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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
Q

Epinephrine

A

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
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26
Q

Phenylephrine

A

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
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27
Q

Clonidine

A

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

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28
Q

Isoproterenol

A

CNS: nervousness, headache
CV: palpitations, tachycardia, angina
Flushed skin

Arrhythmias
Heart block caused by digitalis compounds
Coronary heart disease, coronary insufficiency
Diabetes
Hyperthyroidism

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29
Q

Dobutamine

A

CV: PVCs, tachycardia, angina

Idiopathic hypertrophic subaortic stenosis
Arrhythmias
Hypovolemia

30
Q

Albuterol

A

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
Q

Salmeterol

A

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
Q

Phentolamine

A

CNS: dizziness
CV: orthostatic hypotension, reflex tachycardia, arrhythmias
GI: NVD
Nasal congestion

MI, coronary insufficiency, angina

33
Q

Phenoxybenzamine

A 
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
Q

Prazosin

A

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
Q

Tamsulosin

A

CNS: dizziness, insomnia, syncope
CV: orthostatic hypotension
GU: abnormal ejaculation

Caution with PDE5 inhibitors

36
Q

Yohimbine

A

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
Q

Carvedilol

A

CV: bradycardia, hypotension, orthostatic hypotension
CNS: dizziness
GI: NVD

ABRUPT DC; TAPER OVER 1-2 WEEKS
ASTHMA
IV INOTROPES
Hepatic disease
Elderly
Diabetes
38
Q

Propranolol

A

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
Q

Timolol

A

Eye pain, conjunctivitis, itching
CNS: dizziness, headache

ACUTE BRONCHOSPASM, PULMONARY EDEMA, ASTHMA
BRADYCARDIA, AV BLOCK
Hepatic disease
Raynaud's disease
Diabetes
40
Q

Metoprolol

A

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
Q

Pindolol

A

Generally mild
CNS: dizziness, fatigue
CV: edema

ABRUPT DC CAN PRODUCE MYOCARDIAL ISCHEMIA, MI, ARRHYTHMIAS, SEVERE HYPERTENSION
Diabetes

42
Q

Alpha-Methyltyrosine

A

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
Q

Alpha-Methyldopa

A

CNS: transient sedation, parkinsonism
Usually reversible elevated LFTs (if under 3x normal then you are gucci)
Hemolytic anemia

Hepatic disease
Dopamine antagonists

44
Q

Reserpine

A

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
Q

Botulinum Toxin A

A

Ptosis, local muscle weakness
Dysphagia, dystonia
Immunogenic response: fever, flu-like symptoms, pain at injection site, urticaria, edema

Preexisting neuromuscular disorders

46
Q

Amphetamine

A

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
Q

Cocaine

A

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
Q

Paroxetine

A

CNS: drowsiness, dizziness, insomnia, anxiety, anorexia
GI: NV, xerostomia, constipation

MAO INHIBITOR THERAPY
Renal insufficiency
Hepatic disease
Pregnancy Risk Category D

49
Q

Atomoxetine

A

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
Q

Phenelzine

A

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
Q

Cyclophosphamide

A

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
Q

Temozolomide

A

Hepatotoxicity

Perform baseline and periodic LFTs and also approx. 2-4 weeks after last dose

53
Q

Carboplatin

A

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
Q

Bleomycin

A

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
Q

Doxorubicin

A

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
Q

5-fluorouracil

A

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
Q

Gemcitabine

A

HEME: myelosuppression
Flu-like symptoms
Hepatotoxicity: reversible elevation in LFTs
Progressive hemolytic syndrome

Potent radiosensitizer, not used with radiotherapy except in clinical trials

58
Q

Methotrexate

A

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
Q

Vincristine

A 
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
Q

Paclitaxel

A

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
Q

Etoposide

A

Dose-limiting toxicity is leukopenia
NVD and stomatitis
Reversible alopecia

CrCL 45-60, reduce dose 15%
CrCL 30-44, reduce dose 20%
CrCL

62
Q

Irinotecan

A

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
Q

Bevacizumab

A 
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
Q

Cetuximab

A

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
Q

Rituximab

A

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
Q

Trastuzumab

A

Infusion rxns
CV: potentially fatal ventricular dysfunction, CHF
DC may be necessary

Assess LVEF prior to and during TX

67
Q

Temsirolimus

A 
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
Q

Erlotinib

A

Rash, diarrhea, anorexia, fatigue

Periodic LFTs

69
Q

Imatinib

A

NVD, Elevated LFTs, edema, myelosuppression

Monitor LFTs
Taken with food and water to minimize GI distress

70
Q

Sunitinib

A

Hypertension, ND, rash, yellow discoloration of skin, hypothyroidism, stomatitis, fatigue, cardiac dysfunction, neutropenia

Monitor LFTs
Baseline and periodic LFTs

71
Q

Succinylcholine

A

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)

FM1 (6 decks)

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