DIP Episode 433 - Adverse Drug Reactions for The USMLE exams Part 2 (Step 1-3)

Welcome my name is divine welcome to episode 433 of the divine intervention podcasts. Into this podcast we're going to be talking about adverse drug reactions, adverse drug reactions. I am going to be focusing primarily on things that can affect your white blood cells, things that can affect your red blood cells, things that can affect your platelets. That's what I'm going to focus on. If I decide to focus on everything it will just be really hard. So again this is something I can easily make future podcasts on just focusing on other systems. But for now I'm just going to focus on white blood cells, red blood cells and platelets. And the reason I'm choosing this focus is because these things are tested very heavily on exams. These things are tested very very heavily on exams. Whatever reason they like to concentrate on the hematologic system when testing adverse drug reactions. So we're just going to focus on adverse real reactions in relation to white blood cells, red blood cells, platelets, blood infactors and stuff like that. Basically stuff that floats around in your blood. And real quick for I just want to make an announcement so naturally reached out to me. So this is a person that is in charge of the document on my website that many people know that involves a transcription of my podcasts. So this individual, his name is Lucas, LUKASZ is in charge of this document. And he's looking for people that are willing to transcribe my step one podcast.

So the thing is many people have contributed significantly to transcribing the step two podcasts. So now this is a public call if you want to offer help with transcribing the step one podcasts. If you're interested, don't reach out to me, reach out to this email. It's Lucas Adam Chick. I believe that's the pronunciation if I'm right. At gmail.com. I'm going to spell it. It's LUKASZ D-A-D-A-M-C-Z-Y-K at gmail.com. And I'm also going to put it in the podcast announcement. The notes below the podcast. But LUKASZ D-A-D-A-M-C-Z-Y-K at gmail.com. I believe it's Lucas Adam Chick. So just reach out to this person. This person is really nice. Just reach out to them directly. And you can join the efforts. So let's go ahead and jump right into it. So what if they give you a question about a patient, the patient has a prior hitch from breast cancer. And this lady is 45 years old. And then now for the past two hours, this person has been having profound shortness of breath. And the patient had a heart rate of 145. What's going on here? This is going to be tamoxifen. This is going to be tamoxifen. Remember tamoxifen can cause people to have venous tremble and boiling disease. This person actually has a PE. When you see a person that has this sudden shortness of breath, especially with the right risk factors. And then you notice that hmm, this person has sinus-tactic cardiomy. You really want to think about a PE. So tamoxifen can absolutely cause PE's. So don't forget your germs.

Remember tamoxifen is an estrogen receptor antagonist in the breast. So that's why we use it for chemical peroxies for breast cancer. But it's an estrogen receptor antagonist in the breast. So that's where it's helpful. But it's an estrogen receptor antagonist in the uterus. So you can actually increase your risk of endometrial cancer. But then it's also an estrogen receptor antagonist in the bone. So it actually reduces your risk for osteoporosis. But this thing, this thing, just like estrogen, is going to raise your risk of venous tremble and boiling disease. So, germs keep that in mind for something that could potentially increase your risk of developing venous tremble and boiling disease. So they can give you a certain question. They can give you a person that is on OCP's. That's why if you have a history of venous tremble and boiling disease, any OCP, any world contraceptive pill that contains estrogen is maybe not the smartest idea in the world. They can also pretty much write a similar question for a person that is on some kind of homer replacement therapy. Because the person is having significant postmenopausal symptoms, hot flashes, you know, pain with vaginal intercourse, yada yada yada. So just going to keep these things in mind. All these things can absolutely cause a person to have venous tremble and boiling disease. And then what if they give you a question about a patient?

