Emergency Medicine
Terms
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-
Side effects of:
ACEI -
rash
cough
taste changes
teratogenic
proteinuria
angioedema -
Side effects of:
amantidine -
Livido reticularis (skin appears mottled L>UE)
ataxia -
Side effects of:
aminoglycosides -
ototoxicity
nephrotoxicity (ATN) - Amiodarone
-
pulm fibrosis
peripheral deposition causing bluish discolouration
arrhythmias
hypo/hyperthyroidism
corneal deposition -
Side effects of:
amphotericin -
fever/chills
nephrotoxicity
bone marrow suppression
anemia -
Side effects of:
antipsychotics -
tardive dyskinesia
sedation
acute dystonic rxn
akathisia
parkinsonism
neuroleptic malignant syndrome - acute dystonia
-
involuntary m cont/spasm - torticollis, oculogyric crisis)
Rx
anticholinergic (benztropine) or diphenhydramine
Prevent
prophylatic benztropine - akathisia
-
subjective/objective restlessness
Rx
↓neuroleptic
βblocker (propranolol)
+/- benzos, anticholinergics - dyskinesia
-
pseudoparkinsonism
Rx
anticholinergic (benztropine)
or DA agonist (amantidine)
↓neuroleptic or d/c - tardive dyskinesia
-
stereotypic oral-facial mvts
likely d/t DA receptor sensitization
50% irreversible
Rx
↓neuroleptic or d/c or change drugs
giving anticholinergics or ↓neuroleptic may initially WORSEN TD - Neuroleptic Malignant syndrome
-
fever
muscle rigidity
autonomic instability
clouded consciousness
↑CPK, WBCs
Rx
stop neuroleptic
dantrolene/bromocriptine
IV fluids - Evolution of EPS
-
4 hours
acute dystonia
4 days
akathisia
4 weeks
akathisia
4 months
tardive dyskinesia -
Side effects of:
-azoles (fluconazole) - inhibition of P450
- P450 inducers
-
carbamazepine
EtOH
glucocorticoids
griseofulvin
omeprazole 1A2)
phenobarbital
phenytoin
primidone
quinine
rifampin - P450 inhibitors
-
amniodarone
cimetidine
erythromycin
grape fruit
INH
ketoconazole
metronidazole
omeprazole (2C8)
quinidine
sulfonamides -
Side effects of:
AZT -
TCP
megaloblastic anemia -
Side effects of:
β-blockers -
asthma exacerbation
masking of hypoglycemia
impotence -
Side effects of:
benzos -
sedation
dependence
respiratory depression -
Side effects of:
Bile acid resins -
GI upset
malabsorption of vitamens & medications -
Side effects of:
CCBs -
peripheral edema
constipation
cardiac depression -
Side effects of:
carbemazepine -
P450 induction
agranulocytosis
aplastic anemia -
Side effects of:
choramphenicol -
grey baby syndrome
aplastic anemia -
Side effects of:
Cisplatin -
nephrotoxicity
acoustic nerve damage -
Side effects of:
Clonidine -
dry mouth
severe rebound h/a
rebound HTN -
Side effects of:
clozapine - agranulocytosis
-
Side effects of:
Corticosteroids -
mania (acute)
thin skin
easy bruising
immunosuppression
bone mineral loss
cataracts
myopathy (late) -
Side effects of:
cyclophosphamide -
myelosuppression
hemorrhagic cystitis* -
Side effects of:
Digoxin -
GI disturbances
yellow visual changes
arrhythmias - junctional SVT -
Side effects of:
Doxorubicin - cardiotoxicity - cardiomyopathy
-
Side effects of:
ethyl alcohol - renal dysfunction
-
Side effects of:
fluoroquinolones -
cartilage damage in kids
achilles tendon rupture in adults -
Side effects of:
furosemide -
ototoxicity
hypokalemia
nephritis -
Side effects of:
gemfibrozil -
myositis
reversible ↑LFTs -
Side effects of:
Gold -
renal dysfunction
leukopenia
rash -
Side effects of:
halothane -
hepatotoxicity
malignant hyperthermia* -
Side effects of:
HMG-CoA reductase inhibitors -
myositis
reversible ↑LFTs -
Side effects of:
hydralazine - drug induced SLE
-
Side effects of:
HCTZ -
hypokalemia
hyperuricemia
hyperglyemia -
