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Pharmacology II - EXAM 3 > Adverse Drug Reactions > Flashcards

Adverse Drug Reactions Flashcards

1
Q

What is the most common ADR associate with Colchicine?

What additional common ADR is seen?

A

Diarrhea

Sore Throat

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2
Q

What THREE warnings are associated with Colchicine?

A

Blood Dyscrasias
Neuromuscular Toxicity
Rhabdomyolysis

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3
Q

What ADRs are associated with Allopurinol?

A

Rash (can lead to SJS, so d/c immediately if you see a rash)
Diarrhea
Nausea

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4
Q

What lab values can become elevated with Allopurinol?

A

LFTs

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5
Q

Could you see an acute gout attack after starting Allopurinol?

A

Yes

Administer with Colchicine or NSAIDs upon initiation

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6
Q

A patient with a gout flare is given Probenecid, does this have the potential to exacerbate his flare?

A

Yes

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7
Q

What ADRs are associated with Probenecid?

A

Kidney Stones (Uric Acid)
Headache
Nausea
Dizziness

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8
Q

What organ failure is associated with Febuxostat?

A

Hepatic Faliure

Monitor baseline LFTs

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9
Q

Which has a higher rate of cardiovascular events…..

Febuxostat or Allopurinol?

A

Febuxostat

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10
Q

What is the most concerning risk of giving Pegloticase for gout?

How is this prevented?

A

Anaphylaxis

Most be given with antihistamines and corticosteroids

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11
Q

Other than anaphylaxis…..

What ADRs are associated with Pegloticase?

A 
Gout Flares
Nausea
Ecchymosis
Nasopharyngitis
Constipation
Chest Pain
Emesis
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12
Q

What co-morbid condition could Pegloticase administration exacerbate?

A

CHF

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13
Q

What unique blood ADR is Rasburicase associated with?

A

Methemoglobinemia

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14
Q

Which kidney side effects are associated with Lesinurad?

What additional ADRs are associated with it?

A

Increased sCr
Renal Failure
Kidney Stones

Additional…..

Headache
Flu-Sx
GERD

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15
Q

What ADRs are associated with short-term systemic corticosteroid use?

A 
Hyperglycemia 
Increased Appetite 
Fluid Retention
Weight Gain
HTN
Peptic Ulcers
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16
Q

What ADRs are associated with long-term systemic corticosteroid use?

A 
Adrenal Suppression
Growth Suppression
Osteoporosis
HTN
DM
Cushing's
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17
Q

What ADRs are associated with Methotrexate?

A 
N/V/D
Hair Loss
Rash
Fatigue
Mouth Sores
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18
Q

T/F: Methotrexate is not associated with increased LFTs?

A

False

It is associated with increased LFTs

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19
Q

Methotrexate has an increased risk for what?

A

Infection

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20
Q

Leflunomide is associated with what organotoxicity?

A

Hepatotoxicity

Monitor LFTs every 6-8 weeks for 6 months

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21
Q

What is the most common ADR associated with leflunomide?

What additional ADRs are associated with Leflunomide?

A

Diarrhea

Additional ADRs….

Nausea
Abdominal Pain 
Indigestion
Rash 
Hair Loss
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22
Q

What is the most concerning ADR of hydroxychloroquine?

How is this prevented?

A

Bull’s Eye Maculopathy

Need baseline and annual eye examinations from a retinal specialist

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23
Q

Other than retinal toxicity….

What ADRs are associated with Hydroxychloroquine?

A 
Nausea
Diarrhea
Rash
Skin Changes
Hair changes
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24
Q

What ADRs are associated with Sulfasalazine?

A

Photosensitivity
Nausea
Abdominal Pain

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25
Q

What ADRs are associated with Sulfasalazine?

A

GI Upset
Dizziness
Rash
Photosensitivity

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26
Q

Should minicycline be used in pregnancy?

A

No, remember that this is a tetracycline and is associated with permanent tooth staining.

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27
Q

What infections are associated with Anti-TNF use?

