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FM1 > Pharm Block 2 Adverse Rxns/Precautions > Flashcards

Pharm Block 2 Adverse Rxns/Precautions Flashcards

1
Q

Prednisone

A

CNS: headache, insomnia, vertigo, depression, anxiety, euphoria, personality changes, psychosis
GI: NVD, anorexia, gastritis
Cataracts
Opportunistic infections

CUSHING’S SYNDROME
HIGH DOSES AND LONG-TERM THERAPY CAN SUPPRESS HPA AXIS, AVOID ABRUPT DC OF PROLONGED THERAPY
Preexisting bacterial, viral, fungal infections
Chronic corticosteroid use should have occasional testing for cataracts

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2
Q

Cyclosporine

A 
Nephrotoxicity; CNIs induce interstitial fibrosis and vasoconstriction of afferent arterioles leading to tubular necrosis
Hypertension
Hirsutism
Gingival hyperplasia
CNS: tremor
Opthalamic application may cause burning
Hyperglycemia

Therapeutic drug monitoring=maintain 150-200 ng/mL
Hepatic disease, renal disease, hypertension

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3
Q

Tacrolimus

A 
Nephrotoxicity; CNIs induce interstitial fibrosis and vasoconstriction of afferent arterioles leading to tubular necrosis
Hypertension
CNS: tremor, insomnia, headaches
GI: NVD, elevated LFTs
Hyperglycemia

Diabetes
Therapeutic drug monitoring=5-20 ng/L
Hepatic disease, renal disease, hypertension

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4
Q

Sirolimus

A

PULM: dyspnea, pharyngitis
HEME: myelosuppression
GI: NVD, hepatotoxicity, elevated LFTs
MET: hyperlipidemia, hypertriglyceridemia, electrolyte imbalances, edema
Nephrotoxicity; may potentiate CNI-induced nephrotoxicity

Therapeutic drug monitoring= 12-24 ng/mL

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5
Q

Azathioprine

A

HEM: myelosuppression, potentially severe leukopenia
GI: NVD, abdominal pain, elevated LFTs
Rashes

Thiopurine methyltransferase deficiency -> enhanced toxicity
Tx with allopurinol -> enhanced toxicity
Pregnancy risk category D

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6
Q

Mycophenolate mofetil

A 
GI: NVD, abdominal pain
CNS: headache
CV: hypertension
HEM: myelosuppression
DERM: acne

Chronic renal insufficiency
Pregnancy Risk Category D

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7
Q

Muromonab-CD3

A

Trigger cytokine release syndrome: fever, chills, headache, tremor, dyspnea, chest pain, NVD
Syndrome subsides after first day and can be minimized by pretreatment with glucocorticoids, acetaminophen, diphenhydramine
Seizures
Rare but potentially fatal anaphylaxis

Allergy to mouse proteins
CV: heart failure, hypertension, hypotension
Epilepsy

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8
Q

Basiliximab

A 
Incidence and severity much lower than muromonab-CD3
GI: NVD, pain
MET: electrolyte imbalances
CV: hypertension, arrhythmias
Rare, potentially fatal anaphylaxis

Pediatric patients

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9
Q

Adalimumab

A 
Mild injection site reactions
Headache
Rash
CV: hypertension
MET: hyperlipidemia

Chronic or recurrent infection; TB
Travel to regions where mycoses or TB are endemic

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10
Q

Carbachol

A

Rarely iritis or corneal clouding

Acute cardiac failure; bradycardia
Asthma
Hyperthyroidism
Peptic ulcer
Urinary tract obstruction
Parkinsonism
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11
Q

Methacholine

A

Headache
Throat irritation
Lightheadedness
Itching

Acute cardiac failure; bradycardia
Asthma
Hyperthyroidism
Peptic ulcer
Urinary tract obstruction
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12
Q

