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
QUESTIONS 1 of 9 1 2 3 4 5 6 7 8 9 Previous Next Lab Values Blood Hematologic Cerebrospinal Sweat, Urine, and BMI Blood, Plasma, Serum Reference Range ALT 8-20 U/L Amylase, serum 25-125 U/L AST 8-20 U/L Bilirubin, serum (adult) Total // Direct 0.1-1.0 mg/dL // 0.0-0.3 mg/dL Calcium, serum (Ca2+) 8.4-10.2 mg/dL Cholesterol, serum Rec: < 200 mg/dL Cortisol, serum 0800 h: 5-23 μg/dL //1600 h: 3-15 μg/dL 2000 h: ≤ 50% of 0800 h Creatine kinase, serum Male: 25-90 U/LFemale: 10-70 U/L Creatinine, serum 0.6-1.2 mg/dL Electrolytes, serum Sodium (Na+) 136-145 mEq/L Chloride (Cl-) 95-105 mEq/L Potassium (K+) 3.5-5.0 mEq/L Bicarbonate (HCO3-) 22-28 mEq/L Magnesium (Mg2+) 1.5-2.0 mEq/L Estriol, total, serum (in pregnancy) 24-28 wks // 32-36 wks 30-170 ng/mL // 60-280 ng/mL 28-32 wk // 36-40 wks 40-220 ng/mL // 80-350 ng/mL Ferritin, serum Male: 15-200 ng/mLFemale: 12-150 ng/mL Follicle-stimulating hormone, serum/plasma Male: 4-25 mIU/mL Female: premenopause: 4-30 mIU/mL midcycle peak: 10-90 mIU/mL postmenopause: 40-250 pH 7.35-7.45 PCO2 33-45 mmHg PO2 75-105 mmHg Glucose, serum Fasting: 70-110 mg/dL2-h postprandial:<120 mg/dL Growth hormone - arginine stimulation Fasting: <5 ng/mLProvocative stimuli: > 7ng/mL Immunoglobulins, serum IgA 76-390 mg/dL IgE 0-380 IU/mL IgG 650-1500 mg/dL IgM 40-345 mg/dL Iron 50-170 μg/dL Lactate dehydrogenase, serum 45-90 U/L Luteinizing hormone, serum/plasma Male: 6-23 mIU/mL Female: follicular phase: 5-30 mIU/mL midcycle: 75-150 mIU/mL postmenopause 30-200 mIU/mL Osmolality, serum 275-295 mOsmol/kd H2O Parathyroid hormone, serume, N-terminal 230-630 pg/mL Phosphatase (alkaline), serum (p-NPP at 30° C) 20-70 U/L Phosphorus (inorganic), serum 3.0-4.5 mg/dL Prolactin, serum (hPRL) < 20 ng/mL Proteins, serum Total (recumbent) 6.0-7.8 g/dL Albumin 3.5-5.5 g/dL Globulin 2.3-3.5 g/dL Thyroid-stimulating hormone, serum or plasma .5-5.0 μU/mL Thyroidal iodine (123I) uptake 8%-30% of administered dose/24h Thyroxine (T4), serum 5-12 μg/dL Triglycerides, serum 35-160 mg/dL Triiodothyronine (T3), serum (RIA) 115-190 ng/dL Triiodothyronine (T3) resin uptake 25%-35% Urea nitrogen, serum 7-18 mg/dL Uric acid, serum 3.0-8.2 mg/dL Hematologic Reference Range Bleeding time 2-7 minutes Erythrocyte count Male: 4.3-5.9 million/mm3Female: 3.5-5.5 million mm3 Erythrocyte sedimentation rate (Westergren) Male: 0-15 mm/hFemale: 0-20 mm/h Hematocrit Male: 41%-53%Female: 36%-46% Hemoglobin A1c ≤ 6 % Hemoglobin, blood Male: 13.5-17.5 g/dLFemale: 12.0-16.0 g/dL Hemoglobin, plasma 1-4 mg/dL Leukocyte count and differential Leukocyte count 4,500-11,000/mm3 Segmented neutrophils 54%-62% Bands 3%-5% Eosinophils 1%-3% Basophils 0%-0.75% Lymphocytes 25%-33% Monocytes 3%-7% Mean corpuscular hemoglobin 25.4-34.6 pg/cell Mean corpuscular hemoglobin concentration 31%-36% Hb/cell Mean corpuscular volume 80-100 μm3 Partial thromboplastin time (activated) 25-40 seconds Platelet count 150,000-400,000/mm3 Prothrombin time 11-15 seconds Reticulocyte count 0.5%-1.5% of red cells Thrombin time < 2 seconds deviation from control Volume Plasma