Term
| What are the side effects of benzodiazepines? |
|
Definition
Sedation, cognitive and psychomotor impairment
Interacts with alcohol
Discontinuation-related difficulties
Potential for abuse in predisposed individuals
Not effective for comorbid depression |
|
|
Term
| What is a potentially severe and dangerous side effect of giving benzodiazepines via IV? |
|
Definition
|
|
Term
| Why are benzodiazepines contraindicated in pregnancy and nursing? |
|
Definition
Birth defects may occur if used in 1st trimester
Neonatal CNS depression and withdrawal if used near term |
|
|
Term
| Benzodiazepines should not be combined with what? |
|
Definition
| Alcohol or other CNS depressants |
|
|
Term
| What are the contraindications for morphine use? |
|
Definition
| Respiratory compromise, asthma, intracranial injuries (increased intracranial pressure), paralytic ileus |
|
|
Term
| What are the side effects of morphine? |
|
Definition
| Euphoria and dysphoria, respiratory depression, nausea, constipation, sedation, pruritus, urticaria, bronchospasms, urinary retention, anxiety, hypotension, miosis |
|
|
Term
| What are the CNS effects of morphine? |
|
Definition
| Analgesia (most effective for visceral pain), euphoria, sedation, cough suppression**, respiratory depression, miosis, nausea/emesis, physical and psychological dependence, tolerance |
|
|
Term
| What are the cardiovascular effects of morphine? |
|
Definition
| Vasodilation, decreases blood pressure, some negative inotropic response |
|
|
Term
| What are the pulmonary effects of morphine? |
|
Definition
|
|
Term
| What are the effects of morphine on the skin? |
|
Definition
| Histamine release to cause itchiness |
|
|
Term
| What are the effects of morphine on the GI? |
|
Definition
| Decreases secretions and motility of gut |
|
|
Term
| How does morphine effect smooth muscle? |
|
Definition
Increases smooth muscle tone
Results in increased biliary tract contraction, detrusor muscle tone, urinary urgency, urinary retention, bronchoconstriction, reduced uterine tone prolonging labor, etc. |
|
|
Term
| What are the adverse effects of Meperidine? |
|
Definition
| Excess accumulation can cause seizures, avoid in renal patients |
|
|
Term
| Tramadol should be avoided alongside what drugs? |
|
Definition
|
|
Term
| What are the adverse effects of TCAs? |
|
Definition
Anticholinergic effects (blockade of muscarinic receptors)
Dry mouth, blurred vision, constipation, urinary retention, perspiration, orthostatic hypotension, sedation, seizures, conduction delays, weight gain |
|
|
Term
| What kind of drug interactions are there with TCAs? |
|
Definition
Alcohol increases CNS depression
Anticholinergic agents
Insulin, oral hypoglycemic agents increase hypoglycemia
Monoamine oxidase inhibitors are toxic |
|
|
Term
| What are the adverse effects of SNRI use? |
|
Definition
Dizziness, dry mouth, anorexia, somnolence, increased sweating, *nausea*
Possible serotonin syndrome
Hypertension in larger doses |
|
|
Term
| Duloxetine should be avoided in what patients? |
|
Definition
| Avoid in hepatic insufficiency or end-stage renal disease |
|
|
Term
| What are the adverse effects of MAO-inhibitors? |
|
Definition
Orthostatic hypotension
Insomnia
Weight gain
Sexual dysfunction
Anticholinergic effects
Tyramine-induced hypertensive crisis |
|
|
Term
| What kind of drug interactions are there for MAO-inhibitors? |
|
Definition
CNS stimulants can cause a hypertensive crisis
Any agent that would increase 5-HT levels may lead to serotonin syndrome |
|
|
Term
| What are the adverse effects of SSRIs? |
|
Definition
Some tolerance, sexual dysfunction, headache
Akathesia (particularly with fluoxetine)
May induce a sudden switch to mania in vulnerable
Withdrawal |
|
|
Term
| What are potential drug interactions of SSRIs? |
|
Definition
Can cause increased concentration of clozapine and may precipitate seizures
Should not be used with TCAs
Cautious use with lithium – may lead to seizures
Serotonin Syndrome (avoid with MAOIs) |
|
|
Term
| What are the manifestations of serotonin syndrome? |
|
Definition
| Akathisia-like restlessness, muscle twitches and myoclonus, hyperreflexia, sweating, shivering and tremor leading to seizures and coma |
|
|
Term
| What are the adverse effects of Bupropion? |
|
Definition
Headache, nausea, dry mouth, insomnia, tremor, CNS effects due to DA
Should not be used with MAOIs – may cause hypertensive crisis |
|
|
Term
| What are the adverse effects of Nefazodone? |
|
Definition
Strong inhibitor of CYP3A4
Significant interaction with triazolam, alprazolam |
|
|
Term
| What are the adverse effects of Mirtazapine? |
|
Definition
Significant weight gain
Somnolence
Dry mouth
Constipation |
|
|
Term
| What are the adverse effects of lithium? |
|