Side effects of:
hydroxychloroquine - retinopathy
-
Side effects of:
INH -
peripheral neuropathy - prevent with Vit B6
inhibits P450
hepatotoxicity
seizures with OD -
Side effects of:
MAOIs -
hypertensive tyramine rxn
serotonin syndrome (with meperidine) - Serotonin syndrome
- MAOIs used with meperidine, SSRIs, TCAs, and indirect sympathomimetics (in main OTC cold remedies)
- Serotonin syndrome S/S
-
Triad:
1. altered MS
2. autonomic dysfunction
3. neuromuscular abnormalities
restlessness
confusion
lethargy
euphoria - feeling drunk & dizzy
rapid eye mvt
hyperreflexia
myoclonus
hypertonicity
clumsiness - Common symptoms of NMS and Sertonin syndrome
-
excitement
diaphoresis
rigidity
hyperthermia
↑HR, BP -
Side effects of:
methanol - blindness
-
Side effects of:
MTX -
hepatic fibrosis
pneumonitis
anemia -
Side effects of:
methyldopa -
+ve Coomb's test
drug induced SLE - Coombs' test
-
direct
measures presence of Ab on RBC SURFACE
- detects autoAb against RBCs
Indirect
measures presence of Ab to RBCs in BLOOD
- detects Ab in blood capable of attaching to RBCs (other than ABO & Rh) - +ve direct Coombs' test DDx
-
autoimmune hemolytic anemia
drug-induced hemolytic anemia (procainamide, quinidine, methyldopa)
infectious mono
mycoplasma infection
syphilis
CLL
SLE
transfusion rxn - +ve Indirect Coomb's test DDx
-
incompatible xmatched blood (test in blood bank)
Erythroblastosis fetalis -
Side effects of:
metronidazole -
disulfuram rxn
vestibular dysfunction
metallic taste* -
Side effects of:
Niacin - cutaneous flushing
-
Side effects of:
Nitroglycerin -
hypotension
h/a
↑HR
tolerance -
Side effects of:
Penicillins/βLactams - hypersensitivity rxns
- Side effects of: penicillamine
- drug induced SLE
-
Side effects of:
phenytoin -
nystagmus
diplopia
gingival hyperplasia*
ataxia
hirsutism -
Side effects of:
Prazosin - 1st dose hypotension
-
Side effects of:
Procainamide - Drug induced SLE
-
Side effects of:
PTU - agranulocytosis
-
Side effects of:
Quinidine -
Cinchonism - h/a, tinnitus
TCP
arrhythmias (torsade) -
Side effects of:
Reserpine - depression
-
Side effects of:
rifampin -
induction of P450
red-orange secretions -
Side effects of:
salicylates -
fever
hyperventilation with resp alkalosis and met acidosis*
dehydration
diaphoresis
hemorrhagic gastritis -
Side effects of:
SSRIs -
anxiety
sexual dysfunction* -
Side effects of:
Succinylcholine - Malignant hyperthermia
-
Side effects of:
tetracyclines -
tooth discolouration
photosensitivity
Fanconi's syndrome - Fanconi's syndrome
-
polyuria, polydipsia, dehydration
dilute urine
proteinuria
hypokalemia
hypophosphatemia
hyperchloremic metabolic acidosis
Rickett's (defect in Vit D conversion)
FTT*
variable mode of inheritance -
Side effects of:
TCAs -
sedation coma
anticholinergic effects
seizures
arrhythmias -
Side effects of:
valproic acid - NTD
-
Side effects of:
Vancomycin -
nephrotoxicity
ototoxicity
"red man syndrome" - histamine release (not allergy) -
Side effects of:
Vinblastine - severe myelosuppression
-
Side effects of:
Vincristine - peripheral neuropathy
- EtOH withdrawl syndrome
-
Mild withdrawl (6-24h from last drink)
tremor, anxiety, N/V, insomnia
Major Withdrawl (10-72h)
visual/auditory hallucinations, whole body tremor, vomiting, diaphoresis,↑BP
Withdrawl seizures - 6-48hrs
DTs - 2-7d
severe autonomic instability/hyperactivity
(↑HR, BP)
delerium, confusion, agitation, hallucinations
fever
positional nystagmus
death - mortality 15-20% - EtOH withdrawl Rx including DTs
-
benzos* (DOC)
haloperidol for hallucinations
clonidine, BBs for hyperadrenergic state
