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147 Cards in this Set
- Front
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What is the toxicity of Vancomycin?
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"*There is NOT toxicity
Nephrotoxic Ototoxic Thrombophlebitis |
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What are the Ototoxicity-causing drugs?
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"AMG's
Loops (Furosemide) Vancomycin Quinidine Chloroquine |
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What is the toxicity of AMG's?
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"*There is NNO toxicity
Neurotoxic (teratogenic) Nephrotoxic Ototoxic |
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What is the toxicity of Tetracyclines?
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"Discoloration of teeth (children)
Abnormal bone growth (children) Photosensitivity Drug-induced Hepatitis Fanconi Syndrome (old Tetracyclines) |
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What are the SE's of Macrolides?
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"Acute Cholestatic Hepatitis
Eosinophilia |
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What is the toxicity of Chloramphenicol?
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"Dose-dependent Anemia
Dose-independent Aplastic anemia Grey Baby Syndrome (premature infants) |
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What is the toxicity of Clindamycin?
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Pseudomembranous Colitis
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What is the tx for Pseudomembranous Colitis secondary to C. Difficile?
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"Vancomycin
Metronidazole |
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What is the toxicity of Sulfonamides
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"Displaces drugs from albumin (e.g. Warfarin)
Hemolytic Anemia (G6PD Def Pt's) Hypersensitivity Kernicteris (kids) Tubulointerstitial Nephritis Photosensitivity |
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What is the toxicity of Trimethoprim?
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Megaloblastic Anemia
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What is the toxicity of Quinolones?
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"Tendonitis (adults)
Cartilage rupture (kids) |
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What is an additional SE of Moxifloxicin?
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Screws with K+ leading to Torsades de Pointes (aka Prolonged QT Syndrome)
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What is the toxicity of Metronidazole?
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"Disulfram-like reaction with alcohol
Dysguzia Drug-induced pancreatitis Teratogenic |
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What is the toxicity of Polymyxins?
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"ATN (acute tubular necrosis)
Neurotoxicity |
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What is the toxicity of INH?
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"Drug-induced SLE
Neurotoxicity (that's why we give concomittant Vit B6) Hepatotoxicity Hemolytic anemia (G6PD Pt's) |
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What is the toxicity of Ethambutol?
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"Optic Neuritis
Central Scotoma |
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What is the toxicity of Dapsone?
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"*HAM
Hemolytic Anemia Agranulocytosis Methemoglobinemia |
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What are the drugs that cause Agranulocytosis?
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"Clozapine
Colchicine Carbamazepine PTU Dapsone Ticlopidine Methimazole |
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What is/are the SE(s) of Amphotericin B?
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"Fever/Chills
Hypotension Phlebitis Arrhythmias Nephrotoxicity |
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What is/are the SE(s) of Fluconazole?
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Torsades de Pointe (aka Prolonged QT Syndrome)
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What is/are the SE(s) of Flucytosine?
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Bone marrow suppression
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What is/are the SE(s) of Griseofulvin?
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Increased metabolism of Warfarin
Teratogenic Carcinogenic |
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What is/are the SE(s) of Amantidine?
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"Ataxia
Dizziness Slurred speech (SE's due to skrewed up cerebellum) |
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What is/are the SE(s) of Foscarnet?
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Nephrotoxicity
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What is/are the SE(s) of Indinavir?
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"Crystal-induced Nephropathy
Thrombocytopenia |
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What is/are the SE(s) of all of the NRTI's (& 3-letter acronyms)?
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"All NRTI's: Lactic acidosis
Ziduvidine (AZT/ZDV) --Aplastic anemia --Megaloblastic anemia Didanosine (DDI) --Drug-induced pancreatitis Zalcytobine (DDC): --SJS --Peripheral neuropathy Lamuvidine (3TC) --only lactic acidosis Stavudine (D4T) --Peripheral neuropathy Abacavir (ABC) --Hypersensitivity syndrome |
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What is/are the SE(s) of Efuvarin?
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SJS
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What is/are the SE(s) of Navirapine?
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"SJS
Hepatotoxicity |
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What is/are the SE(s) of Atropine?
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Hot as a Hare: Warm skin (dec'd sweat --> reflex vasodilation)
Dry as a Bone: Dry skin/eyes (dec'd sweat/dec'd lacrimation) Red as a Beet: Flushing (reflex vasodilation secondary to dec'd sweat) Blind as a Bat: Mydriasis/Cycloplegia (dec'd PS's) Mad as a Hatter: Confusion/Disorientation (CNS effects on M4/M5 rec's) |
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What is/are the SE(s) of Phentolamine?
