USMLE Step 1 Drug Side Effects

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Courtesy of Dr. Werner

Acetaminophen (1)

1. glutathione depletion with hepatotoxicity (acetylcysteine is antidote)

Acetazolamide (2)

1. metabolic acidosis
2. hypokalemia

Acyclovir/Ganciclovir (2)

1. crystalline nephropathy (if adequate H2O not provided)
2. seizures

Adenosine (3)

1. hypotension
2. 3rd degree AV block
3. cardiac arrest

Alendronate/Risedronate (2)

1. esophageal erosions
2. osteonecrosis of jaw

Allopurinol (2)

1. may precipitate gouty arthritis
2. rash when given with ampicillin

Alteplase (2)

1. bleeding
2. hemorrhagic stroke

Amikacin (2)

1. nephrotoxic
2. ototoxic

Amiloride (1)

1. hyperkalemia

Amiodarone (5)

1. hyperthyroidism
2. hypothyroidism
3. pulmonary fibrosis
4. prolong QT
5. torsades de pointes (but not as much as Class 1A and other class III meds)

Amoxicillin & Ampicillin (3)

1. rash in pts with EBV
2. pseudomembranous colitis
3. IgE hypersensitivity

Amphotericin B (5)

1. acute renal failure
2. type 1 RTA
3. hypokalemia and hypomagnesiumia
4. fever
5. anemia due to decreased erythropoietin production

Aspirin (4)

1. decreases platelet function for life of platelet (10 days)
2. AG metabolic acidosis + respiratory alkalosis
3. low dose --> decreases uric acid secretion
4. high dose (>3.6 gm/day) --> increases uric acid secretion

Atorvastatin (3)

1. myopathy (esp. w/ gemfibrozil)
2. hepatitis
3. cataracts

Bacitracin (1)

1. allergic contact dermatitis

Bleomycin (1)

1. pulmonary fibrosis

Busulfan (1)

1. pulmonary fibrosis

Captopril/Enalapril (2)

1. increases bradykinin --> cough, angioedema
2. hyperkalemia

Carbamazepine (2)

1. marrow aplasia
2. SIADH (hyponatremia)

Carvedilol (3)

1. AV block
2. CHF
3. bronchospasm

Chloramphenicol (2)

1. aplastic anemia (irreversible in 1/30,000)
2. Gray baby syndrome

Chloroquine (1)

1. retinopathy

Chlorpromazine (2)

1. movement disorders
2. tardive dyskinesia

Chlorpropamide (1)

1. SIADH (hyponatremia)

Cimetidine (3)

1. confusion in elderly
2. loss of libido and gynecomastia
3. increases plasma creatinine concentration

Ciprofloxacin (3)

1. damages growing cartilage
2. arthropathy
3. tendonitis and tendon repture

Cisapride (1)

1. ventricular arrhythmias

Cisplatin (2)

1. nephrotoxicity
2. peripheral sensory neuropathy

Clindamycin (2)

1. clostridium difficile colitis
2. diarrhea

Clofibrate/Fenobibrate (2)

1. hepatitis
2. myopathy

Clonidine (1)

1. rebound HTN upon withdrawal

Codeine (1)

1. constipation

Colchicine (1)

1. diarrhea

Cyclophosphamide (2)

1. hemorrhagic cystitis
2. hematuria

Cyclosporine (3)

1. nephrotoxicity
2. HTN
3. hyperglycemia

Dapsone (1)

1. anemia

Daunorubicin (1)

1. cardiomyopathy

Demeclocycline (1)

1. nephrogenic DI

Diazepam (2)

1. respiratory acidosis
2. CNS toxicity (reversed with FLUMAZENIL)

Digoxin (4)

1. atrial tachycardia with block
2. hyperkalemia
3. serum level increases when administered with Quinidine or Verapamil
4. hypopkalemia precipitates digitalis toxicity

Diphenhydramine (1)

1. urinary retention in males with BPH

Disopyramide (1)

1. precipitates CHF in those with low ejection fraction

Doxorubicin (1)

1. cardiomyopathy

Doxycycline (3)

1. photosensitivity
2. esophagitis
3. stained teeth in children

Dipyridamole (1)

1. myocardial ischemia exacerbation

Ergotamine (3)

1. vasospasm
2. bowel infarction
3. systemic HTN

Erythromycin (1)

1. increases cyclosporine and theophylline levels

Estrogens (3)

1. DVT and PE (increases clotting factors 2, 7, 9, and 10 and decreases anti-thrombin)
2. endometrial hyperplasia
3. HTN

Etanercept (2)

