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Pharmacology II - EXAM 2 > Adverse Drug Reactions > Flashcards

Adverse Drug Reactions Flashcards

1
Q

What SERIOUS ADRs are associated with Triptans?

A 
Coronary artery Vasospasm
Transient MI
MI
Ventricular Tachycardia/Fibrillation
HTN
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2
Q

What are more COMMON ADRs associated with Triptan use?

A 
Paresthesias
Fatigue
Flushing
Chest Tightness 
Swelling
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3
Q

What is St. Anthony’s Fire?

What class of HA treatment medications is it associated with?

A

Associated with Ergotamines

Sx include......
Headache
Emesis
Diarrhea
Gangrene
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4
Q

Why is life-threatening ischemia associated with erogtamines?

A

When administered with CYP3A4 inhibitors (such as macrolides) it increases ergot levels leading to an increased risk of ischemia

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5
Q

What COMMON ADRs are associated with ergotamines?

A 
Nausea
Emesis
Abdominal Pain
Weakness
Parethesias
Myalgia
Diarrhea
Chest Tightness
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6
Q

Does Butorphanol have addictive properties?

A

Yes

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7
Q

What COMMON ADRs are associate with Butorphanol?

Remember: This is a partial opioid agonist

A 
Somnolence
Dizziness
Nausea
Emesis
Nasal Congestion
Insomnia
Respiratory Depression
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8
Q

What COMMON ADRs are associated with Fiorinal/Fioricet?

A

Nausea
Drowsiness
Dizziness
Abdominal Pain

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9
Q

If Fiorinal or Fioricet are overused (more than 2x weekly) what an occur?

A

Rebound-Headache from withdrawal

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10
Q

What ADRs are seen with IV metoclorpamide use for headache treatment?

A

Akathisia

Drowsiness

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11
Q

Why should you use PA-free formulations of butterbur?

A

Because the PA forms are associated with Hepatoxicity

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12
Q

What psychiatric warnings are associated with interferon beta?

A

Depression

Suicidal Ideation

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13
Q

What organotoxicity is associated with Interferon Beta?

A

Hepatotoxicity

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14
Q

Is CHF a potential warning of interferon beta?

A

Yes

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15
Q

What COMMON ADRs are seen with interferon Beta?

A

Flu-like Symptoms (Fever, mayalgia)
Insomina
Injection Site Reaction
Edema

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16
Q

Can you see HTN with Interferon Beta?

A

Yes

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17
Q

What can be given prior to injection of Interferon Beta to prevent the flu-like reaction?

A

Acetaminophen/Ibuprofen

30 minutes prior

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18
Q

What post-injection reactions are seen in Glutiramer Acetate?

A 
Flushing
Chest Pain
Palpitations
Anxiety
Urticaria
Throat Constriction
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19
Q

Can a patient undergoing Glatiramer Acetate injections for MS treatment have Lipoatrophy or skin necrosis at the injection site?

A

Yes

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20
Q

What organotoxicity is associated with Mitoxantrone?

What should be done to monitor this?

A

Cardiotoxicity

Need Baseline LVeF
Repeat before each dose

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21
Q

What can be seen when Mitoxantrone is used for leukemia?

A

Myelosuppression

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22
Q

T/F: Secondary AML is seen with Mitoxantrone use

A

True

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23
Q

What are COMMON ADRs seen with Mitoxantrone?

A

Nausea
Alopecia
Menstrual Changes
UTI / URI

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24
Q

An MS patient presents complaining of a her urine now appearing a “blue-green” color…..

What medication is likely the culprit?

A

Mitoxantrone

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25
Q

Progressive Multifocal Leukoencephalopathy is associated with what MS medication?

A

Natalizumab

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26
Q

Would you expect to see leukopenia or leukocytosis with Dimethyl Fumarate?

A

Leukopenia

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27
Q

What ADRs are associated with Dimethyl Fumarate?

A

Flushing, Redness (Due to it’s metabolite)
Rash
N/V/D
Abdominal Pain

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28
Q

What organotoxicity is NEWLY associated with Dimethyl Fumarate?

A

Hepatotoxicity

Normalizes after stopping medication

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29
Q

First-dose bradycardia is associated with what MS medication?

A

Fingolimod

EKG prior to dosing and monitor 6 hours after dose

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30
Q

Varicella Zoster is associated with what MS medication?

A

Fingolimod

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31
Q

Is Fingolimod associated with increased or decreased mortality?

A

Increased

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32
Q

What COMMON ADRs are associated with Fingolimod?

A 
Headache
Influenza 
Diarrhea
Back Pain
Abnormal LFTs
Cough
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33
Q

Is Teriflunomide teratogenic?

