Drug reactions (Pg. 239)

Question 1

S/E - Coronary Vasospasm

Answer 1

Amphetamin, cocaine, ergot alkaloids, sumatriptan

Question 2

S/E - Cutaneous flushing

Answer 2

Vancomycin, Adenosine, Niacin, Nitrates, Ca2+ channel blockers, Echinocandins (VANNCE)

Question 3

S/E - Dilated cardiomyopathy

Answer 3

Anthracyclines (eg, doxorubicin, daunorubicin); prevent with dexrazoxane

Question 4

S/E - Torsades de pointes

Answer 4

AntiArrhythmics (class IA, III), antiBiotics (eg, macrolides), anti“C”ychotics (eg, haloperidol), antiDepressants (eg, TCAs), antiEmetics (eg, ondansetron) (ABCDE)

Question 5

S/E - Adrenocortical insufficiency

Answer 5

HPA suppression 2° to glucocorticoid withdrawal

Question 6

S/E - Diabetes insipidus

Answer 6

Lithium, demeclocycline

Question 7

S/E - Hot flashes

Answer 7

Tamoxifen, clomiphene

Question 8

S/E - Hyperglycemia

Answer 8

“Taking Pills Causes Nasty Hyperglycemia”
Tacrolimus, Protease inhibitors, Niacin, HCTZ,
Corticosteroids

Question 9

S/E - Hypothyroidism

Answer 9

Lithium, amiodarone, sulfonamides

Question 10

S/E - SIADH

Answer 10

Carbamazepine, Cyclophosphamide, SSRIs Can’t Concentrate Serum Sodium

Question 11

S/E - Acute cholestatic hepatitis, jaundice

Answer 11

Erythromycin

Question 12

S/E - Diarrhea

Answer 12

Acamprosate, acarbose, cholinesterase inhibitors, colchicine, erythromycin, ezetimibe, metformin, misoprostol, orlistat, pramlintide, quinidine, SSRIs
(AACCEEMM -OPQSS)

Question 13

S/E - Focal to massive hepatic necrosis

Answer 13

Liver “HAVAc”

• Halothane
• Amanita phalloides (death cap mushroom)
• Valproic acid
• Acetaminophen

Question 14

S/E - Hepatitis

Answer 14

Rifampin, isoniazid, pyrazinamide, statins, fibrates (Antimycobacterial drugs vs. Lipid lowering agents)

Question 15

S/E - Pancreatitis

Answer 15

“Drugs Causing A Violent Abdominal Distress”

• Didanosine, Corticosteroids, Alcohol, Valproicacid, Azathioprine, Diuretics (furosemide, HCTZ)

Question 16

S/E - Pill-induced esophagitis

Answer 16

Bisphosphonates, ferrous sulfate, NSAIDs, potassium chloride, tetracyclines

Question 17

S/E - Pseudomembranous colitis

Answer 17

Ampicillin, cephalosporins, clindamycin, fluoroquinolones

Question 18

S/E - Agranulocytosis

Answer 18

“Can Cause Pretty Major Collapse of Granulocytes”

• Clozapine, Carbamazepine, Propylthiouracil, Methimazole, Colchicine, Ganciclovir

Question 19

S/E - Aplastic anemia

Answer 19

“Can’t Make New Blood Cells Properly”

• Carbamazepine, Methimazole, NSAIDs, Benzene, Chloramphenicol, Propylthiouracil

Question 20

S/E - Direct Coombs-positive hemolytic anemia

Answer 20

Methyldopa, penicillin

Question 21

S/E - Drug reaction with eosinophilia and systemic symptoms (DRESS)

Answer 21

Allopurinol, anticonvulsants, antibiotics, sulfa drugs

Potentially fatal delayed hypersensitivity reaction. Latency period (2–8 weeks) followed by fever, morbilliform skin rash, and frequent multiorgan involvement. Treatment: withdrawal of offending drug, corticosteroids.

