What is the antidote for acetaminophen overdose?
What are the two treatments for salicylate overdose?
Alkalinization of urine and dialysis if necessary
What compound is used to alkalinize urine?
NaHCO3; weak acids are better excreted when the urine is alkaline
What is the treatment for amphetamine overdose?
Amphetamines are _____ (acidic/basic); therefore, overdose is treated with _____ (NH4Cl/NaHCO3) to _____ (acidify/alkalinize) the urine.
Basic; NH4Cl; acidify
What are the two antidotes for anticholinesterase toxicity?
Atropine to block cholinergic receptors and pralidoxime to regenerate acetylcholinesterase
What are the antidotes for organophosphate poisoning?
Atropine and pralidoxime; organophosphates inhibit acetylcholinesterase
What is the antidote for toxicity caused by anticholinergic agents?
it inhibits acetylcholinesterase, increasing the available acetylcholine to overcome anticholinergic toxicity
Physostigmine is the antidote for toxicity caused by what two types of agents?
Antimuscarinic agents and anticholinergic agents
What is the antidote for β-blocker toxicity?
What are five treatments for digitalis toxicity?
Stop the medication
normalize the potassium level; give the patient lidocaine; give the patient anti-digoxigenin Fab fragments; give the patient magnesium
What is the antidote for iron toxicity?
Deferoxamine, a chelating agent
What are four treatments for lead poisoning?
Edetate calcium disodium, dimercaprol, succimer, and penicillamine
Penicillamine is the antidote for toxicity caused by what substances?
Copper, arsenic, gold
What are three treatments for arsenic poisoning?
Dimercaprol, succimer, penicillamine
What are two treatments for mercury poisoning?
Dimercaprol and succimer
What are three treatments for gold poisoning?
Dimercaprol, succimer, penicillamine
Dimercaprol and succimer are the antidotes for toxicity caused by what substances?
Mercury, arsenic, gold
The combination of thiosulfate and nitrite is the antidote for toxicity caused by what substance?
Hydroxocobalamin is the antidote for toxicity caused by what substance?
What are the treatments for cyanide poisoning?
Hydroxocobalamin, or a combination of nitrite and thiosulfate
What is the treatment for methemoglobinemia?
Methylene blue, vitamin C
Methylene blue is used to treat elevated serum levels of what substance?
What are the treatments for carbon monoxide poisoning?
100% oxygen and hyperbaric oxygen
What are the treatments for methanol and ethylene glycol (antifreeze) poisoning?
Ethanol, dialysis, and fomepizole
Fomepizole is an antidote for toxicity caused by what substances?
Methanol, ethylene glycol
What are the antidotes for opioid overdose?
Naloxone or naltrexone
Naloxone is the antidote for overdose of what substance?
What is the antidote for benzodiazepine overdose?
it reduces the action of benzodiazepines at γ-aminobutyric acid receptors
Flumazenil is the antidote for overdose of what substance?
What is the treatment for tricyclic antidepressant overdose?
it can prevent cardiac arrhythmias
Alkalinization of the serum with sodium bicarbonate is a treatment for overdose with what class of antidepressant medications?
the alkalinization can prevent cardiac arrhythmias
What is the reversal agent for heparin?
Protamine is used to reverse the effects of what pharmacologic agent?
however, it does not reverse low-molecular-weight heparin
What agents are used to reverse the effects of warfarin?
Vitamin K and fresh frozen plasma
Vitamin K is used to reverse the effects of what pharmacologic agent?
What agent is used to reverse the effects of both tissue plasminogen activator and streptokinase?
Aminocaproic acid is used to reverse the effects of what two pharmacologic enzymes?
Tissue plasminogen activator and streptokinase
What is the antidote for theophylline?
A woman brings her 3-year-old son to the emergency room because she found him eating pills out of the acetaminophen bottle. She is not sure how many he ate, but says that the bottle was almost empty by the time she got to him, and that he was eating them one hour ago. Which drug should be administered to minimize further liver toxicity?
Which component of multivitamins is the most likely to cause fatal overdose in children?
What is the mechanism of cell death in iron poisoning?
Peroxidation of membrane lipids
What will a patient with acute iron poisoning present with?
After gastrointestinal bleeding in the acute phase of iron poisoning, what is the progression of the clinical presentation?