Bethanechol

A

Rare, but reflect cholinergic stimulation

Acute cardiac failure; bradycardia
Asthma
Hyperthyroidism
Peptic ulcer
Urinary tract obstruction
Parkinsonism
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13
Q

Pilocarpine

A

Blurred vision
Exocrine glands; hypersalivation, diaphoresis
Flushing
Headache

ASTHMA
IRITIS
POSTERIOR SYNECHIAE (ADHESION BETWEEN IRIS AND LENS)
RETINAL DETACHMENT
Heart disease
Parkinsonism
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14
Q

Nicotine

A

CNS: dizziness, insomnia, irritability
CV: increase BP and positive inotropic and chronotropic actions
GI: constipation, diarrhea

Angina, arrhythmia, MI
Caution in patients with hypertension, pheochromocytoma, insulin-dependent diabetes, vasospastic diseases, thyroid disease resulting in thyrotoxicosis
Pregnancy Risk Category D

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15
Q

Varenicline

A

GI-related: mild-to-moderate, transient, nausea, constipation, flatulence
CNS: insomnia, vivid dreams

Renal insufficiency; do not exceed 0.5 mg BID if CrCL

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16
Q

Physostigmine

A

CNS: restlessness, seizures
CV: irregular pulse, palpitations, bradycardia
GI: hypersalivation, cramps, NVD
UG: urinary urgency
Lung: bronchospasm, dyspnea, increased secretions
Eye: miosis, lacrimation, blurred vision

ASTHMA
GI OBSTRUCTION
URINARY TRACT OBSTRUCTION
Peptic ulcer
Heart disease
Hyperthyroidism
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17
Q

Neostigmine

A

CV: irregular pulse, palpitations, bradycardia
GI: hypersalivation, cramps, NVD
UG: urinary urgency
Lung: bronchospasm, dyspnea, increased secretions
Eye: miosis, lacrimation, blurred vision

ASTHMA
GI OBSTRUCTION
URINARY TRACT OBSTRUCTION
Peptic ulcer
Heart disease
Hyperthyroidism
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18
Q

Edrophonium

A

Dysphonia, dysarthia, dysphagia, convulsions
CV: irregular pulse, palpitations, bradycardia
GI: hypersalivation, cramps, NVD
UG: urinary urgency
Lung: bronchospasm, dyspnea, increased secretions
Eye: miosis, lacrimation, blurred vision

GI OBSTRUCTION
URINARY TRACT OBSTRUCTION
Asthma
Heart disease

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19
Q

Echothiophate

A

Eye: stinging, blurred vision, lacrimation, increased incidence of cataracts with prolonged therapy

Uveitis

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20
Q

Pralidoxime

A 
CNS: dizziness, excitement, agitation, headache
CV: tachycardia, hypertension
GI: NV
Transient elevations in ALT and AST
Eye: diplopia, blurred vision

Renal insufficiency
AChE inhibitor TX for myasthenia gravis

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21
Q

Atropine

A

CNS: dizziness, confusion, amnesia, hallucinations, delirium, insomnia
CV: cardiac conduction abnormalities, fibrillation, PVCs, SVT, QT prolongation

ACUTE MI
BLADDER OBSTRUCTION, URINARY TRACT OBSTRUCTION, PROSTATIC HYPERTROPHY
GLAUCOMA
GI OBSTRUCTION, ILEUS
HYPERTHYROIDISM
Chronic pulmonary disease; thickens mucous
Conditions that elevate core body temp. (strenuous exercise, fever, dehydration)

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22
Q

Oxybutynin

A

Antiholinergic and antispasmolytic activity
CNS: dizziness, confusion, headache, drowsiness
CV: palpitations, tachycardia
GI: constipation, diarrhea

GI OBSTRUCTION, ILEUS
TOXIC MEGACOLON, ULCERATIVE COLITIS
URINARY RETENTION OR URINARY TRACT OBSTRUCTION
UNCONTROLLED NARROW-ANGLE GLAUCOMA

