2025 – PAGE 244 – PHARMACOLOGY & DRUG PEARLS

METOCLOPRAMIDE & PROMETHAZINE

Metoclopramide and promethazine can cause acute dystonic reactions. If presented with a child who suddenly has a fixed and uncomfortable looking “pose,” or a fixed gaze, treat with Diphenhydramine!

BLEOMYCIN

Bleomycin can cause Pulmonary Fibrosis.

MNEMONIC: “BLOW-mycin”

VINCRISTINE AND VINBLASTINE

Both vincristine and vinblastine can cause neurologic side effects (neuropathies, palsies, seizures, etc.) and SIADH.

MNEMONIC: I don’t know about you, but wine gives me severe neurologic side effects. Did you know “VIN” is French for wine? As in “vin rose urine” seen in iron chelation? If that doesn’t work, how about viNcristine and viNblastine, where the N reminds you of neurologic side effects?

DOXORUBICIN AND DAUNOMYCIN

Doxorubicin and daunomycin are cardiotoxic anthracyclines.

MNEMONIC: DoxoRUBIcin seems to help me remember the heart. RUBI RED HEART.

CYCLOPHOSPHAMIDE

Hemorrhagic cystitis is the key side effect to remember for cyclophosphamide.

ASPARAGINASE

Pancreatitis is the key side effect to remember for asparaginase.

MNEMONIC IMAGE: Note the ASPARAGUS in place of the PANCREAS.

METHOTREXATE (AKA MTX)

Methotrexate (AKA MTX) can cause ulcers along the GI tract.

MNEMONIC: mtX – Imagine the “X” being a pair of sharp scissors being swallowed and causing ulcers.

MALIGNANT HYPERTHERMIA

Malignant hyperthermia should be suspected in anyone who gets anesthesia and then has tachypnea + muscle rigidity + increased pCO2 + acidosis. Treat with DANTROLENE + Cooling + O₂ + Hyperventilation beyond existing tachypnea. DO NOT give bromocriptine because it’s a dopa agonist. Also look for high CK, arrhythmias, and myoglobinuria. Kids with muscular dystrophy and other neuromuscular disorders are at risk for malignant hyperthermia.

MNEMONIC: Malignant Hyperthermia = “Caused by those MALICIOUS ANESTHESIA DOCS who sit there all day putting a DENT in every stool in the hospital.”