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Toxicity and side effect, Toxicity treatment, reaction - Coggle Diagram
Toxicity and side effect
Toxicity treatment
β-blocker: atropine, glucagon
digitalis: anti-dig Fab fragment
copper: penicillamine, trientine
acetaminophen: N-acetylcysteine
antimuscarinic, anticholinergic agent: physostigmine, control hyperthermia(熱中症)
arsenic: dimercaprol, succimer
carbon monoxide: 100% O₂, hyperbaric(高圧) O₂
cyanide: nitrite+thiosulfate, hydroxocobalamin
AChE inhibitor, organophosphate: atropine>pralidoxime
benzodiazepine: flumazenil
methanol, ethylene glycol: fomepizole>ethanol, dialysis
warfarin: vitaminK, fresh frozen plasma
salicylate: NaHCO₃, dialysis
heparin: protamine sulfate
lead(鉛): EDTA, dimercaprol, succimer, penicillamine
opioid: naloxone
mercury: dimercaprol, succimer
iron: deferoxamine, deferasirox, deferiprone
TCAs: NaHCO₃
methemoglobin: methylene blue, vitamin C
reaction
musculoskeletal/skin/connective tissue
lupus: methyldopa, sulfa drug, hydralazine, isoniazid, procainamide, phenytoin, etanercept
fat redistribution: protease inhibitor, glucocorticoid
gingival hyperplasia: cyclosporine, Ca²⁺ channel blocker, phenytoin
hyperuricemia(gout): pyrazinamide, thiazide, furosemide, niacin, cyclosporine
myopathy: statin, fibrate, niacin, colchicine, daptomycin, hydroxychloroquine, interferon-α, penicillamine, glucocorticoid
osteoporosis: corticosteroid, depot medroxyprogesterone acetate, GnRH agonist, aromatase inhibitor, anticonvulsant, heparin, PPIs
phtosensitivity: sulfonamide, amiodarone, tetracycline, 5-FU
rash (stevens-Johnson syndrome): anti-epileptic drug, allopurinol, sulfa drug, penicillin
teeth discoloration: tetracycline
tendon and cartilage damage: fluoroquinolone
hematologic
agranulocytosis: clozapine, carbamazepine, propylthiouracil, methimazole, colchicine, ganciclovir
aplastic anemia: carbamazepine, methimazole, NSAIDs, benzene, chloramphenicol, propylthiouracil
direct Coombs-positive hemolytic anemia: penicillin, methyldopa, cephalosporin
eosinophilia: allopurinol, anticonvulsant, antibiotics, sulfa drug
gray baby syndrome: chloramphenicol
hemolysis in G6PD deficiency: isoniazid, sulfonamide, dapsone, primaquine, aspirin, ibuprofen, nitrofurantoin
megaloblastic anemia: hydroxyurea, phenytoin, methotrexate, sulfa drug
thrombocytopenia: heparin, vancomycin, linezolid
thrombotic complication: oral contraceptive(避妊薬), hormone replacement therapy, SERMs
endocrine/reproductive
adrenocortical insufficiency: glucocorticoid withdrawal
diabetes insipidus: lithium, demeclocycline
hot flash: SERMs(閉経後骨粗鬆症治療薬)
hyperglycemia: tacrolimus, protease inhibitor, niacin, HCTZ, corticosteroid
hyperprolactinemia: typical antipsychotics, atypical antipsychotics, metoclopramide, methyldopa
hyperthyroidism: lithium, amiodarone
hypothyroidism: amiodarone, sulfonamide, lithium
SIADH: carbamazepine, cyclophosphamide, SSRIs
gastrointestinal
acute cholestatic hepatitis, jaundice: macrolide
diarrhea: acamprosate, antidiabetic agent, colchicine, cholinesterase inhibitor, lipid-lowering agent, macrolide, quinidine, SSRIs
focal to massive hepatic necrosis: halothane, amantia phalloides, valproic acid, acetaminophen
pseudomembranous colitis: ampicillin, cephalosporin, clidamycin, fluoroquinolone
hepatitis: rifampin, isoniazid, pyrazinamide, statin, fibrate
pancreatitis: didanosine, corticosteroid, alcohol, valproic acid, azathioprine, diuretics
pill-induced esophagitis: bisphosphonate, ferrous sulfate, NSAIDs, potassium chloride, tetracycline
neurologic
pseudotumor cerebri: growth hormone, tetracycline, vitaminA
seizure: isoniazid, bupropion, imipenem, cilastatin, tramadol, enflurane
peripheral neuropathy: phenytoin, vincristine
tardive dyskinesia: antipsychotic, metoclopramide
parkinson-like syndrome: antipsychotics, reserpine, metochlopramide
visual disturbance: topiramate, digoxin, isoniazid, vigabatrin, PDE-5 inhibitor, ethambutol
cinchonism(キナ中毒:tinnitus;耳鳴り, hearing/vison loss, psychosis): quinidine, quinine
cardiovascular
cutaneous flushing: vancomycin, adenosine, niacin, Ca²⁺ channel blocker, echinocandin, nitrate, (red man syndrome: widespread pruritic erythema)
TdP: antiarrhythmic, antibody, anticychotics, antidepressant, antiemetics(制吐剤)
coronary vasospasm: cocaine, amphetamine, sumatriptan, ergot alkaloid
dilated cardiomyopathy: anthracycline
renal/genitourinary
hemorrhagic cystitis: cyclophosphamide, ifosfamide
interstitial nephritis: penicillin, furosemide, NSAIDs, PPIs, sulfa drug
fanconi syndrome: cisplatin, ifosfamide, expired tetracycline, tenofovir
multiorgan
antimuscarinic: atropine, TCAs, H₁-blocker, antipsychotics
disulfiram-like reaction: 1-st sulfonylureas, procarbazine, cephalosporin, griseofulvin, metronidazole
nephrotoxicity/ ototoxicity: loop diuretics, aminoglycoside, cisplatin, vancomycin, amphotericin B
cytochrome P-450 interactions
-
sodium valproate, isoniazid, cimetidine, ketoconazole, fluconazole, acute alcohol abuse, chloramphenicol, erythromycin, clarythromycin, sulfonamide, ciprofloxacin, omeprazole, metronidazole, amiodarone, grapefruit juice
substrate
anti-epileptic, theophyline, warfarin, OCPs
+
modafinil, chronic alcohol use, St.John's wort, phenytoin, phenobarbital, nevirapine, rifampin, griseofulvin, carbamazepine
respiratory
dry cough: ACE inhibitor
pulmonary fibrosis: methotrexate, nitrofurantoin, carmustine, bleomycin, busulfan, amiodarone
pupil size
↑
anticholinergics (atropine, TCA, tropicamide, scopolamine, antihistamines)
drugs of abuse (amphetamines, cocaine, LSD)
sympathomimetics
↓
antipsychotics (haloperidol, risperidone, olanzapine)
drugs of abuse (heroin, opioid)
parasympathomimetics (pilocarpine), organophosphate
sulfa drug
sulfa allergy: fever, urinary tract infection, Stevens-Johnson syndrome, hemolytic anemia, thrombocytopenia, agranulocytosis, acute interstitial nephritis, urticaria(蕁麻疹)
sulfonamide antibody, sulfasalazine, probenecid, furosemide, acetazolamide, celecoxib, thiazide, sulfonylureas