Definition
Low therapeutic index
Initially can cause polyuria or polydipsia, may induce nephrogenic diabetes insipidus
CV defects in pregnant, secreted in milk
Periodic concentration determination is crucial |
|
|
Term
| How do you prevent changes in in weight & depressed mood due to taking anti-epileptic drugs? |
|
Definition
| Inevitable with chronic use and adjusting dosage to minimize these side effects is not recommended since it can compromise anti-seizure efficacy |
|
|
Term
| How are anti-epileptics used in pregnant patients? |
|
Definition
Almost all of the established antiepileptics have been reported to cause birth defects, but the majority of mothers on antiepileptic medication deliver normal infants
The fetus has a better prognosis when the pregnant woman is on a single AED vs a combination of AEDs |
|
|
Term
| The risk of hepatotoxicity with valproic acid is greatest in what patients? |
|
Definition
Patients under 2 yrs & taking multiple medications
Fatal within 4 months |
|
|
Term
| What are the taratogenic effects of valproic acid? |
|
Definition
Spina bifida
Cardiovascular defects
Malformation of digits |
|
|
Term
| What are the contraindications for the use of ethosuximide? |
|
Definition
May exacerbate tonic-clonic seizures & complex partial seizures
Ineffective in management of psychomotor or major motor seizures |
|
|
Term
| What are the contraindications for the use of phenytoin? |
|
Definition
| Not useful in absence seizures |
|
|
Term
| What are the important pharmacokinetic characteristics of phenytoin? |
|
Definition
| Metabolism is saturable, if the dosing rate exceeds elimination capacity, the plasma levels of the drug quickly reach toxic levels |
|
|
Term
| What is the therapeutic index of phenytoin? |
|
Definition
Very narrow
Therapeutic effects are seen at plasma concentration between 50-100 µmol/L
Adverse effects above 100 µmol/L |
|
|
Term
| What are the side effects of chronic phenytoin use? |
|
Definition
Gingival hyperplasia especially in children & young adults
Hirsutism, coarsening features
Rash (hypersensitivity to hydantoins)
Hyperglycemia (inhibits insulin secretion)
Osteomalacia |
|
|
Term
| What are the taratogenic effects of phenytoin? |
|
Definition
Cleft palate
Heart malformations
Hypoprothrombinemia and hemorrhage |
|
|
Term
| Concurrent administration with what drug should be avoided when taking Carbamezapine? |
|
Definition
| MAO-Is due to its similarity in structure to TCA's |
|
|
Term
| What are the side effects of Carbamezapine? |
|
Definition
Antidiuretic effects and hyponatremia
Pregnancy category D, Teratogenic
Severe dermatological hypersensitivity reactions (rare) |
|
|
Term
| What kind of severe dermatological hypersensitivity reactions are associated with carbamezapine use? What causes this? |
|
Definition
Toxic epidermal necrolysis (TEN) and Stevens-Johnson Syndrome (SJS)
Strongly associated with HLA-B1502 allele, much greater risk in asians |
|
|
Term
| What are the side effects of phenobarbital? |
|
Definition
Drowsiness, Sedation, Habit-forming
Chronic treatment with high doses of causes behavioral problems in children
Agitation & confusion in adults
Over dose: Respiratory depression, CNS depression, coma, death |
|
|
Term
| Clorazepate is not used in what demographic? |
|
Definition
|
|
Term
| What are the side effects of Clonazepam and Clorazepate? |
|
Definition
Behavioral disturbances in children; hyperactivity, irritability
Drowsiness, sedation, ataxia, insomnia
Overdose: Respiratory depression
Abrupt withdrawal can cause status epilepticus |
|
|
Term
| Felbamate has what black box warning? |
|
Definition
|
|
Term
| What are the problems associated with administration of Levodopa (L-DOPA) alone |
|
Definition
Less than 1% of the dose reaches cerebral circulation due to degradation by AAD and MAO
Dopamine produced by peripheral conversion of L-DOPA produces side effects such as nausea, vomiting, cardiovascular effects |
|
|
Term
| What are the side effects of Carbidopa/Levodopa (Sinemet)? |
|
Definition
Hypotension due to peripheral dopamine induced vasodilation
Cardiac arrhythmias, daytime sleepiness, schizophrenia
Mydriasis & acute increases in intraocular pressure (IOP)
Dyskinesia: Involuntary writhing movements
On/Off periods |
|
|
Term
| Carbidopa/Levodopa (Sinemet) is contraindicated in patients with what? |
|
Definition
Psychosis
Narrow angle glaucoma
Peptic ulcer disease
Patients taking nonspecific inhibitors of MAO |
|
|
Term
| What are the consequences of long term L-Dopa therapy? |
|
Definition
Tolerance and sensitization to the medication resulting in a “narrow therapeutic window”
Decreased buffer synaptic concentrations of dopamine
Altered the sensitivity to synaptic dopamine levels accentuating, responses to high (On) & low (off ) concentrations |
