Adverse Effects Flashcards
Adrenaline
After Cardiac arrest —> adrenaline induced hypertension
Use in conscious pts —> anxiety, tremor, headaches, palpitations
In those with existing heart disease —> angina, MI, arrhythmias
Corticosteroids (systemic)
1️⃣ Immunosuppression
2️⃣Metabolic - osteoporosis, diabetes mellitus, proximal muscle weakness, bruising, gastritis
3️⃣Mood changes - suicidal, insomnia, confusion
4️⃣Mineralocorticoid - hypertension, hypokalaemia, oedema
5️⃣Adrenal atrophy over time -> Addisonian crisis if rapidly withdrawn
6️⃣Chronic glucocorticoid deficiency (fatigue, weight loss, arthralgia)
Thiazide like Diuretics
⚠️ Hyponatraemia
⚠️ Hypokalaemia (Na swapped for K in DCT) —> arrhythmias
⚠️ Increase plasma glucose, TGs, LDL-cholesterol
⚠️ Impotence in men
Statins
⚠️Headaches and GI Distrubances
‼️ Muscle problems ranging from aches to myopathy to rhabdomyolysis
⚠️ Increase in ALT
‼️ Drug induced hepatitis (rare but serious)
Clopidogrel
⚠️Bleeding
⚠️GI upset
⚠️Thrombocytopenia
Antihistamines
First generation (e.g. chlorphenamine) cause sedation as act in the 🧠 Second gen are fine
5a-reductase inhibitors
Impotence Reduced libido Gynaecomastia Hair growth Breast cancer
Alpha blockers
Doxazosin, tamsulosin, alfuzosin
Postural hypotension
Dizziness
Syncope
Particularly after first dose
Acetylcholinesterase inhibitors
Donepezil, Rivastigmine
Increased cholinergic activity in peripheral nervous system ->
Nausea
Vomiting
Diarrhoea
Exacerbation of asthma/COPD
Peptic Ulcers and bleeding
Bradycardia and heart block
Central cholinergic effects ->
Hallucinations
Altered/aggressive behaviour
Extrapyramidal symptoms
Neuroleptic malignant syndrome
B-blockers
Propanolol, bisoprolol, atenolol, metoprolol, carvedilol
Fatigue Cold extremities Headache GI disturbance Sleep disturbance Impotence
Acetylcysteine
Can cause anaphylactoid reaction - give antihistamine & bronchodilator, then restart acetylcysteine.
When inhaled can cause bronchospasm so give bronchodilator first
Activated charcoal
Aspiration ➡️ pneumonitis, bronchospasm, airway obstruction
Intestinal obstruction
Black stools
Vomiting
💊 will reduce dose available for absorption of therapeutic drugs as well as poisons
Adenosine
By interfering with SAN and AVN it can induce bradycardia and asystole accompanied with SOB and ‘sense of impending doom’ - this is all short lived
Aldosterone antagonists
spironolactone, eplenerone
Hyperkalaemia –> muscle weakness, arrhythmias, cardiac arrest
Gynaecomastia (spironolactone)
Endocrine side effects (eplenerone)
Liver impairment and jaundice
Steven-Johnson syndrome (T-cell-mediated hypersensitivity reaction that causes bullous skin eruption)
Alginates and antacids
Gaviscon, Peptac
Diarrhoea (Mg salts)
Constipation (Al salts)
Allopurinol
Starting can trigger or worsen acute attack of gout therefore co-px with NSAID or colchicine in the initiation phase. Skin rash (Stevens-Johnson syndrome, toxic epidermal necrolysis) Allopurinol hypersensitivity syndrome = severe, fever, eosinophilia, lymphadenopathy and other organ involvement
Aminoglycosides
gentamicin, amikacin, nneomycin
Ototoxicity (hearing loss, tinnitus, vertigo)
Nephrotoxicity (reduced eurine output, rising serum creatinine and urea)
