Adverse effects Flashcards
What drugs prolong the QTc?
Long QTc = Bruce Lee
Come Mother Fucker
C.O.M.E M.F
Citalopram / venfexaline
Ondasetron
Macrolides
EPS / first gen antipsychotics
Macrolides/ Antibiotics
Fluranes
What drugs should be avoided in the elderly?
Benadryl and older antihistamines. …
Sleep medications. …
Muscle relaxers. …
Antispasmodics. …
Seroquel and other antipsychotic medications. …
Tricyclic antidepressants. …
Barbiturates. …
Indomethacin.
What is the normal QTc?
440ms in men and 460 ms in women
What is a risk of ondasetron in pregnancy?
Ondansetron during pregnancy is associated with a small increased risk of cleft palate/lip - the MHRA advise that these risks need to be discussed with the pregnant woman before use
What is the effect of the COCP?
Combined oral contraceptive pill
increased risk of breast and cervical cancer
protective against ovarian and endometrial cancer
What causes gingival hyperplasia?
Gingival hyperplasia: phenytoin, ciclosporin, calcium channel blockers and AML
ACE inhibitor side effects
C ough
A naphylaxis (or A ngioedema)
P alpitations
T aste disturbance
O rthostatic hypotension
P otassium elevated
R enal impairment
I mpotence
Sildenafil adverse effects
visual disturbances
blue discolouration
non-arteritic anterior ischaemic neuropathy
nasal congestion
flushing
gastrointestinal side-effects
headache
priapism
blue discolouration of vision
Gliclazide
Weight gain
Hypoglycaemia
What drug should be avoided in patients with an allergy to aspirin?
Patients who are allergic to aspirin may also react to sulfasalazine
Colchicine
Abdominal pain; diarrhoea; nausea; vomiting
Runs before walking
Monitor FBC
Allopurinol
Rash (discontinue therapy; if rash mild re-introduce cautiously but discontinue immediately if recurrence)
Amiodarone
Diarrhoea; gout aggravated; headache; hepatic disorders; nausea; oedema; skin reactions
Ciclosporin
Appetite decreased; diarrhoea; electrolyte imbalance; fatigue; fever; flushing; gastrointestinal discomfort; gingival hyperplasia; hair changes; headaches; hepatic disorders; hyperglycaemia; hyperlipidaemia; hypertension; hyperuricaemia; leucopenia; muscle complaints; nausea; paraesthesia; peptic ulcer; renal impairment (renal structural changes on long-term administration); seizure; skin reactions; tremor; vomiting
Name a drug that should never be prescribed in heart failure?
Verapamil as it is negatively ionotropic
What is given instead of adenosine for SVT in asthmatics?
Verapamil
Suggest which antibiotic should be avoided in epilepsy?
Levofloxacin is a fluoroquinolone antibiotic that has been associated with an increased risk of seizures in patients with epilepsy. This is thought to be due to its inhibitory effect on the gamma-aminobutyric acid (GABA) receptor, which plays a crucial role in the regulation of neuronal excitability. In patients with epilepsy, where there is already a tendency for hyperexcitability, this inhibition can potentially trigger seizures. Therefore, according to UK guidelines, it should be avoided in these patients.
Suggest how steroids should be reduced?
The BNF suggests gradual withdrawal of systemic corticosteroids if patients have:
received more than 40mg prednisolone daily for more than one week
received more than 3 weeks treatment
recently received repeated courses
What % of patients allergic to penicillin are allergic to cephalosporins?
The principal side-effect of the cephalosporins is hypersensitivity and about 0.5-6.5% of penicillin-sensitive patients will also be allergic to the cephalosporins.
Name two medicines taken at night?
Simvastatin
Amytriptalline
BPO and adapalene
What antibiotic is most likely to cause hearing loss?
Gentamicin is an aminoglycoside antibiotic and this class of medication can cause damage to the vestibular nerve if blood concentrations are high. As such, patients on these antibiotics should be monitored for signs of ototoxicity during treatment.
Suggest a co-prescription that increases risk of respiratory depression.
Co-prescription of benzodiazepines and opiates increases the risk of respiratory depression, coma, and death. Co-prescription should only be considered if there is no alternative and, if necessary, the lowest possible doses should be given for the shortest duration.
Oxybutynin side effects
Oxybutynin is an anti-muscarinic medication, which has a range of side effects that most commonly occur in elderly patients. A common anti-muscarinic side effect is dry mouth. Other common anti-muscarinic side effects include constipation, dizziness, drowsiness, dyspepsia, flushing, headache, nausea, palpitations, skin reactions, tachycardia, urinary disorders, vision disorders and vomiting. The BNF also lists diarrhoea as a general side effect of oxybutynin.
Co-amoxiclav side effects
Diarrhoea; hypersensitivity; nausea; skin reactions; thrombocytopenia; vomiting
Ticagrelor
Dyspnoea
Bisoprolol
Diarrhoea is a recognised common side effect of bisoprolol fumarate, and beta-blockers in general.
