Pharma - Toxicities & Side Effects Flashcards
1
Q
What is the antidote for acetaminophen overdose?
A
N-acetylcysteine
2
Q
What are the two treatments for salicylate overdose?
A
Alkalinization of urine and dialysis if necessary
3
Q
What compound is used to alkalinize urine?
A
NaHCO3; weak acids are better excreted when the urine is alkaline
4
Q
What is the treatment for amphetamine overdose?
A
NH4Cl
5
Q
Amphetamines are _____ (acidic/basic); therefore, overdose is treated with _____ (NH4Cl/NaHCO3) to _____ (acidify/alkalinize) the urine.
A
Basic; NH4Cl; acidify
6
Q
What are the two antidotes for anticholinesterase toxicity?
A
Atropine to block cholinergic receptors and pralidoxime to regenerate acetylcholinesterase
7
Q
What are the antidotes for organophosphate poisoning?
A
Atropine and pralidoxime; organophosphates inhibit acetylcholinesterase
8
Q
What is the antidote for toxicity caused by anticholinergic agents?
A
Physostigmine
it inhibits acetylcholinesterase, increasing the available acetylcholine to overcome anticholinergic toxicity
9
Q
Physostigmine is the antidote for toxicity caused by what two types of agents?
A
Antimuscarinic agents and anticholinergic agents
10
Q
What is the antidote for β-blocker toxicity?
A
Glucagon
11
Q
What are five treatments for digitalis toxicity?
A
Stop the medication
normalize the potassium level; give the patient lidocaine; give the patient anti-digoxigenin Fab fragments; give the patient magnesium
12
Q
What is the antidote for iron toxicity?
A
Deferoxamine, a chelating agent
13
Q
What are four treatments for lead poisoning?
A
Edetate calcium disodium, dimercaprol, succimer, and penicillamine
14
Q
Penicillamine is the antidote for toxicity caused by what substances?
A
Copper, arsenic, gold
15
Q
What are three treatments for arsenic poisoning?
A
Dimercaprol, succimer, penicillamine
16
Q
What are two treatments for mercury poisoning?
A
Dimercaprol and succimer
17
Q
What are three treatments for gold poisoning?
A
Dimercaprol, succimer, penicillamine
18
Q
Dimercaprol and succimer are the antidotes for toxicity caused by what substances?
A
Mercury, arsenic, gold
19
Q
The combination of thiosulfate and nitrite is the antidote for toxicity caused by what substance?
A
Cyanide
20
Q
Hydroxocobalamin is the antidote for toxicity caused by what substance?
A
Cyanide
21
Q
What are the treatments for cyanide poisoning?
A
Hydroxocobalamin, or a combination of nitrite and thiosulfate
22
Q
What is the treatment for methemoglobinemia?
A
Methylene blue, vitamin C
23
Q
Methylene blue is used to treat elevated serum levels of what substance?
A
Methemoglobin
24
Q
What are the treatments for carbon monoxide poisoning?
A
100% oxygen and hyperbaric oxygen
25
What are the treatments for methanol and ethylene glycol (antifreeze) poisoning?
Ethanol, dialysis, and fomepizole
26
Fomepizole is an antidote for toxicity caused by what substances?
Methanol, ethylene glycol
27
What are the antidotes for opioid overdose?
Naloxone or naltrexone
28
Naloxone is the antidote for overdose of what substance?
Opioids
29
What is the antidote for benzodiazepine overdose?
Flumazenil
## Footnote
it reduces the action of benzodiazepines at γ-aminobutyric acid receptors
30
Flumazenil is the antidote for overdose of what substance?
Benzodiazepines
31
What is the treatment for tricyclic antidepressant overdose?
Sodium bicarbonate
## Footnote
it can prevent cardiac arrhythmias
32
Alkalinization of the serum with sodium bicarbonate is a treatment for overdose with what class of antidepressant medications?
Tricyclic antidepressants
## Footnote
the alkalinization can prevent cardiac arrhythmias
33
What is the reversal agent for heparin?
Protamine
34
Protamine is used to reverse the effects of what pharmacologic agent?
Heparin
## Footnote
however, it does not reverse low-molecular-weight heparin
35
What agents are used to reverse the effects of warfarin?
Vitamin K and fresh frozen plasma
36
Vitamin K is used to reverse the effects of what pharmacologic agent?
Warfarin
37
What agent is used to reverse the effects of both tissue plasminogen activator and streptokinase?
Aminocaproic acid
38
Aminocaproic acid is used to reverse the effects of what two pharmacologic enzymes?
Tissue plasminogen activator and streptokinase
39
What is the antidote for theophylline?
β-Blockers
40
A woman brings her 3-year-old son to the emergency room because she found him eating pills out of the acetaminophen bottle. She is not sure how many he ate, but says that the bottle was almost empty by the time she got to him, and that he was eating them one hour ago. Which drug should be administered to minimize further liver toxicity?
N-acetylcysteine
41
Which component of multivitamins is the most likely to cause fatal overdose in children?
Iron
42
What is the mechanism of cell death in iron poisoning?
Peroxidation of membrane lipids
43
What will a patient with acute iron poisoning present with?
