ADR's

Question 1

Urticaria (Hives)

Answer 1

Type I

Immune mediated: B lactams

Non-immune: Contrast dye, morphine

Question 2

Angioedema

Answer 2

Type I

ACE-I

Question 3

Anaphylaxis

Answer 3

Type I

B-lactams > FQ’s

Question 4

Serum Sickness

Answer 4

Type III

cefaclor & sulfonamides

Question 5

Hypersensitivity

Vasculitis

Answer 5

Type III

B-lactams
sulfonamides

Question 6

Drug-induced exanthems

Answer 6

Type IV
Most common cutaneous drug rxn (maculopapular rash)

B-lactams, sulfonamides

Question 7

Erythroderma, exfoliative dermatitis

Answer 7

Type IV

B-lactams
sulfonamides

Question 8

Steven Johnson Syndrome

TEN

Answer 8

Type IV

MM involvement (oral, conjunctiva, genital)

phenytoin
carbamazepine 
lamotrigine 
sulfonamides 
allopurinol

Question 9

DRESS

Answer 9

Type IV

Eosinophilia

anti-seizure meds (CBZ > VPA, phenytoin, lamotrigine)
sulfonamides
allopurinol

Question 10

Fixed Drug Eruption

Answer 10

Type IV

TMP/SMX
NSAIDS

Question 11

Drug-induced photosensitivity

Answer 11

Rx: Exaggerated sunburn on skin

FQ’s
Tetracyclines (doxy)
Amiodarone
Topical retinoids

Tx: sun protection, stop drug, cool compress

Question 12

Drug-induced alopecia

Answer 12

Anagen effluvium:
bleomycin, cyclophosphamide, fluorouracil

Telogen effluvium:
interferons, Li+, isotretinoin, valproate, warfarin

Question 13

Drug-induced melanonychia

Answer 13

AZT, minocycline, chemo

beau’s lines: chemo

Question 14

Drug-induced hyperpigmentation

Answer 14

minocycline

amiodarone

Question 15

Esophagitis

Answer 15

Bisphosphonates
Tetracyclines
NSAIDS

Tx: drink full glass of water, don’t lie down after med

Question 16

Pancreatitis

Answer 16

Isotretinoin - INC trigs
NRTI’s (ddl, D4T) - intrinsic toxicity

PEARL: all statins and most ACEI

Question 17

Liver Injury

Answer 17

MC cause of acute liver failure

APAP (#1)
INH (#2)
PTU (#3)
clavulanate

Pearl: MC reason for drug withdrawal from market

Question 18

Diarrhea

Answer 18

antacids 
ABX
PPIs
NSAIDS
caffeine 
chemo

Question 19

HTN

Answer 19

INC SBP by 10-20mmHg

stimulants (methylphenidate, cocaine)
transplant meds
corticosteroids 
EPO
NSAIDS
sympathomimetics 

Tx: d/c drug, lower dose, or add CCB or ACEI/ARB

Question 20

Lipid alterations

Answer 20

Hormones (estrogen, androgens, testosterone)
Glucocorticoids
Transplant meds 
Thiazide diuretics 
Protease inhibitors 
Valproate

Question 21

QT prolongation

Answer 21

5 A's:
anti-arrhythmics
antimicrobials (macrolides, FQ) 
anti-psychotics (haloperidol )
antidepressants (TCAs)
antiemetics (promethazine)  

Tx: ECG and monitor closely if QT > 500

Question 22

Raynaud’s

Answer 22

Triptans/ergots 
oral decongestants 
caffeine 
nicotine 
phentermine

Question 23

Edema

Answer 23

DHP CCB’s (amlodipine)
Thiazolidinedione’s (pioglitazone)
Gabapentin, pregabalin

Tx: lifestyle (reduce Na, elevate legs, exercise, compression stockings)

Question 24

Bronchospasm

Answer 24

B blockers
Cocaine
IV contrast
ASA*/NSAIDs/MDI propellants

Tx: withdrawal, O2, +/- steroids

Question 25

Acute/Subacute Pneumonitis

Answer 25

Days/months post exposure, constitutional symptoms, dyspnea, non-productive cough Amiodarone Tx: withdrawal, O2, +/- steroids

Question 26

Pulmonary Fibrosis

Answer 26

Months to years after exposure, insidious DOE, nonproductive cough Methotrexate Bleomycin Nitrofurantoin Tx: withdrawal, O2, +/- steroids

Question 27

Lupus

Answer 27

F/c, malaise, pleuritis/effusion, pneumonitis, myalgias Procainamide Hydralazine Isoniazid Tx: withdrawal, O2

Question 28

Pleural Effusion

Answer 28

Methotrexate Nitrofurantoin Phenytoin Tx: none

Question 29

Discoloration of Urine: 1. Yellow-brown 2. Yellow-orange 3. Red-orange/pink 4. Red-brown: 5. Brown-black 6. Blue +/- green

Answer 29

1. Nitrofurantoin, SMX 2. Phenazopyridine, entacapone 3. Rifampin* 4. Warfarin/Heparin (hematuria)* 5. Metronidazole, nitrofurantoin 6. Amitriptyline, Propofol, triamterene

Question 30

Nephrotoxicity 1. Altered intraglomerular hemodynamics* 2. Tubular cell toxicity* 3. Inflammation* 4. Crystal nephropathy 5. Rhabdomyolysis 6. Thrombotic microangiopathy

Answer 30

1. NSAIDs, ACEIs/ARBs 2. Abx (aminoglycosides) 3. Beta lactams (PCN/ampicillin), FQs, NSAIDs, AEDs 4. Acyclovir, triamterene, methotrexate 5. Statins 6. Clopidogrel

Question 31

Male Infertility 1. Impaired spermatogenesis/function 2. Decreased testosterone 3. Inhibition of GnRH or gonadotropin secretion 4. Decreased libido

Answer 31

1. 5-alpha reductase inhibitors, alpha blockers, alkylating meds, anti-androgens, AE, azathioprine 2. Opioids, oral corticosteroids, spirinolactone 3. Anti-androgens, antipsychotics, cannabinoids, GnRH analogues, opioids, testosterone, androgenic steroids 4. SSRI, SNRI, TCA, MAOI, antipsychotics, lithium, alpha blockers, thiazides, allopurinol