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Nimna's Flash Cards > Pharm and Drug Adverse Events > Flashcards

Pharm and Drug Adverse Events Flashcards

1
Q

Cyclophosphamide SE

A

High risk of bladder cancer

Haemorrhagic cystitis

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2
Q

Sorafenib SE

A

Hand-foot syndrome

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3
Q

Tenofovir (TDF) SE

A

Renal failure

Osteoporosis

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4
Q

Benzodiazepine reversal

A

Flumazenil - can trigger seizures

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5
Q

Magnesium (when used in high doses in asthma and pregnancy)

A
  • hypotension
  • vasodilation
  • bradycardia
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6
Q

What do you need to monitor for in TCA overdose ECG

A

wide QRS >160ms

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7
Q

Side effect of Nintedanib

A

Diarrhoea

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8
Q

Drugs causing vavulopathies

A

Related to serotonin

  • Cabergoline
  • ergotamine
  • Pergolide
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9
Q

Mechanism of Vancomycin red man syndrome

A

Direct mast cell degranulation

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10
Q

Common side effect of ticagrelor

A

Shortness of breath - 10%

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11
Q

SE of Tacrolimus

A

Diabetes

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12
Q

When cant Sofosbuvir used for Hep C?

A

In CKD eGFR<30

Can use Glecaprevir instead

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13
Q

Levatenib (used in HCC) SE

A

Hypertension

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14
Q

At what eGFR can SGLT2i be used?

A

eGFR > 45

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15
Q

EGFR-TKI Side effects

A

Acne
Dry skin
diarrhoea

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16
Q

Cholinergic toxicity reversal

A

Atropine + Pralidoxime

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17
Q

Anticholinergic toxicity reversal

A

Physostigmine

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18
Q

Resistance formed in EGFR TKIs

A

T790M

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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.

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20
Q

Methotrexate SE

A

alopecia, hepatotoxicity, myelotoxicity, methotrexate lung injury.

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21
Q

Methotrexate cannot be taken with which Abx

A

Trimethoprim

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22
Q

Sulfasalazine SE

A

Agranulocytosis
Azospermia
Lupus

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23
Q

Hydroxychloroquine SE

A

Retinopathy
Hyperpigmentation
Cardiomyopthy

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24
Q

Leflunomide SE

A

HTN, pneumonitis, neuropathy, diarrhoea

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25
Q

Anticholinergic side effects

A 
Hot 
Dry 
Mad 
Red
Tachycardic
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26
Q

Cholinergic side effects

A 
Salivation 
Lacrimation 
Urination 
Diaphoresis 
GI symptoms 
Emesis
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27
Q

Causes of anti-clockwise hysteresis curves

A

slow distribution to tissue of action
active metabolites
irreversibly binding drugs

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28
Q

Causes of clockwise hysteresis curves

A

Drugs with tachyphylaxis (tolerance) - eg opioids

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29
Q

Causes increased risk of prarcetamol toxicity in overdose

A

CHRONIC alcoholism

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30
Q

Polymorphism of Carvedilol

A

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%

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31
Q

Phase 1 clinical trial

A

Safe dose and side effects

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32
Q

Phase 2 clinical trial

A

Efficacy in human population and side effects

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33
Q

Phase 3 clinical trial

A

Comparison with current standard

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34
Q

Phase 4 clinical trial

A

Post marketing analysis - long term side effects, interactions, other uses

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35
Q

Linezolid SE

A

Diarrhoea, myelosuppressive, deranged LFTs

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36
Q

Pristinamycin SE and MOA

A

Works on 50S sub unit of ribosomes.

SE: GI disturbance, dermatitis.

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37
Q

Carbapenem SE

A

neurotoxicity at high concentrations

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38
Q

Vancomycin SE

A

nephrotoxicity, rash

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39
Q

Vancomycin SE

A

nephrotoxicity, rash, red man syndrome

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40
Q

MOA of rifampicin

A

inhibits mRNA synthesis

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41
Q

Linezolid MOA

A

Inhibits 50S ribosomal unit. Preventing 70S being formed.

42
Q

Daptomycin SE

A

Chest pain, oedema, sore throat

43
Q

Daptomycin MOA

A

depolarises cell membrane, stopping transcription and translation occurring.

44
Q

Daptomycin SE

A

Chest pain, oedema, sore throat, myalgia.

45
Q

TNF inhibitors increase the incidence of which infections

A

mycobacterial infections

46
Q

Buproprion SE (smoking cessation drug)

A

Seizures

47
Q

Rifampicin MOA and SE

A

Inhibits bacterial RNA synthesis by binding to the beta subunit of DNA-dependent RNA polymerase

SE: CYP inducer, orange secretions, hepatotoxicity.

48
Q

Isoniazid MOA and SE

A

Inhibits mycolic acid synthesis

SE: Hepatotoxicity, peripheral neuropathy, psychosis, optic neuritis, B6 deficiency.

49
Q

Pyrazinamide MOA and SE

A

MOA unknown, lowers pH in TB cells.

SE: Hepatotoxicity, hyperuricaemia, arthralgias.

50
Q

Ethambutol MOA and SE

A

MOA: Inhibits arabinosyl transferase resulting in impaired mycobacterial cell wall synthesis

SE: Optic neuritis

51
Q

Tocilizumab SE

A 
Hypercholesterolemia 
Hepatotoxic 
Infusion reaction 
Hypothyroid
GI perforation 
Increased fungal infection
52
Q

Kings college criteria for paracetamol toxicity

A

Acidosis
Encephalopathy
INR
Creatinine

53
Q

Pizotifen MOA

A

Used in migraines.