Gastric bleeding
44
After gastrointestinal bleeding in the acute phase of iron poisoning, what is the progression of the clinical presentation?
Metabolic acidosis followed by gastrointestinal strictures and obstruction
45
Which antidepressants can cause tachycardia due to anticholinergic action?
Tricyclic antidepressants
46
Which drugs can cause coronary vasospasm?
Cocaine and sumatriptan
47
Which drugs can cause cutaneous flushing as an adverse effect?
Vancomycin, adenosine, niacin, calcium channel blockers (remember: **VANC**)
48
Which drugs cause dilated cardiomyopathy?
Doxorubicin (Adriamycin), daunorubicin
49
Which drugs can cause torsades de pointes?
Class III (sotalol) and class IA (quinidine) antiarrhythmic agents, cisapride
50
What cardiac adverse effect can result from either cocaine or sumatriptan use?
Coronary vasospasm
51
What is the major adverse effect of niacin use?
Flushing
52
Which drugs can cause agranulocytosis as an adverse effect?
Clozapine, carbamazepine, colchicine, propylthiouracil, methimazole
53
Which drugs (or exposures) can cause aplastic anemia as an adverse effect?
Chloramphenicol, benzene, nonsteroidal antiinflammatory drugs, propylthiouracil, methimazole
54
Which antihypertensive drug can cause hemolytic anemia?
α-Methyldopa
55
Which antibiotic can cause "grey baby syndrome"?
Chloramphenicol
56
Which drugs can cause hemolytic anemia in G6PD-deficient patients?
**I**soniazid, **S**ulfonamides, **P**rimaquine, **A**spirin, **I**buprofen, **N**itrofurantoin (remember: hemolysis **IS PAIN**)
57
Which drugs can cause megaloblastic anemia?
**P**henytoin, **M**ethotrexate, **S**ulfa drugs (remember: Having a **blast** with **PMS**)
58
What is a major adverse effect of oral contraceptives?
Thrombotic events such as deep vein thrombosis and pulmonary embolus
59
Which antihypertensive drug can cause chronic cough?
Angiotensin-converting enzyme inhibitors
60
What is the advantage of angiotensin II receptor blockers (like losartan) over angiotensin-converting enzyme inhibitors?
Angiotensin II receptor blockers are often prescribed as an alternative renoprotective antihypertensive medication in patients with angiotensin-converting enzyme inhibitor-induced cough
61
Which drugs can cause pulmonary fibrosis?
Bleomycin, busulfan, amiodarone
62
What adverse effect would you suspect in a newly jaundiced patient recently started on azithromycin?
Acute cholestatic hepatitis
63
Which drugs (or exposures) can cause hepatic necrosis?
Halothane, valproic acid, acetaminophen, *Amanita phalloides*
64
What effect can isoniazid have on the liver?
Hepatitis
65
Which drugs can cause pseudomembranous colitis?
Clindamycin and ampicillin are commonly implicated, but many antibiotics can be responsible
66
Administration of clindamycin or ampicillin can cause overgrowth of which bacteria in the colon?
*Clostridium difficile*, which leads to pseudomembranous colitis
67
What adverse effect occurs when exogenous glucocorticoids are rapidly withdrawn?
Adrenocortical insufficiency due to long-term hypothalamic-pituitary-adrenal axis suppression; this is why steroids are usually tapered as opposed to abruptly discontinued
68
Which drugs are known to cause gynecomastia?
**S**pironolactone, **D**igitalis, **C**imetidine, **A**lcohol (chonic use), estrogens, **K**etoconazole (remember: **S**ome **D**rugs **C**reate **A**wesome **K**nockers)
69
Which drugs can cause hot flashes?
Tamoxifen, clomiphene
70
Which drug can cause gingival hyperplasia?
* Phenytoin
* Calcium channel blockers (e.g., nifedipine, amlodipine, verapamil, diltiazem)
* Cyclosporine
71
Which drugs can cause gout?
Furosemide and thiazide diuretics
72
Osteoporosis can be caused by long-term use of which drugs?
Steroids, heparin
73
Which drugs induce photosensitivity?
**S**ulfonamides, **A**miodarone, **T**etracyclines (remember: **SAT** for a photo)
74
Which drugs can cause Stevens-Johnson syndrome?
Ethosuximide, lamotrigine, carbamazepine, phenobarbital, phenytoin, sulfa drugs, penicillin, allopurinol; think anticonvulsants and antibiotics
75
Which drugs can cause a lupus-like syndrome?
**H**ydralazine, **I**soniazid, **P**rocainamide, **P**henytoin (remember: it's not **HIPP** to have lupus)
76
Which adverse effects of fluoroquinolones are specific to children?
Tendonitis, tendon rupture, and cartilage damage
77
Which drug can cause Fanconi's syndrome if taken after its expiration date?
Tetracycline
78
Which drugs can cause interstitial nephritis?
Methicillin, nonsteroidal antiinflammatory drugs, and furosemide
79
Which two drugs can cause hemorrhagic cystitis?
Cyclophosphamide and ifosfamide
80
Which drug is administered to prevent hemorrhagic cystitis from the use of ifosfamide or cyclophosphamide?
