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Adverse Effects
Adverse Effects Review for NAPLEX/CPJE
| Question | Answer |
|---|---|
| Hydralazine | Lupus-like Syndrome |
| Clonidine | DOC for HTN in pt on dialysis |
| Meperidine | Normeperidine is an active metabolite that builds up during renal dysfunction-causes seizures |
| Carbapenems (imipenim) | Seizures |
| carbamazepine | aplastic anemia agranulocytosis hepatotoxicity Stevens Johnson Syndrome |
| Valproic Acid | hepatotoxicity teratogenicity pancreatitis |
| topiramate | oligohydrosis glaucoma weight loss Kidney stones |
| zonisamide | oligohydrosis stevens johnson syndrome Kidney stones |
| lamotrigine | toxic epidermal necrosis (esp with VA) |
| vigabatrin | permanent vision loss |
| methyldopa | DOC for HTN in pregnancy |
| Ribavirin | Hemolytic Anemia teratogenicity |
| exenatide (byetta)and liraglutide (victoza) | pancreatitis, dose limiting SE is nausea |
| Pancreatitis | byetta, victoza, valproic acid stavudine, didanosine |
| oligohydrosis | topiramate, zonisamide |
| hepatotoxicity | valproic acid, carbamazepine, NNRTIs |
| Nevirapine (Viramune) | NNRTI-induces own metabolism |
| Protease Inhibitors | Fat maldistribution, hypertriglyceridemia, hyperglycemia, hyperlipidemia, nephrolithiasis |
| NRTIs | lactic acidosis and severe hepatomegaly |
| "D" NRTIs | Didanosine, Zalcitabine, Stavudine (cause pacreatitis, peripheral neuropathy, and lactic acidosis) |
| Lamivudine (Epivir) | Bone Marrow Suppression NRTI |
| Zidovudine (Retrovir) | BMS (neutropenia, and anemia)NRTI |
| Abacavir (Ziagen) | patients must be tested for HLA-B 5701 to determine risk for hypersensitivity. ANY rxns (rash, cough, N/V, fatigue)- D/C!!!!!! |
| What is in Combivir? | Zidovudine and Lamivudine (both NRTIs) |
| What is in Trizivir? | Zidovudine, Lamivudine, and Abavavir (All NRTIs) |
| HIV and pregnancy | avoid efavirenz, avoid combining stavudine and didanosine, and consider starting tx after the 1st trimaster |
| omalizumab (Xolair) | Anti IgE therapy indicated for severe persistent asthma patients who have frequent trips to the ER. SQ q 2-4 weeks. Most serious ADRs are malignancies and anaphylaxis. Injection site rxn 45% of the time because solution is viscous. |
| What should be inhaled swiftly? | DPIs- Pulmicort (budesonide) Flovent Diskus, Advair Diskus, Asmanex, Foradil (Formoterol) and Serevent (salmeterol) |
| Use bronchodilator and ICS. Which should you use first? | Use the bronchodilator first, wait several minutes then use the ICS-this will allow better penetration of the steroid |
| Therapeutic goal of theophylline? | 5-15mcg/ml (<15= no toxicity, >20 60% toxic and >30 80% toxic) SMOKING induces liver enzymes and will cause theophylline levels to decrease!! |
| Sx of methylxanthine toxicity | N/V, seizures, hyperactivity, ventricular arrhythmias (severe toxicity is not necessarily preceded by milder sx) |
| Zileuton (Zyflo) | hepatotoxicity (leukotriene modifier) |
| Amantadine (Symmetrel) | livedo reticularis (red mottling of the skin-affects 80% of patients)Increase dopaminergic transmission by unknown mechanism |
| Selegiline | Selective MAO-B inhibitor at doses <10mg/day-can decrease levodopa dose by 10-30% (after third dose) |
| Pramipexole (Mirapex)and Ropinirole (Requip) | Falling asleep during ADLs |
| Apomorphine (Apokyn) | SC only (IV admin can cause pulmonary embolism) Will cause emesis-must pretreat with Trimethobenzamide or Domperidone-Start 3 days prior to use- NOT HT3 ANT-hypotension and loss of consciousness |
| Fluorouracil (Adrucil) | GI and diarrhea |
| Chemotherapy drugs with low risk of BMS | Asparaginase (Elspar), Vincristine (Oncovin), bleomycin and busulfan |
| Bleomycin (Blenoxane) and busulfan (Busulfex) | Pulmonary fibrosis, SOB; hyperpigmentation of skin |
| Cyclophosphamide (Cytoxan) | Metabolized to acrolein causes hemorrhagic cystitis at doses >1g/m2 ; give mesna at doses >1g/m2 |
| Cytarabine (ara-C) | Keratitis, conjunctivitis; severe CNS toxicity in doses >1g/m2 |
| Cisplatin (Platinol) | Ototoxicity, and CNS toxicity; acute and related emesis; nephrotoxicity (les with carbo; give IV fluids or amifostine) |
| Daunorubicin (Cerubidine), doxorubicin (Adriamycin), epirubicin (Ellence), idarubicin (Idamycin) | Cardiac toxicity if cumulative doses >400mglm2 for daun/dox but less for idarubicin and more for epirubicin; extravasation risk |
| Dexrazoxane | Used to Prevent cardiac toxicity during doxorubicin treatment or treat extravasation |
| Dactinomycin (Cosmegen) | Extravasation risk |
| Ixabepilone (Ixempra) | Peripheral neuropathy |
| Ifosfamide (Ifex) | Metabolized to acrolein causing hemorrhaguc cystitis; give mesna |
| Irinotecan (Camptosar; CPT11) | Severe acute and delayed diarrhea |
| Methotrexate | Mucositis; liver toxicity/fibrosis; leucovorin can be used for toxicity |
