ADR's Flashcards
Which drugs are known to impair glucose tolerance?
Thiazides Furosemide Steroids Tacrolimus Ciclosporin Interferon-alpha Nicotinic acid Anti-psychotics
Beta Blockers
Why should beta blockers be used with caution in diabetics?
Slight impairment of glucose tolerance
Interfere with metabolic and autonomic response to hypoglycaemia
Which drugs are known to induce urinary retention?
Tricyclic antidepressants Anticholinergics Opioids NSAID's Disopyramide
Give examples of tricyclic antidepressants
Amitriptyline
Nortriptyline
Trimipramine
Give examples of anticholinergics
Atropine
Ipratropium
Tolterodine
What is disopyramide used for?
Prevention and treatment of ventricular and supra ventricular tachycardia
What drugs are known to cause lung fibrosis?
Amiodarone
Cytotoxic agents - bleomycin and bulsuphan
Anti-Rheumatoid - Methotrexate and Sulfasalazine
Nitrofurantoin
Ergot-derived dopamine agonists - bromocriptine, cabergoline, pergolide
Which drugs are used to treat tuberculosis?
6 Months: - Rifampicin - Isoniazid 2 Months: - Pyrazinamide - Ethambutol
What are the ADR’s associated with Rifampicin?
- Liver enzyme inducer
- Hepatitis
- Orange secretions
- Flu-like symptoms
What are the ADR’s associated with Isoniazid?
- Peripheral neuropathy
- Hepatitis
- Agranulocytosis
- Liver enzyme inhibitor
How are the peripheral neuropathy effects of Isoniazid prevented?
Pyridoxine (Vitamin B6)
What are the ADR’s associated with Pyrazinamide?
- Hyperuricaemia - Gout
- Arthralgia
- Myalgia
- Hepatitis
What are the ADR’s associated with Ethambutol?
- Optic neuritis
What is important to know when prescribing ethambutol?
Check visual acuity pre and post treatment
Dose adjustment for renal impairment
What are the main side effects of glucocorticoids?
Endocrine - impaired glucose regulation, increased appetite, weight gain, hirsutism, hyperlipidaemia
Cushing’s syndrome
MSK - osteoporosis, proximal myopathy, avascular necrosis of femoral head
Immunosuppression
Psych - insomnia, depression, mania, psychosis
GI - peptic ulcer, acute pancreatitis
Ophthalm - glaucoma and cataracts
Intracranial hypertension
Suppression of growth in children
Neutrophilia
What are the main side effects of mineralocorticoids?
Fluid retention
Hypertension
What should you be aware of when prescribing long term steroids?
Double dose during illness
Gradual withdrawal if:
- Pred >40mg daily >1wk
- > 3wks of treatment or recently repeated courses
What common ADR’s are associated with Gentamicin and Vancomicin use?
- Nephrotoxicitiy
- Ototoxicity
What should you be aware of when prescribing antibiotics (specifically broad spectrum)?
C Diff colitis
Common in cephalosporins and ciprofloxacin
What are the main ADR’s of ACE inhibitors?
- Hypotension
- Electrolyte abnormalities
- AKI
- Dry cough
What are the main ADR’s of Beta Blockers?
- Hypotension
- Bradycardia
- CI in asthmatics
- Worsen heart failure but help chronic
- Impair glucose tolerance
What are the main ADR’s of Ca blockers
- Hypotension
- Bradycardia
- Peripheral oedema
- Flushing
What are the main ADR’s of diuretics?
- Hypotension
- Electrolyte abnormalities (Key is K+ but also Ca2+ and Na+)
- AKI
What are the main ADR’s associated with Digoxin use?
Nausea D&V Blurred vision Confusion Xanthosia - disturbed yellow/green visual perception
Toxicity managed with Digibind
What are the main ADR’s associated with amiodarone use?
Interstitial lung disease
Thyroid disease
Skin greying
Corneal deposits
What are the ADR’s of lithium?
Early - tremor
Intermediate - tiredness
Late - Seizures, arrhythmia’s, coma, renal failure, diabetes insipidus
What are the ADR’s of antipsychotics?
Acute dystonia
Akathisia
Tardive dyskinesia
Drowsiness
Clozapine - agranulocytosis
What are the key ADR’s of NSAID’s?
Renal failure Systolic dysfunction - heart failure Asthma Indigestion Dyscrasia - clotting abnormality
What are the main ADR’s of statins?
Myalgia
Abdo pain
Increased ALT/AST
Rhabdomyolysis
What factors aggravate psoriasis?
Trauma
Alcohol
Drugs - beta blockers, lithium, antimalarials, NSAID’s, ACE inhibitors, infliximab
Withdrawal of systemic steroids
What are the CYP450 Inhibitors?
S - Sodium Valproate I - Isoniazid C - Cimetidine K - Ketoconazole F - Fluconazole A - Allopurinol C - Chloramphenicol E - Erythromycin S - SSRI's C - Ciprofloxacin O - Omeprazole M - Methotrexate
What are the CYP450 Inducers?
C - carbamazepine R - rifampicin A - Alcohol P - Phenytoin G - Goserulin P - Phenobarbitone S - Sulphonylureas/Smoking
Which drugs interact with alcohol?
NSAIDs Warfarin Metrinidazole and Disulfiram Metformin MAO inhibitors Barbituates, opioids, benzodiazepines
What may an NSAID alcohol interaction cause?
GI bleeding
What may a Warfarin alcohol interaction cause?
Increased anticoagulation
What may an alcohol metrinidazole/disulfiram interaction cause?
Sweating
Flushing
Nausea
Vomiting
What may happen if alcohol and metformin interact?
Lactic Acidosis
What may happen if alcohol interacts with MAO inhibitors?
Hypertensive crisis
What may happen if alcohol interacts with barbituates, opioids or benzodiazepines?
Sedation
Which drugs can cause peptic ulcer disease?
NSAID’s
Corticosteroids
Which drugs can cause renal impairment?
ACE inhibitors
NSAID’s
What can exacerbate psoriasis?
Trauma Alcohol Beta blockers Lithium Antimalarials - chloroquine/hydroxychloroquine NSAID's ACEi Infliximab Steroid withdrawal
Which drugs may exacerbate heart failure?
Thiazolinediones - pioglitazone - fluid retention
Verapamil - negative inotropic effect
NSAID/glucocorticoid caution - fluid retention (apart from 75mg aspirin)
Class I antiarrhythmics - negative inotropic and proarrhythmic effects
