Every contraindication, prohibition and named reaction in the three Exam 1 decks, in one place. 71 entries, each citing the slide it came from. Built after Dr. McInnis’s email that students over-study mechanism and under-study indications, patient education, side effects and contraindications.
| Drug or class | What it says | Source |
|---|---|---|
| Carbapenems imipenem, meropenem, ertapenem, doripenem | Monitor renal and hepatic function, full blood count for bleeding, signs of anaphylaxis — and SEIZURES, specifically with imipenem. That pairing is the one carbapenem fact most likely to be asked. | L1 slide 44 |
| Vancomycin | Infusion-related reaction — “Red Man Syndrome”, with fever, chills and phlebitis. The deck also titles a slide “Vancomycin Infusion Syndrome”. It is an infusion-rate problem, which is why the drug is infused over 60 minutes. | L1 slide 51 |
| Macrolides erythromycin, clarithromycin, azithromycin | QT prolongation and Torsades de pointes — worse in combination with class Ia and III antiarrhythmics and with electrolyte abnormalities. | L1 slide 57 |
| Fluoroquinolones ciprofloxacin, levofloxacin, moxifloxacin | Tendonitis and Achilles tendon rupture. Caution if under 18 years old. Also peripheral neuropathy and central nervous system toxicity — dizziness, insomnia, somnolence. | L1 slide 79 |
| Fluoroquinolones ciprofloxacin, levofloxacin, moxifloxacin | QT prolongation and Torsades de Pointes. Photosensitivity, and they complex with cations — iron, antacids, multivitamins, calcium and dairy. | L1 slide 79 |
| Trimethoprim / sulfamethoxazole Septra, Bactrim | Stevens-Johnson syndrome and toxic epidermal necrolysis. Blood dyscrasias — thrombocytopenia, agranulocytosis, megaloblastic anemia. Hepatotoxicity and hyperbilirubinemia. | L1 slide 85 |
| Metronidazole Flagyl | Disulfiram-like reaction with ethanol. The single most testable fact about this drug — counsel the patient not to drink. | L1 slide 86 |
| Linezolid Zyvox | Serotonin syndrome with SSRIs, tyramine-containing foods and pseudoephedrine. Also thrombocytopenia. | L1 slide 71 |
| Albendazole, mebendazole Albenza, Emverm | Very well tolerated, but rash including Stevens-Johnson syndrome and toxic epidermal necrolysis is described. | L1 slide 115 |
| Atropine and antimuscarinics | The anticholinergic toxidrome: mad as a hatter (sedation, anxiety, hallucinations, seizures), blind as a bat (mydriasis, blurry vision), red as a beet (flushing), dry as a bone (decreased secretions), hot as Hades (hyperthermia), plus constipation, urinary retention and tachycardia. | L3 slide 50 |
| Succinylcholine | Malignant hyperthermia with halothane in genetically susceptible people — muscular rigidity, metabolic acidosis, tachycardia and hyperpyrexia. Treat by rapid cooling and dantrolene (Dantrium). | L3 slide 70 |
| Clonidine Catapres | Rebound hypertension with abrupt discontinuance. Also lethargy, sedation, constipation and xerostomia. | L3 slide 97 |
| Alpha-1 blockers prazosin, terazosin, doxazosin, tamsulosin, alfuzosin | “First-dose” syncope. Also dizziness, lack of energy, nasal congestion, headache, drowsiness and orthostatic hypotension. | L3 slide 111 |
| Phenoxybenzamine | Epinephrine reversal — it blocks the alpha vasoconstriction of epinephrine but not its beta vasodilation, so blood pressure falls. Block is irreversible; the body must synthesize new receptors, taking at least 24 hours. | L3 slide 109 |
| Propranolol non-selective beta blocker | Arrhythmias if stopped abruptly, from up-regulation of beta receptors — never stop a beta blocker suddenly. Also central effects: depression, hallucinations, vivid dreams and nightmares. | L3 slide 117 |
| Drug or class | What it says | Source |
|---|---|---|
| Tetracyclines tetracycline, doxycycline, minocycline | Avoid in the 2nd and 3rd trimester of pregnancy. Also photosensitivity, and they chelate with cations — iron, calcium and dairy block absorption. | L1 slide 63 |
| Tetracyclines — for acne Lecture 2 restates it harder | Contraindicated in children under 8 years and in pregnant women. Lecture 2 words this as an outright contraindication where Lecture 1 says “avoid”. | L2 slide 28 |
