Pharmacology - toxicities and side effects

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jknell
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210579
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Pharmacology - toxicities and side effects
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2013-03-31 22:28:54
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Pharm toxicities and side effects
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  1. Toxin
    Antidote/treatment
  2. Acetaminophen
    N-acetylcysteine (replenishes glutathione)
  3. Salicylates
    • NaHCO3 (alkalinize urine)
    • dialysis
  4. Amphetamines (basic)
    NH4Cl (acidify urine)
  5. Acetylcholinesterase inhibitors, organophosphates
    • Atropine
    • pralidoxime
  6. Antimuscarinic, anticholinergic agents
    • Physostigmine salicylate
    • control hyperthermia
  7. β-blockers
    Glucagon
  8. Digitalis
    • Normalize K+
    • Lidocaine
    • Anti-dig Fab fragments
    • Mg2+
    • (KLAM)
  9. Iron
    • Deferoxamine
    • deferasirox
  10. Lead
    • CaEDTA
    • dimercaprol
    • succimer
    • penicillamine
  11. Mercury, arsenic, gold
    • Dimercaprol (BAL)
    • succimer
  12. Copper, arsenic, gold
    Penicillamine
  13. Cyanide
    • Nitrite + thiosulfate
    • hydroxocobalamin
  14. Methemoglobin
    • Methylene blue
    • vitamin C
  15. Carbon monoxide
    • 100% O2
    • hyperbaric O2
  16. Methanol, ethylene glycol (antifreeze)
    • Fomepizole > ethanol
    • dialysis
  17. Opioids
    Naloxone/naltrexone
  18. Benzodiazepines
    Flumazenil
  19. TCAs
    NaHCO3 (plasma alkalinization)
  20. Heparin
    Protamine
  21. Warfarin
    • Vitamin K
    • Fresh frozen plasma
  22. tPA, streptokinase, urokinase
    Aminocaproic acid
  23. Theophylline
    β-blocker
  24. Drug reactions
    Cardiovascular
    • Coronary vasospasm: cocaine, sumatriptan, ergot alkaloid
    • Cutaneous flushing: Vancomycin, Adenosine, Niacin, Ca2+ channel blockers (VANC)
    • Dilated cardiomyopathy: Doxorubicin (Adriamycin), daunorubicin
    • Torsades de pointes: Class III (sotalol) and class IA (quinidine) antiarrhythmics
  25. Drug reactions
    Hematologic
    • Agranulocytosis: Clozapine, Carbamazepine, Colchicine, Propylthiouracil, Methimazole, Dapsone
    • **Agranulocytosis Could Certainly Cause Pretty Major Damage
    • Aplastic anemia: Chloramphenicol, benzen, NSAIDs, propylthiouracil, methimazole
    • Direct Coombs-positive hemolytic anemia: Methyldopa, penicillin
    • Gray baby syndrome: Chloramphenicol
    • Hemolysis in G6PD-deficient patients: Isoniazid (INH), Sulfonamides, Primaquine, Aspirin, Ibuprofen, Nitrofurantoin
    • **Hemolysis IS PAIN
    • Megaloblastic anemia: Phenytoin, Methotrexate, Sulfa drugs
    • **Having a blast with PMS
    • Thrombotic complications: OCPs (e.g., estrogens)
  26. Drug reactions
    Respiratory
    • Cough: ACE inhibitors
    • Pulmonary fibrosis: BLeomycin, Amiodarone, Busulfan
    • *It's hard to BLAB when you have pulmonary fibrosis
  27. Drug reactions
    GI
    • Acute cholestatic hepatitis, jaundice: Erythromycin
    • Focal to massive hepatic necrosis: Halothane, Amanita phalloidesValproic acid, Acetaminophen
    • **Liver "HAVAc"
    • Hepatitis: INH
    • Pseudomembranous colitis: Clindamycin, ampicillin
  28. Drug reactions
