questions 9

Drug Reactions and Side Effects

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Topic updated on 11/06/17 4:51pm

Overview
  • Drug reactions organized by system
    • cardiovascular
    • GI
    • hematologic 
    • musculoskeletal
    • neurologic
    • renal
    • reproductive/endocrine
    • respiratory
    • multiorgan
Medication Reactions
 
Reaction
Causal Agent
Cardiovascular
Atropine-like side effects
  • TCAs
Coronary vasospasm
  • Cocaine
  • Sumatriptan
Cutaneous flushing
  • Vancomycin
  • Adenosine
  • Niacin (reduced by co-administration of aspirin)
  • Calcium channel blockers
Dilated cardiomyopathy
  • Doxorubicin (Adriamycin) 
  • Daunorubicin
  • Cocaine
Torsades de pointes
  • Class IA antiarrhythmic (disopyramide, quinidine, procainamide)
  • Class III  antiarrhythmics (amiodarone, sotalol)
  • Lithium
  • Chloroquine
  • Erythromycin, clarithromycin
  • Haloperidol, thioridazine, ziprasidone
GI
Acute cholestatic hepatitis
  • Macrolides
  • Troglitazone
Focal to massive hepatic necrosis
  • Halothane
  • Valproic acid
  • Acetaminophen
  • Amanita phalloides
  • Carbon tetrachloride
Hepatitis
  • INH
  • Phenytoin
  • Methyldopa
Pseudomembranous colitis
  • Clindamycin
  • Ampicillin
  Hematologic
 Agranulocytosis  
  • Clozapine
  • Carbamazepine
  • Colchicine
  • Propylthiouracil
  • Methimazole
  • Dapsone
  • Cephalosporins
Aplastic anemia
  • Chloramphenicol
  • Benzene
  • NSAIDs
  • Propylthiouracil
  • Methimazole
  • Carbamazepine
  • Phenytoin
Direct Coombs-positive hemolytic anemia
  • Methyldopa
  • Penicillin
Gray baby syndrome
  • Chloramphenicol
Hemolysis in G6PD-deficient patients
  • Isoniazid (INH)
  • Dapsone
  • Sulfonamides
  • Primaquine
  • Chloroquine
  • Aspirin
  • Ibuprofen
  • Nitrofurantoin
  • Methylene blue
Megaloblastic anemia
  • Phenytoin
  • Methotrexate
  • Sulfonamides
  • 6-mercaptopurine
  • Cytosine arabinoside
Thrombotic complications
  • Contraceptives
Musculoskeletal
Gingival hyperplasia
  • Phenytoin
  • Cyclosporin
  • Nifedipine
Gout
  • Furosemide
  • Thiazides
  • Cyclosporin
  • Levodopa
  • Niacin
Osteoporosis
  • Corticosteroids
  • Heparin
  • Proton pump inhibitors
  • Lithium
Photosensitivity
  • Sulfonamides
  • Amiodarone
  • Tetracycline
  • Fluoroquinolones
Rash (Stevens-Johnson syndrome)
  • Ethosuximide
  • Lamotrigine
  • Carbamazepine
  • Phenobarbital
  • Phenytoin
  • Sulfonamides
  • Fluorquinolones
  • Furosemide
  • Penicillin
  • Allopurinol
Rhabdomyolysis
  • Statins
SLE-like syndrome
  • Hydralazine
  • INH
  • Procainamide
  • Phenytoin
  • Carbamazepine
Tendonitis, tendon rupture, and cartilage damage in children
  • Fluoroquinolones 
Neurologic
Cinchonism 
  • Quinidine
  • Quinine
Diabetes insipidus
  • Lithium
  • Demeclocycline
Parkinson-like syndrome
  • Haloperidol
  • Chlorpromazine
  • Reserpine
  • Metoclopramide
  • MPTP (causes permanent Parkinson's)
  • Clozapine
  • Prochlorperazine
  • Cinnarizine
Seizures
  • Bupropion
  • Venlafazine
  • Tramadol
  • Diphenhydramine
  • Imipenem/cilastatin
  • Isoniazid
Tardive dyskinesia
  • Antipsychotics (chlorpromazine)
Renal/GU
Fanconi's syndrome
  • Expired tetracycline
  • Tenofovir
Interstitial nephritis
  • Methicillin
  • NSAIDs
  • Acetominophen
  • Furosemide
  • Allopurinol
Hemorrhagic cystitis
  • Cyclophosphamide
  • Ifosfamide (prevented by mesna administration)
Reproductive/Endocrine
Adrenocortical insufficiency
  • Withdrawal of glucocorticoid therapy
Gynecomastia
  • Spironolactone
  • Digitalis
  • Cimetidine
  • Clomiphene
  • Busulfan, nitrourea, vincristine (direct testicular injury)
  • Chronic alcohol use
  • Estrogens
  • Ketoconazole
  • Finasteride
Hot Flashes
  • Tamoxifen
  • Clomiphene
Hypothyroidism
  • Lithium
  • Amiodarone
  • Neck radiation therapy
Respiratory
Cough
  • ACE inhibitors
Pulmonary fibrosis
  • Bleomycin
  • Amiodarone
  • Busulfan
  • Methotrexate
  • Cyclophosphamide
  • Hydralazine
  • Tocainide
  Multiorgan
Disulfiram-like reaction
  • Sulfonylurea
  • Metronidazole
Nephrotoxicity/neurotoxicity
  • Polymyxins
Nephrotoxicity/ototoxicity
  • Aminoglycosides (neomycin)
  • Vancomycin
  • Loop diuretics (ethacrynate, furosemide, bumetanide)
  • Cisplatin
  • Mercuric chloride