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23
Q

Ipratropium

A

Xerostomia
Cough, hoarseness, throat irritation, nasal dryness

Glaucoma
Urinary retention, bladder obstruction

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24
Q

Mecamylamine

A 
CNS: choreiform movements, mental changes, paresthesias, seizures, dizziness
CV: postural hypotension, tachycardia
GI: xerostomia, constipation, ileus
UG: urinary retention, impotence
Eye: blurred vision, mydriasis

Cerebral or coronary atherosclerosis or other conditions of deficient blood flow
Recent MI
Glaucoma
Renal insufficiency

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25
Epinephrine
CNS: anxiety, nervousness, insomnia, aggressive behavior CV: arrhythmias, PVCs, tachycardia ``` Narrow-angle glaucoma Intraarterial administration Nonanaphylactic shock Labor, can cause fetal anoxia or decreased HR due to increased uterine contractility or decreased uterine blood flow Extravasation Hypertension Hyperthyroidism Diabetes ```
26
Phenylephrine
Few reactions with intranasal or opthalmic routes Parenteral dosing can produce angina, hypertension, anxiety, insomnia ``` CV diseases; MI, artery disease, angina, atrial or ventricular flutter or fibrillation, arrhythmias, hypertension, tachycardia Narrow-angle glaucoma Labor Extravasation Hyperthyroidism ```
27
Clonidine
CNS: sedation, lethargy, dizziness CV: orthostatic hypotension, palpitations, tachycardia, bradycardia GI: xerostomia, NV, constipation Effects generally will subside with continued therapy Abrupt DC -> withdrawal syndrome consisting of rebound increase in catecholamines -> severe hypertension, tachycardia, agitation (should be tapered off) Breast-feeding: 2x concentrated in breast milk CV disease: MI or severe heart failure, hypotensive effects decrease perfusion and worsen ischemia in these conditions
28
Isoproterenol
CNS: nervousness, headache CV: palpitations, tachycardia, angina Flushed skin Arrhythmias Heart block caused by digitalis compounds Coronary heart disease, coronary insufficiency Diabetes Hyperthyroidism
29
Dobutamine
CV: PVCs, tachycardia, angina Idiopathic hypertrophic subaortic stenosis Arrhythmias Hypovolemia
30
Albuterol
CNS: anxiety, tremor, headache CV: increase BP, angina, palpitations, sinus tachycardia, arrhythmia GI: NV, dyspepsia ``` Angioedema Coronary artery disease Hypertension Hyperthyroidism Diabetes Increasing use of inhaled short-acting beta agonists is a sign of deteriorating asthma, can be life-threatening ```
31
Salmeterol
Cough, headache, pharyngitis, disease of nasal cavity/sinus, upper respiratory tract infection Coronary heart disease, hypertension Hyperthyroidism Diabetes Black box warning of increased risk of asthma-related death with long-acting beta2 agonists
32
Phentolamine
CNS: dizziness CV: orthostatic hypotension, reflex tachycardia, arrhythmias GI: NVD Nasal congestion MI, coronary insufficiency, angina
33
Phenoxybenzamine
``` CNS: dizziness, syncope, fatigue CV: reflex tachycardia, orthostatic hypotension UG: impotence Eye: Miosis Nasal congestion ``` Congestive heart failure Coronary artery disease Renal disease Hypotensive effects can worsen these conditions
34
Prazosin
CNS: dizziness (first-dose syncope), lightheadedness, drowsiness, headache CV: palpitations, orthostatic hypotension GI: pain, NVD GU: impotence, incontinence Angina; prazosin-induced hypotension may worsen condition Syncope can be hazardous for patients in occupations for which alertness is required Caution with PDE5 inhibitors
