Adverse drug reactions Flashcards
Gentamicin
Vancomycin
Nephrotoxicity, ototoxicity
Any antibiotic (but most commonly the broad-spectrum antibiotics like cephalosporins or ciprofloxacin)
Clostridium difficile colitis
ACE-inhibitors, e.g. lisinopril
Hypotension, electrolyte abnormalities, acute kidney injury, dry cough
Beta-blockers, e.g. bisoprolol
Hypotension, bradycardia, wheeze in asthmatics, worsens acute heart failure (but helps chronic heart failure)
Calcium-channel blockers, e.g. diltiazem
Hypotension, bradycardia, peripheral oedema, flushing
Diuretics e.g. furosemide, bendroflumethiazide, spironolactone
Hypotension, electrolyte abnormalities, acute kidney injury,
Thiazides - gout
Heparins
Haemorrhage (especially if renal failure or <50 kg), heparin-induced thrombocytopaenia
Warfarin
Haemorrhage (note that ironically warfarin has a pro-coagulant effect initially as well as taking a few days to become an anti-coagulant; thus heparin should be prescribed alongside warfarin and continued until the INR exceeds 2.
Aspirin
Haemorrhage, peptic ulcers and gastritis, tinnitus in large doses
Digoxin
Nausea, vomiting and diarrhoea, blurred vision, confusion and drowsiness, xanthopsia (disturbed yellow/green visual perception including ‘halo’ vision)
Amiodarone
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
Mood stabalisers - Lithium
Early – tremor
Intermediate – tiredness
Late – arrhythmias, seizures, coma, renal failure, diabetes insipidus
Haloperidol
Dyskinesias, e.g. acute dystonic reactions, drowsiness
Clozapine
Agranulocytosis (requires intensive monitoring of full blood count)
Dexamethsaone and predisolone
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
Fludrocortisone
Hypertension/sodium and water retention
NSAIDs
NSAID: No urine (renal failure), Systolic dysfunction (heart failure), Asthma, Indigestion (any cause), Dyscrasia (clotting abnormality)
Statins
Myalgia, abdominal pain, increased ALT/AST (can be mild),
rhabdomyolysis (can be just mildly increased creatine kinase though)
Which drugs have narrow therapeutic index?
Please Wife Diana
Phenytoin
Warfarin
Digoxin
Which drugs need careful titrating of dose according to effect?
Antihypertensives
Diabetic drugs
Which drugs are enzyme inducers?
PC BRAS
Phenytoin Carbamazepine Barbiturates Rifampacin Alcohol (chronic) Sulphonylureas
Which drugs are enzyme inhibitors
AO DEVICES
Allopurinol Omeprazole Disulfiram Erythromycin Valproate Isoniazid Ciprofloxacin Ethanol (acute) Sulphonamides
ketoconazole, erythromycin, ciprofloxacin most common
Grapefruit juice!
Which drugs have a synergistic effect?
Beta blockers and verapamil - severe hypotension. esp if IV verapamil
Which drug is likely to cause lactic acidosis?
metformin
