Adverse effects Flashcards
Reflex tachycardia; headache, flushing & ↑Intraocular pressure
Fenoldopam
Nitrofurantoin
(1) Nausea, vomiting and diarrhea (take with meals to decrease adverse effects) (2) Hemolytic anemia associated with G6PD deficiency (3) Colors the urine brown
Hypokalemia Impaired glucose tolerance/hyperglycemia Hyperuricemia Hyperlipidemia*
Hydrochlorothiazide and indapamide
– Hyperkalemia – Renal impairment – Potential teratogen
Aliskiren
Sodium nitroprusside
excessive lowering of BP; accumulation of cyanide byproduct of its metabolism
Clonidine
Dry mouth; sedation; rebound hypertension (on withdrawal)
bradycardia & cardiac conduction problems; impotence, peripheral vascular insufficiency, hyperglycemia, diabetes, asthma Withdrawal s/s nervousness, tachycardia, increase BP
Propranolol
Calcium acetate & calcium carbonate
GI side effects including constipation, diarrhea, nausea, vomiting, and abdominal pain Hypercalcemia
(1) Nausea, vomiting and diarrhea (take with meals to decrease adverse effects) (2) Hemolytic anemia associated with G6PD deficiency (3) Colors the urine brown
Nitrofurantoin
Irreversible ototoxicity: high-pitched tinnitus; high frequency loss followed by loss of low frequency (cochlear); N/V, vertigo (vestibular) Reversible nephrotoxicity Neuromuscular blockade (inhibit ACh release; Administration of a calcium salt can overcome this effect)
Aminoglycosides
Nilutamide
Hot flashes, gynecomastia, GI disturbances (nausea, diarrhea or constipation), liver function test abnormalities (including hepatitis) can cause interstitial pneumonitis
Captopril, Lisinopril, Enalapril, Ramipril
– Dry cough – Angioedema – Teratogenic Hyperkalemia
Fosfomycin
Diarrhea, nausea
i. Hypertension ii. Thrombotic/vascular events iii. Deep vein thrombosis
Erythropoietic growth factors (epoetin alfa)
Angioedema; teratogenic
Losartan, Candesartan, Valsartan, Eprosartan
Ferrous sulfate and ferric gluconate
Oral admin: (a) heartburn (b) constipation or diarrhea (c) nausea (d) upper abdominal pain IV admin anaphylaxis hypotension dizziness iron overload
Impotence and gynecomastia Hyperkalemia Metabolic acidosis
Spironolactone
Spironolactone
Impotence and gynecomastia Hyperkalemia Metabolic acidosis
(1) Nausea, vomiting (2) Rash (3) Hepatitis (rare but fatal), liver enzymes (4) Endocrinologic abnormalities, e.g., women, menstrual irregularities; men, gynecomastia; due to inhibition of steroid biosynthesis
Azoles more important for ketoconazole
Sedation; postural hypotension (in volume depleted patients)
Methyldopa (Aldomet)
Hypersensitivity reactions GI distress and diarrhea Neurotoxicity (myoclonus or seizures, agitation, confusion and hallucinations, or lethargy and stupor progressing to coma) Ampicillin rash
Penicillins - Piperacillin-tazobactam
Aminoglycosides
Irreversible ototoxicity: high-pitched tinnitus; high frequency loss followed by loss of low frequency (cochlear); N/V, vertigo (vestibular) Reversible nephrotoxicity Neuromuscular blockade (inhibit ACh release; Administration of a calcium salt can overcome this effect)
Hypotension Peripheral edema Headache/dizziness Cardiodepression
Verapamil; Diltiazem
Verapamil; Diltiazem
Hypotension Peripheral edema Headache/dizziness Cardiodepression
Dorzolamide; Acetazolamide
Metabolic acidosis
Metabolic acidosis
Dorzolamide; Acetazolamide
Bicalutamide & flutamide Antiandrogens
Hot flashes, gynecomastia, GI disturbances (nausea, diarrhea or constipation), liver function test abnormalities (including hepatitis)
a. GI: nausea, vomiting, abdominal discomfort b. CNS: headache, dizziness c. Have been shown to cause arthropathy in immature animals of a variety of species
Fluoroquinolones ciprofloxacin, levofloxacin
i. Hypernatremia and dehydration due to water loss in excess of sodium excretion ii. Increases plasma osmolality leading to hyponatremia manifested as headache, nausea and vomiting due to the movement of fluid into the extracellular compartments
Mannitol
Propranolol
bradycardia & cardiac conduction problems; impotence, peripheral vascular insufficiency, hyperglycemia, diabetes, asthma Withdrawal s/s nervousness, tachycardia, increase BP
Calcitriol, paricalcitol
i. Hypercalcemia ii. Hyperphosphatemia iii. soft-tissue and vascular calcification
Mannitol