A

Yes

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34
Q

What organotoxicitiy is associated with teriflunomide?

A

Hepatotoxicity

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35
Q

Other than hepatotoxicity and teratogenicity, what serious ADRs are associated with Teriflunomide?

A

Neuropathy
Bone MArrow Supressions
Hyperkalemia
Transient Renal Failure

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36
Q

What ADRs are associated with Dantrolene?

A

Drowsiness
Dizziness
Malaise
Diarrhea

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37
Q

What ADRs are associated with Nudexta?

A

N/V/D

Cough

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38
Q

What lab needs to be monitored in patients on Levodopa?

A

LFTs

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39
Q

What ADR is seen commonly in patients who are on Levodopa long-term?

A

Dyskinesia (Choreiform Movements)

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40
Q

What is the “on-off” effect of Levodopa?

What medication class is used to “smooth” this out?

A

Off - Akinesia
On - Dyskinesia

This is due to fluctuations in Levodopa concentrations

Dopamine Receptor Agonist

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41
Q

What ADRs are associated with Levodopa?

A

Nausea
Anorexia Hypotension

Confusion
Insomnia

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42
Q

What psychiatric like syndrome is associated with Levodopa?

A

Schizophrenic-like syndrome

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43
Q

What ADRs are associated with Dopamine Receptor agonists?

A 
Anoreaxia
hypotension
Nausea
Emesis
Hallucinations
Sedation
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44
Q

Are cardiac arrhythmias a possible ADR of dopamine receptor agonists?

A

Yes

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45
Q

When Ergot DRA (Bromocriptine, Cabergoline) are used at Parkinson’s doses, what is a potiental ADR?

A

Cardiovulvopathy

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46
Q

Which Non-Ergot DRA is associated with sudden somnolence?

A

Rotigotine (Transdermal)

Patients on this should not drive

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47
Q

What may occur if metoclopramide is given with a DRA or Levodopa?

This makes it hard to distinguish what?

A

Tardive Dyskinesia

In Parkinson’s patients this would make it hard to distinguish if this was a side effect of metoclopramida or worsening Parkinson’s

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48
Q

If Selegiline or Rasagiline where given to a cocaine abuser, what may occur?

A

Fatal Hyperthermia

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49
Q

Selegiline blocks MAO-A at high doses…..

What ADR may be seen if this occurs?

A

HTN Crisis

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50
Q

What potential organtoxicity is seen in patients on Talcapone?

A

Hepatootoxicity

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51
Q

A Parkinson’s patients presents complaining of an orange discoloration to his urine…..

What class of medication is likely the culprit?

A

COMT Inhibitors

Talcapone
Entacapone

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52
Q

What COMMON ADRs are associated with COMT inhibitors?

A

Diarrhea
Abdominal Pain
Orthostatic Hypotension
Sleep Disturbance

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53
Q

What ADRs are associated with Amantadine?

A

CNS (Restlessness, Depression, Insomnia, Agitation, Hallucinations, Seizures)

54
Q

What dose of Amantadine is potentially fatal?

55
Q

What ADRs are associated with Trihexyphenidyl and Benzotrpine?

A 
Dry Mouth
Lack of Diaphoresis
Urinary Retention
Constipation
Drowsiness
Confusion
56
Q

What ADRs are associated with Pimavanserin?

A 
Peripheral Edema
Nausea
Confusion
Hallucinations
Constipation
Gait Changes
57
Q

What ADRs are associated with Safinamide?

A

Dyskinesia
Falls
Nausea

58
Q

T/F: Retinopathy is associated with Safinamide

59
Q

Is a patient on Safinamide more likely to experience hypotension or hypertension?

60
Q

What ADRs are common amongst all Cholinesterase Inhibitors?

61
Q

Which Cholinesterase Inhibitor is associated with muscle cramps?

62
Q

Which Cholinesterase Inhibitors are associated with weight loss?

A

Rivastigmine

Galantamine

63
Q

T/F: Rivastigmine is associated with Hepatotoxicity

64
Q

What ADRs are associated with Memantine?

A 
Agitation
Diarrhea
Insomnia
Dizziness
Headache
Hallucinations
65
Q

Overdose of Pyridostigmine is associated with what crisis?

How is this tested?

How would this crisis be treated?

A

Cholinergic Crisis

Tesilon Test (Endrophonium)

If Weakness worsens = Cholinergic Crisis which is treated with atropine

If weakness improves = Myasthenia Crisis

66
Q

What COMMON ADRs are seen with pyridostigmine?

A 
Rash
N/V/D
Increased Salivation
Increased Bronchial Secretion
Miosis
Diaphoresis
67
Q

Riluzole can show an elevated in what lab value?

