 4

Stomach upset, nausea, gastitis, ulcers, tinnitus

Question 5

Acetaminophen

Answer 5

Elevated liver enzymes, liver damage

Question 6

Common causes of Steven Johnson syndrome?

Answer 6

• Allopurinol
• Anticonvulsants
• Antipsychotics
• NSAIDs
• Acetaminophen
• Beta-lactams (cillins and ceph/cefs)

Question 7

Anticonvulsants (carbamazepine, phenytoin)

Answer 7

Dizziness; drowsiness; confusion; fainting

Folate deficiency

Blood deficiencies:

• anemia: macrocytic, aplastic
• WBCs + platelets

Rash (5-10%)

Question 8

Antidiabetics

Answer 8

Nausea; heartburn; fatigue; dizziness

Hypoglycemia

Question 9

HTN drugs

Answer 9

Dizziness; drowsiness; chest pain; loss of appetite; leg pain

Question 10

Cerebral stimulants (ADHD, narcolepsy)

Answer 10

Insomnia; irritability; restless, decreased growth

Abuse potential

Question 11

Decongestants (alpha agonists, pseudophedrine)

Answer 11

Alpha agonists (oxymetazoline, phenylephrine): sedation, dry mouth and nasal mucosa, bradycardia, orthostatic hypotension

Pseudophedrine: insomnia, anxiety, dizziness

Question 12

Topicals

Answer 12

Rash; skin irritation; burning

Question 13

PPI / H2 blocker

Answer 13

Headache, nausea, diarrhea

Reduce absorption of B12 + folate

Question 14

Anti-diarrheal (loperamide)

Answer 14

constipation, dizziness, nausea

Question 15

SSRI/SNRI (fluoxetine, escitalopram, venlafaxine)

Answer 15

Nausea, nervous/restlessness, anorexia, insomnia, sexual dysfunction, risk of GI bleeding

Black Box: increased risk of suicide in those under 24

Intxns: hypericum, trytophan/5-htp, other classes of antidepressants

Question 16

NDRI (buproprion)

Answer 16

AE: nausea, nervous/restlessness, anorexia, insomnia,

DOES NOT cause weight gain + sexual side effect

Question 17

Antipsychotics/neuroleptics (risperidone, aripiprazole, haloperidol)

Answer 17

Extrapyramidal symptoms, including tardive dyskinesia (irregular, jerky movements)

Rare but deadly: neuroleptic malignant syndrome

Question 18

Describe extrapyramidal symptoms

Answer 18

• Dystonia (continuous spasms and muscle contractions)
• Akathisia (motor restlessness)
• Parkinsonism (rigidity, bradykinesia, and tremor)
• Tardive dyskinesia (irregular, jerky movements)

D/t blocking of dopamine receptors

Haloperidol is the worst

Question 19

Which antiemetic can also cause extrapyramidal symptoms?

Answer 19

Metoclopramide

Also blocks dopamine receptors (D2)

Question 20

Lithium is no joke:

Answer 20

AE: drowsiness, tremor, loss of appetite, dehydration, hypothyroidism

• Can precipitate serotonin syndrome if combined with SSRIs, etc.
• Can cause nephrogenic diabetes insipidus.
• Concentration of lithium increased/can become toxic with diuretics, ACEs, ARBs, NSAIDs.
• Must monitor kidney function, thyroid function, and blood levels of lithium to maintain therapeutic level.

Question 21

Which drugs reduce folate?

Answer 21

• OCPs
• Anticonvulsants (phenytoin and carbamazepine)
• Methotrexate
• Sulfasalazine
• Metformin
• Trimethoprim (TMP-sulfa)
• PPIs/H2 blockers (reduce absorption)

Question 22

Which drugs reduce cobalamin?

Answer 22

• Methotrexate
• Metformin
• PPIs/H2 blockers (reduce absorption)

Question 23

Which drugs can induce hemolytic anemia in G6P deficiency?

Answer 23

• Sulfasalazine
• Phenazopyridine
• Hydroxychloroquinine
• Ciprofloxacin
• Doxorubicin
• Nitrofurantoin

Question 24

Which drugs and herbs can cause hypokalemia?

Answer 24

Drugs:

• Thiazides and loops
• Bisacodyl (laxative)
• Steroids
• Insulin
• Digoxin

Herbs:

• Glycerrhiza
• Digitalis
• Cathartic laxatives: cassia/senna, rhamnus

Question 25

Anticholinergics

• atropine
• amitriptyline
• tolterodine

Answer 25

Dry mouth, dilated pupils and blurry vision, constipation, difficulty urinating, sedation/confusion/delerium

Herbs include:

• Belladonna
• Datura
• Hyoscymus

Question 26

Immunosuppressants

• methotrexate
• adalimumab
• cyclosporine
• penicillamine

Answer 26

AE: increased risk of infections, cancer, bone marrow suppression

Question 27

Chemotherapeutics

• doxorubicin
• 5-fu
• methotrexate
• paclitaxel
• vinblastine

Answer 27

AE: N+V, loss of appetite, hair loss, taste changes + mouth inflammation, rash (think rapidly dividing tissue: GI + hair)

neurotoxic, bone marrow suppression, heart toxicity

Question 28

Dopamine agonists

• amantadine (also anticholinergic)
• bromocriptine
• pramipexole

Answer 28

Hallucinations, exacerbation of pre-existing seizure disorders and psychiatric symptoms

Headaches + orthostatic hypotension

Question 29

Glucocorticoids (systemic)

• dexamethasone (strongest)
• prednisone
• hydrocortisone (weakest)

Answer 29

Immunodeficiecy, hyperglycemia, fragile skin + bone loss, abdominal weight gain, insomnia, HPA axis insufficiency

Cushing’s syndrome

Question 30

Drugs to avoid in narrow-angle glaucoma:

Answer 30

• atropine (+belladonna, datura, hyoscymus)
• diazepam
• phentermine
• phenylephrine

Question 31

Alzheimer/demetia drugs

• donepezil
• rivastigmine

Answer 31

Lower seizure threshold, inc. risk GI bleed

Headache, nausea, diarrhea (cholinergic)