Adverse Drug Reactions Flashcards by Zachary Schulz

What is the most common ADR associate with Colchicine?

What additional common ADR is seen?

Diarrhea

Sore Throat

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What THREE warnings are associated with Colchicine?

Blood Dyscrasias
Neuromuscular Toxicity
Rhabdomyolysis

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What ADRs are associated with Allopurinol?

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

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What lab values can become elevated with Allopurinol?

LFTs

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Could you see an acute gout attack after starting Allopurinol?

Yes

Administer with Colchicine or NSAIDs upon initiation

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

Yes

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What ADRs are associated with Probenecid?

Kidney Stones (Uric Acid)
Headache
Nausea
Dizziness

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What organ failure is associated with Febuxostat?

Hepatic Faliure

Monitor baseline LFTs

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Which has a higher rate of cardiovascular events…..

Febuxostat or Allopurinol?

Febuxostat

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

How is this prevented?

Anaphylaxis

Most be given with antihistamines and corticosteroids

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Other than anaphylaxis…..

What ADRs are associated with Pegloticase?

Gout Flares
Nausea
Ecchymosis
Nasopharyngitis
Constipation
Chest Pain
Emesis

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What co-morbid condition could Pegloticase administration exacerbate?

CHF

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What unique blood ADR is Rasburicase associated with?

Methemoglobinemia

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Which kidney side effects are associated with Lesinurad?

What additional ADRs are associated with it?

Increased sCr
Renal Failure
Kidney Stones

Additional…..

Headache
Flu-Sx
GERD

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

Hyperglycemia 
Increased Appetite 
Fluid Retention
Weight Gain
HTN
Peptic Ulcers

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

Adrenal Suppression
Growth Suppression
Osteoporosis
HTN
DM
Cushing's

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What ADRs are associated with Methotrexate?

N/V/D
Hair Loss
Rash
Fatigue
Mouth Sores

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

False

It is associated with increased LFTs

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Methotrexate has an increased risk for what?

Infection

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Leflunomide is associated with what organotoxicity?

Hepatotoxicity

Monitor LFTs every 6-8 weeks for 6 months

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What is the most common ADR associated with leflunomide?

What additional ADRs are associated with Leflunomide?

Diarrhea

Additional ADRs….

Nausea
Abdominal Pain 
Indigestion
Rash 
Hair Loss

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What is the most concerning ADR of hydroxychloroquine?

How is this prevented?

Bull’s Eye Maculopathy

Need baseline and annual eye examinations from a retinal specialist

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Other than retinal toxicity….

What ADRs are associated with Hydroxychloroquine?

Nausea
Diarrhea
Rash
Skin Changes
Hair changes

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What ADRs are associated with Sulfasalazine?

Photosensitivity
Nausea
Abdominal Pain

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What ADRs are associated with Sulfasalazine?

GI Upset Dizziness Rash Photosensitivity

Should minicycline be used in pregnancy?

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

What infections are associated with Anti-TNF use?

URI Sinusitis Pharnygitis

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

Rash Itching Burning

What Infusion related ADRs are associated with Anti-TNFs?

Headache | Abdominal Pain

What ADRs are associated with Abatacept? | This is a non-TNF medication

Headache URI Nasopharyngitis Nausea

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

Prednisone | Diphenydramine

Is Rituximab associated with HTN or Hypotension?

Hypotension

What warnings are associated with Rituximab?

``` Tumor Lysis Syndrome SJS/TEN Hep Activation Cardiac Arrhythmia Renal Toxicity Bowel Obstruction/Perforations ```

T/F: Tocilizumab may decrease cholesterol levels

False It is associated with increased cholesterol

Ustekinumab (Stelara) is associated with what?

Malignancy

What common ADRs is Ustekinumab associated with?

``` Nasopharyngitis URI Headache Fatigue Arthralgia Nausea ```

Which is more potent vitamin D2 or D3?

At what levels does vitamin D become toxic?

> 500 nmol/L Sx include..... weight loss arrhythmias polyuria hypercalcemia

Should patients with GERD take bisphosphonates? If they do what precautions should be taken?

No Take on an empty stomach Remain upright for 30-60 minutes

What should be monitored while administering bisphosphonates?

DEXA Scan Alkphosphate Urine NTX, CTX

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

Jaw Osteonecrosis

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

Eye Examination Risk of uveitis and scleritis

What ADRs are associated with Alendronate (Fosamax)?

GI Effects..... ``` Dyspepsia Abdominal Pain Reflux Constipation Diarrhea Nausea ```

Is Alendronate (Fosamax) associated with hypercalcemia or hypocalcemia?

