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166 Cards in this Set
- Front
- Back
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Cyclosporine
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Predisposes patients to viral infection and lymphoma; NEPHROTOXIC (prevent with mannitol diuresis)
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Tacrolimus (FK506)
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Significant NEPHROTOXICITY, peripheral neuropathy, HTN, pleural effusion, hyperglycemia
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Azathioprine
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Bone marrow suppression. Metabolized by xanthine oxidase. Therefore, toxicity increased by allopurinol
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Muromonab-CD3 (OKT3)
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cytokine release syndrome, hypersensitivity
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Sirolimus
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hyperlipidemia, thrombocytopenia, leukopenia
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Heparin
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Bleeding, Heparin induced thrombocytopenia, osteoporosis, drug interactions. Use PROTAMINE SULFATE for heparin reversal
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LMW heparin
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not easily reversible
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Warfarin
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bleeding, teratogen, skin/tissue necrosis, drug interactions. FFP AND VITAMIN K for acute overdose
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Streptokinase Urokinase tPA(alteplase) anistreplase
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bleeding. CI in patients with active bleeding, recent surgery, or severe HTN. Treat toxicity with AMINOCAPROIC ACID
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Aspirin
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gastric ulcers, bleeding, hyperventilation (metabolic acidosis), Reye's syndrome, tinnitus
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Clopidogrel Ticlopidine
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neutropenia (ticlopidine)
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Abciximab
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bleeding, thrombocytopenia
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Methotrexate
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MYELOSUPRESSION (reversible with LEUCOVORTIN). Fatty change in liver, mucositis, teratogen
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5-Flurouracil (5-FU)
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MYELOSUPRESSION. Not reversible with leucovorin. Photosensitivity. Overdose rescue with THYMIDINE.
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6-Mercaptopurine (6-MP)
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Bone marrow, GI, liver toxic. Metabolized by xanthine oxidase - thus toxicity increased with allopurinol
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6-thioguanine (6-TG)
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bone marrow depression, liver. Can be given with allopurinol
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Cytarabine
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leukopenia, thrombocytopenia, megaloblasic anemia
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Dactinomycin (Actinomycin D)
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myelosupression
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doxorubicin (adriamycin) daunorubicin
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CARDIOTOXICITY, myelosupression, alopecia.
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Bleomycin
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PULMONARY FIBROSIS, skin changes, minimal myelosupression
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Etoposide Teniposide
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myelosupression, GI irritation, alopecia
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Cyclophosphamide ifosphamide
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HEMORRHAGIC CYSTITIS (partially prevented with MESNA). myelosupression
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Nitrosoureas - Carmustine Lomustine Semustine Streptozocin
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CNS toxicity (dizziness, ataxia)
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Busulfan
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PULMONARY FIBROSIS, hyperpigmentation
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Vincristine Vinblastine
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Vincristine - neurotoxicity, paralytic ileus Vinblastine - Bone marrow suppression.
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Paclitaxel
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myelosuppression, hypersensitivity
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Cisplatin Carboplatin
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Nephrotoxicity (prevent by pretreatment with AMIFOSTINE), acoustic nerve damage
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Hydroxyurea
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Bone marrow suppression, GI upset
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Tamoxifen Raloxifene
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Tamoxifen increases risk of endometrial cancer. Raloxifene does not because it is an endometrial antagonist
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Trastuzumab (Herceptin)
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cardiotoxicity
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Imatinib (Gleevec)
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fluid retention
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Pilocarpine
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Resistant to AChE
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Atropine
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increased body temp, tachycardia, dry mouth and skin, cycloplegia, constipation, disorientation
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Hexamethonium
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orthostatic hypotension, blurred vision, constipation, sexual dysfunction
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Phenoxybenzamine (irreversible); Phentolamine (reversible)
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orthostatic hypotension, reflex tachycardia
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Prazosin Terazosin Doxazosin
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1st dose orthostatic hypotension, dizziness, headache
