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119 Cards in this Set
- Front
- Back
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ACEIs -
Toxicity |
Cough
rash proteinuria angioedema taste changes teratogenic effects |
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Amantadine -
Toxicity |
Ataxia
livedo reticularis |
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Aminoglycosides -
Toxicity |
Ototoxicity
nephrotoxicity - ATN |
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Amiodarone -
Toxicity |
Pulmonary fibrosis
peripheral deposition - => bluish discoloration, arrhythmias, hypo-/hyperthyroidism, corneal deposition |
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Amphotericin -
Toxicity |
Fever/chills
nephrotoxicity bone marrow suppression anemia |
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Antipsychotics -
Toxicity |
Sedation
acute dystonic reaction akathisia parkinsonism tardive dyskinesia neuroleptic malignant syndrome |
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Azoles (e.g., fluconazole) -
Toxicity |
Inhibition of P-450 enzymes
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AZT -
Toxicity |
Thrombocytopenia
megaloblastic anemia |
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β-blockers -
Toxicity |
Asthma exacerbation
masking of hypoglycemia impotence |
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Benzodiazepines -
Toxicity |
Sedation
dependence respiratory depression |
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Bile acid resins -
Toxicity |
GI upset
malabsorption of vitamins and medications |
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Calcium channel blockers -
Toxicity |
Peripheral edema
constipation cardiac depression |
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Carbamazepine -
Toxicity |
Induction of P-450 enzymes
agranulocytosis aplastic anemia |
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Chloramphenicol -
Toxicity |
Gray baby syndrome
aplastic anemia |
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Cisplatin -
Toxicity |
Nephrotoxicity
acoustic nerve damage |
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Clonidine -
Toxicity |
Dry mouth
severe rebound headache hypertension |
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Clozapine
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Agranulocytosis
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Corticosteroids -
Toxicity |
Mania (acute) immunosuppression
bone mineral loss thinning of skin easy bruising myopathy (chronic) cataracts |
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Cyclophosphamide -
Toxicity |
Myelosuppression
hemorrhagic cystitis |
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Digoxin -
Toxicity |
GI disturbance
yellow-green visual changes arrhythmias - junctional tachycardia or SVT, varying amts of AV node blocks |
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Doxorubicin -
Toxicity |
Cardiotoxicity
(dilated cardiomyopathy) |
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Ethyl alcohol -
Toxicity |
Renal dysfunction
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Fluoroquinolones -
Toxicity |
Cartilage damage in children Achilles tendon rupture
in adults |
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Furosemide -
Toxicity |
Ototoxicity
hypokalemia nephritis |
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Gemfibrozil -
Toxicity |
Myositis
reversible ↑ in LFTs |
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Halothane -
Toxicity |
Hepatotoxicity
malignant hyperthermia |
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HCTZ -
Toxicity |
Hypokalemia
hyperuricemia hyperglycemia |
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HMG-CoA reductase inhibitors -
Toxicity |
Myositis
reversible ↑ in LFTs |
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Hydralazine -
Toxicity |
Drug-induced SLE
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Hydroxychloroquine -
Toxicity |
Retinopathy
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INH -
Toxicity |
Peripheral neuropathy -
prevent with vitamin B6 hepatotoxicity inhibition of P-450 enzymes seizures with overdose |
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MAOIs -
Toxicity |
Hypertensive tyramine reaction
serotonin syndrome - with meperidine |
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Methanol -
Toxicity |
Blindness
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Methotrexate -
Toxicity |
Hepatic fibrosis
pneumonitis anemia |
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Methyldopa -
Toxicity |
Pos. Coombs’ test
drug-induced SLE |
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Metronidazole -
Toxicity |
Disulfiram reaction
vestibular dysfunction metallic taste |
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Niacin -
Toxicity |
Cutaneous flushing
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Nitroglycerin -
Toxicity |
Hypotension
tachycardia headache tolerance |
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Penicillin/β-lactams -
Toxicity |
Hypersensitivity reactions
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Penicillamine -
Toxicity |
Drug-induced SLE
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Phenytoin -
Toxicity |
Nystagmus
diplopia ataxia gingival hyperplasia hirsutism |
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Prazosin -
Toxicity |
First-dose hypotension
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Procainamide -
Toxicity |
Drug-induced SLE
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Propylthiouracil -
