Step I Drug toxicities

[katiesb]

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So I'm studying for a cummulative pharm final + boards this weekend...I've always had trouble keeping some of the toxicities straight. It seems like tons of drugs cause three big toxicities: liver, renal and bone marrow. (Especially liver toxicity...it seems obvious that any drug metabolized in the liver has a potential for slightly elevated LFTs)

Is it worth trying to compile a list of all these toxicities? Or should I just memorize the few drugs that are listed under these systems in the pharm section of FA (pg 271, 2012 ed.)?? Thanks in advance!

 

[mdeast]

So I'm studying for a cummulative pharm final + boards this weekend...I've always had trouble keeping some of the toxicities straight. It seems like tons of drugs cause three big toxicities: liver, renal and bone marrow. (Especially liver toxicity...it seems obvious that any drug metabolized in the liver has a potential for slightly elevated LFTs)

Is it worth trying to compile a list of all these toxicities? Or should I just memorize the few drugs that are listed under these systems in the pharm section of FA (pg 271, 2012 ed.)?? Thanks in advance!

Well not sure about your individual pharm final. But for Step 1, I'd say drug toxicities are pretty high yield topic that is tested. I wouldn't bother learning all of them, but each drug has 1-2 toxicities that are classic, clinically relevant, and very testable. (i.e. a person underwent surgery and then presents with massive liver necrosis= inhaled anesthetic toxicity from halothane).

I feel like...at least for Step 1....these are weak points for everyone at the beginning. Just keep going over them, doing questions, etc. and eventually you won't even really need mnemonics to remember them.

 

[katiesb]

Ya, I have no problem with the individual toxicities (ie. phenytoin and gingival hyperplasia). And I've accepted that I have to memorize the P450 inducers & inhibitors. Specifically I'm wondering about non-classic, less specific effects like liver, renal and bone marrow toxicity. I feel like so many drugs fall under those categories, and not every source I have says the same thing. If that makes any sense :/

 

[mdeast]

Ya, I have no problem with the individual toxicities (ie. phenytoin and gingival hyperplasia). And I've accepted that I have to memorize the P450 inducers & inhibitors. Specifically I'm wondering about non-classic, less specific effects like liver, renal and bone marrow toxicity. I feel like so many drugs fall under those categories, and not every source I have says the same thing. If that makes any sense :/

Well. I'd personally say that renal toxicity, liver toxicity and bone marrow toxicity are classic toxicities and not super random. I.e. Amiodarone requires LFT monitoring (+PFTs, +TFTs). Anything that causes bone marrow suppression is super important and makes you susceptible to infection- this is pretty much all of the cancer drugs and at least some of the antibiotics/anti-fungals. Also an easy way to test something "patient comes in with all these recurrent bacterial infections, she has a low neutrophil count, etc....she takes a seizure medication. Which one is it?" (i.e. carbamazepine).

Sometimes they're even good ways to trick you up on questions and test other concepts and ways to differentiate disease (i.e. a patient with a malar rash, joint pain, etc. comes in with anti-histone antibodies. she has a history of heart problems. what is the diagnosis?).

I can guarantee you though. Once you go through enough UWorld/QBank questions and drill them in, they start to become second nature and you see them as easy points on the exam rather than difficult questions. You just gotta work at it. I'm terrible at drugs and hated them at the beginning. But if I can do it, you can too 😉

The P450 enzymes inducers/inhibitors only take about 10 minutes to memorize. Use the First Aid mnemonics. After a few days of reviewing the mnemonic you won't even need it anymore.

 

[johndoe3344]

Ya, I have no problem with the individual toxicities (ie. phenytoin and gingival hyperplasia). And I've accepted that I have to memorize the P450 inducers & inhibitors. Specifically I'm wondering about non-classic, less specific effects like liver, renal and bone marrow toxicity. I feel like so many drugs fall under those categories, and not every source I have says the same thing. If that makes any sense :/

The problem is that a lot of drugs have a LOT of toxicities. FA will present you with a list of maybe 10 side effects, and your textbook will probably have a list of 20 side effects. There's no real way to "know" which are important (read: shows up on USMLE) and which are less important. This is something that will come to you as you do more and more questions or look at different sources ("Oh, I've come across that drug X does A, B, and C three times now... I better remember this"). But unfortunately, you have to start somewhere, and you have to make that decision yourself about what's important. Often, like mdeast has said, things like various organ toxicities are pretty key to know. But very frequently you can get more than one drug that will do the same exact thing; it's just that other drug is "less frequently tested" for that particular effect. As an example, the anti-seizure drug that mdeast was talking about could just as easily be phenytoin since it can also cause aplastic anemia and agranulocytosis. But of course, we all know that phenytoin is more "classically" known for its role in gingival hyperplasia, fetal hydrantoin syndrome, etc.

 

[lemonade90]

Too bad people who make the drugs don't name them anything like molecules made by organic chemists (i.e. IUPAC). That would have helped cut down on the memorization. I have often felt like they pick names off a dartboard but I guess that is a pretty accurate assessment:

http://www.usatoday.com/money/industries/health/2007-10-07-drug-names_N.htm

 

[katiesb]

Too bad people who make the drugs don't name them anything like molecules made by organic chemists (i.e. IUPAC). That would have helped cut down on the memorization. I have often felt like they pick names off a dartboard but I guess that is a pretty accurate assessment:

http://www.usatoday.com/money/industries/health/2007-10-07-drug-names_N.htm

Haha seriously! Half the battle is just memorizing the names!

Thanks for the input everyone. I miss the good ole days of undergrad when I could just understand a concept and move on. I hate that everything in med school takes a zillion repetitions to learn 😴 Guess I will suck it up and continue to go through flashcards and practice Qs.

 

[mdeast]

Haha seriously! Half the battle is just memorizing the names!

Thanks for the input everyone. I miss the good ole days of undergrad when I could just understand a concept and move on. I hate that everything in med school takes a zillion repetitions to learn 😴 Guess I will suck it up and continue to go through flashcards and practice Qs.

Woot! Stick with it. Drugs/Bugs become easy by the end.