Adverse Effects Flashcards
1
Q
Abx
A
- Gentamicin/Vancomycin: ototoxicity and nephrotoxicity
- Others: C.diff
- Flucloxacillin and Co-amox: cholestatic hepatitis and jaundice
- Idiosyncratic, not dose related
- Onset may be delayed for up to 2 months following Tx
2
Q
ACE-Is
A
- Hypotension
- Hyperkalaemia
- AKI
- Dry cough
3
Q
Beta-blockers
A
- Hypotension
- Bradycardia
- Wheeze in asthmatics
- Worsens acute HF (but helps chronic HF)
4
Q
CCBs
A
- Hypotension
- Bradycardia
- Peripheral oedema
- Flushing
5
Q
Diuretics
A
- Hypotension
- Electrolyte disturbances
- AKI
- Spironolactone: gynaecomastia
6
Q
Heparin
A
- Haemorrhage (especially if renal failure/<50kg)
- Heparin-induced thrombocytopenia
- ?Hyperkalaemia
7
Q
Warfarin
A
- Haemorrhage
- Warfarin initially has procoag effect so take heparin alongside until INR exceeds 2
8
Q
Aspirin
A
- Haemorrhage
- Peptic ulcers and gastritis
- Tinnitus (large doses)
9
Q
Digoxin
A
- Nausea and vomiting
- Diarrhoea
- Blurred vision
- Confusion
- Dizziness
- Xanthopsia (disturbed yellow/green visual perception including halo vision)
10
Q
Digoxin and potassium
A
- HypERkalaemia can limit digoxin effects
- HypOkalaemia ca increase digoxin effects (toxicity)
11
Q
Amiodarone
A
SEs continue even after stopping!
- Interstitial lung disease (pulmonary fibrosis)
- Thyroid disease (both hypo- and hyper-)
- Raised AST (steato hepatitis)
- Phototoxicity
- Skin greying
- Corneal deposits
12
Q
Lithium
A
- EPSEs
- Hyper/hypothyroidism
- QT prolongation
- Weight gain
- Early: tremor
- Intermediate: tiredness
- Late: arrhythmias, seizures, coma, renal failure, diabetes insipidus, nephrotic syndrome
13
Q
Haloperidol
A
- Dyskinesias (acute dystonic reactions, drowsiness)
14
Q
Clozapine
A
- Agranuloyctosis - monitor FBCs
15
Q
Dexamethasone and prednisolone
A
STEROIDS
- Stomach ulcers
- Thin skin
- Edema
- Right and left HF
- Osteoporosis
- Infection (candida)
- Diabetes (hyperglycaemia)
- Syndrome - Cushing’s
- Mood changes
- Hyperlipidaemia
- Hypernatraemia
- Hypokalaemia
16
Q
Fludrocortisone
A
- HTN
- Sodium and water retention
17
Q
Ibuprofen
A
NSAIDS
- No urine (renal failure)
- Systolic dysfunction (HF)
- Asthma
- Indigestion
- Dyscrasia
18
Q
Simvastatin
A
- Myalgia
- Abdo pain
- Interstitial lung disease
- Increased ALT/AST
- Rhabdomyolysis
19
Q
Tx of statin-induced myalgia
A
- Exclude rhabdomyolysis (CK and urine dip - myoglobin)
- Ensure needs statin
- Reduce dose
- Switch to another statin with lower risk
20
Q
Myalgia risk of statins (in order)
A
- Simvastatin
- Atorvastatin
- Pravastatin
- Fluvastatin
or a fibrate
21
Q
Metformin
A
- Lactic acidosis
22
Q
Alcohol use
A
- Acute: increases warfarin effect
- Chronic: reduces warfarin effect
23
Q
MAOIs
A
- Hypertensive crisis
24
Q
Sedation causes
A
- Barbiturates
- Opioids
- Benzos
25
Alcohol: Metronidazole and disulfiram
- Sweating
- Flushing
- Nausea
- Vomiting
26
Tx of rhabdomyolysis
- Stop drug
- If renal failure - urgent dialysis
- IV fluids
- Consider sodium bicarbonate
- Monitor serum potassium (hyper from cell breakdown)
27
DOACs
- Bleeding
- Anaemia
- Nausea
28
Carbimazole
- Rash
- Pruiritis
- Agranulocytosis (SORE THROAT)
- Bone marrow suppression
- Jaundice
- Acute pancreatitis
29
Methotrexate
- Stomatitis
- Stevens-Johnson
- Toxic epidermal necrolysis
- Blood disorders
- Hepatotoxicity
- Interstitial pneumonitis
30
Phenytoin
- Gingival hypertrophy
- Hirsutism
- Tremor
- Leucopenia
- Steven-Johnsons
- Pneumonitis
31
Theophylline
- Hypokalaemia
- N+V
- Tremor
- Palpitations
32
Sodium Valproate
- SIADH
- Hyponatraemia
- Pancreatitis
- Bone marrow failure
- Anaemia
33
Drugs that increase GI bleed risk
- Antiplatelets: aspirin, clopidogrel
- Anticoagulants: warfarin
- Corticosteroids
- NSAIDs
- SSRIs
- Bisphosphonates
- Doxycycline
34
Drugs that cause weight gain
- SSRIs
- Anti-psychotics: clozapine, lithium, olanzapine, quetiapine, risperidone
- Sulphonylureas
- Corticosteroids
- Amitryptilline
- Sodium Valproate
- Insulin
35
HRT adverse effects
- HTN, STOP if BP > 160/96 (sodium and fluid retention)
- Can cause cholestatic jaundice, but no routine LFTs needed
- Serum cholesterol can increase but unlikely if on statin. Regular statin measurements.
- Can cause weight gain
- Breast cancer
36
HRT monitoring
- BP
- Breast status
- Statins (not as important)
37
Statins and ALT
Measure liver enzymes at baseline, 3 months and 12 months
- Stop if > 3x baseline
- Fine if < 3x baseline