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Rx Adverse Effects

Pharmacology

QuestionAnswer
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