thiamine, folate, vitamens
replace lytes
IV fluids - Barbituate withdrawl
-
anxiety
seizures
delerium
tremor
cardiac & resp depression
Rx
benzos - Benzodiazepine withdrawl
-
rebound anxiety
seizures
tremor
instability
Rx
benzos - Cocaine/amphetamine withdrawl
-
depression
hyperphagia
hypersomnolence
Rx
supportive
avoid BBs (results in excess uninhibited cardiac activation) - Opioid withdrawl
-
anxiety
insomnina
flu-like symptoms*
sweating
piloerection
fever
rhinorrhea
stomach cramps
diarrhea
mydriasis
Rx
clonidine +/or buprenorphine for mod withdrawl
methadone for severe
naltrexone in pts drug-free for 7-10d - metabolism by P450 enzymes
-
benzos
amide anaesthetics
metoprolol, propranolol
nifedipine
phenytoin
quinidine
theophylline
warfarin
barbituates - induction of P450
-
barbituates
phenytoin
carbamazepine
rifampin - inhibition of P450
-
cimetidine
ketoconazole
INH - increasing risk of digoxin toxicity
-
quinidine
cimetidine
amniodarone
CCB - competition for albumin binding sites
-
warfarin
ASA
phenytoin - drug induced blood dyscrasias
-
ibuprophen
quinidine
methyldopa
chemo agents - Drug induced hemolysis in G6PD deficiency
-
sulfonamides
INH
primaquine
ASA
ibuprofen
nitrofurantoin - drug induced gynecomastia
-
cimetidine
spironolactone
ketoconazole - Drug induced Steven Johnson syndrome
-
ethosuximide
sulphonamides
penicillins
phenytoin
carbamazepine
barbituates - Steven Johnson syndrome
-
= erythma multiforme major
immune-complex mediated hypersensitivity disorder
3-15% mortality - Steven Johnson syndrome S/S
-
non-specific URTI 1-14d prodrome (fever, pharyngitis, chills, h/a, malaise +/- V/D)
abrupt onset non-pruritic mucocutaneous rash (most often truncal)
- begins as macules → papules, vesicles, bullae, urticarial plaques or confluent erythema
"target lesion" pathognomonic
involvement of: oral, nasal, eye, vaginal, urethral, GI, lower resp - Steven Johnson syndrome causes
-
1. infectious
2. drug induced
3. malignancy related
4. idiopathic - drug induced photosensitivity
-
tetracycline
amniodarone
sulphonamides - Drug induced SLE
-
procainamide
penicillamine
hydralazine
INH -
Name the antidote:
Acetominophen - N-acetylcystine
-
Name the antidote:
anticholinesterases, organophosphates -
atropine
pralidoxime -
Name the antidote:
antimuscarinic, anticholinergic agents - physostigmine
-
Name the antidote:
black widow bite - Ca gluconate
-
Name the antidote:
Iron - defuroximine
-
Name the antidote:
methanol, ethylene glycol -
EtOH
fomepizole
dialysis -
Name the antidote:
Lead -
Succimer
CaEDTA
dimercaprol
penicillamine -
Name the antidote:
arsenic
Hg
Gold -
succimer
dimercaprol -
Name the antidote:
Copper
arsenic
lead
gold - penicillamine
-
Name the antidote:
cyanide -
Na thiosulfate
nitrate -
Name the antidote:
salicylates -
alkalinize urine
dialysis
activated charcoal -
Name the antidote:
heparin - protamine sulfate
-
Name the antidote:
methemoglobin - methylene blue
-
Name the antidote:
opioids - naloxone
-
Name the antidote:
benzos - flumazenil
-
Name the antidote:
barbituates -
alkalinize urine
dialysis
activated charcoal -
Name the antidote:
TCAs -
benzos for seizures
cardiac monitor
NaHCO3 for QRS prolongation -
Name the antidote:
warfarin -
FFPs
Vit K -
Name the antidote:
carbon monoxide - hyperbaric/100% O2
-
Name the antidote:
tPA, streptokinase - aminocaproic acid
-
Name the antidote:
Digitalis -
digitalis specific Fab
lidocaine for torsades
stop dig
normalize K+ -
Name the antidote:
Beta-blockers - glucagon
-
Name the antidote:
PCP - NG suction
-
Name the antidote:
theophylline - activated charcoal