Metabolic acidosis followed by gastrointestinal strictures and obstruction
Which antidepressants can cause tachycardia due to anticholinergic action?
Which drugs can cause coronary vasospasm?
Cocaine and sumatriptan
Which drugs can cause cutaneous flushing as an adverse effect?
Vancomycin, adenosine, niacin, calcium channel blockers (remember: VANC)
Which drugs cause dilated cardiomyopathy?
Doxorubicin (Adriamycin), daunorubicin
Which drugs can cause torsades de pointes?
Class III (sotalol) and class IA (quinidine) antiarrhythmic agents, cisapride
What cardiac adverse effect can result from either cocaine or sumatriptan use?
What is the major adverse effect of niacin use?
Which drugs can cause agranulocytosis as an adverse effect?
Clozapine, carbamazepine, colchicine, propylthiouracil, methimazole
Which drugs (or exposures) can cause aplastic anemia as an adverse effect?
Chloramphenicol, benzene, nonsteroidal antiinflammatory drugs, propylthiouracil, methimazole
Which antihypertensive drug can cause hemolytic anemia?
Which antibiotic can cause "grey baby syndrome"?
Which drugs can cause hemolytic anemia in G6PD-deficient patients?
Isoniazid, Sulfonamides, Primaquine, Aspirin, Ibuprofen, Nitrofurantoin (remember: hemolysis IS PAIN)
Which drugs can cause megaloblastic anemia?
Phenytoin, Methotrexate, Sulfa drugs (remember: Having a blast with PMS)
What is a major adverse effect of oral contraceptives?
Thrombotic events such as deep vein thrombosis and pulmonary embolus
Which antihypertensive drug can cause chronic cough?
Angiotensin-converting enzyme inhibitors
What is the advantage of angiotensin II receptor blockers (like losartan) over angiotensin-converting enzyme inhibitors?
Angiotensin II receptor blockers are often prescribed as an alternative renoprotective antihypertensive medication in patients with angiotensin-converting enzyme inhibitor-induced cough
Which drugs can cause pulmonary fibrosis?
Bleomycin, busulfan, amiodarone
What adverse effect would you suspect in a newly jaundiced patient recently started on azithromycin?
Acute cholestatic hepatitis
Which drugs (or exposures) can cause hepatic necrosis?
Halothane, valproic acid, acetaminophen, Amanita phalloides
What effect can isoniazid have on the liver?
Which drugs can cause pseudomembranous colitis?
Clindamycin and ampicillin are commonly implicated, but many antibiotics can be responsible
Administration of clindamycin or ampicillin can cause overgrowth of which bacteria in the colon?
Clostridium difficile, which leads to pseudomembranous colitis
What adverse effect occurs when exogenous glucocorticoids are rapidly withdrawn?
Adrenocortical insufficiency due to long-term hypothalamic-pituitary-adrenal axis suppression; this is why steroids are usually tapered as opposed to abruptly discontinued
Which drugs are known to cause gynecomastia?
Spironolactone, Digitalis, Cimetidine, Alcohol (chonic use), estrogens, Ketoconazole (remember: Some Drugs Create Awesome Knockers)
Which drugs can cause hot flashes?
Which drug can cause gingival hyperplasia?
Which drugs can cause gout?
Furosemide and thiazide diuretics
Osteoporosis can be caused by long-term use of which drugs?
Which drugs induce photosensitivity?
Sulfonamides, Amiodarone, Tetracyclines (remember: SAT for a photo)
Which drugs can cause Stevens-Johnson syndrome?
Ethosuximide, lamotrigine, carbamazepine, phenobarbital, phenytoin, sulfa drugs, penicillin, allopurinol; think anticonvulsants and antibiotics
Which drugs can cause a lupus-like syndrome?
Hydralazine, Isoniazid, Procainamide, Phenytoin (remember: it's not HIPP to have lupus)
Which adverse effects of fluoroquinolones are specific to children?
Tendonitis, tendon rupture, and cartilage damage
Which drug can cause Fanconi's syndrome if taken after its expiration date?
Which drugs can cause interstitial nephritis?
Methicillin, nonsteroidal antiinflammatory drugs, and furosemide
Which two drugs can cause hemorrhagic cystitis?
Cyclophosphamide and ifosfamide
Which drug is administered to prevent hemorrhagic cystitis from the use of ifosfamide or cyclophosphamide?
Name two drugs that can cause cinchonism.