(due to accumulation in cells –> apoptosis)
Aminosalicylates
mesalazine, sulfasalazine
GI upset Headache Blood abnormalities (leucopenia, thrombocytopenia) Renal impairment Oligospermia (sulfasalazine) Serious hypersensitivity reaction
Amiodarone
Acute = sometimes hypotension Chronic use: pneumonitis bradycardia / AV block hepatitis photosensitivity / grey discolouration thyroid abnormalities (as contains iodine) V LONG t1/2
ACE-i
ramipril, lisinopril, perindopril
First dose hypotension
Cough (due to increased bradykinin)
Hyperkalaemia (due to lower aldosterone level)
Renal failure (esp. in renal artery stenosis)
Angioedema and anaphylactoid reactions
ARBs
loasartan, candesartan, irbesartan
First dose hypotension
Hyperkalaemia
Renal Failure
Antidepressants - SSRI’s
citalopram, sertraline, fluoxetine, escitalopram
GI upset
Changes in appetite and weight
Hypersensitivity rxn
Hyponatraemia
Suicidal thoughts and behaviour
Lower seizure threshold
Some can prolong the QT interval -> arrhythmias
Increase risk of bleeding
Serotonin syndrome (autonomic hyperactivity, altered mental state and neuromuscular excitation)
Sudden withdrawal can cause GI upset, neuro sx, flu like sx and sleep disturbance
Antidepressants - tricyclics
Amitriptyline, lofepramine
Blocking antimuscarinic receptors causes -> dry mouth, constipation, urinary retention and blurred vision
Blockade of H1- and α1- receptors -> sedation and hypotension
Cardiac adverse effects
Brain adverse effects (convulsions, hallucinations and mania)
Blockade of dopamine receptors -> breast changes, sexual dysfxn and extrapyramidal effects (tremor and dyskinesia)
Dangerous in overdose
Sudden withdrawal can cause GI upset, neuro sx, flu like sx and sleep disturbance
Antidepressants - venlafaxine and mirtazapine
GI upset Neurological effects Hyponatraemia Serotonin syndrome Suicidal thoughts Prolong QT interval (venlafaxine) Sudden withdrawal can cause GI upset, neuro sx, flu like sx and sleep disturbance
Antiemetics - D2 receptor antagonists
domperidone, metoclopramide
Diarrhoea Extrapyramidal sx (metoclopramide) - mostly acute dystonic reaction QT interval prolonged + arrhythmias (domperidone)
Antiemetics - H1 receptor antagonists
cyclizine, cinnarizine, promethazine
Drowsiness
Dry throat and mouth (anti-cholinergic effects)
Transient tachycardia (after IV infusion)
Antiemetics - 5-HT3 receptor antagonists
ondansetron, granisetron
Rare
Antifungal drugs
fluconazole, clotrimazole, nystatin
Topical - local irritation
Fluconazole (oral): GI upset headache hepatitis hypersensitivity Rare but life threatening = severe hepatic toxicity, prolonged QT interval, arrhythmias, cutaneous reactions, anaphylaxis
Antihistamines - H1 receptor antagonists
cetirizine, loratidine, fexofenadine, chlorphenamine
1st gen = sedation
2nd gen = few adverse effects (do not cross blood brain barrier)
Antimotility drugs
loperamide, codeine phosphate
GI effects (e.g. constipation, flatulence, abdo cramps) Opioid toxicity/dependence
Antimuscarinics, bronchodilators
ipratropium, tiatropium, glycopyrronium, aclidinium
After inhalation antimuscarinic bronchodilators are absorbed from lungs into circulation where inactivated by hydrolysis - happens at different rates.
