Boxed Warnings

Question 1

Abacavir

Answer 1

Hypersensitivity (HLA B*5701),

Question 2

APAP

Answer 2

risk of med errors

hepatotoxicity

Question 3

Fluoroquinolones

e.g. moxifloxacin, levofloxacin, ciprofloxacin

Answer 3

“Serious adverse reactions”:

• Risk of tendonitis and tendon rupture
• peripheral neuropathy
• CNS effects

Exacerbation of myasthenia gravis

Question 4

Aminoglycosides

e.g. tobramycin, gentamicin

Answer 4

Ototoxicity

nephrotoxicity

Question 5

ACE Inhibitors and ARBs

Answer 5

Fetal Toxicity

Question 6

Beta Blockers

metoprolol, atenolol

Answer 6

“Ischemic heart disease”: abrupt discontinuation can result in exacerbations of angina pectoris, even MI. Gradually taper off.

Question 7

Calcineurin inhibitors (topical)

Answer 7

maybe malignancy

Question 8

Calcineurin Inhibitors

Answer 8

malignancies and serious infection

mortality in liver transplantation

Question 9

Loop Diuretics

furosemide, bumetanide

Answer 9

Volume and electrolyte depletion

Question 10

Estrogen

Answer 10

breast cancer

endometrial cancer (unopposed estrogens)

cardiovascular disease: MI, stroke, VTE

use lowest effective dosage for shortest amount of time

increased risk of dementia

Question 11

NSAIDs

Answer 11

serious CV thrombotic events: MI, stroke

serious GI events: bleeding, ulcerations, perforation

Question 12

Oral contraceptives

Answer 12

> 35 + cigarette smoking (contraindication)

Question 13

SSRIs

Answer 13

Increased risk of suicidal thinking and behavior in children, adolescents and young adults

Question 14

Antipsychotics

atypical and typical

Answer 14

Increased mortality in elderly patients with dementia-related psychosis

Question 15

Amiodarone

Answer 15

life-threatening arrhythmias

worsened arrhythmias (initiate in a clinical setting)

pulmonary toxicity

hepatotoxicity

Question 16

Atomoxetine

Answer 16

suicidal ideation in children and adolescents

Question 17

Clozapine

Answer 17

Severe neutropenia: baseline ANC must be >1500, need ANC monitoring. Agranulocytosis

seizures; dose-related

myocarditis, cardiomyopathy and mitral valve incompetence

orthostatic hypotension, bradycardia, syncope

Increased mortality in elderly pts w/dementia related psychosis

Question 18

Fentanyl

Answer 18

Duragesic: do NOT expose to heat

Life threatening respiratory depression

addiction, abuse, misuse

accidental exposure

CYP4503A4 interactions

Neonatal Opioid withdrawal syndrome

Risks w/concomitant BZDs or CNS depressants

Risk of med errors

Question 19

Opioids

Answer 19

Addiction, abuse, misuse

Benefits outweigh risks

Life threatening respiratory depression

accidental ingestion

neonatal opioid withdrawal

CYP3A4 interactions

Risks from concomitant BZDs and CNS depressants

Risk of med errors

Question 20

ketoconazole

Answer 20

appropriate use

hepatotoxicity

QT prolongation

Question 21

Methadone

Answer 21

all opioid BWs

Life threatening QT prolongation

Question 22

Thiazolidinediones

Answer 22

congestive heart failure: can cause or exacerbate

Question 23

Selective Estrogen Receptor Modulators (SERMs)

Answer 23

Increased risk of VTE

Cardiovascular disease: increased risk of death d/t stroke

Question 24

LABAs

e.g. salmeterol

Answer 24

asthma-related death (as monotherapy for asthma, need ICS too)