Adverse Effects Flashcards
5α reductase inhibitors
finasteride
Antiandrogen action:
Impotence
Reduced libido
Hair growth
Breast cancer (men)
α-blockers
doxazosin, tamsulosin, alfuzosin
Postural hypotension
Dizziness
Syncope
(Particularly present after first dose)
Acetylcholinesterase inhibitors
donepezil, rivastigmine
Nausea, diarrhoea and vomiting
Exacerbation of asthma/COPD
Peptic ulcers, bleeding, bradycardia, heart block
Hallucinations
Altered/aggressive behaviour
Extrapyramidal symptoms & neuroleptic malignant syndrome
Acetylcysteine (N-acetylcysteine)
IV administration:
Anaphylactoid reaction
Nebulised administration:
Bronchospasm
Activated charcoal
Black stools, vomiting
Aspiration → pneumonitis, bronchospasm, airway obstruction
Intestinal obstruction
Adenosine
Bradycardia
Asystole
Sinking feeling, breathlessness
Sense of impending doom
Adrenaline
epinephrine
After Cardiac arrest:
Adrenaline induced hypertension
Use in conscious patients:
Anxiety, tremor, headaches, palpitations
In those with existing heart disease:
Angina, MI, arrhythmias
Aldosterone antagonists
spironolactone, eplerenone
Hyperkalaemia
Gynaecomastia
Liver impairment + jaundice
Alginates and antacids
gaviscon, peptac
Magnesium salts → diarrhoea
Aluminium salts→ constipation
Allopurinol
Can trigger/worsen acute attack of gout
Skin rash (Stevens-Johnson syndrome, toxic epidermal necrolysis)
Allopurinol hypersensitivity syndrome (fever, eosinophilia, lymphadenopathy)
Aminoglycosides
gentamicin, amikacin, neomycin
Nephrotoxicity (reduce urine output, rising serum creatinine + urea)
Ototoxicity (hearing loss, tinnitus, vertigo)
Aminosalicylates
mesalazine, sulfasalazine
GI upset
Headache
Leucopenia, thrombocytopenia
Renal impairment
Sulfasalazine:
Oligospermia (reversible)
Serious hypersensitivity reaction
Amiodarone
Hypotension
Lungs (pneumonitis)
Heart (bradycardia, AV block)
Liver (hepatitis)
Skin (photosensitivity, grey discolouration)
Thyroid abnormalities
ACE inhibitors
ramipril, lisinopril, perindopril
Hypotension (particularly after first dose)
Persistent, dry cough (increased bradykinin)
Hyperkalaemia (low aldosterone promotes K retention)
Can cause or worsen renal failure
Angioedema
Anaphylactoid reactions
Angiotensin receptor blockers
losartan, candesartan, irbesartan
Hypotension (particularly after first dose)
Persistent, dry cough (increased bradykinin)
Hyperkalaemia (low aldosterone promotes K retention)
Antidepressants
tricyclics; amitriptyline, lofepramine
GI upset
Changes in appetite/weight loss
Hypersensitivity reactions (inc. rash)
Hyponatraemia
Suicidal thoughts and behaviour
Lower seizure threshold
Prolonged QT interval
Bleeding
Serotonin syndrome
Sudden withdrawal can cause GI upset, neurological and influenza-like symptoms and sleep disturbance
Antidepressants
venlafaxine, mirtazapine
Dry mouth
Sedation
Hypotension
Arrhythmias + ECG changes
Convulsions, hallucinations ad mania
Breast changes
Sexual dysfunction
Extrapyramidal symptoms (rarely)
Dangerous in overdose
Sudden withdrawal can cause GI upset, neurological and influenza-like symptoms and sleep disturbance
Antiemetics - dopamine D2-receptor antagonists
metoclopramide, domperidone
Diarrhoea
Metoclopramide:
Extrapyramidal symptoms (movement abnormalities)
Acute dystonic reaction
Domperidone:
QT-prolongations
Arrhythmias
Antiemetics - histamine H1-receptor antagonists
cyclizine, cinanrizine, promethazine
Drowsiness
Dry throat + mouth
Tachycardia, palpitations
Antiemetics - serotonin 5-HT3-receptor antagonists
ondansetron, granisetron