| Itraconazole Sporanox | Teratogenic. Substrate for and inhibitor of CYP3A4. | L1 slide 104 |
| Fluconazole Diflucan | Teratogenic in animals. Inhibits CYP3A4 and CYP2A4. | L1 slide 106 |
| Voriconazole Vfend | Teratogenic in animals. Visual effects in 30%, plus liver and renal effects. The intravenous vehicle cyclodextrin accumulates in renal failure. | L1 slide 107 |
| Isotretinoin Accutane | CONTRAINDICATED in pregnancy and breastfeeding — men should avoid as well. Enrollment in iPledge is required. Monitor for signs of developing depression and for raised serum lipids. | L2 slide 27 |
| Topical retinoids tretinoin, adapalene, tazarotene | Avoid during pregnancy. Photosensitivity and severe sunburn. Benzoyl peroxide inactivates tretinoin, and tretinoin is photolabile so it is applied nightly. | L2 slide 24 |
| Drug or class | What it says | Source |
|---|---|---|
| Ceftriaxone Rocephin | Cannot be used during the first 30 days of life. Cefotaxime is preferred in neonatal fever or sepsis. No dosage adjustment is needed in renal insufficiency. | L1 slide 34 |
| Tetracyclines tetracycline, doxycycline, minocycline | Avoid under 8 years old — causes discoloration of teeth (doxycycline more than the others) and depression of skeletal growth. | L1 slide 63 |
| Tetracyclines — for acne Lecture 2 restates it harder | Contraindicated in children under 8 years and in pregnant women. Lecture 2 words this as an outright contraindication where Lecture 1 says “avoid”. | L2 slide 28 |
| Fluoroquinolones ciprofloxacin, levofloxacin, moxifloxacin | Tendonitis and Achilles tendon rupture. Caution if under 18 years old. Also peripheral neuropathy and central nervous system toxicity — dizziness, insomnia, somnolence. | L1 slide 79 |
| Topical corticosteroids | Local: skin atrophy, acne, rosacea, allergic dermatitis. Systemic: adrenal suppression, infections, hyperglycemia, glaucoma, cataracts, and growth retardation in children. Risk rises with potency, duration, area covered and occlusiveness — ointment > cream > lotion. | L2 slide 38 |
| Drug or class | Tier | What it says | Source |
|---|---|---|---|
| Aminopenicillins amoxicillin, ampicillin | Contraindicated | Contraindicated in patients allergic to penicillin, and in a patient with a past history of cholestatic jaundice or hepatic dysfunction. | L1 slide 21 |
| Aminopenicillins amoxicillin, ampicillin | Caution | Reduces the effectiveness of oral contraceptives — use backup birth control. Prolongs prothrombin time with anticoagulants. | L1 slide 20 |
| Penicillins — class | Caution | Adverse reactions are hypersensitivity reaction, rash and diarrhea. Dosing is adjusted for renal function. Monitor renal and hepatic function and platelets. | L1 slide 22 |
| Cephalosporins — class | Caution | Penicillin cross-sensitivity of approximately less than 1% — the number to know when a stem gives you a penicillin-allergic patient. | L1 slide 30 |
| Ceftriaxone Rocephin | Avoid / do not use | Cannot be used during the first 30 days of life. Cefotaxime is preferred in neonatal fever or sepsis. No dosage adjustment is needed in renal insufficiency. | L1 slide 34 |
| Carbapenems imipenem, meropenem, ertapenem, doripenem | Named reaction | Monitor renal and hepatic function, full blood count for bleeding, signs of anaphylaxis — and SEIZURES, specifically with imipenem. That pairing is the one carbapenem fact most likely to be asked. | L1 slide 44 |
| Aztreonam monobactam | Safe exception | The exception worth memorizing: NO cross-reactivity with beta-lactams, so it can be used in truly penicillin-allergic patients. | L1 slide 41 |
| Drug or class | Tier | What it says | Source |
|---|---|---|---|
| Vancomycin | Named reaction | Infusion-related reaction — “Red Man Syndrome”, with fever, chills and phlebitis. The deck also titles a slide “Vancomycin Infusion Syndrome”. It is an infusion-rate problem, which is why the drug is infused over 60 minutes. | L1 slide 51 |
| Vancomycin | Caution | Monitor for ototoxicity and nephrotoxicity, and follow renal clearance. Requires therapeutic drug monitoring — trough drawn 15–30 minutes before the next dose, around the 3rd or 4th dose. | L1 slide 51 |
| Drug or class | Tier | What it says | Source |
|---|---|---|---|