i. Hypernatremia and dehydration due to water loss in excess of sodium excretion ii. Increases plasma osmolality leading to hyponatremia manifested as headache, nausea and vomiting due to the movement of fluid into the extracellular compartments
Ethacrynic acid
i. Hypocalcemia ii. Hypomagnesemia iii. Hypokalemia; predisposes patient to cardiac arrythmias iv. Metabolic alkalosis Decreased glucose tolerance Irreversible ototoxicity
Sevelamer
GI side effects including constipation, diarrhea, nausea, vomiting, and abdominal pain
Fluoroquinolones ciprofloxacin, levofloxacin
a. GI: nausea, vomiting, abdominal discomfort b. CNS: headache, dizziness c. Have been shown to cause arthropathy in immature animals of a variety of species
Leuprolide; Goserelin
i. Disease flare-up manifested clinically as increased bone pain or increased urinary symptoms ii. Endocrine-related including hot flashes, impotence, and decreased libido
3rd Generation Cephalosporin - Ceftriaxone
Hypersensitivty Local reactions at injection site Nephropathy (Risk of tubular necrosis in patients with underlying renal disease or who are taking potentially nephrotoxic drugs)
Acute hemolytic anemia (G6P deficiency) Steven Johnson Syndrome Crystalluria Kernicterus in newborns
Trimethoprim-Sulfamethoxazole
i. Hypocalcemia ii. Hypomagnesemia iii. Hypokalemia; predisposes patient to cardiac arrythmias iv. Metabolic alkalosis Decreased glucose tolerance Reversible ototoxicity
Furosemide
Aliskiren
– Hyperkalemia – Renal impairment – Potential teratogen
Hypotension Peripheral edema Headache/dizziness
Nifedipine; Amlodipine
Nifedipine; Amlodipine
Hypotension Peripheral edema Headache/dizziness
Testosterone replacement
Sodium retention Gynecomastia Decreased HDL cholesterol levels Polycythemia Hepatotoxicity (oral) contact dermatitis (topical)
Hot flashes, gynecomastia, GI disturbances (nausea, diarrhea or constipation), liver function test abnormalities (including hepatitis) can cause interstitial pneumonitis
Nilutamide
Oral admin: (a) heartburn (b) constipation or diarrhea (c) nausea (d) upper abdominal pain IV admin anaphylaxis hypotension dizziness iron overload
Ferrous sulfate and ferric gluconate
Alfuzosin, doxazosin, tamsulosin, and terazosin
Cardiovascular: Orthostatic hypotension CNS: Dizziness, somnolence Genitourinary: Impotence Increased hypotensive effect when given with antihypertensive drugs such as β-blockers, diuretics, ACEIs, calcium channel blockers
Reflex tachycardia; Postural hypotension
Prazosin; Doxazosin
Losartan, Candesartan, Valsartan, Eprosartan
Angioedema; teratogenic
Sildenafil, tadalafil, vardenafil
Hypotension i. Increased sensitivity to light ii. Blurred vision iii. Loss of blue-green color discrimination Back and muscle pain Priapism Sudden hearing loss usually on one side involving partial or complete loss of usual hearing; reversible Headache, facial flushing, rhinitis (due to vasodilation)
Finasteride; Dutasteride
i. Genitourinary: ejaculation disorders (dry sex or delayed ejaculation) and erectile dysfunction (may be due to drug-induced inhibition of NO synthesis) ii. Endocrine: gynecomastia iii. Pregnancy category X - suppresses levels of DHT in male fetus inhibiting development of external genital organs and leading to feminization of a male fetus
Hypotension i. Increased sensitivity to light ii. Blurred vision iii. Loss of blue-green color discrimination Back and muscle pain Priapism Sudden hearing loss usually on one side involving partial or complete loss of usual hearing; reversible Headache, facial flushing, rhinitis (due to vasodilation)
Sildenafil, tadalafil, vardenafil
i. Hypercalcemia ii. Hyperphosphatemia iii. soft-tissue and vascular calcification
Calcitriol, paricalcitol
Diarrhea, nausea
Fosfomycin
Dry mouth; sedation; rebound hypertension (on withdrawal)
Clonidine
Minoxidil; Pinacidil
(i) Reflex tachycardia; (ii) Fluid retention; (iii) Excessive hair growth; (iv) Headaches/Flushing excess cerebral/cutaneous dilation
Sodium retention Gynecomastia Decreased HDL cholesterol levels Polycythemia Hepatotoxicity (oral) contact dermatitis (topical)
Testosterone replacement
Prazosin; Doxazosin
Reflex tachycardia; Postural hypotension
GI side effects including constipation, diarrhea, nausea, vomiting, and abdominal pain
Sevelamer
Alprostadil