Mesna
81
Name two drugs that can cause cinchonism.
Quinidine and quinine; cinchonism describes headache and tinnitus
82
Which adverse effect of lithium can cause hypernatremia?
Diabetes insipidus
83
Name two drugs that can cause diabetes insipidus.
Lithium and demeclocycline
84
Name three drugs that can cause seizures.
Bupropion, imipenem/cilastatin, isoniazid
85
Which class of drugs can result in tardive dyskinesia?
Antipsychotics
86
What drugs can cause a disulfiram-like reaction?
Metronidazole, certain cephalosporins, procarbazine, first-generation sulfonylureas
87
Polymyxins are toxic to which organ systems?
Neural and renal; as a result it is usually only used topically
88
Which drugs can cause both ototoxicity and nephrotoxicity?
Aminoglycosides, vancomycin, loop diuretics, cisplatin
89
A 60-year-old man presents with sudden severe great toe pain. On microscopy, an aspirate of the joint shows crystals. His medications include daily baby aspirin, a thiazide diuretic to control hypertension, a ß-blocker to control a cardiac arrhythmia, and a nonsteroidal antiinflammatory drug for joint pain. Which of these medications likely contributed to his presentation?
Thiazide diuretics
90
What are the seven most common drugs that induce cytochrome P450 enzyme activity?
**Q**uinidine, **B**arbituates, **S**t. John's Wort, **P**henytoin, **R**ifampin, **G**riseofulvin, **C**arbamazepine (remember: **Q**ueen **B**arb **S**teals **P**hen-phen and **R**efuses **G**reasy **C**arbs)
91
What are the six most common substances that inhibit cytochrome P450 enzyme activity?
**S**ulfonamides, **I**soniazid, **C**imetidine, **K**etoconazole, **E**rythromycin, **G**rapefruit juice, **Acute** alcohol use (remember: **Inhibit** yourself from drinking beer from a **KEG** because it makes you **Acute**ly **SIC**k)
92
Which drug can both induce and inhibit different forms of cytochrome P450 enzymes? Is induction or inhibition its more significant effect?
Quinidine; induction is more significant
93
Ethylene glycol is converted to oxalic acid by which enzyme?
Alcohol dehydrogenase
94
Alcohol dehydrogenase converts ethylene glycol into what?
Oxalic acid
95
What substance is converted to oxalic acid by alcohol dehydrogenase?
Ethylene glycol; it is usually found in antifreeze
96
What are two adverse effects of oxalic acid?
Acidosis and nephrotoxicity; oxalic acid crystalizes in the kidney to cause damage
97
What enzyme converts methanol to formaldehyde and formic acid?
Alcohol dehydrogenase
98
What does alcohol dehydrogenase convert methanol into?
Formaldehyde and formic acid
99
What are two adverse effects of formaldehyde and formic acid?
Severe acidosis, retinal damage
100
Alcohol dehydrogenase converts what alcohol into formaldehyde and formic acid?
Methanol
101
What enzyme converts ethanol to acetaldehyde?
Alcohol dehydrogenase
102
Acetaldehyde dehydrogenase converts what substrate into acetic acid?
Acetaldehyde
103
What does alcohol dehydrogenase convert ethanol into?
Acetaldehyde
104
What enzyme that is involved in ethanol metabolism is inhibited by disulfiram?
Acetaldehyde dehydrogenase
105
Ethanol competes with what endogenous hormone substrate for binding in renal tubules?
Antidiuretic hormone; the result is a diuretic effect
106
Alcohol dehydrogenase converts what alcohol into acetaldehyde?
Ethanol
107
What are four adverse effects of acetaldehyde?
Nausea, headache, vomiting, hypotension
108
Alcohol dehydrogenase is involved in the metabolism of what three alcohols?
Ethylene glycol, methanol, and ethanol
109
Alcohol dehydrogenase is inhibited by what drug?
Fomepizole
## Footnote
the drug can be used to prevent toxicities of methanol and ethylene glycol ingestions
110
Acetaldehyde dehydrogenase is inhibited by what drug?
Disulfiram
## Footnote
the drug worsens the adverse effects of alcohol use and is also called Antabuse
111
What enzyme converts acetaldehyde to acetic acid?
Acetaldehyde dehydrogenase
112
What does acetaldehyde dehydrogenase convert acetaldehyde into?
Acetic acid
113
Name the eight drugs that can cause allergic reactions in patients with known sulfa allergies.
Celecoxib, probenicid, furosemide, thiazides, trimethoprim/sulfamethoxazole, sulfonylureas, sulfasalazine, and sumitriptan
114
What are some clinical manifestations of sulfa allergic reactions?
Fever, pruritic rash, Stevens-Johnson syndrome, hemolytic anemia, thrombocytopenia, agranulocytosis, uriticaria (hives)
115
A patient presents to the emergency room with a fever, intensely pruritic rash, and urticaria. You ask her what medications she is taking, and she replies, "I can't remember the names, but I just switched to a different type of diuretic." What is a possible drug-related cause of her symptoms?
She is allergic to sulfa drugs and was just switched to furosemide or a thiazide
