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119 Cards in this Set

  • Front
  • Back
ACEIs -
Toxicity
Cough
rash
proteinuria
angioedema
taste changes
teratogenic effects
Amantadine -
Toxicity
Ataxia
livedo reticularis
Aminoglycosides -
Toxicity
Ototoxicity
nephrotoxicity - ATN
Amiodarone -
Toxicity
Pulmonary fibrosis
peripheral deposition -
=> bluish discoloration,
arrhythmias,
hypo-/hyperthyroidism,
corneal deposition
Amphotericin -
Toxicity
Fever/chills
nephrotoxicity
bone marrow suppression
anemia
Antipsychotics -
Toxicity
Sedation
acute dystonic reaction
akathisia
parkinsonism
tardive dyskinesia
neuroleptic malignant syndrome
Azoles (e.g., fluconazole) -
Toxicity
Inhibition of P-450 enzymes
AZT -
Toxicity
Thrombocytopenia
megaloblastic anemia
β-blockers -
Toxicity
Asthma exacerbation
masking of hypoglycemia
impotence
Benzodiazepines -
Toxicity
Sedation
dependence
respiratory depression
Bile acid resins -
Toxicity
GI upset
malabsorption of vitamins
and medications
Calcium channel blockers -
Toxicity
Peripheral edema
constipation
cardiac depression
Carbamazepine -
Toxicity
Induction of P-450 enzymes
agranulocytosis
aplastic anemia
Chloramphenicol -
Toxicity
Gray baby syndrome
aplastic anemia
Cisplatin -
Toxicity
Nephrotoxicity
acoustic nerve damage
Clonidine -
Toxicity
Dry mouth
severe rebound headache
hypertension
Clozapine
Agranulocytosis
Corticosteroids -
Toxicity
Mania (acute) immunosuppression
bone mineral loss
thinning of skin
easy bruising
myopathy (chronic)
cataracts
Cyclophosphamide -
Toxicity
Myelosuppression
hemorrhagic cystitis
Digoxin -
Toxicity
GI disturbance
yellow-green visual changes
arrhythmias -
junctional tachycardia
or SVT,
varying amts of AV node blocks
Doxorubicin -
Toxicity
Cardiotoxicity
(dilated cardiomyopathy)
Ethyl alcohol -
Toxicity
Renal dysfunction
Fluoroquinolones -
Toxicity
Cartilage damage in children Achilles tendon rupture
in adults
Furosemide -
Toxicity
Ototoxicity
hypokalemia
nephritis
Gemfibrozil -
Toxicity
Myositis
reversible ↑ in LFTs
Halothane -
Toxicity
Hepatotoxicity
malignant hyperthermia
HCTZ -
Toxicity
Hypokalemia
hyperuricemia
hyperglycemia
HMG-CoA reductase inhibitors -
Toxicity
Myositis
reversible ↑ in LFTs
Hydralazine -
Toxicity
Drug-induced SLE
Hydroxychloroquine -
Toxicity
Retinopathy
INH -
Toxicity
Peripheral neuropathy -
prevent with vitamin B6
hepatotoxicity
inhibition of P-450 enzymes
seizures with overdose
MAOIs -
Toxicity
Hypertensive tyramine reaction
serotonin syndrome -
with meperidine
Methanol -
Toxicity
Blindness
Methotrexate -
Toxicity
Hepatic fibrosis
pneumonitis
anemia
Methyldopa -
Toxicity
Pos. Coombs’ test
drug-induced SLE
Metronidazole -
Toxicity
Disulfiram reaction
vestibular dysfunction
metallic taste
Niacin -
Toxicity
Cutaneous flushing
Nitroglycerin -
Toxicity
Hypotension
tachycardia
headache
tolerance
Penicillin/β-lactams -
Toxicity
Hypersensitivity reactions
Penicillamine -
Toxicity
Drug-induced SLE
Phenytoin -
Toxicity
Nystagmus
diplopia
ataxia
gingival hyperplasia
hirsutism
Prazosin -
Toxicity
First-dose hypotension
Procainamide -
Toxicity
Drug-induced SLE
Propylthiouracil -
Toxicity
Agranulocytosis
Quinidine -
Toxicity
Cinchonism -
(headache, tinnitus)
thrombocytopenia
arrhythmias -
torsades de pointes
Reserpine -
Toxicity
Depression
Rifampin -
Toxicity
Induction of P-450 enzymes
orange-red body secretions
Salicylates -
Toxicity
Fever
hyperventilation with
respiratory alkalosis
and metabolic acidosis
dehydration
diaphoresis
hemorrhagic gastritis
SSRIs -
Toxicity
Anxiety
sexual dysfunction
Succinylcholine -
Toxicity
Malignant hyperthermia
Tetracyclines -
Toxicity
Tooth discoloration
photosensitivity
Fanconi’s syndrome
TCAs -
Toxicity
Sedation
coma
anticholinergic effects
seizures
wide QRS
in severe cases -
prolonged QT
=> torsade
Valproic acid -
Toxicity
Teratogenicity
=> neural tube defects
Vancomycin -
Toxicity
Nephrotoxicity
ototoxicity
“red man syndrome” -
histamine release
not an allergy
Vinblastine -
Toxicity
Severe myelosuppression
Vincristine -
Toxicity
Peripheral neuropathy
Acetaminophen -
What is the Antidote
N-acetylcysteine
Acid/alkali ingestion -
What is the Antidote
Upper endoscopy
to evaluate for stricture
Anticholinesterases,
organophosphates -
What is the Antidote
Atropine
pralidoxime
Antimuscarinic/
anticholinergic agents -
What is the Antidote
Physostigmine
Arsenic, mercury, gold -
What is the Antidote
Succimer
dimercaprol
β-blockers -
What is the Antidote
Glucagon
Barbiturates (phenobarbital) -
What is the Antidote
Urine alkalinization (bicarb)
dialysis
activated charcoal
Benzodiazepines -
What is the Antidote
Flumazenil
Black widow bite -
What is the Antidote
Calcium gluconate
Carbon monoxide -
What is the Antidote
100% O2
hyperbaric O2
Copper, arsenic, lead, gold -
What is the Antidote
Penicillamine
Cyanide -
What is the Antidote
Nitrite
sodium thiosulfate
Digitalis -
What is the Antidote
Stop digitalis,
normalize K+,
lidocaine (for torsades), anti-digitalis Fab
Heparin -
What is the Antidote
Protamine sulfate
Iron salts -
What is the Antidote
Deferoxamine
Lead -
What is the Antidote
Succimer
CaEDTA
dimercaprol
Methanol, ethylene glycol (antifreeze) -
What is the Antidote
EtOH
fomepizole
dialysis
Methemoglobin -
What is the Antidote
Methylene blue
Opioids -
What is the Antidote
Naloxone
Phencyclidine hydrochloride (PCP) -
What is the Antidote
NG suction
Salicylates -
What is the Antidote
Urine alkalinization
dialysis
activated charcoal
TCAs -
What is the Antidote
Na bicarb - QRS prolongation
diazepam or lorazepam for Szs
cardiac monitor for
arrhythmias
Theophylline -
What is the Antidote
Activated charcoal
tPA, streptokinase -
What is the Antidote
Aminocaproic acid
Warfarin -
What is the Antidote
Vitamin K, FFP
Cardiac Life Support -
What are the Basic Principles
Check if responsive
call for help
Pt. on firm, flat surface
ABCs -
Airway open?
Breathing?
CPR
IV meds before intubate