They tell you that this guy is a 25-year-old male and he has a history of HIV and his most recent CD-4 count was measured at 50. So they tell you that he was started on highly active antiretroviral therapy and appropriate prophylactic antibiotics. And then you're told that he comes from office visit six months later and his hemoglobin is seven and you notice his MCV is 115. Well what's going on there? Well the thing that's happening is that this person has developed megaloblastic anemia from trimethoprimsulfomephoxysone. So what's the mechanism there? Well if you think about it, trimethoprim this person obviously has HIV. CD-4 count is 50. Well I would hope that you know that okay huh okay this person got highly active antiretroviral therapy great. But a CD-4 count of 50 if I'm reading my math correctly it's less than 200 and it's also less than 100. So this person likely got trimethoprimsulfomephoxysone as prophylaxis, as prophylaxis against toxoplasmagondi, which will prophylaxis against when your CD-4 goes on the 100 and also against pneumocystis-gervetsi which is something we prophylaxis against when your CD-4 count goes on the so trimethoprimsulfomephoxysone. Well remember TMPSMX, probably the TMP part, really the TMP and the SMX but they both inhibit fully synthesis. The SMX the sulfomephoxysone works by inhibiting dihydroctorate synthetase but the trimethoprim part inhibits dihydrofolid reductase.

So these people are going to have problems with the synthesis of folate. If you have issues with the synthesis of folate you're going to develop a mechanoblastic anemia. Remember whenever you have a folate or a B-12 deficiency you're going to develop a mechanoblastic anemia from it. So again this basically what I'm trying to do here is to give you like a representative example of a hematologic side effect then I'll just give you all the veneats that can essentially give you the same presentation. So if for example a person is on an antipyneptic especially phenetoin it can also cause the same thing. Phenetoin messes up your reabsorption of folate or you can even give you a question about a person that is a chronic alcoholic. The enzyme conjugase that really helps your reabsorb folate in your genjunum. Remember folates reabsorptin the genjunum not in the duodenum. But what matters is iron folates genjunum. So conjugase and enzyme that helps your reabsorb folate in your genjunum is actually inhibited by alcohol. So alcohol basically messes up that enzyme. It can also give you a question about a person that has rheumatoid arthritis that has the same problem. Well I will develop it. Well I hope you're thinking about methyl trixate. Remember methyl trixate is also an inhibitor of dihydrofolate reductase. It's an inhibitor of dihydrofolate so it can absolutely cause megaloblastic anemia as well. The common final path of all of this is you don't have enough folates.

You're going to develop a folid deficiency or you can even give you a question about a person that's on chemotherapy and the person develops a megaloblastic anemia. Or you see a person that has sickle cell disease and you notice that they develop a megaloblastic anemia you're like man this is bizarre because sickle cell disease sickle cell anemia usually causes a normal siliconemia because it's a kind of hemolive anemia. But if you see megaloblastic anemia and a person that has sickle cell disease think about hydroxyurea. Remember hydroxyurea inhibits DNA synthesis. It inhibits ribonucleotide reductase. So by inhibiting that enzyme again it can cause it can cause sickle cell it can cause megaloblastic anemia. Basically if something messes up a thing that helps you with DNA synthesis you're going to get megaloblastic anemia. So that's not because I know someone may be like well it's just folid or B12. No. Really anything that messes up DNA synthesis is going to cause megaloblastic anemia. So it just so happens that you need folate for DNA synthesis. And you also need you know B you need many things you need many many things for that for that process right. So again folid deficiency can cause a megaloblastic anemia again there are many drugs that can cause you to have folate issues. So again or DNA synthesis issues. DNA synthesis issues.

So again don't forget methyl trexate right don't forget your sulfonamides TMP SMX and whatnot don't forget your anti-pilaptics like phenitoin don't forget hydroxyurea. Remember B12 deficiency as well can also cause a megaloblastic anemia. So if you're vegan or say for example you have preneciacinemia that can all those things can all cause a person to have megaloblastic anemia. And then what if they give you a question about a patient they tell you that this patient is a 33 year old. Let's see let's try to come up with a good dissemination here. Well let's say this patient is a 33 year old male and this person has you know just return you know he's an IV drug user and this person was placed on pharmacotherapy and this was placed on pharmacotherapy because you know TB skin test was positive but the chest texture was negative and you know IV drug users probably has lethal TB obviously if you have lethal TB you're gonna be on isonize it and then they tell you that this person's urine is red. Well why is this person's urine red? Why is this person's urine red? And the adetika nice one is it it's kind of weird of course they would try to put something about it as one of the answer choices because you know right. Famping and cause red or insecticrecyms that will obviously be wrong. So why why why in the world is this person's urine red? Well the reason this person's urine is red is because they have G6 PD deficiency. They have G6 PD deficiency.