Male: 25-43 mL/kgFemale: 28-45 mL/kg Red cell Male: 20-36 mL/kgFemale: 19-31 mL/kg Cerebrospinal Fluid Reference Range Cell count 0-5/mm3 Chloride 118-132 mEq/L Gamma globulin 3%-12% total proteins Glucose 40-70 mg/dL Pressure 70-180 mm H2O Proteins, total < 40 mg/dL Sweat Reference Range Chloride 0-35 mmol/L Urine Calcium 100-300 mg/24 h Chloride Varies with intake Creatinine clearance Male: 97-137 mL/minFemale: 88-128 mL/min Estriol, total (in pregnancy) 30 wks 6-18 mg/24 h 35 wks 9-28 mg/24 h 40 wks 13-42 mg/24 h 17-Hydroxycorticosteroids Male: 3.0-10.0 mg/24 hFemale: 2.0-8.0 mg/24 h 17-Ketosteroids, total Male: 8-20 mg/24 hFemale: 6-15 mg/24 h Osmolality 50-1400 mOsmol/kg H2O Oxalate 8-40 μg/mL Potassium Varies with diet Proteins, total < 150 mg/24 h Sodium Varies with diet Uric acid Varies with diet Body Mass Index (BMI) Adult: 19-25 kg/m2 Calculator ( ) xy AC 7 8 9 Ă· 4 5 6 Ă— 1 2 3 - 0 . = + (M1.PH.17) A 75 year-old gentleman presents to the primary care physician with a 2 week history of right sided achilles tendon pain. He states that the pain has had a gradual onset and continues to worsen, now affecting the left side for the past 2 days. 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? Review Topic QID: 104902 1 Refer patient to an orthopedic surgeon 3% (6/178) 2 Switch medication and avoid exercise 68% (121/178) 3 Place permanent urinary catheter 6% (10/178) 4 Perform MRI 12% (22/178) 5 Perform CT scan 9% (16/178) M1 Select Answer to see Preferred Response PREFERRED RESPONSE 2 Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (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? Review Topic QID: 106368 1 Alkylating agent 64% (131/204) 2 Intercalating agent 11% (22/204) 3 Reverse transcriptase inhibitor 3% (7/204) 4 Microtubule inhibitor 16% (32/204) 5 Folic acid analogue 4% (9/204) M1 Select Answer to see Preferred Response PREFERRED RESPONSE 1 (M1.PH.4707) A 32-year-old female presents to her primary care physician with a 4 day history of vaginal odor. 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 2 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? Review Topic QID: 108437 FIGURES: A 1 Alcohol intolerance 53% (150/282) 2 Aplastic anemia 11% (30/282) 3 Ototoxicity 21% (59/282) 4 Red man syndrome 3% (8/282) 5 Tendon rupture 10% (29/282) M1 Select Answer to see Preferred Response PREFERRED RESPONSE 1 Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (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? Review Topic QID: 106846 FIGURES: A B C D E 1 Figure A 58% (72/124) 2 Figure B 6% (8/124) 3 Figure C 16% (20/124) 4 Figure D 6% (8/124) 5 Figure E 8% (10/124) M1 Select Answer to see Preferred Response PREFERRED RESPONSE 1 (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? Review Topic QID: 101958 1 Hair loss 0% (0/26) 2 Weight loss 0% (0/26) 3 Pancreatic insufficiency 8% (2/26) 4 Systolic hypertension 31% (8/26) 5 Pathologic fractures 58% (15/26) M1 Select Answer to see Preferred Response PREFERRED RESPONSE 5
Drug reactions Pharmacology - Teaching Case Patient presents with salivation, lacrimation, urination and defecation as...