Side Effects of Medications:

1. Hepatotoxicity:
Drugs:
-Jaundice/Dark Urine/Clay Colored Stool R = Rifampin
-Abdominal Pain/N&V A = Ace
taminophen
-Weakness/Fatigue/Anorexia A
CE Inhibitors
P = Phenytoin ( Dilantin)
E = Erythromycin
Estrogens
N = NSAIDS

2. Nephrotoxicity:
Drugs:
-Proteinuria/Cloudy & Punk Urine T = Tetracy
cline
-Edema ( Sacral/Feet/Ankle) R = Ri
fampin
-Oliguria/Anuria
A = Aminoglycosides
-Weight Gain
Amphotericin B
-Dyspnea/Jugular Vein Distention Ac
etaminophen
Acyclovir
N = NSAIDS

3.Ototoxicity:
Drugs:
-Hearing Loss/Tinnitus A
= Aminoglycosides
-Ataxia/Vertigo
B = Bumetanide
-N&V
C = Cisplatin
F = Furosemide ( Lasix)
E = Erythromycin
Ethacrynic Acid
N = NSAIDS
S = Salycilates
V = Vancomycin
 ANTIDOTES TO COMMON MEDICATIONS:
*Acetaminophen = Acetylcyteine or Mucomyst ( give orally, solution dilute in
(Tylenol) cola/wa
ter/juice or by nasogastric tube)
*Acute Poisoning ( mercury/gold/arsenic) = BAL ( Dimacaprol)
*Alupent ( Metaproterenol), Theophylline, Caffeine = Esmolol
*Allergies ( Anaphylaxis) = Epinephrine
*Ammonia = Lactulose
*Anticholinesterase = Atropine or Pralidoxime
*Anticholinergics = Physostigmine
*Antifreeze = Fomeprizole, Ethanol
*Arsenic = BAL ( Dimecaprol), CHEMET ( Succimer)
*Barbiturates = Urine Alkanization, Dialysis, Activated Charcoal
*Benzodiazepines = Romazicon ( Flumazenil)
*Beta-Blockers = Glucagon, Epinephrine
*Bethanechol Chloride ( Urecholine) = Atropine Sulfate
*Ca Channel Blockers = Ca Chloride, Glucagon
*Carbon Monoxide (CO2)=Hyperbaric, Oxygen (100%O2) via nonrebreather face mask
*Cholinesterase Inhibitors = Atropine Sulfate
*Coumadin ( Warfarin) = Vit. K ( Aquamephyton), Phytonadione
*Curare = Tensilon
*Cyanide = Methylene Blue, Amyl Nitrite, Sodium Nitrite, Sodium Thiosulfate
*Digoxin = Digibind or Digoxin Immune Fab
*Dopamine = Phentolamine ( Regitine)
*Endrophonium ( Tensilon) = Atropine Sulfate
*EPS ( Extrapyramidal Symptoms) = Benadryl ( Diphenhydramine)
*Ethylene Glycol = Fomepizole ( Antizol)
*Fluorouracil = Leucovorin Calcium
*Flunitrazepam (Rohypnol) = Romazicon ( Flumazenyl)
*Gold = BAL ( Dimecaprol)
*Heroin = Narcan ( Naloxone) or Nalmefene
*Heparin = Prothamine Sulfate ( give intravenous = over 3 minutes)
*Insulin Reaction = IV Glucose ( D50)
*Iron ( Fe) = Deferoxamine ( Desferal)
*Isoniazid ( INH) = Vit. B6
*Lead = EDTA ( Edetate Calcium Disodium), BAL ( Dimecaprol) ,
CHEMET ( Succimer)
*Malignant Hyperthermia ( MH) = Dantrolene
*Magnesium Sulfate = Ca Gluconate
*Mestinon = Atropine Sulfate
*Methanol = Ethanol, Fomepizole, Dialysis
*Methemoglobin = Methylene Blue
*Methotrexate = Laeucovorin Calcium
*Muscarinic Receptor Blockers = Physostigmine
*Narcotics = Narcan ( Naloxone) or Nalmefene
*Neostigmine = Pralidoxime Chloride ( PAM)
*Opioid Analgesics = Narcan ( Naloxone) or Nalmefene
*Organophosphate ( OPP) is cholinesterase inhibitor = Atropine or Pralidoxime
*Potassium ( K) = Insulin & Glucose, NaHCO3 ( Sodium Bicarbonate), Albuterol
Inhaler, Kayexalate
*Phenelzine Sulfate ( Nardil) = Phentolamine ( Regitine)
*Phencyclidine Hydrochloride ( PCP) = NG Suction
*Pilocarpine Hydrochloride ( Isopto-Carpine) = Atropine Sulfate
*Rat Poison = Vitamin K
*Salicylates = Urine Alkanization, Dialysis, Activated Charcoal
*Snake Bites = Antivenin
*Streptokinase = Aminocaproic Acid ( Amicar)
*TCA ( Tricyclic Antidepressants/Quinidine) = Physostigimne or Sodium Bicarbonat
e
*Tissue Plasminogen Activator ( t-PA), Streptokinase =Aminocaproic Acid

