Info

(Coombs' positive)

The side effects of diuretics are high yield.Thiazides cause hyperglycemia, hyperuricemia, hy-perh.pidem.ia, hyponatremia, hypokalemic metabolic alkalosis, and hypovolemia.Thiazides also cause colefinn retention and, because they are sulfa drugs, should be avoided in patients with sulfa allergy. Loop diuretics cause hypokalemic metabolic alkalosis, hypovolemia, ototoxicity, and calcium excretion. All loop diuretics except ethacrynic acid are also sulfa drugs. Carbonic anhydrase inhibitors cause rneiubolic cicidovi.s.

Antihypertensives a re notorious for causing sedation, depression (the worst is methyldopa), and sexual dysfunction. Beta blockers also cause bradycardia, heart block, and congestive heart failure in susceptible patients. Calcium channel blockers also should be avoided in some cardiac patients for the same: reason. Because beta blockers may precipitate asthmatic attacks and mask tlit- symptoms of hypoglycemia, they should be avoided in asthmatics and diabetics. Alpha-one antagonists are notorious lor severe first-dose orthostatic hypotension.

The side effects of psydiiatr.it;: medications are also high yield. See psychiatry chapter.

A few drug interactions are high yield. Do not give the following drugs together:

1. Monoamine oxidase inhibitors and meperidine (coma)

2. Monoamine oxidase inhibitors and selective serotonin reuptake inhibitors (serotonin syndrome: hyperthermia, rigidity, myoclonus, autonomic: instability)

3. Ketoconazole and astemizole/terfenadine (lethal arrhythmias)

4 Aminoglycosides and loop diuretics (enhanced ototoxicity)

5. Thiazides and lithium (lithium toxicity)

Important points:

1. Rifampin is gi ven for' prophylaxis in contacts of a pat ient with Neisseria meningitidis.

2. Barbiturates, anl:iepileptics, and rifampin induce hepatic enzymes; ennetidine and ketoconazole inhibit hepatic: enzymes (important for ch ug, drug interactions).

3. If a patient responds to placebo, it does not mean that the disease is psychosomatic; it means simply that the patient responded to placebo! Normal people with real diseases often have an improvement in symptoms with placebo.

Antidotes

Antidotes

VOI SON lNG OR OVERDOSi; -

Acetaminophen

Cholinesterase inhibitors

Qimridine or tricyclic antidepressants

Iron

Digoxin

Methanol or ethylene glycol benzodiazepines

Beta blockers

Lead

Copper/gold Opioids

Cirhon monoxide Muscarinic receptor blockers

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