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USLME Step 1 > Drug Toxicities - First Aid 2014 > Flashcards

Drug Toxicities - First Aid 2014 Flashcards

1
Q

What is the antidote for acetaminophen?

A

N-acetylcysteine (replenishes glutathione)

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2
Q

What is the antidote for AChE inhibitors/organophosphates?

A

Atropine (blocks effects of excess ACh) followed by pralidoxime (regenerates AChE).

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3
Q

What is the antidote for Amphetamines?

A

Weak base so give NH4Cl (acidify urine)

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4
Q

What is the antidote for anti-muscarinic/anti-cholinergic agents?

A 
Physostigmine salicylate (goes into CNS), control hyperthermia.
Overheating from loss of sweating. Unclear whether there is blocking of anterior hypothalamus (keeping body cool through parasym).
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5
Q

What is the antidote for benzodiazepines?

A

Flumazenil (competitive antagonist at GABA benzo receptor).

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6
Q

What is the antidote for beta-blockers?

A

Glucagon (it also activates cAMP through non-adrenergic pathway G protein receptors…therefore bypassing Beta blockade)

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7
Q

What is the antidote for carbon monoxide?

A

100% O2, hyperbaric O2.

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8
Q

What is the antidote for copper?

A

Penicillamine.

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9
Q

What is the antidote for cyanide?

A

Nitrite (converts hemoglobin to methemoglobin, which binds cyanide better) + thiosulfate (binds the cyanide-globin complex and is excreted in the urine) or hydroxocobalamin (has high affinity for cyanide).

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10
Q

What is the antidote for digitalis?

A

anti-dig Fab fragments

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11
Q

What is the antidote for Heparin?

A

Protamine sulfate (very cationic peptide that binds to negatively charged heparin and allows for urinary excretion)

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12
Q

What is the antidote for iron?

A

DeFERoxamine, deFERrasirox.

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13
Q

What is the antidote for Lead?

A

EDTA, dimercaprol, succimer, penicillamine.

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14
Q

What is the antidote for Mercury?

A

diMERCaprol (BAL), succimer.

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15
Q

What is the antidote for arsenic/gold?

A

Penicillamine, dimercaprol (BAL), succimer

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16
Q

What is the antidote for methanol, ethylene glycol (antifreeze)?

A

Fomepizole (competitive inhibitor of alcohol dehydrogenase) > ethanol, dialysis

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17
Q

What is the antidote for methemoglobin?

A

Methylene blue (converts methemoglobin back to hemoglobin, decreasing half life of toxin from hours to minutes), Vitamin C.

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18
Q

What is the antidote for opioids?

A

Naloxone

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19
Q

What is the antidote for salicylates?

A

it’s a weak acid so NaHCO3 (alkalinize urine), dialysis

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20
Q

What is the antidote for TCAs?

A

it’s a weak acid so NaHCO3 (plasma alkalinization)

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21
Q

What is the antidote for tPA, streptokinase, urokinase?

A

Aminocaproic acid (lysine analogue that inhibits plasmin).

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22
Q

What is the antidote for warfarin?

A

Vitamin K, plasma (if bleeding to restore clotting factors)

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23
Q

Which drugs cause coronary vasospasm?

A

Cocaine, Sumatriptan, Ergot alkaloids

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24
Q

Which drugs cause cutaneous flushing?

A

Vancomycin, Adenosine, Niacin, Ca+2 channel blockers

VANC

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25
Q

Which drugs cause dilated cardiomyopathy?

A

Doxorubicin, daunorubicin

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26
Q

Which drugs cause torsades de pointes?

A

Class III (e.g. sotalol) and class IA (e.g. quinidine) antiarrhythmics, macrolide antibiotics, antipsychotics, TCAs.

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27
Q

Which drugs cause Adrenocortical insufficiency?

A

HPA suppression secondary to glucocorticoid withdrawal.

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28
Q

Which drugs cause hot flashes?

A

Tamoxifen, clomiphene.

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29
Q

Which drugs cause hyperglycemia?

