1. Drugs that amplify warfarin: 
- Tylenol, NSAIDs
- Phenytoin
- The standard CYP inhibitors
- Omeprazole
- Antibiotics
- Amiodarone
- Synthroid
- Foods: cranberry juice, ginkgo, vitamin E.
2. Drugs that dampen warfarin: 
- The standard CYP inducers (st.johns wort, rifampin, carbamazepine etc)
- Foods rich in vitamin K (leafy greens)
- Ginseng
- OCPs
3. Lupus 
- Cyclophosphamide is indicated in the management of lupus when there are significant renal or CNS symptoms
- For lupus nephritis, this small trial (n=80s) found that cyclophosphamide was superior to azathioprine in terms of measured Cr at 5 year f/u and incidence of HZV infection.
4. Miscellaneous drug side effects:
- Cochlear dysfunction: platinum chemo agents, aminoglycosides, lasix
- Optic neuritis: ethambutol, hydroxychloroquine/plaquenil (tx malaria, lupus, RA, sjogrens)
- Peripheral neuropathy: vincristine, isoniazid, phenytoin, heavy metals, chronic alcoholism
- Digital vasospasm/raynauds: beta-blockers, ergot
- Thyroid dysfunction: lithium (also causes tremor, nephro DI, teratogen), amiodarone (also makes you blue)
- Crystal arthritis/gout: cyclosporine
- Acute pancreatitis: steroids
5. Bronchiectasis
- Signs: COPD sx + copious sputum (>100ml/day), hemoptysis, cough + sputum most days of the week, rhinosinusitis, fevers, sx resolve with antibiotics
- Causes: post-infectious (aspergillus, viral, TB), congenital (CF, a1-antitrypsin), immunodeficiency (hypogammaglobulinemia), obstruction (ie. cancer), toxins, systemic rheum (RA, sjogrens)
- Dx with high-res CT; bronch them if its focal to look for tumor, genetic/immune/autoimmune testing if its diffuse.
6. Guillain-Barre
- Assoc with respiratory and GI infection (often campy)
- Sx: symmetric ascending muscle weakness with absent/low deep tendon reflexes, bulbar sx (dysarthria/dysphasia), facial nerve palsy, mild sensory symptoms, autonomic dysfunction. 2/3 c/o severe back or LE pain.
- Dx: LP with elevated protein, normal white count
- Treat with plasmapharesis, IvIg (steroids do not help)
7. Nephrotic syndrome
- Abnormal lipid metabolism (elevated LDL, low HDL)
- Hypercoagulability (affects vv>aa, esp renal vv)
- Increased risk of MI/stroke (because of the above 2)
- Can cause hyperparathyroidism 2/2 loss of vitamin D in the urine
8. Giant cell/temporal arteritis:
- Affects branches of the aorta-- aortic aneurysm is a possible complication. Patients should be followed with serial chest x-rays
9. Toxic shock syndrome
- High fevers T > 38.9 (102)
- Overlapping macular erythematous rash (looks like sunburn)
- Shock vitals
- Multiorgan involvement:
GI (v/d)
Renal (Cr>1-2x upper limit of normal)
Heme (platelets <100K)
MSK (severe myalgias, CK up)
Liver (ast/alt/t-bili >2x ULN)
Mucous membrane hyperemia
CNS (AMS without focal signs)
- +/- leukocytosis: bands usually up, platelets usually down.
- Toxic shock toxin = superantigen, T-cell activation
- Tx with antistaph antibiotics
10. Post infectious glomerulonephritis
- IgA nephropathy: few days (<5) after URI. Nl complement.
- Post strep: GN occurs 10 days after strep pharyngitis, 21 days for strep impetigo. Complement low.