ADR Flashcards
SE of thiazides?
dyslipidaemia (inhibits lipoprotein lipase in capillaries more lipoproteins), gout
SE of Ciprofloxacin?
Tinnitus
- ACEi + NSAIDs can result in what?
AKI
- ACEi (i.e. carvedilol) + K-sparing diuretic (i.e. amiloride) can cause what?
Hyperkalaemia
Digoxin side effects?
o SEs: N&V, blurred vision, xanthopsia (disturbed yellow/green vision incl. ‘halo’ vision)
o MoA: antagonises K+ at myocyte Na/K-ATPase limiting Na+ influx Ca2+ accumulates inside the cell, prolonging the action potential lowing of heart rate
Hypokalaemia enhances digoxin effect
Hyperkalaemia reduces digoxin effect
What can’t be given alongside trimethoprim?
Methotrexate
Side effects of amiodarone?
hyper/hypothyroid, skin greying, corneal deposits
o Mx: withhold amiodarone if thyrotoxic
Alcohol + metformin?
lactic acidosis
ETOH excess + wafarin?
Excessive anticoagulation (bleeding risk)
Alcohol + metronidazole/disulfiram?
Sweating, flushing, N&V
IV fluid choice if hypernatraemic/hypoglycaemic?
5% dextrose
IV fluid choice if ascites?
Human albumin solution (HBS)
IV fluid choice if bleeding shock
Blood transfusion (crystalloid first if no blood available)
Resuscitation fluid:
o Sodium chloride 0.9%
o 500mL bolus 250-500mL PRN bolus (if HF and still fluid deplete, use 500mL)
o Over 15 minutes
When should you give an ACEi?
In the evening
Insulin requirements with steroids?
Increased
When to decrease insulin?
Alcohol, reduced calories, reduced renal function
COCP rules when having surgery?
Stop 4 weeks before and start 2 weeks after
First line for vasomotor symptoms in menopause?
SSRIs eg. fluoxetine
What statin should be taken in the evening?
Simvastatin
What drugs can’t be taken alongside statins?
macrolides (clarithromycin, erythromycin)
SEs of statins?
Myositis
Statin Monitoring
o Baseline bloods:
Full lipid profile (non-fasting)
LFTs
TSH
U&Es
CK (only if persistent, generalised, unexplained muscle pains if ≥5x ULN, repeat after 7/7):
* RFs: CKD, hypothyroid, FHx/PMHx of hereditary muscular disorders, history of unexplained muscle pain, liver disease, ETOH excess, ≥70yo w/ polypharmacy
* If still ≥5x ULN, do not offer statin
* If <5x ULN, offer statin at a reduced dose
HbA1c (for high risk of DM patients)
o 3 months:
Full lipid profile (non-fasting)
LFTs
HbA1c (for high risk of DM patients)
o 6 months:
LFTs
Effect of warfarin and statins?
High INR (only in some people)
When to stop a statin when looking at the LFT results?
IF >3x the upper limit of normal (ALT/AST)
When should a statin be stopped?
-Severe muscle pains
-Creatinine kinase >5x ULN
-Prescribing macrolides
-LFTs >3x ULN
How do you treat delirium aggression?
IM haloperidol (give lorazepam in Parkinson’s)
Aggression medical treatment?
Oral lorazepam first line, IM lorazepam second line
Alcohol avoidance is recommended with which drugs?
ABx (metronidazole, doxycycline)
Benzodiazepines
sedating antihistamines
Fluoxetine
Disulfiram
Statins (must stay within limits
Warfarin
Treatment for neuropathic pain?
o 1st line neuropathic pain:
Amitriptyline (10mg oral nightly)
Pregabalin (75mg oral 12-hourly)
o 1st line diabetic neuropathy duloxetine (60 mg oral daily)
Drugs to avoid in heart failure?
o Thiazolidinediones (pioglitazone) - fluid retention
o NSAIDs/glucocorticoids - caution: fluid retention [75mg aspirin exception]
o Verapamil - negative inotropic effect
o Class I antiarrhythmics (flecainide) - negative inotropic and proarrhythmic effects
Drugs to take at night?
Statins, amitrytiptiline
Treatment for insomnia?
o 1st line: Z-drugs (Zopiclone)
o 2nd line / severe insomnia: BDZ (Nitrazepam; 2-4w)
When do you consider blood tranfusion for iron deficiency ?
- Severely symptomatic
- Hb <70g/L
Raises Hb by 10g/L per unit given
What is the first line management for iron deficiency anaemia?
o 1st line: ferrous sulphate, 200mg, PO, TDS [take with food]
Given until Hb normal + further 3 months to replace stores
Consider SE as a cause of non-compliance if Hb not rising (constipation, black tarry stools)
Reduce to BD if side effects are prominent and reassess in 2-4 weeks
Liver enzymes and drugs: ALT : ALP >5
Paracetamol
NSAIDs
Statins
Amiodarone
Liver enzymes and drugs: ALT : ALP <2
Co-amoxiclav
Erythromycin
Chlorpromazine
Hormonal contraception
Liver enzymes and drugs: ALT : ALP 2-5
Phenytoin
Sulphonamides
Carbamazepine
Steroid side effects?
Stomach ulcers
Thin skin (easy bruising)
(O)edema
Right (and left) heart failure
Osteoporosis
Infection
Diabetes
Syndrome (Cushing’s)
NSAID cautions and CIs?