| Macrolides erythromycin, clarithromycin, azithromycin | Named reaction | QT prolongation and Torsades de pointes — worse in combination with class Ia and III antiarrhythmics and with electrolyte abnormalities. | L1 slide 57 |
| Macrolides erythromycin, clarithromycin, azithromycin | Caution | Cholestatic hepatitis (rare, more with the estolate salt) and transient hearing loss with large intravenous doses or in renal insufficiency. | L1 slide 57 |
| Macrolides erythromycin, clarithromycin, azithromycin | Caution | CYP3A4 interaction raises levels of carbamazepine, cyclosporine, digoxin, midazolam and theophylline. Erythromycin > clarithromycin > azithromycin. Check the drug profile before prescribing. | L1 slide 59 |
| Tetracyclines tetracycline, doxycycline, minocycline | Avoid / do not use | Avoid under 8 years old — causes discoloration of teeth (doxycycline more than the others) and depression of skeletal growth. | L1 slide 63 |
| Tetracyclines tetracycline, doxycycline, minocycline | Avoid / do not use | Avoid in the 2nd and 3rd trimester of pregnancy. Also photosensitivity, and they chelate with cations — iron, calcium and dairy block absorption. | L1 slide 63 |
| Clindamycin Cleocin | Caution | Clostridium difficile and pseudomembranous colitis — the reaction this drug is known for. Also rash, neutropenia and thrombocytopenia. | L1 slide 81 |
| Linezolid Zyvox | Named reaction | Serotonin syndrome with SSRIs, tyramine-containing foods and pseudoephedrine. Also thrombocytopenia. | L1 slide 71 |
| Aminoglycosides gentamicin, tobramycin, amikacin | Caution | Renal toxicity and ototoxicity — renally adjusted, and they require therapeutic drug monitoring with peak and trough levels. | L1 slide 68 |
| Drug or class | Tier | What it says | Source |
|---|---|---|---|
| Fluoroquinolones ciprofloxacin, levofloxacin, moxifloxacin | Named reaction | Tendonitis and Achilles tendon rupture. Caution if under 18 years old. Also peripheral neuropathy and central nervous system toxicity — dizziness, insomnia, somnolence. | L1 slide 79 |
| Fluoroquinolones ciprofloxacin, levofloxacin, moxifloxacin | Named reaction | QT prolongation and Torsades de Pointes. Photosensitivity, and they complex with cations — iron, antacids, multivitamins, calcium and dairy. | L1 slide 79 |
| Moxifloxacin Avelox | Avoid / do not use | Do not use for urinary tract infections — the one fluoroquinolone that does not cover them. It also has no pseudomonas coverage. | L1 slide 78 |
| Drug or class | Tier | What it says | Source |
|---|---|---|---|
| Trimethoprim / sulfamethoxazole Septra, Bactrim | Named reaction | Stevens-Johnson syndrome and toxic epidermal necrolysis. Blood dyscrasias — thrombocytopenia, agranulocytosis, megaloblastic anemia. Hepatotoxicity and hyperbilirubinemia. | L1 slide 85 |
| Trimethoprim / sulfamethoxazole Septra, Bactrim | Caution | Raises phenytoin, rifampin and digoxin levels; causes hypoglycemia with sulfonylureas; and significantly increases INR (international normalized ratio) with warfarin by inhibiting CYP2C9. | L1 slide 85 |
| Metronidazole Flagyl | Named reaction | Disulfiram-like reaction with ethanol. The single most testable fact about this drug — counsel the patient not to drink. | L1 slide 86 |
| Polymyxin B and Polymyxin E colistin | Black box | BLACK BOX WARNINGS for nephrotoxicity, neurotoxicity and neuromuscular blockade. | L1 slide 88 |
| Drug or class | Tier | What it says | Source |
|---|---|---|---|
| Echinocandins caspofungin, micafungin, anidulafungin | Caution | Adverse reactions: tachycardia, headache, insomnia, hypokalemia, hypomagnesemia and blood dyscrasias. | L1 slide 109 |
| Amphotericin B | Caution | Fever and chills from interleukin-1 and tumor necrosis factor — pre-treat with paracetamol, antihistamines and corticosteroids. Infused over 4 hours; side effects limit treatment. | L1 slide 98 |
| Amphotericin B | Caution | Electrolyte abnormalities — hypokalemia and hypomagnesemia, hypotension, uremia in 80% with decreased filtration, and renal tubule damage — hydrate with normal saline. | L1 slide 99 |
| Itraconazole Sporanox | Avoid / do not use | Teratogenic. Substrate for and inhibitor of CYP3A4. | L1 slide 104 |