Rare
Constipation, diarrhoea and headaches can occur
Antifungal drugs
nystatin, clotrimazole, fluconazole
Topical nystatin and clotrimazole:
Local irritation
Oral fluconazole: GI upset Headache Hepatitis Hypersensitivity
Rare: Severe hepatic toxicity Prolonged QT interval, arrhythmias Cutaneous reactions Anaphylaxis
Antihistamines - H1-receptor antagonists)
cetirizine, loratadine, fexofenadine, chlorphenamine
Chorphenamine can cause sedation
Antimotility drugs
loperamide, codeine phosphate
GI effects
Indirectly, risk of opioid toxicity and dependence with codeine
Antimuscarinics - bronchodilators
ipratropium, tiotropoium, glycopyrronium, aclidinium
Irritation to respiratory tract (nasopharyngitis, sinusitis, cough)
GI disturbance (dry mouth, constipation, urinary retention, blurred vision, headaches)
Antimuscarinics - cardiovascular and GI uses
atropine, hyoscine butylbromide, glycopyrronium
Tachycardia
Dry mouth
Constipation
Urinary retention in patients with BPH
Blurred vision
Drowsiness + confusion
Antimuscarinics - GU uses
oxybutynin, tolterodine, solifenacin
Dry mouth
Tachycardia
Constipation
Blurred vision
Antipsychotics - 1st generation (typical)
haloperidol, chlorpromazine, prochlorperazine
Extrapyramidal effects:
- Acute dystonic reactions
- Akathisia
- Neuroleptic malignant syndrome
- Tardive dyskinesia
Drowsiness Hypotension QT prolongation Arrythmias Hyperprolactinaemia Erectile dysfunction
Antipsychotics - 2nd generation (atypical)
quetiapine, olanzapine, risperidone, clozapine
Sedation
Extrapyramidal effects
Metabolic disturbance
QT prolongation
Arrythmias
Breast symptoms
Sexual dysfunction
Agranulocytosis
Myocarditis
Antiviral drugs
aciclovir
Headache
Dizziness
GI disturbances
Rash
Phlebitis at injection site
Acute renal failure
Antiplatelet drugs - ADP-receptor antagonists
clopidogrel, ticagrelor, prasugrel
Bleeding
GI upset
Thrombocytopenia
Antiplatelet drugs
aspirin
GI irritation
Peptic ulceration
Haemorrhage
Bronchospasm
Tinnitus
Life-threatening in overdose
Azathioprine
Bone marrow suppression
Nausea
Hypersensitivity reactions:
- Diarrhoea + vomiting
- Rash
- Fever
- Myalgia
- Hypotension
- Pancreatitis
Veno-occlusive disease
Hepatotoxicity
Lymphoma
β-blockers
bisoprolol, atenolol, propanolol, metoprolol, carvedilol
Fatigue
Cold extremities
Headache
Nausea
Impotence
β2-agonists
salbutamol, terbutaline, salmeterol, formoterol, indacaterol
Tachycardia
Palpitations
Anxiety
Tremor
Muscle cramps
Benzodiazepines
diazepam, temazepam, lorazepam, chlordiazepoxide, midazolam
Drowsiness
Sedation
Coma
Dependence
Withdrawal reaction
Bisphosphonates
alendronic acid, disodium pamidronate, zoledronic acid
Oesophagitis
Hypophosphataemia
Osteonecrosis of the jaw
Atypical femoral fracture
Calcium and vitamin D
calcium carbonate, calcium gluconate, colecalciferol, alfacalcidol
Dyspepsia
Constipation
Cardiovascular collapse
Local tissue damage
Calcium channel blockers
amlodipine, nifedipine, dilitiazem, verapamil
Amlodipine + nifedipine:
Ankle swelling
Flushing
Headache
Palpitations
Verapamil:
Constipation
Bradycardia
Heart block
Cardiac failure
Carbamazepine
GI upset
Neurological effects
Hypersensitivity
Anti-epileptic hypersensitivity syndrome
Oedema
Hyponatraemia
Cephalosporins and carbapenems
cefalexin, cefotazime, meropenem, ertapenem
GI upset
Antibiotic-associated colitis
Hypersensitivity
Neurological toxicity
Seizures
Chloramphenicol
Stinging, burning + itching
Dose-related bone marrow suppression
Aplastic anaemia
Grey baby syndrome
Optic and peripheral neuritis
