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PSA > Adverse Drug reactions > Flashcards

Adverse Drug reactions Flashcards

1
Q

Common ADR of gentamicin

A

Nephrotoxicity, ototoxicity

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2
Q

Common ADR of Vancomycin

A

Nephrotoxicity, ototoxicity

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3
Q

Common ADR of ciprofloxacin

A

C diff (technically any antibiotic)

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4
Q

Common ADR of cephalosporin

A

C diff (technically any antibiotic)

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5
Q

CADR of ACEi

A

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

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6
Q

CADR of Beta blockers

A

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

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7
Q

CADR of CCB e.g. diltiazem

A

Hypotension, bradycardia, peripheral oedema, flushing

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8
Q

CADR of Diuretics

A

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

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9
Q

CADR of Heparins

A

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

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10
Q

CADR of Warfarin

A

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.

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11
Q

CADR of Aspirin

A

Haemorrhage, peptic ulcers and gastritis, tinnitus in large doses

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12
Q

CADR of Digoxin

A

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

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13
Q

CADR of amiodarone

A

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

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14
Q

CADR of lithium

A

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

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15
Q

CADR of haloperidol

A

Dyskinesias, e.g. acute dystonic reactions, drowsiness

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16
Q

CADR of Clozapine

A

Agranulocytosis (requires intensive monitoring of full blood count)

17
Q

CADR of dexmethosone and prednisolone

A

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

18
Q

CADR of fludrocortisone

A

Hypertension/sodium and water retention

19
Q

CADR of ibuprofen (NSAIDs)

A

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

20
Q

CADR of statins

A

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

21
Q

Drugs with narrow therapeutic index

A

warfarin, digoxin, phenytoin, theophylline

22
Q

drugs that require careful titration of dose according to effect

A

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

23
Q

Enzyme inducers

A

Phenytoin
Carbamazepine
Barbiturates
Rifampicin
Alcohol (chronic)
Sulphonylureas

24
Q

which drug should you not prescribe with verapamil

A

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

25
Q

Enzyme inhibitors

A

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

26
Q

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

A

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

27
Q

what kind of drug is amiloride

A

K sparing diuretic

28
Q

What kind of drug is carvidiol

A

BB

29
Q

what should you prescribe alongside morphine?

A

Metoclopramide - to prevent opioid induced nausea

30
Q

Which drugs are taken at night

A

Satins, Amiltryptaline

31
Q

what level of paracetamol is considered toxic

A

150mg/kg
500mg in 1 tablet

32
Q

Patient advice for alendrotnic acid

A

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

33
Q

Drugs which raise serum K

A

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

34
Q

Drugs which reduce serum K

A

Thiazide diuretics
Loop diuretics
Acetazolamide

35
Q

which two hypertension meds should you NOT prescribe together

A

BB and Verapamil

36
Q

which conditions are a ‘caution’ for lithium

A

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

37
Q

Is trimethoprim okay in pregnancy and breast feeding

A

no in 1st trimester
okay for short while breastfeeding

38
Q

which drugs are contra-indicated in pregnancy

A

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)

PSA (9 decks)

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