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Flashcards in Pharmacology - Toxicities & Side Effects Deck (115):
1

What is the antidote for acetaminophen overdose?

N-acetylcysteine

2

What are the two treatments for salicylate overdose?

Alkalinization of urine and dialysis if necessary

3

What compound is used to alkalinize urine?

NaHCO3; weak acids are better excreted when the urine is alkaline

4

What is the treatment for amphetamine overdose?

NH4Cl

5

Amphetamines are _____ (acidic/basic); therefore, overdose is treated with _____ (NH4Cl/NaHCO3) to _____ (acidify/alkalinize) the urine.

Basic; NH4Cl; acidify

6

What are the two antidotes for anticholinesterase toxicity?

Atropine to block cholinergic receptors and pralidoxime to regenerate acetylcholinesterase

7

What are the antidotes for organophosphate poisoning?

Atropine and pralidoxime; organophosphates inhibit acetylcholinesterase

8

What is the antidote for toxicity caused by anticholinergic agents?

Physostigmine; it inhibits acetylcholinesterase, increasing the available acetylcholine to overcome anticholinergic toxicity

9

Physostigmine is the antidote for toxicity caused by what two types of agents?

Antimuscarinic agents and anticholinergic agents

10

What is the antidote for β-blocker toxicity?

Glucagon

11

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

12

What is the antidote for iron toxicity?

Deferoxamine, a chelating agent

13

What are four treatments for lead poisoning?

Edetate calcium disodium, dimercaprol, succimer, and penicillamine

14

Penicillamine is the antidote for toxicity caused by what substances?

Copper, arsenic, gold

15

What are three treatments for arsenic poisoning?

Dimercaprol, succimer, penicillamine

16

What are two treatments for mercury poisoning?

Dimercaprol and succimer

17

What are three treatments for gold poisoning?

Dimercaprol, succimer, penicillamine

18

Dimercaprol and succimer are the antidotes for toxicity caused by what substances?

Mercury, arsenic, gold

19

The combination of thiosulfate and nitrite is the antidote for toxicity caused by what substance?

Cyanide

20

Hydroxocobalamin is the antidote for toxicity caused by what substance?

Cyanide

21

What are the treatments for cyanide poisoning?

Hydroxocobalamin, or a combination of nitrite and thiosulfate

22

What is the treatment for methemoglobinemia?

Methylene blue, vitamin C

23

Methylene blue is used to treat elevated serum levels of what substance?

Methemoglobin

24

What are the treatments for carbon monoxide poisoning?

100% oxygen and hyperbaric oxygen

25

What are the treatments for methanol and ethylene glycol (antifreeze) poisoning?

Ethanol, dialysis, and fomepizole

26

Fomepizole is an antidote for toxicity caused by what substances?

Methanol, ethylene glycol

27

What are the antidotes for opioid overdose?

Naloxone or naltrexone

28

Naloxone is the antidote for overdose of what substance?

Opioids

29

What is the antidote for benzodiazepine overdose?

Flumazenil; it reduces the action of benzodiazepines at γ-aminobutyric acid receptors

30

Flumazenil is the antidote for overdose of what substance?

Benzodiazepines

31

What is the treatment for tricyclic antidepressant overdose?

Sodium bicarbonate; it can prevent cardiac arrhythmias

32

Alkalinization of the serum with sodium bicarbonate is a treatment for overdose with what class of antidepressant medications?

Tricyclic antidepressants; the alkalinization can prevent cardiac arrhythmias

33

What is the reversal agent for heparin?

Protamine

34

Protamine is used to reverse the effects of what pharmacologic agent?

Heparin; however, it does not reverse low-molecular-weight heparin

35

What agents are used to reverse the effects of warfarin?

Vitamin K and fresh frozen plasma

36

Vitamin K is used to reverse the effects of what pharmacologic agent?

Warfarin

37

What agent is used to reverse the effects of both tissue plasminogen activator and streptokinase?

Aminocaproic acid

38

Aminocaproic acid is used to reverse the effects of what two pharmacologic enzymes?