Corticosteroids (glucocorticoids) - inhaled
beclometasone, budesonide, fluticasone
Oral candidiasis
Hoarse voice
Pneumonia (COPD)
Corticosteroids (glucocorticoids) - systemic
prednisolone, hydrocortisone, dexamethasone
Immunosuppression
Metabolic effects
Mood + behavioural changes
Adrenal atrophy
Addisonian crisis
Chronic glucocorticoid deficiency
Corticosteroids (glucocorticoids) - topical
hydrocortisone, betamethasone
Local adverse effects e.g. skin thinning, striae, telangiectasia and contact dermatitis
Rebound worsening of skin condition
Adrenal suppression
Systemic adverse effects
Digoxin
Bradycardia
GI disturbance
Rash
Dizziness
Visual disturbance
Digoxin toxicity
Dipeptidylpeptidase-4 inhibitors
sitagliptin, linagliptin, saxagliptin
Hypoglycaemia
Acute pancreatitis
Direct oral anticoagulants (DOACs)
apixaban, dabigatran, edoxaban, rivaroxaban
Bleeding
GI bleeding
Anaemia
GI upset
Dizziness
Elevated liver enzymes
Loop diuretics
furosemide, bumetanide
Dehydration
Hypotension
Low electrolyte state
Hearing loss + tinnitus
Thiazide and thiazide-like diuretics
bendroflumethiazide, indapamide, chlortalidone
Hyponatraemia
Hypokalaemia
Cardiac arrhythmias
Impotence
Dopaminergic drugs for Parkinson’s disease
levodopa as co-careldopa/co-beneldopa, ropinirole, premipexol
Nausea
Drowsiness
Confusion
Hallucinations
Hypotension
Dyskinesias
Emollients
aqueous cream, liquid paraffin
Greasy skin
Exacerbation of acne
Folliculitis
Fibrinolytic drugs
alteplase, streptokinase
Nausea + vomiting
Bruising
Hypotension
Serious bleeding
Allergic reaction
Cardiogenic shock
Cardiac arrest
Cerebral oedema
Arrythmias
Gabapentin and pregablin
Drowsiness
Dizziness
Ataxia
Heparins and fondaparinux
enoxaparin, dalteparin, fondaparinux, unfractioned heparin
Haemorrhage
Hyperkalaemia
Heparin-induced thrombocytopenia
Insulin
insulin aspart, insulin glargine, biphasic insulin, soluble insulin
Hypoglycaemia
Iron
ferrous fumarate, ferrous sulfate
Intestinal disease
Atopic predisposition
Lamotrigine
Headache
Drowsiness
Irritability
Blurred vision
Dizziness
GI symptoms
Skin rash
Severe hypersensitivity reaction
Laxatives - osmotic
lactulose, macrogol, phosphate enema
Flatulence
Abdominal cramps
Nausea
Diarrhoea
Local irritation
Electrolyte disturbances
Leukotriene receptor antagonists
montelukast
Headache
Abdominal pain
Hyperactivity + reduced concentration
Churg-Strauss syndrome
Lidocaine
Stinging on administration
Drowsiness
Restlessness
Tremor
Fits
Hypotension
Arrhythmias
Macrolides
clarithromycin, erythromycin, azithromycin
Irritant
Allergy
Antibiotic-associated colitis
Cholestatic jaundice
QT prolongation
Arrythmias
Ototoxicity
Metformin
GI upset
Lactic acidosis
Methotrexate
Mucosal damage
Bone marrow suppression
Hypersensitivity reactions
Hepatic cirrhosis
Pulmonary fibrosis
Risk of accidental overdose
Metronidazole
GI upset
Hypersensitivity
Peripheral and optic neuropathy
Seizures
Encephalopathy
Naloxone
Effect of opioid reversal may be significant in an opioid-dependent individual
Nitrates
isosorbide mononitrate, glyceryl trinitrate
Flushing
Headaches
Light-headedness
Hypotension
Tolerance
Nitrofurantoin
GI upset
Hypersensitivity
Chronic pulmonary reactions
Hepatitis
Peripheral neuropathy
Haemolytic anaemia
NSAIDs
naproxen, ibuprofen, etoricoxib
GI toxicity
Renal impairment
Cardiovascular events
Hypersensitivity reactions
Fluid retention
Ocular lubricants - artificial tears
hypromellose, carbomers, liquid and white soft paraffin
Stinging on application
Blurring of vision
Oestrogens and progestogens