A

URI
Sinusitis
Pharnygitis

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28
Q

What Injection-site reaction ADRs are associated with Anti-TNFs?

A

Rash
Itching
Burning

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29
Q

What Infusion related ADRs are associated with Anti-TNFs?

A

Headache

Abdominal Pain

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30
Q

What ADRs are associated with Abatacept?

This is a non-TNF medication

A

Headache
URI
Nasopharyngitis
Nausea

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31
Q

What should be given prior to Rituximab infusion ot prevent ADRs?

A

Prednisone

Diphenydramine

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32
Q

Is Rituximab associated with HTN or Hypotension?

A

Hypotension

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33
Q

What warnings are associated with Rituximab?

A 
Tumor Lysis Syndrome
SJS/TEN
Hep Activation
Cardiac Arrhythmia
Renal Toxicity
Bowel Obstruction/Perforations
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34
Q

T/F: Tocilizumab may decrease cholesterol levels

A

False

It is associated with increased cholesterol

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35
Q

Ustekinumab (Stelara) is associated with what?

A

Malignancy

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36
Q

What common ADRs is Ustekinumab associated with?

A 
Nasopharyngitis
URI
Headache
Fatigue
Arthralgia
Nausea
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37
Q

Which is more potent vitamin D2 or D3?

A

D3

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38
Q

At what levels does vitamin D become toxic?

A

> 500 nmol/L

Sx include…..

weight loss
arrhythmias
polyuria
hypercalcemia

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39
Q

Should patients with GERD take bisphosphonates?

If they do what precautions should be taken?

A

No

Take on an empty stomach
Remain upright for 30-60 minutes

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40
Q

What should be monitored while administering bisphosphonates?

A

DEXA Scan

Alkphosphate
Urine NTX, CTX

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41
Q

Cancer patients taking bisphosphonates and undergoing dental procedures ate risk for what?

A

Jaw Osteonecrosis

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42
Q

Patients should undergo an examination of what prior to starting bisphosphonates?

Why?

A

Eye Examination

Risk of uveitis and scleritis

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43
Q

What ADRs are associated with Alendronate (Fosamax)?

A

GI Effects…..

Dyspepsia
Abdominal Pain
Reflux
Constipation
Diarrhea
Nausea
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44
Q

Is Alendronate (Fosamax) associated with hypercalcemia or hypocalcemia?

A

Hypocalcemia

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45
Q

Patients on Alendronate (Fosamax) should always be evaluated for what?

A

Atypical Trochanteric Fractures

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46
Q

Patients taking Ibandronate (Boniva) must wait 60 minutes prior to doing what?

A

Eating or Drinking

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47
Q

What is the most common ADR associated with Zoledronate (Reclast) infusions?

A

Flu-like symptoms

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48
Q

What needs to be monitored in patients over 65 taking Zoledronic Acid?

A

Renal Function

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49
Q

What Black Box warnings are associated with Raloxifene use for OA?

A

DVT

Stroke

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50
Q

What black box warning is associated with N 1-34 PTH (Teriparatide)?

A

Osteosarcoma

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51
Q

What ADRs are associated with Teriparatide (Forteo_?

A

Transient/Persistent Hypercalcemia
Headache
Transient Myalgia/Arthralgia

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52
Q

Is Abaloparatide (Tymlos) associated with hypercalciuria or hypocalciuria?

Hypercalcemia or hypocalcemia?

A

Hypercalciuria

Hypercalcemia

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53
Q

What ADRs are associated with Denosumab?

A 
Cellulitis
Eczema
Flatulence
Fatigue
Asthenia
Hypophosphatemia
Nausea
Dyspnea
Arthralgia
Headache
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54
Q

T/F: Stimulants for ADHD treatment have a LOW abuse potential

A

False

They have a high abuse potential

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55
Q

Stimulants for ADHD carry a warning for an effect what ‘organ’?

A

Cardiovascular Effects (Sudden Death in adults, and children with structural abnormalities)

Need a personal and family history

56
Q

What peripheral vascular phenomenon is associated with stimulant use for ADHD?

