Pharmacology/Toxicology

Question 1

What are antidotes to cyanide exposure?

Answer 1

1st line: Hydroxocobalamin
2nd line: Sodium thiosulphate.
If antidotes are not available, can give nitrites to induce methemoglobinemia

Question 2

What medication can cause cyanide poisoning?

Answer 2

Nitroprusside (antihypertensive)

Question 3

What blood thinners are recommended in patients with kidney disease?

Answer 3

Unfractionated heparin and warfarin.
Low-molecular-weight heparin (enoxaparin), fondaparinux (injection factor Xa inhibitor) and rivaroxaban (oral factor Xa inhibitor) should be avoided because renal clearance is required

Question 4

What is aspirin exacerbated respiratory disease (AERD)?

Answer 4

Associated with asthma, chronic rhinosinusitis with nasal polyposis, and bronchospasm or nasal congestion following the ingestion of aspirin or NSAIDS. It is a pseudoallergic reaction (not IgE-mediated)

Question 5

What is the mechanism of dobutamine?

Answer 5

Stimulates beta-1 adrenergic receptors

Question 6

What is the most common serious adverse affect of hydroxychloroquine?

Answer 6

Retinopathy - pts should have a baseline ophthalmologic evaluation. Then annual evaluations after 5 years of use (retinopathy does not typically occur until 5-7 years)

Question 7

What medication is favored for chemotherapy-induced nausea?

Answer 7

Metoclopramide

Question 8

What are the major adverse affects of cyclophosphamide?

Answer 8

Acute hemorrhagic cystitis, bladder carcinoma, sterility, and myelosuppression

Question 9

What are common side effects of cyclosporine?

Answer 9

Nephrotoxicity, HTN (tx with calcium channel blocker), neurotoxicity (usually reversible: HA, visual disturbances, seizure, mild tremor, etc), glucose intolerance, infection, malignancy (esp squamous cell carcinoma of the skin and lymphoproliferative diseases), gingival hyperplasia, hirsutism, and GI sx (e.g. anorexia, N/V, diarrhea).

Question 10

What medications are associated with drug-induced pancreatitis?

Answer 10

Valproic acid, diuretics (e.g. furosemide, thiazides), drugs for inflammatory bowel disease (e.g. sulfasalazine, 5-ASA), immunosuppressive agents (e.g. azothioprine), HIV-related meds (e.g. didanosine, pentamidine), and antibiotics (e.g. metronidazole, tetracycline)

Question 11

What QRS interval is an indication for sodium bicarb therapy in TCA overdose?

Answer 11

> 100 msec

Question 12

How does sodium bicarb help with TCA toxicity?

Answer 12

TCAs inhibit fast sodium channels resulting in QRS prolongation and ventricular arrhythmias. Sodium bicarb increases pH and extracellular sodium. The increased pH decreases drug avidity for sodium channels

Question 13

What medications should be used with caution when prescribing a phosphodiesterase-5 inhibitors (e.g. sildenafil)?

Answer 13

Nitrates and alpha blockers (e.g. doxazosin) because it can cause severe hypotension. If given together, pt should take them at least 4 hrs apart

Question 14

How can erythropoietin therapy affect blood pressure?

Answer 14

Up to 30% of pts may develop new or worsening hypertension, which typically occurs 2-8 wks after treatment initiation.

Question 15

What is the acid-base disturbance in aspirin overdose?

Answer 15

Respiratory alkalosis with concomitant metabolic acidosis

Question 16

What medication can cause melanosis coli (dark pigmentation of the colon)?

Answer 16

Regular use of laxatives (bisacodyl or polyethylene-containing)

Question 17

What function should be routinely measured in patients taking trastuzumab for breast cancer?

Answer 17

Can cause cardiotoxicity so echocardiography should be done at regular intervals including before starting therapy to get baseline function. Therapy should be stopped in patients with symptomatic heart failure

Question 18

What is the mechanism of action of riluzole?

Answer 18

Glutamate inhibitor - used to treat ALS

Question 19

How does lithium toxicity present?

Answer 19

Tremor, hyperreflexia, ataxia, seizures, vomiting, and diarrhea

Question 20

How does phenytoin toxicity present?

Answer 20

Horizontal nystagmus, cerebellar ataxia, and confusion

Question 21

How do nitrates provide pain relief in pts with chest pain?

Answer 21

Systemic vasodilation (more than coronary vasodilation) because this lowers preload and left ventricular end-diastolic volume which reduces myocardial oxygen demand by reducing wall stress

Question 22

What are common side effects of cyclosporin?

Answer 22

Gingival hyperplasia, hypertension, and hirsutism

Question 23

What are common side effects of mycophenolate mofetil?

Answer 23

Bone marrow suppression, vomiting, diarrhea, hypertension, back pain, coughing, peripheral edema, elevated BUN, and hyperglycemia. Hypercholesterolemia is also common.

Question 24

What are common side effects of tacrolimus?

Answer 24

Diarrhea, hypertension, and hyperglycemia