Adverse drug reactions

Question 1

ADR gent

Answer 1

nephrotoxicity and ototoxicity

Question 2

ADR vanc

Answer 2

nephrotoxicity and ototoxicity

Question 3

ADR antibiotics

Answer 3

C. diff colitis

Question 4

ACEi ADR

Answer 4

hypotension

electrolyte abnormalities
AKI
dry cough

Question 5

beta blockers ADR

Answer 5

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

Question 6

CCB ADR

Answer 6

Hypotension, bradycardia, peripheral oedema, flushing

Question 7

diuretics ADR

Answer 7

Hypotension, electrolyte abnormalities, acute kidney injury, subclass-dependent effects e.g. spironolactone causes gynaecomastia

Question 8

Heparin ADR

Answer 8

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

Question 9

Warfarin ADR

Answer 9

Haemorrhage (note that ironically warfarin has a procoagulant effect initially, as well as taking a few days to become an anticoagulant; thus heparin should be prescribed alongside warfarin and continued until the INR exceeds 2.

Question 10

Aspirin ADR

Answer 10

Haemorrhage, peptic ulcers and gastritis, tinnitus in large doses

Question 11

Digoxin ADR

Answer 11

Nausea, vomiting and diarrhoea, blurred vision, confusion and drowsiness, xanthopsia (disturbed yellow/green visual perception including ‘halo’ vision)

Question 12

Amiodarone ADR

Answer 12

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

Question 13

Lithium ADR

Answer 13

Early - tremor
Intermediate - tiredness
Late - arrhythmias, seizures, coma, renal failure, siabetes insipidus

Question 14

Haloperidol ADR

Answer 14

Dyskinesias, e.g. acute dystonic reactions, drowsiness

Question 15

Colzapine ADR

Answer 15

Agranulocytosis

Question 16

Dexamethasone and prednisolone ADR

Answer 16

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

Question 17

fludrocortisone ADR

Answer 17

HTN / sodium and water retention

Question 18

Statins ADR

Answer 18

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

Question 19

NSAID ADR

Answer 19

GI bleeding

Question 20

metformin ADR

Answer 20

Lactic acidosis

Question 21

alcohol and warfarin ADR

Answer 21

Increased anticoagulation caused by: warfarin (with acute alcohol due to enzyme inhibition); chronic alcohol causes enzyme induction and thus reduces anticoagulant effect

Question 22

MAO inhibitors ADR

Answer 22

Hypertensive crisis

Question 23

metronidazole and disulfiram ADR

Answer 23

sweating, flushing, nausea and vomiting

Question 24

methotrexate and NSAID ADR

Answer 24

low platelets

Question 25

methotrexate and trimethoprim ADR

Answer 25

bone marrow suppression

Question 26

methotrexate and PPI

Answer 26

increases level of methotrexate

Question 27

Enzyme inducers

Answer 27

PC BRAS * Phenytoin * Carbamazepine * Barbiturates * Rifampicin * Alcohol * Sulphonylurea

Question 28

Enzyme inhibitors

Answer 28

AODEVICES: * Allopurinol * Omeprazole * Disulfirim * Erythromycin * Valporate * Isoniazie * Ciprofloxacin * Ethanol (acute) * Sulphonamides