*Tranquilizers-EPS Symptoms = Benadryl ( Diphenhydramine)

*Thorazine ( Chlorpromazine) = Cogentin ( Benztropine)
*Valium = Flumazenil( Romazicon)
*Versed = Flumazenil ( Romazicon)
*Vincristine = Hyaluronidase
*Wild Mushrooms = Atropine

Therapeutic Drug Levels:

2 – 5 mcg/ml: 5 – 10 mcg/ml: 5 – 12 mcg/ml:
*Proca
inamide *Gentamycin *Carbamazepine (Tegret
ol)
*Quinidine *Tobramycin *Primidone

10 – 20 mcg/ml: “PACT” 10 – 30 mcg/ml:

P = Phenytoin ( Dilantin) *Phenobarbi
tal
A = Acetaminophen/ Aminophylline 20 – 25 mcg/ml:
C = Chloramphenicol *Kanamycin
T = Theophylline 20 – 30 m
cg/ml
*Amikacin
20 – 40 mcg/ml:
*Vancomycin
4 – 10 mcg/ml 40 – 100
mcg/ml:
*Procainamide *Ethosu
ximide
*Valproic Acid
50 – 100 ng/ml 50 – 150
ng/ml
*Propranolol *Nor
triptyline
150 – 300 ng/ml: “… amine” 120 – 150 ng/ml
*Desipramine *Ami
triptyline
*Imipramine

*Digoxin = 0.5 – 2.0 ng/ml *Lithium = 0.6

– 1.2 mEq/L
*Digitoxin = 20 – 35 ng/ml *Lidocaine = 1
.5 – 5.0 mcg/ml
*Diazepam ( Valium) = 100 – 1000 mcg/ml *Librium = 700 – 1000 mcg/ml
*Salicylates (Aspirin) = 100 – 250 mcg/dl or 10 – 20 mg/dl

FOOD-DRUG INTERACTIONS:
1. Medications which Should be Taken = on Empty Stomach:
(1hr before or 2 hrs. after meals)
a)ACE Inhibitors =only that:Captopril(Capoten)&Moexipril(Univasc)(1 hr before me
al)
b)Bisphosphonates( for Osteoporosis) = Alendronate ( Fosamax) = at morning/Boniv
a
(Osteoporosis/ Paget’s D) Etidronate ( Didronel )=take with
full glass H2O
c)Antibiotics = Ampicillin / Erythromycin*/Oxacillin/Penicillin /Tetracycline/
Zithromax/Levofloxacin/Ciprofloxacin ( Cipro)
( 1 hr before or 2 hrs after meal = with full glass of
H2O
Sulfonamides = Bactrim/ Septra = with full glass of H2O
d) Antituberculous Drugs = Isoniazid ( INH)/ Rifampin /Rifabutin ( Mycobutin)
e) Digoxin
f) Bethanechol ( Urecholine)
g) Nitrates = Nitroglycerin ( Nitrostat)/Isordil/Nitrodur/Imdur/Ismo( Isosorbide
)
h) Acetaminophen (Tylenol)
i) Stimulant Laxatives = Bisacodyl ( Dulcolax)
j) Antiviral = Didanosine ( Videx) ( can be crushed)
Anti-HIV = Only Indinavir ( Crixivan) =with full glass of H2O.
Zalcitabine ( Hivid) = best on empty stomach,can also tak
e with food
k) Erectile Dysfunction Drugs = Viagra
l) Thyroid Hormones = Levothyroxine ( Synthroid) = first in the morning
m) PPI’s ( proton pump inhibitor) = Omeprazole ( Prilosec) = 15 min. before breakf
ast
If Treating Ulcer with H.Pilori = Take together with Antibiotic ( Amoxicill
in)
at same time of the day./ Lansoprazole ( Prevacid) =15 min. before breakfas
t
PPI’s = (best if taken on empty stomach , but can also be taken with food or mi
lk.)
n) Antiulcer = Sucralfate ( Carafate) (with water on empty stomach)
o) Antiarrthythmic = Quinidine Sulfate /Pronestyl ( Procainamide)/ Procanbid
( best =on empty stomach with full glass of water, but can be take also with fo
od)
p) Antiasthmatic = Zafirlukast ( Accolate) = bronchodilator
q) Antithrombotics = Persantine ( Dipyridamole)( best =on empty stomach with ful
l
glass of water, but can be take also with food)
r) Antihistamines =Hismanal ( Astemizole)
s) Chemotherapy = Methotrexate/Cytoxan ( Cyclophosphamide) ( take =on empty stom
ach /if stomach upset = take with food/with full glass of H2O)

