Drug Reactions Flashcards
Coronary Vasospasm
Cocaine
Sumatriptain (5HT-1b/1d, rx: migraines)
ergot alkaloids
Cutaneous Flushing
Vancomycin, Adenosine, Niacin, Ca Ch. blockers
VANC
Dilated Cardiomyopathy
Doxorubicin (Adriamycin), Daunorubicin
Gen. free radicals, breaks DNA, rx: solid tumors, leuk/lymph
Torsades de pointes
Class III (sotalol) and Class IA (quinidine) antiarrhythmics
[Class IAs (Double Quarter Pounder: Disopyramide, Quinidine, Procainamide) Class IIIs (AIDS, Amiodarone, Ibutilide, Dofetilide, Sotalol)
Amiodarone
Pulmonary fibrosis, hepatotoxicity, hypo/hyperthyroid (40% iodine by weight), corneal deposits, skin deposits (blue/grey) resulting in photodermatitis, neurologic effects, constipation, bradycardia, CHF, heart block
Slows everything down, hypothyroid, pulm fibrosis, constipation, bradycardia, CHF, heart block
Agranulocytosis
Agranulocytosis Could Certainly Cause Pretty Major Damage
Clozapine, Carbamazepine, Colchicine, Propylthiouracil, Methimazole
Gray Baby Syndrome
Chloramphenicol
Hemolysis in G6PD
Hemolysis IS PAIN
Isoniazid, Sulfonamides, Primaquine, Aspirin, Ibuprofen, Nitrofurantoin
also Dapsone
Megaloblastic anemia
Having a BLAST with PMS
Phenytoin, Methotrexate, Sulfa drugs
Phenytoin
Nystagmus, diplopia, ataxia, sedation, gingival hyperplasia, hirsutism, MEGALOBLASTIC ANEMIA, teratogenesis (fetal hydantoin syndrome), SLE-LIKE SYNDROME, P450 inducer, lymphadenopathy, STEVENS JOHNSON RASH, osteopenia
1st line: Tonic-Clonic, Prophylaxis for Status, Increased Na channel inactivation
Carbamazepine
Diplopia, atazia, blood dyscrasia (agranulocytosis, aplastic anemia), liver toxicity, teratogenesis, P450 inducer, SIADH, Stevens Johnson
1st line: Simple Partial, Complex Partial, Tonic-Clonic
Na channel inactivation
Cross-eyed, shooting CARBINE but just winging people (bone marrow, in the limbs), because he’s holding it like an action hero, hitting himself in the liver, inducing P45, he’s too scared even to pee (SIADH), and he’s all red all over like Stevens Johnson rash
Valproic Acid
Gi distress, rare but fatal HEPATOTOXICITY, neural tube defects for fetus, tremor, weight gain.
1st line: Tonic Clonic, Myoclonic
Na inactivation, GABA concentration
Ethosuximide
GI distress, fatigue, headache, urticaria, Stevens Johnson
1st line: Absence
T type Ca++
EFGH - Ethosux, Fatigue, GI, Headache
Thrombotic complications
OCPs (estrogens)
Cough
ACE inhibitors (-pril)
Pulmonary fibrosis
hard to BLAB with p.f.
BLeomycin, Amiodarone, Busulfan
Bleomycin - free radicals, DNA strand breaks
rx: Testicular cancer and Hodgkins lymphoma
Busulfan - alkylates DNA; CML
Acute Cholestatic Hepatitis, jaundice
Erythromycin
Focal to massive hepatic necrosis
Liver HAVAC (Havoc)
Halothane, Amanita phalloides, Valproic Acid, Acetaminophen
Hepatitis
INH
Pseudomembranous colitis
Clindamycin, ampicillin
Adrenocortical insufficiency
Glucocorticoid withdrawal (HPA suppression)
Gynecomastia
Some Drugs Create Awkard Knockers
Spironolactone, Digitalis, Cimetidine, chronic Alcohol, estrogens, Ketoconazole
Digoxin
CHF patient with non-specific neuro and GI complaints think Dig Toxicity
nausea, vomiting, diarrhea, blurry yellow vision
ECG: +PR, -QT, ST scooping, T-wave inversion, arrhythmia, AV block, hyperkalemia poor prognostic marker
Excreted proximal tubule
Can be for A fib and HF
Antidote: KLAM
Normalize K+, Lidocaine, Anti-dig Fab fragments, Mg2+
Amphotericin B
Amphoterrible
Fever/Chills “shake and bake”
hypotension, NEPHROTOXICITY, ARRHYTHMIA, ANEMIA, IV phlebitis.
