Pharm FA II Tox & SE p247 - 253 Flashcards
(80 cards)
1
Q
acetaminophen
A
N-acetylcysteine (replenishes glutathione)
2
Q
AChE inhibitors, organophosphates
A
Atropine > pralidoxime
3
Q
Antimuscarinic, anticholinergic agents
A
Physostigmine, control hyperthermia
4
Q
Arsenic
A
Dimercaprol, succimer
5
Q
Benzodiazepines
A
Flumazenil
6
Q
Beta Blockers
A
Atropine, glucagon, saline
7
Q
Carbon monoxide
A
100% Oxygen, hyperbaric oxygen
8
Q
Copper
A
“penny” cillamine ( penicillamine), trientine
9
Q
Cyanide
A
Nitrite +thiosulfate, hydroxycobalamin
10
Q
Digitalis ( digoxin)
A
Digoxin-specific antibody fragments
11
Q
Heparin
A
protamine sulfate
12
Q
iron
A
deferoxamine, deferasirox, deferiprone
13
Q
Lead
A
Calcium disodium EDTA, dimercarprol, succimer, penicillamine
14
Q
mercury
A
dimercaprol, succimmer
15
Q
methanol, ethylene glycol ( antifreeze)
A
fomepizole >ethanol, dialysis
16
Q
Methemoglobin
A
methylene blue, Vitamin C ( reducing agent)
17
Q
opioids
A
naloxone
18
Q
salicylates
A
NaHCO3- ( alkaline urine) dialysis
19
Q
TCAs
A
NaHCO3- ( stabilizes cardiac membrane)
20
Q
warfarin
A
Vitamin K ( delayed effect), PCC/FFP ( immediate effect)
PCC - prothrombin complex concentrate
FFP - fresh frozen plasma
21
Q
Coronary vasospasm
A
Cocaine, Amphetamines, Sumatriptan, Ergot alkaloids (CASE)
22
Q
Cutaneous flushing
A
Vancomycin, Adenosine, Niacin, Ca2+ channel blockers, Echinocandins, Nitrates (flushed from VANCEN [dancing])
23
Q
Red man syndrome?
A
rate-dependent infusion reaction to vancomycin causing widespread pruritic erythema. Manage with diphenhydramine, slower infusion rate.
24
Q
Dilated cardiomyopathy?
A
Anthracyclines (eg, Doxorubicin, Daunorubicin); prevent with Dexrazoxane
Use Dex for Dox Dilated cardiomyopathy
25
Prevent Rx induced dilated cardiomyopathy?
prevent with Dexrazoxane
Use Dex for Dox Dilated cardiomyopathy
26
Torsades de pointes
Agents that prolong QT interval: antiArrhythmics (class IA, III), antiBiotics (eg, macrolides), anti“C”ychotics (eg, haloperidol), antiDepressants (eg, TCAs), antiEmetics (eg, ondansetron) (ABCDE)
27
Adrenocortical insufficiency
HPA suppression 2° to glucocorticoid withdrawal
28
Diabetes insipidus
Nephrogenic DBI
Lithium, demeclocycline (ADH antagonist)
29
Hot flashes
SERMs (eg, tamoxifen, clomiphene, raloxifene
30
Hyperglycemia
* Tacrolimus ((-) IL2 transcription by blocking calcineurin)
* Protease inhibitors
* Niacin
* HCTZ,
* Corticosteroids
31
Hyperprolactinemia
* Typical antipsychotics - Haloperidol, pimozide, trifluoperazine, fluphenazine, thioridazine, chlorpromazine.
* atypical antipsychotics - Aripiprazole, asenapine, clozapine, olanzapine, quetiapine, iloperidone, paliperidone,
risperidone, lurasidone, ziprasidone.
* metoclopramide, (anti-emetic)
* methyldopa
* reserpine (stops resorption of catecholamines into vesicle in neuron VMAT)
32
Hyperthyroidism
Amiodarone, thyroid replacement therapy, iodine
33
Hypothyroidism
AMiodarone, SUlfonamides, Lithium
I AM SUddenly Low
34
SIADH
SIADH:
Carbamazepine, Cyclophosphamide, SSRIs
Can’t Concentrate Serum Sodium
35
Acute cholestatic hepatitis, jaundice
Macrolides (eg, erythromycin)
36
Diarrhea
* Acamprosate - dec desire for alcohol
* antidiabetic agents (acarbose, metformin, pramlintide),
* colchicine,
* cholinesterase inhibitors,
* lipid-lowering agents (eg, ezetimibe, orlistat),
* macrolides (eg, erythromycin),
* SSRI
37
Focal to massive hepatic necrosis
**H**alothane, **A**manita phalloides (death cap mushroom), **V**alproic acid, **Ac**etaminophen
Cause HAVAc to Liver
38
Hepatitis
Rifampin, isoniazid, pyrazinamide, statins, fibrates
TB rx and Chol lowering rx.