A

Raynaud’s Phenomenon

57
Q

What common ADRs are associated with stimulant use for ADHD?

A 
Insomnia
Decreased appetite
Weight loss
Hypertension
Arrhythmia 
Anxiety, panic, agitation
58
Q

What warnings are associated with Atomoxetine (Strattera)?

A 
Increased SI risk in children
Increase BP, HR
Liver Injury
Urinary Retention 
Priapism
59
Q

What ADRs are seen in pediatric patients on Atomoxetine?

A 
Nausea
Emesis
Decreased Appetite
Fatigue 
Somnolence
60
Q

What ADRs are seen in adult patients on Atomoxetine?

A 
Constipation
Dry Mouth
Nausea
Fatigue
Insomnia
ED
Urinary Hesitation/Retention
Flushing
61
Q

T/F: Zolpidem (Ambien) is associated with angioedema

A

True

62
Q

What ADRs are associated with Zolpidem (Ambien)?

A

Parasomnias (Sleep driving, eating)
Abnormal Thinking
Strange Behavior

Rebound Insomnia
Drowsiness
Dizziness
Dry Mouth
Abdominal Pain 
Headache
63
Q

Why should patients taking Zolpidem (Ambien) driving the next day?

A

Zolpidem (Ambien) is associated with next day impairment

64
Q

What is the most common ADR associated with Eszopiclone (Lunesta)?

What additional ADRs are associated with this?

A

Unpleasant Taste

Additional ADRs….

Headache
Infection
Next Day impairment
Parasomnias
Anaphylaxis (Angioedema)
65
Q

Should patients taking melatonin drive or operate heavy machinery?

A

No

66
Q

What ADRs are associated with melatonin?

A

Daytime Drowsiness
Headache
Dizziness

67
Q

If a perimenopausal women takes melatonin what my occur?

A

Resumption of menstrual flow

68
Q

What ADRs are associated with Ramelteon?

A

Somnolence
Fatigue
Dizziness

69
Q

What unique ADRs are associated with Tasimelteon (Hetlioz)?

A

Nightmares

Unusual Dreams

70
Q

What medication for insomnia is associated with the following ADRs……

Next-Day Impairment
Behavioral Changes
Depression
Decreased Respiratory Function
Hallucination
Sleep Paralysis
A

Suvorexant (Belsomra)

71
Q

What ADRs are associated with antidepressant use, specifically Doxepin (Silenor)?

A 
Sedation
Dry Mouth
Dry Eyes
Orthostasis
Arrhythmias
72
Q

Valerian Root is associated with what organotoxicity?

A

Hepatotoxicity

73
Q

What common ADRs are associated with Valerian Root?

A 
Headache
GI Upset
Mental Dullness
Excitability 
Cardiac Disturbance
Insomnia
74
Q

What black box warning is associated with all anti-depressants in patients under the age of 24?

A

Suicidality

75
Q

Which antidepressant is best tolerated and has the highest efficacy in children?

A

Fluoxetine

76
Q

Which anti-depressant has the highest risk for suicidality?

A

Venlafaxine

77
Q

What syndrome is associated with SSRIs, SNRI, and triptans?

A

Serotonin Syndrome

Sx include…..

Hallucinations, Agitation
Tachycardia
HTN
Hyperreflexia
N/V/D
Ocular Clonus
78
Q

T/F: There is an increased risk of bleeding (Intercranial Hemorrhage, GI Bleeding) associated with SSRIs

A

True

79
Q

What are the THREE most common ADRs associated with SSRIs?

What are additional ADRs?

A

Nausea
Emesis
Insomnia

Additional ADRs….

Weight Gain
Headache
Bruxism
ED
Diaphoresis
Orthostasis
Akathisia
Osteopenia
GI Bleeding
80
Q

SSRIs in the first trimester of pregnancy are associated with what?

Third trimester?

