Adverse Drug reactions Flashcards
Common ADR of gentamicin
Nephrotoxicity, ototoxicity
Common ADR of Vancomycin
Nephrotoxicity, ototoxicity
Common ADR of ciprofloxacin
C diff (technically any antibiotic)
Common ADR of cephalosporin
C diff (technically any antibiotic)
CADR of ACEi
Hypotension, electrolyte abnormalities (hyperkalaemia), acute kidney injury, dry cough
CADR of Beta blockers
Hypotension, bradycardia, wheeze in asthmatics, worsens acute heart failure (but helps chronic heart failure)
CADR of CCB e.g. diltiazem
Hypotension, bradycardia, peripheral oedema, flushing
CADR of Diuretics
Hypotension, electrolyte abnormalities, acute kidney injury, subclass- dependent effects
CADR of Heparins
Haemorrhage (especially if renal failure or <50 kg), heparin-induced thrombocytopaenia
CADR of Warfarin
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.
CADR of Aspirin
Haemorrhage, peptic ulcers and gastritis, tinnitus in large doses
CADR of Digoxin
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
CADR of amiodarone
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
CADR of lithium
Early – tremor
Intermediate – tiredness
Late – arrhythmias, seizures, coma, renal failure, diabetes insipidus
CADR of haloperidol
Dyskinesias, e.g. acute dystonic reactions, drowsiness
CADR of Clozapine
Agranulocytosis (requires intensive monitoring of full blood count)
CADR of dexmethosone and prednisolone
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
CADR of fludrocortisone
Hypertension/sodium and water retention
CADR of ibuprofen (NSAIDs)
NSAID: No urine (renal failure), Systolic dysfunction (heart failure), Asthma, Indigestion (any cause), Dyscrasia (clotting abnormality)
CADR of statins
Myalgia, abdominal pain, increased ALT/AST (can be mild), rhabdomyolysis (can be just mildly increased creatine kinase though)
Drugs with narrow therapeutic index
warfarin, digoxin, phenytoin, theophylline
drugs that require careful titration of dose according to effect
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
Enzyme inducers
Phenytoin
Carbamazepine
Barbiturates
Rifampicin
Alcohol (chronic)
Sulphonylureas
which drug should you not prescribe with verapamil
B-blockers and verapamil together can cause hypotension and asystole
avoided together and strictly avoided if IV Verapamil
Enzyme inhibitors
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
Drugs that have potent interactions with alcohol (and the reaction)
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
what kind of drug is amiloride
K sparing diuretic
What kind of drug is carvidiol
BB
what should you prescribe alongside morphine?
Metoclopramide - to prevent opioid induced nausea
Which drugs are taken at night
Satins, Amiltryptaline
what level of paracetamol is considered toxic
150mg/kg
500mg in 1 tablet
Patient advice for alendrotnic acid
Take with meals, sit up for 30 mins (oesophagitis)
Go to dentist before, and regular checkup
hip and thigh pain, go to dr
Drugs which raise serum K
ACE inhibitors
Angiotensin-2 receptor blockers
Spironolactone
Potassium sparing diuretics (amiloride, triamterene)
Potassium supplements (Sando-K, Slow-K)
Drugs which reduce serum K
Thiazide diuretics
Loop diuretics
Acetazolamide
which two hypertension meds should you NOT prescribe together
BB and Verapamil
which conditions are a ‘caution’ for lithium
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
Is trimethoprim okay in pregnancy and breast feeding
no in 1st trimester
okay for short while breastfeeding
which drugs are contra-indicated in pregnancy
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)
