Adverse Effects and Interactions Flashcards
Adverse Effects
Drugs Causing Toxic Acute Tubular Necrosis
- aminoglycosides
- cisplatin
- ethylene glycol (antifreeze)
Adverse Effects
Drugs Causing Acute Confusion
- Morphine
- metoclopramide
- benzos
- anticholinergics
- anticonvulsants
- parkinson’s meds
- steroids
- intoxication - alcohol, drugs
- carbon monoxide
- heavy metals
- withdrawal - barbiturates, alcohol, opiates, deficiency of thiamine, nicotinic acid or B12
Adverse Effects
Drugs Causing Pulmonary Fibrosis
- amiodarone
- bleomycin
- busulfan
- nitrofurantoin
- methotrexate
- gold
- penicillamine
- illicit drugs - crack cocaine, heroin
Adverse Effects
Drugs Causing Low Potassium
- potassium wasting diuretics: thiazides, frusemide
- laxatives
- beta adrenergics (salbutamol),
- theophylline
- corticosteroids and fludrocortisone
- penicillins, aminoglycosides,
- amphotericin B
- insulin
- pseudoephidrine
- verapamil OD
Adverse Effects
Drugs Causing Acute Pancreatitis
- thiazides, frusemide
- azathioprine
- tetracyclines
- valproate
- oestrogens, OCP
- corticosteroids
- sulphonamides
Adverse Effects
Drugs Causing Low Sodium
- carbamazepine, lithium
- haloperidol, fluphenazine
- SSRIs, tricyclics
- MDMA
- tramadol
- vincristine
- desmopressin
- fluphenazine
Adverse Effects
Drugs Causing High Potassium
- potassium-sparing diuretics: amiloride, spiro
- ACE inhibitors, ARBs
- NSAIDs
- ciclosporin, tacrolimus
- pentamidine (for PCP pneumonia)
- co-trimoxazole
- ketoconazole
- metyrapone (cortisol blocker)
Adverse Effects
Drugs Causing Urinary Retention
- aminoglycosides - gentamicin
- chemo - cisplatin, carboplatin
Adverse Effects
Drugs Causing Urinary Retention
- opioids
- anticholinergics
- antipsychotics
- antidepressants
- respiratory (ipratropium)
- detrusor relaxants
- GA
- alpha agonists
- benzodiazepines (diazepam)
- NSAIDs
- CCB
- antihistamines
- alcohol
Adverse Effects
Drugs Causing Temporary Ototoxicity
- salicylates
- quinines
- loop diuretics
Hepatic Enzyme Inducers
INDUCERS = hepatic enzyme is more active, so it BREAKS things DOWN
therefore other meds/chemicals/effects are decreased
B = Barbituates
R = Rifampicin
E = Epilepsy = carbemazepine, phenytoin
A = Athlete’s foot = griseofulvin
K = K-sparing diuretic = spironolactone
S = Smoking
DOWN = Drinking Over What’s Normal (chronic alcohol use)
Hepatic Enzyme Inhibitors
INHIBITORS = hepatic enzymes are less active
therefore other meds/chemicals are in the blood longer - enzyme inhibitors KEEP DRUG ACTIVE.
K = ketoconazole and fluconazole
E = erythromycin
E = ethanol (acute)
P = PPIs and antacids = omeprazole, cimetidine
D = depression = fluoxetine and sertraline
R = ritonavir
U = sUlphonamides
G = gout = allopurinol
A = amiodarone
C = ciprofloxacin
T = too much grapefruit
I = isoniazid
V = valproate
E = eye drops = chloramphenicol
Avoid in Heart Failure
Fluid retention
- pioglitazone (fluid retention)
- NSAIDs (except low-dose aspirin)
- glucocorticoids
Negative inotropy
- verapamil
- flecanide (class I anti arrhythmics)
Alendronic Acid
Counselling Points
- swallow whole with plenty of water
- sit upright during and for 30mins after
- take on an empty stomach
- 30mins before further oral intake
Digoxin
Interactions
decreased renal clearance combined with:
- amiodarone
- verapamil
- propafenone
- captopril
increased absorption with erythromycin
Digoxin
Signs of Toxicity
- heart block
- atrial tachycardia
- ventricular arrhythmias
- xanthopsia
Statins
Side Effects
- myalgia (common)
- myopathy, myositis, rhadbomyolysis (rare)
- deranged LFTs
- don’t reduce or stop dose unless LFTs 3x normal limit
- GI disturbance
- sleep disturbance
- headache
Things to consider giving when prescribing steroids
- PPI (ulcers)
- medic alert bracelet/card
- higher doses during stress (infection, surgery)
- calcium, vitamin D, bisphosphonates (osteoporosis)
Steroids
Avoid giving these things
- NSAIDs (ulcer risk)
- live vaccines within 3 months
Steroids
Patients to monitor carefully
- Diabetics - for worsening sugars
- glaucoma - for worsening pressures
- CCF for fluid retention
Steroids
How to withdraw
if prescribing for more than 3 weeks, reduce gradually
Steroids
(Oral)
Side Effects
- hypertension and CCF
- osteoporosis
- peptic ulcers and GORD
- diabetes
- psych: depression, anxiety, confusion, psychosis, irritability, mood swings
- appearance: thin skin, cushingoid facies (moon face), straie, intrascapular fat pad, acne, bruising
- eyes: glaucoma, cataracts
- decreased immune function - delayed wound healing
Monitoring
Allopurinol
serum urate
Monitoring
ACEi
renal function