No urine (renal failure)
Systolic dysfunction
Asthma
Indigestion
Dyscrasia of the blood (clotting abnormality)
What to stop in acute HF?
Beta Blocker
Drugs that increase bleeding (aspirin, heparin, warfarin) not to be given to those?
Suspected of bleeding
At risk of bleeding
* Prolonged PT in liver disease
* Acute ischaemic stroke (haemorrhagic transformation; ≤2 months)
On enzyme inhibitors (i.e. erythromycin) and warfarin
Which antihypertensives can cause bradycardia?
BB and CCBs
Which antihypertensives can cause Electrolyte disturbances?
ACEi, diuretics
- CCBs side effects?
peripheral oedema, flushing
- Diuretics side effects?
renal failure, gout (loop diuretics), gynaecomastia (spironolactone)
First line for nausea?
1st line (most cases) Cyclizine, 50mg 8-hourly, IM/IV/oral
* SE: fluid retention (not for HF)
2nd line Metoclopramide, 10mg 8-hourly, IM/IV/oral
* Avoid in Parkinson’s (DA antagonist) – use domperidone (does not cross BBB)
* Avoid in young women (risk of dyskinesia i.e. acute dystonia)
Beware of warfarin and which antibiotic?
+ ciprofloxacin / erythromycin
o Neutropenic sepsis can be caused by what?
Piptazobactam (Tazocin) + Gentamicin
digoxin SE and what to not give alongside?
o Arrhythmia + hypotension, (no BB or non-DHP as can cause hypotension)
Prescription review pneumonic?
- PReSCRIBER
o Patient details (3 identifying factorsOR addressograph)
o Reaction (allergy + reaction to drug)
o Sign the front of the chart
o check for Contraindications to each drug
o check Route for each drug
o prescribe IV fluids if needed
o prescribe Blood clot prophylaxis if needed
o prescribe anti-Emetics if needed
o prescribe pain Relief if needed
Ciprofloxacin side effect?
Tinnitus
SE of Metoclopramide?
Exacerbates parkinsonism (crosses BBB, unlike domperidone)
K+-sparing diuretics SE?
Hyperkalaemia
Loop diuretics SE?
Hypokalaemia, gout
Trimethoprim SE?
Neutropenic sepsis
Opiates SE?
Constipation
Urinary retention
Thiazolidinedione SE?
Fluid retention
Enoxaparin (heparin) SE?
Bleeding (≤2m after a stroke)
Amiodarone SE?
Hyper/hypothyroid
Corneal deposits
Skin greying
barbiturates, opioids, BDZs + alcohol = what?
o Sedation
- ACEi + NSAIDs = ?
AKI
metronidazole, disulfiram + ETOH = ?
o Sweating, flushing, N&V
MAO-I, RIMA + ETOH = ?
o Hypertensive crisis
Upper gastrointestinal bleeding caused by alcohol and what?
Aspirin, NSAIDs
Monitoring with ciclosporin?
U&Es monitoring regularly required. Every 2 weeks for first 3 months
What is required alongisde steroids?
Gastroprotection and bone protection
(regular BM monitoring also required)
1st line for diabetic neuropathy?
Duloxetine - 60mg oral daily
Which medications should be taken in the evening?
Statins and amitriptyline
which DOAC must be taken with food?
Rivaroxaban
Which DOAC must be taken whole?
Dabigatran
Safest SSRI in IHD?
Sertraline
Communication points for SSRIs?
- NEVER STOP SUDDENLY
- MAY WORSEN SYMP TOMS BEFORE IMPROVING THEM
- MAY TAKE A FEW WEEKS TO WORK
- WORKS BEST WITH ADJUNCTS LIKE TALKING THERAPY
SSRI SEs?
Safest in IHD: Sertraline ~ think safe ticker
* SSRI <18s – Fluoxetine
* SEs: GI upset, peptic ulcer, insomnia, reduced libido
Methotrexate monitoring
Monitor FBC, renal and liver function (reports of blood dyscrasias (any disease of the blood) and liver cirrhosis)
Dabigatran is the only reversible DOAC, with what agent?
idarucizumab
Management of stable popliteal aneurysm?
femoral-distal bypass (indications: S/S, in vivo thrombus, >2cm aneurysm)
Indications for bypass surgery generally… aneurysm, trauma, occlusion
Management of acute popliteal aneurysm?
Embolectomy ± femoral-distal bypass
o RFs of AAA?
HTN, smoking, hypercholesterolaemia, gender (males have inc. risk, but females have inc. rupture risk)
Screening for AAA?
o Screening = males ≥65yo single abdominal USS:
3 – 4.5 fu scan in 12 months
4.5 – 5.5 fu scan in 3 months
>5.5 2ww referral to vascular
Ix for AAA?
o 1st USS abdomen (always 1st line for diagnosis)
o 2nd CTA/CT (required for pre-operative planning) MRA/MRI (if contrast allergy)
o Other: ESR (raised), CRP, FBC, BC
- Complications (AAA)?
Rupture, embolism (trash foot), thrombus, DVT (pressure), fistulation
Medical management for AAA?
Statins, aspirin, BP management
When is surgery performed electively for AAA?
Aneurysms growing >1cm in one year, aneurysms lager than 5.5cm at screening
