DIP Episode 387 - Adverse Drug Reactions for Step 2CK/3

Okay, welcome. My name is Devine. This is episode 387 of the Devine Intervention podcasts and into this podcast I'm going to be addressing high-yield adverse drug reactions to know for the USMLE step 2, CKN step 3 exams. High-yield adverse drug reactions. I try to cover all of the major ones in this podcast but if I cannot I'll just have a part to on this. And if you're taking the USMLE step 2, CKN step 3 or complex level 2 or 3 exams, I have some courses that are available. First I have a very comprehensive 75-hour school. It's called a disc school. It's gonna be taking place in the first two weeks of the month of May. It's gonna be from Monday to Friday 7 and a half hours each day. Very high-level course. We're gonna be doing an expanded test, taking strategy scores. We're gonna be doing a lot of stuff with adaptive learning. We will use images and keywords and things to review a lot of material very rapidly and then we'll have the actual traditional review and I'm also gonna spend a lot of time answering people's questions and things like that. I'm gonna invest deeply in every single person that attends. There's a little bit of space available. If you're interested shoot me an email through the website and I'll be happy to give you some more information. And also if you're taking you know step 2, CKN step 3, have a smaller course. It's the 20-hour course. It's gonna be taking place on the 21st and 28th of May.

It's gonna be 10 hours each of those days for a total of 20 hours. Gonna review a lot of concepts from Peds from Internal Medicine, Surgery, OB-Guy, Neuro-Cyc, Bio-Stats, Ethics, Communications, Healthcare Systems, Multi-Systems Processes, and Disorders. And then I have the MBME Testic and Strategy's class. Again tons of people have taken this class. They've done extremely well on the exams as a result. It's gonna be on the 20th of May from 5 to 7 30 pm Pacific Standard Time. So if you're interested in any of these courses just shoot me an email and I'll be more than happy to give you some more information. The courses are all gonna be held over Zoom and especially with a 20-hour course and the Test Against Strategy's course. I try to put it at a time to where I know that people will not be on rotations and they'll be able to attend. So it's like two back to back Saturdays and then the Test Against Strategy's class is like a Friday evening literally. So again if you're interested just shoot me an email. So let's just jump right into it. So what if they give you a question about a patient. The tell you that the patient has a history of grave disease and the patient was recently studied on pharmacotherapy and then you notice that wow this person for the last two days they've been having fevers and shields and shortness or breath. Now what are you thinking about? They may not have shortness or breath. They just have fevers and shields. Now what are you gonna be thinking about?

Well if you see that I really hope you're saying oh divine this person probably has a granuloseitis right from P Tium etymazole. These are classic things they love to test. Let me just tell you this. This podcast you're going to for sure see questions on this stuff on your exams. You'll be highly unlikely. Like take an exam I don't see anything tested from here right. So that's your granuloseitis. So remember this is something we find with PTU or we find with methymazole the anti-thyroid medications. P Tium etymazole they have this adverse effect of a granulose itis. Remember a granuloseitis is not just an adverse effect of P Tium etymazole and also find this with other drugs right. Don't forget like they can give you a person on therapy for trigeminal neurologia or on anti-seizure medication and in those circumstances right I would imagine that you're thinking of carbamazepine. carbamazepine can absolutely cause a granuloseitis or they can give you a question about a person that has resistance gets afraid and they usually thinking about clasping. Remember clasping also causes many of the things like gum. Myocarditis so it can cause heart failure. Remember clasping can also cause a person to have hyper salivation right. Those people would just be leaking a lot of saliva. Just something you want to keep at the back of your mind for example. And then a granuloseitis is something you can find with chloramphenicol. Chloramphenicol is a big big big drug for causing a granulose itis.