2. Medications which Should be Taken = ½ hr Before Meals.

*Belladonna *Glipizide ( Glucotrol) *Neostigm
ine (Prostigmine)
*Cholestyramine *Metoclopramide (Reglan) = also take at bedtime
*Donnatal * Pro-Banthine
3. Medications which Should be Taken = with Food or Milk:
a)Diuretics = Lasix/Bumex/Demadex/Diuril
Chlorothiazide/ Spironolactone
take with milk /take in the morning*
b) Antibiotics = Erythromycin Base*: Ilosone/E-Mycin/Biaxin/Zythromax/
Nitrofurantoin ( Macrobid)
Cephalosporins = Ceclor/Cafaclor/Cafprozil ( Cefzil)/Keflex ( Cephalexin)
Cephadroxil(Duricef)/Cefazolin ( Kefzol) (take
with food or milk)
c)Antidiabetic = Gluburide ( Diabeta/Micronase) = take with breakfast/
Glucophage ( Metformin)
Repaglinide (Prandin ) = take 15 min. before meal
d)NSAIDS = Aspirin/Celebrex/Motrin/Naproxen/Ibuprofen/Advil/Aleve/Indomethacin/
Piroxicam/Voltaren ( Diclofenac)/Ketorolac/Etodolac/Fenopro
fen/Tolmetin/
Sulindac ( Clinoril) take with full glass of H2O
e)Corticosteroids = Methyprednisolone/Prednisone/Deltasone/Cortisone ( Cortef)
f)Statins = Lipitor/Zocor/
Only Lovastatin (Mevacor)= take with evening meal.
g)Beta-Blockers = Atenolol/Metoprolol/Propranolol
h) Metronidazol ( Flagyl)/Mebendazol( Vermox)= antihelmintic
i) Antifungals = Fluconazole ( Diflucan)/Griseofulvin ( Grifulvin)/Ketoconazole
( Nizoral)/Intraconazole ( Sporanox)
j) Antianxiety/Benzodiazepines = Clonazepam (Klonopin*)
k) Antiviral/Anti-HIV = Ritonavir ( Norvir)/Saquinavir/ Nelfinavir ( Viracept)
l) Antiulcer = Misoprostol ( Cytotec)
m) Ca Supplements = Ca Carbonate
n) Antacids = Maalox ( Simethicone, Aluminum Hydroxide)( 1 hr after meal)
o) Ca Channel Blockers = Diltiazem ( Cardizem)
p) Antimanic = Lithium ( Lithobid)
Carbamazepine ( Tegretol)/ Valproic Acid ( Depakene)
q) Iron Preparations = Fe Fumarate/Fe Sulfate/Fe Gluconate = give with juice hig
h in vitamin c: orange or tomato/drink through straw & rinse mouth after (can st
ain the teeth)