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Mirtazapine
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sedation, increased cholesterol and appetite
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Diuretics, ACEi, ARBs, B-Blockers, Potassium Sparing Diuretics
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B-Blockers are contraindicated in decompensated CHF
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ACEi/ARBs, Calcium Channel Blockers, diuretics, B-Blockers, a-Blockers
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ACEi are protective against diabetic nephropathy
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Hydralazine
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Compensatory tachycardia (CI in angina/CAD), fluid retention, nausea, headache, angina. LUPUS-like syndrome
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Minoxidil
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hypertrichosis, pericardial effusion, reflex tachycardia, angina, salt retention
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Nifedipine Verapamil Diltiazem
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Cardiac depression, AV block, peripheral edema, flushing, dizziness, and constipation
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Nitroglycerin, Isosorbide dinitrate
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reflex tach, hypOtension, flushing, headache, "Monday disease" (Development of tolerance for the vasodilating action during the work week and loss of tolerance over the weekend, resulting in tachycardia, dizziness, and headache on reexposure
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Diazoxide
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Hyperglycemia (reduces insulin release)
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Nitrates, B-Blockers, Calcium Channel Blockers
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Pindolol and acebutolol (partial B-agonists) are contraindicated in angina. Read about antianginals in FA
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Digoxin
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Cholinergic - nausea, vomiting, diarrhea, blurry yellow vision. ECG shows increased PR interval, decreased QT interval. T-wave inversion, arrhythmia, HYPERKALEMIA. Toxicity worsened by renal failure (decreased excretion), hypokalemia, quinidine. Treat toxicity by normalizing K, lidocaine, cardiac pacer, anti-dig Fab fragments and Mg.
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Quinidine Procainamide Disopyramide
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Torsades de pointes. Quinidine causes cinchonism (headache, tinnitus, thrombocytopenia). Procainamide causes reversible LUPUS-like syndrome.
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Lidocaine Mexilitine Tocainide Phenytoin
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Local anesthetic. CNS stimulation/depression. Cardiovascular depression
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Flecainide Encainide Propafenone
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Proarrythmic, especially post-MI contraindicated. Significantly prolongs refractory period in AV node
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Propranolol Esmolol Metoprolol Atenolol Timolol
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Impotence, exacerbation of asthma, cardiovascular effects (bradycardia, AV block, CHF), CNS effects (sedation, sleep alterations). Masks signs of hypOglycemia. Treat overdose with GLUCAGON. Metoprolol may cause dyslipidemia
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Sotalol Ibutilide Bretylium Dofetilide Amiodarone
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Sotalol - B-Blocker and torsades. Ibutilide - torsades. Bretylium - new arrhythmias, hypOtension. Amiodarone - pulmonary fibrosis, hepatotoxicity, hypo/hyperthyroidism, corneal deposits, skin deposits, photodermatitis, neurologic effects, constipation, bradycardia, heart block, CHF.
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Verapamil Diltiazem
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Constipation, flushing, edema, CHF, AV block, sinus node depression
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Adenosine
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Flushing, hypOtension, chest pain. Effects blocked by theophylline
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Lovastatin Pravastatin Simvastatin Atorvastatin Rosuvastatin
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hepatoxicity, rhabdomyolysis
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Niacin
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flushing (decreased by aspirin or long-term use), hyperglycemia (acanthosis nigricans), hyperuricemia (exacerbates gout)
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Cholestyramine Colestipol Colesevelam
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GI discomfort, decreased absorption of fat-soluble vitamins; cholesterol gallstones
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Ezetimibe
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Rare increase in LFTs
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Gemfibrozil Clofibrate Bezafibrate Fenofibrate
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myositis, hepatotoxic, cholesterol gallstones
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Cimetidine Ranitidine Famotidine Nizatidine
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Cimetidine inhibits P-450. It also has antiandrogenic effects (prolactin release, gynecomastia, impotence, and decreased libido in males). It can cross BBB and placenta. Cimetidine and ranitidine can decrease renal excretion of creatinine. Other H2 blockers are relatively free of these effects
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Bismuth Sucralafate
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Part of the treatment for H. Pylori ulcer: Metronidazole, Amoxicillin or Tetracycline, and Bismuth
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Misoprostol
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Diarrhea. CI in women of child-bearing age
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Pirenzepine Proprantheline
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Tachycardia, dry mouth, difficulty focusing eyes
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Aluminum OH
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HypOkalemia, constipation, hypophosphatemia, proximal muscle weakness, osteodystrophy, seizures
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Magnesium OH
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hypOkalemia, diarrhea, hyporeflexia, hypOtension, cardiac arrest