| Mechlorethamine (Mustargen) | Extravasation risk |
| Oxaliplatin (Eloxatin) | Oral pharyngeal paraesthia; peripheral neuropathy; avoid exposure to cold stimulus to avoid exacerbation |
| Streptozocin (Zanosar) | Insulin dependent diabetes (historically used to treat pancreatic cancer) |
| Docetaxel (Taxotere), Paclitaxel (Taxol) | Peripheral neuropathy (mainly paclitaxel); edema/fluid retention (mainly docetaxel) |
| Vinblastine (velban), vincristine (oncovin), vinorelbine (navelbine) | Peripheral neuropathy (vincristine>>vinblastine); extravasation risk; vincristine has less risk of BMS |
| Contraindications for Lithium | renal disease, severe cardiovascular disease, hx of leukemia, first trimaster of pregnancy |
| Monitoring parameters for Lithium | Thyroid (Lithium may cause hypothyroidism), SCr and BUN, CBC w/ diff (may cause leukocytosis or reactivate leukemia), electrolytes, ECG (may cause flattened or inverted T waves), urinalysis (may decrease specific gravity) |
| Lithium steady state levels | 4-5 days (half life=24h) maintenance: 0.8-1 mEq/L (draw the level weekly for 4 weeks and then monthly for 3 months |
| Lithium toxicity | 1.5-2.0mEq/L N/V, diarrhea, muscle weakness, fatigue, fine hand tremor, difficulty w/conc &memory 2-2.5mEq/L ataxia,lethargy,nyastgmus, worsening confusion, severe GI upset, coarse tremors, increase DTR >3.0mEq/L coma,seizures, respir complic/death |
| Pernicious anemia- What deficiency causes this? | B12 (cyanocobalamin)-lack of intrinsic factor in stomach- vegetables have no B12-VEGANS HAVE 12 PROBLEMS-animal derived foods are rich in B12 |
| Dose of cyanocobalamin | to treat prenicious anemia: 1000 mcg IM qd x 7 days then 1mg weekly for 1-2 months (until H/H return to normal) then once monthly |
| Thiamine deficiencys | (B1) leads to beriberi and Wernicke's encephalopathy |
| Niacin deficiency | Pellagra- rash sore mouth, diarrhea, mental deterioration |
| Vitamin D deficiency | rickets |
| Vitamin C deficiency | Scurvy-red spots on skin, gums hemorrhage, teeth fall out, hemorrhaging occurs in cells through out the body |
| Daily need for fluid and TBW | 30-35ml/kg; Females (60%) Males (50%) |
| Chromium (what does it do) | essential for incorporation of glucose into the cells and the intracellular metabolism of glucose-refractory hyperglycemia (check for chromium deficiency) |
| Non-isotonic solutions hurt the most when they are injected how? | SQ-in contact the longest and close to nerves |
| HEPA filters | remove 99.97% of air particles 0.3 microns or larger |
| Microdrip set | 60 drops/min (normal drip set is 15-20 drops/min) |
| Drugs that must be protected to light during administration | amphotericin, BiCNU (carmustine), furosemide, nitroprusside, vinblastin (velban), vincristine (oncovin) |
| Reopro (Abciximab) | Antiplatelet agent used for PCI |
| Benzyl Alcohol as solvent in injectables | causes a fatal syndrome "gasping syndrome" in premature infants |
| 3 drugs that are used in propylene glycol for injection | phenytoin, valium, and digoxin |
| SE of propylene gylcol for injection | hypotension, CV collapse, CNS depression (will cause gel formation with other solvents) |
| Only po DMARD? | Arava (leflunomide) |
| Leflunomide (arava) | hepatotoxicity, TEN/ SJS, immunosupp, CI in women of child bearing age, use cholestyramine for fasting elimination (8g tid) otherwise stays in body for up to 2 years |
| hydroxychloroquine (Plaquenil) | retinopathy- used as antimalaria and RA |
| entanercept (Enbrel) | 50mg SQ weekly- Anti-TNF- watch for infections and neutropenia |
| Inlfiximab (Remicade) | IV q 2-8 weeks (anti TNF)-watch for TB |
| Adalimab (Humira) | SC qoweek (anti TNF)- watch for TB |
| rifmapin | used to tx TB with INH-May impart a red-orange color to urine, feces, saliva, sputum, sweat, skin & teeth - will permanently discolor soft contact lenses. hepatotoxicity |
| ethambutol (Myambutol) | Never use alone-used with other TB drugs to prevent the development of other resistant strains (decreases visual activity), MAY PRECIPITATE GOUT |
| TPN in vein should next exceed what percent of glucose? | 10-12.5% peripheral 20-40% central |
| Amino Acid requirement | 1-1.5g/kg/d -AA are 16% N |
| Calcium Phosphate incompatibility | ALWAYS ADD Ca LAST! Can result in massive pulmonary emboli and death! |
| Pulmonary disease and TPN | avoid excess carbs-carbs cause higher CO2 production |
| Felbamate (Felbatol) | Aplastic anemia and hepatic failure |
| fenofibrates | gall stones, rhabdo, absolute CI in severe renal and hepatic dx |
| Niacin | hyperuricemia, decrease insulin sensitivity, rhabdo |
| long term effects of heparin | hyperkalemia, alopecia, and osteoporosis |
| Black box warning for LMWHs | Spinal/epidural hematoma formation |
Created by:
lukaszewiczj
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