Remember G6 PD deficiency those people they cannot deal with oxidative issues because they cannot make enough NADPH. Remember G6 PD glucose 6-phosphid dehydrogenase helps you make NADPH as part of the oxidative phase of the pentose phosphate pathway. So if you're not able to make NADPH you have a lot of issues dealing with oxidative stress. So basically our friends at the USML is they can write many questions that deal with oxidative stress. And if you if you struggle with knowing these drugs that cause oxidative stress then you can have a lot of issue because again an oxidative stress drug is going to cause your body to deeply that glutathione. If you deeply glutathione you're going to need to NADPH to replenish that glutathione. So if you don't have NADPH because you have G6 PD deficiency which by the way is an excellent recessive disorder. So you know I would hope you something to think about just email on exams then you're probably getting trouble on tests. So just know the drugs that can cause oxidative damage. I soniase it which is a TB treatment. Again they can give you a question about trimethylperam cell from a thox as all. It can also cause himolysis in a person that has G6 PD deficiency because so phonoamides they are very powerful oxidizing agents. If you think about it just go back to the periodic table in as a college student or whatever or wherever you learned about the periodic table. Oxygen is in group 6 of the periodic table.

Oxygen is a powerful oxidizing agent. Soffers literally right below oxygen in the periodic table. I believe soffers like in in 16 from remembering correctly but so phonoamides can cause powerful oxidation or they can give you a question about the person getting therapy for malaria. Remember primal queen is a very powerful oxidizing agent is the thing that destroys plus modium vivax and ovale those are those things that love to stay dormant in the liver. Asprin believator notes is also very powerful oxidizing agent. Asprin your insets like ibuprofenin do methamphetamine very powerful oxidizing agents they can cause oxidative stress. Even they can give you a leprosy question dapsal or they can they may not even make it a leprosy question they can just give you a question about a person that gets from a therapy for the for the rash that you find in celiac disease. Remember that dermatitis are pretty formuses. That is like a vesicular rash. It's got her pretty formus because it looks like herpes is it's her pety formus vesicular or an extensive surfaces. Dapsal is actually very good for treating dermatitis are pretty formuses or you know they can give you a nitroferan towing question. Nitroferan towing can also cause oxidative stress but again it will be really hard for them to write that kind of question because nitroferan towing is used almost exclusively in females. I don't think nitroferan towing accumulates in the bladder of meals very well.

So they usually treat cystitis in meals and it's only meals that can really get g6 pd deficiency. You know for the most part because it's an excellent processive disorder. When nitroferan towing potentially theoretically something that can is a very powerful oxidizing oxidizing agent. I remember you may be like why is this person's urine red? The reason this person's urine is red is because of the hemoglobin that isn't your urine. Not myoglobin. So these people's urinalysis if they have g6 pd deficiency and they are going through a hemoletic episode. If you check their urinalysis you're going to find three or four plus blood and you're going to find a commensurate number of red blood cells. You're going to find like 30, 40, 50 red blood cells for high pyrophil. That's not the same thing as what you find in rapidomyeluses. That's not the same thing as what you find in rapidomyeluses. I can already imagine a very pervasive USM question that can be written concerning that. So if a person has rapidomyeluses remember you're going to see three or four plus blood on your analysis. But you're not going to find a commensurate number of red blood cells on your microscope. So you're going to find like zero to ten or something red blood cells for high pyrophil. That makes no sense if you're seeing three or four plus blood. The stuff you think you're seeing that's blood is actually myoglobin. It's actually myoglobin.