Toxicity |
Agranulocytosis
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Quinidine -
Toxicity |
Cinchonism -
(headache, tinnitus) thrombocytopenia arrhythmias - torsades de pointes |
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Reserpine -
Toxicity |
Depression
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Rifampin -
Toxicity |
Induction of P-450 enzymes
orange-red body secretions |
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Salicylates -
Toxicity |
Fever
hyperventilation with respiratory alkalosis and metabolic acidosis dehydration diaphoresis hemorrhagic gastritis |
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SSRIs -
Toxicity |
Anxiety
sexual dysfunction |
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Succinylcholine -
Toxicity |
Malignant hyperthermia
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Tetracyclines -
Toxicity |
Tooth discoloration
photosensitivity Fanconi’s syndrome |
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TCAs -
Toxicity |
Sedation
coma anticholinergic effects seizures wide QRS in severe cases - prolonged QT => torsade |
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Valproic acid -
Toxicity |
Teratogenicity
=> neural tube defects |
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Vancomycin -
Toxicity |
Nephrotoxicity
ototoxicity “red man syndrome” - histamine release not an allergy |
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Vinblastine -
Toxicity |
Severe myelosuppression
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Vincristine -
Toxicity |
Peripheral neuropathy
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Acetaminophen -
What is the Antidote |
N-acetylcysteine
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Acid/alkali ingestion -
What is the Antidote |
Upper endoscopy
to evaluate for stricture |
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Anticholinesterases,
organophosphates - What is the Antidote |
Atropine
pralidoxime |
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Antimuscarinic/
anticholinergic agents - What is the Antidote |
Physostigmine
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Arsenic, mercury, gold -
What is the Antidote |
Succimer
dimercaprol |
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β-blockers -
What is the Antidote |
Glucagon
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Barbiturates (phenobarbital) -
What is the Antidote |
Urine alkalinization (bicarb)
dialysis activated charcoal |
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Benzodiazepines -
What is the Antidote |
Flumazenil
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Black widow bite -
What is the Antidote |
Calcium gluconate
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Carbon monoxide -
What is the Antidote |
100% O2
hyperbaric O2 |
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Copper, arsenic, lead, gold -
What is the Antidote |
Penicillamine
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Cyanide -
What is the Antidote |
Nitrite
sodium thiosulfate |
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Digitalis -
What is the Antidote |
Stop digitalis,
normalize K+, lidocaine (for torsades), anti-digitalis Fab |
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Heparin -
What is the Antidote |
Protamine sulfate
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Iron salts -
What is the Antidote |
Deferoxamine
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Lead -
What is the Antidote |
Succimer
CaEDTA dimercaprol |
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Methanol, ethylene glycol (antifreeze) -
What is the Antidote |
EtOH
fomepizole dialysis |
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Methemoglobin -
What is the Antidote |
Methylene blue
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Opioids -
What is the Antidote |
Naloxone
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Phencyclidine hydrochloride (PCP) -
What is the Antidote |
NG suction
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Salicylates -
What is the Antidote |
Urine alkalinization
dialysis activated charcoal |
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TCAs -
What is the Antidote |
Na bicarb - QRS prolongation
diazepam or lorazepam for Szs cardiac monitor for arrhythmias |
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Theophylline -
What is the Antidote |
Activated charcoal
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tPA, streptokinase -
What is the Antidote |
Aminocaproic acid
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Warfarin -
What is the Antidote |
Vitamin K, FFP
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Cardiac Life Support -
What are the Basic Principles |
Check if responsive
call for help Pt. on firm, flat surface ABCs - Airway open? Breathing? CPR IV meds before intubate CPR if alone - 2 breaths check pulse - carotid or femoral 15 compressions CPR if have help - 2 breaths 5 compressions |
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Burns -
Hx/PE |
2nd leading cause of death
in kids don't underestimate degree of nonvisible deep destruction- esp. with electrical burns thorough airway & lung exam respiratory burn - pt. may need early intubation before edema sets in |
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Burns -
Dx Rule of 9's |
ABCs
aware of possible - shock inhalation injury CO poisoning evaluate % of BSA involved rule of 9's - BSA (Body Surface Area) head = 18% front = 18% back = 18% each arm = 9% each leg = 18% |
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Burns -
