Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
43 Cards in this Set
- Front
- Back
|
Drug-induced Lupus (7)
|
Procainamide
Hydralazine Methyldopa Isoniazid Chlorpromazine Quinidine Minocycline |
|
|
% Cases DIL
|
10
|
|
|
Clues DILupus
|
1. Exposure to drug
2. No history idiopathic SLE 3. Development of ANA 4. 1+ clinical features 5. Rapid improvement with D/C |
|
|
Labs for DILpus
|
antibodies against ssDNA NOT dsDNA
|
|
|
Drug-induced Liver Hit List (7)
|
APAP
Alcohol ASA/NSAIDs PCN antibiotics Isoniazid HART (NNRTIs) Anti-epileptics |
|
|
Hepatocellular injury pattern
|
high elevations in serum
aminotransferasses (>5 ULN) |
|
|
Drugs hepatocellular injury patern
|
acarbose
allopurinol fluoxetine losartan |
|
|
Centrolobular necrosis pattern
|
dose-related
predictable rxns mild: Asx elevations in serum aminotransferases severe: N/V, upper abdominal pain, jaundice |
|
|
Centrolobular necrosis drugs
|
APAP
ASA VPA |
|
|
NASH pattern
|
accumulation of fatty acids in hepatocytes
|
|
|
NASH drugs
|
alcohol
Tetracycline VPA |
|
|
Phospholipidosis pattern
|
accumulation of phospholipids instead of FA
|
|
|
Phospholipidosis drugs
|
amiodarone
|
|
|
Hepatocellular necrosis pattern
|
drugs make metabolites that bind proteins to make haptens which induce innate immune response
|
|
|
Heptocellular necrosis drugs
|
isoniazid, ketoconazole
|
|
|
toxic cirrhosis pattern
|
scarring effects of hepatitis in liver
|
|
|
toxic cirrhosis drugs
|
methotrexae, vit A
|
|
|
cholestatic injury pattern
|
involves bile canicuar system
prevent movement of bile through canalicular system -->accumulation of toxic bile acids + excretion products |
|
|
acute cholestasis
|
cholestasis with/without hepatitis and cholestasis with bile duct injury
|
|
|
chronic cholestasis
|
vanishing bile duct syndrome, sclerosing cholangitis, cholelithiasis
|
|
|
most common drug induced
|
cholestasis with hepatitis
|
|
|
drugs cholestatic injury
|
chlorpromazine, phenothiazines
antibiotics (augmentin, bactrim) CBZ sulfonamides/su, captopril |
|
|
mixed hepatocellular and cholestatic injury pattern
|
focal lesions in hepatic venules, sinusoids, portal veins
|
|
|
mixed drugs
|
chemo, sex hormones, azathioprine, tamoxifen, danazol
|
|
|
drug induced aki pre-renal
|
hypoperfusion
diuretics: dec. IV volume ACE/ARB: dec. efferent arteriole resistance NSAIDs: inhibition renal PG production/afferent vasodilation increased risk with ckd volume depletion |
|
|
AIN
|
nsaids, antibiotics, beta-latams
renal interstitum inflamed and edematous monocytes, eos, macs |
|
|
ATN
|
renal ischemia
endogenous toxins: myo, hemo, uric acid exogenous toxins: contrast dyes, Aminoglycosides |
|
|
post-renal
|
anticholingers: prevent bladder emptying
|
|
|
drug induced pancreatisis
|
diagnosis of exclusion:
5-ASA, sulfasalazine Asparaginase Azathioprine, mercaptopurine Corticosteroids, estrogens Cytarabine Didanosine Enalapril, furosemide Opioids Pentamidine, SMP-TMX, tetracycline Valproic acid/salts Class 1 definite association |
|
|
High risk patients
|
(multiple meds, immunomodulating meds, geriatric, HIV-positive, cancer)
*Direct toxic effects, hypersensitivity, drug-induced hypertriglyceridemia, alterations of cellular function in pancreas/duct |
|
|
Pancreatitis Labs
|
