Adverse drug reactions Flashcards
nephrogenic diabetes insipidus
a. data interpretation (blood)
b. drugs causing (4)
a. low Na;
b. Demeclocycline (abx for lyme disease, acne, bronchitis); Lithium; effervecent/IV preparations with high Na; excess IV saline
Drug causing high neutrophils
Steroid
Drugs causing low neutrophils (2)
Clozapine (anti-psychotic)
Carbimazole (anti-thyroid)
Drugs causing hyponatraemia (1)
Diuretics (any)
hypovolaemic
Drugs causing hypokalaemia (2)
Loop diuretics
thiazide diuretics
Drugs causing hyperkalaemia (6)
1- Potasium sparing diuretics (spironolactone)
2- ACE inhibitors
3- Angiotensin II receptor blockers
4- ciclosporin
5- amiloride
ACE inhibitors
How do ACE inhibitors or NSAIDs cause pre-renal AKI?
can trigger renal artery stenosis = hypoperfused kidneys
Drugs causing intrinsic AKI (4)
Nephrotoxic abx (gentamycin, vancomycin and tetracyclines)
ACE inhibitors
NSAIDs
IV contrast
Hepatitis/cirrhosis
a. data interpretation (blood)
b. drugs causing this(3)
a. raised bilirubin + raised AST/ALT = hepatocellular damage
b. Paracetamol overdose
Statins
Rifampicin
Cholestasis
a. data interpretation (blood)
b. drugs causing this (5)
a. raised bilirubin + raised ALP = obstructive damage
b.
Flucloxacillin
Co-amoxiclav
nitrofurantoin
Steroids
Sulphonylureas
hyperkalaemia on ECG
Tall tented T waves
- height >2/3 of QRS
- all leads
Drugs causing low platelets (thrombocytopaenia)
penicillamine (treatment for RA) - reduces production of platelets
Heparin - incr destruction of platelets
CPY450 inducers (7main types)
antiepileptics: phenytoin, carbamazepine
barbiturates: phenobarbitone
rifampicin
St John’s Wort
chronic alcohol intake
griseofulvin
smoking (affects CYP1A2, reason why smokers require more aminophylline)
CPY50 inhibitors (11 main types)
antibiotics: ciprofloxacin, clarithromycine/erythromycin isoniazid cimetidine,omeprazole amiodarone allopurinol imidazoles: ketoconazole, fluconazole SSRIs: fluoxetine, sertraline ritonavir sodium valproate acute alcohol intake quinupristin
adverse effect of azathioprine
bone marrow depression
pandreatitis
incr risk of non-melanoma skni cancer
Drugs causing myelosuppression/agranolocytosis
- methotrexate
- azathioprine
- carbimazole
- pheytoin
- carbamazepine
TCA adverse effects caused by
1. antagonism of histamine receptors
2. antagonism of muscarinic receptors
3. antagonism of adrenergic receptors
4. other important AE
- drowsiness
- dry mouth; blurred vision; constipation; urinary retention
- postural hypotension
- lengthening QT interval
Drugs causing urinary retention (5)
- TCAs
- anticholinergics= antipsychotics, antihistamines
- opioids
- NSAIDs
- disopyramide
Psychiatric drugs which reduce seizure threshold (2)
- ciprofloxacin
- antipsychotics
Quinolone antibiotics
1. examples
2. AE (4)
- ciprofloxacin, levofloxacin
- Lower seizure threshold (in epilepsy)
- Tendon damage (incl rupture) - > if also on steroids
- cartilage damage (in animal models) - avoid in children
- lengthens QT interval
Lithium adverse effects (9)
- N&V, D
- fine tremor
- nephrotoxicity (polyuria 2ry to nephrogenic diabetes insipidus)
- thyoid enlargement –> +/- hypothyroidism
- ECG = T wave flattening/inversion
- weight gain
- idiopathic intracranial hypertension
- leucocytosis
- hyperparathyroidism + hypercalcaemia
Extrapyramidal side effects
- parkinsonism
- acute dystonia (sustained mucle contraction – torticollis, oculogyric crisis)
- akathisia (severe restlessness)
- tardive dyskinesia (late onset of choreoathetoid movement - abnormal involuntary movements)
Main adverse effects of typical antipsychotics
+ examples of drugs
main:
- extrapyramidal side-effects
- hyperprolactinaemia common
other:
- prolonged QT (haloperidol)
- neuroleptic malignant syndrome
- impaired glucose tolerance
- antimuscarinic (dry mouth, blurred vision, urinary retention, constipation)
haloperidol, chlorpromazine
Atypical antipsychotics main AE
metabolic effects
extrapyramidal side-effects and yperprolactinaemia are less common
greater reduced seizure threshold