Intracavernosal Cavernosal plaques or areas of fibrosis at injection sites Burning discomfort or dull pain near the injection site or during the erection Priapism Intraurethral Urethra injury leading to urethral stricture and difficulty voiding Urethral pain Female sexual partners may experience vaginal burning, itching, or pain Priapism
i. Nausea and vomiting ii. Hypocalcemia manifested as paresthesias, myalgias, cramping, tetany, and convulsions
Cinacalcet
Hyperkalemia Metabolic acidosis
Triamterene; Amiloride
Reflex sympathetic activation → Tachycardia; ↓Insulin release (due to Kchannel opening); Edema (salt and water retention)
Diazoxide
i. Genitourinary: ejaculation disorders (dry sex or delayed ejaculation) and erectile dysfunction (may be due to drug-induced inhibition of NO synthesis) ii. Endocrine: gynecomastia iii. Pregnancy category X - suppresses levels of DHT in male fetus inhibiting development of external genital organs and leading to feminization of a male fetus
Finasteride; Dutasteride
Triamterene; Amiloride
Hyperkalemia Metabolic acidosis
Cardiovascular: Orthostatic hypotension CNS: Dizziness, somnolence Genitourinary: Impotence Increased hypotensive effect when given with antihypertensive drugs such as β-blockers, diuretics, ACEIs, calcium channel blockers
Alfuzosin, doxazosin, tamsulosin, and terazosin
i. Disease flare-up manifested clinically as increased bone pain or increased urinary symptoms ii. Endocrine-related including hot flashes, impotence, and decreased libido
Leuprolide; Goserelin
(i) Reflex tachycardia; (ii) Fluid retention; (iii) Excessive hair growth; (iv) Headaches/Flushing excess cerebral/cutaneous dilation
Minoxidil; Pinacidil
GI side effects including constipation, diarrhea, nausea, vomiting, and abdominal pain Hypercalcemia
Calcium acetate & calcium carbonate
Hot flashes, gynecomastia, GI disturbances (nausea, diarrhea or constipation), liver function test abnormalities (including hepatitis)
Bicalutamide & flutamide Antiandrogens
Hypersensitivty Local reactions at injection site Nephropathy (Risk of tubular necrosis in patients with underlying renal disease or who are taking potentially nephrotoxic drugs)
3rd Generation Cephalosporin - Ceftriaxone
Penicillins - Piperacillin-tazobactam
Hypersensitivity reactions GI distress and diarrhea Neurotoxicity (myoclonus or seizures, agitation, confusion and hallucinations, or lethargy and stupor progressing to coma) Ampicillin rash
Furosemide
i. Hypocalcemia ii. Hypomagnesemia iii. Hypokalemia; predisposes patient to cardiac arrythmias iv. Metabolic alkalosis Decreased glucose tolerance Reversible ototoxicity
GI disturbances (diarrhea or constipation, nausea)
Saw palmetto
Erythropoietic growth factors (epoetin alfa)
i. Hypertension ii. Thrombotic/vascular events iii. Deep vein thrombosis
Azoles more important for ketoconazole
(1) Nausea, vomiting (2) Rash (3) Hepatitis (rare but fatal), liver enzymes (4) Endocrinologic abnormalities, e.g., women, menstrual irregularities; men, gynecomastia; due to inhibition of steroid biosynthesis
excessive lowering of BP; accumulation of cyanide byproduct of its metabolism
Sodium nitroprusside
Cinacalcet
i. Nausea and vomiting ii. Hypocalcemia manifested as paresthesias, myalgias, cramping, tetany, and convulsions
Diazoxide
Reflex sympathetic activation → Tachycardia; ↓Insulin release (due to Kchannel opening); Edema (salt and water retention)
Hydrochlorothiazide and indapamide
Hypokalemia Impaired glucose tolerance/hyperglycemia Hyperuricemia Hyperlipidemia*
Trimethoprim-Sulfamethoxazole
Acute hemolytic anemia (G6P deficiency) Steven Johnson Syndrome Crystalluria Kernicterus in newborns
Saw palmetto
GI disturbances (diarrhea or constipation, nausea)
Methyldopa (Aldomet)
Sedation; postural hypotension (in volume depleted patients)
Intracavernosal Cavernosal plaques or areas of fibrosis at injection sites Burning discomfort or dull pain near the injection site or during the erection Priapism Intraurethral Urethra injury leading to urethral stricture and difficulty voiding Urethral pain Female sexual partners may experience vaginal burning, itching, or pain Priapism
Alprostadil
i. Hypocalcemia ii. Hypomagnesemia iii. Hypokalemia; predisposes patient to cardiac arrythmias iv. Metabolic alkalosis Decreased glucose tolerance Irreversible ototoxicity
Ethacrynic acid
Fenoldopam
Reflex tachycardia; headache, flushing & ↑Intraocular pressure
– Dry cough – Angioedema – Teratogenic Hyperkalemia
Captopril, Lisinopril, Enalapril, Ramipril