combined ethinylestradiol products, desogestrel
Irregular bleeding
Mood changes
Cardiovascular disease
Stroke
Breast/cervical cancer risk
Opioids - strong
morphine, oxycodone
Respiratory depression
Neurological depression
Nausea + vomiting
Pupillary constriction
Constipation
Itching
Tolerence + dependence
Withdrawal reaction
Opioids - weak/moderate
tramadol, codeine, dihydrocodeine
Nausea
Constipation
Dizziness
Drowsiness
Neurological + respiratory depression
Codeine + dihydrocodeine must never be given IV - causes reaction similar to anaphylaxis
Oxygen
Discomfort from mask e.g. dry throat
Paracetamol
Few side effects
Causes liver failure in overdose
Penicillins
benzylpenicilin, phenoxymethylpenicillin
Allergy occurs in 1-10% if people
Skin rash
Anaphylactic reaction
Neurological toxicity
Penicillins - antipseudomonal
piperacilllin with tazobactam - tazocin
GI upset
Antibiotic-associated colitis
Hypersensitivity
Penicillins - broad-spectrum
amoxicillin, co-amoxiclav
GI upset
Antibiotic-associated colitis
Allergy
Acute liver injury e.g. jaundice, hepatitis
Penicillins - penicillinase-resistant
flucloxacillin
GI upset
Allergy
Skin rash
Anaphylactic reaction
Liver toxicity
Phosphodiesterase (type 5) inhibitors
sildenafil
Flushing
Headache
Dizziness
Nasal congestion
Hypotension
Tachycardia
Palpitations
Prostaglandin analogue of eye drops
latanoprost, bimatoprost
Blurred vision
Conjunctival reddening (hyperaemia)
Occular irritation + pain
Permanent change in eye colour
Protein pump inhibitors
lansoprazole, omeprazole, pantoprazole
GI disturbances
Headache
Hypomagnesaemia
Quinine
quinine sulfate
Tinnitus
Deafness
Blindness
GI upset
Hypersensitivity reactions
QT prolongation
Hypoglycaemia
Quinolones
ciprofloxacin, moxifloxacin, levofloxacin
GI upset
Hypersensitivity reactions
Neurological effects
Rupture of muscle tendons
QT prolongation
Arrhythmias
Serotonin 5HT1-receptor agonists
sumatriptan
Pain/discomfort in chest + throat
MI
Sex hormone antagonists for breast cancer
tamoxifen, anastrozole, letrozole
Vaginal dryness
Hot flushes
Loss of bone density
VTE
Endometrial cancer
Agranulocytosis
Liver failure
Statins
simvastatin, atorvastatin, pravastatin, rosuvastatin
Headache
GI disturbances
Aches
Myopathy
Rhabdomyolysis
Rise in liver enzymes
Sulphonylureas
glicazide
GI upset
Hypoglycaemia
Rare hypersensitivity reactions
Tetracyclines
doxycycline, lymecycline
Nausea, vomiting + diarrhoea
Hypersensitivity reactions
Oesophageal irritation
Photosensitivity
Discolouration and/or hypoplasia of tooth enamel
Hepatotoxicity
Intracranial hypertension
Thyroid hormones
levothyroxine, liothyronine
Similar to symptoms of hyperthyroidism
GI - diarrhoea, vomiting, weight loss
Cardiac - palpitations, arrhythmias, angina
Neurological - tremors, restlessness, insomnia
Trimethoprim
trimethoprim, co-trimoxazole
GI upset
Skin rash
Hypersensitivity reactions
Haematological disorders
Hyperkalaemia
Valproate (valproic acid)
sodium valproate, valproic acid
GI upset
Neurological and psychiatric effects
Thromobcytopenia
Increased liver enzymes
Hair loss
Vancomycin
Thrombophlebitis
Red man syndromem
Immediate/delayed hypersensitivity reaction
Nephrotoxicity
Ototoxicity
Neutropenia
Thrombocytopenia
Vitamins
folic acid, thiamine, hydroxocobalamin, phytomenadione
Anaphylaxis (rarely)
Warfarin
Bleeding
Z-drugs
zopiclone, zolpidem
Daytime sleepiness
Rebound insomnia when stopped
Neurological effects
Dependence
Withdrawal symptoms
Drowsiness, coma and respiratory depression in overdose
Zopiclone:
Taste disturbance
Zolpidiem:
GI upset