Tissue plasminogen activator and streptokinase

39

What is the antidote for theophylline?

β-Blockers

40

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?

N-acetylcysteine

41

Which component of multivitamins is the most likely to cause fatal overdose in children?

Iron

42

What is the mechanism of cell death in iron poisoning?

Peroxidation of membrane lipids

43

What will a patient with acute iron poisoning present with?

Gastric bleeding

44

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

45

Which antidepressants can cause tachycardia due to anticholinergic action?

Tricyclic antidepressants

46

Which drugs can cause coronary vasospasm?

Cocaine and sumatriptan

47

Which drugs can cause cutaneous flushing as an adverse effect?

Vancomycin, adenosine, niacin, calcium channel blockers (remember: VANC)

48

Which drugs cause dilated cardiomyopathy?

Doxorubicin (Adriamycin), daunorubicin

49

Which drugs can cause torsades de pointes?

Class III (sotalol) and class IA (quinidine) antiarrhythmic agents, cisapride

50

What cardiac adverse effect can result from either cocaine or sumatriptan use?

Coronary vasospasm

51

What is the major adverse effect of niacin use?

Flushing

52

Which drugs can cause agranulocytosis as an adverse effect?

Clozapine, carbamazepine, colchicine, propylthiouracil, methimazole

53

Which drugs (or exposures) can cause aplastic anemia as an adverse effect?

Chloramphenicol, benzene, nonsteroidal antiinflammatory drugs, propylthiouracil, methimazole

54

Which antihypertensive drug can cause hemolytic anemia?

α-Methyldopa

55

Which antibiotic can cause "grey baby syndrome"?

Chloramphenicol

56

Which drugs can cause hemolytic anemia in G6PD-deficient patients?

Isoniazid, Sulfonamides, Primaquine, Aspirin, Ibuprofen, Nitrofurantoin (remember: hemolysis IS PAIN)

57

Which drugs can cause megaloblastic anemia?

Phenytoin, Methotrexate, Sulfa drugs (remember: Having a blastwith PMS)

58

What is a major adverse effect of oral contraceptives?

Thrombotic events such as deep vein thrombosis and pulmonary embolus

59

Which antihypertensive drug can cause chronic cough?

Angiotensin-converting enzyme inhibitors

60

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

61

Which drugs can cause pulmonary fibrosis?

Bleomycin, busulfan, amiodarone

62

What adverse effect would you suspect in a newly jaundiced patient recently started on azithromycin?

Acute cholestatic hepatitis

63

Which drugs (or exposures) can cause hepatic necrosis?

Halothane, valproic acid, acetaminophen, Amanita phalloides

64

What effect can isoniazid have on the liver?

Hepatitis

65

Which drugs can cause pseudomembranous colitis?

Clindamycin and ampicillin are commonly implicated, but many antibiotics can be responsible

66

Administration of clindamycin or ampicillin can cause overgrowth of which bacteria in the colon?

Clostridium difficile, which leads to pseudomembranous colitis

67

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

68

Which drugs are known to cause gynecomastia?

Spironolactone, Digitalis, Cimetidine, Alcohol (chonic use), estrogens, Ketoconazole (remember: Some Drugs Create Awesome Knockers)

69

Which drugs can cause hot flashes?

Tamoxifen, clomiphene

70

Which drug can cause gingival hyperplasia?

Phenytoin

71

Which drugs can cause gout?

Furosemide and thiazide diuretics

72

Osteoporosis can be caused by long-term use of which drugs?

Steroids, heparin

73

Which drugs induce photosensitivity?

Sulfonamides, Amiodarone, Tetracyclines (remember: SATfor a photo)

74

Which drugs can cause Stevens-Johnson syndrome?

Ethosuximide, lamotrigine, carbamazepine, phenobarbital, phenytoin, sulfa drugs, penicillin, allopurinol; think anticonvulsants and antibiotics

75

Which drugs can cause a lupus-like syndrome?

