Adverse Drug reactions

Question 1

Common ADR of gentamicin

Answer 1

Nephrotoxicity, ototoxicity

Question 2

Common ADR of Vancomycin

Answer 2

Nephrotoxicity, ototoxicity

Question 3

Common ADR of ciprofloxacin

Answer 3

C diff (technically any antibiotic)

Question 4

Common ADR of cephalosporin

Answer 4

C diff (technically any antibiotic)

Question 5

CADR of ACEi

Answer 5

Hypotension, electrolyte abnormalities (hyperkalaemia), acute kidney injury, dry cough

Question 6

CADR of Beta blockers

Answer 6

Hypotension, bradycardia, wheeze in asthmatics, worsens acute heart failure (but helps chronic heart failure)

Question 7

CADR of CCB e.g. diltiazem

Answer 7

Hypotension, bradycardia, peripheral oedema, flushing

Question 8

CADR of Diuretics

Answer 8

Hypotension, electrolyte abnormalities, acute kidney injury, subclass- dependent effects

Question 9

CADR of Heparins

Answer 9

Haemorrhage (especially if renal failure or <50 kg), heparin-induced thrombocytopaenia

Question 10

CADR of Warfarin

Answer 10

Haemorrhage (note that ironically warfarin has a pro-coagulant effect initially as well as taking a few days to become an anti-coagulant; thus heparin should be prescribed alongside warfarin and continued until the INR exceeds 2.

Question 11

CADR of Aspirin

Answer 11

Haemorrhage, peptic ulcers and gastritis, tinnitus in large doses

Question 12

CADR of Digoxin

Answer 12

Nausea, vomiting and diarrhoea, blurred vision, confusion and drowsiness, xanthopsia (disturbed yellow/green visual perception including ‘halo’ vision)

Digoxin competes with potassium at the myocyte Na+/K+ ATPase, limiting Na+ influx. Since Ca2+ outflow relies on Na+ influx, Ca2+ accumulates in the cell. This lengthens the action potential and slows the heart rate. This summary is important because changes in serum K+ at the receptor can compete with digoxin; low K+ augments digoxin effect. High levels limit the effect

Question 13

CADR of amiodarone

Answer 13

Interstitial lung disease (pulmonary fibrosis), thyroid disease (both hypo- and hyperthyroidism are reported; it is structurally related to iodine, hence its name amIODarone), skin greying, corneal deposits

Question 14

CADR of lithium

Answer 14

Early – tremor
Intermediate – tiredness
Late – arrhythmias, seizures, coma, renal failure, diabetes insipidus

Question 15

CADR of haloperidol

Answer 15

Dyskinesias, e.g. acute dystonic reactions, drowsiness

Question 16

CADR of Clozapine

Answer 16

Agranulocytosis (requires intensive monitoring of full blood count)

Question 17

CADR of dexmethosone and prednisolone

Answer 17

STEROIDS: Stomach ulcers, Thin skin, Edema, Right and left heart failure, Osteoporosis, Infection (including Candida), Diabetes (commonly causes hyperglycaemia; uncommonly progresses to diabetes); and Cushing’s Syndrome

Question 18

CADR of fludrocortisone

Answer 18

Hypertension/sodium and water retention

Question 19

CADR of ibuprofen (NSAIDs)

Answer 19

NSAID: No urine (renal failure), Systolic dysfunction (heart failure), Asthma, Indigestion (any cause), Dyscrasia (clotting abnormality)

Question 20

CADR of statins

Answer 20

Myalgia, abdominal pain, increased ALT/AST (can be mild), rhabdomyolysis (can be just mildly increased creatine kinase though)

Question 21

Drugs with narrow therapeutic index

Answer 21

warfarin, digoxin, phenytoin, theophylline

Question 22

drugs that require careful titration of dose according to effect

Answer 22

antihypertensives and antidiabetics

e.g. contrast can cause renal impairment, which can then cause metformin induced lactic acidosis or ACEi AKI
hint: if low GCS or acidotic behaviour in question, look to see if it mentions metformin

Question 23

Enzyme inducers

Answer 23

Phenytoin
Carbamazepine
Barbiturates
Rifampicin
Alcohol (chronic)
Sulphonylureas

Question 24

which drug should you not prescribe with verapamil

Answer 24

B-blockers and verapamil together can cause hypotension and asystole
avoided together and strictly avoided if IV Verapamil

Question 25

Enzyme inhibitors

Answer 25

Most common: ketoconazole, ciprofloxacin and erythromycin. Do not forget grapefruit juice (not included below)! AODEVICES: Allopurinol Omeprazole Disulfiram Erythromycin Valproate Isoniazid Ciprofloxacin Ethanol (acute intoxication) Sulphonamides

Question 26

Drugs that have potent interactions with alcohol (and the reaction)

Answer 26

Gastrointestinal bleeding caused by: nonsteroidal anti-inflammatory drugs, including aspirin and ibuprofen Lactic acidosis caused by: metformin Increased anticoagulation caused by: warfarin (with acute alcohol due to enzyme inhibition); chronic alcohol causes enzyme induction and thus reduces anticoagulant effect Hypertensive crisis caused by: monoamine oxidase inhibitors Sweating, flushing, nausea and vomiting caused by: metronidazole and disulfiram Sedation caused by: barbiturates, opioids and benzodiazepines

Question 27

what kind of drug is amiloride

Answer 27

K sparing diuretic

Question 28

What kind of drug is carvidiol

Answer 28

BB

Question 29

what should you prescribe alongside morphine?

Answer 29

Metoclopramide - to prevent opioid induced nausea

Question 30

Which drugs are taken at night

Answer 30

Satins, Amiltryptaline

Question 31

what level of paracetamol is considered toxic

Answer 31

150mg/kg 500mg in 1 tablet

Question 32

Patient advice for alendrotnic acid

Answer 32

Take with meals, sit up for 30 mins (oesophagitis) Go to dentist before, and regular checkup hip and thigh pain, go to dr

Question 33

Drugs which raise serum K

Answer 33

ACE inhibitors Angiotensin-2 receptor blockers Spironolactone Potassium sparing diuretics (amiloride, triamterene) Potassium supplements (Sando-K, Slow-K)

Question 34

Drugs which reduce serum K

Answer 34

Thiazide diuretics Loop diuretics Acetazolamide

Question 35

which two hypertension meds should you NOT prescribe together

Answer 35

BB and Verapamil

Question 36

which conditions are a 'caution' for lithium

Answer 36

Avoid abrupt withdrawal; cardiac disease; concurrent ECT (may lower seizure threshold); diuretic treatment (risk of toxicity); elderly (reduce dose); epilepsy (may lower seizure threshold); myasthenia gravis; psoriasis (risk of exacerbation); QT interval prolongation; review dose as necessary in diarrhoea; review dose as necessary in intercurrent infection (especially if sweating profusely); review dose as necessary in vomiting; surgery

Question 37

Is trimethoprim okay in pregnancy and breast feeding

Answer 37

no in 1st trimester okay for short while breastfeeding

Question 38

which drugs are contra-indicated in pregnancy

Answer 38

Antibiotics: Tetracyclines aminoglycosides sulphonamides and trimethoprim quinolones Other drugs: ACEi, Angiotensin II receptor antagonists statins warfarin sulfonylureas retinoids (including topical) Cytotoxic agents anti-epileptics (valproate, carbamazepine, phenytoin)