Side Effects - NCLEX-PN

The ringing in the ear is tinnitus, which is indicative of ototoxicity. Nausea, metallic taste in mouth, difficulty swallowing and skin reactions are not associated with the development of ototoxicity.

Nausea, vomiting, and diarrhea are common symptoms of digoxin toxicity. Other symptoms may include confusion, anorexia, irregular heartbeat, and palpitations. Tremors, mood swings, and rash are not generally seen with digoxin toxicity.

All of these are potential side effects of ACE (angiotensin-converting enzyme) inhibitors such as enalapril, but angioedema (the swelling of the face, lips, and/or tongue) is a potentially life threatening condition, as swelling can obstruct the airway.

Meperidine is contraindicated because in high doses it can form a toxic metabolite that can lead to seizures. All other drugs listed are appropriate for pain control for sickle cell crisis.

The symptoms this patient are presenting with are consistent with serotonin syndrome, a rapid onset and potentially life-threatening condition of excess circulating serotonin. Symptoms can range from mild to severe, and may include tachycardia, nausea and vomiting, diarrhea, hyperreflexia, sweating, mydriasis, myoclonus, mental status changes, headache, and coma. Serotonin syndrome is generally caused by drug interaction or overdose of drugs that raise circulating serotonin levels, such as selective serotonin reuptake inhibitors (SSRI's) and monoamine oxidase inhibitors (MAOI's).

Extrapyramidal side effects generally present as slow or repetitive motions or postures (dystonia), spasm, tremor, slurred speech, slowed thought process, restlessness and anxiety, paranoia, and general overall distress. These effects are caused by antipsychotic drugs that act as dopamine D2 receptor antagonists.

Extrapyramidal side effects are common with typical antipsychotic drugs that act as dopamine D2 receptor antagonists. These include many selective serotonin reuptake inhibitors (SSRI's), serotonin–norepinephrine reuptake inhibitors (SNRI's), and norepinephrine–dopamine reuptake inhibitors (NDRI's), as well as antiemetics such as metclopramide.

Alprazolam is a benzodiazepine and is not associated with extrapyramidal adverse effects.

The most likely cause of uncontrollable muscle movements in the absence of other systemic symptoms in a patient with a history of antipsychotic drug use is tardive dyskinesia. This is a disorder of rapid involuntary movements, most often in the face or head but also potentially affecting the extremities. It's exact cause is not well understood, but it is theorized to be an issue of sensitization of the D2 dopamine receptors after long-term neuroleptic use.

While SSRI's have been known to cause a variety of adverse effects, including diminished libido, increased risk of suicide in children and adolescents, restlessness, photosensitivity, and increased risk of bone fracture, individuals taking SSRI's are not associated with any increased incidence of coronary heart disease.

Acetaminophen has surpassed viral hepatitis as the most common cause of acute hepatic failure in the United States. Hepatotoxicity can occur in doses of 7.5g or up for adults and 150millg/kg of body weight in children aged 1-6. None of the other drugs listed are particularly hepatotoxic.

Acetaminophen depletes glutathione, one of the body's most important antioxidants. The liver is the body's main processing organ for environmental and ingested toxins, and glutathione is the primary molecule the liver uses to rid itself of the harmful biproducts of the detoxification process. When glutathione is severely depleted, such as with acetaminophen overdose, hepatic cells can rapidly necrose, resulting in liver failure and even death.

Alendronate is a bisphosphonate drug used in the treatment of osteoporosis and osteogenesis imperfecta. An individual taking this medication should be instructed to remain upright for a minimum of thirty minutes after ingestion in order to avoid esophagitis. Other gastrointestinal adverse effects of alendronate include esophageal strictures, achalasia, gastric ulcers, and gastritis. None of the other medications listed are associated with esophagitis.

The most common side effects of beta blockers are fatigue, dizziness, weakness, cold hands or feet, dry mouth, headache, nausea, diarrhea, and shortness of breath.

Chlorpropamide, an antidiabetic medication in the sulfonylurea class, has been associated with drug-induced SIADH (syndrome of inappropriate antidiuretic hormone secretion). This is a rare but serious complication that will generally resolve once drug treatment has stopped. None of the other drugs listed are associated with this side effect.

Most opiates can cause respiratory depression when taken in toxic levels. They do this by reducing the sensitivity of respiratory center neurons to carbon dioxide, which results in decreased breathing. In more moderate cases brain damage can precede death due to CNS hypoxia. Opiates generally are not associated with liver failure (unless taken as a combination drug with acetaminophen, such as hydrocodone), heart attack, or serotonin syndrome.

Many opiates stimulate histamine release by mast cells. The cause of this stimulation remains unclear, but it is considered to be a non-immunological (therefore, not an allergy). There is some speculation that opiates trigger the release of histamine from mast cells by directly activating G proteins on mast cell surfaces. Opiates are not generally associated with kidney failure, and the most common symptoms in opiate allergy include hives, flushing, hives, low blood pressure, gastrointestinal discomfort (though constipation is typical in most patients and does not indicate allergic reaction), and angioedema.

NSAID's are frequently associated with irritation of the gastric mucosa. This can lead to gastritis, ulcer formation, gastric bleeding, or perforation. NSAID use is not generally associated with weight gain, loss of bone density, muscle spasms, or hypertension.

Of the drugs listed, the only one associated with this bizarre side effect is rifampicin, a broad spectrum antibiotic used in tuberculosis. Urine, sweat, saliva, or tears may be turned any shade from red to reddish orange.

Gentamicin is an aminoglycoside antibiotic. Most antibiotics in the aminoglycoside class can have significant ototoxic effects. Of these, streptomycin and gentamicin are primarily toxic to the vestubular system, while amikacin, neomycin, dihydrosterptomycin, and kanamicin primarily affect the cochlea. None of the other antibiotics listed are generally associated with ototoxicity.