Remember we also try to avoid giving it to women that are pregnant if we can or like very little kids because remember it can absolutely cause gray baby syndrome. It can cause like heart failure and all those things. Not a good look obviously in those circumstances. And then what if they give you a question about a patient. They tell you that this patient is a young guy. He was recently treated for some kind of tachyrithmia. And then over the last two weeks he has been having like joint pain and he has like this rasha on his face that is worsened with some exposure. Well if you see that I'll really hope you're saying oh divine. This is going to be drug induced lupus. Drug induced lupus remembers that. So she's not an anti-histone antibodies and it's something you're going to find in this person I guess we're pro kinamide. You can also find it with hydrozene. You can find it with isonize it. So phonomides. You can find it with it. It's an accept. Right. So those are the classic drugs. Fennitoin as well can also be a sort of drug induced lupus. Although remember let me just maybe back up a little bit. So this pro kinamide business I said right obviously the tachyrithmia the person had was wolf Parkinson white. So remember WPW we we acutely treated with pro kinamide but long term is actually kind of high you to know that you know only putting people on pro kinamide forever. No that's not smart or prevent.

The thing you don't want to do for those people is you want to oblique that pathway. That's that primary treatment of choice. Best long term treatment for wolf Parkinson white syndrome. Remember obviously I was going to have that delta wave although these days our friends at the NB Ms are like let's not do delta wave again all these medicine is not the stuff. So they're going to replace it on your exam with sharp PR plus white PR. So if you see that boom that's all you need. The person has a WPW especially in a young person. For the most part they're not going to give WPW to a 70 year old person on an exam. Okay now what if they give you a question about a patient. He tell you that this patient just received chemotherapy for a testicular cancer. They have like a three month course of chemotherapy. Well that now this person has been having sharpness of breath and they give you some pulmonary labs. I noticed that the long capacities are like the long volumes are decreased and the FF1-12 VC ratio though is normal. If you see something like that what do you want to think about? I really hope you think about pulmonary fibrosis. Remember pulmonary fibrosis can happen with a couple of drops on exams right. So with chemotherapy agents we're looking while on the lines of like your sulfan, bleomysin, methyl trexet. Those things can absolutely cause pulmonary fibrosis.

But some other ones that we should think about with pulmonary fibrosis actually you want to think about drugs like amyoteurone so they can give you a question about a person that is on chronic therapy for an arrhythmia because there are some people that believe it or not take amyoteurone on a chronic basis. Although as physicians we try to not do that often anymore. But then also think of nitrofurentoin right. The drug that's known as macrobid. Many people take nitrofurentoin. This side effect is extremely rare but people can absolutely get pulmonary fibrosis with nitrofurentoin. So that's something you want to keep at the back of your mind for exams. Now what if they give you a question about a patient you know they tell you that this patient has a history of hasn't history of a familiar hypercholosterolemia and they tell you that you know he's on therapy for primary prevention of a myocardial infarction he takes it every day or you can even make a question where a person has like low back pain and they are taking a particular kind of drug every day for their pain and then they tell you that this person has now started having respiratory difficulty and that the respiratory difficulty typically arises a few hours after the person has taken the medication. What do you want to think about? I would encourage you to think about asthma right. Remember aspirin and not just aspirin but NSA's in general they can trigger asthma in certain individuals.

So what's the pathophysiology there? Well you're going to be ready to memorize much of anything here but if you remember the synthesis pathway involving arachidonic acid you know first off you can convert membrane phospholipids to arachidonic acid then arachidonic acid can go one of two ways it can go through the cyclooxygenis pathway to make personal glandins or you can go down the like-poxygenis pathway to make lucotrines. So the thing is if you give an insect or aspirin and that inhibits cyclooxygenis then the only pathway available for arachidonic acid is the lucotrine pathway so you make a lot of lucotrines like lucotrine B4 for example. Remember lucotrine B4 is a very powerful chemotactic factor for neutrophils and you know ultimately you can cost things like increase vascular permeability and all those things. So it can certainly trigger a person's asthma symptoms. So remember that there's this thing called aspirin induced asthma. Although these days they call it aspirin exacerbated respiratory disease. That's the pathophysiology so you can get that with aspirin and you can absolutely get that with NSAID. And then what if they give you a question about a patient? The tell you the dispassion is on you know was an immigrant and presented a few months ago with fevers, night sweats, weight loss and the person was placed on a combination of macotherapy.

