MSK-rheum drug adverse effects Flashcards
succinylcholine
- hemodynamic effects
- hyperkalemia
- muscle pain from fasciculations
- myoglobinuria
what is the worst side effect of succinylcholine? how is it caused? how is it treated?
malignant hyperthermia
- uncontrolled release of Ca from sarc reticulum
- treat with dantrolene (O2, treat hyperkalemia and acidosis)
3 NSAID common adverse effects
increase blood pressure
inhibit platelets (may be beneficial)
GI toxicity
what is the most effective way to avoid GI toxicity of NSAIDs?
proton pump inhibitors
what adverse effect of NSAIDs is rare but still accounts for 10% of the cases of this related to drugs?
hepatotoxicity
NSAID use can interfere with function of what important organ and how?
kidney: prostaglandins vital for autoregulation: renal ischemia, reduced GFR, ARF
what causes salicylate poisoning and what happens?
aspirin
- causes hyperventilation: respiratory alkalosis, dehydration, compensatory metabolic acidosis
- ultimately, cerebral and pulmonary edema and CV collapse
what four things should be monitored in patients on chronic NSAIDs?
- LFTs
- CBCs (rare blood dyscrasias)
- serum creatinine/BUN
- stool guaiac for GI toxicity
what two RA drugs are contraindicated in pregnancy/breast feeding?
methotrexate and leflunomide
what 2 toxicities are common to all non-biologic, non-NSAID drugs in RA treatment?
blood dyscrasias increased LFTs (except hydroxychloroquine)
what should be monitored in patients on hydroxychloroquine?
ophthalmalogic exams
what should be tested in methotrexate before beginning treatment
pulmonary test
what should patients be screened for before prescribing steroids?
osteoporosis
fasting blood glucose
glaucoma risk
ankle edmea
what risk factor do RA patients have and which drugs increase this? how?
CV events: corticosteroids:
-adverse lipid profile, insulin resistance, obesity
what should be avoided with use of biologic RA drugs? what is a common risk in their use?
vaccines
awaking dormant pathogens, e.g. TB
which biologic is contraindicated in CHF?
infliximab
what are two adverse effects of rituximab?
rarely, SJS
IgG cross placenta and deplete B cells in fetus
what biologic contains maltose and complicates blood glucose tests
abatacept
what biologic can affect the serum lipid profile
toclizumab
what are two adverse effects of colchicine and what should be monitored?
GI disturbances most common
hepatotoxicity-monitor LFTs
what are two adverse effects of indomethacine and what drugs should be avoided?
GI toxicity
CNS: severe frontal headaches
-antagonizes furosemide and HCTZ
what is the main adverse effect of allopurinol?
increases incidences of acute gouty arthritis due to mobilization of urate deposits in joints/tissues
what 2 drugs does allopurinol interact with?
6-mercaptopurine/6-thioguanine: inhibit metabolism by HGPRT by buildup up hypoxanthine
what are the adverse effects of febuxostat?
few: but occasionally elevated LFTs (like allopurinol)
what two drugs interfere with action of probenecid?
salicylates and HCTZ
what is the adverse effect of pegloticase? how can it be treated/avoided?
gout flares due to dissolution of tophi
-prophylactic colchicine, NSAIDs, glucocorticoids
