Updated: 10/12/2020

Drug Reactions and Side Effects

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Questions
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Evidence
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Topic
Overview
  • Drug reactions organized by system
    • cardiovascular
    • GI
    • hematologic 
    • musculoskeletal
    • neurologic
    • renal
    • reproductive/endocrine
    • respiratory
    • multiorgan
  • Type A reactions
    • predictable
    • common
    • mild and self resolving
    • dose-dependent
  • Type B reactions  
    • unpredictable
    • rare
    • severe
    • idiosyncratic
    • not dose-dependent
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
  • Trastuzumab 
  • 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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Questions (11)
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(M1.PH.17.4707) 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? Tested Concept

QID: 108437
FIGURES:
1

Alcohol intolerance

53%

(160/303)

2

Aplastic anemia

11%

(34/303)

3

Ototoxicity

20%

(61/303)

4

Red man syndrome

3%

(10/303)

5

Tendon rupture

11%

(32/303)

M 3 C

Select Answer to see Preferred Response

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(M1.PH.15.75) 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? Tested Concept

QID: 106846
FIGURES:
1

Figure A

56%

(92/163)

2

Figure B

7%

(12/163)

3

Figure C

20%

(32/163)

4

Figure D

6%

(10/163)

5

Figure E

7%

(11/163)

M 1 D

Select Answer to see Preferred Response

(M1.PH.14.17) 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? Tested Concept

QID: 104902
1

Refer patient to an orthopedic surgeon

3%

(7/220)

2

Switch medication and avoid exercise

68%

(149/220)

3

Place permanent urinary catheter

7%

(15/220)

4

Perform MRI

11%

(25/220)

5

Perform CT scan

9%

(20/220)

M 3 D

Select Answer to see Preferred Response

(M1.PH.14.54) 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? Tested Concept

QID: 106368
1

Alkylating agent

65%

(178/273)

2

Intercalating agent

10%

(27/273)

3

Reverse transcriptase inhibitor

4%

(11/273)

4

Microtubule inhibitor

16%

(43/273)

5

Folic acid analogue

4%

(11/273)

M 2 D

Select Answer to see Preferred Response

(M1.PH.14.21) 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? Tested Concept

QID: 101958
1

Hair loss

0%

(0/39)

2

Weight loss

3%

(1/39)

3

Pancreatic insufficiency

8%

(3/39)

4

Systolic hypertension

23%

(9/39)

5

Pathologic fractures

64%

(25/39)

M 3 E

Select Answer to see Preferred Response

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Evidence (9)
POSTS (1)
Topic COMMENTS (4)
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