Pharm and Drug Adverse Events Flashcards
1
Q
Cyclophosphamide SE
A
High risk of bladder cancer
Haemorrhagic cystitis
2
Q
Sorafenib SE
A
Hand-foot syndrome
3
Q
Tenofovir (TDF) SE
A
Renal failure
Osteoporosis
4
Q
Benzodiazepine reversal
A
Flumazenil - can trigger seizures
5
Q
Magnesium (when used in high doses in asthma and pregnancy)
A
- hypotension
- vasodilation
- bradycardia
6
Q
What do you need to monitor for in TCA overdose ECG
A
wide QRS >160ms
7
Q
Side effect of Nintedanib
A
Diarrhoea
8
Q
Drugs causing vavulopathies
A
Related to serotonin
- Cabergoline
- ergotamine
- Pergolide
9
Q
Mechanism of Vancomycin red man syndrome
A
Direct mast cell degranulation
10
Q
Common side effect of ticagrelor
A
Shortness of breath - 10%
11
Q
SE of Tacrolimus
A
Diabetes
12
Q
When cant Sofosbuvir used for Hep C?
A
In CKD eGFR<30
Can use Glecaprevir instead
13
Q
Levatenib (used in HCC) SE
A
Hypertension
14
Q
At what eGFR can SGLT2i be used?
A
eGFR > 45
15
Q
EGFR-TKI Side effects
A
Acne
Dry skin
diarrhoea
16
Q
Cholinergic toxicity reversal
A
Atropine + Pralidoxime
17
Q
Anticholinergic toxicity reversal
A
Physostigmine
18
Q
Resistance formed in EGFR TKIs
A
T790M
19
Q
How does Probenecid increase the concentration of other drugs
A
Probenecid inhibits organic anion transporters (OATs) causing less active tubular secretion of drugs into the urine.
20
Q
Methotrexate SE
A
alopecia, hepatotoxicity, myelotoxicity, methotrexate lung injury.
21
Q
Methotrexate cannot be taken with which Abx
A
Trimethoprim
22
Q
Sulfasalazine SE
A
Agranulocytosis
Azospermia
Lupus
23
Q
Hydroxychloroquine SE
A
Retinopathy
Hyperpigmentation
Cardiomyopthy
24
Q
Leflunomide SE
A
HTN, pneumonitis, neuropathy, diarrhoea
25
Anticholinergic side effects
```
Hot
Dry
Mad
Red
Tachycardic
```
26
Cholinergic side effects
```
Salivation
Lacrimation
Urination
Diaphoresis
GI symptoms
Emesis
```
27
Causes of anti-clockwise hysteresis curves
slow distribution to tissue of action
active metabolites
irreversibly binding drugs
28
Causes of clockwise hysteresis curves
Drugs with tachyphylaxis (tolerance) - eg opioids
29
Causes increased risk of prarcetamol toxicity in overdose
CHRONIC alcoholism
30
Polymorphism of Carvedilol
Carvedilol is a mixture of equal amounts of left-handed S(-) and right-handed R(+) enantiomers. Enantiomers are molecules that are mirror images of each other. The nonselective beta-adrenoreceptor blocking activity of carvedilol is present in the S(-) enantiomer; and the α1-adrenergic blocking activity is present in both R(+) and S(-) enantiomers at equal potency.
In individuals who are “CYP2D6 poor metabolizers”. Plasma concentrations of R(+)- carvedilol are 2–3 times higher in poor metabolizers, and levels of S(-)-carvedilol are increased by approximately 20% to 25%
31
Phase 1 clinical trial
Safe dose and side effects
32
Phase 2 clinical trial
Efficacy in human population and side effects
33
Phase 3 clinical trial
Comparison with current standard
34
Phase 4 clinical trial
Post marketing analysis - long term side effects, interactions, other uses
35
Linezolid SE
Diarrhoea, myelosuppressive, deranged LFTs
36
Pristinamycin SE and MOA
Works on 50S sub unit of ribosomes.
| SE: GI disturbance, dermatitis.
