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Rx Adverse Effects
Pharmacology
| Question | Answer |
|---|---|
| CI in pregnancy | ARBs, ACEI, radio I for thyroid, nitroprusside (for HTN emergency) |
| ACEI AEs | Cough; Angioedema; Hyperkalemia; Rash; CI in PG; use cautiously in renal artery stenosis (RAS) |
| ARBs AEs | Hyperkalemia; Angioedema (rare, 10% cross-over); CI in PG; cautious use in RAS; check kidney function |
| Diuretics: AEs | Hypokalemia; Volume depletion; Gout; increased insulin resistance; hyponatremia; increased chol levels |
| DHP CCBs: AEs | Ankle edema; Flushing; HA; Increased HR |
| Diltiazem/Verapamil: AEs | Bradycardia; Constipation |
| If elevated uric acid: | cannot use diuretic |
| PPI AE | Diarrhea, nausea, abdominal pain, HA; poss C diff; hip fx risk if used LT |
| retrobulbar neuritis is potential adverse effect of: | ethambutol |
| sulfonamides cause hemolytic rxn in pts with: | G6PD def |
| cataracts can be 2/2: | corticosteroids, lovastatin |
| ototoxic: | AGs (streptomycin, neomycin), chloramphenicol |
| Meds that increase glucose | diuretics, estrogens, beta blockers, corticosteroids |
| Meds that decrease glucose: | acetaminophen, alcohol, propanolol, anabolic steroids |
| Contraindications to continuing certain oral DM agents | Worsened hepatic fn; advanced CHF |
| Oral DM agents: If creatinine >1.5 (M) or 1.4 (F): | stop metformin |
| Oral DM agents: Contrast dye load / cardiac catheterization: | hold metformin |
| Drugs that cause Hyperprolactinemia | Anti-DA (Anti-psychotics; Reglan); TCAs; SSRI; Verapamil; Alcohol, esp Beer; Heroin; Cocaine |
| levothyroxine AE | Osteoporosis; Inc cardiac contractility; Inc risk of A-fib; Allergic rxn dye in tablets |
| PTU & Tapazole AE: | Benign rash; potl agranulocytosis; hepatotoxicity |
| hyperthyroidism (thyrotoxicosis) may be 2/2: | amiodarone: type I (xs thy hor; may cause ophthalmopathy) or type II (destructive thyroiditis) |
| in hypoPTH, avoid: | phenothiazines & furosemide |
| TZDs CI in: | CHF (esp NYHA 3 or 4) or liver dz |
| may cause osteomalacia | PHENYTOIN; tegretol, valproate, barbiturates |
| statins AE | myositis (esp w/niacin or fibrate) |
| fibrates AE | myositis, cholelithiasis, hepatitis |
| nephrotoxic (avoid in nephrotic syndrome): | NSAIDs, aminoglycosides |
| PDE-5 (for ED) AE | HA, flushing, dyspepsia, rhinitis, visual disturbance |
| Estrogens and progestins Black Box warning: | should not be used for the prevention of cardiovascular disease |
| Progestin CI | Hypersensitivity to progestins; Active thrombophlebitis, thromboembolic disorders or cerebral hemorrhage; Impaired liver function or dz; BrCa or genital ca; Undiagnosed vaginal bleeding |
| Most common HRT AE | breast tenderness, HA, irregular bleeding |
| Prometrium is contraindicated in anyone with an allergy to: | Peanuts |
| When HRT is tapered what is the most common withdrawal vasomotor symptom | Hot flashes |
| Estrogens and progestins should not be used for the prevention of: | Cardiovascular dz |
| What are the absolute contraindications for estrogen | Breast cancer, estrogen-dependent neoplasia, undiagnosed abnormal genital bleeding, thromboembolic disease, pregnancy, porphyria, active liver disease |
| Risks associated with HRT | Breast cancer, endometrial cancer, thromboembolic events, increased risk of dementia |
| Unopposed estrogen can lead to | Endometrial cancer |
| Increased risk of ovarian cysts with: | IUD (esp Mirena) |
| Risks of tx of cervical abnormalities | Antibodies to sperm; Cervical Stenosis; Incompetent Cervix; Missing a significant lesion |
| endomet bx CI | PG; infxn; diathesis, cerv stenosis or ca (refer) |
| endomet bx: most common AE: | Cramping |
| Acyclovir is Category: | C |
| Pre-eclampsia tx: Loss of patellar reflexes is observed at magnesium levels of __mg/dL or higher | 10 |
| Pre-eclampsia tx: Respiratory paralysis may occur at magnesium levels of __ or higher | 15 |