And then now he tell you that over the last three days he has been having yellow in his skin and he's been having a right-upper quadrant pain. You want to think about hepatitis right? You want to think about hepatitis. Now remember there are certain drugs that can touch the liver. Don't forget the TB drugs these things love to go after the liver right? Fampine is hepatotoxic. Isomiazid is hepatotoxic. In fact there is this pneumonia I use because isomiazid so people call it ionic. I remember it as I for isomiazid is never is a neurotoxic so you can cause seizures and all those problems. That's the end. But it's also hepatotoxic. It can cause liver failure. That's the each right? So don't forget hepatotoxic with the TB drugs right? Fampine and ionized it. But also don't forget it with acetaminophen. Acetaminophen is probably the most it's not probably. It is the most common drug cause of liver failure. You want to think of that with acetaminophen but also do not forget your statins. Your statins can also be hepatotoxic. And then don't forget amuterone. Remember amuterone you're going to be checking a person's PF Ts, LF Ts and TF Ts. Amuterone is also a hepatotoxic medication because he's heavily metabolized by the liver. And then what if they give you a question about a patient? They tell you that she's a 35 year old female. And for the last two months she has been having this non-specific retopocorjan pain. But they tell you that the EST and ALT are just mildly elevated.

And they tell you that she's on medications for the prevention of pregnancy. If you see that what are you thinking about? I really hope you're thinking about hepatocatynomins and OC Ps or contraceptive P Ls. Remember especially the ones that contain estrogen. They're not good in people that have histrophypaticatynomins because those things grow in response to estrogen. That's very high up to now. Those things grow in response to estrogen. Those things grow in response to estrogen. And remember hepatocatynomins many times you don't touch those things. They will try to trick you on the exam into like intervening. No, you don't intervene for hepatocatynomins. Those are those do not touch lesions, right? Remember the astringent leave religions that you don't touch. Hepaticatynomins you don't touch. Folk or nodulah hyperplegia you don't touch. Hepatic hemangelmas you don't touch. Just leave well enough alone. Just leave well enough alone. You don't have to get too creative. You only intervene for those lesions if the person is like very symptomatic. But most times you don't have to touch those things. And also they can decide not to give you an OCP question and they can just give you a question about a person that has like testicular atrophy and looks very muscular and a polyesterid. And a polyesterid can absolutely cause hepatocatynomins to grow as well. So that's just something you want to keep at the back of your mind for for exams.

And then what if they give you a question about a child you would say that this child had been in Gyrus, was placed like a new unit, was placed on an antibiotic and then now this child has developed John this, right? And then they give you some labs and you notice that the total bilirubin is four and indireg bilirubin is 0.9. Well obviously that tells you that okay this person is direct bilirubin is 3.1. So the thing is what drug did this person child get? This child obviously got like septriaxal. Remember septriaxal has the ability to cause intrahepatic holostasis. So that can present with an obstructive pattern of liver disease. It can present an obstructive pattern of liver disease. So that's just something you want to keep in mind. Yeah, just certain drugs that slow down the movement of bar. So that can cause almost like an obstructive picture of liver disease. So that's something you're going to potentially find on exams with. Third generation several sports like septriaxal, although that's usually more in the pediatric population. We can also find this again with just estrogen with anabolic steroids, with OC Ps, things like that. So if a woman is on hormone replacement therapy, I mean notice she starts getting like John this and she has direct type of bilirubinemia. They want to think about this person potentially having hepatic holostasis. Remember intrahepatic holostasis is also something you can find in pregnancy, right?

You'll be a pregnant woman because again, remember in pregnancy, you have very high levels of estrogen, right? I literally just said that OC Ps estrogen and all these anabolic steroids can cause colostasis. Well, surprise surprise. Pregnancy is a high estrogen state. It would absolutely make sense that this book can get colostasis. That's how people that's actually the pathophase behind the intrahepatic holostasis of pregnancy. Remember for those people are going to give them or so dial. Remember, sometimes we call or so dial or so the oxycolic acid, right? So we can use that for that for that purpose on on exams. And then what if they give you a question about a patient, they tell you that this patient try to commit suicide, right? And they tell you that the person is like a GI bleed. If you see something like that, I would really hope you're thinking of iron poisoning. Remember iron loves to torture persons stomach. It can cause like a hemorrhagic gastritis. So iron is obviously not the best idea. So if you ever see a person and you know it's a drug of abuse situation and you see them having like hemocall positive tools or a lot of like GI bleeding, I really, really want you to think about iron poisoning. Many times if you actually take an X ray, because remember iron is like an actual metal. So when you take an X ray, you're actually going to see the pills pretty clearly on radiography. So that's something you can keep in mind for for exams.