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Calcium Carbonate
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hypOkalemia, hypercacemia, rebound acid increase
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Infliximab
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Respiratory infection (including reactivation of TB), fever, hypOtension
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Sulfasalazine
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Malaise, nausea, sulfonamide toxicity, reversible oligospermia
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Ondasetron
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Headache, constipation
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Metoclopramide
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Increase parkinsonian effects, restlessness, drowsiness, fatigue, depression, nausea, diarrhea. Drug interaction with digoxin and diabetic agents. CI in patients with small bowel obstruction
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Lispro (SA) Aspart (SA) Regular (SA) NPH (IA) Glargine (LA) Detemir (LA)
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hypoglycemia, hypersensitivity rxn
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Tolbutamide Chlorpropamide
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Disulfiram-like effects
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Glyburide Glimepiride Glipizide
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hypoglycemia
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Metformin
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lactic acidosis (contraindicated in renal failure)
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Pioglitazone Rosiglitazone
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weight gain, edema, hepatotoxic, CV toxicity
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Acarbose Miglitol
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GI disturbances
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Pramlintide
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hypoglycemia, nausea, diarrhea
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Exenatide
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nausea, vomiting, pancreatitis
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Orlistat
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steatorrhea, GI discomfort, reduced absorption of fat-soluble vitamins, headache
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Sibutramine
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HTN, tachycardia
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Propylthiouracil
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skin rash, agranulocytosis, aplastic anemia
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Methimazole
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skin rash, agranulocytosis, aplastic anemia
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Levothyroxine Triiodothyronine
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tachycardia, heat intolerance, tremors, arrhythmias
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Demeclocycline
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nephrogenic DI; photosensitivity, abnormalities of bone and teeth (in the tetracycline family)
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Hydrocortisone Prednisone Triamcinolone Dexamethasone Beclomethasone
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Iatrogenic Cushing's, diabetes (if chronic)
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Aspirin
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gastric upset. Chronic use can lead to acute renal failure, interstitial nephritis, and upper GI bleeding. Reye's syndrome in children with viral infection
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Ibuprofen Naproxen Indomethacin Ketorolac
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Renal damage, fluid retention, aplastic anemia, GI distress, ulcers
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Celecoxib
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increased risk of thrombosis. Sulfa allergy. Less toxicity to GI mucosa (lower incidence of ulcers, bleeding than NSAIDs.
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Acetaminophen
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overdose produces hepatic necrosis. Acetominophen metabolite depletes glutathione and forms toxic tissue adducts in liver. N-acetylcysteine is antidote - it regenerates glutathione
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Etidronate Pamidronate Alendronate Risedronate
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corrosive esophagitis, nausea, diarrhea. Be sure to put patient on calcium and vit D
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Colchicine
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GI side effects, especially if given orally.
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Allopurinol
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increases concentration of azathioprine and 6-MP due to their metabolism by xanthine oxidase
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Infliximab
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predisposes to infections (reactivation of latent TB)
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Epinephrine
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mydriasis, stinging. Contraindicated in closed-angle glaucoma
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Brimonidine
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no pupillary or vision changes
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Timolol Betaxolol Carteolol
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no pupillary or vision changes
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acetazolamide
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no pupillary or vision changes
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Pilocarpine Carbachol
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miosis, cyclospasm
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Physostigmine Echothophate
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miosis, cyclospasm
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Latanoprost
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darkens color of iris
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Morphine Fentanyl Codeine Heroin Methadone Meperidine
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Addiction, respiratory depression, constipation, miosis, additive CNS depression with other drugs. Tolerance does not develop to miosis and constipation. Treat toxicity with naloxone or naltrexone.
