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USMLE 1 > Pharmacology- Toxicities and side effects > Flashcards

Pharmacology- Toxicities and side effects Flashcards

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USMLE® Step 1 flashcards
1
Q

Specific toxicity treatments

  • Acetaminophen
  • AChE inhibitors, organophosphates
  • Antimuscarinic, anticholinergic agents
  • Arsenic
  • Benzodiazepines
A

N-acetylcysteine (replenishes glutathione)

Atropine > pralidoxime

Physostigmine, control hyperthermia

Dimercaprol, succimer

Flumazenil

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2
Q

Specific toxicity treatments

  • β-blockers
  • Carbon monoxide
  • Copper
  • Cyanide
  • Digitalis (digoxin)
A

Atropine, glucagon

100% O2, hyperbaric O2

Penicillamine, trientine

Nitrite + thiosulfate, hydroxocobalamin

Anti-dig Fab fragments

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3
Q

Specific toxicity treatments

  • Heparin
  • Iron
  • Lead
  • Mercury Dimercaprol, succimer
  • Methanol, ethylene glycol (antifreeze)
A

Protamine sulfate

Deferoxamine, deferasirox, deferiprone

EDTA, dimercaprol, succimer, penicillamine

Dimercaprol, succimer

Fomepizole > ethanol, dialysis

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4
Q

Specific toxicity treatments

  • Methemoglobin
  • OpiOids
  • Salicylates
  • TCAs
  • Warfarin
A

Methylene blue, vitamin C (reducing agent)

NalOxOne

NaHCO3 (alkalinize urine), dialysis

NaHCO3 (stabilizes cardiac cell membrane)

Vitamin K (delayed effect), fresh frozen plasma
(immediate)
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5
Q

Drug reactions—cardiovascular

  • Coronary vasospasm
  • Cutaneous flushing
  • Dilated cardiomyopathy
A

Cocaine, Amphetamines, Sumatriptan, Ergot alkaloids (CASE)

Vancomycin, Adenosine, Niacin, Ca2+ channel blockers, Echinocandins, Nitrates (flushed from VANCEN [dancing])

Anthracyclines (eg, Doxorubicin, Daunorubicin); prevent with Dexrazoxane

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6
Q

Drug reactions—cardiovascular

- Torsades de pointes

A

Agents that prolong QT interval: “ABCDE”

antiArrhythmics (class IA, III), 
antiBiotics (eg, macrolides),
anti“C”ychotics (eg, haloperidol), 
antiDepressants (eg, TCAs),
antiEmetics (eg, ondansetron)
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7
Q

Drug reactions—endocrine/reproductive

  • Adrenocortical insufficiency
  • Diabetes insipidus
  • Hot flashes
  • Hyperglycemia
A

HPA suppression 2° to glucocorticoid withdrawal.

Lithium, demeclocycline

SERMs (eg, tamoxifen, clomiphene, raloxifene)

Tacrolimus, Protease inhibitors, Niacin, HCTZ, Corticosteroids

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8
Q

Drug reactions—endocrine/reproductive

  • Hyperprolactinemia
  • Hyperthyroidism
  • Hypothyroidism
  • SIADH
A

Typical antipsychotics, atypical antipsychotics, metoclopramide, methyldopa.

Lithium, amiodarone

AMiodarone, SUlfonamides, Lithium

“Can’t Concentrate Serum Sodium”
Carbamazepine, Cyclophosphamide, SSRIs

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9
Q

Drug reactions—gastrointestinal

  • Acute cholestatic hepatitis, jaundice
  • Diarrhea
  • Focal to massive hepatic necrosis
  • Hepatitis
A

Macrolides

Acamprosate, antidiabetic agents (acarbose, metformin, pramlintide), colchicine, cholinesterase inhibitors, lipid-lowerin agents (eg, ezetimibe, orlistat), macrolides (eg,
erythromycin), quinidine, SSRIs

HAVA: Halothane, Amanita phalloides (death cap mushroom), Valproic acid, Acetaminophen

Rifampin, isoniazid, pyrazinamide, statins, fibrates

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10
Q

Drug reactions—gastrointestinal

  • Pancreatitis
  • Pill-induced esophagitis
  • Pseudomembranous colitis
A

Didanosine, Corticosteroids, Alcohol, Valproic acid, Azathioprine, Diuretics (furosemide, HCTZ).