And then what if they give you a question about a patient and they tell you that this patient had a good ococcal in, you know, had like a pelvic inflammatory disease. This is called a PID, right? Had PID, a person was placed on pharmacotherapy. But now this person has the syringe on their skin that works since with certain exposure. And of course the MDM Es, they'll probably put some drug induced lupus cancer, which will be wrong. In this case, I want you to think about tetracycline. Tetracycline, tetracycline, tetracycline, these things are not good, right? They can cause photosensitivity. Remember tetracycline, you're told many times. You can even give you a question where a person is on tetracycline. And they see which of the photos you should be explained to the patient prior to discharge or whatever. You want to tell them to try to avoid the sun because it's associated with photosensitivity, right? So tetracycline have a very strong association with photosensitivity. And there are other drugs that have that association. So phonomites, also associated with photosensitivity, amyoteurone is also associated with photosensitivity. In fact, there's this numonic that I learned back in the day in Med School called SAD for photo, SAD for photo, the S stands for phonomites, the A stands for amyoteurone, the T stands for tetracycline, those drugs are associated with photosensitivity as a side effect. Again, that's very high yield, very important to know for exams.

And then what if they give you a question about a patient, and the tell you that this patient is on, is on a person had an MRI like six months ago, and they're on pharmacotherapy because they had a state placed in their hearts. And then the tell you that this person, when they get out of bed in the morning, they feel like the world is spinning around them and they tell you that they have this buzzing sensation in their ears. If you see that, I'll really hope you're saying, oh, divine, this is salicylic to poison, right? So, or salicylic toxicity. Remember this something we'll find with aspirin. Remember it can cost tenidus, it can cause a vertigo, right? Salicylics. Remember again, salicylics can also cause a person to have a combination metabolic acidosis and respiratory alkalosis. Although remember salicylates, I don't know, the NBM is they like this kind of question where they'll give you salicylate poisoning and they'll give you answers and they'll give you some sodium and potassium stuff. It's just kind of important to remember that salicylies don't really affect your sodium and potassium balance at all. The things they really mess up are your pH, your bicarb and your PCO2. The lower your PCO2, because they cause a respiratory alkalosis, the lower your bicarb, because they cause a metabolic acidosis, right?

Acidosalicylic acid is literally an acid, but your pH will be roughly normal for the most part, because that metabolic acidosis kind of counters the respiratory alkalosis. That's something you certainly want to make sure you know for, for example. And then, what if they give you a question about a patient? Detail of the dispassion came into the hospital, you know, for surgery and like a near replacement of something. And then they tell you that the person, five days after they have the surgery and just prior to discharge some labs are obtained. And you notice that the apolitic count is like 40,000. What happened? Well, the thing that happened is hit. Remember, hit is heparinine-used thrombocytopenia. So that's what happens whenever you get any heparinine product like low molecular weight heparin or unfraxinated heparin. Remember, those are both heparinines but they're not the same. There's unfraxinated heparin, that's like the straight-up heparin, and then there's low molecular weight heparin. Now for the most part is a factor 10 inhibitor. The unfraxinated heparin is more of a factor 10 and factor 2 inhibitor. So what's the pathofis behind hit? Well, basically, heparin will make a complex with something completely factor 4. Platelet factor 4 is a platelet protein. We know to get married. It actually makes your platelets get activated. So you don't be forming all this platelet from by and all these things, which obviously puts you in a hypercoglable situation.