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"Orthostatic Hypotension
Reflex Tachycardia |
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What is/are the SE(s) of Prazosin?
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"1st-dose Orthostatic Hypotension
Priapism |
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What is/are the SE(s) of Pindalol?
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"Impotence
Impotence Exacerbates asthma Masks hypoglycemia in DM Cardiovascular efffects (bradycardia, AV block, CHF) CNS effects (sedation, sleep alteration) |
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What is/are the SE(s) of L-Dopa?
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"Arrythmia
Dyskinesia |
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When & Why is Sumatriptan contraindicated?
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"Due to risk of vasospasm, Sumatriptan is contraindicated in:
Pregnancy (must order pregnacy test first) Praziquental angina CAD |
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What is/are the SE(s) of Topiramate?
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"Mental dulling
Renal stones Wt loss |
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What is/are the SE(s) of Gabapentin?
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"Movement disorders
Nystagmus Wt loss |
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What is/are the SE(s) of Lamotrigine?
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SJS
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What is/are the SE(s) of Ethosuxamide?
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"SJS
SLE Urticaria = mild form of SJS |
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What is/are the SE(s) of Phenobarbital?
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"Sedation
Tolerance Dependence Induces P-450 |
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What is/are the SE(s) of Benzodiazepine?
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"Sedation
Tolerance Dependence |
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What are the SE's of Valproic Acid (one of the top 10 drugs tested on USMLE)?
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"Fetal Hepatotoxicity
Neural Tube Defects Drug-Induced Pancreatitis |
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What are the SE's of Phenytoin (one of the top 10 drugs tested on USMLE)?
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"*Indian men want a wife who is ""LIGHT-skinned AND MMPSS""
Lymphadenopathy Induces P450 Gingival Hyperplasia Hirsutism Teratogenic (Fetal Hydantoin Syndrome) Ataxia Nystagmus Diplopia Megaloblastic anemia Malignant Hyperthermia Peripheral Neuropathy SLE Sedation |
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What are the contraindications of Barbiturates?
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Porphyrias
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What is the tx for Benzodiazepine overdose?
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Flumazenil
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What can abrupt cessation of Olprazelam cause?
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Generalized seizures
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What is the tx for alcohol withdrawal?
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Chlordiazepoxide
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What is/are the SE(s) of Chlorpromazine?
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"EPS SE's
NMS |
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What are 3 features of Neuroleptic Malignant Syndrome?
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"Autonomic Instability
Hyperthermia Muscle Rigidity |
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What is the tx for Neuroleptic Malignant Syndrome?
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Dantrolene + DA Agonist
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What are 4 features of EPS and the timeline involved for each feature?
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"4 Hrs: Dystonia (sustained muscle contractions causing twisting and repetitive
movements or abnormal postures) 4 Days: Akinesia (inability to initiate movement due to difficulty selecting and/or activating the movement pathway) 4 Wks: Akathisia (unpleasant sensations of "inner" restlessness that manifests itself with an inability to sit still or remain motionless) 4 Mos: Tardive Dyskinesia (disorder resulting in involuntary, repetitive body movements having a slow or belated onset) |
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What is the tx for Acute Dystonia?
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"Diphenhydramine
Benztropine Trihexyphenidy |
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What is the toxicity of Thioridazine?
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Pigmented Retinopathy
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What is the toxicity of Fluphenazine?
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Hyperthermia due to disruption of the thermo-regulatory center
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What is/are the SE(s) of Clozapine?
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Agranulocytosis
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What is/are the SE(s) of Olanzapine?
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Weight gain
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What is/are the SE(s) of Quetiapine?
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Cataracts
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What is/are the SE(s) of Lithium?
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"*LMNOP
L = Lithium M = Muscle rigidity = tremors N = Nephrogenic Diabetes Insipidus O = HyOthyroidism P = Pregnancy = Ebstein's Anomaly or Total Anomalous Pulmonary Venous Return (TAPVR) P = Psoriasis Exacerbation (added day 9) |
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What is/are the SE(s) of Fluoxetine?
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Sexual retardation
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What is the c/u for Fluoxetine?
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Premature ejaculation
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What are the contraindications of Fluoxetine?
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Concomittant use with MAOI's will cause Serotonin Syndrome
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What is/are the SE(s) of Doxapine?
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"*The 4 C's
Confusion Cardiotoxicity Convulsion Coma |
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What are the contraindications of Fenalzine?
