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Boards High Yield > Drug Toxicities > Flashcards

Drug Toxicities Flashcards

1
Q

what drugs can cause Coronary vasospasm

A

C-TEAM Cocaine, Triptan, Ergot alkaloids, Amphetamine, Methamphetamine

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2
Q

what drugs can cause Cutaneous flushing

A

mn: flushed from my doing the Niasty with VANCE

  1. Niacin (avoid by coadmin with Aspirin)
  2. Vancomycin *a/w red man syndrome
  3. Adenosine
  4. Nitrates
  5. Ca2+ channel blockers (amlodipine specifically)
  6. Echinocandins
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3
Q

what drugs can cause Dilated cardiomyopathy

A

Alcohol, Cocaine, Doxorubicin (Adriamycin), daunorubicin, trastuzumab

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4
Q

what drugs can cause Torsades de pointes

A

mn: ABCDEF

  1. Anti-Arrhythmics
    • Class 1A antiarrhythmics (quinidine, procainamide disopyramide)
    • Class III antiarrhythmics: (dronedarone, amiodarone, sotolol, ibutilide, dofetilide)
  2. anti-Biotics: Macrolides & Fluoroquinolones
  3. Anti-C-cotics (antipsych) (chlorpromazine, phenothiazide, ziprasidone)
  4. anti-Depressants (TCAs)
  5. anti-Emetics
  6. anti-Fungals
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5
Q

what drugs can cause Agranulocytosis

A

Dapsone, Clozapine, Carbamazepine, Colchicine, Propylthiouracil, Methimazole (Drugs CCCrush Myeloblasts and Promyelocytes)

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6
Q

Aplastic anemia

A

Carbamazepine, Chloramphenicol, benzene, NSAIDs, propylthiouracil, methimazole

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7
Q

what drugs can cause Direct Coombs positive hemolytic anemia

A

Methyldopa, Penicillin

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8
Q

what drugs can cause Gray baby syndrome

A

Chloramphenicol

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9
Q

what drugs can cause Hemolysis in G6PD-deficient patients

A

Isoniazid (INH), Sulfonamides, Dapsone, Fava Beans, Napthalene, Primaquine, Aspirin, Ibuprofen, Nitrofurantoin

mn: hemolysis IS DFN PAIN

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10
Q

what drugs can cause Megaloblastic anemia

A

Phenytoin, Methotrexate, Sulfa drugs

mn: having a blast with PMS

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11
Q

what drugs can cause Thrombocytopenia ***

A

Heparin, cimetidine(H2 blocker)

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12
Q

what drugs can cause Thrombosis

A

OCPs

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13
Q

what drugs can cause Cough

A

ACE inhibitors (note: ARBs like losartan - no cough)

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14
Q

what drugs can cause Pulmonary fibrosis

A

Bleomycin, Amiodarone and dronedarone, Busulfan, Methotrexate

mn: Breathing Air Badly from Medications

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15
Q

what drugs can cause Acute cholestatic hepatitis

A

Macrolides (Erythromycin)

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16
Q

Focal to massive hepatic necrosis

A

Halothane, Amanita phalloides, Valproic acid, Acetaminophen (liver HAVAc)

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17
Q

Hepatitis

A

INH

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18
Q

Pseudomembranous colitis

A

Clindamycin, ampicillin, cephalosporins

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19
Q

Adrenocortical insufficiency

A

Glucocorticoid withdrawal (HPA suppression)

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20
Q

Gynecomastia

A

Spironolactone, Digitalis, Cimetidine, chronic Alcohol use, estrogens, Ketoconazole, Pot (Some Drugs Create Awesome Knockers)

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21
Q

Hot flashes

A

Tamoxifen, clomiphene

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22
Q

Hypothyroidism

A

Lithium, amiodarone, sulfonamides (Fat SAL)

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23
Q

Hyperglycemia

A

Tacrolimus, protease inhibitors, Niacin, HCTZ, B blockers, Corticosteroids (Taking Pills Necessiates Having Blood Checked)

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24
Q

Fat redistribution

A

Glucocorticoids, protease inhibitors Fat PiG

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25
Q

Gingival hyperplasia

A

Phenytoin, verapamil, cyclosporine, nifedipine

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26
Q

Gout

A

Furosemide, thiazides, niacin, cyclosporine, pyrazinamide (Painful Tophi and Feet Need Care)

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27
Q

Myopathies

A

Fibrates, Niacin, Colchicine, Hydroxychlorquine, Interferon-α, Penicillamine, Statins, Glucocorticoids, (Fish N CHIPS Give you myopathies)

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28
Q

Osteoporosis

A

Corticosteroids, heparin

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29
Q

Photosensitivity

A

Sulfonamides, Amiodarone, Tetracycline, Quinolone (SAT for a photo)