But also your platelet count goes down because you're using up those platelets. So those people, what's going to be your first step for them on exams? The very first thing you want to do for these people on exams is obviously go ahead and stop the heparin product. If you see that as an answer, that's always the better answer than treating. That's always the first thing you should do. And then after you do that, the next thing you want to do on exams is to put them on a factor 2 inhibitor. So something like a gattroban or a dabi gattran or bivaliridium. Remember bivaliridium is an anti-quagulant. It's a factor 2 inhibitor. It's derived from leeches or made on the same principle behind leeches. Because remember leeches is the suck blood. If you want a sucker persons blood, you've got to make sure that that blood is flowing. If you don't want the blood to clot, after it's that it's sucking. I mean, that goes your launch or dinner or breakfast if you're a leech. So the leeches, they actually inject an anti-quagulant into the host and then the so that the blood can keep flowing. So it would make sense that an anti-quagulant would be derived from leeches. Remember leeches they belong to the class Herodemia. That's where the term bivaliridium comes from. So bivaliridium, a gattroban, dabi gattran. So some people usually ask me, divine, can we use a factor 10 inhibitor for hints? So like a pixaban, river oxaban, doxaban. Yes, you can use those things.

But like 99% of the time on NV Me exams, the gumo for the factor 2 inhibitors. So that's kind of high you to know for, for exams. So a hair print can cause thrombocytopenia. But remember, thrombocytopenia is also something you can find with quinidine. quinidine quinidine quinidine, right? It can cause synch anism. Thrombocytopenia is something you can have, but synch anism also involves that ringing in the ear. So if you see a ringing in the ear, tonight, you really want to think about two drugs and one disorder on exams. The two drugs, one is aspirin and your other salicylics, two is quinidine. And then in terms of a disorder, you want to think about a person that has many years disease. Remember, many years disease, sometimes they call it an exam that endolemphatic hydrops is also associated with tenderness or ringing in the ears. So it'll be a person that has this feeling of fullness in the ears. You see stuff like that. Think about my nearest disease, okay? Think about my nearest disease. And then, what if they give you a question about a patient that is pregnant? And then this patient was studied on an anti-hypertensive, you know, because they had hypertension. And then the tell you that the person develops jaundice. But then you notice that this jaundice is associated with an indirect hyperbular minimia. If you see that, what should you be thinking about? I really hope you're saying to me, divine. This sounds an awful lot like a hemoletic anemia, right?

So notice the endym is in the great wisdom they're going to put like help syndrome or something weird. They'll put like help syndrome or they'll put like intraepartic holostasis of pregnancy as answers, but those will be wrong. So remember, let's kind of tease this apart a little by little, right? So first things first, intraepartic holostasis of pregnancy is going to give you an obstructive pattern of liver disease. So the direct bilirubin is going to be up. The outfoss is going to be up, okay? People that have help syndrome, right? They'll have hemoletic anemia, they'll have elevated liver enzymes, low pleatlets, fine. But that's more of an acute situation. And that's something we're going to be seeing in the third trimester on exams, right? But you see this person, they have this hemoletic anemia, they have indirect type of aloe verbenemia, that's important. And you see the temporal association with institution of an anti-hypertensive impregnancy when we're thinking about hemoletic anemias. Remember, hemoletic anemias are very common with methyl dopa. I mean with the they are very common with methyl dopa. Methyl dopa is something we can use to manage hypertension impregnancy. Remember, hypertension impregnancy we can also manage it with hydrozene, labetolol or nifetypene, right? But methyl dopa is associated with hemoletic anemias.

And don't forget you don't also get hemoletic anemias with the cell wall inhibitors like penicillin, so they can give you a question about a woman that develops indirect hyperbibular venemia after getting treatment for like group B-strip or something like that. You want to think about hemoletic anemias. Quenidin also, again, Quenidin is a pretty high value drug for exams, right? Again, it can cause himolucanemias, it can cause low pleaklets, it can cause tenitis, right? These are all high old things you want to keep at the back of your mind for exams. And then, remember, they can also give you questions about drugs on exams where, you know, people start these drugs or let's say a person recently went for a procedure, got a local anesthetic, and then they start having very oral cyanosis. Well, that's going to be methyl molybineemia, right? Remember, methyl molybineemia is something you're going to find with drugs that are patholoxidizing agents. So, like local anesthetics, like benzokine, all those drugs that end in kin, you can get them with like nitrate medications, you can get them with so phonamides, you can get them with many different things, mitrofioranthoen, look at the name of nitro, right? Nitrates, very patholoxidizing agents, can get them with like nitrofioranthoen, you can get them with many things on exams, right?

