Common Toxicities

Question 1

Ototoxicity

Answer 1

Aminoglycosides (Gentamicin)
Cisplatin
Loop diuretics (IV administration)
Salicylates
Vancomycin

Question 2

QTc Prolongation

Answer 2

Antiarrhythmics
Antimalarials (hydroxychloroquine)
Azole
Macrolides
Quinolones
Antidepressants (SSRI, TCA)
– do not exceed Celexa 20 mg in elderly or 40 mg/day
– do not exceed Lexapro 10 mg in elderly or 20 mg/day
Antipsychotics (1st gen&raquo_space;> 2nd gen)
Antiemetics (metoclopramide, ondansetron, promethazine, droperidol)
Oncology (TKI, Androgen deprivation)

Question 3

CNS Depression

Answer 3

OPIOIDS
Skeletal muscle relaxants
Antiepileptic drugs
Benzos
Barbiturates
Hypnotics
Antidepressants (Trazodone, Mirtazapine)
Propanolol/Clonidine
Cannabis (dronabinol
Sedation antihistamines
Cough syrups with antihistamine or opioids

HIGH RISK:
opioid + benzo

Question 4

Nephrotoxicity

Answer 4

Aminoglycosides
Amp B
Polymyxins
Vancomycin
Cisplatin
Calcineurin Inhibitors (Tacrolimus, Cyclosporine)
Loop Diuretics
NSAIDs
Radiographic contrast dye

Question 5

Anticholinergic toxicity

Answer 5

Symptoms: dry mouth, CNS depression, constipation, blurry eyes, urinary retention

Antidepressants/ Antipsychotics (Paxil, TCA, 1st gen antipsych)

Sedating Antihistamines (Diphenhydramine, Brompheniramine, chlorpheniramine, doxyamine, hydroxyzine, meclizine, cyproheptadine)

Centrally acting Anticholingerics (Benztropine)

Muscle relaxants (Carisoprodol, baclofen, cyclonezaprine)

Antimuscarinics (Oxybutynin, tolerodine, darifenacin)

Question 6

Hypotension/ Orthostasis

Answer 6

PDE inhibitrs (Sildenafil, Tadalafil, Vardenafil, Avanafil) are CYP3A4 substrates so CYP3A4 inhibitors will increase hypotension

Nitrates (NTG)
Alpha-1 blockers (Tamsulosin, Doxazosin, Terazosin)

Question 7

Hepatoxicity

Answer 7

APAP
Amiodarone
Isoniazid
Ketoconazole
Methotrexate
Nefazodone
Nevirapine
NRTI
Propylthiouracil
Valproic Acid
Bosentan

Question 8

Drug induced lupus erthematosis (DILE)

Answer 8

My Pretty Malar Mark Probably Has A TransIent Quality

Minocycline
Proylthiouracil (hyperthroidism)
Methimazole (hyperthyroidism)
Methyldopa (alpha 2 agonist)
Procainamide (Class 1a)
Hydralazine
Anti-TNH
Terbinafine
Isoniazid
Quinidine

Question 9

Increase uric acid (GOUT)

Answer 9

Diuretics
Niacin
low dose ASA
Pyrazinamide (for TB)
Cyclosporine
Tacrolimus
Chemotherapy (Tumor Lysis Syndrome)

Question 10

Therapeutic range for Digoxin

Answer 10

0.8 - 2 ng/mL (HF)
0.5 -0.9 ng/mL (AF)

Question 11

Therapeutic range for Lithium

Answer 11

0.6 - 1.2 mEq/L

Question 12

Therapeutic reange for Carbamazepine

Answer 12

4 -12 mcg/mL

Question 13

Therapeutic range for Gentamicin

Answer 13

Peak: 5 - 10 mcg/mL
trough < 2

Question 14

Therapeutic range of Theophylline

Answer 14

5 - 15 mcg/mL

Question 15

Therapeutic range for Free Phenytoin

Answer 15

1 - 2.5 mcg/mL

Phenytoin/Fosphenytoin 10 - 20 mcg/mL
**if Albumin is low, calculate a new level!

Question 16

Therapeutic range for Valproate

Answer 16

50 - 100 mcg/mL

Question 17

Therapeutic range for Prcainamide / NAPA

Answer 17

4 - 10 mcg/mL

NAPA 15 - 25 mcg/mL

Combined 10 - 30 mcg/mL

Question 18

Hyperglycemia

Answer 18

Beta blockers (or hypo)
Thiazides
Loop
Tacrolimus/Cyclosporine
Protease Inhibitors
Quinolones (or hypo)
Antipsychotics (Olanzapine, Quetiapine)
Statins
Steroids
Cough Syrups
Niacin

Question 19

Hypoglycemia

Answer 19

Beta blockers (or hyper)
Quinolines (or hyper)
Tramadol