And remember the cumstest is going to be negative in these people that have g6 pd deficiency because the hemolysis is not immune mediated. The hemolysis is not immune mediated. So again if you notice this is supposed to be a part it is actually a podcast on adverse robra reactions. But again you can see how many integrations our friends at the mbme's can make with this stuff. That's why again you cannot just memorize your weirdo's success on the USMLE exams. I'm just perfectly honest with you. The USMLE exams especially like step one step two step three. These things depend on your ability to solve problems or your ability to integrate concepts or your ability to reason through complex bits of material. Because notice I've literally been talking about isoniaz and dapsone and primal quen and then I went into the story about your analysis so you can see they can go in many different directions. And by the way if you're taking your USMLE exams anytime soon like the USMLE step one exam I'll encourage you to attend the course I'm offering that starts next week. It starts in the new year. It goes from the fifth to the seventh and from the ninth to the tenth of January. It's a 25 hour class. It's intended for people taking step one or complex one. Also intended for people that are taking step two or complex two step three or complex three as well. If you have a poor basic science background. If you notice the USML Es they literally use one content outline for all their exams.

So the thing is if your foundation from step one and complex one is bad. It's going to be really hard for you to carry that bad foundation is basically going to carry over to step two step three, complex two, complex three. So if you want to fix those foundations this course is perfect for you. And again if you're coming for a class if you're expecting a class that is just lectures don't come. It's not the class is not going to benefit you at all. It's absolutely not going to benefit you. It's going to be based almost entirely on scenarios on scenarios. And the thing is knowing that it's a step one review and it's an MBME based review. There's going to be lots of graphs. There's going to be lots of tables and different things. So you're actually going to have to like reason to answer to you're going to learn not just the content but you're going to learn how to reason through the content. I'm going to give you scenarios. So you're going to become very very proficient at analyzing graphs, manipulating experiments. You know how on the USMELIS step one they give all these all these questions where they will give you some mice model or they will give you some receptor thing and then they'll give you a stack of nucleotides and all these crazy things or they'll give you all these cardiovascular parameters. This 25 hour class has all of those.

So if you want to get if you want to get good at one just like learning the content deeply on a very deep level but also seeing how it's going to be presenting questions this 25 hour course will be perfect for you. And then I also have a step two CK step three review that's going to be taking place. That's going to be taking place from the you know I believe is the third or fourth week of this of January. It's actually going to be taking place from 23 to the 24th and the 26 to the 27th of January. So again if you're interested in that shoot me an email it's for people taking step two or step three or complex two or three and then I have an MDME test taking strategies class. This is for step two and step three and also for step one step one especially for the clinically oriented questions that's going to be taking place on the 20th of January. And then I also have a social sciences and ethics class that will be taking place in the month of January as well and a biostatistics bootcamp. Again you see many people they're like oh biostats I just write down the formulas and you just write down the formulas and you still not even to solve a lake of any question may be exempt. Well why do you think that happened? Many of the questions they write these days are based on understanding. Many of them don't even require a math. You just have to reason through the bio stats.

So again if you want to learn bio stats at a deep level you want to learn how to actually reason through bio stats instead of just blindly memorizing stuff. Again I was strongly encouraged to take the bio statistics bootcamp. It's going to be on the 30th of January. It's a four hour class again it's not lectures is entirely like 98% scenarios where again you truly deeply learn how to manipulate bio statistical knowledge. And the social sciences and ethics class again is helpful for step one to step three. As you know 10 to 20% of the US Emily questions these days tests social sciences, quality improvement, healthcare systems, communications and things like that. Again if you want to learn that material from the context of understanding, from the context of scenarios then you want to strongly consider the five hour social sciences and ethics class that's going to be taking place in the month of January. So let's go ahead and continue. So when I was talking about g6 pd deficiency and you know I was like oh it's going to be cum negative because it's a non-immune meditated anemia. I guess one thing I can maybe throw in here are the immune medicated anemias. Right so there are certain drugs believe there are no that can cause autoimmune hemolytic anemias. Although remember autoimmune hemolytic anemias not just something fine with drugs it's something to find with lupus. People that have lupus they especially prone to type 2 hypersensitivity reaction.