Hypocalcemia

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

Atypical Trochanteric Fractures

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

Eating or Drinking

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

Flu-like symptoms

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

Renal Function

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

DVT | Stroke

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

Osteosarcoma

What ADRs are associated with Teriparatide (Forteo_?

Transient/Persistent Hypercalcemia Headache Transient Myalgia/Arthralgia

Is Abaloparatide (Tymlos) associated with hypercalciuria or hypocalciuria? Hypercalcemia or hypocalcemia?

Hypercalciuria Hypercalcemia

What ADRs are associated with Denosumab?

``` Cellulitis Eczema Flatulence Fatigue Asthenia Hypophosphatemia Nausea Dyspnea Arthralgia Headache ```

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

False They have a high abuse potential

Stimulants for ADHD carry a warning for an effect what 'organ'?

Cardiovascular Effects (Sudden Death in adults, and children with structural abnormalities) Need a personal and family history

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

Raynaud's Phenomenon

What common ADRs are associated with stimulant use for ADHD?

``` Insomnia Decreased appetite Weight loss Hypertension Arrhythmia Anxiety, panic, agitation ```

What warnings are associated with Atomoxetine (Strattera)?

``` Increased SI risk in children Increase BP, HR Liver Injury Urinary Retention Priapism ```

What ADRs are seen in pediatric patients on Atomoxetine?

``` Nausea Emesis Decreased Appetite Fatigue Somnolence ```

What ADRs are seen in adult patients on Atomoxetine?

``` Constipation Dry Mouth Nausea Fatigue Insomnia ED Urinary Hesitation/Retention Flushing ```

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

True

What ADRs are associated with Zolpidem (Ambien)?

Parasomnias (Sleep driving, eating) Abnormal Thinking Strange Behavior ``` Rebound Insomnia Drowsiness Dizziness Dry Mouth Abdominal Pain Headache ```

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

Zolpidem (Ambien) is associated with next day impairment

What is the most common ADR associated with Eszopiclone (Lunesta)? What additional ADRs are associated with this?

Unpleasant Taste Additional ADRs.... ``` Headache Infection Next Day impairment Parasomnias Anaphylaxis (Angioedema) ```

Should patients taking melatonin drive or operate heavy machinery?

What ADRs are associated with melatonin?

Daytime Drowsiness Headache Dizziness

If a perimenopausal women takes melatonin what my occur?

Resumption of menstrual flow

What ADRs are associated with Ramelteon?

Somnolence Fatigue Dizziness

What unique ADRs are associated with Tasimelteon (Hetlioz)?

Nightmares | Unusual Dreams

What medication for insomnia is associated with the following ADRs...... ``` Next-Day Impairment Behavioral Changes Depression Decreased Respiratory Function Hallucination Sleep Paralysis ```

Suvorexant (Belsomra)

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

``` Sedation Dry Mouth Dry Eyes Orthostasis Arrhythmias ```

Valerian Root is associated with what organotoxicity?

Hepatotoxicity

What common ADRs are associated with Valerian Root?

``` Headache GI Upset Mental Dullness Excitability Cardiac Disturbance Insomnia ```

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

Suicidality

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

Fluoxetine

Which anti-depressant has the highest risk for suicidality?

Venlafaxine

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

Serotonin Syndrome Sx include..... ``` Hallucinations, Agitation Tachycardia HTN Hyperreflexia N/V/D Ocular Clonus ```

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

True

What are the THREE most common ADRs associated with SSRIs? What are additional ADRs?

Nausea Emesis Insomnia Additional ADRs.... ``` Weight Gain Headache Bruxism ED Diaphoresis Orthostasis Akathisia Osteopenia GI Bleeding ```

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

First: Cardiac Defects Third: Low birth weight Prematurity Neonatal Withdrawal Pulmonary HTN

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

Most Sedating

Which ADRs are associated with Sertaline (Zoloft)?

Dry Mouth Sedation Insomnia Tremor Dizziness Sexual Dysfunction

Which ADRs are associated with Escitalopram (Lexapro)?

Nausea Sedation Insomnia Sexual Dysfunction

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

Are the SRNIs associated with HTN or hypotension?

HTN

Other than HTN.... What ADRs are associated with the SNRIs?

``` Hyperlipidemia Dry mouth Headache Sexual dysfunction Insomnia/sedation N/V Akathisia Diaphoresis Weight changes ```

What ADRs are commonly associated among all of the following.... Venlafaxine (Effexor) Desvenlafaxine (Pristiq) Duloxetine (Cymbalta)

Nausea Dry Mouth Somnolence Constipation

What ADRs are commonly associated among all of the following.... Milnicipran (Savella) Levomilnicipran (Fetzima)

Hyperhidorsis Increased HR Palpitations Tachycardia

What are the TWO most common ADRs associated with Mirtazapine (Remeron)? Can patients taking this use alcohol?

