Adverse Drug Reactions

Question 1

Gentamicin, Vancomycin

Answer 1

Nephrotoxicity

Ototoxicity

Question 2

Anti antibiotic, but usually broad spec

Answer 2

C. Diff infection

Question 3

ACEi

Answer 3

Hypotension
Electrolyte abnormalities
AKI
Dry cough

Question 4

Beta Blockers

Answer 4

Hypotension
Bradycardia
Wheeze in asthmatics
worsens acute HF (but helps w/ chronic)

Question 5

CCBs

Answer 5

Hypotension
bradycardia
peripheral oedema
flushing

Question 6

Diuretics

Answer 6

Hypotension
electrolyte abnormality
AKI

Question 7

Heparin

Answer 7

Haemorrhage (esp if renal failure or <50kg)

Heparin induced thrombocytopenia

Question 8

Warfarin

Answer 8

Haemorrhage

Note, warfarin is pro-coagulant in first few days (so prescribe with heparin until INR >2)

Question 9

Aspirin

Answer 9

haemorrhage
Peptic ulcers
gastritis
tinnitus in large doses

Question 10

DIgoxin

Answer 10

Nausea, vomiting, diarrhoea
Blurred vision
Confusion and drowsiness
Xanthopsia - disturbed yellow green visual perception inc halo vision
Note, hypokalaemia increases digoxin affect (digoxin competes w/ K at Na/K pump, which is required for Ca2+ release –> Ca2+ release causes contractions –> therefore digoxin slows heart rate) –> less K = less competition = more effect

Question 11

Amiodarone

Answer 11

Lung fibrosis
Thyroid disease - both hyper and hypo (contains iodine0
skin greying
corneal deposits

Question 12

Lithium

Answer 12

Early - tremor
intermediate - tiredness
Late - arrythmia, seizures, coma, renal failure, diabetes insidious

Question 13

Haloperidol

Answer 13

Dyskinesias e.g acute dystonic reactions

drowsiness

Question 14

Clozapine

Answer 14

Agranulocytosis - needs FBC monitoring

Question 15

Dexamethasone/prednisolone (STEROIDS)

Answer 15

Stomach Ulcers
Thin Skin
Edema 
Right and Left heart faulure
Osteoperosis 
Infection
Diabetes 
Cushing's syndrome

Question 16

Fludrocortisone

Answer 16

HTN

Sodium and water retention

Question 17

NSAIDs

Answer 17

No urine - renal failure 
Systolic dysfunction - heart failure
Asthma
Indigestion
Dyscrasia - clotting abnormalities

Question 18

Statins

Answer 18

Myalgia
Abdominal pain
Increased AST/ALT
Rhabdomyolsys - can just be mildly raised CK

Question 19

β blocker and verapamil together

Answer 19

Profound hypotension and asystole

combo strictly contradicted if IV verapamil

Question 20

Drugs w/ a narrow therapeutic window

Answer 20

warfarin
digoxin
phenytoin

Question 21

Drugs require careful titrating

Answer 21

Anithypertensives

Antidiabetics

Question 22

Metformin - what to bare in mind (re contrast)

Answer 22

Iodinated contrast media can cause renal impairment
this increases risk of metformin induced lactic acidosis
If the scenario has things like low GCS, kussmaul breathing etc, look for metformin

Question 23

What can contrast media do w/ ACEi

Answer 23

contrast media causes renal impairment, which increase risk of ACEi induced AKI

Question 24

most common enzyme inhibitors

Answer 24

Ketoconazole
Ciprofloxacin
Erythromycin (clarithromycin too apparently)

Also - valproate, isoniazid, sulphonamides, allopurinol, disulfram, grape fruit juice

Question 25

What drug class, w/ alcohol, causes GI bleeding

Answer 25

NSAIDs

Question 26

What drug, w/ alcohol, causes lactic acidosis

Answer 26

Metformin

Question 27

What drug, w/ alcohol, causes increased anticoagulastion

Answer 27

warfarin (w/ acute intoxication as it’s an enzyme inhibitor –> chronic alcohol will reduce warfarin’s effects as its an inducer)

Question 28

What drug, w/ alcohol, causes sweating, flushing, nausea and vomiting

Answer 28

Metronidazole

also, disulfram (but that’s the point innit)

Question 29

What drug, w/ alcohol, causes a hypertensive crisis

Answer 29

Monoamine oxidase inhibitors

Question 30

What drugs, w/ alcohol, causes sedations

Answer 30

barbituates
opioids
benzos

Question 31

Drugs causing urinary retention

Answer 31

opiates
Anticholinergics (eg, antipsychotic drugs, antidepressant agents, anticholinergic respiratory agents, detrusor relaxants),
General anaesthetics,
Alpha-adrenoceptor agonists,
Benzodiazepines (e.g. diazepam),
Non-steroidal anti-inflammatory drugs (e.g. ibuprofen),
Calcium-channel blockers,
Antihistamines,
Alcohol.

Question 32

drugs causing confusion

Answer 32

opiates
Metoclopramide
Other drugs that might cause confusion include:
Anticholinergics (eg, antipsychotic drugs, antidepressant agents, anticholinergic respiratory agents, detrusor relaxants),
Antipsychotics,
Antidepressants,
Anticonvulsants.
Less common causes (histamine H2 receptor antagonists, digoxin, beta-blockers, corticosteroids, non-steroidal anti-inflammatory agents and antibiotics.