1. increased lymphomas
2. increased URIs

Ethambutol (1)

1. optic neuritis (altered red-green color vision and blurred vision

Fenobibrate (2)

1. myopathy with HMG CoA reductase inhibitors (statins)
2. hepatotoxicity

Finasteride (4)

1. teratogenicity to male fetus - hypospadius
2. gynecomastia
3. erectile dysfunction
4. androgen-sensitive hair growth

Flecainide/Encainide (1)

1. sudden death in patients with myocardial ischemia - proarrhythmic

Fluocinonide (topical steroid) (1)

1. atrophy and thinning of skin

5-Fluorouracil (2)

1. mucositis
2. diarrhea

Fluticasone (inhaled) (1)

1. oral thrush

Furosemide (5)

1. hypokalemia
2. decreases serum Ca2+
3. hyperglycemia
4. hyperuricemia
5. ototoxicity

Gemfibrozil (2)

1. myopathy with HMG CoA reductase inhibitors (statins)
2. hepatotoxicity

Gentamicin (2)

1. nephrotoxic (high-output ATN)
2. ototoxic (vestibular and hearing)

Halothane (3)

1. hepatitis
2. malignant hyperthermia
3. arrhythmias

Haloperidol (3)

1. tardive dyskinesia
2. hyperprolactinemia
3. amenorrhea

Heparin (3)

1. bleeding
2. thrombocytopenia
3. monitor anticoagulant effect with PTT

Hydralazine (1)

1. SLE=like syndrome with arthritis (kidney and brain spaired) + ANA

Hydrochlorothiazide (4)

1. increases serum Ca2+
2. hyperglycemia
3. hyperuricemia
4. hypokalemia

Ibuprofen (NSAIDS) (6)

1. peptic ulcer
2. platelet dysfunction for 2-3 days
3. hepatotoxicity
4. type 4 RTA
5. decreased renal function
6. diuretic resistance

Imipenem (1)

1. seizures in renal failure

Indinavir (2)

1. nephrolithiasis
2. nephrotoxicity

Indomethacin (3)

1. impaired renal function
2. ulcers
3. vertigo limits dosing in gout

Iron (2)

1. abdominal pain
2. bloody diarrhea

Isoniazid (3)

1. hepatotoxicity
2. peripheral neuritis (vit B6)
3. sideroblastic anemia (vit B6)

Isorbide dinitrate (2)

1. headache
2. methemoglobinemia (treat with methylene blue)

Isotretinoin, Tretinoin (4)

1. teratogenic, pregnancy test
2. elevated TG
3. corneal opacities
4. dry skin

Ketoconazole (azoles) (2)

1. elevated liver enzymes
2. rarely hepatitis

Leuprolide (3)

1. hot flashes
2. erectile dysfunction
3. gynecomastia

Levodopa/Carbidopa (3)

1. movement disorders
2. neuroleptic malignant syndrome
3. orthostasis

Levofloxacin (3)

1. QT prolongation
2. arthropathy
3. tendonitis and tendon rupture

Lidocaine (1)

1. seizures

Lindane (1)

1. nephrotoxicity

Lithium (2)

1. nephrogenic DI
2. low T4 and high TSH

Lovastatin (3)

1. hepatotoxicity
2. cataracts
3. myositis

MAOI (1)

1. hypertensive crisis from tyramine

Mefloquine (4)

1. depression
2. psychosis
3. seizures
4. long QT

Metformin (1)

1. lactic acidosis if serum creatinine >2.0

Methadone (1)

1. CNS depression

Methicillin (1)

1. interstitial nephritis

Methimazole (1)

1. agranulocytosis

Methotrexate (3)

1. mucositis
2. diarrhea
3. bone marrow suppression

Methyldopa (1)

1. Coombs positive hemolytic anemia

Methyltestosterone (1)

1. cholestatic jaundice

Methysergide (2)

1. retro-peritoneal fibrosis
2. urinary tract obstruction

Metoclopramide (1)

1. movement disorders (tardive dyskinesia)

Metronidazole (2)

1. disulfiram-like reaction*
2. teratogenic

Minoxidil (2)

1. tachycardia
2. hair growth

Misoprostol (2)

1. miscarriage
2. diarrhea

Morphine (1)

1. hypoventilation with acute respiratory acidosis

Nafcillin (3)

same as ampicillin (more interstitial nephritis)
1. rash in pts with EBV
2. pseudomembranous colitis
3. IgE hypersensitivity

Naproxen (6)