So, don't forget, they can even give you a HIV patient started on back trip, try methylperenzoid from a thoxesol, those things are very patholoxidizing agents, right? And you're going to have a much higher risk if you have like G6 PD deficiency, because you're not going to be able to deal with oxidative stress at all. So, don't forget methyl molybineemia. Obviously, in those circumstances, you're going to trip with methylene blue, you're going to trip with methylene blue. And then they can give you a question about a person that is an archimotherapeutic agent. And then a few days after therapy started, they started having like lural tributyidema, druglovinous distension, new spree heart sound. When you see that, try to you want to think about a cardiomyopathy, more specifically, want to think about a dilated cardiomyopathy, right? So, remember, that's something we're going to find with doxoo and donor rubissing, those are the anthrocyclins, because an irreversible dilated cardiomyopathy that could have been prevented if you took like dexerzoxine, which is an ion chelator, because remember, the fentine reaction is essentially how these doxoo donor rubissine agents can cause problems. And then they can also give you a breast cancer patient on that has the hereto mutation, right? And obviously, in those circumstances, trust to zoom up. In fact, they call it her septin. There is this numonic, I think, I'm seeing you first, back in the day, like heart septin.

How these drugs can also cause a dilated cardiomyopathy. Remember, trust to zoom up can cause a reversible dilated cardiomyopathy, but doxoo and donor rubissine can cause an irreversible dilated cardiomyopathy. Again, very high able to keep the stuff at the back of your mind, for example. And then do not forget, any drug that inhibits folate synthesis can cause megaloblastic anemia on the exams. So if a presence on methyl treatise, you can remember that inhibited dehydratory fully reductase that can absolutely cause megaloblastic anemia, but also if you're in sulfonamides, right? Tri-mythropin, sulfonethoxazone that can cause a megaloblastic anemia in HIV patient. If you're in OC Ps, if you're on 5 FU, right? 5-florear urester. Remember, 5-florear urester in inhibits thymidilatesin please, it can absolutely cause megaloblastic anemia. Or if you're on 5 FU sideosin as a HIV patient for a long enough period of time, yes, it can absolutely also cause megaloblastic anemia, because remember, 5-florear urester is converted by sideosin diamines to 5-florear urester. And that will then go ahead and inhibit thymidilatesin please in the fungus, more specifically cryptococcusinium formants. That's why we would use, that's the only reason, we would use 5-florear urester. So all those things can cause macrositic anemia that's sulfonamides, tri-mythropinamethoxazone, right? Thinitowing. Many of these anti-epileptic drugs they can cause, they can inhibit fully synthesis.

That's why you try to avoid giving those drugs to pregnant women, right? Because of this whole concern about neuro-tuber defects, about neuro-tuber defects. So again, these are all things you want to keep at the back of your mind for exams. And then don't forget, you know, if they give you a present that was studying on an anti-hypertensive and they have cough, you really, really want to be thinking about your ACE inhibitors, right? Because remember, the inhibits ACE and ACE is an enzyme that brings down bradykining. But if you inhibiting ACE, they're not going to leave it to bradykining. So bradykining levels are going to go up and you're going to get in trouble, right? So those are just all things you want to keep at the back of your mind on exams. And they don't forget, you see a person, they take antibiotics and they have like a water or bloody diarrhea afterwards, that's C-diff, right? C-diff, C-diff, D-diret, is something you can absolutely get after taking an anti-biotics. You see recent anti-biotic use, diarrhea afterwards, watery blood, it doesn't matter, that's going to be C-diff. Obviously for C-diff, you're going to use oral vancomycin or phidaxomycin as treatment. And then also do not forget that incents, regular incents, you want to avoid them right after an M-I, one of them right after an M-I. At least for the first six months after an M-I, you only said you really should be taking incidences as a aspirin, right?