|
|
Term
| What are the disadvantages of dopamine receptor agonists compared to L-Dopa? |
|
Definition
| Hallucinations and hypotension are much more common |
|
|
Term
| Why is pergolide no longer used as a dopamine receptor agonist? |
|
Definition
| Long-term use associated with significant damage to cardiac valves. The drug has been removed from the market |
|
|
Term
| What are the side effects of ergot alkaloid non-specific dopamine receptor agonists? |
|
Definition
Initial treatment causes profound hypotension
Often induce nausea and fatigue with initial treatment |
|
|
Term
| What are the side effects of Ropinirole and Pramipexole (selective dopamine receptor agonists)? |
|
Definition
| Hallucinations, Somnolence |
|
|
Term
| What are the side effect considerations of apomorphine? What should it be given alongside? |
|
Definition
High potential to cause nausea & vomiting
Pretreatment with antiemetic trimethobenzamide |
|
|
Term
| Apomorphine should be avoided alongside what drugs? |
|
Definition
Antiemetics that are 5HT3 antagonists (ex. ondansetron)
Causes significant hypotension and can lead to fainting episodes |
|
|
Term
| Inhibition of MAO-A retards breakdown of all central & peripheral catecholamines can lead to life threatening side effects when combined with what drugs? |
|
Definition
| Drugs that increase catecholamine levels (TCAs, SSRIs, SNRIs, tyramines etc.) |
|
|
Term
| What are the side effects of Selegiline? |
|
Definition
MAO-B inhibitor, increases the adverse motor and cognitive effects of L-DOPA therapy in advanced Parkinson's
Metabolized into amphetamine and methamphetamine |
|
|
Term
| What are the side effects of muscarinic receptor antagonists? |
|
Definition
Sedation and mental confusion
Blurred vision through cycloplegia
Cautious use in narrow-angle glaucoma
Constipation
Urinary retention |
|
|
Term
| What drugs increase the symptoms of schizophrenia by increasing neurotransmitter levels? |
|
Definition
Amphetamines
Methyphenidate and Cocaine
L-DOPA |
|
|
Term
| What are the side effects of typical anti-psychotics? |
|
Definition
| Significant motor side effects (EPS) and hyperprolactinemia |
|
|
Term
| What are the side effects of atypical anti-psychotics? |
|
Definition
| Minimal EPS and hyperprolactinemia |
|
|
Term
| What causes the side effects seen in first generation typical anti-psychotics? |
|
Definition
Non-target blockade of D2 receptors
Motor side effects aka extrapyramidal symptoms (EPS) due to blockade of dopamine receptors in the nigrostriatal pathway |
|
|
Term
| What causes the autonomic histaminergic side effects seen with the use of all anti-psychotics? |
|
Definition
Blockade of D2 receptors in the tuberoinfundibular pathway causes hyperprolactinemia
Blockade of muscarinic receptors:
Dry mouth, difficulty urinating or retention, constipation, blurred vision, confusion
Blockade of α adrenoceptors: Orthostatic hypotension
Blockade of H1 histamine receptors: Sedation |
|
|
Term
| Which atypical anti-psychotics also cause the EPS and neuroendocrine symptoms at high doses seen with typical anti-psychotic use? |
|
Definition
|
|
Term
| What side effect is slightly more pronounced in atypic anti-psychotics compared to typicals? |
|
Definition
Weight gain
Less of a problem with the newest atypicals (Ziprasidone & Aripiprazole) |
|
|
Term
| Why is the use of Clozapine (atypical) restricted? |
|
Definition
| Danger of fatal neutropenia |
|
|
Term
| What is an unusual side effect of Clorazapine? |
|
Definition
| Instead of causing dry mouth, this drug causes hyper salivation |
|
|
Term
| What are the drawbacks of Olanzapine (atypicals) |
|
Definition
Minimal effective dose is 10 mg. Increased incidence of EPS at doses > 25-30 mg
Weight gain more than the other antipsychotics |
|
|
Term
| What are the drawbacks of Risperidone (atypical)? |
|
Definition
At doses higher than 8 mg:
EPS, Hyperprolactinemia, Weight gain |
|
|
Term
| What are the side effects of Quetiapine (atypical)? |
|
Definition
Somnolence/Sedation
Postural hypotension |
|
|
Term
| What is the black box warning for Aripirprazole? |
|
Definition
| Studies have shown that older adults with dementia have an increased chance of death during treatment. Older adults with dementia may also have a greater chance of having a stroke or ministroke or other severe side effects during treatment |
|
|
Term
| Which of the following should not be used in patients with sulfonamide allergies? |
|
Definition
|
|
Term
| What are general concerns with use of all anesthetic drugs? |
|
Definition
Very narrow therapeutic index, must monitor levels since the margin between surgical anesthesia and fatal respiratory/circulatory depression is narrow
Most decrease myocardial contractility and reduce BP
