Toxins and Drug reactions Flashcards
Tetrodotoxin
Source: pufferfish
Action: highly potent, binds fast VG-Na+ channels in cardiac/nerve tissue (prevent depolarization)
Symptoms: nausea, diarrhea, paresthesias, weakness, dizziness, loss of reflexes
Tx: supportive
Ciguatoxin
Source: reef fish (barracuda, snapper, moray eel)
Action: opens Na+ channels (depolarization)
Symptoms: nausea, diarrhea, perioral numbness, hot and cold reversal, bradycardia, heart block, hypotension
Tx: supportive
Histamine (scombroid poisoning)
Source: spoiled dark-meat fish (tuna, mahi-mahi, mackerel, bonito)
Action: bacterial histadine carboxylase converts histadine to histamine
*Frequently misdiagnosed as fish allergy
Symptoms: mimics anaphylaxis–acute burning of mouth, flushing of face, erythema, urticaria, itching (may progress to bronchospasm, angioedema, hypotension)
Tx: antihistamines, albuterol/epinephrine if needed
Beers criteria
> 50 meds that should be avoided in elderly
- anticholinergics, antihistamines, antidepressants, benzos, opioids = increased risk of delirium, sedation, falls, constipation, urinary retention
- A-blocks = increased risk of hypotension
- PPIs = increased risk of C. Diff
- NSAIDs = increased risk of GI bleeding
Acetaminophen tx
N-acetylcysteine (replenishes glutathione)
AChE inhibitors, organophosphate tx
Atropine > pralidoxime
Antimuscarinic/anticholinergic tx
Physostigmine
Control hyperthermia
Arsenic tx
Dimercaprol
Succimer
Benzo tx
Flumazenil
B-block tx
Atropine
Glucagon (increase fat and glucose)
CO tx
100% o2
Hyperbaric o2
Copper tx
Penicillamine
Trientine
Cyanide tx
Nitrite + thiosulfate
Hydroxocobalamin
Digitalis (digoxin) tx
Anti-dig Fab fragments
Heparin tx
Protamine sulfate
Iron tx
Deferoxamine
Deferasirox
Deferiprone
Lead tx
EDTA
Dimercaprol (like arsenic)
Succimer (like arsenic)
Penicillamine (like copper)
Mercury tx
Dimercaprol
Succimer
(Like arsenic, lead)
Methanol, ethylene glycol (antifreeze) tx
Fomepizole > ethanol
Dialysis
Methemoglobin tx
Methylene blue
Vitamin C
Opioids tx
Naloxone
Salicylates tx
NaHCO3 (alkalinize urine)
Dialysis
TCAs tx
NaHCO3
Warfarin tx
Vitamin K (delayed effect) FFP (immediate)
Cause coronary vasospasm
Amphetamines
Cocaine
Ergot alkaloids
Sumatriptan
Cause cutaneous flushing
Vancomycin Adenosine Niacin Nitrates CCBs Echinocandins
Cause dilated cardiomyopathy
Anthracyclines (doxorubicin, daunorubicin)
Cause torsades de pointes
Antiarrhythmics Antibiotics (macrolides) Antipsychotics (haloperidol) Antidepressants (TCAs) Antiemetics (ondansetron)
Cause adrenocortical insufficiency
HPA suppression secondary to glucocorticoid withdrawal
Cause DI
Lithium
Demeclocycline
Cause hot flashes
Tamoxifen
Clomiphene
Cause hyperglycemia
Tacrolimus Protease inhibitors Niacin HCTZ Corticosteroids
Cause hypothyroidism
Lithium
Amiodarone
Sulfonamides
Cause SIADH
Carbamazepine
Cyclophosphamide
SSRIs
Cause acute cholestatic hepatitis, jaundice
Erythromycin
Cause diarrhea
Acamprosate Acarbose Cholinesterase inhibitors Colchicine Erythromycin Ezetimibe Metformin Misoprostol Orlistat Pramlintide Quinidine SSRIs
Cause focal to massive hepatic necrosis
Halothane
Amanita phalloides
Valproic acid
Acetaminophen
Cause hepatitis
Rifampin Isoniazid Pyrazinamide Statins Fibrates
Cause pancreatitis
Didanosine Corticosteroids Alcohol Valproic acid Azathioprine Diuretics (furosemide, HCTZ)
Cause pill-induced esophagitis
Bisphosphonates Ferrous sulfate NSAIDs Potassium chloride Tetracyclines
Cause pseudomembranous colitis
Ampicillin
Cephalosporin
Clindamycin
Fluoroquinolones
Cause agranulocytosis
Clozapine Carbamazepine PTU Methimazole Colchicine Ganciclovir
Cause aplastic anemia
Carbamazepine Methimazole NSAIDs Benzene Chloramphenicol PTU
Cause direct Coombs, positive hemolytic anemia
Methyldopa
Penicillin
Cause DRESS (drug rxn with eosinophilia and systemic symptoms)
Allopurinol
Anticonvulsants
Antibiotics
Sulfa drugs