Quinidine and quinine; cinchonism describes headache and tinnitus
Which adverse effect of lithium can cause hypernatremia?
Name two drugs that can cause diabetes insipidus.
Lithium and demeclocycline
Name three drugs that can cause seizures.
Bupropion, imipenem/cilastatin, isoniazid
Which class of drugs can result in tardive dyskinesia?
What drugs can cause a disulfiram-like reaction?
Metronidazole, certain cephalosporins, procarbazine, first-generation sulfonylureas
Polymyxins are toxic to which organ systems?
Neural and renal; as a result it is usually only used topically
Which drugs can cause both ototoxicity and nephrotoxicity?
Aminoglycosides, vancomycin, loop diuretics, cisplatin
A 60-year-old man presents with sudden severe great toe pain. On microscopy, an aspirate of the joint shows crystals. His medications include daily baby aspirin, a thiazide diuretic to control hypertension, a ß-blocker to control a cardiac arrhythmia, and a nonsteroidal antiinflammatory drug for joint pain. Which of these medications likely contributed to his presentation?
What are the seven most common drugs that induce cytochrome P450 enzyme activity?
Quinidine, Barbituates, St. John's Wort, Phenytoin, Rifampin, Griseofulvin, Carbamazepine (remember: Queen Barb Steals Phen-phen and Refuses Greasy Carbs)
What are the six most common substances that inhibit cytochrome P450 enzyme activity?
Sulfonamides, Isoniazid, Cimetidine, Ketoconazole, Erythromycin, Grapefruit juice, Acute alcohol use (remember: Inhibit yourself from drinking beer from a KEG because it makes you Acutely SICk)
Which drug can both induce and inhibit different forms of cytochrome P450 enzymes? Is induction or inhibition its more significant effect?
Quinidine; induction is more significant
Ethylene glycol is converted to oxalic acid by which enzyme?
Alcohol dehydrogenase converts ethylene glycol into what?
What substance is converted to oxalic acid by alcohol dehydrogenase?
Ethylene glycol; it is usually found in antifreeze
What are two adverse effects of oxalic acid?
Acidosis and nephrotoxicity; oxalic acid crystalizes in the kidney to cause damage
What enzyme converts methanol to formaldehyde and formic acid?
What does alcohol dehydrogenase convert methanol into?
Formaldehyde and formic acid
What are two adverse effects of formaldehyde and formic acid?
Severe acidosis, retinal damage
Alcohol dehydrogenase converts what alcohol into formaldehyde and formic acid?
What enzyme converts ethanol to acetaldehyde?
Acetaldehyde dehydrogenase converts what substrate into acetic acid?
What does alcohol dehydrogenase convert ethanol into?
What enzyme that is involved in ethanol metabolism is inhibited by disulfiram?
Ethanol competes with what endogenous hormone substrate for binding in renal tubules?
Antidiuretic hormone; the result is a diuretic effect
Alcohol dehydrogenase converts what alcohol into acetaldehyde?
What are four adverse effects of acetaldehyde?
Nausea, headache, vomiting, hypotension
Alcohol dehydrogenase is involved in the metabolism of what three alcohols?
Ethylene glycol, methanol, and ethanol
Alcohol dehydrogenase is inhibited by what drug?
the drug can be used to prevent toxicities of methanol and ethylene glycol ingestions
Acetaldehyde dehydrogenase is inhibited by what drug?
the drug worsens the adverse effects of alcohol use and is also called Antabuse
What enzyme converts acetaldehyde to acetic acid?
What does acetaldehyde dehydrogenase convert acetaldehyde into?
Name the eight drugs that can cause allergic reactions in patients with known sulfa allergies.
Celecoxib, probenicid, furosemide, thiazides, trimethoprim/sulfamethoxazole, sulfonylureas, sulfasalazine, and sumitriptan
What are some clinical manifestations of sulfa allergic reactions?
Fever, pruritic rash, Stevens-Johnson syndrome, hemolytic anemia, thrombocytopenia, agranulocytosis, uriticaria (hives)
A patient presents to the emergency room with a fever, intensely pruritic rash, and urticaria. You ask her what medications she is taking, and she replies, "I can't remember the names, but I just switched to a different type of diuretic." What is a possible drug-related cause of her symptoms?
She is allergic to sulfa drugs and was just switched to furosemide or a thiazide