All depress respiration markedly and increase arterial PCO2 |
|
|
Term
| What are the dangers of using Thiopental as an anesthetic? |
|
Definition
Slowly metabolized, accumulates in the body, prolonged effect if given repeatedly, tissue damage if extravascular
Precipitates when it comes in contact with drugs in acidic solution
Narrow margin of error: CV depression |
|
|
Term
| What are the drawbacks of using Etomidate as an anesthetic? |
|
Definition
Severe nausea
Causes involuntary movements during induction
Risk of adrenocortical suppression |
|
|
Term
| What are the drawbacks of using Ketamine as an anesthetic? |
|
Definition
High incidence of hallucinations etc
Can raise intracranial pressure |
|
|
Term
| What are the side effects of Ziprasidone? |
|
Definition
Newer generation atypical similar to Aripiprazole
Potential for cardiac arrhythmia in patients with baseline risk factors:
Elderly, preexisting cardiac disease
Taking diuretics or medication that prolong QT interval |
|
|
Term
| What is nitrous oxide toxicity? |
|
Definition
Caused by chronic use
Leads to symptoms similar to B12 deficiency (pernicious anemia) such as neuropathy, tinnitus, numbness
Increases cerebral blood flow
Expands air-filled cavities due to being 40x as soluble as nitrogen, is passes from the blood into the cavity faster than nitrogen can diffuse out |
|
|
Term
| Nitrous oxide use is contraindicated in what patients? |
|
Definition
Patients with
bowel obstruction
pneumothorax
middle ear and sinus disease
during general anesthesia for gas-filled eye procedures
Patients with increased intracranial pressure |
|
|
Term
| The Minimal Alveolar Concentration (MAC) for anesthetics decreases in what kind of patients? |
|
Definition
| Elderly patients, patients with hypothermia, presence of adjuvant drugs, hypoxemia, hypotension, or anemia |
|
|
Term
| How do inhaled anesthetics affect the cardiovascular system? |
|
Definition
Decrease mean arterial pressure in direct proportion to alveolar concentration
Decrease systemic vascular resistance
Reduce myocardial oxygen consumption causing ischemia |
|
|
Term
| What unique side effect does Halothane have on the cardiovascular system? |
|
Definition
Sensitizes the myocardium to catecholamines
Enflurane and halothane have greater myocardial depressant effects |
|
|
Term
| What are the side effects on the respiratory system when using inhaled anesthetics? |
|
Definition
Dose-dependent decrease in tidal volume and increase in respiratory rate during spontaneous ventilation
Decreased minute ventilation & ventilatory response to CO2
Depresses mucociliary function in the airway
Bronchodilatory effects |
|
|
Term
| What are the side effects on the kidneys when using inhaled anesthetics? |
|
Definition
Decreased renal blood flow
Theoretical nephrotoxicity |
|
|
Term
| How might enflurane and sevoflurane cause nephrotoxicity? |
|
Definition
| Metabolism could lead to formation of fluoride ions intrarenally. However, there are no reports of renal injury, risk is theoretical |
|
|
Term
| Which anesthetic can, in rare cases, cause potentially severe and life-threatening hepatitis, particularly in obese patients undergoing multiple exposures within a short amount of time? |
|
Definition
|
|
Term
| How might inhaled anesthetics cause malignant hyperthermia? |
|
Definition
Autosomal dominant genetic disorder of skeletal muscle
Occurs in susceptible individuals undergoing general anesthesia with inhaled agents and muscle relaxants |
|
|
Term
| Which inhaled anesthetics are most likely to cause malignant hyperthermia in susceptible individuals? |
|
Definition
Halothane and enflurane
Involves increase in free calcium concentration |
|
|
Term
| The anesthetic Isoflurane has what unintended side effects? |
|
Definition
May cause MI in patients with coronary disease
Irritant to respiratory tract |
|
|
Term
| The anesthetic Desflurane has what unintended side effects? |
|
Definition
Similar to isoflurane, faster onset and recovery
Respiratory irritant causes cough and laryngospasm |
|
|
Term
| The anesthetic Sevoflurane has what unintended side effects? |
|
Definition
Similar to desflurane but no respiratory irritation
Theoretical risk of nephrotoxicity : No evidence |
|
|
Term
| The anesthetic Enflurane has what unintended side effects? |
|
Definition
Similar to halothane but less metabolism, less toxicity
Risk of epilepsy like seizures |
|
|
Term
| What are the risks associated with spinal anesthesia? |
|
Definition
| Bradycardia, hypotension, respiratory depression if it spreads to the brain, urinary retention |
|
|
Term
| What are the neurotoxic effects of local anesthetics? |
|
Definition
| All can be neurotoxic at very high concentrations. Ex. Pooling in the cauda equina |