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30
Q

Rash (Stevens Johnson syndrome)

A

Anti-epileptics (Ethosuximide, Carbamazepine, Lamotrigine, Phenytoin, Phenobarbital) Allopurinol, Sulfa Drugs, Penicillin

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31
Q

SLE-Iike syndrome

A

SHIPPE MAQ: Sulfa Drugs, Hydralazine, INH, Procainamide, Phenytoin, Etanercept, Minocyline, a-methyldopa, quinidine

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32
Q

Teeth (kids)

A

Tetracyclines

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33
Q

Tendonitis, tendon rupture, and cartilage damage (kids)

A

Fluoroquinolones

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34
Q

Diabetes insipidus

A

Lithium, demeclocycline

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35
Q

Fanconi’s syndrome

A

Expired tetracycline, Heavy metal exposure wilsons disease

36
Q

Interstitial nephritis

A

Methicillin, NSAIDs, furosemide

37
Q

Hemorrhagic cystitis

A

Cyclophosphamide, ifosfamide (prevent by coadministering with mesna)

38
Q

SIADH

A

Carbamazepine, cyclophosphamide, SSRI’s (Cant Concentrate Serum Sodium)

39
Q

Cinchonism

A

Quinidine, quinine, salicylates

40
Q

Parkinson-like syndrome

A

Antipsychotics, reserpine, metoclopramide (rigidity of ARM)

41
Q

Seizures

A

Isoniazid, Bupropion, Imipenem/cilastatin, Tramadol, Enflurane, Metoclopramide (With seizures I BITE My tongue) Alcohol/Benzo withdrawal

42
Q

Tardive dyskinesia

A

Antipsychotics, metoclopramide

43
Q

Antimuscarinic

A

Atropine, TCAs, H1 blockers, neuroleptics, digoxin

44
Q

Disulfiram-like reaction

A

Metronidazole, certain cephalosporins (cefoperazone), griseofulvin, procarbazine, 1st-generation sulfonylureas,

45
Q

Nephrotoxicity/ ototoxicity

A

CLAV: Aminoglycosides, vancomycin, loop diuretics, cisplatin,

46
Q

P-450 inducers

A

CRABS MPNG, Carbamazepine Rifampin Alcohol use: Chronic Barbs St. Johns Wart Modafinil Phenytoin Nevirapine Griseofulvin

47
Q

P-450 inhibitors

A

MAGIC RACKS GQV Macrolides Amiodarone Grapefruit juice INH Cimetidine Ritonavir (Protease -) Alcohol: Acute Ciproflaxacin (flouro) Ketoconazole (-azoles) Sulfonamides Gemfibrozil Quinidine Valproic acid

48
Q

P 450 Substrates

A

Anti-epileptics Antidepressants Antipsychotics Anesthetics Theophylline Warfarin Statins OCPs Always Always Always Always Think When Starting Others

49
Q

Sulfa drugs

A

Probenecid, Furosemide, Acetazolamide, Celecoxib, Thiazides, Sulfonamide antibiotics, Sulfasalazine, Sulfonylureas. (Popular FACTSSS) Patients with sulfa allergies may develop fever, urinary tract infection, pruritic rash, Stevens-Johnson syndrome, hemolytic anemia, thrombocytopenia, agranulocytosis, and urticaria (hives). Symptoms range from mild to life-threatening.

50
Q

Nephrogenic DI

A

lithium Demeclocyline

51
Q

Nephrotoxicity and neurotoxicity

A

Aminoglycosides, cisplatin, polymxin

52
Q

Acetominophen (Tylenol)

A

N-acetylcysteine (replenishes glutathione)

53
Q

how does acute Salicylate toxicity present and what’s the treatment

A

combined anion gap metabolic acidosis and respiratory alkalosis.

salicylates increase the sensitivity of respiratory centers –> hyperventilation and resp alkalosis, while at the same time, metabolites of salicylates (lactic acid) cause metabolic acidosis.

on labs, this looks like high PH, low Co2, High PO2 but with an anion gap

treatment:

NaHCO3 (bicarb) :Sodium bicarbonate facilitates conversion to the lipophobic, ionized form of salicylate (Sal−), which traps much of the compound in the bloodstream and increases its urinary excretion.