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Concomittant use with SSRI's or Meperidine
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DAY 6:
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What are the 2 rules of Anesthetics?
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"1) Solubility in BLOOD tells me:
a. Induction time b. Recovery time (directly related) 2) Solubility in LIPIDS tells me: a. Potency b. Minimum Alveolar Concentration (MAC) (inversely related) |
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If Halothane is highly soluble in lipids & therefore goes into tissues quickly, is the induction time fast or slow?
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Cannot be determined; LIPID solubility indicates Potency & MAC
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If Nitrous Oxide is poorly soluble in blood & therefore must go into tissues, is potency high or low?
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Cannot be determined; BLOOD solubility indicates Induction & Recovery time
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What is/are the SE(s) of Halothane?
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Hepatotoxic
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What is/are the SE(s) of Enflurane?
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Convulsions (lowers seizure threshhold)
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What is/are the SE(s) of Methoxyflurane?
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Nephrotoxic
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What is/are the SE(s) of Sevoflurane?
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Malignant Hyperthermia
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What is the c/u for Midazolam? Why?
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Endoscopic anesthesia b/c it causes anterograde amnesia
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With anesthetics, is the goal to increase or decrease cerebral blood flow? Why?
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Decrease b/c we want them to sleep
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What are the significant CV features of Ketamine that makes it indicated in certain pt's?
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"Increased cerebral blood flow
Stimulates the heart --> increased cardiac output |
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What is the c/u for Ketamine? Why?
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Anesthesia for pt's in heart trouble b/c it increases cardiac output
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Neonate infant with a large VSD: in terms of anesthesia, what is your concern?
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You don't want to decrease the pt's cardiac output
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In general, what are the indications for Ketamine?
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"Anytime you don't want to decrease the pt's HR and/or cardiac output:
e.g. Diastolic Coronary Dysfunction (HR) e.g. Neonate requiring surgery (CO) |
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What is a unique feature of Ketamine that permits its use as an anesthetic?
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Dissociative amnesia (pt doesn't remember anything)
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What is a key feature and c/u of Propofol?
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"Rapid induction of anesthesia (& therefore rapid recovery, as well)
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If Propofol has RAPID induction/recovery times, what is its LIPID solubility (low or high)?
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"Cannot be determined; LIPID solubility can only be determined if Potency &/or MAC are known (Induction/Recovery times determine BLOOD solubility)
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What is the c/u for Succinylcholine?
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Depolarizing muscular blockade
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How is Phase I of depolaring muscular blockade reversed? Why?
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It CAN'T be reversed b/c post synaptic membranes are "stuck in" depolarization
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Why can't Phase II of depolarizing muscular blockade be reveresed? Explain.
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It CAN be reversed with the use of ChEI's!
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In regards to reversal of depolarizing muscular blockade, what is the difference between Phase I and Phase II?
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"Phase I is CAN'T be reversed: it is depolarized (only)
Phase II CAN be reveresed: it is repolarized, but "blocked" |
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What effects does increased ACh have on Phase I of depolarizing muscular blockade? Why?
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"It potentiates the blockade; The membrane potential is "stuck" in the "depolarized" state (positive membrane potential) and therefore additional action potentials are "blocked" --> If Neostigmine is given, ACh "knocks off" SCh b/c it has a higher receptor affinity; this prevents anything else from binding to the post-synaptic receptors and maintains the positive membrane potential for longer, thereby POTENTIATING the blockade
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What effects does increased ACh have on Phase I of depolarizing muscular blockade? Why?
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"The membrane potential is ""repolarized"" (negative membrane potential), however, SCh is ""sitting on"" the post-synaptic recpetors, thereby ""blocking"" any additonal action potentials; If Neostigmine is given, ACh ""knocks off"" SCh b/c it has a higher receptor affinity; this stimulates the post-synaptic receptors and an action potential ensues, thereby REVERSING the blockade
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What are the Non-Depolarizing muscular blockers?
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"Just be able to recognize:
"-accurines" "-accuriums" |
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What Non-Depolarizing muscular blocker should be used in a pt with Renal Failure?
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Rocuronium
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What Non-Depolarizing muscular blocker should be used in a pt with Renal Failure & Hepatic Failure? Why?
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"Atracurium b/c spontaneously degenerates in the blood, therefore it is neither renally nor hepatically excreted
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How is anasthesia managed in a pt with infected tissue that requires "stitching"?