That's something you want to keep at the back of your mind for exams. And then don't forget many of these anti-plitlet drugs, any of these anti-coagulants, they cause bleeding. Bleeding, bleeding, bleeding is like a very big thing that's associated with with many of these drugs, right? So don't forget bleeding, bleeding, bleeding. So the key thing I just really wanted to hit here, it gets me let me say a few more things. Again, I don't want this podcast to go for too long, but don't forget if you see peripheral neuropathy, the ascertain drugs that cause peripheral neuropathy, they can give you a TB patient, those are going to be, that's going to be isonize it, it can absolutely cause a peripheral neuropathy, but don't forget that anti-cancer drugs being Christian and then blasting, right? The increase in then blasting, those things are absolutely associated with peripheral neuropathy, the increase in then blasting, those have a very strong association with peripheral neuropathy, those are the key ones you want to know. Hemorrhagic cystitis, right? Remember you can get hemorrhagic cystitis from adenovirus, adenovirus is something that can absolutely cause hemorrhagic cystitis, but besides adenovirus, you can also get this recital phosphamide, so you can give you a question about a person that is on pharmacotherapy for one of these vasculidities, right?

Like, truck strouse, which we call xenophilic granulomatosis repollionjitis, or wegners which we call granulomatosis repollionjitis, remember those things can absolutely, absolutely positively cause hemorrhagic cystitis, right? Cyclophosphamide, cyclophosphamide, the treatment for those disorders can absolutely cause hemorrhagic cystitis, and then if you see a person that just has a lot of MSS, MSS, MSS, like a lot of vomiting, and the chemotherapy agent, think of your platinum agents. Your platinum agents are very bad on causing a lot of, you know, they are very good, big on causing a lot of vomiting. In fact, it was understanding the pharmacology of chemotherapy of those platinum agents like cisplatin that on dancetron was formed, because they realized that wow, hmm, this cisplatin has very powerful serotonin receptor agonist activity, and that's how it causes this MSS in the, you know, by stimulating the chemoreceptor trigger zone. So, drug companies kind of figured out, you know, what if we shut down these serotonin receptors with zophron, you know, that's the trade name, this is on dancetron, then in those circumstances you can stop that chemotherapy and use the MSS. So that's just something you want to keep at the back of your mind for, for example. So I'm going to go ahead and stop here. I believe I've covered again, there are many drug adverse reactions, but that more extended this, this question is probably more so for step one, than for step two, ck step three.

But if you listen to this, I suspect that most, the vast majority of the adverse drug reactions questions, you'll get them right for step two, for step three, for complex level two, complex level three. So thank you for listening to me. Again, I do offer one on one tutoring for all the USMEL exams, step one to step three, complex level one to three. The only thing I don't do is OMM, and all those legal things that shop with complex, what I do to pretty much every other part of these exams. And I mean, if you want one on one tutoring for me, this is something you have to book, far into the future, because my schedule feels up pretty quickly. And then I also offer these group courses for step two, ck and step three. I already discussed them at the very beginning of this podcast. And then I also have these podcasts on Apple podcasts, on Google podcasts on Spotify, at least the most for 1,150. And then I have a You Tube channel, Divine Intervention, USMEL podcasts and videos. That's where I post the videos that I make. And then if you want to get an email notification, whenever I make a podcast, if you want to see all my podcasts from episode one, and then remember the all free, you know, not charging for them from episode one, all the way to episode 387, which is this episode I believe. Right? Go ahead and on the website, divineinterventionpodcasts.com.

And then I also have a new website called Divineinterventionlifelessens.com, where I post some life lessons, many of you know, I'm a Christian. So I make podcasts relating to some Bible-based lessons, you know, that are just common problems that are faced by humanity. I even have it on Apple podcasts. It's called the Divine Intervention Life Lessons Podcast. So thank you for listening to me today. Now one encouragement, I will encourage you. I guess the one life lesson I'll put today is just the importance of being wise with your priorities. The thing is, many people they spend, you know, probably you've heard of this 80-20 year old. You see, many people they spend 20% of their lives on things that should be the number one priorities and 80% of their lives on things that should absolutely not be a priority for them. So I'll just encourage you to leave a more high-yield life. How do you leave a more high-yield life? You leave a more high-yield life by just spending most of your hours on things that have value for your life, on things that it should be your number one priorities. So for example, if you have a family and you're spending 10 hours a day watching on social media, I want to mention a specific company here, on social media or on a streaming service, you have your priorities all wrong. That is just the truth. You know, maybe once in a while it's your day off fine, whatever. But you know, if you have a family, you're not spending that liquid amounts of time with them.

