Urticaria (Hives)
Type I
Immune mediated: B lactams
Non-immune: Contrast dye, morphine
Angioedema
Type I
ACE-I
Anaphylaxis
Type I
B-lactams > FQ’s
Serum Sickness
Type III
cefaclor & sulfonamides
Hypersensitivity
Vasculitis
Type III
B-lactams
sulfonamides
Drug-induced exanthems
Type IV
Most common cutaneous drug rxn (maculopapular rash)
B-lactams, sulfonamides
Erythroderma, exfoliative dermatitis
Type IV
B-lactams
sulfonamides
Steven Johnson Syndrome
TEN
Type IV
MM involvement (oral, conjunctiva, genital)
phenytoin carbamazepine lamotrigine sulfonamides allopurinol
DRESS
Type IV
Eosinophilia
anti-seizure meds (CBZ > VPA, phenytoin, lamotrigine)
sulfonamides
allopurinol
Fixed Drug Eruption
Type IV
TMP/SMX
NSAIDS
Drug-induced photosensitivity
Rx: Exaggerated sunburn on skin
FQ’s
Tetracyclines (doxy)
Amiodarone
Topical retinoids
Tx: sun protection, stop drug, cool compress
Drug-induced alopecia
Anagen effluvium:
bleomycin, cyclophosphamide, fluorouracil
Telogen effluvium:
interferons, Li+, isotretinoin, valproate, warfarin
Drug-induced melanonychia
AZT, minocycline, chemo
beau’s lines: chemo
Drug-induced hyperpigmentation
minocycline
amiodarone
Esophagitis
Bisphosphonates
Tetracyclines
NSAIDS
Tx: drink full glass of water, don’t lie down after med
Pancreatitis
Isotretinoin - INC trigs
NRTI’s (ddl, D4T) - intrinsic toxicity
PEARL: all statins and most ACEI
Liver Injury
MC cause of acute liver failure
APAP (#1)
INH (#2)
PTU (#3)
clavulanate
Pearl: MC reason for drug withdrawal from market
Diarrhea
antacids ABX PPIs NSAIDS caffeine chemo
HTN
INC SBP by 10-20mmHg
stimulants (methylphenidate, cocaine) transplant meds corticosteroids EPO NSAIDS sympathomimetics
Tx: d/c drug, lower dose, or add CCB or ACEI/ARB
Lipid alterations
Hormones (estrogen, androgens, testosterone) Glucocorticoids Transplant meds Thiazide diuretics Protease inhibitors Valproate
QT prolongation
5 A's: anti-arrhythmics antimicrobials (macrolides, FQ) anti-psychotics (haloperidol ) antidepressants (TCAs) antiemetics (promethazine)
Tx: ECG and monitor closely if QT > 500
Raynaud’s
Triptans/ergots oral decongestants caffeine nicotine phentermine
Edema
DHP CCB’s (amlodipine)
Thiazolidinedione’s (pioglitazone)
Gabapentin, pregabalin
Tx: lifestyle (reduce Na, elevate legs, exercise, compression stockings)
Bronchospasm
B blockers
Cocaine
IV contrast
ASA*/NSAIDs/MDI propellants
Tx: withdrawal, O2, +/- steroids
Acute/Subacute Pneumonitis
Days/months post exposure, constitutional symptoms, dyspnea, non-productive cough
Amiodarone
Tx: withdrawal, O2, +/- steroids
Pulmonary Fibrosis
Months to years after exposure, insidious DOE, nonproductive cough
Methotrexate
Bleomycin
Nitrofurantoin
Tx: withdrawal, O2, +/- steroids
Lupus
F/c, malaise, pleuritis/effusion, pneumonitis, myalgias
Procainamide
Hydralazine
Isoniazid
Tx: withdrawal, O2
Pleural Effusion
Methotrexate
Nitrofurantoin
Phenytoin
Tx: none
Discoloration of Urine:
- Yellow-brown
- Yellow-orange
- Red-orange/pink
- Red-brown:
- Brown-black
- Blue +/- green
- Nitrofurantoin, SMX
- Phenazopyridine, entacapone
- Rifampin*
- Warfarin/Heparin (hematuria)*
- Metronidazole, nitrofurantoin
- Amitriptyline, Propofol, triamterene
Nephrotoxicity
- Altered intraglomerular hemodynamics*
- Tubular cell toxicity*
- Inflammation*
- Crystal nephropathy
- Rhabdomyolysis
- Thrombotic microangiopathy
- NSAIDs, ACEIs/ARBs
- Abx (aminoglycosides)
- Beta lactams (PCN/ampicillin), FQs, NSAIDs, AEDs
- Acyclovir, triamterene, methotrexate
- Statins
- Clopidogrel
Male Infertility
- Impaired spermatogenesis/function
- Decreased testosterone
- Inhibition of GnRH or gonadotropin secretion
- Decreased libido
- 5-alpha reductase inhibitors, alpha blockers, alkylating meds, anti-androgens, AE, azathioprine
- Opioids, oral corticosteroids, spirinolactone
- Anti-androgens, antipsychotics, cannabinoids, GnRH analogues, opioids, testosterone, androgenic steroids
- SSRI, SNRI, TCA, MAOI, antipsychotics, lithium, alpha blockers, thiazides, allopurinol