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Dextromorphan
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Same
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Loperamide Diphenoxylate
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Same
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Butorphanol
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Less respiratory depression than full agonist. Will cause withdrawal symptoms if on full agonist
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Tramadol
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Similar to opioids. Decreases seizure threshold
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Phenytoin
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nystagmus, ataxia, diplopia, sedation, induction of CYP450. Gingival hyperplasia in children, peripheral neuropathy, hirsutism, megaloblastic anemia (decrease folate absorption). Teratogen. Lupus-like syndrome
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Carbamazepine
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diplopia, ataxia, blood dyscrasias (aplastic, agranulocytosis), liver toxicity, teratogen, SIADH, induction of CYP450. Stevens-Johnson syndrome
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Lamotrigine
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Stevens-Johnson syndrome
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Gabapentin
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Sedation, ataxia
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Topiramate
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Sedation, mental dulling, kidney stones, weight loss
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Phenobarbital Pentobarbital Thiopental Secobarbital
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Dependence, additive CNS depression with alcohol, respiratory or cardiovascular depression, induction of CYP450. Treat overdose with symptom management (assist respiration, BP)
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Diazepam Lorazepam Chlordiazepoxide Midazolam Alprazolam Triazolam Temezepam Oxazepam
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Dependence, additive CNS depression effects with alcohol,. Less risk of respiratory depression and coma than with barbituates
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Valproic Acid
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GI distress, rare but fatal hepatotoxicity, neural tube defects (spina bifida), tremor, weight gain. Contraindicated in pregnancy).
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Ethosuximide
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Gi distress, fatigue, headache, urticaria, Stevens-Johnson
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Halothane Enflurane Isoflurane Sevoflurane Methoxyflurane Nitrous Oxide
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Halothane - hepatotoxicity. Methoxyflurane - nephrotoxicity. Enflurane - proconvulsant. Nitrous oxide - expansion of trapped gas. Malignant hyperthermia
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Thiopental
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Postoperative nausea
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Midazolam
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Severe postoperative respiratory depression, decreased BP, and amnesia. Treat overdose with flumazenil
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Ketamine
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Disorientation, hallucination, and bad dreams.
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Morphine Fentanyl
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Propofol
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Less postoperative nausea than thiopental. Michael Jackson
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Procaine Cocaine Tetracaine Lidocaine Mepivacaine Bupivacaine
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CNS excitation, severe cardiovascular toxicity (bupivicaine), arrhythymias (cocaine), HTN, hypOtension
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Succinylcholine
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Hypercalcemia, Hyperkalemia. Phase I prolonged depolarization - no antidote, cholinesterase inhibitors potentiate block. Phase II (repolarized but blocked). Antidote consists of cholinesterase inhibitors (neostigmine)
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Tubocurarine Atracurium Mivacurium Pancuronium Vecuronium Rocuronium
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Blockade reversed with neostigmine, edrophonium, and other cholinesterase inhibitors
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Dantrolene
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Amantadine
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ataxia
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L-dopa/carbidopa
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Arrhythmias from peripheral conversion to dopamine. Long-term use can lead to dyskinesia following administration. Carbidopa is given with L-dopa because it is a peripheral decarboxylase inhibitor that helps to increase the bioavailablity of L-dopa in the brain and also helps to limit peripheral side effects
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Selegiline
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enhances adverse effects of L-dopa
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Memantine
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dizziness, confusion, hallucinations
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Donepozil Galantamine Rivastigmine
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nausea, dizziness, insomnia
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Sumatriptan
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Coronary vasospasm (contraindicated in patients with CAD or Prinzmetal's angina), mild tingling
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Haloperidol Trifluoperazine Fluphenazine Thioridazine Chlorpromazine
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lipid soluble. EPS side effects (dystonia, akinesia, akathisia, tardive dyskinesia). Hyperprolactinemia leading to galactorrhea due to dopamine inhibition. Muscarinic blockade (dry mouth, constipation). Alpha1 blockade (hypotension). Histamine blockade (sedation). NEUROLEPTIC MALIGNANT SYNDROME (treat with dantrolene, bromocriptine).
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Olanzapine Clozapine Quetiapine Risperidone Aripiprazole Ziprasidone
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Fewer EPS and anticholinergic side effects than typical antipsychotics. Olanzapine, Clozapine may cause weight gain. Clozapine may cause agranulocytosis.
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Lithium
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tremor, sedation, edema, heart block, hypOthyroidism, polyuria (ADH antagonist), teratogen. Narrow therapeutic window
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Buspirone
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Does not cause sedation, addiction, or tolerance. Does not interact with alcohol.