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1) Give epinephrine "proximal" to the wound: Epinephrine --> vasoconstriction which keeps it local
2) Give local anesthetic at a higher dose than if it were non-infected: infections cause the area to be more "acidic", which decreases its potency, therefore a higher dose must be given |
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What is the order of analgesia in nerve fiber blockade?
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1st: small fibers --> large fibers
2nd: unmyelinated --> myelinated (insulated)* *Signals travel "faster" on myelinated nerve fibers, however, anesthesia takes "longer" on myelinated nerve fibers because, electricity can "jump", sensation cannot (it takes time for the anesthetic agents to get through the myelination/insulation) |
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What is the order of blockade in nerve fiber blockade by size AND myelination?
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1st: small unmyelinated
2nd: small myelinated 3rd: large myelinated (last) 4th: none* *The last nerve blocked is large myelinated nerves; Large unmyelinated nerve fibers DO NOT EXIST in the body --> therefore large unmyelinated will be a WRONG answer (ALWAYS eliminate it immediately!) |
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What is the order of analgesia in nerve fiber blockade by sensation type?
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1st: Pain
2nd: Temperature 3rd: Touch 4th: Pressure (last) |
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What drug binds to Kappa receptors?
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Dinorphin
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What drug binds to Delta receptors?
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Enkaphalin
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What drug binds to Mu receptors
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Morphine
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What Mu antagonist is used clinically to treat cough suppression?
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DextraMorphine (Robitussin DM ring a bell?)
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What Mu antagonist is used clinically to treat Diarrhea?
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Loperamide
Dyphenoxylate |
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What drug is used for long-term maintenance tx for opiods?
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Methadone
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What drug is used for acute toxicity of opiods?
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Naloxone
Naltrexone |
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What are the SE's of opiod toxicity?
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Miosis
Constipation CNS depression Respiratory depression |
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What is the MOA of Naproxin?
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REVERSIBLY blocks Cox I & Cox II
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What is the MOA of Valdecoxib?
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REVERSIBLY blocks Cox II
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What is the c/u for Valdecoxib?
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Arthritis
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What is the MOA of Tylenol?
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Tylenol = Acetaminophen
MOA: REVERSIBLY blocks Cox I & Cox II Full Name: N-Acetyl-Para-Aminophenol (APAP) Other Names: Tylenol (U.S.) Paracetamol (outside North America) |
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What is the MOA of Aspirin?
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"Aspirin = AcetylSalicylic Acid, ASA
Acetylates & IRRIVERSIBLY blocks Cox I & Cox II" |
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Which drugs REVERSIBLY inhibit the Cox Pathway?
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NSAIDS & Acetaminophen
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What is the tx for tylenol toxicity?
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"Tylenol = Acetaminophen"
N-Acetylcysteine |
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What is the MOA of N-Acetylcysteine?
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Regenerates glutithione & binds toxic metabolite NAPQI
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What is/are the SE(s) of Metolazone?
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"*Hyper-GLUC:
HyperGlycemia HyperLipidemia HyperUricemia HyperCalcemia |
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What are the 4 main Thiazide Diuretics?
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Hydrochlorothiazide
Indapamide Metolazone Chlortalidone |
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What is the toxicity of Methydopa?
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Positive Coomb's Test
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What is the toxicity of Bumetanide?
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Bumetanide = Loop Diuretic
*POH-DANG ("POH" for Hy-POH-kalemia): Pancreatitis (drug-induced) Ototoxicity HyPOHkalemia Dehydration Allergies (Sulfa) Nephritis (interstitial) Gout |
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What is the toxicity of Hexamethonium?
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Sympatholytic
Severe orthostatic Hypotension Sexual Dysfunction Parasympatholytic Constipation Blurred Vision |
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What is the toxicity of Reserpine?
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Depression
Diarrhea |
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What is the toxicity of Guanethidine?
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Sexual Dysfunction
Diarrhea |
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What is the toxicity of Prazosin?
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1st-dose Orthostatic Hypotension
Priapism |
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What is the toxicity of Hydralazine?
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*SARS
Salt retention Angina Reflex tachycardia SLE-like sx's |
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What is the differentiation between Hexamethonium, Reserpine, & Guanethidine?
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*Each of them involves defication (either constipation or diarrhea)
*Hexamethonium: SEXual Dysfunction, Orthostatic Hypotension, & Constipation *2 D's = Reserpine: Depression & Diarrhea *Guanethidine has one SE in common with both Hexamethonium (SEXual dysfunction) and Reserpine (Diarrhea) |
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What is the physiology leading to the Cardiovascular-related SE's of Hydralazine?
