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Adverse Effects

Adverse Effects Review for NAPLEX/CPJE

Hydralazine Lupus-like Syndrome
Clonidine DOC for HTN in pt on dialysis
Meperidine Normeperidine is an active metabolite that builds up during renal dysfunction-causes seizures
Carbapenems (imipenim) Seizures
carbamazepine aplastic anemia agranulocytosis hepatotoxicity Stevens Johnson Syndrome
Valproic Acid hepatotoxicity teratogenicity pancreatitis
topiramate oligohydrosis glaucoma weight loss Kidney stones
zonisamide oligohydrosis stevens johnson syndrome Kidney stones
lamotrigine toxic epidermal necrosis (esp with VA)
vigabatrin permanent vision loss
methyldopa DOC for HTN in pregnancy
Ribavirin Hemolytic Anemia teratogenicity
exenatide (byetta)and liraglutide (victoza) pancreatitis, dose limiting SE is nausea
Pancreatitis byetta, victoza, valproic acid stavudine, didanosine
oligohydrosis topiramate, zonisamide
hepatotoxicity valproic acid, carbamazepine, NNRTIs
Nevirapine (Viramune) NNRTI-induces own metabolism
Protease Inhibitors Fat maldistribution, hypertriglyceridemia, hyperglycemia, hyperlipidemia, nephrolithiasis
NRTIs lactic acidosis and severe hepatomegaly
"D" NRTIs Didanosine, Zalcitabine, Stavudine (cause pacreatitis, peripheral neuropathy, and lactic acidosis)
Lamivudine (Epivir) Bone Marrow Suppression NRTI
Zidovudine (Retrovir) BMS (neutropenia, and anemia)NRTI
Abacavir (Ziagen) patients must be tested for HLA-B 5701 to determine risk for hypersensitivity. ANY rxns (rash, cough, N/V, fatigue)- D/C!!!!!!
What is in Combivir? Zidovudine and Lamivudine (both NRTIs)
What is in Trizivir? Zidovudine, Lamivudine, and Abavavir (All NRTIs)
HIV and pregnancy avoid efavirenz, avoid combining stavudine and didanosine, and consider starting tx after the 1st trimaster
omalizumab (Xolair) Anti IgE therapy indicated for severe persistent asthma patients who have frequent trips to the ER. SQ q 2-4 weeks. Most serious ADRs are malignancies and anaphylaxis. Injection site rxn 45% of the time because solution is viscous.
What should be inhaled swiftly? DPIs- Pulmicort (budesonide) Flovent Diskus, Advair Diskus, Asmanex, Foradil (Formoterol) and Serevent (salmeterol)
Use bronchodilator and ICS. Which should you use first? Use the bronchodilator first, wait several minutes then use the ICS-this will allow better penetration of the steroid
Therapeutic goal of theophylline? 5-15mcg/ml (<15= no toxicity, >20 60% toxic and >30 80% toxic) SMOKING induces liver enzymes and will cause theophylline levels to decrease!!
Sx of methylxanthine toxicity N/V, seizures, hyperactivity, ventricular arrhythmias (severe toxicity is not necessarily preceded by milder sx)
Zileuton (Zyflo) hepatotoxicity (leukotriene modifier)
Amantadine (Symmetrel) livedo reticularis (red mottling of the skin-affects 80% of patients)Increase dopaminergic transmission by unknown mechanism
Selegiline Selective MAO-B inhibitor at doses <10mg/day-can decrease levodopa dose by 10-30% (after third dose)
Pramipexole (Mirapex)and Ropinirole (Requip) Falling asleep during ADLs
Apomorphine (Apokyn) SC only (IV admin can cause pulmonary embolism) Will cause emesis-must pretreat with Trimethobenzamide or Domperidone-Start 3 days prior to use- NOT HT3 ANT-hypotension and loss of consciousness
Fluorouracil (Adrucil) GI and diarrhea
Chemotherapy drugs with low risk of BMS Asparaginase (Elspar), Vincristine (Oncovin), bleomycin and busulfan
Bleomycin (Blenoxane) and busulfan (Busulfex) Pulmonary fibrosis, SOB; hyperpigmentation of skin
Cyclophosphamide (Cytoxan) Metabolized to acrolein causes hemorrhagic cystitis at doses >1g/m2 ; give mesna at doses >1g/m2
Cytarabine (ara-C) Keratitis, conjunctivitis; severe CNS toxicity in doses >1g/m2
Cisplatin (Platinol) Ototoxicity, and CNS toxicity; acute and related emesis; nephrotoxicity (les with carbo; give IV fluids or amifostine)
Daunorubicin (Cerubidine), doxorubicin (Adriamycin), epirubicin (Ellence), idarubicin (Idamycin) Cardiac toxicity if cumulative doses >400mglm2 for daun/dox but less for idarubicin and more for epirubicin; extravasation risk
Dexrazoxane Used to Prevent cardiac toxicity during doxorubicin treatment or treat extravasation
Dactinomycin (Cosmegen) Extravasation risk
Ixabepilone (Ixempra) Peripheral neuropathy
Ifosfamide (Ifex) Metabolized to acrolein causing hemorrhaguc cystitis; give mesna
Irinotecan (Camptosar; CPT11) Severe acute and delayed diarrhea
Methotrexate Mucositis; liver toxicity/fibrosis; leucovorin can be used for toxicity
Mechlorethamine (Mustargen) Extravasation risk