|
|
Term
| Which local anesthetics are more clinically likely to cause neurotoxicity? |
|
Definition
Lidocaine or chlorprocaine
When used for continuous spinal(subarachnoid) block |
|
|
Term
| What are the cardiovascular side effects of local anesthetics? |
|
Definition
Depression of myocardial contractility/strength, conduction block and vasodilation due to blocked Na+ influx
Blockade of AV conduction and Ca+ stores
Vasodilation at vasculature and indirectly inhibited sympathetic activity causes sudden fall in BP |
|
|
Term
| What are the unique cardiovascular effects of cocaine? |
|
Definition
| Hypertension, arrhythmias |
|
|
Term
| How might local anesthetics cause cardiovascular collapse? |
|
Definition
Epidural needle or continuous infusion catheters enter an epidural vein and is not recognized
Epidural veins enlarge during pregnancy |
|
|
Term
| How do you rule out inadvertent subarachnoid injection (total spinal results) or intravascular injection (seizure, cardiac effects) with local anesthetics? |
|
Definition
Give a "test dose" of epinephrine containing lidocaine prior to giving a large volume of local anesthetic epidurally
Not always 100% accurate |
|
|
Term
| What are the CNS side effects of local anesthetics? |
|
Definition
Light-headedness, tinnitus, metallic taste, circumoral numbness, drowsiness, slurred speech and nystagmus
At higher levels: Anxiety development of fine tremors of the muscles of the hands and/or face
Tonic/Clonic seizures
Severe CNS depression and death |
|
|
Term
| What local anesthetic has high CNS and CV side effects and are therefore not used? |
|
Definition
|
|
Term
| Prilocaine causes what unusual side effect in high doses? |
|
Definition
Methhemoglobinemia
May lead to accumulation of o-toluidine (oxidizing agent capable of converting HgB to methemoglobin) |
|
|
Term
| What are the concerns associated with the use of epinephrine? |
|
Definition
Cardiac arrhythmias in patients with heart disease or with concomitant use of halothane
May be detrimental to flap viability (grafts)
Dangerous if used on tips of fingers, penis
Hypertension |
|
|
Term
| What types of drugs interact poorly with phase I of succinylcholine? |
|
Definition
|
|
Term
| What are the side effects of succinylcholine? |
|
Definition
Postoperative muscle pain due to fasciculations
Decreases HR, increases IOP at high doses by blocking ganglionic nicotinic receptors
Hyperkalemia |
|
|
Term
| What types of patients experience greater bouts of hyperkalemia as a side effect of succinylcholine? |
|
Definition
| Patients with burns (peaks in 7-10 days) trauma or spinal cord injury, peripheral nerve dysfunction, or muscular dystrophy |
|
|
Term
| What is the most serious possible side effect of succinylcholine? |
|
Definition
|
|
Term
| Which isoqinolone based non-depolarizing blocker can cause hypotension due to ganglion block and release of histamine, bronchoconstriction due to histamine release |
|
Definition
|
|
Term
| Which isoqinolone based non-depolarizing blocker is associated with hypotension, histamine release, the toxic metabolite laudanosine, and has greater accumulation with renal failure |
|
Definition
|
|
Term
| Which isoqinolone based non-depolarizing blocker causes the least amount of hypertensive side effects as well as less histamine release and less formation of toxic metabolites? |
|
Definition
|
|
Term
| Which amino steroid based non-depolarizing blocker can promote muscarinic block as a side effect? |
|
Definition
|
|
Term
| What are the side effects of neuromuscular junction blockers? |
|
Definition
| Respiratory paralysis, histamine release, autonomic effects |
|
|
Term
| Which anesthetics can strongly potentiate and prolong neuromuscular blockade? |
|
Definition
| Inhaled neuromuscular junction blocking anesthetics, particularly isoflurane |
|
|
Term
| Potentiation and prolonged relaxant action of neuromuscular blockers occurs with what drugs? |
|
Definition
| Aminoglycoside antibiotics and antiarrhythmic agents |
|
|
Term
| What are the side effects of Cyclobenzaprine? |
|
Definition
Marked sedative and antimuscarinic action
May cause confusion and visual hallucinations in some patients |
|
|
Term
| Methocarbamol is contraindicated under what conditions? |
|
Definition
|
|
Term
| What is the primary side effect of Carisoprodol? |
|
Definition
| Drowsiness, avoid with alcohol |
|
|
Term
| Triggered rhythms are in danger of progressing to what? |
|
Definition
|
|
Term
| What causes Torsades de Points? |
|
Definition
Prolongation of QT due to:
Electrolyte imbalance
Persistent bradycardia
Class I or III drugs (block cardiac K+ channels)
Certain non-cardiac drugs
Congenital QT prolongation |
|
|
Term
| What effect do class IA drugs have on ECG readings? |
|
Definition
|
|