hydration to reduce nephrotox; supplement K and Mg
Rx serious systemic mycosis (crypto, cocci, blasto, histo, mucor, candida)
Hot flashes
Tamoxifen, clomiphene (SERMs)
Tamoxifen (antag breast, ag bone; risk endometrial cancer)
Clomiphene (Infertility and PCOS, prevents LH/FSH feedback)
Hyperglycemia
Niacin, tacrolimus, protease inhibitors, HCTZ, corticosteroids
tacrolimus - like cyclosporine, inhibits calcineurin and secretion of IL2
Navir tease a protease
Protease Inhibitors
Navir tease a protease
hyperglycemia, GI intolerance (ND), lipodystrophy (cushingoid effect), nephropathy, hematuria
N - nephropathy A - Awkward fat distribution V - Vomiting, Nausea, Diarrhea I - Insulin resistance like effect (hyperglycemia) R - RBCs in urine (hematuria)
NRTIs and NNRTIs
Bone marrow suppression (reversible, G-CSF, EPO), peripheral neuropathy, lactic acidosis (nucleosides), rash (non-nucleosides), Megaloblastic Anemia (ZDV)
Hypothyroid
Lithium, amiodarone, sulfonamides
Fat redistribution
Glucocorticoids, protease inhibitors
Gingival hyperplasia
Phenytoin, verapamil
Very Pink gums (verapamil, phenytoin)
Gout
Furosemide, thiazides, niacin, cyclosporine
Myopathies
Fish N CHIPS Give you myopathy
Fibrates, Niacin, Colchicine, Hydroxychloroquine, Intereron-a, Penicillamine, Statins, Glucocorticoids
Osteoporosis
Corticosteroids, heparin
Photosensitivity
SAT for a photo
Sulfonamides, Amiodarone, Tetracycline
Rash (Stevens Johnson)
Bad rash after a PEC SLAPP
Penicillin, Ethosuximide, Carbamazepine, Sulfa drugs, Lamotrigine, Allopurinol, Phenytoin, Phenobarbital
SLE-like syndrome
its SHIPPE to have lupus (shitty. its shitty to have lupus)
Sulfa drugs, Hydralazine, INH, Procainamide, Phenytoin, Etanercept
Isoniazid
INH Injures Neurons and Hepatocytes
Neurotoxicity (seizures), hepatotoxicity, Lupus. B6 can prevent neurotox
Isoniazid, “I say no acid” - inh. mycolic acid synth.
Rifampin
RifaMpin - prevents transcription of mRNA
4 R’s - RNA polymerase inh., Revs up P450, Red/orange fluids, Rapid resistance if used alone
hepatotox, red/orange fluids
Ethambutol
Optic neuropathy, red-green color blindness
Teeth (kids)
Tetracyclines
Tendonitis, tendon rupture, cartilage damage
Fluoroquinolones
Diabetes Insipidus
Lithium, demeclocycline
Lithium
LMNOP
Tremor, sedation, edema, heart block, hypothyroid, polyuria, teratogenesis
Fetal cardiac defects include Ebstein anomaly (tricuspid valve displacement), and malformation of great vessels
LMNOP - Lithium: Movement (tremor), Nephrogenic di, hypOthyroidism, Pregnancy problems
SSRIs
Flashbacks paralyze senior citizens
Fluoxetine, paroxetine, sertraline, citalopram
GI distress, Sexual dysfunction
Serotonin Syndrome: hyperthermia, confusion, myoclonus, cardiovascular collapse, flushing, diarrhea, seizures. Rx: cyproheptadine (5-HT2 antag)
(also MAOI, SNRIs, TCAs)
Tricyclic Antidepressants
-iptyline, -ipramine, doxepine and amoxapine
Sedation, alpha 1 block effects like postural hypotension, atropine-like side effects like tachycardia, urinary retention, dry mouth. Desipramine less sedating and has higher seizure threshold.
Tri-C’s: Convulsions, Coma, Cardiotoxicity (arrhythmia), also respiratory depression, hyperpyrexia.
Antidote for cardiotoxicity: NaHCO3
MAOIs
Mao Takes Pride In Shanghai
Tranylcypromine, Phenelzine, Isocarboxazid, Selegiline
Hypertensive crisis (tyramine intake, wine, cheese).