CPR if alone -
2 breaths
check pulse -
carotid or femoral
15 compressions

CPR if have help -
2 breaths
5 compressions
Burns -
Hx/PE
2nd leading cause of death
in kids
don't underestimate degree of
nonvisible deep destruction-
esp. with electrical burns

thorough airway & lung exam
respiratory burn -
pt. may need early intubation
before edema sets in
Burns -
Dx
Rule of 9's
ABCs
aware of possible -
shock
inhalation injury
CO poisoning
evaluate % of BSA involved

rule of 9's -
BSA (Body Surface Area)
head = 18%
front = 18%
back = 18%
each arm = 9%
each leg = 18%
Burns -
Categories
1st degree -
epidermis involved
area painful
no blisters
capillary refill intact

2nd degree -
epidermis & superficial dermis
area painful
blisters

3rd degree -
epidermis & dermis
area painless
white & charred
Burns -
Tx
■ Tx supportive
■ freq. dressing changes
rehydrate
topical silver sulfadiazine
and mafenide
■ circumferential burns -
at risk for compartment syn
need early escharotomy
■ early skin graft -
prevent contractures
■ fluid req. -
in 1st 24 hrs. -
BSA x wt(kg) x 4cc
give 1/2 in 1st 8 hrs
1/4 in next 8 hrs
1/4 in last 8 hrs

