Tuesday, November 6, 2012

Side Effects

As an intern, I saw a guy in urgent care with seizures who was on Tegretol. The attending asked me, "What are the main bad side effects of Tegretol?"

"Agranulocytosis," I said. (One of the few things I remembered from med school pharm class)

"Right, what's the other side effect?"

"Um..." She's pretty much reached the limits of what I know about the side effects of Tegretol. "Nausea? Dizziness?"

"Look it up."

I went into epocrates and I get the list of common adverse reactions. I read it to her: "Agranulocytosis, syncope, dizziness, nausea, vomiting, hyponatremia, anemia, thrombocytopenia, elevated liver enzymes, photosensitivity, pruritis, edema, arrhythmias, urinary retention, uh... it's kind of a big list. Which one were you thinking of?"

"Elevated liver enzymes."


So somehow my guesses from the list was less correct than her selection from the list. It's nice to be an attending and always get to be right.


  1. Your attending is now my clinical instructor for nursing. From the quiz, to the "look it up," to the random choosing of one particular side effect of a drug. I guess this is supposed to teach us something.....keep the drug guide in your pocket.

  2. Hey, where's the chlorophyll answer? :-)

  3. Interesting note: pruritis is actually spelt pruritus. One of rarer words in medicine that doesn't end in -itis

  4. What you bitching about, Fizz?

    You a attending now, hotshot.

  5. She probably called that "the other one" because both warrant periodic monitoring with lab tests.

    Nausea/vomiting don't seem as medically important, although they do impact the patient's quality of life.

  6. Haha I'm in neurology now, so these questions get asked ALL the time. And all side effects lists start with "nausea vomiting diarrhea sedation" and end with "elevated liver enzymes and kidney failure". The "most common side effect" of Acyclovir is especially variable, depending on who you ask - or rather, who asks you. I'm ALWAYS wrong, no matter how much literature I have to back me up. "Yeah their study is flawed, my personal experience is far more superior".

  7. "Guess what I'm thinking..."

    The mantra of medical educators