Antipsychotics
haloperidol + “-azines” (Azin is fucking crazy)
Extrapyramidal side effects - dyskinesias, dystonia, akisthesia (restless), tardive dyskinesia (mouth stuff), parkinson’s like (tremor, bradykinesia)
Endocrine - D antagonism, hyperPRLemia, galactorrhea
Side effects - muscarinic, alpha and histamine block
Dry mouth, constipation, hypotension, sedation
Neuroleptic malignant syndrome (NMS) - FEVER
Fever, encephalopathy, vitals unstable, Elevated enzymes, Rigidity. also myoglobinuria. Rx Dantrolene, bromocriptine
High potency vs Low potency antipsychotics
High potency: Trifluoperazine, Fluphenazine, Haloperidol
Try to Fly High - extrapyramidal symptoms (flap your arms and fly, you crazy bastard)
Low potency: Chlorpromazine, Thioridazine
Cheating Thieves are low
non-neuro side effects, anticholinergic, antihistamine, alpha 1 block
Fanconi’s Syndrome
expired tetracycline
loss of bicarb, a.a.’s, glucose, etc in urine instead of being reabsorbed
Hemorrhagic Cystitis
Cyclophosphamide, ifosfamide
prevent with MESNA coadministration
Interstitial nephritis
Methicillin, NSAIDs, furosemide
Furosemide
OH DANG!
Ototoxicity, Hypokalemia, Dehydration, Allergy (sulfa), Nephritis (interstitial), Gout
Hydrochlorothiazide
Hypos and Hypers
Hypo: -kalemia, -natremia
Hyper: -glycemia, -lipidemia, -uricemia, -calcemia.
Sulfa allergy
SIADH
Carbamazepine, cyclophosphamide
Cinchonism
(hearing loss, headache, abd pain, vertigo, dizziness, NV, rash)
Quinidine, quinine
named for Cinchona bark, the source of quinine
Parkinsons-like syndrome
Antipsychotics, reserpine, metoclopramide
reserpine - huntington’s rx
metoclopramide - rx diabetic gastroparesis
Seizures
with seizures, I BITE My tongue
INH, Bupropion, Imipenem/cilastatin, Tramadol, Enflurane, Metoclopramide
Tardive dyskinesia
Antipsychotics
Typical - Haloperidol + “azines”
Atypical - its atypical for Old Closets to Whisper Quietly from A to Z
Olanzepine, clozepine, risperidone, quietapine, aripiprazole, ziprasidone
Antimuscarinic
Atropine, TCA’s, H1 blockers, neuroleptics
Disulfiram-like reaction
Metronidazole, some cephalosporins, procarbazine, 1st gen sulfonylureas
Nephrotoxicity/Ototoxicity
Aminoglycosides, vancomycin, loops, cisplatin
Sulfa reaction
fever, UTI, pruritic rash, Steven’s Johnson syn, hemolytic anemia, thrombocytopenia, agranulocytosis and urticaria. symptoms vary form mild to life-threatening
Popular FACTSSS
Probenecid, Furosemide, Acetazolamide, Celecoxib, Thiazides, Sulfonamide antibiotics, Sulfasalazine, Sulfonylureas
Aminoglycosides
Nephrotoxicity, Ototoxity, Neuromuscular blockade, Teratogen
Macrolides
MACRO
Motility issues, Arrhythmia via prolonged QT, acute Cholestatic hepatitis, Rash, eOsinophilia
Trimethoprim
TMP Treats Marrow Poorly
Megaloblastic anemia, Leukopenia, Granulocytopenia
Leucovorin rescue (folinic acid)
Antibiotics to Avoid in Pregnancy
SAFe Children Take Really Good Care. Sulfonamides - kernicterus Aminoglycosides - ototoxicity Fluoroquinolones - cartilage damage Clarithromycin - embryotoxic Tetracyclines - Discolored teeth Ribavarin (antiviral) - teratogenic Griseofulvin (antifungal) - teratogenic Chloramphenicol - Gray Baby
Ganciclovir
Leukopenia, neutropenia, thrombocytopenia, renal toxicity
Cyclosporin
Nephrotoxicity, hypertension, hyperlipidemia, hyperglycemia, tremor, gingival hyperplasia, hirsutism
Calcium Channel Blockers
Cardiac depression, AV block, peripheral edema, FLUSHING, dizziness, constipation
Vasc. smooth muscle:
amlodipine=nifedipine >diltiazem > verapamil
Heart:
verapamil> diltiazem > amlodipine = nifedipine
Hydralazine
Fluid retention, nausea, headache, SLE-like syndrome
Reflex tachy –> ci in angina/CAD
Statins