1st choice - lactate ringers
2nd choice - NS (0.9%)
hydrate enough to maintain
urine outut at least
1cc/kg/hr
Burns -
Complications
Shock
superinfection -
esp. Pseudomonas
CO Poisoning -
What is it
Hypoxemic poisoning syn
causes -
car exhaust
smoke inhalation
barbeque in poor ventilation
old appliances
CO Poisoning -
HX/PE
Cherry-red skin
confusion
headaches
if severe -
coma
seizures
chronic low-level exposure -
flu-like Sxs

suspect smoke inhalation in -
singed nose hairs
facial burns
hoarseness
wheezing
carbonaceous sputum
CO Poisoning -
Dx
ABG
normal serum carboxyHb level -
< 5% in nonsmokers
< 10% in smokers

laryngoscopy
bronchoscopy
EKG -
elderly
h/o cardiac dis.
CO Poisoning -
Tx
100 O2
hyperbaric O2 -
pregnant
neuro Sxs
severely ↑ carboxyHb

smoke inhalation -
may need early intubation
(before edema sets in)
Aortic Disruption -
What is it
Rapid deceleration injury
most common causes -
high speed MVAs
fall from great heights
ejection from vehicles

complete -
rapidly fatal
usu have contained hematoma
within adventitia
laceration usu at
lig. arteriosum
Aortic Disruption -
Dx
■ CXR immed. -
wide mediastinum
loss of aortic knob
pleural cap
trachea dev. to right
left main stem bronchus -
depressed
■ aortography - gold standard
■ transesoph echo before OR

always suspect if -
sternal fractures or
1st & 2nd rib fractures
Aortic Disruption -
Tx
OR emergently
Aortic Dissection -
What is it
Risk Factors
Surging of blood through
tear in aortic intima
sep. of intima & media
=> false lumen

■ Stanford type A -
ascending aorta
■ type B -
desc. thoracic aorta
(distal to lt. subclavian)

■ risk factors -
HTN
trauma
coarctation of aorta
syphilis
pregnancy
Ehlers-Danlos
Marfan's
Aortic Dissection -
Hx/PE
Acute onset
severe tearing chest pain
radiates to back
=> syncope
stroke
MI
asymm or dec. periph pulses
paraplegia
shock - as worsens
type A - aortic regurg
with diastolic murmur
Aortic Dissection -
Dx
CXR
CT with IV contrast
transesoph echo or
MRI/MRA or
angiography - gold standard
EKG
Aortic Dissection -
Tx
Stabilize HBP or low
HBP -
IV nitrates
B blockers
goal -
systolic < 120
HR < 70

type A - emergent surgery
type B - med management
Aortic Dissection -
Complications
MI
CHF
cardiac tamponade
postop hemorrhage
future dissection
future aneurysm
death
Postop Fever -
What is it Caused By
(What are the 6 W's)
Wind
Water
Wound
Walk
Wonderdrug
Wire

Wind - atelectasis, pneumonia
Water - UTI
Wound - abscess
Walk- DVT
Wonderdrug - drug reaction
Wire - catheter
Postop Fever -
How to Decrease Risk
Incentive spirometry
short-term foley use
early ambulation
DVT prophylaxis
pre- & post-op ABx

fevers before POD3-
probably not infectious
unless
Clostridium
or B-hemolytic strep
Acute Abdomen -
What is it
Abdom Sxs so severe
surgery should be considered
primary Sx -
acute abdom pain
Acute Abdomen -
Hx/PE
OPQRST
Onset
Precip factors
Quality
Radiation
Sxs
Temporal quality
Tx modalities

full GYN Hx
LMP
STD Sxs
pelvic exam
pregnancy test -
r/o PID,
ectopic pregnancy,
ovarian torsion
Acute Abdomen -
Character of Pain
■ Sharp -
parietal (peritoneal)
■ dull, diffuse -
visceral (organ)
■ perforation -
sudden onset of diffuse,
severe pain
■ obstruction -
acute onset of colicky
■ inflammation -
gradual onset
over 10-12 hrs
constant, ill-defined
Acute Abdomen -
Dx
■ Assess stability