    Reproductive/endocrine
    • Adrenocortical insufficiency: Glucocorticoid withdrawal (HPA suppression)
    • Gynecomastia: Spironolactone, Digitalis, Cimetidine, chronic Alcohol use, estrogens, Ketoconazole
    • **Some Drugs Create Awkward Knockers
    • Hot flashes: Tamoxifen, clomiphene
    • Hyperglycemia: Niacin, tacrolimus, protease inhibitors, HCTZ, corticosteroids
    • Hypothyroidism: Lithium, amiodarone, sulfonamides
  29. Drug reactions
    Musculoskeletal/connective tissue
    • Fat redistribution: Glucocorticoids, protease inhibitors
    • Gingival hyperplasia: Phenytoin, verapamil
    • Gout: Furosemide, thiazides, niacin, cyclosporine
    • Myopathies: Fibrates, Niacin, Colchicine, Hydroxychloroquine, Interferon-α, Penicillamine, Statins, Glucocorticoids
    • **Fish N CHIPS Give you myopathies
    • Osteoporosis: corticosteroids, heparin
    • Photosensitivity: sulfonamides, Amiodarone, Tetracycline
    • **SAT for a photo
    • Rash (Stevens-Johnson syndrome): Penicillin, Ethosuximide, Carbamazepine, Sulfa drugs, Lamotrigine, Allopurinol, Phenytoin, Phenobarbital
    • **Bad rash after a PEC SLAPP
    • SLE-like syndrome: Hydralazine, INH, Procainamide, Phenytoin
    • **It's not HIPP to have lupus
    • Teeth (kids): Tetracyclines
    • Tendonitis, tendon rupture, and cartilage damage: Fluoroquinolones
  30. Drug reactions
    Renal/GU
    • Diabetes insibipidus: Lithium, demeclocycline
    • Fanconi's syndrome: Expired tetracycline
    • Hemorrhagic cystitis: Cyclophosphamide, ifosfamide (prevented by coadministering with mesna)
    • Interstitial nephritis: Methicillin, NSAIDs, furosemide
    • SIADH: Carbamazepine, cyclophosphamide
  31. Drug reactions
    Neurologic
    • Cinchonism: Quinidine, quinine
    • Parkinson-like syndrome: Antipsychotics, reserpine, metoclopramide
    • Seizures: Isoniazid, Bupropion, Imipenem/cilastatin, Tramadol, Enflurane, Metoclopramide
    • **with seizures, I BITE My tongue
    • Tardive dyskinesia: Antipsychotics
  32. Drug interactions
    Multiorgan
    • Antimuscarinic: Atropine, TCAs, H1-blockers, neuroleptics
    • Disulfiram-like reaction: Metronidazole, certain cephalosporins, procarbazine, 1st generation sulfonylureas
    • Nephrotoxicity/ototoxicity: aminoglycosides, vancomycin, loop diuretics, cisplatin
  33. P-450 interactions
    inducers
    • Modafinil
    • Barbiturates
    • St. John's wort
    • Phenytoin
    • Rifampin
    • Griseofulvin
    • Carbamazepine
    • Chronic alcohol use
    • **Momma Barb Steals Phen-phen and Refuses Greasy Carbs Chronically
  34. P-450 interactions
    inhibitors
    • Macrolides
    • Amiodarone
    • Grapefruit juice
    • Isoniazid
    • Cimetidine
    • Ritonavir
    • Acute alcohol abuse
    • Ciprofloxacin
    • Ketoconazole
    • Sulfonamides
    • Gemfibrozil
    • Quinidine
    • MAGIC RACKS in GQ
  35. Sulfa drugs
    • Probenecid
    • Furosemide
    • Acetazolamide
    • Celecoxib
    • Thiazides
    • Sulfonamide antibiotics
    • Sulfasalazine
    • Sulfonylureas
    • **Popular FACTSSS
    • Patients with sulfa allergies may develop fever, urinary tract infections, pruritic rash, Stevens-Johnson syndrome, hemolytic anemia, thrombocytopenia, agranulocytosis, and urticaria (hives)
    • Symptoms range from mild to life-threatening

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