Hepatotoxicity, rhabdomyolysis (myalgias, esp with fibrates)
Fibrates
Myositis, hepatotoxicity, chol gallstones
myalgia esp with statins
Class 1A antiarrhythmics
Double Quarter Pounder
Disopyramide - Heart Failure
Quinidine - cinchonism: headache, tinnitus
Procainamide - reversible SLE-like syndrome
thrombocytopenia, TORSADES from increased QT
Class 1B antiarrhythmics
Lettuce, Tomato, Mayo
Lidocaine, Tocainide, Mexiletine
1B = Is Best post MI
Local anesthetic, CNS stimulation/depression, Cardiovascular depression
Class 1C antiarrhythmics
More Fries Please
Flecainide, Propafenone
proarrhythmic esp. post MI. Significantly prolongs refractory period in AV node
1C = Is Contraindicated post MI
Class II antiarrhythmics
Beta blockers
impotence, astma, bradycardia, AV block (decrease PR interval), CHF, sedation, MASKS HYPOGLYCEMIA
metoprolol - dyslipidemia
Overdoes Rx: glucagon
Class III antiarrhythmics
K Ch. blockers, think Torsades because of increased QT
Biguanides
metformin
GI upset, LACTIC ACIDOSIS - ci in renal failure
Sulfonylureas
glyburide, glipizide
hypoglycemia
Glitazones/thiazolinediones
pioglitazone
Weight gain, edema, hepatotoxicity, heart failure
GLP-1 analogs
Exenatide, liraglutide
Nausea, vomiting, PANCREATITIS
Propylthiouracil/methimazole
Agranulocytosis, aplastic anemia, rash
PTU - liver toxicity
MTZ - teratogen
H2 blockers
cimetidine, ranitidine
Antiandrogenic: PRL release, gynecomastia, impotence
Cross BBB: confusion, dizziness, HA
decrease renal creatinine excretion
PPI’s
omeprazole
C Diff risk, PNA, hip fx, low Mg++ chronically
Specific Antacid complications
Aluminum hydroxide - “minimum” feces (constipation)
Magnesium hydroxide - Mg = must go = diarrhea, hypotension, cardiac arrest
Calcium carbonate - hypercalcemia, rebound acid production
ADP receptor inhibitors
Ticlopidine
Neutropenia
Methotrexate
Myelosuppression reversible with leucovorin
Macrovesicular fatty liver change
Mucositis
Teratogen
5-flurorouracil
Myelosuppression, non reversible
Overdose rescue: thymidine
6-mercaptopurine, Azathioprine
Bone marrow, GI, Liver toxicity (which are increased with coadministration of allopurinol)
Vincristine, Vinblastine
vincristine - neurotoxicity (areflexia, peripheral neuritis), paralytic ileus
vinblastine blasts bone marrow (suppression)
Cisplatin
Nephrotoxicity, acoustic nerve damage
prevent nephrotox with Amifostine and chloride diuresis
Trastuzumab
Herceptin for Her-2 (c-erbB2)
Cardiotoxicity
Bisphosphonates
Alendronate, for osteoporosis/hyperCa/paget’s
Corrosive esophagitis, osteonecrosis of the jaw
Zolpidem
Ataxia, headaches, confusion
Halothane
Hepatotoxicity (fulminant), malignant hyperthermia
Methoxyflurane
Nephrotoxicity, malignant hyperthermia
Enflurane
Proconvulsant, malignant hyperthermia
Local anesthetics
CNS excitation, severe cardiovascular toxicity (bupivicaine), hypertension or hypotension
Levodopa
Arrhythmias from increased peripheral formation of catecholamines
Sumatriptan
Coronary vasospasm (ci in CAD pts/prinzmetals angina)
Trazodone
Priapism, sedation, nausea, hypotension
Mannitol
Pulmonary edema, dehydration
ci in anuria, CHF
ACE inhibitors
Captopril’s CATCHH
Cough, Angioedema, Teratogen (fetal renal malf), Creatinine increase (reversible decrease in GFR), Hyperkalemia, Hypotension
Estrogens
Endometrial cancer, postmenopausal bleeding, clear cell adenocarcinoma of vagina of women exposed to DES in utero, thrombosis risk
Antihistamines (1st gen)
sedation
antimuscarinic (dry mouth, urinary retention, constipation
anti alpha-adrenergic (hypotension)
end in -en/ine or -en/ate (chlorpheniramine, diphenhydramine)
(2nd gen: loratadine, fexofenadine, desloratadine, end in -adine)