A

First: Cardiac Defects

Third:

Low birth weight
Prematurity
Neonatal Withdrawal
Pulmonary HTN

81
Q

Paroxetine is the ______ (most/least) sedating of the SSRIs

A

Most Sedating

82
Q

Which ADRs are associated with Sertaline (Zoloft)?

A

Dry Mouth
Sedation
Insomnia
Tremor Dizziness Sexual Dysfunction

83
Q

Which ADRs are associated with Escitalopram (Lexapro)?

A

Nausea
Sedation
Insomnia
Sexual Dysfunction

84
Q

Citalopram (Celexa) is associated with a prolongation of what cardiac interval?

A

QT

85
Q

Are the SRNIs associated with HTN or hypotension?

A

HTN

86
Q

Other than HTN….

What ADRs are associated with the SNRIs?

A 
Hyperlipidemia
Dry mouth
Headache
Sexual dysfunction
Insomnia/sedation
N/V
Akathisia
Diaphoresis
Weight changes
87
Q

What ADRs are commonly associated among all of the following….

Venlafaxine (Effexor)
Desvenlafaxine (Pristiq)
Duloxetine (Cymbalta)

A

Nausea
Dry Mouth
Somnolence
Constipation

88
Q

What ADRs are commonly associated among all of the following….

Milnicipran (Savella)
Levomilnicipran (Fetzima)

A

Hyperhidorsis
Increased HR
Palpitations
Tachycardia

89
Q

What are the TWO most common ADRs associated with Mirtazapine (Remeron)?

Can patients taking this use alcohol?

A

Sedation
Somnolence

No, patients on Mirtazapine should avoid EtOH and other CNS depressants

90
Q

Mirtazapine is associated with an increase in what TWO lab values?

A

Elevated Cholesterol

Elevated LFTs

91
Q

Is Mirtazapine associated with weight loss or weight gain?

A

Weight Gain

92
Q

What ADRs are associated with Bupropion (Wellbutrin)?

A 
Agitation, anxiety, insomnia
Weight loss
Psychosis, delusions, hallucinations, confusion
Hypertension
Nausea/Vomiting 
Headache
Dry mouth
93
Q

T/F: TCAs are associated with anticholinergic effects

A

True

94
Q

Other than anti-cholinergic effects…..

What ADRs are common amongst TCAs?

A

Arrhythmias
Sexual Dysfunction
Increased Fall Risk
Diaphoresis

95
Q

TCAs have a ___% chance of fatality in OD

A

70%

96
Q

What neurologic manifestation may occur in a patient who has OD’d on TCAs?

Would they likely be hypertensive or hypotensive?

A

Seizures

Hypotensive

97
Q

What is the ‘triad’ of symptoms in TCA OD?

A

CV Symptoms - (Palpitation, CP)

CNS Symptoms - (Convulsions, AMS, Drowsiness)

Peripheral Symptoms (Dry Mouth/Eyes, Urinary Retention)

98
Q

T/F: Trazodone and Vilazodone are associated with a prolonged QT

A

True

99
Q

What ADRs are commong among both Trazodone and Vilazodone?

A 
Sedation
Dry Mouth
Headache
Dizziness
Priapism
100
Q

What syndrome is associated with MAOIs?

A

Serotonin Syndrome

101
Q

T/F: MAOIs are associated with Hypotensive crisis

A

False

Hypertensive Crisis

102
Q

Are MAOIs associated with weight loss or weight gain?

A

Weight Gain

103
Q

Why should patients taking St. John’s Wort take it in the morning?

A

Due to its association with insomnia

104
Q

T/F: St. John’s Wort is associated with vivid dreams

A

True

105
Q

Benzodiazepines are all associated with varying degrees of what?

A

Lipophilicity

106
Q

What CNS effects are associated with Benzodiazepines?

A 
Sedation
Consfusion, Diorientation
Ataxia
Euphria
Irritability
"Loss of Control"
107
Q

What cardiovascular effects are associated with benzodiazepines?

A

Respiratory Depression

Hypotension

108
Q

Do Bezodiazepines have a risk of physical dependence?

A

Yes

109
Q

What are the Sx of BZD withdrawal?