Question 22

S/E - Gray baby syndrome

Answer 22

Chloramphenicol

Question 23

S/E - Hemolysis in G6PD deficiency

Answer 23

“Hemolysis IS D PAIN”

• Isoniazid, Sulfonamides, Dapsone, Primaquine, Aspirin, Ibuprofen, Nitrofurantoin

Question 24

S/E - Megaloblastic anemia

Answer 24

“You’re having a mega blast with PMS”

• Hydroxyurea, Phenytoin, Methotrexate, Sulfa drugs

Question 25

S/E - Thrombocytopenia

Answer 25

Heparin

Question 26

S/E - Thrombotic complications

Answer 26

Combined oral contraceptives, hormone replacement therapy, SERMs (eg, tamoxifen, raloxifene, clomiphene) (Estrogen-mediated S/E)

Question 27

S/E - Fat redistribution

Answer 27

"Fat PiG" - Protease inhibitors, Glucocorticoids

Question 28

S/E - Gingival hyperplasia

Answer 28

Phenytoin, Ca2+ channel blockers, cyclosporine

Question 29

S/E - Hyperuricemia (gout)

Answer 29

"Painful Tophi and Feet Need Care" - Pyrazinamide, Thiazides, Furosemide, Niacin, Cyclosporine

Question 30

S/E - Myopathy

Answer 30

Statins, fibrates, niacin, colchicine, daptomycin, hydroxychloroquine, interferon-α, penicillamine, glucocorticoids

Question 31

S/E - Osteoporosis

Answer 31

Corticosteroids, depot medroxyprogesterone acetate, GnRH agonists, aromatase inhibitors, anticonvulsants, heparin

Question 32

S/E - Photosensitivity

Answer 32

"SAT For Photo" - Sulfonamides, Amiodarone, Tetracyclines, 5-FU

Question 33

S/E - Rash (Stevens- Johnson syndrome)

Answer 33

"Steven Johnson has epileptic allergy to sulfa drugs and penicillin" - Anti-epileptic drugs (especially lamotrigine), allopurinol, sulfa drugs, penicillin

Question 34

S/E - SLE-like syndrome

Answer 34

Having lupus is “SHIPP-E” - Sulfa drugs, Hydralazine, Isoniazid, Procainamide, Phenytoin, Etanercept

Question 35

S/E - Teeth discoloration

Answer 35

"Teethracyclines" - Tetracyclines

Question 36

S/E - Tendonitis, tendon rupture, and cartilage damage

Answer 36

Fluoroquinolones

Question 37

S/E - Cinchonism

Answer 37

Quinidine, quinine Can present with tinnitus, hearing/vision loss, psychosis, and cognitive impairment

Question 38

S/E - Parkinson-like syndrome

Answer 38

"Cogwheel rigidity of ARM" - Antipsychotics, Reserpine, Metoclopramide

Question 39

S/E - Seizures

Answer 39

"With seizures, I BITE my tongue" - Isoniazid (vitamin B6 deficiency), Bupropion, Imipenem/cilastatin, Tramadol, Enflurane

Question 40

S/E - Tardative dyskinesia

Answer 40

Antipsychotics, metoclopramide

Question 41

S/E - Fanconi syndrome

Answer 41

Cisplatin, ifosfamide, expired tetracyclines, tenofovir

Question 42

S/E - Hemorrhagic cystitis

Answer 42

Cyclophosphamide, ifosfamide Prevent by coadministering with mesna

Question 43

S/E - Interstitial nephritis

Answer 43

Penicillins, furosemide, NSAIDs, proton pump inhibitors, sulfa drugs

Question 44

S/E - Dry cough

Answer 44

ACE inhibitors

Question 45

S/E - Pulmonary fibrosis

Answer 45

"My Nose Cannot Breathe Bad Air" - Methotrexate, Nitrofurantoin, Carmustine, Bleomycin, Busulfan, Amiodarone

Question 46

S/E - Antimuscurinic

Answer 46

Atropine, TCAs, H1-blockers, antipsychotics

Question 47

S/E - Disulfiram-like reaction

Answer 47

"Sorry Pals, Can’t Go Mingle" - 1st-generation Sulfonylureas, Procarbazine, certain Cephalosporins, Griseofulvin, Metronidazole

Question 48

S/E - Nephrotoxicity/ototoxicity

Answer 48

Aminoglycosides, vancomycin, loop diuretics, cisplatin, amphotericin B Cisplatin toxicity may respond to amifostine.