- potentially fatal delayed hypersensitivity rxn. Latency period (2-8 weeks) followed by: fever, morbilliform skin rash, frequent multi organ involvement
- Tx: withdrawal of agent, corticosteroids
Cause gray baby syndrome
Chloramphenicol
Cause G6PD hemolysis
Isoniazid Sulfonamides Dapsone Primaquine Aspirin Ibuprofen Nitrofurantoin
Cause megaloblastic anemia
Hydroxyurea
Phenytoin
Methotrexate
Sulfa drugs
Cause thrombocytopenia
Heparin
Cause thrombotic complications
OCPs, hormone replacement, SERMs
Cause fat redistribution
Protease inhibitors
Glucocorticoids
Cause gingival hyperplasia
Phenytoin
CCB
Cyclosporine
Cause hyperuricemia
Pyrazinamide Thiazides Furosemide Niacin Cyclosporine
Cause myopathy
Statins Fibrates Niacin Colchicine Daptomycin Hydroxychloroquine Interferon-alpha Penicillamine Glucocorticoids
Cause osteoporosis
Corticosteroids Depot medroxyprogesterone GnRH agonists Aromatase inhibitors Anticonvulsants Heparin
Cause photosensitivity
Tetracyclines
Sulfonamides
Amiodarone
5-FU
Cause Stevens-Johnson syndrome
Anti-epileptic drugs (esp. lamotrigine)
Allopurinol
Sulfa drugs
Penicillin
Cause SLE-like syndrome
Sulfa drugs Hydralazine Isoniazid Procainamide Phenytoin Etanercept
Cause teeth discoloration
Tetracyclines
Cause tendonitis/rupture/cartilage damage
Fluoroquinolones
Cause cinchonism
Quinidine
Quinine
-Tinnitus, hearing/vision loss, psychosis, cognitive impairment
Cause Parkinson-like syndrome
Antipsychotics
Reserpine
Metoclopramide
Cause seizures
Isoniazid (vitamin B6 deficiency) Bupropion Imipenem/cilastatin Trauma doll Enflurane
Cause tardive dyskinesia
Antipsychotics
Metoclopramide
Cause Fanconi syndrome
Cisplatin
Ifosfamide
Expired tetracyclines
Tenofovir
Cause hemorrhagic cystitis
Cyclophosphamide
Ifosfamide
Cause interstitial nephritis
Penicillins Furosemide NSAIDs PPI Sulfa drugs
Cause pulmonary fibrosis
Methotrexate Nitrofurantoin Carmustine Bleomycin Busulfan Amiodarone
Cause antimuscarinic effects
Atropine
TCAs
H1-blockers
Antipsychotics
Cause disulfiram-like reactions
1st-generation sulfonylureas Procarbazine Certain cephalosporins Griseofulvin Metronidazole
Cause nephrotoxicity/ototoxicity
Aminoglycosides Vancomycin Loop diuretics Cisplatin Amphotericin B
Sulfa drugs
Sulfonamide antibiotics Sulfasalazine Probenecid Furosemide Acetazolamide Celecoxib Thiazides Sulfonylureas
-Allergies = fever, UTI, Steven-Johnson syndrome, hemolytic anemia, thrombocytopenia, agranulocytosis, acute interstitial nephritis, urticaria
Cytochrome P450 inducers
-Increase metabolism = decreased drug
Chronic alcohol use St. John's wort Phenytoin Phenobarbital Nevirapine Rifampin Griseofulvin Carbamazepine
Cytochrome P450 substrates
Anti-epileptics
Theophylline
Warfarin
OCPs
Cytochrome P450 inhibitors
-Decrease metabolism = increased drug
Sodium valproate Isoniazid Cimetidine Ketoconazole Fluconazole Acute alcohol abuse Chloramphenicol Erythromycin (macrolides) Sulfonamides Ciprofloxacin Omeprazole Metronidazole
-azole
Ergosterol synthesis inhibitor
-bendazole
Antiparasitic/antihelminthic
-cillin
Transpeptidase (penicillin-binding protein)
-cycline
Protein synthesis inhibitor
-ivir
Neuraminidase inhibitor
-navir
Protease inhibitor
-ovir
DNA polymerase inhibitor
-thromycin
Macrolide antibiotic
-ane
Inhaled general anesthetic
-azine
Typical antipsychotic
-barbital
Barbiturate
-caine
Local anesthetic
-etine
SSRI
-ipramine -triptyline
TCA
-triptan
5-HT agonist
-zepam-zolam
Benzodiazepine
-chol
Cholinergic agonist
-curium -curonium
Nondepolarizing paralytic
-olol
BB
-stigmine
AChE inhibitor
-terol
B2 agonist
-zosin
Alpha1 antagonist
-afil
PDE5 inhibitor
-dipine
Dihydropyridine CCB
-pril
ACE inhibitor
-sartan
Angiotensin 2 receptor blocker
-statin
HMG-CoA reductase inhibitor
-xaban
Direct factor Xa inhibitor
-dronate
Bisphosphonate
-glitazone
PPAR-gamma activator
-prazole
PPI
-prost
Prostaglandin analog
-tidine
H2-antagonist
-tinib
Tyrosine kinase inhibitor
-tropin
Pituitary hormone
-ximab
Chimeric monoclonal Ab
-zumab
Humanize monoclonal Ab