Pharmacology- Toxicities and side effects Flashcards by Ivan Roque Sanchez

Specific toxicity treatments

Acetaminophen
AChE inhibitors, organophosphates
Antimuscarinic, anticholinergic agents
Arsenic
Benzodiazepines

N-acetylcysteine (replenishes glutathione)

Atropine > pralidoxime

Physostigmine, control hyperthermia

Dimercaprol, succimer

Flumazenil

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Specific toxicity treatments

β-blockers
Carbon monoxide
Copper
Cyanide
Digitalis (digoxin)

Atropine, glucagon

100% O2, hyperbaric O2

Penicillamine, trientine

Nitrite + thiosulfate, hydroxocobalamin

Anti-dig Fab fragments

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Specific toxicity treatments

Heparin
Iron
Lead
Mercury Dimercaprol, succimer
Methanol, ethylene glycol (antifreeze)

Protamine sulfate

Deferoxamine, deferasirox, deferiprone

EDTA, dimercaprol, succimer, penicillamine

Dimercaprol, succimer

Fomepizole > ethanol, dialysis

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Specific toxicity treatments

Methemoglobin
OpiOids
Salicylates
TCAs
Warfarin

Methylene blue, vitamin C (reducing agent)

NalOxOne

NaHCO3 (alkalinize urine), dialysis

NaHCO3 (stabilizes cardiac cell membrane)

Vitamin K (delayed effect), fresh frozen plasma
(immediate)

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Drug reactions—cardiovascular

Coronary vasospasm
Cutaneous flushing
Dilated cardiomyopathy

Cocaine, Amphetamines, Sumatriptan, Ergot alkaloids (CASE)

Vancomycin, Adenosine, Niacin, Ca2+ channel blockers, Echinocandins, Nitrates (flushed from VANCEN [dancing])

Anthracyclines (eg, Doxorubicin, Daunorubicin); prevent with Dexrazoxane

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Drug reactions—cardiovascular

- Torsades de pointes

Agents that prolong QT interval: “ABCDE”

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

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Drug reactions—endocrine/reproductive

Adrenocortical insufficiency
Diabetes insipidus
Hot flashes
Hyperglycemia

HPA suppression 2° to glucocorticoid withdrawal.

Lithium, demeclocycline

SERMs (eg, tamoxifen, clomiphene, raloxifene)

Tacrolimus, Protease inhibitors, Niacin, HCTZ, Corticosteroids

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Drug reactions—endocrine/reproductive

Hyperprolactinemia
Hyperthyroidism
Hypothyroidism
SIADH

Typical antipsychotics, atypical antipsychotics, metoclopramide, methyldopa.

Lithium, amiodarone

AMiodarone, SUlfonamides, Lithium

“Can’t Concentrate Serum Sodium”
Carbamazepine, Cyclophosphamide, SSRIs

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Drug reactions—gastrointestinal

Acute cholestatic hepatitis, jaundice
Diarrhea
Focal to massive hepatic necrosis
Hepatitis

Macrolides

Acamprosate, antidiabetic agents (acarbose, metformin, pramlintide), colchicine, cholinesterase inhibitors, lipid-lowerin agents (eg, ezetimibe, orlistat), macrolides (eg,
erythromycin), quinidine, SSRIs

HAVA: Halothane, Amanita phalloides (death cap mushroom), Valproic acid, Acetaminophen

Rifampin, isoniazid, pyrazinamide, statins, fibrates

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Drug reactions—gastrointestinal

Pancreatitis
Pill-induced esophagitis
Pseudomembranous colitis

Didanosine, Corticosteroids, Alcohol, Valproic acid, Azathioprine, Diuretics (furosemide, HCTZ).

Bisphosphonates, ferrous sulfate, NSAIDs, potassium chloride, tetracyclines.

Ampicillin, cephalosporins, clindamycin, fluoroquinolones

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Drug reactions—hematologic

Agranulocytosis
Aplastic anemia

“Can Cause Pretty Mayor Collapse of Granulocytes” Clozapine, Carbamazepine, Propylthiouracil, Methimazole, Colchicine, Ganciclovir.

“Cant Make New Blood Cells Properly”
Carbamazepine, Methimazole, NSAIDs, Benzene, Chloramphenicol, Propylthiouracil

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Drug reactions—hematologic

Direct Coombs positive hemolytic anemia
eosinophilia and systemic symptoms
Gray baby syndrome
Thrombocytopenia

“P Diddy Coombs”
Penicillin, methylDopa, Cephalosporins

Allopurinol, anticonvulsants, antibiotics, sulfa drugs

Chloramphenicol

“Help Very Low platelets”
Heparin, Vancomycin, Linezolid

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DRESS

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.

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Drug reactions—hematologic

Hemolysis in G6PD deficiency
Megaloblastic anemia
Thrombotic complications

“hemolysis IS D PAIN”
Isoniazid, Sulfonamides, Dapsone, Primaquine, Aspirin, Ibuprofen, Nitrofurantoin.

