Pharmacology Black Box Warnings Quiz

Study Notes

Hydrocodone/APAP

Exercise caution in patients with a history of drug or alcohol abuse; prolonged use may lead to physical and psychological dependency.

Atorvastatin

Associated with a dose-related risk of myopathy, heightened by concurrent 3A4 inhibitors, fibric acid derivatives (e.g., gemfibrozil), or niacin (>1 g/day).
Elderly patients are at an increased risk of myopathy; monitor CPK levels in case of unexplained muscle soreness and discontinue if CPK exceeds 10 times the upper limit of normal.
Rhabdomyolysis may lead to acute renal failure if not managed.
Baseline LFTs required, with rechecking at 3 weeks and semiannually. Discontinue if LFTs increase to >3 times the upper limit of normal.

Levothyroxine

Can rapidly increase metabolic rate and cardiac output, which may result in angina, myocardial infarction, congestive heart failure, arrhythmias, or sudden cardiac death.

Lisinopril

Black Box Warning for pregnancy; drugs affecting the angiotensin system can cause fetal injury or death in the 2nd or 3rd trimester.
Risk of angioedema is present at any time during therapy, particularly in African American patients.
Occasional chronic cough due to bradykinin buildup; dry and unproductive cough typically resolves after a month once discontinued.
Use caution due to potential hyperkalemia, especially in renal dysfunction, diabetes, or potassium-sparing diuretics. Discontinue if serum creatinine increases by >35% from baseline.
Hypotension risk is greater during initial therapy, particularly in volume-depleted patients.

Amoxicillin

Requires dosage adjustment in patients with renal impairment.

Esomeprazole

Maximum recommended dose is 20 mg/day for patients with severe hepatic impairment.

Clopidogrel

Caution advised for patients with bleeding disorders or who are at increased risk of bleeding.
Use cautiously in individuals with severe renal or hepatic impairment.

Metoprolol Tartrate

Beta-blockers can induce hypotension and may worsen bronchospastic conditions like asthma.
Can mask hypoglycemia symptoms; sweating remains the only unmasked symptom of low blood sugar.

Montelukast

Not suitable for treating bronchoconstriction caused by Aspirin/NSAID hypersensitivity.
Not for treating acute asthmatic attacks; effective only as maintenance therapy.

Escitalopram

Black Box Warning for suicidal ideation in children, adolescents, and young adults (18-24 years) with major depressive disorder or other psychiatric conditions; increased energy may precede mood improvement, heightening suicide risk.
Not approved for bipolar disorder; risk of inducing mania in susceptible patients.
Can inhibit platelet aggregation, raising bleeding risk, particularly for patients on NSAIDs or anticoagulants.
Risk of serotonin syndrome with symptoms such as agitation, diarrhea, tachycardia, hallucinations, and more.
Use cautiously in patients with a history of seizures; taper slowly to mitigate withdrawal symptoms like anxiety, headache, or seizures.

Albuterol Inhaler

Rarely, may cause paradoxical bronchospasm if symptoms worsen after use.
Monitor for immediate hypersensitivity reactions upon initial use.
Caution is advised for patients with a seizure history or cardiovascular issues (hypertension or heart failure).
May elevate serum glucose levels; important for diabetic management considerations.
Beta agonists can lower serum potassium levels; use with caution in patients at risk for hypokalemia.

Description

Test your knowledge on important black box warnings and precautions regarding various medications, including Hydrocodone/APAP and Atorvastatin. This quiz highlights critical safety information that is essential for healthcare professionals.