| Fluconazole Diflucan | Avoid / do not use | Teratogenic in animals. Inhibits CYP3A4 and CYP2A4. | L1 slide 106 |
| Voriconazole Vfend | Avoid / do not use | Teratogenic in animals. Visual effects in 30%, plus liver and renal effects. The intravenous vehicle cyclodextrin accumulates in renal failure. | L1 slide 107 |
| Posaconazole Noxafil | Caution | QT prolongation, fever, diarrhea, hypokalemia, hypomagnesemia and thrombocytopenia. | L1 slide 105 |
| Ketoconazole | Caution | Inhibits CYP3A4 — significant drug interactions. Does not enter the central nervous system, and is now rarely used. | L1 slide 103 |
| Flucytosine 5-flucytosine, Ancobon | Caution | Bone marrow suppression and hepatotoxicity. | L1 slide 101 |
| Griseofulvin | Caution | Induces CYP1A2 and CYP2C9. Headache in 15%, mental confusion, fatigue and blurred vision. Absorption increases with a high-fat meal. | L1 slide 111 |
| Drug or class | Tier | What it says | Source |
|---|---|---|---|
| Allylamines naftifine, terbinafine (Lamisil) | Caution | The deck records only local irritation — no systemic contraindication is given for this class. | L2 slide 53 |
| Tetracyclines — for acne Lecture 2 restates it harder | Contraindicated | Contraindicated in children under 8 years and in pregnant women. Lecture 2 words this as an outright contraindication where Lecture 1 says “avoid”. | L2 slide 28 |
| Isotretinoin Accutane | Contraindicated | CONTRAINDICATED in pregnancy and breastfeeding — men should avoid as well. Enrollment in iPledge is required. Monitor for signs of developing depression and for raised serum lipids. | L2 slide 27 |
| Topical retinoids tretinoin, adapalene, tazarotene | Avoid / do not use | Avoid during pregnancy. Photosensitivity and severe sunburn. Benzoyl peroxide inactivates tretinoin, and tretinoin is photolabile so it is applied nightly. | L2 slide 24 |
| Topical corticosteroids | Caution | Local: skin atrophy, acne, rosacea, allergic dermatitis. Systemic: adrenal suppression, infections, hyperglycemia, glaucoma, cataracts, and growth retardation in children. Risk rises with potency, duration, area covered and occlusiveness — ointment > cream > lotion. | L2 slide 38 |
| Topical immunomodulators tacrolimus (Protopic), pimecrolimus (Elidel) | Avoid / do not use | Possible cancer risk. Avoid in patients with weakened immune systems. Second line after topical steroids; use a high-SPF (sun protection factor) sunscreen. | L2 slide 43 |
| Polymyxin B topical | Avoid / do not use | Avoid using on open wounds or denuded skin in high doses — risk of neurotoxicity and nephrotoxicity. | L2 slide 48 |
| Neomycin topical aminoglycoside | Caution | Frequently causes sensitization, and topical aminoglycosides can accumulate systemically. | L2 slide 49 |
| Benzoyl peroxide | Caution | Can bleach hair, clothes, and irritates skin and mucous membranes. Start at 2.5% once daily. | L2 slide 21 |
| Intralesional and oral corticosteroids acne | Caution | Systemic absorption can occur → adrenal suppression and local tissue atrophy. Oral courses need tapering to prevent flare-up. | L2 slide 30 |
| Drug or class | Tier | What it says | Source |
|---|---|---|---|
| Cholinergic agonists — class bethanechol, carbachol, pilocarpine | Caution | Muscarinic excess causes bronchospasm, decreased blood pressure, salivation, sweating, flushing, nausea, abdominal pain and diarrhea — which is why these are a problem in reactive airway disease. | L3 slide 31 |
| Acetylcholinesterase inhibitors neostigmine, pyridostigmine | Caution | Same muscarinic burden — salivation, flushing, decreased blood pressure, nausea, abdominal pain, diarrhea and bronchospasm. | L3 slide 38 |
| Physostigmine Antilirium | Caution | Convulsions at high doses, bradycardia, decreased cardiac output, and paralysis of skeletal muscle from acetylcholine accumulation. | L3 slide 37 |
| Organophosphate poisoning irreversible AChE inhibitors | Caution | Pralidoxime (Protopam) reactivates inhibited acetylcholinesterase — but it does not penetrate the central nervous system and cannot overcome reversible inhibitors such as physostigmine. | L3 slide 42 |