Hydroxyurea, Phenytoin, Methotrexate, Sulfa drugs

Combined oral contraceptives, hormone replacement therapy, SERMs. *estrogens side effect

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Drug reactions—musculoskeletal/skin/connective tissue

Lupus
Fat redistribution
Gingival hyperplasia

“having lupus is Mega “SHIPP-E”
Methyldopa, Sulfa drugs, Hydralazine, Isoniazid, Procainamide, Phenytoin, Etanercept

Protease inhibitors, Glucocorticoids

“Can Caus Puffy gums”
Cyclosporine, Ca2+ channel blockers, Phenytoin

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Drug reactions—musculoskeletal/skin/connective tissue

Hyperuricemia (gout)
Myopathy
Osteoporosis

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“Painful Tophy and Feet Need Care”
Pyrazinamide, Thiazides, Furosemide, Niacin, Cyclosporine.

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

Corticosteroids, depot medroxyprogesterone acetate, GnRH agonists, aro.matase inhibitors, anticonvulsants, heparin, PPIs

Drug reactions—musculoskeletal/skin/connective tissue

Photosensitivity
Rash (Stevens- Johnson syndrome)
Teeth discoloration
Tendon and cartilage damage

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“SAT For PHOTO”
Sulfonamides, Amiodarone, Tetracyclines, 5-FU

Anti-epileptic drugs (especially lamotrigine), allopurinol, sulfa drugs, penicillin

Tetracyclines

Fluoroquinolones

Drug reactions—neurologic

Cinchonism
Parkinson-like syndrome
Peripheral neuropathy
Pseudotumor cerebri

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Quinidine, quinine

“ARM” Antipsychotics, Reserpine, Metoclopramide

Phenytoin, vincristine

Growth hormones, tetracyclines, vitamin A

Cinchonism

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Can present with tinnitus, hearing/vision loss,

psychosis, and cognitive impairment

Drug reactions—neurologic

Seizures
Tardive dyskinesia

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“with seizures I BITE my tounge “
Isoniazid (vitamin B6 deficiency), Bupropion, Imipenem/cilastatin, Tramadol, Enflurane

Antipsychotics, metoclopramide

Drug reactions—neurologic

- Visual disturbance

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“These Drugs Disturbe Very Pretty Eyes”

Topiramate (blurred vision/diplopia, haloes),
Digoxin (yellow-tinged vision),
Isoniazid (optic neuropathy/color vision changes), Vigabatrin (bilateral visual field defects),
PDE-5 inhibitors (blue-tinged vision),
Ethambutol (color vision changes)

Drug reactions—renal/genitourinary

Fanconi syndrome
Hemorrhagic cystitis
Interstitial nephritis

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Cisplatin, ifosfamide, expired tetracyclines, tenofovir

Cyclophosphamide, ifosfamide. *prevent by coadministering with mesna

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

Drug reactions—respiratory

Dry cough
Pulmonary fibrosis

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ACE inhibitors

“My Nose Cannot Breath Bad Air”
Methotrexate, Nitrofurantoin, Carmustine, Bleomycin, Busulfan, Amiodarone

Drug reactions—multiorgan Drug Reaction:

Antimuscarinic
Disulfiram-like reaction
Nephrotoxicity/ ototoxicity

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Atropine, TCAs, H1-blockers, antipsychotics

“Sorry Pals Cannot Go Mingle”
1st-generation Sulfonylureas, Procarbazine,
certain Cephalosporins, Griseofulvin, Metronidazole

Loop diuretics, Aminoglycosides, cisPlatin, Vancomycin, amphoTERicin B.

Drugs affecting pupil size | - Midriasis

Anticholinergics (atropine, TCA, tropicamide, scopolamine, antihistamines) Drugs of abuse (amphetamines, cocaine, LSD) Sympathomimetics

Drugs affecting pupil size | - Miosis

Antipsychotics (haloperidol, risperidone, olanzapine) Drugs of abuse (eg, heroin/opioids) Parasympathomimetics (pilocarpine), organophosphates

Cytochrome P-450 interactions (selected) | - Inducers

"Most chronic alcoholics Steal Phen-Phen and Never Refuse Greasy Carbs" ``` Modafinil Chronic alcohol use St. John’s wort Phenytoin Phenobarbital Nevirapine Rifampin Griseofulvin Carbamazepine ```

Cytochrome P-450 interactions (selected) | - Substrates

"Always Think When Outdoors" Anti-epileptics Theophylline Warfarin OCPs

Cytochrome P-450 interactions (selected)

"SICKFACES.COM (when I Am drinking Grapefruit juice)" ``` Sodium valproate Isoniazid Cimetidine Ketoconazole Fluconazole Acute alcohol abuse Chloramphenicol Erythromycin/clarithromycin Sulfonamides Ciprofloxacin Omeprazole Metronidazole Amiodarone Grapefruit juice ```

Sulfa drugs

"Scary Sulfa Pharm FACTS" Sulfonamide antibiotics, Sulfasalazine, Probenecid, Furosemide, Acetazolamide, Celecoxib, Thiazides, Sulfonylureas. Patients with sulfa allergies may develop fever, urinary tract infection, Stevens- Johnson syndrome, hemolytic anemia, thrombocytopenia, agranulocytosis, acute interstitial nephritis, and urticaria (hives).

Drug Names

Pag. 248

Pharmacology- Toxicities and side effects Flashcards

(31 cards)