Bisphosphonates, ferrous sulfate, NSAIDs, potassium chloride, tetracyclines.

Ampicillin, cephalosporins, clindamycin, fluoroquinolones

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11
Q

Drug reactions—hematologic

  • Agranulocytosis
  • Aplastic anemia
A

“Can Cause Pretty Mayor Collapse of Granulocytes” Clozapine, Carbamazepine, Propylthiouracil, Methimazole, Colchicine, Ganciclovir.

“Cant Make New Blood Cells Properly”
Carbamazepine, Methimazole, NSAIDs, Benzene, Chloramphenicol, Propylthiouracil

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12
Q

Drug reactions—hematologic

  • Direct Coombs positive hemolytic anemia
  • eosinophilia and systemic symptoms
  • Gray baby syndrome
  • Thrombocytopenia
A

“P Diddy Coombs”
Penicillin, methylDopa, Cephalosporins

Allopurinol, anticonvulsants, antibiotics, sulfa drugs

Chloramphenicol

“Help Very Low platelets”
Heparin, Vancomycin, Linezolid

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13
Q

DRESS

A

Fatal delayed hypersensitivity reaction.

Latency period (2–8 weeks) followed by fever, morbilliform skin rash, and frequent multiorgan involvement.

Treatment: withdrawal of offending drug, corticosteroids.

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14
Q

Drug reactions—hematologic

  • Hemolysis in G6PD deficiency
  • Megaloblastic anemia
  • Thrombotic complications
A

“hemolysis IS D PAIN”
Isoniazid, Sulfonamides, Dapsone, Primaquine, Aspirin, Ibuprofen, Nitrofurantoin.

Hydroxyurea, Phenytoin, Methotrexate, Sulfa drugs

Combined oral contraceptives, hormone replacement therapy, SERMs. *estrogens side effect

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15
Q

Drug reactions—musculoskeletal/skin/connective tissue

  • Lupus
  • Fat redistribution
  • Gingival hyperplasia
A

“having lupus is Mega “SHIPP-E”
Methyldopa, Sulfa drugs, Hydralazine, Isoniazid, Procainamide, Phenytoin, Etanercept

Protease inhibitors, Glucocorticoids

“Can Caus Puffy gums”
Cyclosporine, Ca2+ channel blockers, Phenytoin

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16
Q

Drug reactions—musculoskeletal/skin/connective tissue

  • Hyperuricemia (gout)
  • Myopathy
  • Osteoporosis
A

“Painful Tophy and Feet Need Care”
Pyrazinamide, Thiazides, Furosemide, Niacin, Cyclosporine.

Statins, fibrates, niacin, colchicine, daptomycin, hydroxychloroquine, interferon-α, penicillamine, glucocorticoids.

Corticosteroids, depot medroxyprogesterone acetate, GnRH agonists, aro.matase inhibitors, anticonvulsants, heparin, PPIs

17
Q

Drug reactions—musculoskeletal/skin/connective tissue

  • Photosensitivity
  • Rash (Stevens- Johnson syndrome)
  • Teeth discoloration
  • Tendon and cartilage damage
A

“SAT For PHOTO”
Sulfonamides, Amiodarone, Tetracyclines, 5-FU

Anti-epileptic drugs (especially lamotrigine), allopurinol, sulfa drugs, penicillin

Tetracyclines

Fluoroquinolones

18
Q

Drug reactions—neurologic

  • Cinchonism
  • Parkinson-like syndrome
  • Peripheral neuropathy
  • Pseudotumor cerebri
A

