pg 71 IM penecilin, pt stay for 30 min, anaphylaxis most likely before 30min.  

(I assume the same for cephalopsporins)

pg 76 Disulfram like reaction – alcohol with certain cepholosporins – disulfram is Antabuse. Flushing, throbbing of head and neck, resp diff, vomiting, sweating, chest pain and hypotension, arrythmias and unconsciousness. 

Alcohol metabolism altered increasing buildup of formeldahyde

Can be caused by other antibiotics also.

pg 138

• Immediately report signs of APAP toxicity which are N/V, anorexia, malaise, diaphoresis, ab pain, confusion, liver tenderness, hypotension, arrythmias, jaundice, any other signs of hep and renal failure. 
• If detected early, more reversible. 
• Toxicity txed with gastric lavage, best within 4 hours of APAP OD. 
• MUCOMYST used to protect liver cells and destroying APAP metabolites. Given by nebulizer within 24 hours of OD and after the gastric lavage.

pg 145

• Capsicum works mainly by inhibiting DECAPEPTIDE SUBSTANCE P (DSP). 
• DSP breaks down joint cartilage and is a pain NT. 
• Also increases bloodflow
• Capsicum might also prevent ulcers by protecting gastric mucosa from alcohol and aspirin.

• pg 194 the tricyclic amoxapine is associated with TARDIVE DYSKENESIA (TD) and NEUROLEPTIC MALIGNANT SYNDROME (NMS).
• TD is involuntary movement that may be irreversible. 
• NMS is similar and includes muscle rigidity, altered mental status, autonomic system problems like tachy or sweating. 
• Occurs more in elderly women. 
• If happens, withhold, PCP notified immediately and tx of the effects should begin quickly.

What is a main adverse reaction of MAOIs?

What is a potentially fatal food interaction of MAOIs?  What are the signs? And what should be done?

pg 195

• With MAOIs, hypertension is an issue 
• Food with TYRAMINE (derived from the AA tyrosine) can lead to hypertensive crisis  
• One of the earliest signs of HTN crisis is headache followed by stiff/sore neck, N/V, sweating, fever, chest pain, dilated pupils, brady or tachy. 
• If hypertensive crisis occurs, requires immediate medical attention/intervention to reduce BP bc risk is stroke and death.

• Is rapidly absorbed and can be toxic. 
• Most common adverse reactions are N/V, tremors, thirst and polyuria. 
• Toxic levels start at 1.5 (early signs begin). 
• Must be monitored more closely when pt is losing fluid (excess sweating, vomiting, etc)

pg 207

• Extrapyramidal syndrome mostly cuased by the antipsychotics, esp. haloperidol. Can also be caused by metoclopramide (Reglan) and antidopinergics. 
• It affects whole body movements, with akathisia and dystonia.
• Usually diminishes with decreased dose and can be treated with antiparkinsonism drugs like benztropine. 
• Can progress to TD (irreversible) if untreated

pg 207

1.5 mEq/L - N/V, diarrhea, drowsiness, weakeness, discoordination (early signs)

2-3 mEq giddiness, ataxia, blurred vision, confusion, tinnitus, vertigo, slurred speech, blackouts, whole body abnormal movements, incontinence, agitation, mania, disarthis (difficulty pronouncing)

More than 3 mEq/L Siezures, arrythmias, hypotension, peripheral vascular collapse, stupor, spasticity and coma.

pg 236

• S/S cholinergic crisis are severe ab cramps, diarrhea, excess salivation, weakness, muslce rigidity and spasm, jaw clenching.
• Report immediately bc requires immediate treatment. 
• Antidote can be atropine .4-.6 mg IV.

pg 279

• Calcium levels are monitored bc biophosphonates inhibit bone resorption, which may lower blood calcium levels (calcium stays in the bones).  
• PCP may prescribe calcium, but do not take calcium and biophosphonates together (counteraction)

pg 295 With antihistamines, elderly more likely to be injured from dizziness due to increased incidence in elderly of hearing loss, visual impairments, etc

Risk for Injury rt admin of antihistamines AEB increased dizziness and preexisting visual impairments

pg 320

• high doses of rosuvostatin (Crestor) for hyperlipidemia linked to myopathy and rhabdomyolysis amonst pts taking cyclosporine, Asians and pts with severe renal insufficiency. For these pts, dose starts lower (5mg).
• rhabdomyolosis is a breakdown of muscle tissue and consequent kidney damage

pg 395 Elderly more sensitive to histamine H2 antagonists. Watch for confusion and dizziness. Prevent falls and ensure safety. Report changes in orientation to PCP

H2 antagonist (acid reducers) are normally quite safe

pg 442

• NEVER omit a dose of glucocorticoid.
• If the pt cannot take orally bc or N/V, notify immediately bc must be given via another route. 
• When glucocorticoid is to be DCed, it must be done gradually.
• Reason is bc abrupt DC can cause acute adrenal insufficiency and death. 
• This is bc glucocorticoid admin causes a cessation of natural production. Therefore, when DCed, there are no natural glucocorticoids.

pg 485

• Herbal diruretics are no more effective than caffeine. 
• Celery, chicory, dandelion, parsley, etc are safe.
• Juniper berries can cause renal damage
• Horsetail can be very toxic. 
• Ephedra should not be used by those with HTN.

pg 526

• leucopenia can be severe with temozolamide (Temodar), esp. when accompanied by radiation to the brain
• Temozolamide is a hydrazine antineoplastic used for certain brain tumors.
• Pt is phrophylactically treated for Pneumocystitis pneumonia (PCP). 
• PCP is an opportunistic fungal pneumonia from fungus Pneumocytitis jirovecii, which is normally present in the lungs, to which immunocomprimised are succeptible.
• Was once called P. carinii

10-20 mg/dL

For renal and hepatic function, Blood Urea Nitrogen

.5-1.2 mg/dL (slightly different for males and females)

For renal function

Creatinine is a product of muscle contraction and excreted by kidneys only

When high, can indicate poor kidney function.  Are other reasons for being high like dehydration, etc.

sodium 135-145 mEq/L

Potassium 3.5-5 mEq/L

Calcium 4.5-5.5 mEq/L

Irritants (e.g. antibiotics) and vesicants (can cause necrosis)

Antineoplastics are most problematic bc they are particularly toxic and can cause necrosis.

Cephalosporins

10%

• Stevens Johnson Syndrome
• Toxic Epidural Necrosis
• SJS is a milder form, and TEN is the more severe form, but both can be fatal
• Hypersensitivity reaction to antibiotics and other medications/conditions
• Epidermis dettaches from the dermis and can also involve internal mucosal layers
• Preceeded by a fevere and URI like S/Ss
• Watch for fever, cough, aches & pains, headache 
• Watch for lesions on skin, mucous membranes, eyes, red wheals, blisters
• Often starts on face and mouth
• Withhold and notify PCP immediately

• Pickled/aged/smoked/fermented foods
• Chocolate
• Alcohol
• Most cheeses
• Fermented foods
• Sour cream and yogurt
• Soy sauce
• Avocados, bananas, pineapple, peanuts

lamotrigine (Lamictal)

Used for partial seizures and bipolar

barbituate phenobarbitol as well