Effects on organ systems

Question 1

Which drugs can cause drug induced bronchospasm

Answer 1

ASA, NSAIDs (COX-1), B-blockers, ACE (cough)

Question 2

Risk factors for ASA, B-blocker, and ACEi induced asthma

Answer 2

ASA: Asthma, nasal polyps, age (more common in 20-30s), female gender
B-blocker: Preexisting airway hyperactivity
ACE: Female, east-asian decent, elderly, HF

Question 3

3 signs of the ASA triad

Answer 3

Also called Samters syndrome: Chronic rhino sinusitis w/ nasal polyps, severe bronchial asthma, ASA or NSAID intolerance

Question 4

Explain the mechanism of how ASA, B-blockers and ACEi cause bronchospasms

Answer 4

ASA: Inhibits COX-1 which decreases PGE2 levels=increased pro inflammatory leukotrienes
B-blockers: Blocking B2 receptors in the lungs prevents endogenous ligand from binding and thus prevents bronchodilation (Bronchoconstriction occurs instead)
ACE: Increased levels of pro inflammatory kinins which causes caugh through 3 different mechanisms (Inflammatory molecules themselves, unmyelination of sensory C fibers, and substance P causes constriction)

Question 5

Symptoms of drug induced asthma

Answer 5

Fast breathing, wheezing, sweating, cyanosis, SOB, cough, chest tightness, anxiety, agitation

Question 6

How to prevent ASA, B-blocker and ACEi induced bronchospasms

Answer 6

ASA: Use APAP, salsalate, meloxicam or celecoxib
B-blocker: Use cardioselective B-blockers
ACEi: Use ARB or other anti-HTN

Question 7

Possible treatments for each type of drug induced bronchospasm

Answer 7

ASA: Montelukast, zafrilukast, ziluteon
B-blocker: Ipratropium
ACEi: Cromolyn, baclofen, theophylline, NSAIDs

Question 8

4 mechanisms of drug induced drug injury

Answer 8

Hepatitis (hepatocellular/ cytotoxic injury, steatosis, phospholipidosis)
Cholestasis
Vascular injury
Neoplasms

Question 9

What drugs cause hepatitis

Answer 9

Hepatocellular/cytotoxic injury: APAP
Steatosis: acute- NRTIs, NNRTIs, PI, Tetracyclines, valproic acid
chronic- steroids, alcohol, IV lipids, methotrexate
Phospholipidosis- amiodarone, TCAs

Question 10

What drugs cause cholestasis?

Answer 10

allopurinol, augmente, carbamazepine, phenytoin, tricyclic antidepressants, rifampin

Question 11

What drugs cause vascular injury?

Answer 11

contraceptive steroids, IV lipids, Vitamin A

Question 12

What drugs cause neoplasms?

Answer 12

Anabolic steroids, cancer drugs

Question 13

What are the symptoms of acute liver injury

Answer 13

Jaundice, scleral icterus, itching, coagulopathy, steatorrhea, abdominal pain, hepatomegaly, hypo/hyperglycemia, ascites, varriceal hemorrhage, encephalopathy

Question 14

How is AKI defined?

Answer 14

Increase in SCr of 0.3 from baseline in <48 hours
Increase in SCr >50% from baseline in <48 hours
Oliguria (<0.5 mL/kg/hr) for ≥6 hours

Question 15

Types of drug-induced kidney injuries?

Answer 15

Hemodynamic mediated (pre-renal)
Acute tubular necrosis (intrinsic)
Acute interstitial nephritis (intrinsic)
Glomerulonephritis (intrinsic)
Nephroliasis (kidney stone, post-renal)

Question 16

What drugs cause hemodynamic mediated kidney injury?

Answer 16

Diuretics, NSAIDs/COX 2 inhibitors, cyclosporine, ACEi/ARB

Question 17

What drugs cause acute tubular necrosis?

Answer 17

Aminoglycosides, amphotericin B, cisplatin, contrast dye

Question 18

What drugs cause acute interstitial nephritis?

Answer 18

Beta-lactams, sulfa drugs, NSAIDs, lithium

Question 19

What drugs cause glomerulonephritis?

Answer 19

lithium

Question 20

What drugs cause nephrolithiasis?

Answer 20

Drugs with acidic PKa’s- i.e. acyclovir, foscarnet, indinavir, sulfa, topiramate

Question 21

Risk factors for drug induced AKI

Answer 21

Use of concomitant nephrotoxins, old age, pre-existing CKD, prolonged therapy, high trough concentrations of ATN, known allergic drug response, decreased fluid intake