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PSA > Adverse drug reactions > Flashcards

Adverse drug reactions Flashcards

1
Q

Give the adverse effects of ACE-In

A
  • Hypotension
  • Dry cough
  • Hyperkalemia
  • AKI
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2
Q

Give the adverse effects of BB

A
  • Hypotension
  • Bradycardia
  • Wheeze in asthmatics
  • Worsens acute heart failure (helps chronic)
  • ED
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3
Q

Give the adverse effects of CCB

A
  • Hypotension
  • Bradycardia
  • Peripheral oedema
  • Flushing
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4
Q

Give adverse effects of diuretics

A
  • Hypotension
  • Electrolyte abnormalities
  • AKI
  • Subclass dependant effects
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5
Q

Give some examples of CCB

A
  • Amolodipine
  • Diltiazem
  • Nifedipine
  • Verapamil
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6
Q

What is a specific adverse effect of spironolactone?

A

Gynaecomastia

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7
Q

Give the adverse effects of amiodarone? What type of drug is it?

A
  • Interstitial lung disease (pulmonary fibrosis)
  • Thyroid disease
  • Structurally related to iodine (amIODarone) - skin greying, corneal deposits

Anti-arrhythmic

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8
Q

What are the adverse effects of digoxin?

A
  • Nausea
  • V+D
  • Blurred vision
  • Confusion and drowsiness
  • Xanthopsia (disturbed yellow/green visual perception, halos)
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9
Q

Give 1 key adverse effect of carbamazepine

A

Hyponatraemia

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10
Q

Give 1 key adverse effect of clozapine

A

Agranulocytosis

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11
Q

What is a key adverse effect if haloperidol?

A

Dyskinesias e.g. acute dystonic reactions, drowsiness

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12
Q

Give 1 key adverse effect of Gliclazide

A

Hypoglycaemia

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13
Q

Give 1 key adverse effect of metformin

A

Lactic acidosis

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14
Q

What are the adverse effect of statins?

A
  • Myalgia
  • Abdo pain
  • Increased ALT/AST
  • Rhabdomyolysis
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15
Q

What is the management of statin induced myalgia?

A
  1. Exclude rhabdomyolysis (urine dip and CK)
  2. Ensure needs statin
  3. Reduce dose
  4. Switch to another statin with lower myalgia risk (simvastatin>atorvastatin>pravastatin)
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16
Q

What are the adverse effects of aminoglycosides?

A
  • Nephrotoxicity
  • Ototoxicity
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17
Q

What are the adverse effects of heparins?

A
  • Haemorrhage
  • Heparin induced thrombocytopenia
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18
Q

What are the adverse effects of warfarin?

A
  • Haemorrhage

Note warfarin has a procoagulant effect initially -heparin (?DOAC) should be prescribed with it until the INR >2

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19
Q

What are the adverse affects of aspirin?

A
  • Haemorrhage
  • Peptic ulcer
  • Gastritis
  • Tinnitus (at large doses)
20
Q

What are the adverse effects of lithium? Divide them into early, intermediate and late.

A
  • Early - tremor
  • Intermediate - tiredness
  • Late - arrhythmias, seizures, coma, renal failure, diabetes insipidus
21
Q

What are the adverse effects of steroids?

A

STERIODS:
- Stomach ulcers
- Thin skin
- Edema
- Right and left heart failure
- Infection
- Osteoporosis
- Diabetes
- Cushing syndrome

22
Q

What are the adverse effects of fludrocortisone?

A
  • Hypertension
  • Sodium and water retention
23
Q

What are the adverse effects of NSAIDs?

A

NSAID
- No urine
- Systolic dysfunction
- Asthma
- Indigestion
- Dyscrasia

24
Q

When can activated charcoal be given in paracetamol overdose?

A

If have taken >12 g or >150mg/kg AND presents within 1 hour

25
Q

What infusion fluid should be administered with Acetylcysteine for paracetamol overdose?