r) Bronchodilators = Theophylline ( Aminophylline) = with milk & crackers/

Albuterol ( Proventil) = with increased fluids to decrease viscosity & increa
se
expectation of secretions
s) Anticonvulsants = Phenytoin (Dilantin)/ Divalproex Sodium ( Depakote) /
Ethosuxumide ( Zarontin) = take with full gla
ss of H2O.
t) Anti-Parkinsonic = Levodopa ( L-Dopa)/Dopar
u) Antigout = Allopurinol ( Zyloprim)/Colchicine/Probenecid(Benemid) = with ful
l
glass of H2O ( increased fluids to promote uric acid excretion)
v) Skeletal Muscle Relaxants = Baclofen ( Lioresal)
w) Ergoline Derivate = Bromocriptine ( Parlodel)
x) Antiarrthythmic = Amiodarone ( Cordarone)
y) Antiplatelet = Ticlopidine(Ticlid)
z) Antidepressants = Trazodone ( Desyrel)
a1) Anti-inflammatory ( to treat inflammatory bowel disease, ulcerative colitis)
=
Sulfasalazine ( Azulfidine) / Olsalazine ( Dipentum)
a2)Potassium Supplements = Potassium Salts ( K-Acetate/Bicarbonate/Citrate)/
Slow-K , K-Lor ( Potassium Chloride)
Niacin ( Vit. B3)
4. Medications which Should be Avoided = with Milk & Diary Products:
*Bisacodyl *Ecotrin
*Demeclocycline *Ferrous Sulfate
*Doxycycline *Tetracycline
*Ducolax *Calcium Carbonate Antacids
( can cause
milk-alkali syndro
me/take only with water)
5. Medication which Should be Taken = with or without Food:
Antibiotics = Amoxicillin ( Augmentin) /Doxycycline/Gantrisin ( full glass of H2
O)
Zithromax ( better on empty stomach, but if stomach upset =
take with food)
Quinolones = Ciprofloxacin / Levofloxacin ( Levaquine) =( take on empty stomach
, but if stomach gets upset take = with food/ take =with full glass of H2O)
Sulfonamides =Bactrim, Septra ( with food/with full 8 oz. glass of H2O)
( Sulfamethoxazole + Trimethoprim)
Antidepressants = Paxil ( Paroxetine)/Zoloft/Prozac ( Fluoxetine)/Cymbalta
Histamine Blockers = Cimetidine ( Tagamet) /Famotidine ( Pepcid)/Ranitidine ( Za
ntac)
ACE Inhibitors :Enalapril ( Vasotec)/Lisinopril ( Zestril)
Statins = Simvastatin ( Zocor)/ Fenofibrate ( Tricor)

Chemotherapy = Methotrexate/Cytoxan ( Cyclophosphamide) ( take =on empty stomach

/if stomach upset = take with food/with full glass of H2O)
Antiviral = Zovirax( Acyclovir)/Valtrex ( Valacyclovir)
Antianxiety/Benzodiazepines =Librium/Valium /Xanax /Buspar( best take before mea
l)
Opioid Analgesics = Hydromorphone/ Hydrocodone ( better with food)/Vicodin =
(Contains Hydrocodone + Acetaminophen)
Anticoagulant = Coumadin ( Warfarin)
Ca Supplements =Ca Citrate Only ( with full glass of 8 oz H2O)
Erectile Dysfunction Drugs = Cialis ( Tadalafil) /Levitra (Vardenafil)
(with full glass of 8 oz H2O
)
Antipsychotics = Zyprexa ( Olanzapine) ( treat schizophrenia & bipolar d-r)
Antiulcer = Prevacid ( Lansoprazole)
Antihistamines = Loratadine ( Claritin)l= with full glass of water/better with f
ood
MAO Inhibitors
Antiseizure = Felbamate ( Felbatol)

6. Medications which Should be Avoided = with Grapefruit Juice:

*Statins = Atorvastatin ( Lipitor)/Lovastatin(Mevacor)/Simvastatin (Zocor)
*Ca Channel Blockers = Diltiazem/Nifedipine/Verapamil/Felodipine ( Plendil)
*Antiviral ( HIV-Meds)= Indinavir/Ritonavir/Saquinavir/Nelfinavir
*Benzodiazepines = Diazepam/Midazolam ( Versed)/Triazolam
*Antianxiety = Xanax/Buspirone ( Buspar)/Sertaline(Zoloft)
*Antidepressant = Trazodone ( Desyrel)/ Clomipramine (TCA)
*Anticonvulsant/Antiseizure = Carbamazepine ( Tegretol)
*Antipsychotic = Haloperodol
*Sedative/Hypnotics = Zolpidem/Zaleplon ( Sonata)
*Antihistamine = Hismanal( Astemizole)
*Antiarrthythmic = Amiodarone/Lidocaine/Quinidine
*Opioid Analgesic = Codeine/Fentanyl/Methadone ( Dolophine)
*Immunosuppressant (prev. transplant rejection)=Cyclosporine/Tacrolimus (Prograf
)
Vicristine
*Erythromycin/Clarithromycin
*Estrogens/Oral Contaceptives (Progesterone/Progestins)
*Finasteride ( Proscar) = treat benign prostate hypertrophy

#Avoid Taken Together:

*Antacids = Avoid Eat Whole Grain Bread
*Antibiotics: Penicillin/Erythromycin = Avoid Citrus, Cola
Tetracycline = Avoid Milk & Diary Products ( Ca products)
*Anticoagulants: Warfarin (Coumadin)=Avoid Vit. K (Green Leafy Vegetables)
*MAO Inhibitors ( Zyvox)= Avoid Thyramine Foods
* Ca Carbonate Antacids = Avoid Milk & Diary Products ( Ca & Vit. D)
*Methotrexate = Avoid Take Folic Acid.
*Avoid Licorice = If Taken Digoxin ( Lanoxin)/Antihypertensive Drugs: Hydrodiuri
l
( Hydrochlothiazide)/Diutretic :Aldactone ( Spironolactone)/Beta-Blockers
#Avoid Taking with Alcohol :
Antianxiety = Xanax/Zoloft/Buspar
Antidepressant = Paxil
Benzodiazepines = Restoril ( Temazepam)/ Clonazepam (Klonopin)
Antidepressants = Trazodone ( Desyrel)
Antibiotic =Metronidazol ( Flagyl)
Nitrates = Nitroglycerin/Isosorbide Dinitrate ( Isordil)/Ismo /Monoket/Imdur
Antiarrthythmic = Procainamide ( Pronestyl)/Procainbid/Quinidine Sulfate
Antifungal = Ketoconazole ( Nizoral)
Antidiabetic = Gliburide/Glipizide
Anticonvulsants = Phenytoin (Dilantin)
#Avoid Taking with Alcohol & Caffeine:
Antianxiety = Diazepam/Lorazepam ( Ativan)/Valium
Antidepressants = Amitriptyline (Elavil)
Bronchodilators = Aminophylline/Teophylline
Histamine Blockers = Cimetidine/Ranitidine
MAO Inhibitors = Marplan/Nardil/Parnate
Quinolones = Ciprofloxacin/Levofloxacin
7. Medications which Should Not be Crushed:
Enteric-coated:
Bisacodyl (Dulcolax), Enteric-Coated Aspirin (Ecotrin ), Lansoprazole (Prevacid)
, Omeprazole (Prilosec), Pancrelipase (Pancrease), Valproic Acid (Depakote),
EES ( Erythromycin)
Extended-release:
Diltiazem (Cardizem ), Fexofenadine/Pseudoephedrine (Allegra), Mesalamine (Asaco
l Pentasa), Verapamil (Calan , Isoptin ), Oxybutynin extended-release (Ditropan
), Propranolol long-acting (Inderal ), Tamsulosin (Flomax), Valproic Acid exte
nded-release (Depakote ), Theophylline ( Theo-Dur/ Theobid)
Sustained Release ( SR Forms):
Procainamide ( Pronestyl SR)
Bitter taste:
Cefuroxime (Ceftin), Ciprofloxacin (Cipro), Docusate (Colace), Ibuprofen (Motrin
)

Irritant:
Alendronate (Fosamax), Atomoxetine (Strattera), Diflunisal (Dolobid), Isotretino
in (Accutane), Piroxicam (Feldene), Risedronate (Actonel), Valproic acid (Depake
ne)
Safety:
Finasteride (Proscar), Mycophenolate (Cellcept), other cancer chemotherapy agent
s
Anesthetizes local mucosa:
Benzonatate (Tessalon Perles)
Fragility:
Mirtazapine (Remeron SolTab), Olanzapine (Zyprexa Zydis)
Ability to stain teeth:
Amoxicillin/Clavulanate (Augmentin), Linezolid (Zyvox),
Iron Products: Feosol ( Fe Sulfate)
Also:
Glucotrol ( Glipizide)
Potassium Chloride = Klor-Con/K-Tab/Slow-K
MS Contin ( Morphine Sulfate)
Phazyme ( Simethicoine)
Prozac ( Fluoxetine Hydrochloride)
Theophylline ( Theobid/Theo-Dur)
Pregnancy Categories for Drugs
Category A = No Risk to Fetus
Category B = Insufficient Data to Use in Pregnancy
Category C & D= Risk to Fetus, but Benefits of Medication Could Outweigh the Ris
k
Category X = Avoid Use in Pregnancy, Potential Risk to Fetus.
Patch Test = is a Skin Test that Involves Administration of an Allergen to the S
urface of the Skin to Identify Specific Allergies.
Instruction, Following Patch Testing:
a) Keep the Test Site = Dry
b) Decrease All Activities = t.k. that Increases Sweating
c) All Loose or Nonadherent Test Patches = Should be Removed.
 Don’t Reapply = Loose or Nonadherent Test Patches.
d) The Initial Reading is Performed = 2 days After Application
The Final Reading = 2-5 days Later.

Drugs that Cause Hyperglycemia (Increase Blood Sugar): “TOTE BAG”

T = Thiazides Diuretics
O = Oral Contraceptives
T = Thyroid Medications
E = Estrogen
B = Bronchodilators
A = Adrenalin
G = Glucocorticoids
Drugs that Cause Hypoglycemia (Decrease Blood Sugar): “MATABA”
M = MAO Inhibitors
A = Anticoagulants
T = Tetracycline
A = ASA ( Aspirin)
B = Beta Blockers
A = Alcohol