They especially prone to generating antibodies that can attack and destroy their red blood cells. But what are the drugs that can cause these problems? I want you to think about the cell wall inhibitors and blood pressure agent in pregnant women. So what are cell wall inhibitors? Things like penicillin, things like your cell flow sporens. These things can bind to your red blood cells and when they bind to your red blood cells your body can generate autoantibodies against them. Those autoantibodies can then obviously bind and when they bind they can activate complement. Remember the constant region of an immunoglobulin has the ability to activate complement. So when you activate complement then you can recruit things you have your c5 to c9 in pregnant attack complex bone you explode your red blood cells. So these drugs your cell inhibitors your penicillin, your several sporens and cause this problem. Methyl dopare. Remember is a drug that we used to control blood pressure in women that are pregnant. We used to control blood pressure in men that are pregnant. That's something that's actually pretty high yield to know because many of the blood pressure medications we use classically like ACE inhibitors, ARBS, those things are terrarogens. You shouldn't give them to a pregnant woman. You're going to destroy the kidneys of set fetus and it's probably not a good thing.

So if a woman is pregnant the thing you're going to try to use is you can use methyl dopare which is the drug we're talking about here. But as an added bonus remember you can use drugs like labeta law, you can use my fatty pin and you can also use there's one more hydrolyzing right I think there's this one. One of hypertensive moms love my fatty pin hypertensive moms love my fatty pin for the drugs that are very good for treating hypertension in women that are pregnant. Many of these drugs are pretty large so they have a lot of trouble crossing the placenta but the methyl dopare part of those things though the methyl dopare again can cause this spore immune hemolecanemia it's going to be a type 2 high-persons C-T-B-T reaction and don't forget here the cum stress is going to be positive. The cum stress is going to be positive because the hemolosis is mediated by antibodies. The hemolosis is is is mediated by by antibodies.

Now what if they give you a question about a patient and they tell you that this person has you know has schizophrenia and this person has been placed on a low period all this person has been placed on trifluor pairs in and the person's symptoms are not well controlled and then they tell you that the patient is started on pharmacotherapy and then you know two weeks after pharmacotherapy starting a patient becomes a febrile but they tell you the patient doesn't really have any symptoms but the patient has a temperature of a 103 Fahrenheit and well what do you want to think about there we want you to think about clausapine only think about clausapine remember clausapine can cause a granulose itosis they can literally write an utropinic fever question with clausapine for you on on exams and again don't forget what are the other that's why you actually have to monitor white blood cell counts when a person is placed on clausapine I mean literally they can write a psych question for you exam and the right answer is to monitor white blood cell counts and you can be scratching your head like what are they going after here well it's going to be clausapine toxicity they're going with now what are the other drugs that can cause a granulose itosis they want to keep in mind for exams again we've talked about dapsone we said dapsone can be useful leprosy we said that dapsone can be used to treat dermatitis or prediformis which you find in people that have cardiac disease dapsone can cause a granulose itosis or they can give you a question about a HIV patient that has eye problems that's going to be CMV retinitis CMV retinitis should have a gun cyclover can absolutely cause a granulose itosis or they can give you a question about a person that has like neuropathic pain on their face that comes for like a few seconds and departs what it happens tons and tons of times every day and yo

u see them developing granulose itosis think of carbame zepine remember this person that I just described has trigeminal neurologia trigeminal neurologia is treated with with carbame zepine carbame zepine is an amazing drug for trigeminal neurologia but it can cause a granulose itosis or they can even give you a question about a person that has a feb the person has weak loss person has heat on intolerance they start from acotherapy and then develop a granulose itosis you want to think about your anti thyroid medications things like ptu propyl fire yourself and methemazole remember those drugs they used to treat hyperthyroidism how do they work they actually work by inhibiting thyroid peroxidides they inhibite thyroid peroxidides remember thyroid peroxidides is a very important drug in the in the thyroid gland it actually helps you with multiple steps of thyroid hormone synthesis it actually helps you with the oxidation step of thyroid hormone synthesis and it helps you with your organification step of thyroid hormone synthesis those drugs have the ability to cause a granulose itosis or they can even give you a question about a person that has doubt and the president develops a granulose itosis after pharmacotherapy think of colchicin remember colchicin inhibits the polymerization of tubulin basically the micro tubules are not going to work great how colchicin is actually a drug that can cause a granulose itosis most of the cancer drugs can absolutely cause a granulose itosis in fact there's this drug that works on the p2y2 receptor I like clopidograble it's not clopidogra it's called tyclopidine like clopidine is a is a p2y12 is a p2y12 active agent it's an anti-plitlet drug and wait let's see hmm how about non-mechanomistic so clopidograble, prestograble, tycagrable I believe yeah tyclopidine is an is an anti-plitlet agent tyclopidine I believe is an anti-plitlet age