68
Q

What are pulmonary side effects of Riluzole?

A

Decreased lung function

PNA

69
Q

T/F: Vertigo is an associated ADR with Riluzole

70
Q

What ADRs are associated with Edaravone?

A

Anaphlyaxis
Bruising
Gait Disturbance

71
Q

What psychiatric ADRs are seen with tetrabenazine?

A

Depression

SI

72
Q

What is the MAXIMUM DAILY DOSE of Acetaminophen for adults?

Pediatrics (< 12 y.o.)

A

Adults: 4 grams daily

Peds: 5 doses of 50/75 mgs/kg

73
Q

T/F: Acetaminophen is the leading cause of liver failure in the USA

74
Q

At what dose does acetaminophen become hepatotoxic?

Fatal?

A

Hepatotoxic: 10 - 15 grams

Fatal: >20 g

75
Q

P450 2E1 _______ (inducers/inhibitors) may result in acetaminophen toxicity.

76
Q

Consuming what in combination with acetaminophen could lead to toxicity?

77
Q

Acetaminophen toxicity leads to metabolism of what toxic metabolite?

78
Q

Acetaminophen has the potential to be toxic to which organs?

A

Liver
Renal (ATN)
Heart
Pancreas

79
Q 
Nausea
Emesis
Acidosis
AMS
Elevated PT/INR

….. Are all Sx of what?

A

Acetaminophen OD

80
Q

Asymptomatic
Normal LFTs
No Liver Injury

……Is what stage of acetaminophen OD?

81
Q 
72-96 Hours
Hepatic Failure
Encephalopathy
AST/ALT > 10,000
Potentially Fatal Stage

……Is what stage of acetaminophen OD?

82
Q

24-36 Hours
AST > 1,000
RUQ Pain / Hepatomegaly
Increase PT, BUN, sCr

……Is what stage of acetaminophen OD?

83
Q

What stage of acetaminophen OD is considered recovery?

84
Q

What side effects are associated with N-acetylcysteine, especially the IV administration?

A 
Anaphylaxis: 
Urticaria
Flushing
N/V
Bronchospasms (Potetially Fatal)
85
Q

Why are NSAIDs associated with renal ischemia?

In what conditions does this risk increase?

A

Because they inhibit prostaglandins which help to maintain renal blood flow

CHF
CKD
Cirrhosis

86
Q

Why should NSAIDs be avoided in the 3rd trimester of pregnancy?

A

May prematurely close PDA

87
Q

What ADRs are COMMONLY associated with NSAIDs?

A 
Nausea
Dyspepsia
Abdominal Pain
Flatulence
Diarrhea
88
Q

What GI risks are associated with NSAID use?

What are examples of medications that can be used to reduced this risk?

A

Peptic Ulcers
GI Bleeding

Naproxen/Esomeprozole
Ibuprofen/Famotidine
ASA/Omeprazole
Mistoprostol

89
Q

What is the MOST COMMON ADR associated with Mistoprostol?

What are additional ADRs?

A

DIARRHEA

Nausea
Abdominal Pain

90
Q

Why is Mistorporstol Pregnancy Category X?

A

Abortifacient Effect

Teratogenicity

91
Q

Should NSAIDs be used for pain control following cardiac surgery?

92
Q

What renal effects can be seen in patients using NSAIDs?

What patients at at increased risk for these?

A

Renal Insufficiency
Hyperkalemia
Renal Papillary Necrosis

CHF
CKD
Elderly
Medications (Diuretics, ACEi, Cyclosporine)

93
Q

What class of ABx should be avoided with NSAIDs due to increase renal risks?

A

Aminoglycosides

94
Q

How is an ASA OD treated?

A

Sodium Bicarbonate

95
Q

Which NSAID has….

  1. Increased risk of cardiac events
  2. Increased liver toxicity
  3. More likely to have GI toxicity
A

Diclofenac

96
Q

If a patient is chronically using Piroxicam, what type of exam should be preformed periodically?

What labs?

A

Eye Exams

CBC
Renal Function
hepatic Function

97
Q

Do you need to dose adjust Celcoxib in patients with renal impairment?

Hepatic Impairment?

A

Renal: No

Hepatic:
Decrease by 50%

98
Q

What ADRs are commonly associated with Opioids?

A 
Sedation
Lethargy
Respiratory Depression
Nausea
Emesis
Pruritis 
Urticaria 
Bronchospams
99
Q

What is the TRIAD of opioid OD?

What is the antidote?

A
  1. Miosis
  2. LOC
  3. Respiratory Depression

Antidote: Naloone (Narcan)

100
Q

Other than the ADRs associated commonly with all opioids……

What additional ADRs are associated with Morphine?