37
Carbapenem SE
neurotoxicity at high concentrations
38
Vancomycin SE
nephrotoxicity, rash
39
Vancomycin SE
nephrotoxicity, rash, red man syndrome
40
MOA of rifampicin
inhibits mRNA synthesis
41
Linezolid MOA
Inhibits 50S ribosomal unit. Preventing 70S being formed.
42
Daptomycin SE
Chest pain, oedema, sore throat
43
Daptomycin MOA
depolarises cell membrane, stopping transcription and translation occurring.
44
Daptomycin SE
Chest pain, oedema, sore throat, myalgia.
45
TNF inhibitors increase the incidence of which infections
mycobacterial infections
46
Buproprion SE (smoking cessation drug)
Seizures
47
Rifampicin MOA and SE
Inhibits bacterial RNA synthesis by binding to the beta subunit of DNA-dependent RNA polymerase
SE: CYP inducer, orange secretions, hepatotoxicity.
48
Isoniazid MOA and SE
Inhibits mycolic acid synthesis
SE: Hepatotoxicity, peripheral neuropathy, psychosis, optic neuritis, B6 deficiency.
49
Pyrazinamide MOA and SE
MOA unknown, lowers pH in TB cells.
| SE: Hepatotoxicity, hyperuricaemia, arthralgias.
50
Ethambutol MOA and SE
MOA: Inhibits arabinosyl transferase resulting in impaired mycobacterial cell wall synthesis
SE: Optic neuritis
51
Tocilizumab SE
```
Hypercholesterolemia
Hepatotoxic
Infusion reaction
Hypothyroid
GI perforation
Increased fungal infection
```
52
Kings college criteria for paracetamol toxicity
Acidosis
Encephalopathy
INR
Creatinine
53
Pizotifen MOA
Used in migraines.
5HT2 (serotonin) + antihistamine + anticholinergic.
54
PDE5/Sildenafil optic side effect
non-arteritic anterior ischaemic optic neuropathy
55
MOA Acetazolamide
Reversible inhibition of the enzyme carbonic anhydrase resulting in reduction of hydrogen ion secretion at renal tubule and an increased renal excretion of sodium, potassium, bicarbonate, and water. Decreases production of aqueous humor and inhibits carbonic anhydrase in central nervous system to retard abnormal and excessive discharge from CNS neurons.
56
Symptoms of DRESS
Cutaneous eruptions, eosinophilia, lymphocytosis, liver injury, AIN, interstitial pneumonia.
The reaction begins two to eight weeks after the initiation of the causative drug
57
Drugs causing DRESS
antiseizure drugs (eg, carbamazepine, lamotrigine, phenytoin, phenobarbital), allopurinol, antibacterial sulfonamides (including sulfasalazine), minocycline, and vancomycin
58
Drugs causing SJS
Allopurinol, NSAIDS, Lamotrigine, Anticonvulsants, Sulphonamide antibiotics.
59
Infection causing SJS
Mycoplasma Pneumoniae
60
Carbimazole MOA and SE
MOA: prevents thyroid peroxidase enzyme from iodinating and coupling the tyrosine residues on thyroglobulin, hence reducing the production of the thyroid hormones T3 and T4
SE: agranulocytosis, hepatotoxicity, pancreatitis
61
When to use PTU over Carbimazole
1. In patients during the first trimester of pregnancy
2. For the initial management of patients with life-threatening thyrotoxicosis or thyroid storm.
3. In patients with minor reactions to carbimazole who do not want definitive treatment with radioiodine or surgery.
62
Withdrawal time frame of benzodiazepines
after 7-10 days
63
Sildenafil SE
headache, bleeding, visual disturbance.
64
Bosentan SE
LFT derrangement, fluid retention
65
Epoprostenol SE
headaches, diarrhoea
66
Colchicine SE
gastrointestinal (eg, diarrhea, nausea, vomiting) bone marrow suppression, hepatotoxicity, and myotoxicity.
67
Clonidine uses and MOA:
- ADHD
- HTN
- Vasomotor symptoms of menopause.
Stimulates alpha-2 adrenoceptors in the brain stem, thus activating an inhibitory neuron, resulting in reduced sympathetic outflow from the CNS, producing a decrease in peripheral resistance, renal vascular resistance, heart rate, and blood pressure
HIGH REBOUND HTN - to be withdrawn gradually.
