Pharmacology - Toxicities and Side Effects Flashcards Preview

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Flashcards in Pharmacology - Toxicities and Side Effects Deck (15)
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1
Q

Specific antidotes/treatments for these toxins

  • Acetaminophen
  • AChE inhibitors, organophosphates
  • Amphetamines (basic)
  • Antimuscarinic, anticholinergic agents
  • Benzodiazepines
  • β-blockers
  • Carbon monoxide
  • Copper, arsenic, gold
  • Cyanide
  • Digitalis
A
  • Acetaminophen
    • N-acetylcysteine (replenishes glutathione)
  • AChE inhibitors, organophosphates
    • Atropine followed by pralidoxime
  • Amphetamines (basic)
    • NH4Cl (acidify urine)
  • Antimuscarinic, anticholinergic agents
    • Physostigmine salicylate, control hyperthermia
  • Benzodiazepines
    • Flumazenil
  • β-blockers
    • Glucagon
  • Carbon monoxide
    • 100% O2, hyperbaric O2
  • Copper, arsenic, gold
    • Penicillamine
  • Cyanide
    • Nitrite + thiosulfate, hydroxocobalamin
  • Digitalis
    • Anti-dig Fab fragments
2
Q

Specific antidotes/treatments for these toxins

  • Heparin
  • Iron
  • Lead
  • Mercury, arsenic, gold
  • Methanol, ethylene glycol (antifreeze)
  • Methemoglobin
  • Opioids
  • Salicylates
  • TCAs
  • tPA, streptokinase, urokinase
  • Warfarin
A
  • Heparin
    • Protamine sulfate
  • Iron
    • Deferoxamine, deferasirox
  • Lead
    • EDTA, dimercaprol, succimer, penicillamine
  • Mercury, arsenic, gold
    • Dimercaprol (BAL), succimer
  • Methanol, ethylene glycol (antifreeze)
    • Fomepizole > ethanol, dialysis
  • Methemoglobin
    • Methylene blue, vitamin C
  • Opioids
    • Naloxone
  • Salicylates
    • NaHCO3 (alkalinize urine), dialysis
  • TCAs
    • NaHCO3 (plasma alkalinization)
  • tPA, streptokinase, urokinase
    • Aminocaproic acid
  • Warfarin
    • Vitamin K, plasma (if active bleeding)
3
Q

Causal agents of drug reactions—cardiovascular

  • Coronary vasospasm
  • Cutaneous flushing
  • Dilated cardiomyopathy
  • Torsades de pointes
A
  • Coronary vasospasm
    • Cocaine, sumatriptan, ergot alkaloids
  • Cutaneous flushing
    • VANC: Vancomycin, Adenosine, Niacin, Ca2+ channel blockers
  • Dilated cardiomyopathy
    • Doxorubicin, daunorubicin
  • Torsades de pointes
    • Kill The CHAMPio_N_: ​K channel blockers (class III, e.g. sotalol), TCAs, Chloroquine, Haloperidol, Antipsychotics, Macrolides, Protease inhibitors, Na channel blockers (class IA, e.g. quinidine)
4
Q

Causal agents of drug reactions—endocrine/reproductive

  • Adrenocortical insufficiency
  • Hot flashes
  • Hyperglycemia
  • Hypothyroidism
A
  • Adrenocortical insufficiency
    • HPA suppression 2° to glucocorticoid withdrawal
  • Hot flashes
    • Tamoxifen, clomiphene
  • Hyperglycemia
    • Taking Pills Necessitates Having Blood Checked
    • Tacrolimus, Protease inhibitors, Niacin, HCTZ, β-blockers, Corticosteroids
  • Hypothyroidism
    • Lithium, amiodarone, sulfonamides
5
Q

