Pharmacology Flashcards
Side Effects of Stimulant medications
Transient: Headaches Abdominal discomfort Mild-to-moderate appetite suppression Irritability "daze-effect," insomnia Tachycardia Mild hypertension
Side Effects of Overdosing stimulant medication
insomnia jitteriness irritability headache (especially as a dose wears off) mild hand tremor palpitations. Unmask a tic disorder Very rare: scan precipitate a psychosis.
Components of cryoprecipitate
- plasma that’s been spun. Contains Fibrinogen, Factors V, VIII, XIII and VWF
Indications:
o severe hypo fibrionginemia
o VIII (and VWF and XIII) – for DIC
Components of plasma (FFP)
FFP (plasma)
- Replaces all factors
Indications:
o give to someone who is vit K deficient until factors kick in
o DIC
o Fulminant liver failure
o Protein C deficiency (severe neonatal purpura fulminans)
Who gets irradiated blood?
Occurs :
o Immunocompromised pts
o When recipient is heterozygous for a HLA haplotype for which the donor is homozygous
Graft Vs Host Dz
- Rare
- 80-90% mortality
- Viable donor lymphocytes attack recipient lymphoid tissue
Who needs CMV -ve blood
High risk pts:
o LBW neonates born to sero-negative mothers
o Immunocompromised oncology pts
o Pts undergoing hematopoietic or solid organ transplantation
Substances contraindicated in breastfeeding mothers
- amphetamine
- bromocriptine (decreases milk production)
- cocaine
- cyclophosphamide
- cyclosporine
- doxorubicin
- ergotamine
- heroin
- lithium
- marijuana
- methotrexate
- nicotine
- phencyclidine (PCP)
- phenindione
Contraindicated medications in breastfeeding
anti-neoplastic : MTX, cyclophosphamide, cisplatin
street drugs (cocaine, heroin, LSD, marijuana, PCP, amphetamines)
Lithium
Metronidazole
Chloramphenicol
Gold salts
Amiodarone
Antimicrobials in breastfeeding: which ones to be aware of
o If the drug is not orally bioavailable to Mom, it won’t be absorbed from breast milk
o Chloramphenicol: possible idiosyncratic bone marrow suppression
o Metronidazole – in vitro mutagen – d/c breastfeeding x12-24 hours to allow excretion if a single dose is used
o Fluroquinolones: No concern for cipro or ofloxacin, no data for others
o Isoniazid: possible hepatotoxicity but considered compatible w breastfeeding – (some would give baby pyridoxine)
o If baby has G6PD deficiency (or is at high risk for it and has not yet been tested) – don’t use nitrofurantoin, or sulfonamides
o Sulfonamides – to be avoided in ill, jaundiced or premature infants
o Tetracyclines- likely safe but some would avoid due to possible tooth staining
Renal transplant girl on cyclosporine. Started on biaxin for infection. Cyclosporine level increased from 100 to 300. Why?