RIP FuckS Liver
39
Pancreatitis
* *D**idanosine (NRTI - HIV rx) , **C**orticosteroids, **A**lcohol, **V**alproic acid, **A**zathioprine ( dec purine synthesis (+) by HGPRT), **D**iuretics (eg, furosemide, HCTZ)
* *D**rugs **C**ausing **A** **V**iolent **A**bdominal **D**istress
40
Pill-induced esophagitis
* Bisphosphonates
* ferrous sulfate,
* potassium chloride
* NSAIDs,
* Tetracyclines
Caustic effect minimized with upright posture and adequate water ingestion
41
Pseudomembranous colitis
Ampicillin, cephalosporins, clindamycin, fluoroquinolones
Antibiotics predispose to superinfection by resistant C difficile
FACC!! I'm shitting from C diff
42
Agranulocytosis
* **D**apsone - leprosy
* **C**lozapine - atypical antipsych
* **C**arbamazepine - anti epileptic
* **P**ropylthiouracil - hyperthyroid
* **M**ethimazole - hyperthyroid
* **C**olchicine - gout
* **G**anciclovir - CMV
**D**rugs **C**an **C**ause **P**retty **M**ajor **C**ollapse of **G**ranulocytes
43
Aplastic anemia
**C**arbamazepine, **M**ethimazole, **N**SAIDs, **B**enzene, **C**hloramphenicol, **P**ropylthiouracil
**C**an’t **M**ake **N**ew **B**lood **C**ells **P**roperly
44
Direct Coombs positive hemolytic anemia
**P**enicillin, methyl**D**opa, **C**ephalosporins
**P** **D**iddy **C**oombs
45
Drug reaction with eosinophilia and systemic symptoms (DRESS)
Allopurinol, anticonvulsants, antibiotics, sulfa drugs
DRESS is a 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
46
Grey Baby syndrome
Chloramphenicol
47
Hemolysis in G6PD deficiency
Isoniazid, Sulfonamides, Dapsone, Primaquine, Aspirin, Ibuprofen, Nitrofurantoin
Hemolysis IS D PAIN
48
Megaloblastic anemia
Hydroxy**u**rea, Phenytoin, Methotrexate, Sulfa drugs
U’re having a **mega blast** with **PMS**
49
Thrombocytopenia
* *H**eparin, **V**ancomycin, **L**inezolid
* *H**elp! **V**ery **L**ow platelets
50
Thrombotic complications
Combined oral contraceptives, hormone replacement therapy, SERMs (eg, tamoxifen, raloxifene, clomiphene)
Estrogen-mediated side effect
51
Drug-induced lupus
**M**ethyldopa, **M**inocycline, **H**ydralazine, **I**soniazid, **P**henytoin, **S**ulfa drugs, **E**tanercept, **P**rocainamide
Lupus **M**akes **M**y **HIPS** **E**xtremely **P**ainful
52
Fat redistribution
**P**rotease **i**nhibitors, **G**lucocorticoids
Fat **PiG**
53
Gingival hyperplasia
* *C**yclosporine, **C**a2+ channel blockers, **P**henytoin
* *C**an **C**ause **P**uffy gums
54
Hyperuricemia (gout)
* *P**yrazinamide, **T**hiazides, **F**urosemide, **N**iacin, **C**yclosporine
* *P**ainful **T**ophi and **F**eet **N**eed **C**are
55
Myopathy
1. Statins
2. fibrates
3. niacin
4. colchicine
5. daptomycin
6. hydroxychloroquine
7. interferon-α
8. penicillamine
9. glucocorticoid
56
Osteoporosis
1. Corticosteroids
2. depot medroxyprogesterone acetate
3. GnRH agonists
4. aromatase inhibitors
5. anticonvulsants
6. heparin
7. PPIs
57
Photosensitivity
* *S**ulfonamides, **A**miodarone, **T**etracyclines, 5-**F**U
* *SAT** **F**or Photo
58
Rash (Stevens-Johnson syndrome)
Anti-epileptic drugs (especially lamotrigine), allopurinol, sulfa drugs, penicillin
Steven Johnson has epileptic allergy to sulfa drugs and penicillin
59
Teeth discoloration
Tetracyclines
Teethracyclines
60
Tendon and cartilage damage
Fluoroquinolones
61
Sx of Cinchonism
tinnitus, hearing/vision loss, psychosis, and cognitive impairment
62
Parkinson-like syndrome
**A**ntipsychotics, **R**eserpine, **M**etoclopramide
Cogwheel rigidity of ARM
