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25 Cards in this Set
- Front
- Back
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how does Amphotericin B cause toxicity in humans? What is seen?
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binding cholesterol to some degree
nephrotoxicity, hypokalemia, hypomagnesemia |
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are ACEinhibitors good for BP control in pregnancy?
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no
teratogenic |
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patient being treated for thrichomonas vaginitis that drinks alcohol might experience?
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disulfiram like rxn
metronidazole + etOH causes this, metronidazole is commonly used to tx trichomonas vaginitis & bacterial vaginosis |
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what can cause disulfiram like reaction?
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metronidazole
cephalosporins procarbazine 1st-gen sulfonylureas (tolbutamide, chlorpropramide) |
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21 lab worker w/rapid-onset breathing difficulties, palpiations, & flushed skin - accidental poisoning - what poison? How does antidote work?
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Cyanide poisoning (rapidly developing cutaneous flushing, tachypnea, headache, tachycardia, nausea/vomiting, confusion weakness, respi & cardiac dysfxn may follow)
nitrates oxidize ferrous iron to ferric, Hb - metHb, which preferentially binds cyanide rescuing mitochondrial cytochromes thiosulfate can also be used, combines w/CN to form thiocyanate (less toxic) which is excreted in urine |
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what is dose limiting toxicity of vincristine? Bleomycin? Doxorubicin? Cyclophosphamide?
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vincristine - neurotoxicity (tingling in hands & fingers
Bleomycin - flagellate skin, pulmonary fibrosis (dry cough & dyspnea) doxorubicin - CHF (edema) cyclophosphamide - hemorrhagic cystitis (burning on urination) |
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toxicity of doxyrubicin? Earliest histologic change? Tx?
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cumulative dose-related cardiomyopathy
anthracycline chemos (doxorubicin, daunorubicin, epirubicin, idarubicin) free radicals cause dmg in myocardium swelling of sarcoplasmic reticulum Tx - DEXRAZOXANE presents w/sx CHF |
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what is the bad side effect w/bupropion? What population is this worst in?
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seizures, especially at high doses
greater risk in pts w/preexisting seizure disorder, bulimia, or anorexia |
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drugs causing seizures?
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Bupropion (antidepressant)
Isoniazid (anti TB, if given w/o pyridoxine) Imipenem (antibiotic) |
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cause of gingival hyperplasia in psych patient? Moa?
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Phenytoin (50% pts w/3-4 mos of therapy), sometimes reversible
increased expression of PDGF, which acts on gingival macrophages, which stimulate proliferation of gingival cells & alveolar bone |
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potential adverse effects of phenytoin?
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mainly CNS - cerebellum: ataxia, vestibular system: nystagmus
long term - gingival hyperplasia, coarsening of facial features, hirsutism interferes w/metabolism of folic acid, megaloblastic anemia induces p450 system fetal hydantoin syndrome if taken during pregnancy (intrauterine growth restriction & microcephaly, minor dysmorphic craniofacial features & limb defects - hypoplastic nails & distal phalange, small subset developmental delay/retardation, rarerly methemoglobinemia) |
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lithium toxicity?
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neuromuscular excitability - irregular coarse tremors, fascicular twitching, rigid motor agitation, ataxia
nephrogenic DI, hypothyroidism, cardiac conduction defects |
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fever, maculopapular rash, & renal failure after beta-lactam - type of failure? Timing?
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acute interstitial nephritis
peripheral eosinophilia & eosinophiluria are important clues 1-3 weeks after tx |
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what is dexrazoxane?
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iron chelating agent
prevents antracycline-induced cardiotoxicity (doxorubicin, etc) |
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seizure drug associated w/generalized lymphadenopathy?
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Phenytoin
pseudolymphoma w/a serum sickness like syndrome |
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big side effect of clozapine? What is clozapine's moa?
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agranulocytosis
seizures also can occur it's used often for treatment resistant schizophrenic pts for both positive & negative sx acts on D4 receptors |
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what antipsychotic causes prolonged QT?
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Ziprasidone
follow ECGs |
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how does n-acetylcysteine help in acetominophen toxicity?
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acts as glutathione substitute binding toxic metabolite
also provides sulfhydryl groups to enhance nontoxic sulfation elimination |
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drug induced lupus - drugs are metabolized how? Examples?
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N-acetylation in liver
genetic slow acetylators are at high risk hydralazine & procainamide are classic examples |
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salicylate overdose findings?
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first an acute respiratory alkalosis, from stimulation of medullary respiratory center --> hyperventillation
a few hours later, an anion gap metabolic acidosis develops (decreased HCO3 blood levels) pH could be anywhere depending on course of specific circumstance and timing |
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absolute contraindication for metformin?
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renal failure
risk of lactic acid accumulation -metformin increases intestinal production of lactate by anaerobic glycolysis, & inhibits lactate use in gluconeogenesis at the same time contraindicated in any situation that might precippitate lactic acidosis - liver dysfxn, CHF, alcoholism, sepsis |
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zidovudine + ganciclovir?
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neutropenia & anemia
they both cause marrow suppression, & ganciclovir often given to AIDS pts so… ganciclovir interferes w/human DNA synth more than acyclovir zidovudine can bind & inhibit some mammalian cellular & mitochondrial DNA polymerases |
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side effect of isoniazid?
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isoniazid can compete with vitamin B6 in synthesis of multiple neurotransmitters (GABA)
it increases urinary excretion of pyridoxine, can cause frank DEFICIENCY that is what causes neuropathy |
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bad side effects of cyclosporine? (on physiology)
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nephrotoxicity w/dose & duration dependent rise in serum BUN & creatinine
increased BP |
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what is metoclopramide? Used for? Contraindicated in?
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it's D2 antagonist that is used to tx vomiting or gastric stasis
contraindicated in Parkinson's, can even cause de novo sx |