| Atropine and antimuscarinics | Named reaction | The anticholinergic toxidrome: mad as a hatter (sedation, anxiety, hallucinations, seizures), blind as a bat (mydriasis, blurry vision), red as a beet (flushing), dry as a bone (decreased secretions), hot as Hades (hyperthermia), plus constipation, urinary retention and tachycardia. | L3 slide 50 |
| Atropine | Caution | Adverse effects: dry mouth, blurred vision, “sandy eyes”, urinary retention, constipation, and central effects — restlessness, confusion, hallucinations, delirium. Dose-dependent heart rate: bradycardia at lower doses, tachycardia at higher doses. | L3 slide 52 |
| Scopolamine Transderm Scop patch | Caution | Wash hands thoroughly after placing the patch — touching the eye afterwards causes blurred vision. Effects otherwise similar to atropine. | L3 slide 54 |
| Succinylcholine | Named reaction | Malignant hyperthermia with halothane in genetically susceptible people — muscular rigidity, metabolic acidosis, tachycardia and hyperpyrexia. Treat by rapid cooling and dantrolene (Dantrium). | L3 slide 70 |
| Succinylcholine | Caution | Hyperkalemia, and prolonged paralysis (apnea) in patients genetically deficient in plasma cholinesterase or with electrolyte imbalance. | L3 slide 70 |
| Atracurium nondepolarizing blocker | Caution | Releases histamine — can produce a fall in blood pressure, flushing and bronchoconstriction. | L3 slide 65 |
| Drug or class | Tier | What it says | Source |
|---|---|---|---|
| Epinephrine | Caution | Hyperthyroidism — enhanced cardiovascular actions. Cocaine — exaggerated cardiovascular actions because reuptake is prevented. Diabetes — increases release of endogenous glucose stores. | L3 slide 87 |
| Epinephrine | Caution | Adverse effects: anxiety, fear, tension, headache, tremor; cerebral hemorrhage from the rise in blood pressure; cardiac arrhythmias; and pulmonary edema. | L3 slide 86 |
| Norepinephrine | Caution | Extravasation causes blanching and sloughing of skin from extreme vasoconstriction — treated with the alpha antagonist phentolamine. | L3 slide 90 |
| Dobutamine | Caution | Increases atrioventricular conduction — caution in atrial fibrillation. Tolerance may develop with prolonged use. | L3 slide 94 |
| Clonidine Catapres | Named reaction | Rebound hypertension with abrupt discontinuance. Also lethargy, sedation, constipation and xerostomia. | L3 slide 97 |
| Alpha-1 blockers prazosin, terazosin, doxazosin, tamsulosin, alfuzosin | Named reaction | “First-dose” syncope. Also dizziness, lack of energy, nasal congestion, headache, drowsiness and orthostatic hypotension. | L3 slide 111 |
| Phenoxybenzamine | Named reaction | Epinephrine reversal — it blocks the alpha vasoconstriction of epinephrine but not its beta vasodilation, so blood pressure falls. Block is irreversible; the body must synthesize new receptors, taking at least 24 hours. | L3 slide 109 |
| Propranolol non-selective beta blocker | Contraindicated | CONTRAINDICATED in patients with chronic obstructive pulmonary disease or asthma — beta-2 blockade causes bronchoconstriction. This is the deck's clearest contraindication in Lecture 3. | L3 slide 115 |
| Propranolol non-selective beta blocker | Caution | Attenuates the normal physiologic response to hypoglycemia and causes fasting hypoglycemia — the reason for care in diabetics. Decreases glycogenolysis and glucagon secretion; raises LDL cholesterol and triglycerides. | L3 slide 115 |
| Propranolol non-selective beta blocker | Named reaction | Arrhythmias if stopped abruptly, from up-regulation of beta receptors — never stop a beta blocker suddenly. Also central effects: depression, hallucinations, vivid dreams and nightmares. | L3 slide 117 |
| Selective beta-1 antagonists atenolol, metoprolol, bisoprolol, esmolol | Caution | Cardioselectivity is LOST at higher doses — which is why “cardioselective” is not a free pass in a patient with airway disease. Useful for hypertension in impaired pulmonary function. | L3 slide 120 |
| Labetalol and carvedilol | Caution | May cause orthostatic hypotension due to alpha-1 blockade. | L3 slide 122 |
| Nicotine | Caution | Depolarizes autonomic ganglia — stimulation first, then paralysis of all ganglia. At higher doses blood pressure falls and gastrointestinal and bladder activity ceases. | L3 slide 59 |