68
CDK inhibitor SE
QTc prolongation + deranged LFTs (Ribociclib), diarrhea, neutropenia (CDK inhibitor class effect)
69
SE Bortezomib
Active due to boron atom
Peripheral neuropathy
GI side effects
myelosuppression
Boron bones bowels burns
70
Common infection with use of Tofacitinib
Shingles
71
ABx which are concentration dependant (Cmax:MIC) - Type 1
Aminoglycoside (Gent)
Metronidazole
Fluoroquinolones
Daptomycin
72
ABx which are time dependant (T>MIC) - Type 2
```
Beta Lactams
Carbapenems
Linezolid
Erythromycin
Clarithromycin
```
73
ABx which are both time and concentration dependant (overall amount) (AUC:MIC) - Type 3
Azithromycin
Tetracyclines
Vancomycin
Clindamycin
74
Oseltamivir SE
nausea and vomiting
75
Gentamycin ototoxicity symptoms
Oscillopsia and imbalance
76
Drug causing TMA
Tacrolimus
77
Disulfiram causes increase in what molecule if alcohol is ingested
acetaldehyde
78
Management of methotrexate toxicity
Mild - High dose IV calcium folinate (Leucovorin®) rescue
Severe - Glucarpidase (formally known as carboxypeptidase G2) is a carboxypeptidase enzyme which converts plasma methotrexate into inactive metabolites, providing an alternative rapid non-renal route of elimination.
79
Drug which targets inosine monophosphate dehydrogenase
Mycophenolate
80
Drug which targets Dihydroorotate reductase
Leflunomide
81
Imiquimod MOA
Imiquimod stimulates the innate immune system by activating toll-like receptor 7 (TLR7)
82
Drugs to avoid with grapefruit juice
- Statins
- Nifedipine
- Amiodarone
- cyclosporin
- budesonide
83
SE of Tofacitinib
CVD
| Thromboembolism
84
Reversal for Organophosphate poisoning (Cholinergics)
Atropine + Pralidoxime
85
Reversal for AV blocking agents - B-blockers + CCB
Insulin + dextrose/ Glucagon
| Atropine (+calcium gluconate for CCB)
86
Reversal for ethylene glycol
Calcium gluconate
| Ethanol
87
Reversal for iron poisoning
Deferoxamine
88
Management of digoxin toxicity
Activated charcoal if <2hrs since ingestion
Atropine
Digoxin FAB fragments
89
Reversal for methanol poisoning
Ethanol
| Folinic acid
90
Reversal of Benzo poisoning
Flumazenil
91
Reversal of methotrexate toxicity
Folinic acid
92
Reversal for cyanide poisoning
B12 - hydroxocobalamin
93
Management of Methemoglobinemia
Methylene blue
94
Management of Sulfonylurea poisoning
Octreotide
95
Reversal of anticholinergic poisoning
Physostigmine
96
Warfarin reversal
Phytomenadione (Vit K)
97
Phase 1 hepatic elimination
oxydation, reduction, hydrolysis
98
Phase 2 hepatic elimination
methylation, glucoronidation, sulfate conjugation
99
Types of Adverse drug reaction
A - Augmented - dose related expected drug reaction.
B - Bizzare - includes allergy
C - Continuing - long term exposure related
D - delayed - occurs a long time after the drug was used
E - end of use - withdrawal drug effects
100
Effect of hepatic extraction ratio on drug clearance
Low extraction ratio - only a small amount of drug eliminated per pass - most effected by fraction unbound and enzyme activity.
High extraction ratio - almost all drug eliminated per pass, therefore most effected by flow rate.
101
Steroid conversion for 5mg pred: (5)
```
1mg Dexa
4mg methlpred
5mg pred
20mg hydrocort
25 cortisone
```
102
Opioid conversion for 10mg oral morphine (7)
```
4mcg/hr fentanyl
5mcg/hr buprenorphine
2mg hydromorph
7.5mg endone
10mg morphine
50mg tapendadol/tramadol
75mg codeine
```