high BG, low albumin, elevated LFTs, high serum TG, serum amylase rise within 4-8 hours and peaks at 24 hours returns 8-14 days
lipase: more specific: concentrations elevated and parallel elevations in amylase but remain elevated with inflammation and return to normal once inflammation resolves |
|
|
drug-induced QTC prolongation
|
Antiarrhythmics: amiodarone, sotalol, quinidine, procainamide, dofetilide, ibutilide
Antibiotics: erythromycin, clarithromycin, levofloxacin, ciprofloxacin, moxifloxacin, ketoconazole, itraconazole Anti-psychotic agents: haloperidol, thioridazine, ziprasidone, quetiapine, droperidol Others: cisapride, sumatriptan, zolmitriptan, arsenic, methadone |
|
|
drug-induced metabolic acidosis: inc. H+ load
|
metformin, antiretroviral therapy (didanosine, stavudine), propfol, PG (lorazepam), statins
|
|
|
Ketoacidosis (met acidosis)
|
alcohol (ethanol)
AP agents |
|
|
Ingestion of subs (met acidosis)
|
methanol, EGlycol, paraldehyde, salicylates, sevelamer
|
|
|
loss of bicarb (met acidosis)
|
carbonic anyhydrase inhibitors
ifosfamide |
|
|
drug-induced high TG
|
Protease inhibitors
Beta-blockers (High dose) Thiazides (High dose) Bile acid sequestrants Oral estrogen hormone replacement therapy OCP with high estrogen content Tamoxifen Glucocorticoids Isotrentinoin Atypical antipsychotics Excessive alcohol intake Propofol |
|
|
Thrombocytopenia
|
• Hapten-induced: penicillin/penicillin derivatives
o Drug forms covalent link to membrane GP and acts as hapten to induce drug-dependent antibody response • Drug-dependent antibody: quinidine, NSAIDs, antibiotics, sedatives, anticonvulsants o Drugs binds membrane GP and forms epitope for which antigen is specific o Antibiotics: isoniazid, rifampin, vancomycin, sulfa drugs, fluconazole, linezolid o CV: digoxin, amiodarone, captopril, HCTZ, atorvastatin, clonidine o GI: H2-antagonists o Neuro: haloperidol, CBZ, methyldopa, phenytoin o Analgesic: NSAID, APAP, sulindac, diclofenac • GP2b/3a inhibitors: tirofiban, eptifibatide • Drug-specific antibody: abciximab • Drug-induced autoantibody: gold salts, procainamide • Immune complex: heparin |
|
|
Psoriasis
|
lithium, propranolol
|
|
|
Leukocytosis
|
steroids, lithium, ESA
|
|
|
Hypoglycemia
|
• Alcohol: dec. GNG
• Salicylates: inc. insulin sensitivity • ACE/ARBs: inc. insulin sensitivity • FQ: inc. insulin release • BB: lipophilic: dec. glycogenolysis; block adrenergic Sx of hypoglycemia • Pentamidine: release of insulin from damaged beta cells • Hydroxychloroquine • Fibric acid derivatives • Disopyramide |
|
|
Hyperglycemia
|
• CS: inc. insulin resistance, inc. hepatic glucose output
• BB: lipophilic:inc. insulin resistance, dec. muscle blood flow • Decongestants: inc. hepatic glucose output (alpha-adrenergic effect) • Thaizide: inc. insulin resistance • FQ: ? • Antipsychotics • Protease inhibitors • Calcineurin inhibitors • Rapamycins • Statins, niacin • Pentamidine |
|
|
CHF Exacerbation
|
• Meds/diet noncompliance
• Negative inotropic effects o Class 1 and 3 o BB o CCB o Itraconazole • Cardiotoxic o Chemo o Ethanol o Cocacine, amphetamines • Na/Water Retention o NSAIDs o COX2 o TZDs o GC o Androgens, estrogens o Salicylates o Sodium-containing drugs: antibiotics, anything given in NaCl • Cilostazol |
