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Pharm II Exam 2 > Side Effects/toxicities > Flashcards

Side Effects/toxicities Flashcards

1
Q

L-triiodothyronine (T3)

Liothyronine Sodium

A

More expensive, harder to monitor, greater risk of cardiotoxicity

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2
Q

L-thyroxin (T4)

Levothyroid Sodium

A

Cardiac symptoms, angina and
palpitations.

Use with care, particularly in elderly

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3
Q

Thioamides- PTU and MMI

A

Skin rash, joint pain,
agranulocytosis in 0.2 % patients
hepatotoxicity (worse in PTU than MMI)

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4
Q

Methimazole

MMI

A

Greater risk of birth defects than PTU

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5
Q

Anion Inhibitors

A

Aplastic anemia

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6
Q

Iodide

A

Uncommon and usually
reversible when d/c

Acniform rash, swollen salivary glands,
mucous membrane ulcerations

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7
Q

Radioactive Iodine

I131

A

Eventually causes
hypothyroidism in 80% of patients, but this
is likely part of natural progression of
disease

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8
Q

Insulin

A

Hypoglycemia (<70 mg/dL) - can be reversed by glucose or glucagon
can be serious or fatal if not properly regulated

Dementia later in life

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9
Q

Biguanides

A

GI effects- N/D/D

May have small weight loss

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10
Q

Sulfonylureas

A

Hypoglycemia,weight gain

Many drug interactions which can enhance hypoglycemic effect and compromise glucose lowering effect

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11
Q

Non-Sulfonylurea Secretagogues (Meglitinides)

A

Hypoglycemia (lower risk than SU), weight gain

Drug interactions

Caution in liver dz pts

Preg risk cannot be ruled out

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12
Q

Thiazolidenediones (TZDs)

A

Fluid retention, weight game

↓ bone density

Poss risk of heart failure and bladder ca

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13
Q

GLP-1 Receptor Agonists

A

N/V/D (will ↓ with continued use but risk for acute renal failure)

↑ Risk of hypoglycemia when combined with insulin
secretagogues

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14
Q

Dipeptidyl Peptidase-4 (DPP-4) Inhibitors

A

↑ Risk of hypoglycemia when combined with insulin
secretagogues

Cleavage not specific to incretins

Pancreatitis, hepatic failure (can be fatal)

Joint pain

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15
Q

α-Glucosidase Inhibitors

A

Abd pain, diarrhea, flatulence (alleviated with dose titration/continued use)

↑ risk of hypoglycemia (must treat with oral glucose because disaccharides will not be absorbed)

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16
Q

Renal SGLT-2 Inhibitors

A

Genital mycotic infections

Recurrent UTIs

LT safety unk (possible ↑ risk bone fx)

Ketoacidosis

Metabolized by UDP-GT → drug interactions

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17
Q

Estrogens

A

High dose unopposed estrogen associated with endometrial cancer

↑ risk thromboembolism (stroke, MI) in cig smokers > 35

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18
Q

Progestins

A

Menstrual bleeding, irregularity, unfavorable lipid changes, LT progestin therapy can cause delayed return to ovulatory fn, androgenic effects (acne, hirsuitism), HA, ↑ B, weight gain

↑ risk breast ca when used w/ estrogen for postmenopausal HRT (compared to estrogen alone)

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19
Q

Estrogen/Progestin Combo Pill

A

N/V, HA, breast enlargement/tenderness alterations in libido, breakthrough bleeding (at lower doses), melasma, hair loss, GB dz

NO ↑ in endometrial ca w/ combo

Drug int- P450 inducers ↓ HL and low dose can lead ot failure, abx may ↓ enterohepatic cycling, phenytoin (anti-epileptic) can ↓ serum levels

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20
Q

Ulipristal

A

Uterine bleeding, menstrual irregularity, N/V, HA, abd pain

P450 substrate → drug interactions

21
Q

Mifepristone

RU486

A

Serious bleeding in 1-5% pts

22
Q

IUDs

A

Uterine perforation (on insertion)

Expulsion

Cramping – after insertion, may persist for a few months

Pelvic Inflammatory Disease risk: first 30 days after insertion

Copper: heavy menses

LNG: irregular spotting

23
Q

Tamoxifen

A

Menopausal symptoms (e.g. hot flashes)

4-6-fold ↑ incidence of endometrial cancer (~0.2% risk). Hence, not administered for more than 5-10 years

24
Q

Toremifene

A

Menopausal symptoms, may ↑ incidence of endometrial cancers

25
Q

Leuprolide

A

Hot flashes, osteoporosis, sexual dysfunction

26
Q

Aromatase Inhibitors

A

Hot flashes, osteopenia, osteoporosis

27
Q

Trastuzumab

A

Infusion reaction (fever and chills, N/V, pain, HA, dizziness and rash)

BBW: hepatotoxicity, liver failure, cardiotoxicity, embryo-fetal toxicity

28
Q

Pertuzumab

A

Cardiotoxicity, severe hypersensitivity, including anaphylaxis

BBW: embryo-fetal toxicity

29
Q

Dose Limiting Tox of Cyclophosphamide

A

Myelosuppression

30
Q

Dose Limiting Tox of Cisplatin

A

Nephrotoxicity (cumulative and non-reversible)

Prevent nephrotox
w/ hydration and
mannitol diuresis

GI major tox

low heme tox

Derm and repro tox uncommon

31
Q

Dose Limiting Tox of Methotrexate

A

Myelosuppression

Renal tox due to crystallization (prevent w/ hydration)

32
Q

Dose Limiting Tox of 5-Fluorouracil

A

Myelosuppression

33
Q

Dose Limiting Tox of 6-Mercaptopurine

A

Myelosuppression

34
Q

Dose Limiting Tox of Vinblastine

A

Bone

marrow suppression

35
Q

Dose Limiting Tox of Vincristine

A

Peripheral
neuropathiees w/ paresthesia

*bone
marrow sparing

36
Q

Dose Limiting Tox of Paclitaxel

A

Myelosuppression and

peripheral neuropathies

37
Q

Dose Limiting Tox of Etoposide

A

Myelosuppression

38
Q

Dose Limiting Tox of Irinotecan

A

Diarrhea and/or

myelosuppression

39
Q

Dose Limiting Tox of Doxorubicin

A

Irreversible chronic
cardiomyopathy

GI and heme major tox

40
Q

Dose Limiting Tox of Bleomycin

A

Pulmonary fibrosis that may be fatal

Derm major tox

Low heme tox

Uncommon GI tox

41
Q

Cyclophosphamide SE

A

Metabolite acrolein → Hemorrhagic cystitis →

prevent with MESNA* (to neutralize acrolein at acidic pH in urine)

Allopecia, N/V

42
Q

Cisplatin SE

A

Ototoxic w/ tinnitus and hearing loss

43
Q

Methotrexate SE

A

Severe GI disturbances

Leucovorin (folinic acid) used to rescue nrml cells from tox

44
Q

5-Fluorouracil SE

A

Diarrhea, N/V, neurotox

45
Q

6-Mercaptopurine SE

A

Drug interaction
between 6-MP and
allopurinol (used to prevent hyperuricemia during tx) →
life-threatening
myelosuppression (must ↓ dose of 6-MP if on allopurinol**)

Gi disturbances, anorexia, N/V

46
Q

Etoposide SE

A

Alopecia

47
Q

Doxorubicin

A

Reversible acute arrhythmias and conduction abnormalities

48
Q

Dose Limiting Tox of Streptozocin

A

Renal is dose lim

major GI tox

uncommon hematologic tox

Pharm II Exam 2 (7 decks)

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