35
Tamsulosin
CNS: dizziness, insomnia, syncope CV: orthostatic hypotension GU: abnormal ejaculation Caution with PDE5 inhibitors
36
Yohimbine
CNS: anxiety, dizziness, headache, restlessness, irritability CV: hypertension, tachycardia, chest pain ANGINA CARDIAC DISEASE HYPERTENSION Generally not used in pregnant women because they don't have dicks , but likely category D risk
37
Carvedilol
CV: bradycardia, hypotension, orthostatic hypotension CNS: dizziness GI: NVD ``` ABRUPT DC; TAPER OVER 1-2 WEEKS ASTHMA IV INOTROPES Hepatic disease Elderly Diabetes ```
38
Propranolol
Mild and temporary, more at onset of therapy CNS: dizziness, fatigue, depression CV: bradycardia, cold hands and feet GI: NVD ABRUPT DC CAN PRODUCE MYOCARDIAL ISCHEMIA, MI, ARRHYTHMIAS, SEVERE HYPERTENSION ACUTE BRONCHOSPASM, PULMONARY EDEMA, ASTHMA BRADYCARDIA, AV BLOCK Hepatic disease Raynaud's disease Diabetes
39
Timolol
Eye pain, conjunctivitis, itching CNS: dizziness, headache ``` ACUTE BRONCHOSPASM, PULMONARY EDEMA, ASTHMA BRADYCARDIA, AV BLOCK Hepatic disease Raynaud's disease Diabetes ```
40
Metoprolol
Mild and Temporary CNS: depression, dizziness, fatigue CV: bradycardia, AV block, hypotension, cold hands and feet GI: xerostomia, NVD ABRUPT DC CAN PRODUCE MYOCARDIAL ISCHEMIA, MI, ARRHYTHMIAS, SEVERE HYPERTENSION ACUTE BRONCHOSPASM, PULMONARY EDEMA, ASTHMA BRADYCARDIA, AV BLOCK Hepatic disease Raynaud's disease Diabetes
41
Pindolol
Generally mild CNS: dizziness, fatigue CV: edema ABRUPT DC CAN PRODUCE MYOCARDIAL ISCHEMIA, MI, ARRHYTHMIAS, SEVERE HYPERTENSION Diabetes
42
Alpha-Methyltyrosine
CNS: transient sedation, anxiety, depression, hallucinations, disorientation, confusion, speech difficulty, drooling, tremor GI: diarrhea Crystalluria with doses > 2g QD Alcohol Fluid intake to produce urine output of 2 L QD
43
Alpha-Methyldopa
CNS: transient sedation, parkinsonism Usually reversible elevated LFTs (if under 3x normal then you are gucci) Hemolytic anemia Hepatic disease Dopamine antagonists
44
Reserpine
CNS: sedation, difficulty concentrating, severe depression lasting for several months following DC, decreased libido in men and women CV: hypotension, bradycardia, arrhythmias, edema GI: NVD, pain UG: impotence DC AT FIRST SIGN OF DEPRESSION ECT, SEIZURE DISORDER
45
Botulinum Toxin A
Ptosis, local muscle weakness Dysphagia, dystonia Immunogenic response: fever, flu-like symptoms, pain at injection site, urticaria, edema Preexisting neuromuscular disorders
46
Amphetamine
CNS: insomnia, restlessness, anorexia, high dose: anxiety, delirium, hallucinations, psychosis, paranoia, hyperthermia, tremor CV: tachycardia, angina, high dose: labile BP and HR ``` ANOREXIA NERVOSA CV: ADVANCED ARTERIOSCLEROSIS, CORONARY ARTERY DISEASE, MODERATE-TO-SEVERE HYPERTENSION, CARDIAC STRUCTURAL ABNORMALITIES MAO INHIBITORS HYPERTHYROIDISM GLAUCOMA (CAN INCREASE IOP) ```
47
Cocaine
CNS: excessive sympathetic activity agitation, anxiety, confusion, hallucinations, seizures, tachypnea, apnea CV: hypertension, PVCs, tachycardia Lung: pulmonary edema Ester-type local anesthetics sometimes produce allergic reactions Inflammation or severely traumatized mucosa at site of application Seizure disorder CV disease: MI, coronary artery disease, Hx of cardiac arrhythmia, uncontrolled hypertension