nt it works yeah it works yeah I believe it works just like clopidograble yeah it does it does work just like clopidograble it's a p2y12 inhibitor yeah I'm pretty sure about that so clopidograble, prestograble tycagrable and tyclopidine those are the p2y12 blockers right remember by blocking p2y12 you can inhibit platelet platelet activation right so remember I guess maybe like a small sidebar maybe quite I'm throwing here a friend at the mbme's they love those anti-plitlet agents but they love you to know exactly what is what and then I'll come back to this tyclopidine the the where I studied this journey is that tyclopidine can cause agranolosaicosis but remember tyclopidine the plicleta business primary hemostasis has three phases it has the adhesion step which is controlled by gp 1b and vulnerable factor and then it has the activation step which is controlled by adp and that p2y12 receptor and then it has the aggregation step which is controlled by gp 2b3a so your anti-plitlet agents they work on different parts of this cascade so sometimes instead of even asking about the mechanism of action of a drop they will just ask about the phase of primary hemostasis that is inhibited for example if they give you a question about inhibition of platelet aggregation you want to think about something like aspirin because aspirin decreases the synthesis of thromboxin 2 so they're going to shut down platelet aggregation because thromboxin 2 promotes platelet aggregation but also if they give you something like a drug like a p6ymable eptiphybotide remember those are drugs that work against gp 2b3 they're going to shut down platelet aggregation but platelet activation are going to be the drugs that block the p2y12 receptor that's the adp receptor they're adp receptor antagonists of course one is one of the easiest ways to make a question hard is just by using a different name you're n

ot used to instead of saying adp receptor antagonists you'll just call these things p2y12 inhibitors so the p2y12 receptor is in fact the adp receptor and is blocked by drugs like clopidogrel, prosogrel, tycagreler, and tyclopidin it's actually pretty high you know to know those drugs and then again the platelet adhesion agents where you have like the gp 1b and the verulbren factor really honestly the only drug that does anything there is the smolpressin which we use to treat certain forms of hemophilia and also to treat vulnerable disease because remember the smolpressin increases the release of a vulnerable factor from the wibopaladi body it increases the release of a vulnerable factor from the wibopaladi body so it's pretty pretty useful in that regard, pretty useful in that regard so again kind of parse those out that was like a segue game plan to discuss but might as well throw it in as a bonus for you but remember tyclopidin can absolutely cause agranolo cytosis and to be honest with you many of these drugs that cause agranolo cytosis they can also cause a plastic anemia remember a plastic anemia is a misnomer because if you look at the name a plastic anemia be like oh it just means the presence anemic no that is actually not true when the presence has a plastic anemia everything is low red cells white cells and platelets are all low it so happens that many of the drugs that cause agranolo cytosis also happen to cause a plastic anemia right like for example your anti thyroid medications believe it or not can cause your ptoamethematosol they can cause a plastic anemia although they usually test them on the context of agranolo cytosis now remember if you exposed to chloramphenicol remember chloramphenicol can cause great bb syndrome as well you can cause a plastic anemia carbamazepine can also cause a plastic anemia really I will remember more the agranolo cytosis

the plastic anemia is something that tests more when you expose to environmental agents the astrayal environmental agents that can cause a plastic anemia like for example if a person is supposed to benzene benzene is one of these weird environmental agents they love to love to test because you find there are many things actually finding many things like if you work in a car plant or you work with like nail polish that although benzene is largely banned in many of these things but you know you never know a friend of the endemic is there sometimes it can be very quink with some of the questions that is thrown example but again just remember a plastic anemia I'll say you know probably just remember more like benzene more like the ptoamethematosol kind of leave it at that agranolo cytosis they love does the more that does one thing that they love to go after a lot more so again it's something I'll just encourage you to kind of keep keep in mind and I guess if we're throwing in these side effects you know we can also throw in drugs that can lure your pletilet count we can throw in drugs that can lure your pletilet counts the big big one they love to test on exams is hapren if you see a person they have a PE they get a drug or they have a DVT they get a drug like five to a few days later they are pletilet count plummeted by like 50% or more it's gonna be hit this is gonna be hapren-induced thrombocytopene right so remember hit you know basically hapren complex complex is with pletilet factor four and you make an auto antibody against it not a wrongt antibody makes you form a ton of clot but it also makes you form a lot of pletilet thrombone with the I mean by forming all this pletilet thrombone actually the pletilet count so you can get through both side opinion you can absolutely get it from from hapren that's actually something that's super super high yield to know for ex