Can cause irritation of respiratory tract
GI disturbance
Urinary retention
Blurred vision
Headaches
Antimuscarinics, cardiovascular and GI uses
atropine, hyoscine butylbromide, glycopyrronium
Tachycardia Dry mouth Constipation Urinary retention Blurred vision Drowsiness Confusion
Antimuscarinics, GU uses
oxybutynin, tolterodine, solifenacin
Tachycardia Dry mouth Constipation Blurred vision Urinary retention may occur if there is bladder outflow obstruction
Antipsychotics - first generation
haloperidol, chlorpromazine, prochlorperazine
Extrapyramidal side effects - acute dystonia/akathisia/neuroleptic malignant syndrome (rigidity, confusion, autonomic dysregulation, pyrexia)/tardive dyskinesia
drowsiness
hypotension
QT interval prolongation -> arrhythmias
erectile dysfunction
hyperprolactinaemia -> galactorrhoea, menstrual disturbances, breast pain
Antipsychotics - second generation
olanzapine, risperidone, clozapine
sedation
EPSE (less common that 1st gen)
Metabolic disturbance (weight gain, DM, lipid changes)
prolong QT interval -> arrhythmias
Sexual dysfunction and breast symptoms
Clozapine -> agranulocytosis and myocarditis
Antiviral drugs
aciclovir
headache dizziness GI disturbances Skin rash phlebitis ast injection site acute renal failure (minimise risk with good hydration and slow infusion)
Antiplatelet drugs - ADP receptor antagonists
clopidogrel, ticagrelor, prasugrel
Bleeding
GI upset
thrombocytopenia
Antiplatelet drugs - aspirin
GI irritation Peptic ulceration and haemorrhage Hypersensitivity (bronchospasm) Tinnitus in regular high-dose Fatal in overdose (hyperventilation, hearing changes, metabolic acidosis, confusion, convulsions, cardiovasular collapse and respiratory arrest)
Azathioprine
Bone marrow suppression -> leukopenia and increased risk of infection
Nausea
Hypersensitivity (diarrhoea, rash, vomiting, fever, myalgia, hypotension and pancreatitis)
Veno-occlusive disease
hepatotoxicity
lymphoma risk
β-blockers
propanolol, bisoprolol, metoprolol, atenolol, carvediol
Fatigue cold-extremities headache GI disturbance Sleep disturbance Impotence in men
β2-agonists
salbutamol, terbutaline, salmeterol, formoterol, indacaterol
fight or flight effects, e.g. tachycardia, palpitations, anxiety and tremor
Increased serum glucose, lactate and muscle cramps
Benzodiazepines
diazepam, temazepam, lorazepam, chlordiazepoxide, midazolam
drowsiness, sedation and coma
overdose -> loss of airway reflexes -> death
dependence
withdrawal reaction
Bisphosphonates
alendronic acid, zolendronic acid, disodium pamidronate
oesophagitis
hypophosphataemia
jaw osteonecrosis
atypical femoral fracture
Calcium and Vitamin D
calcium carbonate, calcium gluconate, colecalciferol, alfacalcidol
dyspepsia
constipation
cardiovascular collapse (if administered too quickly)
local tissue damage (if accidentally given subcut)
Calcium channel blockers
amlodipine, nifedipine, verapamil, diltiazem
A&N: swelling flushing headache palpitations V: constipation bradycardia heart block cardiac failure D: all the above
Carbamazepine
GI upset and neurological effects
hypersensitivity (skin rash)
Antiepileptic hypersensitivity syndrome (10% mortality)
Oedema and hyponatraemia due to an ADH effect
Cephalosporins and carbapenems
cefalexin, cefotaxime, meropenem, ertapenem
GI upset
Antibiotic-associated colitis
Hypersensitivity
Neurological toxicity inc seizures
Chloramphenicol
Topical: burning, itching, stinging
Systemic: bone marrow suppression or aplastic anaemia
Grey baby syndrome
Optic and peripheral neuritis
Corticosteroids (inhaled)
beclometasone, budesonide, fluticasone
oral thrush
hoarse voice
In COPD may cause pneumonia
Corticosteroids (topical)
hydrocortisone, betamethasone
Potent steroids can cause local adverse effects - skin thinning, striae, telangiectasia
use on face - dermatitis or exacerbate acne
withdrawal can cause rebound worsening
adrenal suppression
Digoxin
Bradycardia GI disturbance Rash Dizziness Visual disturbance Arrhythmias with toxic level (narrow therapeutic range)