48
Paroxetine
CNS: drowsiness, dizziness, insomnia, anxiety, anorexia GI: NV, xerostomia, constipation MAO INHIBITOR THERAPY Renal insufficiency Hepatic disease Pregnancy Risk Category D
49
Atomoxetine
Tend to diminish with continued dosing CNS: fatigue, emotional lability, insomnia, headache, restlessness, decreased libido CV: chest pain, tachycardia, hypertension GI: upper GI pain, NV, anorexia, constipation UG: problems with ejaculation, urinary hesitation Hepatic disease, jaundice Narrow-angle glaucoma; can rarely cause mydriasis MAO inhibitors CV: cerebrovascular disease, coronary artery disease, hypertension, stroke, tachycardia, arrhythmias, and other conditions that put a patient at risk due to elevated BP or pulse rate; pulse and BP should be monitored at baseline, after any dose increases, and periodically throughout treatment
50
Phenelzine
Sympathomimetic effects: hypertension, agitation, insomnia, tachycardia, mydriasis, diaphoresis, tremor, aggressiveness Most adverse effects subside over time or respond to dosage reduction CV: acute MI, angina, arrhythmias, heart failure, cerebrovascular disease, hypertension Hepatic disease Pheochromocytoma Radiographic contrast administration (MAOIs can precipitate seizures) Renal disease Sympathomimetics e.g. local anesthetics containing epinephrine, OTC cold remedies Diabetes Tyramine-containing foods
51
Cyclophosphamide
Rapid-onset, potentially fatal heart failure, dysrhythmias, carditis Hemorrhagic cystitis, damage to bladder's epithelium and blood vessels due to acrotein metabolite Aggressive behavior CrCL= 10-24 mL/min should be monitored for Cyclophosphamide toxicity Hepatic impairment may reduce efficacy Administer 2-mercaptoethanesulfonic acid (MESNA) at 20-24% of dose for Cyclophosphamide doses > 550 mg/m2
52
Temozolomide
Hepatotoxicity Perform baseline and periodic LFTs and also approx. 2-4 weeks after last dose
53
Carboplatin
NV less severe than cisplatin and goes away in 24 hr Responds to antiemetic measures (5-HT3 antagonists, cannabis, D2 antagonists) Causes less neurotoxicity, ototoxicity, and nephrotoxicity than cisplatin Myelosuppression (thru thrombocytopenia) is close-limiting toxicity
54
Bleomycin
Minimally myelo- and immunosuppressive; dose-limiting toxicity is slowly progressing PULMONARY TOXICITY dyspnea, pneumonitis, fibrosis Mucocutaneous reactions: rash, vesiculation, hyperpigmentation Chills, fever Anaphylaxis CrCL
55
Doxorubicin
All PX develop cardiotoxicity: myocarditis, arrhythmia, abnormal ECG, myocardial damage, progress to CHF, mortality PX with CHF close to 50% Red discoloration of urine and sweat Vesicant; severe skin or tissue necrosis if extravasation occurs Monitor LVEF, DC at first sign of impaired function Do not exceed 550 mg/m2 cumulative dose
56
5-fluorouracil
Ocular irritation and reversible excessive lacrimation CV: angina GI: NVD, stomatitis, mucositis, mucosal ulceration, anorexia DERM: erythema, desquamation, pain, sensitivity to touch on palms and soles (hand-foot syndrome) Myelosuppression DIHYDROPYRIMIDINE DEHYDROGENASE DEFICIENCY (ENHANCED 5-FU TOXICITY)
57
Gemcitabine
HEME: myelosuppression Flu-like symptoms Hepatotoxicity: reversible elevation in LFTs Progressive hemolytic syndrome Potent radiosensitizer, not used with radiotherapy except in clinical trials
58
Methotrexate
