MSK-rheum drug adverse effects

Question 1

succinylcholine

Answer 1

• hemodynamic effects
• hyperkalemia
• muscle pain from fasciculations
• myoglobinuria

Question 2

what is the worst side effect of succinylcholine? how is it caused? how is it treated?

Answer 2

malignant hyperthermia

• uncontrolled release of Ca from sarc reticulum
• treat with dantrolene (O2, treat hyperkalemia and acidosis)

Question 3

3 NSAID common adverse effects

Answer 3

increase blood pressure
inhibit platelets (may be beneficial)
GI toxicity

Question 4

what is the most effective way to avoid GI toxicity of NSAIDs?

Answer 4

proton pump inhibitors

Question 5

what adverse effect of NSAIDs is rare but still accounts for 10% of the cases of this related to drugs?

Answer 5

hepatotoxicity

Question 6

NSAID use can interfere with function of what important organ and how?

Answer 6

kidney: prostaglandins vital for autoregulation: renal ischemia, reduced GFR, ARF

Question 7

what causes salicylate poisoning and what happens?

Answer 7

aspirin

• causes hyperventilation: respiratory alkalosis, dehydration, compensatory metabolic acidosis
• ultimately, cerebral and pulmonary edema and CV collapse

Question 8

what four things should be monitored in patients on chronic NSAIDs?

Answer 8

1. LFTs
2. CBCs (rare blood dyscrasias)
3. serum creatinine/BUN
4. stool guaiac for GI toxicity

Question 9

what two RA drugs are contraindicated in pregnancy/breast feeding?

Answer 9

methotrexate and leflunomide

Question 10

what 2 toxicities are common to all non-biologic, non-NSAID drugs in RA treatment?

Answer 10

blood dyscrasias
increased LFTs (except hydroxychloroquine)

Question 11

what should be monitored in patients on hydroxychloroquine?

Answer 11

ophthalmalogic exams

Question 12

what should be tested in methotrexate before beginning treatment

Answer 12

pulmonary test

Question 13

what should patients be screened for before prescribing steroids?

Answer 13

osteoporosis
fasting blood glucose
glaucoma risk
ankle edmea

Question 14

what risk factor do RA patients have and which drugs increase this? how?

Answer 14

CV events: corticosteroids:

-adverse lipid profile, insulin resistance, obesity

Question 15

what should be avoided with use of biologic RA drugs? what is a common risk in their use?

Answer 15

vaccines

awaking dormant pathogens, e.g. TB

Question 16

which biologic is contraindicated in CHF?

Answer 16

infliximab

Question 17

what are two adverse effects of rituximab?

Answer 17

rarely, SJS

IgG cross placenta and deplete B cells in fetus

Question 18

what biologic contains maltose and complicates blood glucose tests

Answer 18

abatacept

Question 19

what biologic can affect the serum lipid profile

Answer 19

toclizumab

Question 20

what are two adverse effects of colchicine and what should be monitored?

Answer 20

GI disturbances most common

hepatotoxicity-monitor LFTs

Question 21

what are two adverse effects of indomethacine and what drugs should be avoided?

Answer 21

GI toxicity
CNS: severe frontal headaches
-antagonizes furosemide and HCTZ

Question 22

what is the main adverse effect of allopurinol?

Answer 22

increases incidences of acute gouty arthritis due to mobilization of urate deposits in joints/tissues

Question 23

what 2 drugs does allopurinol interact with?

Answer 23

6-mercaptopurine/6-thioguanine: inhibit metabolism by HGPRT by buildup up hypoxanthine

Question 24

what are the adverse effects of febuxostat?

Answer 24

few: but occasionally elevated LFTs (like allopurinol)

Question 25

what two drugs interfere with action of probenecid?

Answer 25

salicylates and HCTZ

Question 26

what is the adverse effect of pegloticase? how can it be treated/avoided?

Answer 26

gout flares due to dissolution of tophi | -prophylactic colchicine, NSAIDs, glucocorticoids