How long after abrupt discontinuation would these manifest?

A

Insomnia, Restlessness, Muscle Tension, irritability

Short 1/2 Life: 1-2 Days
Long 1/2 Life: 3-8 Days

110
Q

Would you expect the 1.2 of BZDs to be longer or shorter in elderly patients?

What are elderly patients on BZDs at an increased risk for?

A

Longer, increased risk for ADRs

Increased Fall Risk

111
Q

BZDs used in the first trimester of pregnancy are associated with what?

A

Cleft lip/palate malformations

These are pregnancy category D

112
Q

What are the advantages to Buspirone (Buspar) use?

A

Less Sedating

Less Dependency

113
Q

Which first generation anti-pyschotic is associated with a prolonged QT interval?

A

Chloropromazine (Thioridazine)

114
Q

What ADRs are common amongst both first and second generation anti-pyschotic medications?

A

Movement Disorders
Sedation
Weight Gain (1st > 2nd)
Hypotension

115
Q

Which generation of anti-pyschotics is associated with an increased risk of DM?

A

Second-Generation

116
Q

Which second generation anti-pyschotic is associated with……

Myocarditis
Seizures
Nocturnal Salivation
Agranulocytosis

A

Clozapine (Clorazil)

117
Q

Which second generation anti-psychotic is associated with……

Hyperporlactinemia

A

Risperidone (Risperdal)

118
Q

All anti-psychotics have a black box warning for increased mortality in elderly patients with what condition?

What are common causes of mortality?

A

Dementia-related pyschosis

Common Causes…..

CHF
Sudden Death
Infection (PNA)

119
Q

T/F: Iloperidone is associated with a prolonged QT

A

True

120
Q

Is Iloperidone associated with hyperprolactinemia and priapism

A

Yes

121
Q

What common ADRs are associated with Iloperidone?

A 
Dizziness
Somnolence
Tachycardia
Nausea
Dry Mouth
Impairment Motor Skills and Thinking
122
Q

What ADRs are associated with Paliperidone?

A 
Headache
Tachycardia
Somnolence
Anxiety
Akathisia
123
Q

Is Brexipiprazole (Rexulti) associated with…..

Hyperglycemia or hypoglycemia?

Weight gain or weight loss?

Somnolence or insomnia?

A

Hyperglycemia

Weight Gain

Somnolence

124
Q

Should Lithium be used in pregnancy?

A

No, it has teratogenic effects

125
Q

What organotoxicity is associated with Lithium?

How should this be monitored?

A

Renal Toxicity

Monitor sCr and UA
D/C is renal function deteriorates, remind patient to stay hydrated

126
Q

When does Lithium become toxic?

What are Sx of this?

A

> 1.5 mEq/L

Early Sx: Diarrhea, Emesis, Weakness, Coordination Loss

Late Sx: Ataxia, Blurred Vision, Tinnitus, Large Urinary Output

127
Q

Does Lithium have neurological ADRs?

A

Yes, too many to type

128
Q

Is Lithium associated with hypertension or hyptension?

A

Hypotension

129
Q

Lithium may unmask what underlying cardiac condition?

What are manifestions of this condition and where may you see ST elevation of EKG?

A

Brugada Syndrome

ST Elevation: V1 - V3

Sx: Afib, Fever, Nightmares, Syncope

130
Q

What are GI side effects of Lithium?

A

N/V/D

131
Q

T/F: Alopecia is associated with Lithium use

A

True

132
Q

Patients on Lithium may have an increase of what in their urine?

A

Albumin

Glucose

133
Q

Should patients with psoriasis take Lithium?

A

No, it may exacerbate their disease

134
Q

Is lithium use more commonly associated with hypothyroidism or hyperthyroidism?

A

Hypothyroidism

135
Q

Lithium may cause a __________ and ____________ of T-Waves on EKG

A

Flattening

Inversion

136
Q

Is lithium associated with weight loss or weight gain?

A

Weight Gain

Pharmacology II - EXAM 3 (5 decks)

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