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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
What infusion fluid should be administered with Acetylcysteine for paracetamol overdose?
Dextrose 5%
26
A patient presents within 1 hour of taking a single paracetamol OD. What is the management?
- Consider giving activated charcoal - Take bloods 4 hours from ingestion to determine plasma paracetamol levels - If above the tx line treat with acetylcysteine
27
The management of a single paracetamol OD varies based on time from OD. What time groups are used?
- 0-8 hrs - 8-24 hrs - >24 hrs
28
A patient presents 9 hrs after a single paracetamol OD. What is the management?
1. Bloods 2. If taken >150mg/kg give acetylcysteine stat 3. If taken <150mg/kg waiting for bloods before treating
29
A patient presents 26 hrs after a single paracetamol OD. What is the management?
1. Bloods 2. If jaundiced/hepatic tenderness treat with acetylecysteine 3. Otherwise wait for bloods before treating
30
What blood results indicate treatment of paracetamol OD with acetylcystein
- Paracetamol detected - INR >1.3 - ALT >x2 upper limit of normal
31
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)?
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
Stepwise management of anaphylaxis
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
What is the management of someone with high INR with minor bleeding?
1. Stop warfarin 2. Give phytomenadione by slow IV injection
34
When can you restart warfarin following high INR?
When the INR is <5
35
Management of high INR with no bleeding?
1. Stop warfarin 2. Give phytomenadione by mouth using IV preparation orally
36
What the normal INR range?
2-3
37
What drugs have a narrow therapeutic index?
- Warfarin - Digoxin - Phenytoin - Theophylline
38
What are the common enzyme inducers? Which is the strongest?
SCRAP GPS - Sulphynylureas - Carbamazepine/cigarette smoke - Rifampicin - Alcohol (chronic) - Phenytoin - Griseofulvin - Phenobarbital - St Johns wart Rifampicin is the strongest
39
What are the common enzyme inhibitors? Which are the most common?
AODEVICES - Allopurinol - Omeprazole - Disulfiam - Erythromcin - Valporate - Isoniazide - Ciprofloxacin - Ethanol (acute) - Sulphonamides Remember grapefruit Ketoconazole, ciprofloxacin and erythromycin and most common
40
What does St Johns wart interact with?
- Warfarin - Antidepressants - Contraceptives (lowers oestrogen and progesterone levels)
41
What does garlic interact with?
Warfarin Garlic can increase bleeding risk
42
What does liquorice interact with?
Digoxin
43
What does ginseng interact with?
Oral hypoglycaemic meds Ginseng can lower blood sugar
44
What drugs can exacerbate psoriasis?
- Beta blockers - Antimalarials - NSAIDs - ACE inhibitors - Lithium
45
What drugs reduce lithium excretion?
- ACE-In - Diuretics (particularly thiazides) - NSAIDs
46
What are common side effects of phenytoin?
- Dysarthria - Gum hyperplasia

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