Dialysis

54
Q

antidote for Amphetamines intoxication

A

Benzodiazepines (MOA = Benzodiazepines increase GABA binding to GABAa receptors,–> Increases frequency of chloride channel opening at γ-aminobutyric acid type A receptors–> )

+ nitroprusside for critical HTN

55
Q

antidote for AChE inhibitor/organophosphate toxicity

A

Atropine followed by pralidoxime

56
Q

antidote for Antimuscarinic/anticholinergic agents toxicity

A

Physostigmine salicylate, control hyperthermia

57
Q

antidote for Beta Blocker toxicity

A

Glucagon, atropine, saline

58
Q

antidote for Digitalis toxicity

A

PALM:

potassium if hypokalemic, anti-digoxin specific Fab fragments, lidocaine, magnesium

mn: your digits come out of your palm

59
Q

antidote for Iron toxiticity

A

Deferoxamine, Deferasirox, deferiprone

mn: de (undo) - Fer (ferrous)

60
Q

antidote for Lead toxicity

A
  1. penicillamine
  2. EDTA (calcium disodium EDTA)
  3. dimercaprol,
  4. succimer

mn: PEDS eat lead

61
Q

antidote for Mercury, arsenic poisoning

A

Dimercaprol (BAL), succimer

62
Q

antidote for Copper toxicity

A

Penicillamine

mn: “penny” -cillamine is copper

63
Q

antidote for Cyanide toxicity

A

Nitrite + sodium thiosulfate, hydroxocobalamin

64
Q

antidote for Methemoglobin toxicity

A

Methylene blue, vitamin C

65
Q

antidote for Carbon Monoxide toxicity

A

100% O2, hyperbaric O2

66
Q

antidote for Methanol ( competitive inhibitor of alcohol dehydrogenase), ethylene glycol (antifreeze) toxicity

A

Fomepizole then ethanol, +dialysis

67
Q

antidote for Opioid toxicity

A

Naloxone/naltrexone

68
Q

antidote for Benzodiazepines toxicity

A

Flumazenil

mn: I FLU home in my benzo

MOA: competitive antagonist at γ-aminobutyric acid receptor

69
Q

antidote for TCA toxicity

A

NaHCO3 (bicarb) stabilizes cardiac cell membrane

70
Q

antidote for Heparin toxicity

A

Protamine sulfate

71
Q

antidote for Warfarin toxicity/reversal

A

Fresh Frozen Plasma (immediate effect), Vitamin K (delayed effect)

72
Q

treatment for overdose of

tPA, streptokinase, urokinase

A

Aminocaproic acid

73
Q

tx for Theophylline toxicity

A

Theophylline’s effects arise from antagonism of adenosine receptors. Theophylline toxicity should be considered in any patient presenting with seizures, agitation, tachyarrhythmias, hypotension, or persistent vomiting, particularly if there is hypokalemia and hyperglycemia

tx: based on presenting sx, but includes benzodiazapines for seizure, IV lactate ringer for hypotension, phenylephrine or norepinephrine for hypotension, then beta blockers if not working.

74
Q

tx for Hepatic encephalopathy

A

lactulose = disaccharide ==> acidification of gut lumen after breakdown by bacteria ==> trapping of ammonia

75
Q

tx for Serotonin syndrome

A

cyproheptadine = antihistamine w/anti-serotonin actions

76
Q

tx for red man syndrome (aka Vancomycin infusion rxn)

A

slow infusion rate, tx with diphenhydramine (H1 blocker)

77
Q

tx for methotrexate toxicity

A

leucovorin rescue

78
Q

reversal agent for dabigatran

A

Idarucizumab

79
Q

tx for heroin withdrawal

80
Q

cyanide toxicity associations and presentation

A

Cyanide poisoning is commonly seen in the setting of household fires and presents with symptoms such as headache, vomiting, flushing, bright red venules on fundoscopy, and acrid, almond-like odor on the breath.

Cyanide strongly binds to the iron within complex IV of the ETC, thus inhibiting electron transport and cellular respiration.

81
Q

ethylene glycol toxicity presentation

A

Ethylene glycol toxicity causes elevated serum osmolality, high anion gap metabolic acidosis, confusion, hematuria, and crystalluria.

82
Q

what drugs can cause drug induced myopathy

A

cholesterol lowering drugs, glucocorticoids, colchicine

83
Q

what kind of benzos are more prone to cuase dependence/toxicity

A

All benzodiazepines have a relatively high potential for causing dependency. Shorter-acting agents such as oxazepam and alprazolam, temazepam, and triazolam pose a great risk for toxicity and death. are particularly likely to cause dependency.

Diazepam is a benzodiazepine with a long half-life. It is used mainly in the treatment of status epilepticus and delirium tremens. It has the potential for dependency, but its long half-life reduces onset and severity of withdrawal symptoms.

84
Q

which drugs can cause acquired methemoglobinemia?

A

benzocaine (topical anesthetic) and dapsone

(less commonly nitrates/nitrites in drinking ground water)

pathophys: conversion of Fe2+ to Fe3+ (“increased heme iron oxididation”)

tell-tale sign: pts p/w cyanosis and low O2 sat not improved with supplemental oxygen

85
Q

presentation of lithium toxicity

A

Acute toxicity is usually characterized by gastrointestinal symptoms including nausea, vomiting, and diarrhea

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