A

Dextrose 5%

26
Q

A patient presents within 1 hour of taking a single paracetamol OD. What is the management?

A
  • Consider giving activated charcoal
  • Take bloods 4 hours from ingestion to determine plasma paracetamol levels
  • If above the tx line treat with acetylcysteine
27
Q

The management of a single paracetamol OD varies based on time from OD. What time groups are used?

A
  • 0-8 hrs
  • 8-24 hrs
  • > 24 hrs
28
Q

A patient presents 9 hrs after a single paracetamol OD. What is the management?

A
  1. Bloods
  2. If taken >150mg/kg give acetylcysteine stat
  3. If taken <150mg/kg waiting for bloods before treating
29
Q

A patient presents 26 hrs after a single paracetamol OD. What is the management?

A
  1. Bloods
  2. If jaundiced/hepatic tenderness treat with acetylecysteine
  3. Otherwise wait for bloods before treating
30
Q

What blood results indicate treatment of paracetamol OD with acetylcystein

A
  • Paracetamol detected
  • INR >1.3
  • ALT >x2 upper limit of normal
31
Q

The treatment of paracetamol OD includes 3 consecutive acetylcysteine infusions over 21 hrs. What dose and rate are these infusions (include the dose of infusion fluid)?

A
  1. 150mg/kg over 1 hr in 200ml dextrose 5%
  2. 50mg/kg over 4 hrs in 500ml dextrose 5%
  3. 100mg/kg over 16 hrs in 1000ml dextrose 5%
32
Q

Stepwise management of anaphylaxis

A
  1. ABCDE
  2. Remove trigger
  3. IM adrenaline (500μg)
  4. High flow oxygen
  5. Repeat IM adrenaline if no response after 5 mins
  6. IV fluid bolus
33
Q

What is the management of someone with high INR with minor bleeding?

A
  1. Stop warfarin
  2. Give phytomenadione by slow IV injection
34
Q

When can you restart warfarin following high INR?

A

When the INR is <5

35
Q

Management of high INR with no bleeding?

A
  1. Stop warfarin
  2. Give phytomenadione by mouth using IV preparation orally
36
Q

What the normal INR range?

A

2-3

37
Q

What drugs have a narrow therapeutic index?

A
  • Warfarin
  • Digoxin
  • Phenytoin
  • Theophylline
38
Q

What are the common enzyme inducers? Which is the strongest?

A

SCRAP GPS
- Sulphynylureas
- Carbamazepine/cigarette smoke
- Rifampicin
- Alcohol (chronic)
- Phenytoin
- Griseofulvin
- Phenobarbital
- St Johns wart

Rifampicin is the strongest

39
Q

What are the common enzyme inhibitors? Which are the most common?

A

AODEVICES
- Allopurinol
- Omeprazole
- Disulfiam
- Erythromcin
- Valporate
- Isoniazide
- Ciprofloxacin
- Ethanol (acute)
- Sulphonamides

Remember grapefruit

Ketoconazole, ciprofloxacin and erythromycin and most common

40
Q

What does St Johns wart interact with?

A
  • Warfarin
  • Antidepressants
  • Contraceptives (lowers oestrogen and progesterone levels)
41
Q

What does garlic interact with?

A

Warfarin

Garlic can increase bleeding risk

42
Q

What does liquorice interact with?

A

Digoxin

43
Q

What does ginseng interact with?

A

Oral hypoglycaemic meds

Ginseng can lower blood sugar

44
Q

What drugs can exacerbate psoriasis?

A
  • Beta blockers
  • Antimalarials
  • NSAIDs
  • ACE inhibitors
  • Lithium
45
Q

What drugs reduce lithium excretion?

A
  • ACE-In
  • Diuretics (particularly thiazides)
  • NSAIDs
46
Q

What are common side effects of phenytoin?

A
  • Dysarthria
  • Gum hyperplasia

PSA (9 decks)

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