| What are the risks of parenteral pain management in labor (fentanyl PCA) | Maternal risk for aspiration and respiratory depression, fetal risk for respiratory depression (common need for Narcan at delivery) |
| What are the contraindications of labor induction | Prior classical c-section, active genital herpes, placenta or vasa previa, umbilical cord prolapse, transverse lie |
| tPA absolute CI (<3 hr) | CT: bleed/comp (AVM); BP >185 or >110; recent stroke/ICH/ IC surg; bleed elsewhere; anticoag use; plt <100K; h/o seizure preceding stroke |
| tPA CI (3-4.5 hr) | >85 yo; NIH-SS >25; h/o both stroke/DM |
| Carbamazepine fx on PHT | decrease PHT conc |
| Valpro DI | Most sig: on CBZ & PB |
| Valpro AE | Hepatotox (watch out in kids); pancreatitis; N/V; wt; ataxia/tremor; alopecia; rash; plt dysfn; teratogen |
| AED to adj dose for renal: | Gabapentin, pregabalin, zonisamide, Keppra, Sabril |
| Hepatic dosing considerations: | zonisamide, Valp |
| AED & PG | New gen drugs: most Class C; Class D = PHT, CBZ; Valpro is worst |
| BCNU AE | fatigue, low blood counts, pulmo fibrosis |
| Brain tumor: CTx DI: | Dex (closing BBB); phenobarbital (dec nitrosourea efficacy); anti-epileptics (affect CTx metabm) |
| Drug causes of physiologic tremor | Amphetamines, theophylline, lithium, valproate |
| Beta blockers are CI for essential tremor in: | COPD; asthma; DM; bradycardia; AV conduction probs |
| Lithium: caution | Renal dz, diuretic use, CV disease, PG, DI; life-threatening AE’s w/ lithium intoxication |
| Beta blockers: CI/cautions: | Asthma, decompensated HF (?), PVD (non-selective agents), IDDM (may mask signs of hypoglycemia) |
| DA agonists: ergot derivatives: AE | retroperitoneal, pleural & pericardial fibrosis; Cardiac valve fibrosis |
| DA agonists: AE | Anticholinergic s/s; ortho hypoTN; syncope; Dyskinesias; impulse control disorders (compulsive gambling/binge eating) |
| DA: DI | CYP3A4 inhib (protease inhibs, antifungal, macrolides); Serotonin modulators (serotonin syndrome) |
| Tolcapone (COMT inhib) monitoring | LFTs baseline, then every 2-4 weeks for 6 months, then periodically |
| MG: drugs to avoid | NM blockers; quinine; macrolides, FQ; botox; beta/CCB; IV contrast |
| Amantadine AE | ankle edema; livedo reticularis; convulsion (at higher doses) |
| Drugs that exacerbate psoriasis | Lithium; Beta-blockers; Antimalarials; Systemic steroids |
| Phenytoin AE | lethargy, fatigue, drowsiness |
| Levodopa AE | N/V; postural hypotension; cardiac arrhythmia; mental disturbance; dyskinesias (TD; on-off fx or wearing-off fx: shorten interval); psychomotor excitation (agitation, hypomanic) |
| HTN tx CI in PG | ACEI & ARB |
| HTN tx CI | BB: CI in asthma; thiazides: gout or hyponatremia; AA or K-sparing diuretics: poss hyperkalemia |
| flu vax CI in: | egg allergy; acute febrile illness; low plts |
| Nonspecific NSAIDs: Side effects: | HTN, GI, altered renal function, MI (ibuprofen and diclofenac) |
| Joint & Soft Tissue Injections/ Aspirations: CI | Intra-tendinous injections (future rupture likely); drug allergies; steroids are immunosuppressive |
| Joint & Soft Tissue Injections/ Aspirations: Side effects | Tendon rupture, Infection, Hypopigmentation, Fat atrophy, Steroid flare; caution in diabetics |
| Beta blockers AEs | Hypotension; Decrease HR, heart block; May worsen HF symptoms; CNS (fatigue, malaise, depression); Bronchospasm (use ß1 selective agents) |
| Fibrinolytics: absolute CI | Prior hemorrhagic CVA; any cerebrovascular events < 1 year; active internal bleeding; Known intracranial neoplasm; suspected aortic dissection |
| Fibrinolytics: relative CI | BP > 180/110; Use of anticoags w/ INR > 2; Noncompressible vascular punctures; Prolonged CPR (> 10 minutes); PG or Menstruation; Trauma < 2-4 weeks prior; Major surgery < 3 weeks prior |
| aminoglycoside toxicity: | ototoxicity; renal tox (also excreted renally) |
| HCV tx: ribavirin: CI in: | CI in advanced liver dz, psych dz, poss renal, cardiac, DM retinopathy |
Created by:
Abarnard
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