Causal agents of drug reactions—GI

  • Acute cholestatic hepatitis, jaundice
  • Diarrhea
  • Focal to massive hepatic necrosis
  • Hepatitis
  • Pancreatitis
  • Pseudomembranous colitis
A
  • Acute cholestatic hepatitis, jaundice
    • Erythromycin
  • Diarrhea
    • Might Excite Colon On Accident
    • Metformin, Erythromycin, Colchicine, Orlistat, Acarbose
  • Focal to massive hepatic necrosis
    • Liver “HAVAc
    • Halothane, Amanita phalloides (death cap mushroom), Valproic acid, Acetaminophen
  • Hepatitis
    • INH
  • Pancreatitis
    • Drugs Causing A Violent Abdominal Distress
    • Didanosine, Corticosteroids, Alcohol, Valproic acid, Azathioprine, Diuretics (furosemide, HCTZ)
  • Pseudomembranous colitis
    • Clindamycin, ampicillin, cephalosporins
    • Antibiotics predispose to superinfection by resistant C. difficile
6
Q

Causal agents of drug reactions—hematologic

  • Agranulocytosis
  • Aplastic anemia
  • Direct Coombs-positive hemolytic anemia
  • Gray baby syndrome
  • Hemolysis in G6PD deficiency
  • Megaloblastic anemia
  • Thrombocytopenia
  • Thrombotic complications
A
  • Agranulocytosis
    • Drugs CCCrush Myeloblasts and Promyelocytes
    • Dapsone, Clozapine, Carbamazepine, Colchicine, Methimazole, Propylthiouracil
  • Aplastic anemia
    • Can’t Make New Blood Cells Properly
    • Carbamazepine, Methimazole, NSAIDs, Benzene, Chloramphenicol, Propylthiouracil
  • Direct Coombs-positive hemolytic anemia
    • Methyldopa, penicillin
  • Gray baby syndrome
    • Chloramphenicol
  • Hemolysis in G6PD deficiency
    • Hemolysis IS D PAIN
    • INH, Sulfonamides, Dapsone, Primaquine, Aspirin, Ibuprofen, Nitrofurantoin
  • Megaloblastic anemia
    • Having a blast with PMS
    • Phenytoin, Methotrexate, Sulfa drugs
  • Thrombocytopenia
    • Heparin, cimetidine
  • Thrombotic complications
    • OCPs (e.g., estrogens)
7
Q

Causal agents of drug reactions—musculoskeletal/skin/connective tissue

  • Fat redistribution
  • Gingival hyperplasia
  • Hyperuricemia (gout)
  • Myopathy
  • Osteoporosis
  • Photosensitivity
  • Rash (Stevens-Johnson syndrome)
  • SLE-like syndrome
  • Teeth discoloration
  • Tendonitis, tendon rupture, and cartilage damage
A
  • Fat redistribution
    • Fat** **PiG
    • Protease inhibitors, Glucocorticoids
  • Gingival hyperplasia
    • Phenytoin, verapamil, cyclosporine, nifedipine
  • Hyperuricemia (gout)
    • Painful Tophi and Feet Need Care
    • Pyrazinamide, Thiazides, Furosemide, Niacin, Cyclosporine
  • Myopathy
    • Fibrates, niacin, colchicine, hydroxychloroquine, interferon-α, penicillamine, statins, glucocorticoids
  • Osteoporosis
    • Corticosteroids, heparin
  • Photosensitivity
    • SAT For Photo
    • Sulfonamides, Amiodarone, Tetracyclines, 5-FU
  • Rash (Stevens-Johnson syndrome)
    • CLAPPPERS
    • Carbamazepine, _L_amotrigine, _A_llopurinol, _P_henytoin, _P_henobarbital, _P_enicillin, _Ethosuximide, (R_ash), _S_ulfa drugs
  • SLE-like syndrome
    • SHIPP-E
    • Sulfa drugs, Hydralazine, INH, Procainamide, Phenytoin, Etanercept
  • Teeth discoloration
    • Tetracyclines
  • Tendonitis, tendon rupture, and cartilage damage
    • Fluoroquinolones
8
Q

