Adverse drug reactions

Question 1

gentamicin and vancomycin

Answer 1

ototoxicity and nephrotoxicity

Question 2

ACEi

Answer 2

hypotension, hypernatraemia, AKI, dry cough

Question 3

Beta blockers

Answer 3

hypotension, bradycardia, wheeze in asthmatics, worsens acute heart failure (but improves chronic)

Question 4

CCB e.g. dilitiazem and amplodipine

Answer 4

hypotension, bradycardia (veramapil and b blockers) peripheral oedema, flushing

Question 5

diuretics such as furo, bendro and spiro

Answer 5

hypotension, hypokalaemia, hyponatraemia, AKI

spironolaction- gynaecomastia

Question 6

heparins

Answer 6

haemorrhage (esp if renal failure or 50kg), heparin induced thrombocytopenia

Question 7

warfarin

Answer 7

haemorrhage (procoagulant initially)

Question 8

aspirin

Answer 8

haemorrhage, peptic and gastric ulcers, gastritis, tinnitus in large doses

Question 10

digoxin

Answer 10

N+V+D, blurred vision, confusion and drowsiness, halo vision

• low potassium augments digoxin effect , hight lvels augment effect

Question 11

amiodarone

Answer 11

pulmonary fibrosis, thyroid disease (both hypo and hyper), skin greying and corneal deposits

Question 12

lithium

Answer 12

toxicity
- early- tremor
- intermediate- tiredness
- late- arrhythmias, seizure, coma, renal failure, diabetes insipidus

Question 13

haloperidol

Answer 13

acute dystonic reactions, drowsiness

Question 14

clozapine

Answer 14

agranulocytosis

Question 15

dex and pred

Answer 15

• stomach ulcers
• thin skin
• edema
• right and left heart failure
• osteoporosis
• infection
• diabetes
• cushings syndrome

Question 16

fludrocortisone

Answer 16

hypertension/sodium and water retention

Question 17

ibuprofen

Answer 17

renal failure, systolic dysfunction, asthma, indigestion, dyscrasia (clotting abnormality)

Question 18

statins

Answer 18

myalgia, abdominal pain, increased ALT/AST, rhabdomyolysis

Question 19

management of statin induced myalgia

Answer 19

• exclude rhabdo- do CK and urine dip
• if CK >2000 : reduce dose, then switch to another statin with lower risk of myalgia

risk of myalgia : simvastatin > atorvastatin, pravastatin, fluvastatin or fibrate

Question 20

metformin

Answer 20

lactic acidosis

Question 21

sedation caused by

Answer 21

opioid, benzos, barbiturates

Question 22

metronidazole

Answer 22

sweating, flushing, N+V

Question 23

disulfiram

Answer 23

sweating, flushing, N+V

Question 24

drugs with synergistic effects

Answer 24

beta-blockers and veramapil

Question 25

enzyme inducers and inhibitors

Answer 25

Question 26

which electrolyte most important for ACEi

Answer 26

hyperkalaemia

Question 27

common side effect of beta blockers

Answer 27

fatigue
cold extremities
erectile dysfunction
hypotension
bradycardia

Question 28

trimethoprim and related drugs such as co-trimoxazole

Answer 28

folate antagonists -> can lead to bone marrow suppresio

Question 29

if a patient is having an anaphylactic reaction to a drug and has angioedema what should you do first

Answer 29

secure the airway!!!

adrenaline will not do much if airway isnt patent