A

Tacrolimus, Protease inhibitors, Niacin, Hydrochlorothiazide, B-blockers, Corticosteroids.
Taking Pills Necessitates Having Blood Checked

30
Q

Which drugs cause hypothyroidism?

A

Lithium, amiodarone, sulfonamides

31
Q

Which drugs cause acute cholestatic hepatitis, jaundice?

A

Erythromycin

32
Q

Which drugs cause diarrhea?

A

Metformin, Erythromycin, Colchicine, Orlistat (lipase inhibitor…meant for obesity treatment), Acarbose
Might Excite Colon On Accident.

33
Q

Which drugs cause focal to massive hepatic necrosis?

A

Halothane, Amanita phalloides (death cap mushroom), Valproic Acid, Acetaminophen (HAVAc).

34
Q

Which drugs cause hepatitis?

A

isoniazid (INH)

35
Q

Which drugs cause pancreatitis?

A

Didanosine, Corticosteroids, Alcohol, Valproic acid, Azathioprine, Diuretics (foresomide, HCTZ).
Drugs Causing A Violent Abdominal Distress.

36
Q

Which drugs cause pseudomembranous colitis?

A

Clindamycin, ampicillin, cephalosporins.

Antibiotics predispose to superinfection by resistant C. difficile.

37
Q

Which drugs cause agranulocytosis?

A

Dapsone, Clozapine, Carbamazepine, Colchicine, Methimazole, Propylthiouracil.

Drugs CCCrush Myeloblasts and Promyelocytes.

38
Q

Which drugs cause aplastic anemia?

A

Carbamazepine, Methimazole, NSAIDs, Benzene, Chloramphenicol, Propylthiouracil.

Can’t Make New Blood Cells Properly.

39
Q

Which drugs cause Direct Coombs-positive hemolytic anemia?

A

Methyldopa, penicillin.

40
Q

Which drugs cause gray baby syndrome.

A

Chloramphenicol

41
Q

Which drugs cause hemolysis in G6PD deficiency?

A

Izoniazid, Sulfonamides, Dapsone, Primaquine, Aspirin, Ibuprofen, Nitrofurantoin.

Hemolysis IS D PAIN.

42
Q

Which drugs cause megaloblastic anemia?

A

Phenytoin, Methotrexate, Sulfa drugs

Having a BLAST with PMS

43
Q

Which drugs cause thrombocytopenia?

A

Heparin, cimetidine

44
Q

Which drugs cause thrombotic complications?

A

OCPs (e.g. estrogens)

45
Q

Which drugs cause fat redistribution?

A

Protease Inhibitors, Glucocorticoids

FAT PIG.

46
Q

Which drugs cause gingival hyperplasia?

A

Phenytoin, verapamil, cyclosporin, nifedepine.

47
Q

Which drugs cause hyperuricemia (gout)?

A

Pyrazinamide, Thiazides, Furosemide, Niacin, Cyclosporine.

Painful Tophi and Feed Need Care.

48
Q

Which drugs cause myopathy?

A

Fibrates, niacin, colchine, hydroxychloroquine, interferon-alpha, penicillamine, statins, glucocorticoids.

49
Q

Which drugs cause osteoporosis?

A

Corticosteroids, heparin

50
Q

Which drugs cause photosensitivity?

A

Sulfonamides, Amiodarone, Tetracyclines, 5-FU.

SAT For PHOTO.

51
Q

Which drugs cause Rash (Stevens-Johnson Syndrome)

A

Anti-epileptic drugs (ethosuximide, carbamazepine, lamotrigine, phenytoin, phenobarbital), Allopurinol, Sulfa drugs, Penicillin.
Steven Johnson has Epileptic ALLergy to Sulfa drugs and Penicillin.

52
Q

Which drugs cause SLE-like syndrome?

A

Sulfa drugs, Hydralazine, Isoniazid, Procainamide, Phenytoin, Etanercept.
Having lupus is SHIPP-E.

Note: apparently also alpha-methyldopa

53
Q

Which drugs cause teeth discoloration?