Categories |
1st degree -
epidermis involved area painful no blisters capillary refill intact 2nd degree - epidermis & superficial dermis area painful blisters 3rd degree - epidermis & dermis area painless white & charred |
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Burns -
Tx |
■ Tx supportive
■ freq. dressing changes rehydrate topical silver sulfadiazine and mafenide ■ circumferential burns - at risk for compartment syn need early escharotomy ■ early skin graft - prevent contractures ■ fluid req. - in 1st 24 hrs. - BSA x wt(kg) x 4cc give 1/2 in 1st 8 hrs 1/4 in next 8 hrs 1/4 in last 8 hrs 1st choice - lactate ringers 2nd choice - NS (0.9%) hydrate enough to maintain urine outut at least 1cc/kg/hr |
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Burns -
Complications |
Shock
superinfection - esp. Pseudomonas |
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CO Poisoning -
What is it |
Hypoxemic poisoning syn
causes - car exhaust smoke inhalation barbeque in poor ventilation old appliances |
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CO Poisoning -
HX/PE |
Cherry-red skin
confusion headaches if severe - coma seizures chronic low-level exposure - flu-like Sxs suspect smoke inhalation in - singed nose hairs facial burns hoarseness wheezing carbonaceous sputum |
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CO Poisoning -
Dx |
ABG
normal serum carboxyHb level - < 5% in nonsmokers < 10% in smokers laryngoscopy bronchoscopy EKG - elderly h/o cardiac dis. |
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CO Poisoning -
Tx |
100 O2
hyperbaric O2 - pregnant neuro Sxs severely ↑ carboxyHb smoke inhalation - may need early intubation (before edema sets in) |
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Aortic Disruption -
What is it |
Rapid deceleration injury
most common causes - high speed MVAs fall from great heights ejection from vehicles complete - rapidly fatal usu have contained hematoma within adventitia laceration usu at lig. arteriosum |
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Aortic Disruption -
Dx |
■ CXR immed. -
wide mediastinum loss of aortic knob pleural cap trachea dev. to right left main stem bronchus - depressed ■ aortography - gold standard ■ transesoph echo before OR always suspect if - sternal fractures or 1st & 2nd rib fractures |
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Aortic Disruption -
Tx |
OR emergently
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Aortic Dissection -
What is it Risk Factors |
Surging of blood through
tear in aortic intima sep. of intima & media => false lumen ■ Stanford type A - ascending aorta ■ type B - desc. thoracic aorta (distal to lt. subclavian) ■ risk factors - HTN trauma coarctation of aorta syphilis pregnancy Ehlers-Danlos Marfan's |
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Aortic Dissection -
Hx/PE |
Acute onset
severe tearing chest pain radiates to back => syncope stroke MI asymm or dec. periph pulses paraplegia shock - as worsens type A - aortic regurg with diastolic murmur |
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Aortic Dissection -
Dx |
CXR
CT with IV contrast transesoph echo or MRI/MRA or angiography - gold standard EKG |
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Aortic Dissection -
Tx |
Stabilize HBP or low
HBP - IV nitrates B blockers goal - systolic < 120 HR < 70 type A - emergent surgery type B - med management |
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Aortic Dissection -
Complications |
MI
CHF cardiac tamponade postop hemorrhage future dissection future aneurysm death |
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Postop Fever -
What is it Caused By (What are the 6 W's) |
Wind
Water Wound Walk Wonderdrug Wire Wind - atelectasis, pneumonia Water - UTI Wound - abscess Walk- DVT Wonderdrug - drug reaction Wire - catheter |
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Postop Fever -
How to Decrease Risk |
Incentive spirometry
short-term foley use early ambulation DVT prophylaxis pre- & post-op ABx fevers before POD3- probably not infectious unless Clostridium or B-hemolytic strep |
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Acute Abdomen -
What is it |
Abdom Sxs so severe
surgery should be considered primary Sx - acute abdom pain |
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Acute Abdomen -
Hx/PE |
OPQRST
Onset Precip factors Quality Radiation Sxs Temporal quality Tx modalities full GYN Hx LMP STD Sxs pelvic exam pregnancy test - r/o PID, ectopic pregnancy, ovarian torsion |
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Acute Abdomen -
Character of Pain |
■ Sharp -
parietal (peritoneal) ■ dull, diffuse - visceral (organ) ■ perforation - sudden onset of diffuse, severe pain ■ obstruction - acute onset of colicky ■ inflammation - gradual onset over 10-12 hrs constant, ill-defined |
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Acute Abdomen -
Dx |
■ Assess stability
■ emergent surgery & exploratory lap - peritoneal signs impending shock shock ■ if stable - PE pelvic exam (women) CBC with diff electrolytes LFTs amylase lipase urine B-hCG UA KUB US no contrast studies - if suspect complete LBO |
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Acute Abdomen -
Tx |
■ Hemodynamically unstable -
emergent exploratory lap ■ stable - expectant management vitals NPO NG tube IV fluids serial abdom exams serial labs type & cross Foley - monitor urine output monitor fluid status |
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Appendicitis -
What is it |
Always consider in pt.