Causal agents of drug reactions—neurologic

  • Cinchonism
  • Parkinson-like syndrome
  • Seizures
  • Tardive dyskinesia
A
  • Cinchonism
    • Quinidine, quinine
  • Parkinson-like syndrome
    • Cogwheel rigidity of ARM
    • Antipsychotics, Reserpine, Metoclopramide
  • Seizures
    • With seizures, I BITE My tongue
    • INH (vitamin B6 deficiency), Bupropion, Imipenem/cilastatin, Tramadol, Enflurane, Metoclopramide
  • Tardive dyskinesia
    • Antipsychotics, metoclopramide
9
Q

Causal agents of drug reactions—renal/genitourinary

  • Diabetes insipidus
  • Fanconi syndrome
  • Hemorrhagic cystitis
  • Interstitial nephritis
  • SIADH
A
  • Diabetes insipidus
    • Lithium, demeclocycline
  • Fanconi syndrome
    • Expired tetracycline
  • Hemorrhagic cystitis
    • Cyclophosphamide, ifosfamide
    • Prevent by coadministering with mesna
  • Interstitial nephritis
    • Methicillin, NSAIDs, furosemide
  • SIADH
    • Can’t Concentrate Serum Sodium
    • Carbamazepine, Cyclophosphamide, SSRIs
10
Q

Causal agents of drug reactions—respiratory

  • Dry cough
  • Pulmonary fibrosis
A
  • Dry cough
    • ACE inhibitors
  • Pulmonary fibrosis
    • Breathing Air Badly from Medications
    • Bleomycin, Amiodarone, Busulfan, Methotrexate
11
Q

Causal agents of drug reactions—multiorgan

  • Antimuscarinic
  • Disulfiram-like reaction
  • Nephrotoxicity/ototoxicity
A
  • Antimuscarinic
    • muscles wear A HAT
    • Atropine, H1-blockers, Antipsychotics, TCAs
  • Disulfiram-like reaction
    • Must Stop Getting Pina Coladas
    • Metronidazole, 1st-generation _S_ulfonylureas, _G_riseofulvin, _P_rocarbazine, certain _C_ephalosporins
  • Nephrotoxicity/ototoxicity
    • Aminoglycosides, vancomycin, loop diuretics, cisplatin
12
Q

Cytochrome P-450 interactions (selected):
Inducers (+) (9)

A
  • My New Guiness, Coronas, & PBRS induce CHRONIC ALCOHOLISM
  • Modafinil
  • Nevirapine
  • Griseofulvin
  • Carbamazepine
  • Phenytoin
  • Barbiturates (e.g. phenobarbital)
  • Rifampin
  • St. John’s wort
  • Chronic alcohol use
13
Q

Cytochrome P-450 interactions (selected):
Substrates (8)

A
  • Always, Always, Always, Always Think When Starting Others
  • Anti-epileptics
  • Antidepressants
  • Antipsychotics
  • Anesthetics
  • Theophylline
  • Warfarin
  • Statins
  • OCPs
14
Q

Cytochrome P-450 interactions (selected):
Inhibitors (-) (12)

A
  • Q CRACK AMIGGOS
  • Quinidine
  • Cimetidine
  • Ritonavir (protease inhibitors)
  • Acute alcohol abuse
  • Ciprofloxacin
  • Ketoconazole
  • Amiodarone
  • Macrolides
  • Isoniazid
  • Grapefruit juice
  • Gemfibrozil
  • Omeprazole
  • Sulfonamides
15
Q

Sulfa drugs

  • Examples
  • Patients with sulfa allergies may develop/
A
  • Popular Sulfa FACTSS
    • Probenecid, Sulfonamide antibiotics, Furosemide, Acetazolamide, Celecoxib, Thiazides, Sulfasalazine, Sulfonylureas.
  • Patients with sulfa allergies may develop fever, urinary tract infection, Stevens-Johnson syndrome, hemolytic anemia, thrombocytopenia, agranulocytosis, and urticaria (hives).
  • Symptoms range from mild to life threatening.

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