Term
| What effect do class IB drugs have on ECG readings? |
|
Definition
|
|
Term
| What effect do class IC drugs have on ECG readings? |
|
Definition
Inc PR
Inc QRS
QT unchanged or inc |
|
|
Term
| What effect do class II drugs have on ECG readings? |
|
Definition
PR non or inc
QT non or dec |
|
|
Term
| What effect do class III drugs have on ECG readings? |
|
Definition
PR non or inc
QRS non or inc
QT inc |
|
|
Term
| What effect do class IV drugs have on ECG readings? |
|
Definition
|
|
Term
| What are the effects of class IA antiarrhythmics on AP propagation? |
|
Definition
Intermediate acting
Prolongs AP |
|
|
Term
| What are the effects of class IB antiarrhythmics on AP propagation? |
|
Definition
|
|
Term
| What are the effects of class IC antiarrhythmics on AP propagation? |
|
Definition
Slow acting
No effect on AP |
|
|
Term
| What drug interactions are seen with Quinidine? |
|
Definition
| Reduces Digoxin clearance |
|
|
Term
| What are the side effects of Quinidine? |
|
Definition
Marked nausea
Diarrhea
Cinchonism (deafness, tinnitus, blurred vision)
Thrombocytopenic purpura |
|
|
Term
| Quinidine is contraindicated with what condition? |
|
Definition
|
|
Term
| What are the effects of class IA antiarrhythmics on AP propagation? |
|
Definition
Intermediate acting
Prolongs AP |
|
|
Term
| What are the effects of class IB antiarrhythmics on AP propagation? |
|
Definition
|
|
Term
| What are the effects of class IC antiarrhythmics on AP propagation? |
|
Definition
Slow acting
No effect on AP |
|
|
Term
| What are the side effects of Procainamide? |
|
Definition
Lupus-like syndromes, hypotension, depression, hallucination, psychosis
Adjust dosage with renal function |
|
|
Term
| What are the side effects of Disopyramide? |
|
Definition
Pronounced antimuscarinic effects
Dry mouth, blurred vision, constipation, urine retention, and sometimes precipitates glaucoma
Can also worsen heart block & adversely effect sinus node activity
Prolongs QT interval, can cause Torsades
Contraindicated in long QT syndrome |
|
|
Term
| How do you treat class IA antiarrhythmic overdose? |
|
Definition
Cardiac effects can be exacerbated by hyperkalemia
Arrhythmias revered by Sodium Lactate IV which increases the ionic gradient
Sympathomimetics can reverse hypotension |
|
|
Term
| What are the limitations of Lidocaine? |
|
Definition
IV only limits to emergency setting, no maintenance therapy
Adjust dose with reduced hepatic flow such as in CHF or older patients |
|
|
Term
| What are the side effects of Flecainide? |
|
Definition
Very proarrhythmic
CNS effects
Negative ionotropic effects, can aggravate CHF |
|
|
Term
| What are the side effects of Propranolol? What are its contraindications? |
|
Definition
Excessive bradycardia
Bronchospasms
Depression, fatigue
Use with caution in asthma and diabetes |
|
|
Term
| What are the side effects of Sotalol? |
|
Definition
Can prolong QT intervals and cause Torsades
Dyspnea and dizziness
Adjust in renal disease |
|
|
Term
| What are the side effects of Class IV antiarrhythmics and what makes them worse? |
|
Definition
AV block in large doses or in patients with partial block
Made worse with beta-blockers |
|
|
Term
| What are the side effects of Adenosine? |
|
Definition
| Flushing, hypotension, chest pain, dyspnea |
|
|
Term
| What electrolyte abnormality causes AV block with Digitalis? |
|
Definition
|
|
Term
| What are the side effects of nitrates? |
|
Definition
Flushing, Nausea
Throbbing Headache (meningeal artery vasodilation)
Orthostatic Hypotension
Reflex Tachycardia
Syncope, Dizziness
Large IV dose can cause methemoglobinemia |
|
|
Term
| What is the drawback of continued use of nitrates? |
|
Definition
Tolerance develops after days of continual therapy
Overcome with treatment free intervals during the night |
|
|
Term
| Nitrates are contraindicated with what other drugs? |
|
Definition
Phosphodiesterase inhibitors (Sildenafil, Tadelafil)prolongs effects, can cause hypotensive shock
Migraine medication can increase BP and decrease effects |
|
|
Term
| What is the drawback of nitrate tablets? |
|
Definition
| Volatile, loses potency when exposed to air and light, only usable for 6 months after opening |
|
|
Term
| What are the side effects of Bepiridil? |
|
Definition
Heart failure if combined with beta-blockers
Torsades and other arrhythmias
Agranulocytosis |
|
|
Term
| What are the side effects of Verapamil? |
|
Definition
Constipation & Gingival hyperplasia
Sinus bradycardia
High doses can cause myocardial depression, heart failure, edema, hypotension |
|
|
Term
| What are the side effects of Diltiazem? |
|
Definition
Sinus bradycaria
AV block, Heart failure (When used in combination with beta blockers)
Peripheral effects (hypotension, edema) |
|
|
Term