Hydralazine, Isoniazid, Procainamide, Phenytoin (remember: it's not HIPP to have lupus)

76

Which adverse effects of fluoroquinolones are specific to children?

Tendonitis, tendon rupture, and cartilage damage

77

Which drug can cause Fanconi's syndrome if taken after its expiration date?

Tetracycline

78

Which drugs can cause interstitial nephritis?

Methicillin, nonsteroidal antiinflammatory drugs, and furosemide

79

Which two drugs can cause hemorrhagic cystitis?

Cyclophosphamide and ifosfamide

80

Which drug is administered to prevent hemorrhagic cystitis from the use of ifosfamide or cyclophosphamide?

Mesna

81

Name two drugs that can cause cinchonism.

Quinidine and quinine; cinchonism describes headache and tinnitus

82

Which adverse effect of lithium can cause hypernatremia?

Diabetes insipidus

83

Name two drugs that can cause diabetes insipidus.

Lithium and demeclocycline

84

Name three drugs that can cause seizures.

Bupropion, imipenem/cilastatin, isoniazid

85

Which class of drugs can result in tardive dyskinesia?

Antipsychotics

86

What drugs can cause a disulfiram-like reaction?

Metronidazole, certain cephalosporins, procarbazine, first-generation sulfonylureas

87

Polymyxins are toxic to which organ systems?

Neural and renal; as a result it is usually only used topically

88

Which drugs can cause both ototoxicity and nephrotoxicity?

Aminoglycosides, vancomycin, loop diuretics, cisplatin

89

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?

Thiazide diuretics

90

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)

91

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 KEGbecause it makes you Acutely SICk)

92

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

93

Ethylene glycol is converted to oxalic acid by which enzyme?

Alcohol dehydrogenase

94

Alcohol dehydrogenase converts ethylene glycol into what?

Oxalic acid

95

What substance is converted to oxalic acid by alcohol dehydrogenase?

Ethylene glycol; it is usually found in antifreeze

96

What are two adverse effects of oxalic acid?

Acidosis and nephrotoxicity; oxalic acid crystalizes in the kidney to cause damage

97

What enzyme converts methanol to formaldehyde and formic acid?

Alcohol dehydrogenase

98

What does alcohol dehydrogenase convert methanol into?

Formaldehyde and formic acid

99

What are two adverse effects of formaldehyde and formic acid?

Severe acidosis, retinal damage

100

Alcohol dehydrogenase converts what alcohol into formaldehyde and formic acid?

Methanol

101

What enzyme converts ethanol to acetaldehyde?

Alcohol dehydrogenase

102

Acetaldehyde dehydrogenase converts what substrate into acetic acid?

Acetaldehyde

103

What does alcohol dehydrogenase convert ethanol into?

Acetaldehyde

104

What enzyme that is involved in ethanol metabolism is inhibited by disulfiram?

Acetaldehyde dehydrogenase

105

Ethanol competes with what endogenous hormone substrate for binding in renal tubules?

Antidiuretic hormone; the result is a diuretic effect

106

Alcohol dehydrogenase converts what alcohol into acetaldehyde?

Ethanol

107

What are four adverse effects of acetaldehyde?

Nausea, headache, vomiting, hypotension

108

Alcohol dehydrogenase is involved in the metabolism of what three alcohols?

Ethylene glycol, methanol, and ethanol

109

Alcohol dehydrogenase is inhibited by what drug?

Fomepizole; the drug can be used to prevent toxicities of methanol and ethylene glycol ingestions

110

Acetaldehyde dehydrogenase is inhibited by what drug?

Disulfiram; the drug worsens the adverse effects of alcohol use and is also called Antabuse

111

What enzyme converts acetaldehyde to acetic acid?

Acetaldehyde dehydrogenase

112

What does acetaldehyde dehydrogenase convert acetaldehyde into?

Acetic acid

113

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

114

What are some clinical manifestations of sulfa allergic reactions?

Fever, pruritic rash, Stevens-Johnson syndrome, hemolytic anemia, thrombocytopenia, agranulocytosis, uriticaria (hives)

115

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

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