5HT2 (serotonin) + antihistamine + anticholinergic.

54
Q

PDE5/Sildenafil optic side effect

A

non-arteritic anterior ischaemic optic neuropathy

55
Q

MOA Acetazolamide

A

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
Q

Symptoms of DRESS

A

Cutaneous eruptions, eosinophilia, lymphocytosis, liver injury, AIN, interstitial pneumonia.

The reaction begins two to eight weeks after the initiation of the causative drug

57
Q

Drugs causing DRESS

A

antiseizure drugs (eg, carbamazepine, lamotrigine, phenytoin, phenobarbital), allopurinol, antibacterial sulfonamides (including sulfasalazine), minocycline, and vancomycin

58
Q

Drugs causing SJS

A

Allopurinol, NSAIDS, Lamotrigine, Anticonvulsants, Sulphonamide antibiotics.

59
Q

Infection causing SJS

A

Mycoplasma Pneumoniae

60
Q

Carbimazole MOA and SE

A

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
Q

When to use PTU over Carbimazole

A
  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
Q

Withdrawal time frame of benzodiazepines

A

after 7-10 days

63
Q

Sildenafil SE

A

headache, bleeding, visual disturbance.

64
Q

Bosentan SE

A

LFT derrangement, fluid retention

65
Q

Epoprostenol SE

A

headaches, diarrhoea

66
Q

Colchicine SE

A

gastrointestinal (eg, diarrhea, nausea, vomiting) bone marrow suppression, hepatotoxicity, and myotoxicity.

67
Q

Clonidine uses and MOA:

A
  • 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
Q

CDK inhibitor SE

A

QTc prolongation + deranged LFTs (Ribociclib), diarrhea, neutropenia (CDK inhibitor class effect)

69
Q

SE Bortezomib

A

Active due to boron atom
Peripheral neuropathy
GI side effects
myelosuppression

Boron bones bowels burns

70
Q

Common infection with use of Tofacitinib

A

Shingles

71
Q

ABx which are concentration dependant (Cmax:MIC) - Type 1

A

Aminoglycoside (Gent)
Metronidazole
Fluoroquinolones
Daptomycin

72
Q

ABx which are time dependant (T>MIC) - Type 2

A 
Beta Lactams 
Carbapenems 
Linezolid 
Erythromycin 
Clarithromycin
73
Q

ABx which are both time and concentration dependant (overall amount) (AUC:MIC) - Type 3

A

Azithromycin
Tetracyclines
Vancomycin
Clindamycin

74
Q

Oseltamivir SE

A

nausea and vomiting

75
Q

Gentamycin ototoxicity symptoms

A

Oscillopsia and imbalance

76
Q

Drug causing TMA

A

Tacrolimus

77
Q

Disulfiram causes increase in what molecule if alcohol is ingested

A

acetaldehyde

78
Q

Management of methotrexate toxicity

A

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
Q

Drug which targets inosine monophosphate dehydrogenase

A

Mycophenolate

80
Q

Drug which targets Dihydroorotate reductase

A

Leflunomide

81
Q

Imiquimod MOA

A

Imiquimod stimulates the innate immune system by activating toll-like receptor 7 (TLR7)

82
Q

Drugs to avoid with grapefruit juice

A
  • Statins
  • Nifedipine
  • Amiodarone
  • cyclosporin
  • budesonide
83
Q

SE of Tofacitinib

A

CVD

Thromboembolism

84
Q

Reversal for Organophosphate poisoning (Cholinergics)

A

Atropine + Pralidoxime

85
Q

Reversal for AV blocking agents - B-blockers + CCB

A

Insulin + dextrose/ Glucagon

Atropine (+calcium gluconate for CCB)

86
Q

Reversal for ethylene glycol

A

Calcium gluconate

Ethanol

87
Q

Reversal for iron poisoning

A

Deferoxamine

88
Q

Management of digoxin toxicity

A

Activated charcoal if <2hrs since ingestion
Atropine
Digoxin FAB fragments

89
Q

Reversal for methanol poisoning

A

Ethanol

Folinic acid

90
Q

Reversal of Benzo poisoning

A

Flumazenil

91
Q

Reversal of methotrexate toxicity

A

Folinic acid

92
Q

Reversal for cyanide poisoning

A

B12 - hydroxocobalamin

93
Q

Management of Methemoglobinemia

A

Methylene blue

94
Q

Management of Sulfonylurea poisoning

A

Octreotide

95
Q

Reversal of anticholinergic poisoning

A

Physostigmine

96
Q

Warfarin reversal

A

Phytomenadione (Vit K)

97
Q

Phase 1 hepatic elimination

A

oxydation, reduction, hydrolysis

98
Q

Phase 2 hepatic elimination

A

methylation, glucoronidation, sulfate conjugation

99
Q

Types of Adverse drug reaction

A

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
Q

Effect of hepatic extraction ratio on drug clearance

A

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
Q

Steroid conversion for 5mg pred: (5)

A 
1mg Dexa 
4mg methlpred 
5mg pred
20mg hydrocort 
25 cortisone
102
Q

Opioid conversion for 10mg oral morphine (7)

A 
4mcg/hr fentanyl 
5mcg/hr buprenorphine 
2mg hydromorph 
7.5mg endone 
10mg morphine 
50mg tapendadol/tramadol 
75mg codeine

Nimna's Flash Cards (15 decks)

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