GI: stomatitis, esophagitis, oral ulceration DERM: toxic epidermal necrolysis, Stevens-Johnson, exfoliative dermatitis Impaired wound healing Myelosuppression Pneumonitis Hepatotoxicity Renal toxicity NSAIDs reported to reduce tubular secretion of MTX and may enhance toxicity
59
Vincristine
``` Neurotoxicity is dose-limiting Paresthesia and tingling in "stocking-and-glove" pattern, cranial nerve damage, paralysis, ANS dysfunction (orthostatic hypertension, urinary retention) Reversible alopecia (even without cessation) Limited myelosuppression ``` Intrathecal or cisternal administration is fatal
60
Paclitaxel
Stocking-and-glove neuropathy Myelosuppression Asymptomatic ECG, bradycardia Mucositis Pretreat with H1 antagonist, H2 antagonist, and glucocorticoid to reduce likelihood of hypersensitivity rxn Heart disease Reduce dose in patients with abnormal hepatic function or hepatic metastases > 2cm
61
Etoposide
Dose-limiting toxicity is leukopenia NVD and stomatitis Reversible alopecia CrCL 45-60, reduce dose 15% CrCL 30-44, reduce dose 20% CrCL
62
Irinotecan
Dose-limiting toxicity is delayed diarrhea with or without neutropenia Myelosuppression PNS: cholinergic syndrome from inhibition of AChE; short-lasting and responds to atropine UG: hemorrhagic cystitis Homozygous for UGT1A28 allele are increased risk for neutropenia Hepatic status
63
Bevacizumab
``` CV: hypertension, increased arterial thromboembolic events Impaired wound healing GI perfusions, pain, nausea Proteinuria Infusion rxns: Headache, fever, rash ``` Monitor blood pressure every 2-3 weeks during tx Proteinuria great than 2 g suspend tx (resume when
64
Cetuximab
Infusion rxns to mouse antigen: fever, chills, NV, hypotension, angioedema, bronchospasm DERM: acneiform rash, dry skin, fissures, pruritus, exfoliation Monitor for 1 hr after infusion for anaphylaxis TX with epinephrine, corticosteroids, antihistamines, bronchodilators, O2 PRN
65
Rituximab
Severe or life-threatening events in 57% of patients: CV, GI, renal Infusion rxn from mouse antigen Infections Mucocutaneous reactions: rash, vesiculation, exfoliative dermatitis All patients should receive diphenhydramine, acetaminophen, possibly corticosteroids before infusion
66
Trastuzumab
Infusion rxns CV: potentially fatal ventricular dysfunction, CHF DC may be necessary Assess LVEF prior to and during TX
67
Temsirolimus
``` PULM: dyspnea, pharyngitis HEME: myelosuppression GI: mucositis, NVD MET: hyperlipidemia, hypertriglyceridemia, edema DERM: rash, pruritus, dry skin Hypersensitivity/infusion rxns ``` PX should receive prophylactic diphenhydramine, antihistamine before TX
68
Erlotinib
Rash, diarrhea, anorexia, fatigue Periodic LFTs
69
Imatinib
NVD, Elevated LFTs, edema, myelosuppression Monitor LFTs Taken with food and water to minimize GI distress
70
Sunitinib
Hypertension, ND, rash, yellow discoloration of skin, hypothyroidism, stomatitis, fatigue, cardiac dysfunction, neutropenia Monitor LFTs Baseline and periodic LFTs
71
Succinylcholine
Myalgias Increased intracranial, intraocular pressures Hyperkalemia Proliferation of extrajunctional nAChRs (4-5 d) Denervation (e.g. spinal cord injury, stroke) Burns, trauma, prolonged immobility Myopathies - Rhabdomyolysis Duchenne & Becker's muscular dystrophy Phase II block (seen with prolonged use or repeated boluses)

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