ams super super super super super high yield to know for for exams now the other thing I just want to say is you know certain drugs that can cause you to have like eucinophilia like in the context of AI and like allergic in a killing decision of Fridays remember that's usually a trial and exams it's not gonna have fever they're gonna have a rash they're gonna have eucinophilia fever rash and eucinophilia that's something usually fine with antibiotics cell walling hibbers especially like methecyling can cause those things napcyling oxacillin those things that are effective against MSSA methecylene sensitive staphoreus those are usually like pretty classic causes of this particular problem and they're remember though you know another eucinophilia related thing is dress syndrome or you see people they have like this drug reaction dress literally means drug reaction with eucinophilia and systemic symptoms you can find out many of these drugs like the galt drugs like alupino you can find you with these anti convulsants all these drugs that used to treat seizures they can cause this problem also anti biotics again your cell walling hibbers your cell four amides they can absolutely cause dress dress syndrome okay so I think I'm gonna go ahead and pause here I think I've kind of covered most of the high-yield things I kind of had a mind to discuss today well thank you for joining me I do actually I'll have a quick life lesson at the end just again real quick I do offer one of one tutoring for step one to step three come let's one to three preclinical medical exams 30 a-shelf exams if you were needing tutoring for your internal medicine in training exam you turn on medicine for exams I do offer tutoring for those and then I also offer review courses for step one I literally have one coming up next week for step two step three complex two complex three coming up later in the la

ter in the month of January and then I have a biostatistics book camp that's four hours long have an NV Me testing strategies class that's two and a half hours long many people have taken that class have had people just do phenomenally well after taking that class and then I have the five hour social sciences and ethics review and then also have we help with errors applications personal statements mock interviews editing rec letters and things like that so if interest I need any of those things just ship me an email through your website and I'll point you in the right direction and then if you want to rest up for any of my classes just ship me an email through the website as well I'll give you some more information on being able to register the classes are held over zoom is not like something that you have to travel somewhere to to attend and then finally I have these podcasts on many apps on the major podcasts apps apple podcast Google podcasts Spotify at least the most recent 150 is just a podcast uproars not much I can do to convince that but if you want everything from episode one to episode four thirty three go on the website divineinterventionpodcast.com you actually do need to sign up for anything but if you subscribe though with your Word Press account whenever I make a new podcast you will get an email notification if you subscribe with your Word Press account but I don't require any login let's go find the podcast you want and just listen that's pretty pretty pretty much it and then I have a You Tube channel divine intervention usmly podcast and videos actually post videos that correspond to some of these podcasts that I make also have videos shelf reviews and everything on the You Tube channel very comprehensive shelf reviews and then also have another website called divineinterventionlifelessons.com many people have told me oh divine I love love love love love

your life lessons many of you know I'm a Christian so I decided to start a new website divineinterventionlifelessons.com and actually have a podcast associated with it on apple podcasts it's called the divine intervention life lessons podcast and basically I post two podcasts every week usually on Fridays and Sundays that is a life lesson from a biblical perspective just addresses a common problem that people people face so real quick um the life lesson I just want to share because literally we're about from dream and math right about eight hours from the new year the new year is coming and I just want to encourage you that you can make a change just tick stock don't wait till the new year starts but tick stock of 2022 look at areas of your life where you know that man like I could make a change in my life is it your weight is it your health is it your level of studying for your exams is it your commitment to your family is it you being a good husband or a good wife or a good boyfriend or a good girlfriend just find areas of your life where you know you're not doing well and just make it a point to be better with those things I'm telling you like there's nothing like living a life where you do good where you make impact where you transform lives where you're fulfilling so I just encourage you like make it a point just tell yourself and you may not even have to do 10 things just least three areas of your life where you know that man I got to get better at these things typically in my experience working with two or three people one on one and even just in my own personal life I've noticed that when people start doing the right thing in a small area of their lives it inspires them to start doing the right thing in other areas of their lives so I'll encourage you to make make make a change make a change make the world around you a better place by making a change many peop