 



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Qbank (5 Questions)

TAG
(M1.PH.17) A 75 year-old gentleman presents to the primary care physician with a two-week history of right sided achilles tendon pain. He states that the pain has had a gradual onset and continues to worsen. He denies any inciting event. Of note the patient performs self-catheterization for episodes of urinary retention and has been treated on multiple occasions for recurrent urinary tract infections. What is the most important next step in management for this patient's achilles tendon pain? Topic Review Topic

1. Refer patient to an orthopedic surgeon
2. Switch medication and avoid exercise
3. Place permanent urinary catheter
4. Perform MRI
5. Perform CT scan

PREFERRED RESPONSE ▶
TAG
(M1.PH.21) A 42-year-old female with a history of systemic lupus erythematous (SLE) has a 3-year history of daily prednisone (20 mg) use. Due to long-term prednisone use, she is at increased risk for which of the following? Topic Review Topic

1. Hair loss
2. Weight loss
3. Pancreatic insufficiency
4. Systolic hypertension
5. Pathologic fractures

PREFERRED RESPONSE ▶
TAG
(M1.PH.54) A 55-year-old man presents to his primary care provider complaining of blood clots in his urine. On further questioning, he also reports suprapubic discomfort and a feeling of bladder fullness with difficulty voiding. The patient reports recently starting treatment for a newly diagnosed non-Hodgkin lymphoma. Vital signs are within normal limits. Physical exam reveals pain on palpation of the suprapubic region. What is the mechanism of action of the drug most likely responsible for the patient’s complaints? Topic Review Topic

1. Alkylating agent
2. Intercalating agent
3. Reverse transcriptase inhibitor
4. Microtubule inhibitor
5. Folic acid analogue

PREFERRED RESPONSE ▶
TAG
(M1.PH.75) A 37-year-old female with systemic lupus erythematosus is started on a new regimen of corticosteroids to better control her symptoms. The prescribing physician counsels the patients on the possible side effects including weight gain, hirsutism, and skin changes. The physician goes on to state that corticosteroids can also cause a number of changes on the patients laboratory studies. Which figure correctly identifies the cell type that would be expected to INCREASE as a result of corticosteroid use? Topic Review Topic
FIGURES: A   B   C   D   E  

1. Figure A
2. Figure B
3. Figure C
4. Figure D
5. Figure E

PREFERRED RESPONSE ▶
TAG
(M1.PH.4707) A 32-year-old female presents to her primary care physician with a four day history of vaginal itching. When prompted, she says that she has also had some discharge but does not remember details about the discharge. She last had unprotected sex with a new partner two weeks prior to presentation. Physical exam reveals minimal inflammation and wet mounts show the cells demonstrated in Figure A. The antibiotic most likely prescribed in this case has which of the following notable side effects? Topic Review Topic
FIGURES: A          

1. Alcohol intolerance
2. Aplastic anemia
3. Ototoxicity
4. Red man syndrome
5. Tendon rupture

PREFERRED RESPONSE ▶
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