Pharmacology Flashcards
Rifampin
Indications:
- Pruritis of cholestasis
Sertraline
Indications:
Pruritis of cholestasis
Steroid side effects
- Infections
- TB
- Candida
- PJP - Metabolic disturbances
- Hyperglycemia
- Electrolyte imbalances
- Fluid retention
- Hyperlipidemia - Dystrophic reactions
- Delayed wound healing, purpura, dermal atrophy - Myopathy
- Mainly pelvic girdle, but also head flexor and shoulder muscles
- May occur as early as within 2 weeks of starting dex - Bone
- Osteoporosis due to reduced intestinal Ca absorption and increased calciuria - Aseptic necrosis (femoral head) - uncommon
- GI side effects
- PUD, bleeding
- Caution with previous ulcers, NSAIDs, high doses, and intracranial lesions - Hiccup
- Euphoria with mild insomnia, anxiety, steroid psychosis
- Anaphylaxis
- Ocular toxicity (glaucoma)
- Adrenal suppression (after 10 days of > 7.5mg pred/day or 1mg dex)
Neuroleptic malignant syndrome
Neuroleptic malignant syndrome:
- Associated with use of first-gen neuroleptics (Haldol, fluphenazine), but all antipsychotics and antiemetics eg maxeran) can cause it
- Characterised by mental status change, lead pipe rigidity, fever, dysautonomia (tachycardia, labile or high BP, tachypnea, diaphoresis)
- Elevated CK, leukocytosis, electrolyte abnormalities
Treatment:
- Stop med, supportive care including cooling blankets
- clonidine to decrease BP
- benzos for agitation
- DVT prophylaxis
Serotonin syndrome
Serotonin Syndrome:
- Associated with overdose of SSRIs, TCAs, MAOIs
- Shivering, hyperreflexia, myoclonus, ataxia, vomiting and diarrhea, agitation, ocular clonus (slow, continuous horizontal eye movements).
Rigidity and hyperthermia, but less common and severe than in NMS
Diagnosis of Serotonin syndrome = taken serotonergic agent plus one of:
- Spontaneous clonus
- Inducible clonus + agitation or diaphoresis
- Ocular clonus + agitation or diaphoresis
- Tremor + hyperreflexia
- Hypertonia + Temp >38 + ocular or inducible clonus
Treatment of Serotonin syndrome:
- Stop meds
- Supportive care
- Sedate with benzos
- Cyproheptadine as antidote
Anticholinergic toxicity
Anticholinergic toxicity
Causative agents: Parkinson’s meds, benztropine, antipsychotics, benadryl/gravol
Presentation:
- Tachycardia
- Cutaneous vasodilation (red)
- anhidrosis
- anydrotic hyperthermia
- nonreactive mydriasis (dilated pupils)
- delirium and hallucinations
- bladder retention
Diagnosis: Basic labs, EKG (prolonged QRS with some agents)
Management: ABCs, NaHCO3 if long QRS, benzos for seizures/agitation
Antidote: Physostigmine (cholinergic drug - if peripheral and central signs of anticholinergic tox, but NOT in the setting of TCA OD).
Serotonin Syndrome mnemonic
HARMED
- Hyperthermia
- Autonomic instability
- Rigidity
- Myoclonus
- Encephalopathy
- Diaphoresis
*Rigidity and hypertheremia less common and severe than in NMS, no elevation in WBC/CK
Neuroleptic malignant syndrome mnemonic
FEVER
- Fever
- Encephalopathy
- Vital sign instability
- Elevated WBC/CPK
- Rigidity
*No myoclonus as in serotonin syndrome, look for abnormal BW and severe rigidity
Anti-depressant discontinuation syndrome
FINISH
- Flu-like symptoms
- Insomnia
- Nausea
- Imbalance
- Sensory disturbances
- Hyperarousal (anxiety/agitation)
HANGMAN: H - headache A - anxiety N - nausea G - gait instability M - malaise A - asthenia (fatigue) N - numbness (paresthesia)
Treatment of NMS
Treatment:
- Stop causative agent
- Benzos for agitation
- LMWH for DVT prophylaxis
- Clonidine for BP (oral or transdermaL)
- Tylenol for fever (but typically lowered with ice packs etc.)
Treatment of Serotonin Syndrome
- Benzos and supportive care
- If benzos alone in effective, go to Cyproheptadine (given PO)
Cessation of antiparkinsonian meds
Withdrawal syndrome/Parkinsonism-hyperpyrexia syndrome
- Occurs due to suppression of dopaminergic - Manifests as pyrexia, muscular rigidity, reduced LOC, autonomic instability
- Treat with reinstatement of usual antiparkinsonian meds (may need to occur via NG). If no response, consider TD rotigotine