■ emergent surgery &
exploratory lap -
peritoneal signs
impending shock
shock

■ if stable -
PE
pelvic exam (women)
CBC with diff
electrolytes
LFTs
amylase
lipase
urine B-hCG
UA
KUB
US
no contrast studies -
if suspect complete LBO
Acute Abdomen -
Tx
■ Hemodynamically unstable -
emergent exploratory lap
■ stable -
expectant management
vitals
NPO
NG tube
IV fluids
serial abdom exams
serial labs
type & cross
Foley - monitor urine output
monitor fluid status
Appendicitis -
What is it
Always consider in pt.
with acute abdomen
MC - teens & 20's
causes -
no. 1 - lumen obstructed by
lymphoid tissue hyperplasia
no. 2 - fecalith
foreign body
tumor (carcinoid)
parasite

obstruction =>
overdistention
inc. pressure
ischemia & necrosis
Appendicitis -
Hx/PE
■ Dull, vague pain
orig. at umbilicus
lasts 1-12 hrs.
pain then followed by
n/v
anorexia
("hamburger sign")
may have mild fever
sharper pain =>
RLQ at McBurney's point

■ psoas sign
obturator sign
rovsing's sign

■ if perforated -
pain dec.
peritoneal sigs will dev.

■ atypical -
elderly
kids
pregnant
retrocecal appendices
Appendicitis -
Dx
Clinical -
if classic signs & Sxs

mild leukocytosis & lt shift
UA - a few RBCs or WBCs
KUB -
fecalith
loss of psoas shadow
US - r/o gyn abnorm
abdom CT - r/o abscesses
Appendicitis -
Tx
■ strong suspicion -
immed open or lap appendectomy
15-20% false pos. acceptable
if no appendicitis found -
complete exploration of abdo
■ before surgery -
NPO
IV fluids
ABx for anaerobes - 24 hrs.
■ if perforation -
cont. ABx until afebrile &
WBC count normalizes
close wound by delayed
primary closure on POD5
■ if abscess -
broad-spectrum ABx
abscess percutan drained
elective appendectomy 6-8 wks
Appendicitis -
Complications
Risk of perforation &
mortality inc. with
amt of time have appendicitis
(at 48 hrs - 75% risk)
Acute Management
of Trauma Patient -
"ABCDE"
What is "A"
Airway -
airway patency
& adeq ventilation
take precedence over other Tx

■ conscious -
nasal cannula or face mask
unconscious -
chin lift or jaw thrust
to reposition tongue
■ early intubation -
apnea
dec. mental status
impending airway compromise
severe closed head injuries
failed bag mask ventilation
■ cricothyroidectomy -
can't be intubated
signif maxillofacial trauma
■ keep cervical spine stable
never let this concern
delay airway management
Acute Management
of Trauma Patient -
"ABCDE"
What is "B"
Breathing -
5 thoracic causes of immed.
death must not be missed:
tension pneumothorax
cardiac tamponade
open pneumothorax
massive hemothorax
airway obstruction
Acute Management
of Trauma Patient -
"ABCDE"
What is "C"
Circulation -
2 16-gauge IVs
fluid bolus of 1-2L (adults)
vitals rechecked
replete fluid per fluid status
LR or NS -
isotonic
replete 3:1 (fluid to blood)
Acute Management
of Trauma Patient -
"ABCDE"
What is "D"
Disability -
eval CNS dysfunction
via Glasgow Coma Scale
Acute Management
of Trauma Patient -
"ABCDE"
What is "E"
Extra -
check temperature status
foley catheter -
after r/o urethral injury
secondary survey -
full exam
additional XRs -
trauma series:
AP chest
AP pelvis
AP/lat C-spine
T1
Pelvic Fractures -
What are they
MC after trauma
such as a MVA
needs immediate attention
by orthopedist
potentially life-threatening
Pelvic Fractures -
Hx/PE
ABCDE trauma survey
secondary survey -
may reveal unstable pelvis
AP pelvic XR
when stable - CT
if hypotension & shock -
hemorrhage likely

can be assoc with
urethral injury -
■ check for blood
at urethral meatus
■ check high-riding,
"ballotable" prostate
■ check for lack of prostate
■ retrograde urethrogram
■ r/o injury before Foley
■ serial H&H
■ never explore pelvic or
retroperitoneal hematoma
Pelvic Fractures -
Tx
Embolize bleeding vessels
emergent ext. pelvic fixation
internal fixation if
hemodynamically stable