I'm telling you like when you work in a nice CU and you see people passing away, trust me, the only people they want around them are their families. They don't want their gadgets or social media or their favorite streaming service around them. You know, they want to spend time with their families. So don't wait till the end, you know, spend time on those things that matter right now. Again, I'm not saying social media doesn't matter. I'm not saying watching streaming services doesn't matter. Those things absolutely matter. They are very good for keeping them present and check mentally. But I will also encourage you to just prioritize your life, prioritize your life, your medical student. Listen to this. You know that the process is getting more and more competitive every year. Then what are you doing spending 12 hours every day, playing video games and stuff? You got to order your priorities right. Because again, you can pay now and play later or you can play now and pay later. So if you do the wrong thing now, then you're going to be needing people to make calls for you to much into residences. And you're going to have to be worrying about, oh, I have to do even better. I need to do all these things. I need to take this year or for whatever to make my application better. Again, nothing will be taken a year of the astute. Certain disciplines where it's pretty much a requirement, right?

But you see some people have definitely worked with some people where they're literally taken a year off because they just don't have competitive scores. And that year of maybe like, wow, it's not that big of a deal. It's just an extra year. But just imagine you're losing a year of a physician salary. And then those bad decisions you took begin to take on more and more importance. So just kind of think about all these things when you're making decisions. Just put your priorities right. Put your priorities right. Have the right priorities. It won't how you, in how you purchase things. You see some people, the purchase stuff that they do need, the purchase stuff that for the level of income just makes absolutely no sense. So I'll just encourage you just be wise with how you use your resources, be wise with how you use your time because time is one of those things that once it's gone, you'll never get it back. In fact, there's this part of the Bible that says teachers to number our days. So we can apply our hearts to wisdom. Basically, what the Bible is saying, be wise with how you use your time, be wise with your priorities. So I encourage you just be prudent, put your priorities right in life so you can create a very bright, very vibrant future for yourself. Until next time, have a wonderful rest of your day. God bless you. Thank you.

Phenothiazine, Amiodarone, and Tetracycline (SAD mnemonic).

Inhibition of COX shunts arachidonic acid into the LOX pathway, increasing potent leukotriene production.

Hemorrhagic gastritis and visible metallic pills on radiography (X-ray).

Stop all heparin products.

Irreversible dilated cardiomyopathy; this distinguishes it from reversible causes like those seen with Dexrazoxane.

Sulfonamides (e.g., Trimethoprim-sulfamethoxazole), Methotrexate, or 5-Fluorouracil.

SAD (Phenothiazine, Amiodarone, Tetracycline).

Third-generation cephalosporins (e.g., Septriaxacillin); Pregnancy (due to high estrogen levels).

Metabolic acidosis, respiratory alkalosis, and normal sodium/potassium balance (pH buffering).

Isoniazid (TB drug) and anti-cancer agents like Vincristine or Bleomycin.

Stop heparin; use a Factor II inhibitor (e.g., Bivalirudin/Argatroban).

Cyclophosphamide (and other cyclophosphamide-like agents).

SAD (Phenothiazine, Amiodarone, Tetracycline).

Third-generation cephalosporins (e.g., Septriaxacillin); Pregnancy (due to high estrogen levels).

Metabolic acidosis, respiratory alkalosis, and normal sodium/potassium balance (pH buffering).

Isoniazid (TB drug) and anti-cancer agents like Vincristine or Bleomycin.

Stop heparin; use a Factor II inhibitor (e.g., Bivalirudin/Argatroban).

Cyclophosphamide (and other cyclophosphamide-like agents).