| What cardiac drugs are generally avoided in variant angina? |
|
Definition
| Beta-lockers, have minimal effects |
|
|
Term
| What is acute coronary syndrome (ACS)? |
|
Definition
A life threatening condition in pts w/coronary disease
Continuum that ranges from an unstable pattern of angina pectoris to the development of a large acute myocardial infarction (irreversible necrosis of the heart muscle) |
|
|
Term
| What are the side effects of heparin? |
|
Definition
Bleeding is primary adverse effect
Osteoporosis
Heparin induced throbocytopenia
Allergy due to animal origin |
|
|
Term
| What are the contraindications to heparin? |
|
Definition
Hypersensitivity to UFH
Hypersensitivity, pork products, or methylparaben with LMWH
History of HIT |
|
|
Term
| What is given for a heparin overdose? |
|
Definition
|
|
Term
| What are the side effects of Rivaroxaban? |
|
Definition
Bleeding
Black box warning of possible paralysis with enuraxial anesthesia or spinal puncture |
|
|
Term
| What are the side effects of the monovalent direct thrombin inhibitors (Argatroban and Dabigatran etexilate)? |
|
Definition
| Hemorrhage (serious, most common) |
|
|
Term
| Lepirudin is contraindicated alongside what condition? |
|
Definition
|
|
Term
| Argatroban is contraindicated alongside what condition? |
|
Definition
|
|
Term
| Dabigatran should be avoided alongside what other drugs? |
|
Definition
| P-glycoprotein inducers (i.e. rifampin) reduces exposure |
|
|
Term
| What are the side effects of Warfarin? |
|
Definition
Hemorrhage of the bowel or the brain
Correct dosing requires continual monitoring
Birth defects, crosses placenta |
|
|
Term
| What are contraindications to thrombolytic therapy? |
|
Definition
Recent surgery (w/in 10 days)
Serious GI bleed w/in 3 months
History of HTN
Active bleeding disorder
Previous cerebrovascular accident w/in 30mo
Aortic dissection
Acute pericarditis |
|
|
Term
| What are the side effects of fibrinolytic drugs? |
|
Definition
| Hemorrhage due to lysis of fibrin in physiological thrombi |
|
|
Term
| What are the side effects of Tranexamic acid and Aminocaproic acid? |
|
Definition
| Thrombi formation that can lead to renal failure |
|
|
Term
| How does injury encourage the formation of a thrombus? |
|
Definition
| When underlying basal lamina is exposed to the blood stream, PGI2 decreases -> GPIa/IIa receptors on platelets and von Willebrand factor -> COX-1 -> ADP -> GPIIb/IIIa activation -> platelet aggregation |
|
|
Term
| What are the side effects of Aspirin? |
|
Definition
| Bleeding, salicylism – generally with larger doses than used for this indication |
|
|
Term
| What are the side effects of ADP antagonists (Clopidogrel and Prasugrel)? |
|
Definition
| Thrombotic thrombocytopenic purpura |
|
|
Term
| What are the side effects of Aspirin? |
|
Definition
| Bleeding, salicylism – generally with larger doses than used for this indication |
|
|
Term
| What are the side effects of ADP antagonists (Clopidogrel and Prasugrel)? |
|
Definition
| Thrombotic thrombocytopenic purpura |
|
|
Term
| When is Celocoxib contraindicated? |
|
Definition
| With cardiovascular disorders |
|
|
Term
| How does aspirin affect uric acid secretion? |
|
Definition
At low doses, uric acid secretion is decreased
At high doses, excretion is increased, can precipitate gout |
|
|
Term
| What are the side effects of aspirin? |
|
Definition
Reye's syndrome
Liver dysfunction and encephalopathy
Contraindicated in children with viral infections |
|
|
Term
| What are the symptoms of aspirin overdose? |
|
Definition
GI distress and bleeding
Bronchoconstriction
Renal dysfunction
Hypersensitivity
Renal dysfunction |
|
|
Term
| What are the effects of Indomethacin? |
|
Definition
Prominent anti-inflammatory, antipyretic and analgesic activity
Reduces polymorphonuclear leukocyte motility
Reduces development of cellular exudates and reduces vascular permeability in injured tissue |
|
|
Term
| What is the ONLY NSAID that does not cause renal dysfunction? |
|
Definition
|
|
Term
| Why are COX-2 selective inhibitors such as Celocoxib or Dicolfenac dangerous in patients with cardiovascular disease? |
|
Definition
| May increase risk of thrombosis which increases risk of MI or stroke |
|
|
Term
| When are NSAIDs contraindicated with pregnancy? |
|
Definition
| During the third-trimester due to risk of post-partum hemorrhage and delayed labor |
|
|
Term
| What is the side effect of colchicine that severely limits its use? |
|
Definition
|
|
Term
| Probenicid is contraindicated with what condition? |
|
Definition
|
|
Term
| What factors promote rheumatic arthritis? |
|
Definition
Genetic disposition
Age related wear and tear
Hypothermia
Infection |
|
|
Term
| What are the pro-inflammatory cytokines involved in the progression of rheumatoid arthritis? |
