USMLE (Fach) / Pharmacology - Toxicities and side effects (Lektion)
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USMLE First Aid
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- Fanconi syndrome - Cisplatin- Ifosfamide- Expired tetracyclines- Tenofovir
- Hemorrhagic cystitis - Cyclophosphamide- Ifosfamide - Prevent by coadministering with mesna
- Interstitial nephritis - Penicillins- Furosemide- NSAIDs- Proton pump inhibitors- Sulfa drugs
- Pulmonary fibrosis - Methotrexate- Bleomycin- Busulfan- Amiodarone- Nitrofurantoin- Carmustine
- Disulfiram-like reaction - Metronidazole- Griseofulvin- Procarbazine- 1st-generation sulfonylureas- Certain cephalosporines
- Nephrotoxicity/ototoxicity - Cisplatin- Aminoglycosides- Loop diuretics- Vancomycin- Amphotericin B Cisplatin toxicity may respond to amifostine.
- Drugs affecting pupil size ↑ pupil size- Anticholinergics (atropine, TCA, tropicamide, scopolamide, antihistamines)- Drugs of abuse (amphetamines, cocaine, LSD)- Symphathomimetics ↓ pupil size- Antipsychotics (haloperidol, ...
- Cytochrome P-450 inducers - Rifampin- Modafinil- Chronic alcohol use- St. John's wort (antidepressant features)- Anticonvulsants (phenytoin, phenobarbital, carbamazepine)- Griseofulvin- Nevirapine (NNRTI)
- Cytochrome P-450 substrates - Anti-epileptics- Warfarin- Theophylline- Oral contraceptives
- Cytochrome P-450 inhibitors - Isoniazid- Grapefruit juice- Valproate- Cimetidine- Ketoconazole, fluconazole- Acute alcohol abuse- Chloramphenicol- Erythromycin/clarithromycin- Sulfonamides- Ciprofloxacin- Omeprazole- Metronidazole- ...
- Sulfa drugs - Sulfonamide antibiotics- Sulfasalazine- Probenecid- Furosemide- Acetazolamide- Celecoxib- Thiazides- Sulfonylureas Patients with sulfa allergies may develop fever, urinary tract infection, Stevens-Johnson ...
- Ethylene glycol toxicity Toxic alcohol that is metabolized to glycolate, which is cytotoxic to the renal tubules and causes acute tubular necrosis. Glycolate is further metabolized to oxalate, which contributes to oliguric renal ...
- Androgen abuse Cardiovascular: ↑ Hematocrit, ↑ LDL, ↓ HDL cholesterol Dermatologic: Acne, hirsutism, male-pattern hair loss Genitourinaty: Testicular atrophy, ↓ spermatogenesis; clitoromegaly, oligomenorrhea ...
- Cyanide poisoning Deadly poison that binds irreversibly to cytochroma a/a3, preventing electron transfer to oxygen. Sources: Burning of rubber or plastic Presentation:- Reddish skin discoloration- Bitter almond breath- ...
- Nitrate poisoning Nitrates cause poisoning by inducing the conversion of this heme iron to the oxidized ferric (Fe3+) state, leading to the formation of methemoglobin.With iron in the oxidized ferric state, methemoglobin ...
- Carbon monoxide Carbon monoxide binds to cytochrome a/a3 but less tightly than cyanide. It also binds to hemoglobin, displacing oxygen. Sources:- Propane heaters and gas grills- Vehicle exhause- Tobacco smoke- House ...
- Arsenic poisoning Arsenic inhibits lipoic acid- Binds to sulfhydryl groups- Disrupts cellular respiration & gluconeogenesis Sources:- Pesticides/insecticides- Contaminated water (often from wells)- Pressure-treated wood ...
- Methemoglobinuria Clinical features:0-3% of total hemoglobin: physiological>3%: visible cyanosis (a brownish-blue or greyish coloration of the skin and membranes)>20%: clinical symptoms of oxygen deprivation, brown blood ...