A

Tetracyclines

54
Q

Which drugs cause tendonitis, tendon rupture, and cartilage damage?

A

Fluoroquinolones.

55
Q

Which drugs cause Cinchonism?

A

Quinidine (class 1A anti-arrhythmic), quinine (for malaria).

Remember: symptoms include flushed and sweaty skin, ringing of ears, blurred vision, impaired hearing, confusion, headache, abdominal pain, rashes, vertigo, nausea, vomiting, diarrhea. Cardiotoxicity and shock in large doses.

56
Q

Which drugs cause Parkinson-like syndrome?

A

Antipsychotics, Reserpine, Metoclopramide.

Cogwheel rigidity of ARM.

57
Q

Which drugs cause seizures?

A

Isoniazid (Vitamin B6 deficiency), Bupropion, Imipenem/cilastatin, Tramadol, Enflurane, Metoclopramide.

With seizures, I BITE My tongue

58
Q

Which drugs cause tardive dyskinesia?

A

Antipsychotics, metoclopramide.

59
Q

Which drugs cause diabetes insipidus?

A

Lithium, demeclocycline.

60
Q

Which drugs cause Fanconi syndrome?

A

Expired tetracycline.

61
Q

Which drugs cause hemorrhagic cystitis?

A

Cyclophosphamide, ifosfamide.

Prevent by coadministering with mesna (thiol group of mesna binds toxic metabolites).

62
Q

Which drugs cause interstitial nephritis?

A

Methicillin, NSAIDs, furosemide

63
Q

Which drugs cause SIADH?

A

Carbamazepine, Cyclophosphamide, SSRIs.

Can’t Concentrate Serum Sodium.

64
Q

Which drugs cause Dry Cough?

A

ACE inhibitors

65
Q

Which drugs cause pulmonary fibrosis?

A

Bleomycin, Amiodarone, Busulfan, Methotrexate.

Breathing Air Badly from Medications.

66
Q

Which drugs cause anti-muscarinic effects?

A

Atropine, TCAs, H1-blockers, anti-psychotics.

67
Q

Which drugs cause disulfiram-like reaction?

A

Metronidazole, certain cephalosporins, griseofulvin, procarbazine, 1st-generation sulfonylureas.

remember: it involves severe flushing, tachycardia, hypotension

68
Q

Which drugs cause nephrotoxicity/ototoxicity?

A

Aminoglycosides, vancomycin, loop diuretics, cisplatin.

69
Q

What are the inducers of cytochrome P-450?

A 
Inducers:
Chronic alcohol use
Modafinil
St. John's wort
Phenytoin
Phenobarbital
Nevirapine
Rifampin
Griseofulvin
Carbamazepine

Mnemonic: chronic alcohol Mona steals phen-phen and never refuses greasy carbs.

70
Q

What are the inhibitors of the cytochrome P-450 system?

A 
Inhibitors: 
Acute alcohol abuse
Gemfibrozil
Ciprofloxacin
Isoniazid
Grapefruit juice
Quinidine 
Amiodarone
Ketoconazole (all azoles: fluconazole, itraconazole, voriconazole)
Macrolides
Sulfonamides 
Cimetidine
Ritonavir

A cute gentleman Cipped iced Grapefruit juice quickly and kept munching on soft cinammon rolls

71
Q

What are the substrates for P450 metabolism?

A 
Anti-epileptics
Anti-depressants
Anti-psychotics
Anesthetics
Theophylline
Warfarin
Statins
OCPs

Always, Always, Always, Always Think When Starting Orders.

72
Q

Which are the sulfa drugs and what do they cause?

A

Probenecid, Furosemide, Acetazolamide, Celecoxib, Thiazides, Suflonamide antibiotics, Sulfasalazine, Sulfonylureas. Popular FACTSSS.

Patients with sulfa allerges may develop: fever, UTI, Stevens-Johnson syndrome, hemolytic anemia, thrombocytopenia, agranulocytosis, and urticaria (hives). Symptoms range from mild to life threatening.

USLME Step 1 (7 decks)

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