|
Definition
|
|
Term
| C-reactive protein in the blood is indicative of the presence of what? |
|
Definition
|
|
Term
| What are the systemic signs of rheumatoid arthritis? |
|
Definition
Rheumatoid nodules
Vasculitis in finger beds
Pleural effusions and pulmonary fibrosis
Pericarditis
Splenomegaly, neutropenia |
|
|
Term
| What is the drawback of DMARD therapy for rheumatoid arthritis? |
|
Definition
Slow acting, may take months for benefit
No analgesic activity |
|
|
Term
| What should be avoided with Methotrexate? |
|
Definition
Alcohol
Essential to monitor liver function
Must give with folic acid supplements |
|
|
Term
| What are the side effects of Methotrexate? |
|
Definition
Hepatotoxicity
Pulmonary fibrosis
GI distress
Pregnancy category X |
|
|
Term
| What are the side effects of Hydroxychloroquine? |
|
Definition
| A quinine containing drug which causes cinchoism ( flushed and sweaty skin, ringing of the ears (tinnitus), blurred vision, impaired hearing, confusion, reversible high-frequency hearing loss, headache, abdominal pain, etc) |
|
|
Term
| What are the side effects of Sulfasalazine? |
|
Definition
| Causes GI distress, start with low dose |
|
|
Term
| What are the side effects of Leflunomide? |
|
Definition
Metabolized to active metabolite, caution in renal dysfunction
Can combine with methotrexate but high risk of hepatotoxicity |
|
|
Term
| Etanercept should be avoided alongside what drugs? |
|
Definition
| May be combined with DMARD with the exception of Anakinra |
|
|
Term
| What are the general side effects of most DMARDs? |
|
Definition
Injection site reactions
1st dose phenomenon
Headache, dizziness
Immunosuppressive (AVOID with infections) |
|
|
Term
| Anakinra is contraindicated with what drugs? |
|
Definition
TNF antagonists (Etanercept and Infliximab)
Abatacept |
|
|
Term
| Rituximab should be avoided with what conditions? |
|
Definition
Renal dysfunction
Separate from hypertensive therapy for 12hrs |
|
|
Term
| What are the side effects of Rituximab? |
|
Definition
Angioedema
Fatigue
Nausea, vomiting
Headache
Hypotension
Rash, urticaria |
|
|
Term
| How does beta-2 receptor polymorphism impact the treatment of asthma with beta-2 agonists? |
|
Definition
| An Arginine at position 16 increases the risk for exacerbations with short- or long-term agonists |
|
|
Term
| When should oral agents be used instead of inhaled for the treatment of asthma? |
|
Definition
Greater incidence of side effects vs. inhaled
Used in young children unable to use inhalers |
|
|
Term
| What are the side effects of beta-2 agonists? |
|
Definition
Nervousness/anxiety
Palpitations
Tachycardia
Tremors |
|
|
Term
| What drug interactions are there for beta-2 agonists? |
|
Definition
MAO-I
TCA antidepressents
Avoid Anything that increases catecholamines |
|
|
Term
| Beta-2 agonists should be avoided with what conditions? |
|
Definition
Cardiovascular disorders
Convulsive disorders
Diabetes mellitus |
|
|
Term
| What are the side effects of glucocorticoids? |
|
Definition
Epistaxis
Bone demineralization (less likely in inhaled)
Oropharyngeal candidiasis
Pharyngitis
HPA axis suppression (unlikely with inhaled)
Glaucoma
Headache
Fewer systemic effects when inhaled |
|
|
Term
| Glucocorticoids should be avoided alongside what conditions? |
|
Definition
Infections
Glaucoma
If oral, caution with CYP450 metabolizers, diabetes, diabetes, peptic ulcers, osteoporosis |
|
|
Term
| What are the side effects of leukotriene inhibitors? |
|
Definition
Elevated liver enzymes with Zileuton
Nausea/dyspepsia
Neuropsychiatric events: agitation, depression, anxiety, etc. |
|
|
Term
| Leukotriene inhibitors have what drug interaction? |
|
Definition
| Zileuton decreases warfarin and theophylline clearance |
|
|
Term
| Ipratropium should be cautioned alongside what other asthma drug? |
|
Definition
| Combined with albuterol can cause rare occurrence of MI |
|
|
Term
| What are the side effects of muscarinic antagonists? |
|
Definition
Palpitations
Nervousness
Fatigue
Headache
Dry mucus membranes
Influenza-like symptoms |
|
|
Term
| What conditions require caution when using muscarinic antagonists? |
|
Definition
Acute episode of bronchospasm
Myasthenia gravis
Narrow-angle glaucoma
Prostatic hyperplasia
Bladder obstruction |
|
|
Term
| Why is theophylline not commonly used to treat asthma? |
|
Definition
Narrow therapeutic window
Caution in drugs that decrease metabolism or clearance such as zileuton
High doses can cause seizures or cardiac arrhythmia |
|
|
Term
| What are the side effects of Amalizumab? |
|
Definition
Injection-site reactions
Anaphylactic shock, give under supervision
Symptoms return upon cessation of treatment |
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