Pharmacology
Pharmacology
Core60: Drug-induced adverse reaction: bone marrow damage
薬剤性有害反応：骨髄障害
🦴 High-yield / 要点：Bone marrow damage = marrow suppression → anemia, thrombocytopenia, neutropenia. Classic culprits: chemotherapy, chloramphenicol, clozapine, carbamazepine, propylthiouracil.
Definition / 定義
- Bone marrow damage = bone marrow toxicity = bone marrow suppression.
- Reduced production of blood cell lines.
Symptoms by cell line / 血球系統別の症状
| Affected line | Symptoms |
|---|---|
| Anemia | Fatigue, weakness, pale skin, palpitations, shortness of breath, abdominal pain (possibly ischemic) |
| Thrombocytopenia | Easy bruising and bleeding |
| Neutropenia | Frequent infections |
Causative drugs / 原因薬
| Group | Examples |
|---|---|
| Chemotherapy (inhibits rapidly dividing cells) | Cisplatin, cyclophosphamide, doxorubicin, etoposide, methotrexate |
| Antibiotics | Chloramphenicol, linezolid, rifampin, sulfonamides, TMP-SMX |
| Antivirals | Acyclovir, zidovudine, ribavirin |
| Immunosuppressants (inhibit B/T cell proliferation) | Azathioprine, cyclosporine, tacrolimus, mycophenolate mofetil |
| NSAIDs | Phenylbutazone |
| Antipsychotics | Clozapine |
| Antiepileptics | Carbamazepine, phenytoin |
| Thyroid drugs | Propylthiouracil |
Management / 対応
- Immediate cessation of the causative drug.
- Supportive treatment:
- Transfusion.
- G-CSF analogue.
- Antibiotics for infection.
- Monitor blood count.
- Consider an alternative drug.
Remember / 覚え方
- Suppression → anemia + thrombocytopenia + neutropenia
- Clozapine → agranulocytosis monitoring
- Chloramphenicol → aplastic anemia risk
- Stop the drug + support + monitor CBC