ADR

Question 1

ADR from non-selective COX inhibition

Answer 1

• GI (dyspepsia, N/V, ulcers)
• Renal (renal failure)
• Fluids (sodium/water retention, edema, hyperkalemia)
• Lungs (bronchospasm)
• Pseudo-allergy
• Bleeding

Question 2

ADR from COX-2 inhibition

Answer 2

• Renal
• Reproduction (delayed follicular rupture)
• Premature closure of ductus arteriosus in late pregnancy
• Impaired wound healing, exacerbate existing ulcers
• Thrombosis

Question 3

ADR of opioids analgesics

Answer 3

• GI (constipation, N/V)
• Hormonal effects
• Depression
• Respiratory effects
• Falls & fractures
• Sedation
• Tolerance, dependence
• Opioid-induced hyperalgesia

Question 4

ADR of colchicine

Answer 4

• Diarrhea
• N/V
• Abdo pain
• Muscle weakness
• Unusual bleeding
• Pale lips
• Change in urine amount

Question 5

ADR of xanthine oxidase inhibitors

Answer 5

• Nausea, vomiting
• Diarrhea, abdo pain
• Rash
• Fever, sore throat
• Dark urine, jaundice

Question 6

ADR of probenecid

Answer 6

• N/V
• Painful urination
• Lower back pain
• Allergy, rash

Question 7

ADR of methotrexate

Answer 7

Nausea, vomiting
Diarrhea
Anorexia
Mouth, GI ulcers
Alopecia
Photosensitivity
Myelosuppression
Hepatic fibrosis, LFT elevation
Pneumonitis, fibrosis
SJS/TEN
Teratogenic

Question 8

ADR of sulfasalazine

Answer 8

Nausea, vomiting
Dyspepsia
Headache, dizziness
Rash
Hemolytic anemia
Agranulocytosis
Reversible infertility in men
Urine discolouration

Question 9

ADR of leflunomide

Answer 9

Diarrhea
LFT elevation
Alopecia
Weight gain
Myelosuppression
Teratogenic

Question 10

ADR of chloroquine & hydroxychloroquine

Answer 10

Nausea, vomiting
Abdo pain
Dizziness
Alopecia
Hyperpigmentation
Hypoglycemia
Retinopathy
QTc prolongation

Question 11

ADR of JAK inhibitors

Answer 11

• Cytopenia
• Immunosuppression
• Anemia
• Hyperlipidemia
• Higher risk of GI bleed
• Higher risk of thrombosis

Question 12

ADR of anakinra

Answer 12

• Infections
• Injection site reaction

Question 13

ADR of tocilizumab

Answer 13

Infections
Skin eruptions
Stomatitis
Neutropenia
LFT elevation
Hyperlipidemia
Upregulation of 3A4, 2C9, 1A2

Question 14

ADR of abatacept

Answer 14

• Respiratory infections in COPD patients
• Lymphoma

Question 15

ADR of rituximab

Answer 15

• Rash in first dose
• Respiratory infections in COPD

Question 16

ADR of bisphosphonates

Answer 16

Significant:
- ONJ (more in zolendronic acid and cancer patients) & necrosis of the external auditory canal
- Atypical femoral fractures (thigh, hip, groin pain)
- Severe bone / joint / muscle pain
- Upper gI upset
- Ocular effects (iritis, uveitis)
- Hypocalcemia
- Risk of aspiration

Oral: N/V, abdo pain

IV: flu-like symptoms

Question 17

ADR of denosumab

Answer 17

• Muscle, back, bone, joint pain
• N/V, constipation, diarrhea
• Fatigue
• Hyperlipidemia
• Hypocalcemia

Rare:
- Osteonecrosis of the jaw
- Atypical femur fractures

Question 18

ADR of calcitonin

Answer 18

• Red streaks on skin
• Injection site reaction
• Feeling of warmth
• Redness on face, neck, arm, upper chest (occasionally)
• Hypocalcemia

Question 19

ADR of romosozumab

Answer 19

• MI
• CV death, stroke
• Transient hypocalcemia
• ONJ
• Atypical fractures

Question 20

ADR of teriparatide

Answer 20

• Serious calciphylaxis
• Transient orthostasis
• Transient and minimal elevation of serum Ca

Question 21

Cautions for allopurinol

Answer 21

SCAR

Question 22

Cautions for febuxostat

Answer 22

• SCAR but lower risk than allopurinol
• Higher risk of death compared to allopurinol in patients with major CVD

Question 23

Cautions for probenecid

Answer 23

• G6PD
• Not recommended if CrCl < 50
• C/I in hx of urolithiasis

Question 24

ADR of TNF-a inhibitors

Answer 24

Respiratory, skin infections
Risk of lymphoma
Aplastic anemia
Neutropenia
Optic neuritis
Exacerbation of multiple sclerosis