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Therapeutics > Drug Induced Disease > Flashcards

Drug Induced Disease Flashcards

1
Q

QTc prolongation is a QTc of

A

> =500 ms
or
=60 ms from baseline

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2
Q

what are 6 classes that can cause QT prolongation

A

antiarrhythmics
antibiotics
antipsychotics
antidepressants
antiemetics
antifungals

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3
Q

nonmodifiable risks for QT prolongation

A

> 65, female, genetics, CV disease

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4
Q

which 3 antiarrhythmics cause QT prolong

A

sotalol, amiodarone, dofetilide

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5
Q

which 2 antibiotic classes cause QT prolong

A

fluoroquinolones
macrolides

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6
Q

main antidepressant that prolongs QT

A

citalopram

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7
Q

after d/c the offending drug, what is done to treat TORSADES

A

magnesium push or infusion
transcutaneous pacing
isoproterenol infusion

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8
Q

avoid prolonging agents in pt with pretreatment QTc of

A

> 450

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9
Q

reduce dose or d/c prolonging agent if QTc increases

A

> 60 from pretreatment

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10
Q

d/c QT prolonging agent if QTc increases to

A

> 500

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11
Q

which 2 electrolytes should be maintained when treating QT PROLONGATION

A

K>4
Mg>2

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12
Q

which 3 classes contribute to Na and volume retention HF

A

NSAIDs, steroids, TZDs

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13
Q

class with BBW to avoid in HF class III and IV

A

TZDs

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14
Q

2 chemo anthracyclines that cause direct cardiotoxicity and HF

A

doxorubicin, daunorubicin

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15
Q

the max lifetime anthracycline dose is

A

500 mg/m2

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16
Q

is cardiomyopathy from anthracyclines reversible?

A

irreversible

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17
Q

agent that causes reversible cardiomyopathy through inhibition at HER2 receptors

A

trastuzumab

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18
Q

agent with BBW for reductions in LVEF and development of HF

A

trastuzumab

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19
Q

2 classes that can cause HF due to negative inotropy

A

non-DHP CCBs
beta-blockers

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20
Q

agent that causes MI due to vasospasm and vasoconstriction of coronary arteries

A

cocaine

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21
Q

main treatment for chest pain and HTN in cocaine induced MI

A

benzos

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22
Q

agent with BBW for increased risk of thrombotic CV events, MI, or stroke

A

NSAIDs

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23
Q

3 main roles of the liver are

A

metabolism
synthesis
detoxification

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24
Q

what are the 2 aminotransferases? what are their normal ranges?

A

AST & ALT
normal 5-40 U/L

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25
Q

LFT used to confirm elevated ALP is due to liver injurt

A

GGT

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26
Q

which LFT is found most exclusively in hepatocytes

A

ALT

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27
Q

LFT found in liver and bone?
what is its normal range?

A

ALP
normal 30-140 U/L

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28
Q

2 labs that measure synthetic function of the liver

A

albumin, PT/INR

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29
Q

lab involved in jaundice, and its normal range?

A

bilirubin
~1 mg/dL

30
Q

hepatocellular injury is characterized by elevation in?
what R?

A

AST & ALT elevation
R >= 5

31
Q

cholestatic injury is characterized by elevation in?
what R?

A

ALP elevation
R <= 2

32
Q

mixed injury is a R of

A

2.5

33
Q

how do you calculate R for liver injury?

A

R = [ALT/ULN] / [ALP/ULN]

34
Q

top drug CLASS associated with DILI

A

antimicrobials

35
Q

top med that causes DILI

A

amox/clav

36
Q

should someone who had DILI be rechallenged with the med?

A

no unless no alternative

37
Q

top 10 meds causing DILI

A
  1. amox/clav
  2. isoniazid
  3. nitrofurantoin
  4. Bactrim
  5. minocycline
  6. cefazolin
  7. azithromycin
  8. ciprofloxacin
  9. levofloxacin
  10. diclofenac
38
Q

general metabolism of APAP causing overdose?

A

saturated conjugation, 2E1 forms more NAPQI, NAPQI attacks hepatocytes

39
Q

when can activated charcoal be used for APAP overdose

A

within 1-2 hours of ingestion

40
Q

AEs of PO vs IV NAC?

A

PO- bad tase, NV
IV- anaphylactoid rxn

41
Q

how to prepare and administer PO NAC? when should be repeated?

A

dilute solution to 5% with a soft drink and lid to cover smell

repeat dose if vomited within 1 hour

42
Q

when should IV NAC be used over PO?

A

liver failure, pregnancy, inability to tolerate PO

43
Q

what are the situations where statins should NOT be used in relation to DILI

A

decompensated cirrhosis
acute liver failure

44
Q

risk factors for DIKI

A

age>65, CKD, concomitant nephrotoxins, renin-dependent state, allergy to drug, duration of therapy, DM, HTN

45
Q

what is preferred for hydration in DIKI

A

balanced crystalloids (lactated ringers)

46
Q

5 main classes of med that can cause pre-renal or hemodynamic injury

A

ACE, ARB, NSAIDs, diuretics, calcineurin inhibitors

47
Q

mechanism of hemodynamic injury

A

loss of autoregulation – inc risk of low intraglomerular pressure – reduce GFR

48
Q

NSAID & ACE/ARB combos should NOT BE USED TOGETHER in patients with

A

CKD, HF, and liver disease

49
Q

3 meds that cause acute tubular necrosis (ATN)

A

aminoglycosides, amphotericin B, IV contrast

50
Q

hallmark sign of ATN

A

muddy brown casts

51
Q

nephrotoxicity with aminoglycosides correlates with

A

trough

52
Q

how should aminoglycosides be dosed to reduce risks?
what should trough be?

A

extended interval dosing
want undetectable trough concentrations

53
Q

2 contrast media that cause ATN

A

iohexol
iodixanol

54
Q

risks for contrast media AKI

A

DM, large dose, high osmolol, ionic contrast, short interval between 2 admins

55
Q

gold standard treatment for contrast media ATN

A

saline hydration 12 before and after to flush kidneys

56
Q

alternative to saline for contrast media ATN for high risk patients

A

NAC

57
Q

4 classes that cause acute interstitial nephritis (AIN)

A

beta lactams, NSAIDs, sulfa drugs, PPIs

58
Q

what can be used to treat DIKI with AIN if quickly

A

steroids aggressive within 2 weeks

59
Q

mechanism of vancomycin kidney injury

A

not known

60
Q

TDM factors that contribute to injury with vancomycin

A

trough >20
AUC >600
TDD >4g
>7 day treatment
weight >101.4 kg
concomitant nephrotoxins
severity of illness

61
Q

3 meds that may cause nephrolithiasis (post renal injury)

A

topiramate, sulfonamide, furosemide

62
Q

how to treat nephrolithiasis?

A

hydration to induce diuresis

63
Q

meds that cause rhabdomyolysis (post-renal)

A

statin, statin-fibrate combos

64
Q

treatment for rhabdomyolysis

A

aggressive IV fluids

65
Q

CKD can be caused by which med

A

lithium

66
Q

main mechanism causing lithium CKD

A

nephrogenic diabetes insipidus

67
Q

main risk factor for CKD from lithium

A

cumulative lithium exposure

68
Q

possible DDI with lithium that may cause kidney injury

A

HCTZ

69
Q

med that can be used for symptoms of DI in CKD from lithium

A

amiloride for polydipsia & polyuria

70
Q

can lithium be restarted after injury to the kidney is resolved?

A

NO!! NOW HAVE CKD! want to prevent further progression/decline

Therapeutics (27 decks)

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