Biaxin decreases metabolism of cyclo
Lasix Side effects
Hearing loss
- Nephrocalcinosis/nephrolithiasis
- Hyponatremia
- Hypokalemia
- Ischemic hepatitis
- hypercalciuria
Meds known to causes Steven Johnsons Syndrome
Anticonvulsants: Phenobarbital, phenytoin, carbamazepine
Antibiotics: co-trimoxazole, sulfonamides, dapsone
Others: acebutolol, allopurinol, phenylbutazone, procainamide
Nephrotoxic Drugs
Acyclovir Aminoglycosides Amphotericin B Cisplatin Cyclophosphamide Ifosfamide Lithium NSAIDs Radiocontrast dyes
Cardiotoxic drugs
Cardiomyopathy: Daunorubicin Doxorubicin Idamycin Interferon alpha Ipecac
Arrhythmias:
Antiarrhythmics, digoxin
Psychotropic agents (eg. tricyclic antidepressants, tetracyclic antidepressants)
Antibiotics such as eryhtromycin, trimethoprim/sulfamethoxazole
Antihistamines such as terfenadine, astemizole
Cisapride
Phenytoin
Some herbal preparations
Hepatotoxic drugs
Generalized hepatotoxicity: Acetaminophen Amiodarone Cocaine High-dose ASA Isoniazid Ketoconazole Methotrexate Methyldopa Pemoline Phenytoin Valproic acid Cholestasis: Azathioprine Benoxiprofen Chlorpromazine Erythromycin Nitrofurantoin Oral contraceptives/ Sex hormones
Drugs bad for eyes
Eye: Toxic retinopathy: High-dose choloroquine in long term use High-dose thioridazine Optic neuritis: Ethambutol Chloramphenicol
Drugs with ototoxicity
Ototoxicity: ASA in high doses Aminoglycosides Cisplatin Loop diuretics Neomycin Polymyxin B
Maxeran side effects
dystonic reactions with IV administration; also can see incr prolactin, depression and gynecomastia and NMS; prokinetic due to muscarinic properties, but is also a dopamine antagonist
Methadone withdrawal
NAS usually develops by 5 days after birth if its going to develop
Prozac is known to interact with what medication?
Interferes with risperidal (increases its effects)
Warfarin interacts with what medications?
is affected by:
- enhanced by antibiotics, salicylates, anabolic steroids, chloral hydrate, laxatives, allopurinol, vitamin E, and methylphenidate hydrochloride
- diminished by barbiturates, vitamin K, oral contraceptives, phenytoin, and other agents
Warfarin and heparin are contraindicated in what situations?
Contraindications to heparin and coumadin:
- Pregnancy (esp 1st trimester)
- Recent CNS hemorrhage
- bleeding from inaccessible sites
- malignant hypertension
- bacterial endocarditis
- recent surgery of the eye, brain, or spinal cord
- current administration of regional or lumbar block anesthesia.
A pre-existing coagulation defect or bleeding abnormality is a relative contraindication.
Despite these precautions, the frequency of bleeding in patients given heparin anticoagulation is 0.2–1.0%
Which meds can decrease folate?
- Anticonvulsant drugs (e.g., phenytoin, primidone, phenobarbital) can impair absorption of folic acid.
o Frank megaloblastic anemia is rare, however, and responds to folic acid therapy even when administration of the offending drug is continued - Methotrexate, pyrimethamine (for toxoplasmosis), trimethoprim
Growth Hormone is indicated for what scenarios?
GH currently is approved by FDA for:
- GH-deficient children and adults
- Turner syndrome
- Renal insufficiency
- Adults who have AIDS wasting
- Prader-Willi syndrome
- children born SGA who have not reached the 5th 5by age 2 years
- Idiopathic short stature and are not expected to reach an adult height in the normal adult range.
Side Effects of Carbamazepine
leukopenia, aplastic anemia, thrombocytopenia, hepatic dysfunction and rashes
Of note, clarithromycin and erythromycin carbamezapine
Side Effects of Ethosuximide
Ethosuximide
– normalizes EEG in pts with absence szs
– Well tolerated (doesn’t require monitoring of CBC/LFTs)
– Long half life – can have once/BID dosing
– Rare cases of bone marrow suppression (leukopenia, pancytopenia) and rashes.
– Does not cause liver toxicity.
Side Effects of Phenytoin
- Side effects: hepatic dysfunction, lymphadenopathy, movement disorders, SJS and fulminant liver failure
Side Effects of Valproic Acid
- pancreatitis, hepatitis and thrombocytopenia
- fulminant liver failure, hyperammonemia, rash, and stupor
Drugs Associated with Gynecomastia
- Ketoconazole can inhibit testosterone synthesis along with spironolactone, methyldopa, phenothiazines, antidepressants, warfarin, digitalis and heroin (Nelson’s)
- cimetidine, spironolactone, digitalis, phenothiazines, and GH therapy, as well as in the use of marijuana (Endo textbook)
- maxeran