-
Name the antidote:
acid/alkali ingestion - upper endoscopy to evaluate for strictures
-
S/S of Deficiency of:
Vitamin A -
night blindness
dry skin -
S/S of Deficiency of:
B1 (thiamine) -
Beriberi
polyneuritis, DCM, high-output CHF, edema
Wernicke-Korsakoff -
S/S of Deficiency of:
B2 (riboflavin) -
angular stomatitis
corneal vascularization
cheilosis -
S/S of Deficiency of:
B3 (niacin) -
Pellagra
3d's
diarrhea
dermatitis
dementia -
S/S of Deficiency of:
B5 (pantothenate) -
dermatitis
enteritis
adrenal insufficiency
alopecia -
S/S of Deficiency of:
B6 (pyridoxine) -
convulsions
irritability
given prophylactically with INH -
S/S of Deficiency of:
B12 (cobalamin) -
macrocytic, megaloblastic anemia
glossitis
neuro symp
optic neuropathy, subacute combined degeneration, P/N -
S/S of Deficiency of:
Vitamen C -
Scurvy
swollen gums
bruising
anemia
poor wound healing -
S/S of Deficiency of:
Vitamin D -
Ricketts
bending bones
Osteomalacia
soft bones
hypocalcemic tetany -
S/S of Deficiency of:
Vitamin E - Increased fragility RBCs
-
S/S of Deficiency of:
Vitamin K -
neonatal hemorrhage
↑PT, PTT
N bleeding time -
S/S of Deficiency of:
Biotin -
dermatitis
enteritis
Can be caused by eating RAW EGGS -
S/S of Deficiency of:
Folic acid -
Most common Vitamin deficiency
macrocytic, megaloblastic anemia without neuro signs
sprue -
S/S of Deficiency of:
Magnesium -
weakness
muscle cramps
exacerbation of hypocalcemic tetany
CNS hyperirritability leading to:
tremors
choreoathetoid mvt
+ve Babinski -
S/S of Deficiency of:
Selenium - Keshan's syndrome (dilated cardiomyopathy)
- Aortic disruption CXR
-
widened mediastinum
pleural cap
loss of aortic knob
deviation of trachea to R
depression of L main stem bronchus
Always suspect with R1-2#s
aortography - gold standard -
Arrhythmia Rx:
asystole -
epi
atropine -
Arrhythmia Rx:
Vfib - desynchronized shock → epi or vasopressin → shock → lido or amio → shock → procainamide or Mg
-
Arrhythmia Rx:
VTach -
if unstable/pulseless - desynchronized shock
if stable - lido or amio -
Arrhythmia Rx:
PEA -
identify & Rx underlying
+/- epi +/or atropine -
Arrhythmia Rx:
Afib/flutter -
if unstable shock at 100J
If stable
- control rate (CCB, dig, BB)
- +/- rhythm conversion
- anticoagulate -
Arrhythmia Rx:
SVT -
Control rate
valsalva, carotid sinus massage, cold stim
- adenosine (procainamide) -
Arrhythmia Rx:
bradycardia -
if symptomatic consider atropine
if Mobitz II/AVB pace
Acutely, unstable - atropine/dopamine/dobutamine or transvenous pacing - hypovolemic shock
-
↓CO
↓PCWP
↑PVR - cardiogenic shock
-
Causes:
tension PTX
cardiac tamponade
arrhythmia
structural hrt dz
MI
↓CO
↑PCWP
↑PVR - Septic shock
-
↑CO
↓PCWP
↓PVR - anaphylactic shock
-
↑CO
↓PCWP
↓PVR - Rx for malignant HTN
- nitroprusside
- test to r/o urethral injury
- retrograde cystourethrogram
- Radiographic indications for Sx in pts with acute abd
-
free air under diaphragm
extravasation of contrast
severe bowel distension
SOL
mesenteric occlusion (angiography) - Cannon a waves
- complete AVB
- signs of neurogenic shock
-
hypotension
bradycardia - Cushing's triad
-
Signs of ↑ICP
HTN
bradycardia
abnormal respirations - Signs of air embolism
- pt with chest truma previously stable suddenly dies
- Organims/Rx of strep pharyngitis
-
Org
GAS, S. pneumo
Rx
Pen V
Amoxicillin
erythromycin - Organisms causing sinusitis
-
S. pneumo
H. flu
M. catarrhalis
GAS
anaerobes
S. aureus - Rx for sinusitis
-
1st line - Amoxicillin
(TMP-SMX if pen allergic)
2nd line - Amox/clav
3rd line clarithromycin - Acute OM pathogens
-
Viral
S. pneumo
H. flu
M. catarrhalis