ADRs Flashcards
Very common side effect of Liraglutide (GLP1 analogue for Rx of diabetes)
Initial GI symptoms - Nausea and vomiting (common/very common)
What is the first line treatment for HALOPERIDOL-ASSOCIATED (or anti-psychotic induced) parkinsonism?
Procyclidine!!
Anti-cholinergic drug used as first line Rx for anti-psychotic induced Parkinsonism, esp. symptoms of tremors
Which of the following is most likely to interact with serotonin to cause serotonin syndrome?
Metoclopramide Zopiclone Tramadol Paracetamol Morphine sulfate
Tramadol
Common SE of oral iron supplements
Constipation (most common cause for treatment failure as it leads to poor compliance) and black offensive stools
Adverse effects of Lithium
Nausea/vomiting Fine tremor (therapeutic levels - coarse in toxicity) Weight gain Idiopathic intracranial hypertension Psoriasis
IMPORTANT SE: Nephrotoxicity - polyuria secondary to diabetes insipidus (hypernatraemia) Seizures Hypo/hyperthyroidism ECG - T wave flattening/inversion
Lithium toxicity
- Features
- Causes
- Management
- Features: coarse tremor; hyperreflexia; acute confusion; seizures; coma
- Causes: dehydration, renal failure, diuretics (esp bendroflumethiazide), ACE, NSAIDs, metronidazole
- Management:
- Increase fluid intake to inc. UO and supportive Mx
- 1h of ingestion - gastric lavage
- May need to dialyse if neurological symptoms/renal failure
Side effect of beta-blockers that affects males
Erectile dysfunction
Antibiotic that has been shown to cause liver toxicity (jaundice)
Co-amoxiclav (cholestatic jaundice may occur shortly after starting Rx - liver toxicity much greater in co-amoxiclav than in amoxicillin
Prescription that may interact with DOACs (e.g. dabigatran) to cause increased bleeding
SSRIs (citalopram)
Digoxin toxicity
- Features
- Precipitants
- Management
- Features
- generally unwell, lethargy, nausea and vomiting, anorexia, confusion
- yellow-green vision
- arrhythmias (e.g. AV block, bradycardia)
- gynaecomastia - Precipitants
- classically: HYPOkalaemia
- increasing age
- renal failure
- hypomagnesaemia
- hypercalcaemia/hypernatraemia
- acidosis
- hypoalbuminaemia
- hypothermia
- hypothyroid
- drugs: amiodarone, verapamil, quinidine, spironolactone, ciclosporin, diuretics that cause hypoK+ - Mx
- Digibind
- Correct arrhythmias
- Monitor potassium
Serotonin syndrome
- Features
- Management
- Features
- neuromuscular excitation - hyperreflexia, myoclonus, rigidity
- autonomic nervous system excitation - hyperthermia
- altered mental state - Management
- withdraw SSRI
- supportive - fluids!
- benzodiazepines
- more severe cases managed using serotonin antagonists, e.g. chlorpromazine, cryoheptadine
Neuroleptic malignant syndrome
- When does this occur
- Features
- Management
- Usually happens when the antipsychotic is suddenly stopped or the dose is reduced
- Features
- More common in young, male patients
- Onset usually in first 10 d of Rx or after increasing dose
- Pyrexia
- Rigidity
- Tachycardia
- Raised CK is present ± leukocytosis - Management
- Stop antipsychotic
- IV fluids to prevent renal failure
- Dantrolene may be useful
- Bromocriptine (DA agonist) may also be used
SSRIs - drug interactions
- NSAIDs - co-prescribe a PPI if given
- Warfarin/heparin - inc. risk of bleeding - avoid SSRIs; consider mirtazapine
- Aspirin (see above)
- Triptans
- MAOIs - risk of serotonin syndrome
3 drugs to be given with caution in asthma
- NSAIDs (apart from aspirin) - may cause bronchospam
- Adenosine - use verapamil as an alternative
- beta-blockers - bronchospasm