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"Incr'd cGMP --> Vasodilation (VD) --> blood pools in periphery --> decr'd venous return:
1) ANGINA 2) Decr'd CN IX firing --> decr'd CN X firing REFLEX TACHYCARDIA 3) Decr'd renal perfusion --> incr'd RAAS activation --> SALT RETENTION (NOTE: Hydralazine also causes SLE-like sx's) |
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What is/are the SE(s) of Minoxidil (Rogaine)?
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*SHARP
Salt retention Hypertrichosis (too much hair) Angina Reflex tachycardia Pericardial effusion |
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What is/are the SE(s) of Verapamil?
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Constipation
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What is/are the SE(s) of Nitroprusside?
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Cyanide poisoning
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What is/are the SE(s) of ACE Inhibitors?
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*CHAPTOPRIL where ""H"" = Hyperkalemia
C = Cough H = Hyperkalemia A = Angioedema P = Proteinuria T = Taste change O = HypOtension P = Pregnancy problems (fetal renal damage) R = Rash I = Incr'd renin L = Lowers Ang II |
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What is/are the SE(s) of Losartan?
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Fetal renal toxicity
Hyperkalemia |
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Which diuretic works in PCT?
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Mannitol
Acetazolamide |
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What is the MOA of Mannitol?
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"Osmotic Diuretic --> Incr'd tubular fluid osmolarity --> water follows --> therefore it ""pulls water out"" (i.e. into the urine)
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What is the MOA of Acetazolamide?
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Acetazolamide = Carbonic Anhydrase inhibitors work in the PCT
Pushes out HCO3- Pulls in Cl- |
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What is the MOA of Furosemide?
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Furosemide = Loop Diuretic
Na+ K+ 2Cl- transport inhibitor in the TALLOH |
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What is the MOA of Thiazides?
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Na+ Cl- reabsorption in the DCT
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What is the MOA of K+ Sparing drugs?
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*SEAT
Aldosterone antagonists = Inhibiton of Aldosterone receptors in the CORTICAL collecting tubules Spironolactone Eplerenone Epithelial sodium channel blockers = Inhibition of Na+ Channels in the CORTICAL collecting duct Amiloride Triamterene |
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What is the physiology connecting the collecting tubules to the collecting ducts?
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Multiple cortical collecting tubules dump into one cortical collecting duct
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What is the c/u of Mannitol?
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ICP
Incr'd intraocular pressure Shock Drug overdose |
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Under what conditions is Mannitol contraindicated?
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Enuria
CHF |
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What is the c/u for Acetazolamide?
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HTN
Glaucoma Urinary alkalinization Bad metabolic alkalosis Altitude sickness Pseudotumor cerebri Cystinuria |
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What is the c/u for Furosemide?
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SEVERE (only) CHF
HTN Renal Nephrotic Syndrome (secondary to CHF &/or Cirrhosis) Hypercalcemia |
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What is the MOA of Loop Diuretic?
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Na+/K+/2Cl- reuptake inhibitor
Secondarily inhibits Na+/Ca2+ exchange --> throws pt into electrolyte abnormalities |
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What is the tx for mild/moderate CHF?
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Thiazide diuretics; they are milder b/c they only inhibit Na+Cl- reabsorption
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What is the c/u for Thiazide diuretics?
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Mild/moderate CHF
Must get fluids off ASAP! Go back and fix electrolyte abnormality once the pt is stable. |
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What is the c/u for Spironolactone?
|
Diabetic pt's
Torsades De Pointes Hyperaldosteronism PCOS (b/c Spironolactones 2nd MOA blocks the androgen receptors) |
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Which diuretic will cause decr'd urine Cl- concentration?
|
"Acetazolamide = CA inhibitor in the thick ascending limb of the loop of henle pushes out HCO3- and pulls in Cl- leading to hyperchloremic metabolic acidosis (while all other diuretics, Na+ & Cl- are excreted with water)
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Which diuretic will cause a pH of 7.3 (normal pH = 7.4)?
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pH of 7.3 = Acidosis
Acetazolamide K+ sparing drugs retain K+ charge causing acidosis |
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What is the tx for Lithium-Induced Diabetes Insipudis?
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Amiloride
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What is the tx for Nephrogenic Diabetes Insipidus?
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Hydrochlorothiazide
Indomethacin |
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What is the tx for SIADH?
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Demeclocycline
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What is the tx for Neurogenic Diabetes Insipudis?
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Vasopressin
Desmopressin |
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EXPECTATIONS FOR DAY 7:
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SE's of CV drugs (anti-hypertensives)"
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