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25 Cards in this Set

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how does Amphotericin B cause toxicity in humans? What is seen?
binding cholesterol to some degree
nephrotoxicity, hypokalemia, hypomagnesemia
are ACEinhibitors good for BP control in pregnancy?
no
teratogenic
patient being treated for thrichomonas vaginitis that drinks alcohol might experience?
disulfiram like rxn
metronidazole + etOH causes this, metronidazole is commonly used to tx trichomonas vaginitis & bacterial vaginosis
what can cause disulfiram like reaction?
metronidazole
cephalosporins
procarbazine
1st-gen sulfonylureas (tolbutamide, chlorpropramide)
21 lab worker w/rapid-onset breathing difficulties, palpiations, & flushed skin - accidental poisoning - what poison? How does antidote work?
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
what is dose limiting toxicity of vincristine? Bleomycin? Doxorubicin? Cyclophosphamide?
vincristine - neurotoxicity (tingling in hands & fingers
Bleomycin - flagellate skin, pulmonary fibrosis (dry cough & dyspnea)
doxorubicin - CHF (edema)
cyclophosphamide - hemorrhagic cystitis (burning on urination)
toxicity of doxyrubicin? Earliest histologic change? Tx?
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
what is the bad side effect w/bupropion? What population is this worst in?
seizures, especially at high doses

greater risk in pts w/preexisting seizure disorder, bulimia, or anorexia
drugs causing seizures?
Bupropion (antidepressant)
Isoniazid (anti TB, if given w/o pyridoxine)
Imipenem (antibiotic)
cause of gingival hyperplasia in psych patient? Moa?
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
potential adverse effects of phenytoin?
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)
lithium toxicity?
neuromuscular excitability - irregular coarse tremors, fascicular twitching, rigid motor agitation, ataxia

nephrogenic DI, hypothyroidism, cardiac conduction defects
fever, maculopapular rash, & renal failure after beta-lactam - type of failure? Timing?
acute interstitial nephritis
peripheral eosinophilia & eosinophiluria are important clues

1-3 weeks after tx
what is dexrazoxane?
iron chelating agent

prevents antracycline-induced cardiotoxicity (doxorubicin, etc)
seizure drug associated w/generalized lymphadenopathy?
Phenytoin

pseudolymphoma w/a serum sickness like syndrome
big side effect of clozapine? What is clozapine's moa?
agranulocytosis
seizures also can occur

it's used often for treatment resistant schizophrenic pts for both positive & negative sx
acts on D4 receptors
what antipsychotic causes prolonged QT?
Ziprasidone
follow ECGs
how does n-acetylcysteine help in acetominophen toxicity?
acts as glutathione substitute binding toxic metabolite
also provides sulfhydryl groups to enhance nontoxic sulfation elimination
drug induced lupus - drugs are metabolized how? Examples?
N-acetylation in liver

genetic slow acetylators are at high risk

hydralazine & procainamide are classic examples
salicylate overdose findings?
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
absolute contraindication for metformin?
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
zidovudine + ganciclovir?
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
side effect of isoniazid?
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
bad side effects of cyclosporine? (on physiology)
nephrotoxicity w/dose & duration dependent rise in serum BUN & creatinine

increased BP
what is metoclopramide? Used for? Contraindicated in?
it's D2 antagonist that is used to tx vomiting or gastric stasis

contraindicated in Parkinson's, can even cause de novo sx