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Imipramine Amitriptyline Despiramine Nortriptyline Clomimpramine Doxepin Amoxapine
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Sedation, alpha-blocking effects, anticholinergic effects. Amitriptiline (3rd gen) has more anticholinergic effects than does Nortriptyline (2nd gen). For this reason, nortriptyline used in elderly to prevent confusion and hallucinations. Despiramine is the least sedating and has the lowest seizure threshold. All may cause convulsions, coma, arrhythmias, respiratory depression, and hyperpyrexia. Treat CV toxicity with NaHCO3
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Fluoxetine Paroxetine Sertraline Citalopram
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Fewer than TCAs. GI distress, sexual dysfuntion. Serotonin syndrome with any drug that increases serotonin (ex. MAOi). Syndrome includes hyperthermia, muscle rigidity, cardiovascular collapse, flushing, diarrhea, seizures. Treat with cyproheptadine (5-HT2 receptor antagonist).
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Venlafaxine Duloxetine
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Increased BP most common. Also stimulant effects, sedation, nausea
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Phenelzine Tranylcypromine Isocarboxazid Selegiline (selective for MAO-B)
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hypertensive crisis with B-agonists and tyramine ingestion (avoid wine and cheese). CNS stimulation. Contraindicated with SSRI or meperidine (to prevent serotonin syndrome)
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Bupropion
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Tachycardia, Insomnia, headache. NO sexual side effects. Seizure in bulimic patients
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Mirtazapine
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sedation, increased appetite, weight gain, dry mouth
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Maprotiline
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sedation, orthostatic hypotension
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Trazodone
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sedation, nausea, postural hypotension, PRIAPISM
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Mannitol
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pulmonary edema, dehydration. Contraindicated in anuria, CHF
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Acetazolamide
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Hyperchloremic metabolic acidosis, neuropathy, NH3 toxicity, sulfa allergy
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Furosemide
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ototoxicity, hypokalemia, dehydration, sulfa allergy, interstitial nephritis, gout
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Ethacrynic acid
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similar to furosemide. Can be used in hyperuremia and acute gout. However, it is not used to treat gout.
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Hydrochlorothiazide
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Hypokalemic metabolic alkalosis, hyponatremia, hyperglycemia, hyperlipidemia, hyperuricemia, and hypercalcemia. Sulfa allergy
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Spironolactone Eplerenone
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Hyperkalemia (may lead to arrhythmias, endocrine effects with aldosterone antagonists (spironolactone causes gynecomastia)
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Triamterene Amiloride
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hyperkalemia
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Captopril Enalapril Lisinopril
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Cough, angioedema, proteinuria, taste changes, hypOtension, pregnancy problems (fetal renal damage), rash, increased renin, hyperkalemia. Avoid with bilateral renal artery stenosis because ACE inhibitors significantly decrease GFR by preventing constriction of efferent arterioles
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Leuprolide
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antiandrogen, nausea vomiting
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Testosterone
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Masculinization in females; reduces intratesticular testosterone in males by inhibiting release of LH (via negative feedback), leading to gonadal atrophy. Premature closure of epiphyseal plates. Increases LDL and decreases HDL
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Ketoconazole
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gynecomastia and amenorrhea
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Spironolactone
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gynecomastia and amenorrhea
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Ethinyl estradiol DES Mestranol
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increased risk of endometrial cancer, bleeding in postmenopausal women, clear cell adenocarcinoma of vagina in females exposed to DES in utero, increased risk of thrombi. Contraindicated in ER-positive breast cancer, history of DVTs.
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Clomiphene
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hot flashes, ovarian enlargement, multiple simultaneous pregnancies, visual disturbances
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Estrogen Progesterone
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Unopposed estrogen replacement therapy increases the risk of endometrial cancer so progesterone is added. Possible increase in CV risk
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mifepristone (RU-486)
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heavy bleeding, GI effects (nausea, vomiting, anorexia), abdominal pain
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Sildenafil Vardenafil
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headache, flushing, dyspepsia, impaired blue-green color vision. Risk of life threatening hypOtension in patients taking nitrates
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Diphenhydramine Dimenhydrinate Chlorpheniramine
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sedation, anti-muscarinic, anti-alpha adrenergic
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Loratidine Fexofenadine Desloratadine Cetirizine
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less sedating than 1st gen because of decreased entry into CNS
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Guaifenesin
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does not supress cough reflex
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Isoproterenol
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tachycardia (B1)
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Salmeterol
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tremor, arrhythmia
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Theophylline
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narrow therapeutic index, cardiotoxic, neurotoxic, metabolized by P450. Blocks action of adenosine
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Cromolyn
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rare toxicity
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