63
Peripheral neuropathy
Isoniazid, phenytoin, platinum agents (eg, cisplatin), vincristine
64
Idiopathic intracranial hypertension
Growth hormones, tetracyclines, vitamin A
65
Seizures
* Isoniazid (vitamin B6 deficiency),
* Bupropion
* Imipenem/cilastatin
* Tramadol
* Enflurane
With seizures, I BITE my tongue
66
Tardive dyskinesia
Antipsychotics, metoclopramide
67
Visual disturbance
* **T**opiramate (blurred vision/diplopia, haloes), - anti-epileptic
* **D**igoxin (yellow-tinged vision),
* **I**soniazid (optic neuropathy/color vision changes),
* **V**igabatrin (bilateral visual field defects), - anti-epileptic
* **P**DE-5 inhibitors (blue-tinged vision), - sildenafil etc. ED/pulm HTN
* **E**thambutol (color vision changes)
These Drugs Irritate Very Precious Eyes
68
Fanconi syndrome
**Cisplatin, ifosfamide, expired tetracyclines, tenofovir (NRTI)**
**CITT Fanconi**
Fanconi - Generalized reabsorption defect in PCT --\> excretion of amino acids, glucose, HCO3–, and PO43–, and all substances reabsorbed by the PCT
May lead to metabolic acidosis (proximal RTA), hypophosphatemia, osteopenia
69
Hemorrhagic cystitis
Cyclophosphamide, ifosfamide
70
Interstitial nephritis
Diuretics (**P**ee), NSAIDs (**P**ain-free), **P**enicillins and cephalosporins, **P**PIs, rifam**P**in, and **s**ulfa drugs
Remember the **5 P’s**
71
Pulmonary fibrosis
* **M**ethotrexate
* **N**itrofurantoin,
* **C**armustine (DNA alkylating agent),
* **B**leomycin,
* **B**usulfan,
* **A**miodarone
**M**y **N**ose **C**annot **B**reathe **B**ad **A**ir
72
Antimuscarinic
Atropine, TCAs, H1-blockers, antipsychotics
73
Disulfiram-like reaction
1st-generation **S**ulfonylureas, **P**rocarbazine ( Cell cycle phase–nonspecific alkylating agent, brain and hodgkins), certain **C**ephalosporins, **G**riseofulvin, **M**etronidazole
Find di**S**ulfira**M** with a **GPS**
74
Nephrotoxicity/ ototoxicity
* *L**oop diuretics, **A**minoglycosides, cis**P**latin, **V**ancomycin, ampho**TER**icin **B**
* *L**isten **A**nd **P**ee **V**ery **TER**ri**B**ly
75
76
p450 (+)'rs
* Chronic alcohol use
* St. John’s wort
* Nevirapine - anti HIV
* Rifampin - anti TB
* Griseofulvin - anti fungal
* Carbamazepine - anti epileptic
* Phenytoin - anti epileptic
* Phenobarbital - barb
* Modafinil - for narcolepsy - GABA (-)'n, Glu (+)'n
Most **chronic alcoholics** **St**eal **Phen**-**Phen** and **Nev**er **R**efuse **Gr**easy **Carb**
77
Substrates for p450
Warfarin
Anti-epileptics
Theophylline
OCPs
War Against The OCPs
78
p450 (-)'rs
* Acute alcohol abuse
* Grapefruit juice
* Fluconazole - anti fungal
* Isoniazid - anti-TB
* Ketoconazole - anti fungal
* Ciprofloxacin - antibiotic (flouroquinolone)
* Chloramphenicol - antibiotic
* Clarithromycin - antibiotic (macrolides)
* Erythromycin - antibiotic (macrolides)
* Metronidazole - antibiotic
* Sulfonamides - antibiotic
* Cimetidine - H+ blocker
* Omeprazole - PPI
* Amiodarone - class III anti arrythmic (K+ ch blocker)
* Sodium valproate - anti-epileptic
AGH!!! FIK CChEMS (chemical) ChAOS with p450 (-)'rs
79
Ex of Sulfa rx?
* Sulfonamide antibiotics,
* Sulfasalazine,
* Probenecid,
* Furosemide,
* Acetazolamide,
* Celecoxib,
* Thiazides,
* Sulfonylureas.
**S**cary **S**ulfa **P**harm **FACTS**
80
SE of Sulfa drugs
Patients with sulfa allergies may develop fever, urinary tract infection, StevensJohnson syndrome, hemolytic anemia, thrombocytopenia, agranulocytosis, acute interstitial nephritis, and urticaria (hives).