A

Orthostasis

Constipation

101
Q

Can you give fentanyl to a patient with a codeine allergy?

102
Q

What organotoxicity is associated with Meperidine (Demerol)?

Is this reversible with Naloxone?

A

Neurotoxicity (Anxiety, Tremors, Seizures)

No!

103
Q

What organotoxicities are associated with Propoxyphene?

A

Neurotoxicity

Cardiotoxicity

104
Q

What cardiac arrhythmia is associated with Methadone?

105
Q

What ADRs are associated with Naloxone (Narcan)?

A

Headache
Myalgia
Hypertension
Withdrawal

106
Q

Tramadol has a high risk for what at the recommended and increased doses?

This risk is increased with what class of medications?

A

Seizures

Increased risk with....
SSRIs
TCAs
Opioids
MAOIs
107
Q

T/F: There is an increased suicide risk associated with Tramadol

108
Q

Is Serotonin syndrome associated with Tramadol?

109
Q

What has a higher risk of respiratory distress….

Morphine or Tramadol?

110
Q

Tapentadol is potentially fatal when taken with what?

111
Q

What are THREE signs of Opioid Abuse?

A
  1. Early Refills
  2. Requesting higher doses
  3. Prescriber Hoping
112
Q 
Withdrawal Sx (treating with other medications
Taking larger doses than prescribed and taking for longer
Impairment in social and occupational settings

….are all symptoms of opioid ________

A

Dependence

113
Q

What are Sx of opioid withdrawal?

When would these onset?

A 
Mood Liability
Chills
Diaphoresis
Nausea / Diarrhea
Rhinoorhea
Dilated Pupils
Insomnia

Onset 8-16 hours after last dose peaking in 2-4 days

114
Q

Is opioid withdrawal life threatening?

115
Q

How is opioid withdrawal treated?

A

Detoxification either through tapering or reversing medications (Naltrexone)

Can also use clonidine, NSAIDs, anti-diarrheals, muscle relaxants

116
Q

What SERIOUS ADRs are associated with Milnicipran?

Common ADRs?

A

Serious:

SI
Serotonin Syndrome
HTN
Tachycardia

Common:

N/V
Constipation
headache
Hyperhidrosis

117
Q

What ADRs are associated with cyclobenzaprine (Flexeril)?

Remember this has anticholinergic activtiy?

A

Dry Mouth
Constipation
Urinary Retention
Dry Eyes

118
Q

Trnasient Quadriplegia is associated with what muscle relaxant?

What are additional ADRs?

A

Carisoprodol (Soma)

Drowsiness, Vertigo
Depression
Syncope
Hypotension
N/V
119
Q

Is there a withdrawal syndrome seen with Carisoprodol (Soma)?

What are the Sx?

how is it treated?

A

Yes, onsets 3 days after abrupt sesation

Sx…..

Insomnia
Anxiety
Muscle Twitching
Incoordination
N/V
Anorexia

Treatment: Benzodiazapines + Anti-psychotics

120
Q

Metaxalone (Skelaxin) is associated with what THREE serious ADRs?

A

Leukopenia
Hemolytic Anemia
Jaundice

121
Q

What ADRS are associated with Baclofen?

A 
Drowsiness
Dizziness
Fatigue / Wekaness
Nausea
Emesis
Confusion
122
Q

What type of ADRs are seen with Orphenadrine (Norflex)?

A

Anticholinergic:

Dry Mouth
Urinary Retention
Tachycardia
Mydriasis
N/V
123
Q

What medication is associated with idiosyncratic hepatotoxictiy?

A

Chlorzoxazone

124
Q

T/F: Glucosamine Sulfate may have some impact on insulin resistance

125
Q

Ziconotide is associated with what types of ADRs?

What additional ADRs?

A

Neuropshychiatric

Additional:

Dizziness
Ataxia
Somnolence
Nausea

126
Q

Is intrathecal Baclofen associated with hypertonia or hypotonia?

127
Q

What ADRs are associated with PO Menthol use?

Topical?

A

Oral:

Heartburn, Nausea, Emesis

Topical:

Irritation
Dermatitis

128
Q

Why should camphor be avoided orally?

A

It can become toxic leading to seizures and respiratory failure

129
Q

Capsaicin is associated with a worsening cough when taken with what class of antihypertensives?

130
Q

What ADRs are associated with Capsaicin when taken orally?

Topically?

A

Oral:

GI Discomfort
Diaphoresis
Flushing

Topical:

Burning, Stinging, Erythema

Pharmacology II - EXAM 2 (5 decks)

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