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

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

Elevated Cholesterol | Elevated LFTs

Is Mirtazapine associated with weight loss or weight gain?

Weight Gain

What ADRs are associated with Bupropion (Wellbutrin)?

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

T/F: TCAs are associated with anticholinergic effects

True

Other than anti-cholinergic effects..... What ADRs are common amongst TCAs?

Arrhythmias Sexual Dysfunction Increased Fall Risk Diaphoresis

TCAs have a ___% chance of fatality in OD

70%

What neurologic manifestation may occur in a patient who has OD'd on TCAs? Would they likely be hypertensive or hypotensive?

Seizures Hypotensive

What is the 'triad' of symptoms in TCA OD?

CV Symptoms - (Palpitation, CP) CNS Symptoms - (Convulsions, AMS, Drowsiness) Peripheral Symptoms (Dry Mouth/Eyes, Urinary Retention)

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

True

What ADRs are commong among both Trazodone and Vilazodone?

``` Sedation Dry Mouth Headache Dizziness Priapism ```

What syndrome is associated with MAOIs?

Serotonin Syndrome

T/F: MAOIs are associated with Hypotensive crisis

False Hypertensive Crisis

Are MAOIs associated with weight loss or weight gain?

Weight Gain

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

Due to its association with insomnia

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

True

Benzodiazepines are all associated with varying degrees of what?

Lipophilicity

What CNS effects are associated with Benzodiazepines?

``` Sedation Consfusion, Diorientation Ataxia Euphria Irritability "Loss of Control" ```

What cardiovascular effects are associated with benzodiazepines?

Respiratory Depression | Hypotension

Do Bezodiazepines have a risk of physical dependence?

Yes

What are the Sx of BZD withdrawal? How long after abrupt discontinuation would these manifest?

Insomnia, Restlessness, Muscle Tension, irritability Short 1/2 Life: 1-2 Days Long 1/2 Life: 3-8 Days

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?

Longer, increased risk for ADRs Increased Fall Risk

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

Cleft lip/palate malformations | These are pregnancy category D

What are the advantages to Buspirone (Buspar) use?

Less Sedating | Less Dependency

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

Chloropromazine (Thioridazine)

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

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

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

Second-Generation

Which second generation anti-pyschotic is associated with...... Myocarditis Seizures Nocturnal Salivation Agranulocytosis

Clozapine (Clorazil)

Which second generation anti-psychotic is associated with...... Hyperporlactinemia

Risperidone (Risperdal)

All anti-psychotics have a black box warning for increased mortality in elderly patients with what condition? What are common causes of mortality?

Dementia-related pyschosis Common Causes..... CHF Sudden Death Infection (PNA)

T/F: Iloperidone is associated with a prolonged QT

True

Is Iloperidone associated with hyperprolactinemia and priapism

Yes

What common ADRs are associated with Iloperidone?

``` Dizziness Somnolence Tachycardia Nausea Dry Mouth Impairment Motor Skills and Thinking ```

What ADRs are associated with Paliperidone?

``` Headache Tachycardia Somnolence Anxiety Akathisia ```

Is Brexipiprazole (Rexulti) associated with..... Hyperglycemia or hypoglycemia? Weight gain or weight loss? Somnolence or insomnia?

Hyperglycemia Weight Gain Somnolence

Should Lithium be used in pregnancy?

No, it has teratogenic effects

What organotoxicity is associated with Lithium? How should this be monitored?

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

When does Lithium become toxic? What are Sx of this?

> 1.5 mEq/L Early Sx: Diarrhea, Emesis, Weakness, Coordination Loss Late Sx: Ataxia, Blurred Vision, Tinnitus, Large Urinary Output

Does Lithium have neurological ADRs?

Yes, too many to type

Is Lithium associated with hypertension or hyptension?

Hypotension

Lithium may unmask what underlying cardiac condition? What are manifestions of this condition and where may you see ST elevation of EKG?

Brugada Syndrome ST Elevation: V1 - V3 Sx: Afib, Fever, Nightmares, Syncope

What are GI side effects of Lithium?

N/V/D

T/F: Alopecia is associated with Lithium use

True

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

Albumin | Glucose

Should patients with psoriasis take Lithium?

No, it may exacerbate their disease

Is lithium use more commonly associated with hypothyroidism or hyperthyroidism?

Hypothyroidism

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

Flattening Inversion

Is lithium associated with weight loss or weight gain?

Weight Gain