Oxaliplatin (Eloxatin) Oral pharyngeal paraesthia; peripheral neuropathy; avoid exposure to cold stimulus to avoid exacerbation
Streptozocin (Zanosar) Insulin dependent diabetes (historically used to treat pancreatic cancer)
Docetaxel (Taxotere), Paclitaxel (Taxol) Peripheral neuropathy (mainly paclitaxel); edema/fluid retention (mainly docetaxel)
Vinblastine (velban), vincristine (oncovin), vinorelbine (navelbine) Peripheral neuropathy (vincristine>>vinblastine); extravasation risk; vincristine has less risk of BMS
Contraindications for Lithium renal disease, severe cardiovascular disease, hx of leukemia, first trimaster of pregnancy
Monitoring parameters for Lithium Thyroid (Lithium may cause hypothyroidism), SCr and BUN, CBC w/ diff (may cause leukocytosis or reactivate leukemia), electrolytes, ECG (may cause flattened or inverted T waves), urinalysis (may decrease specific gravity)
Lithium steady state levels 4-5 days (half life=24h) maintenance: 0.8-1 mEq/L (draw the level weekly for 4 weeks and then monthly for 3 months
Lithium toxicity 1.5-2.0mEq/L N/V, diarrhea, muscle weakness, fatigue, fine hand tremor, difficulty w/conc &memory 2-2.5mEq/L ataxia,lethargy,nyastgmus, worsening confusion, severe GI upset, coarse tremors, increase DTR >3.0mEq/L coma,seizures, respir complic/death
Pernicious anemia- What deficiency causes this? B12 (cyanocobalamin)-lack of intrinsic factor in stomach- vegetables have no B12-VEGANS HAVE 12 PROBLEMS-animal derived foods are rich in B12
Dose of cyanocobalamin to treat prenicious anemia: 1000 mcg IM qd x 7 days then 1mg weekly for 1-2 months (until H/H return to normal) then once monthly
Thiamine deficiencys (B1) leads to beriberi and Wernicke's encephalopathy
Niacin deficiency Pellagra- rash sore mouth, diarrhea, mental deterioration
Vitamin D deficiency rickets
Vitamin C deficiency Scurvy-red spots on skin, gums hemorrhage, teeth fall out, hemorrhaging occurs in cells through out the body
Daily need for fluid and TBW 30-35ml/kg; Females (60%) Males (50%)
Chromium (what does it do) essential for incorporation of glucose into the cells and the intracellular metabolism of glucose-refractory hyperglycemia (check for chromium deficiency)
Non-isotonic solutions hurt the most when they are injected how? SQ-in contact the longest and close to nerves
HEPA filters remove 99.97% of air particles 0.3 microns or larger
Microdrip set 60 drops/min (normal drip set is 15-20 drops/min)
Drugs that must be protected to light during administration amphotericin, BiCNU (carmustine), furosemide, nitroprusside, vinblastin (velban), vincristine (oncovin)
Reopro (Abciximab) Antiplatelet agent used for PCI
Benzyl Alcohol as solvent in injectables causes a fatal syndrome "gasping syndrome" in premature infants
3 drugs that are used in propylene glycol for injection phenytoin, valium, and digoxin
SE of propylene gylcol for injection hypotension, CV collapse, CNS depression (will cause gel formation with other solvents)
Only po DMARD? Arava (leflunomide)
Leflunomide (arava) hepatotoxicity, TEN/ SJS, immunosupp, CI in women of child bearing age, use cholestyramine for fasting elimination (8g tid) otherwise stays in body for up to 2 years
hydroxychloroquine (Plaquenil) retinopathy- used as antimalaria and RA
entanercept (Enbrel) 50mg SQ weekly- Anti-TNF- watch for infections and neutropenia
Inlfiximab (Remicade) IV q 2-8 weeks (anti TNF)-watch for TB
Adalimab (Humira) SC qoweek (anti TNF)- watch for TB
rifmapin used to tx TB with INH-May impart a red-orange color to urine, feces, saliva, sputum, sweat, skin & teeth - will permanently discolor soft contact lenses. hepatotoxicity
ethambutol (Myambutol) Never use alone-used with other TB drugs to prevent the development of other resistant strains (decreases visual activity), MAY PRECIPITATE GOUT
TPN in vein should next exceed what percent of glucose? 10-12.5% peripheral 20-40% central
Amino Acid requirement 1-1.5g/kg/d -AA are 16% N
Calcium Phosphate incompatibility ALWAYS ADD Ca LAST! Can result in massive pulmonary emboli and death!
Pulmonary disease and TPN avoid excess carbs-carbs cause higher CO2 production
Felbamate (Felbatol) Aplastic anemia and hepatic failure
fenofibrates gall stones, rhabdo, absolute CI in severe renal and hepatic dx
Niacin hyperuricemia, decrease insulin sensitivity, rhabdo
long term effects of heparin hyperkalemia, alopecia, and osteoporosis
Black box warning for LMWHs Spinal/epidural hematoma formation
Created by: lukaszewiczj
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