Quinidine, quinine

“ARM” Antipsychotics, Reserpine, Metoclopramide

Phenytoin, vincristine

Growth hormones, tetracyclines, vitamin A

19
Q

Cinchonism

A

Can present with tinnitus, hearing/vision loss,

psychosis, and cognitive impairment

20
Q

Drug reactions—neurologic

  • Seizures
  • Tardive dyskinesia
A

“with seizures I BITE my tounge “
Isoniazid (vitamin B6 deficiency), Bupropion, Imipenem/cilastatin, Tramadol, Enflurane

Antipsychotics, metoclopramide

21
Q

Drug reactions—neurologic

- Visual disturbance

A

“These Drugs Disturbe Very Pretty Eyes”

Topiramate (blurred vision/diplopia, haloes),
Digoxin (yellow-tinged vision),
Isoniazid (optic neuropathy/color vision changes), Vigabatrin (bilateral visual field defects),
PDE-5 inhibitors (blue-tinged vision),
Ethambutol (color vision changes)

22
Q

Drug reactions—renal/genitourinary

  • Fanconi syndrome
  • Hemorrhagic cystitis
  • Interstitial nephritis
A

Cisplatin, ifosfamide, expired tetracyclines, tenofovir

Cyclophosphamide, ifosfamide. *prevent by coadministering with mesna

Penicillins, furosemide, NSAIDs, proton pump inhibitors, sulfa drugs.

23
Q

Drug reactions—respiratory

  • Dry cough
  • Pulmonary fibrosis
A

ACE inhibitors

“My Nose Cannot Breath Bad Air”
Methotrexate, Nitrofurantoin, Carmustine, Bleomycin, Busulfan, Amiodarone

24
Q

Drug reactions—multiorgan Drug Reaction:

  • Antimuscarinic
  • Disulfiram-like reaction
  • Nephrotoxicity/ ototoxicity
A

Atropine, TCAs, H1-blockers, antipsychotics

“Sorry Pals Cannot Go Mingle”
1st-generation Sulfonylureas, Procarbazine,
certain Cephalosporins, Griseofulvin, Metronidazole

Loop diuretics, Aminoglycosides, cisPlatin, Vancomycin, amphoTERicin B.

25
Q

Drugs affecting pupil size

- Midriasis

A

Anticholinergics (atropine, TCA, tropicamide, scopolamine, antihistamines)

Drugs of abuse (amphetamines, cocaine, LSD)

Sympathomimetics

26
Q

Drugs affecting pupil size

- Miosis

A

Antipsychotics (haloperidol, risperidone, olanzapine)

Drugs of abuse (eg, heroin/opioids)

Parasympathomimetics (pilocarpine), organophosphates

27
Q

Cytochrome P-450 interactions (selected)

- Inducers

A

“Most chronic alcoholics Steal Phen-Phen and Never
Refuse Greasy Carbs”

Modafinil
Chronic alcohol use
St. John’s wort
Phenytoin
Phenobarbital
Nevirapine
Rifampin
Griseofulvin
Carbamazepine
28
Q

Cytochrome P-450 interactions (selected)

- Substrates

A

“Always Think When Outdoors”

Anti-epileptics
Theophylline
Warfarin
OCPs

29
Q

Cytochrome P-450 interactions (selected)

A

“SICKFACES.COM (when I Am drinking Grapefruit
juice)”

Sodium valproate
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Acute alcohol abuse
Chloramphenicol
Erythromycin/clarithromycin
Sulfonamides
Ciprofloxacin
Omeprazole
Metronidazole
Amiodarone
Grapefruit juice
30
Q

Sulfa drugs

A

“Scary Sulfa Pharm FACTS”

Sulfonamide antibiotics, Sulfasalazine, Probenecid, Furosemide, Acetazolamide, Celecoxib, Thiazides, Sulfonylureas.

Patients with sulfa allergies may develop fever, urinary tract infection, Stevens- Johnson syndrome, hemolytic anemia, thrombocytopenia, agranulocytosis, acute
interstitial nephritis, and urticaria (hives).

31
Q

Drug Names

A

Pag. 248

USMLE 1 (73 decks)

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