le they keep wondering they keep saying oh you know the government is not doing their job the mayor is not doing his job or this party that is empowered be democratic or republican they're not doing their jobs no no I'm telling you yes those things are out of your control well you can vote or whatever but that this is not a political conversation those things out of your control but something that's within your control is your own behavior is your own character so just do the right thing if multiple people in a state or even on a street start doing the right thing the world around them will slowly become a better a better place and I just want to say a big thank you to everyone that kind of listen to my podcast this year I really hope you found many of these podcasts to be helpful I really do appreciate you listening because this podcast take a pretty significant amount of time to make a lot of time and effort but thank you for listening to me you know I there many other resources you would have consulted but you keep coming back so I really do appreciate it for those that attended the review courses I offer again I'm great I'm grateful to you for attending and I'm glad that many of you did extremely well on your US semily exams I mean I've had people get as high as the 280's on your US semily exams after taking taking my review courses but thank you for joining me on through all this year next year I have a lot of really great plans for the website obviously I'm going to be making a lot of podcasts probably every now and then make a video there about but for me I really love the podcast format I feel like it's something that can just kind of turn on where you're driving on the street or you're you know going on a long drive or your showering or you're making food making dinner you can basically make things days of parts of your day that are unproductive productive by

just kind of just plugging and playing these these podcasts so thank you to everyone seriously God bless you and I'm really excited for 2023 and what medical education will bring and whatever changes our friends at the NBM Es as we affectionately call them I want to throw in the exam so thank you for listening to me God bless you how wonderful new year I wish you a very very happy new year from Divine Favour which is my name the person that meets the podcast on Divine Intervention Podcast.com and Divine Intervention Life Lessons.com so bye for now see you next year God bless you

Megaloblastic anemia (due to folate or B12 deficiency).

Sulfonamides and trimethoprim (TMP-SMX).

A positive Direct Coombs Test (DAT) indicates an antibody attack; a negative DAT suggests non-immune causes (e.g., G6 PD deficiency).

Isoniazid, Dapsone, Primaquine, or Nitrofurantoin.

It induces an autoimmune response (Type II hypersensitivity) leading to antibody-mediated destruction of red blood cells.

Clopidogrel, Prasugrel, and Ticagrelor.

Heparin-Induced Thrombocytopenia (HIT), due to autoantibodies against the PF4 complex.

Tamoxifen (It is an estrogen receptor antagonist in the breast but increases overall estrogenic effects, raising VTE risk).

Dihydrofolate reductase.

Isoniazid (or Primaquine/Dapsone).

G6 PD hemolysis will show a commensurate number of red blood cells microscopically, whereas rhabdomyolysis shows myoglobin (false positive for blood).

Anti-thyroid medications (PTU/Propylthiouracil) or Carbamazepine.

Type II Hypersensitivity Reaction (Antibody binding to RBC surface).

Clopidogrel, Prasugrel, Ticagrelor; they block the activation phase by inhibiting ADP receptors.

Tamoxifen (It is an estrogen receptor antagonist in the breast but increases overall estrogenic effects, raising VTE risk).

Dihydrofolate reductase.

Isoniazid (or Primaquine/Dapsone).

G6 PD hemolysis will show a commensurate number of red blood cells microscopically, whereas rhabdomyolysis shows myoglobin (false positive for blood).

Anti-thyroid medications (PTU/Propylthiouracil) or Carbamazepine.

Type II Hypersensitivity Reaction (Antibody binding to RBC surface).

Clopidogrel, Prasugrel, Ticagrelor; they block the activation phase by inhibiting ADP receptors.