1. peptic ulcer
2. platelet dysfunction for 2-3 days
3. hepatotoxicity
4. type 4 RTA
5. decreased renal function
6. diuretic resistance

Niacin (4)

1. flushing (prevented with aspirin)
2. hepatotoxicity
3. hyperglycemia (acanthosis nigricans)
4. hyperuricemia/gout

Nifedipine (3)

1. edema
2. constipation
3. may precipitate MI in pts with HTN

Nitrofurantoin (1)

1. pulmonary fibrosis or lung nodules

Nitroglycerin (3)

1. syncope when used with Sildenafil
2. orthostatic hypotension
3. headache

Nitroprusside (2)

1. cyanide toxicity
2. methemoglobinemia

Omeprazole (2)

1. B12 deficiency
2. hypergastrinemia

Oxytocin (2)

1. uterine rupture
2. placental abruption

Pentamidine (2)

1. hypoglycemia
2. pancreatitis

Phenytoin (3)

1. lymphadenopathy
2. gum hyperplasia
3. nystagmus

Pioglitazone (2)

1. edema
2. CHF

Praziquantel (1)

1. miningismus and headache if used without steroids for CNS cysticercosis

Prazosin/Terazocin (2)

1. first-dose syncope
2. improves urinary stream in BPH

Prednisone (6)

1. DM
2. cataracts
3. HTN
4. osteoporosis
5. Cushing's syndrome
6. peptic ulcers

Primaquine (2)

1. methemoglobinemia
2. G6PD anemia

Probenecid (1)

1. increases serum level of PCN

Procainamide (2)

1. SLE-like syndrome with +ANA
2. arthritis (brain and kidney spared)

Propafenone (2)

1. QT prolongation
2. torsades de pointes

Propranolol (5)

1. depression
2. claudication
3. bronchospasm
4. CHF
5. masks hypoglycemic symptoms in diabetics

Propylthiouracil (2)

1. agranulocytosis
2. hepatotoxicity

Pyrimethamine/Sulfadoxine (2)

1. Stevens-Johnson syndrome
2. erythema multiforme

Quinidine (4)

1. cinchonism (vertigo, tinnitus, headache, flushing)
2. prolonged QT
3. increases AV node conduction speed
4. increases digitalis levels

Quinine (2)

1. cinchonism (vertigo, tinnitus, headache, flushing)
2. blackwater fever

Raloxifine (3)

1. DVT
2. PE
3. hot flashes

Rifampin (2)

1. red-orange urine and tears
2. hepatotoxicity

Senna (1)

1. melanosis coli (brown pigmentation of colonic mucosa)

Sildenafil (2)

1. syncope when used with NTG
2. MI from hypotension

Spironolactone (4)

1. hyperkalemia
2. gynecomastia
3. metabolic acidosis
4. teratogenicity

SSRIs (1)

1. serotonin syndrome (diarrhea, HTN, hyperthermia, tremor)

Sulfamethoxazole/Trimethoprim (2)

1. macrocytic anemia
2. leukopenia and hepatitis in pts with AIDS

Sumatriptan (2)

1. coronary vasoconstriction
2. arrhythmias

Tamoxifen (3)

1. menopausal symptoms
2. edema
3. endometrial hyperplasia or cancer

Tamsulosin (1)

1. orthostatic hypotension

Terbutaline (2)

1. tremor
2. tachycardia

Tetracycline (3)

1. dark tooth enamel when given during pregnancy or childhood
2. outdated TCN causes Fanconi syndrome
3. photosensitivity

Thalidomide (1)

1. teratogenicity

Thiabendazole (3)

1. causes Ascaris to migrate
2. Stevens-Johnson syndrome
3. hepatotoxicity

Tobramycin (2)

1. nephrotoxicity
2. ototoxicity

Tramadol (2)

1. serotonin syndrome when used with SSRIs
2. constipation

Triamterene (3)

1. hyperkalemia
2. megaloblastic anemia
3. kidney stones

Vancomycin (2)

1. red man syndrome
2. nephrotoxicity

Verapamil (4)

1. AV block
2. decreased contractility
3. increased digoxin levels
4. gingival hyperplasia

Vinblastine (1)

1. bone marrow suppression

Vincristine (3)

1. neurotoxicity
2. areflexia
3. SIADH (hyponatremia)

Warfarin (3)

1. bleeding
2. cutaneous necrosis from protein C deficiency
3. monitor effect with PT

Zidovudine (2)

1. lactic acidosis
2. bone marrow suppression

Foscarnet (3)

1. generalized seizure
2. hypomagnesemia
3. hypocalcemia

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