with acute abdomen MC - teens & 20's causes - no. 1 - lumen obstructed by lymphoid tissue hyperplasia no. 2 - fecalith foreign body tumor (carcinoid) parasite obstruction => overdistention inc. pressure ischemia & necrosis |
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Appendicitis -
Hx/PE |
■ Dull, vague pain
orig. at umbilicus lasts 1-12 hrs. pain then followed by n/v anorexia ("hamburger sign") may have mild fever sharper pain => RLQ at McBurney's point ■ psoas sign obturator sign rovsing's sign ■ if perforated - pain dec. peritoneal sigs will dev. ■ atypical - elderly kids pregnant retrocecal appendices |
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Appendicitis -
Dx |
Clinical -
if classic signs & Sxs mild leukocytosis & lt shift UA - a few RBCs or WBCs KUB - fecalith loss of psoas shadow US - r/o gyn abnorm abdom CT - r/o abscesses |
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Appendicitis -
Tx |
■ strong suspicion -
immed open or lap appendectomy 15-20% false pos. acceptable if no appendicitis found - complete exploration of abdo ■ before surgery - NPO IV fluids ABx for anaerobes - 24 hrs. ■ if perforation - cont. ABx until afebrile & WBC count normalizes close wound by delayed primary closure on POD5 ■ if abscess - broad-spectrum ABx abscess percutan drained elective appendectomy 6-8 wks |
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Appendicitis -
Complications |
Risk of perforation &
mortality inc. with amt of time have appendicitis (at 48 hrs - 75% risk) |
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Acute Management
of Trauma Patient - "ABCDE" What is "A" |
Airway -
airway patency & adeq ventilation take precedence over other Tx ■ conscious - nasal cannula or face mask unconscious - chin lift or jaw thrust to reposition tongue ■ early intubation - apnea dec. mental status impending airway compromise severe closed head injuries failed bag mask ventilation ■ cricothyroidectomy - can't be intubated signif maxillofacial trauma ■ keep cervical spine stable never let this concern delay airway management |
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Acute Management
of Trauma Patient - "ABCDE" What is "B" |
Breathing -
5 thoracic causes of immed. death must not be missed: tension pneumothorax cardiac tamponade open pneumothorax massive hemothorax airway obstruction |
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Acute Management
of Trauma Patient - "ABCDE" What is "C" |
Circulation -
2 16-gauge IVs fluid bolus of 1-2L (adults) vitals rechecked replete fluid per fluid status LR or NS - isotonic replete 3:1 (fluid to blood) |
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Acute Management
of Trauma Patient - "ABCDE" What is "D" |
Disability -
eval CNS dysfunction via Glasgow Coma Scale |
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Acute Management
of Trauma Patient - "ABCDE" What is "E" |
Extra -
check temperature status foley catheter - after r/o urethral injury secondary survey - full exam additional XRs - trauma series: AP chest AP pelvis AP/lat C-spine T1 |
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Pelvic Fractures -
What are they |
MC after trauma
such as a MVA needs immediate attention by orthopedist potentially life-threatening |
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Pelvic Fractures -
Hx/PE |
ABCDE trauma survey
secondary survey - may reveal unstable pelvis AP pelvic XR when stable - CT if hypotension & shock - hemorrhage likely can be assoc with urethral injury - ■ check for blood at urethral meatus ■ check high-riding, "ballotable" prostate ■ check for lack of prostate ■ retrograde urethrogram ■ r/o injury before Foley ■ serial H&H ■ never explore pelvic or retroperitoneal hematoma |
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Pelvic Fractures -
Tx |
Embolize bleeding vessels
emergent ext. pelvic fixation internal fixation if hemodynamically stable |