Name some drugs that cause tinnitus
Examples include ACE inhibitors such as ramipril. Other examples include aspirin, quinine and diuretics such as furosemide.
Antimuscarininc side effects
A common anti-muscarinic side effect is dry mouth. Other common anti-muscarinic side effects include constipation, dizziness, drowsiness, dyspepsia, flushing, headache, nausea, palpitations, skin reactions, tachycardia, urinary disorders, vision disorders and vomiting. The BNF also lists diarrhoea as a general side effect of oxybutynin.
Folic acid side effects
Abdominal distension; appetite decreased; flatulence; nausea; vitamin B12 deficiency exacerbated
Farting and flacutulence
Stains and CK
No immediate changes are required based on these results. Dose changes or treatment cessation of statins needs to be considered if the CK concentration becomes ‘markedly elevated’ or if the patient feels unable to tolerate side effects. The BNF does not define what they mean by ‘markedly elevated, but the rise in this scenario is very minor. In practice, it would be reasonable to continue monitoring the CK and consider other causes for his muscle pains.
Paracetemol overdose
Paracetamol is metabolised by the liver and in overdose can result in hepatic dysfunction, including a rise in the liver transaminases (ALT and AST) and ALP. There may also be renal dysfunction, which can cause decreased eGFR, but this is less common than hepatic dysfunction.
Following initial nausea and vomiting in the first 24, patients with minor paracetamol overdose do not typically demonstrate continuing symptoms.
Medication overuse headaches
Medication-overuse headache is defined as:
Headache occurring on 15 or more days per month in a person with a pre-existing headache disorder and
Regular overuse for more than 3 months of one or more drugs that can be taken for acute and/or symptomatic treatment of headache.
Pancreatitis causing drugs
Furosemide
Azathioprine/asparaginase
Thiazides/tetracyline
Statins/sulfonamides/sodium valproate
Hydrochlorothiazide
(O)Estrogens
Ethanol
Protease inhibitors & NRTIs (antiretroviral medications)
Co-trimoxazole
Diarrhoea; electrolyte imbalance; fungal overgrowth; headache; nausea; skin reactions
Statin side effects (most common)
Arthralgia; asthenia; constipation; diarrhoea; dizziness; flatulence; gastrointestinal discomfort; headache; muscle complaints; nausea; sleep disorders; thrombocytopenia
How is lithium toxicity managed?
When treating patients with lithium, it is reasonable to aim for plasma lithium levels of 0.4-1.0mmol/L
plasma lithium concentration of 1.6mmol/L it is important to withhold lithium immediately and refer to hospital for further monitoring and to consider measures to reduce serum lithium levels. After this, it would be wise to re-assess his lithium dose and/or formulation.
What two drugs cause a rise in CK?
Macrolides and statins
What is Phenelezine?
Phenelzine is a monoamine oxidase inhibitor most commonly prescribed for patients with severe depression that does not respond to other first-line antidepressants. This group of medications can interact with a number of other drugs, and have several important side effects; they must not be combined with other serotonergic medications (there is often a need to stop existing antidepressants several weeks before starting drugs in this class) due to the risk of serotonin syndrome.
When should a statin be discontinued?
discontinue simvastatin. Given that the serum transaminases are raised more than 3x the upper limit of normal, the statin needs to be stopped. Liver function tests should be regularly monitored whilst patients are taking statin therapies, typically at 3 and 12 months following the commencement of treatment.
When should statins be re-continued at a lower dose?
If you stop it, try and lower dose and symptoms resolve
What is a side effect of tamoxifen?
Increases risk of endometrial cancer
T or F, aciclovir can increase photosensitivity?
T
When should metformin be stopped?
The prescription that should be stopped in this patient is metformin hydrochloride. Metformin itself can cause lactic acidosis, and as a result, if a patient is in a state of metabolic acidosis it should be held whilst the acidosis is corrected.
When should steroid gradual withdrawal be considered?
received more than 40 mg prednisolone (or equivalent) daily for more than 1 week or 2 mg/kg
daily for 1 week or 1 mg/kg daily for 1 month;
been given repeat doses in the evening;
received more than 3 weeks’ treatment;
recently received repeated courses (particularly if taken for longer than 3 weeks);
taken a short course within 1 year of stopping long-term therapy;
other possible causes of adrenal suppression.
What are two adverse affects of finasteride?
Affects PSA values
Should not be prescribed in obstructive uropathy
Cefotaxime and ceftriaxone
Vulvovaginal candiadiasis, pseudomembranous entercolitis, thrombocytopenia, leucopenia
Sertraline
Palpitations are a common or very common side-effect of not just sertraline, but all selective serotonin re-uptake inhibitors (SSRIs).
Metformin
Clinical picture described above is that of a high anion gap metabolic acidosis with raised lactate level. Lactic acidosis is a rare or very rare, but potentially fatal side effect of metformin. Chronic stable heart failure is a risk factor for lactic acidosis. BNF advises that metformin should be witheld if dehydration occurs because acute kidney injury can precipiate lactic acidosis
