Adverse Effects of Drugs Flashcards by Lucy Searle

Which class of antibiotics are both nephrotoxic and ototoxic?

Aminoglycosides e.g. vancomycin, gentamycin

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Name an adverse effect of broad spectrum antibiotics.

C.difficile colitis

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Which antihypertensive drug can cause peripheral oedema and flushing?

Calcium channel blocker

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Which antihypertensive drug can cause fatigue and erectile dysfunction?

Beta blocker

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Name four adverse effects of ACE inhibitors.

Hypotension
Hyperkalaemia
AKI
Dry cough

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In which patients are beta blockers contraindicated?

Asthma

Acute heart failure (helps chronic HF)

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Name an adverse effect of trimethoprim, and the mechanism.

Bone marrow suppression

Folate antagonist

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Which diuretics cause hyperkalaemia, and hypokalaemia?

Loop and thiazide: hypokalaemia

Spironolactone/amiloride: hyperkalaemia

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Name three adverse effects of digoxin use.

Nausea and vomiting
Xanthopsia
Blurred vision

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Which class III anti-arrhythmic may cause pulmonary fibrosis, thyroid disease (both hyper and hypo) and skin greying?

Amiodarone

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Overuse of which asthma drug can result in a fine tremor?

Salbutamol

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Name three side effects of lithium use.

Tremor
Tiredness
Diabetes Insipidus

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Dyskinesia is an adverse effect associated with which class of anti-psychotics?

First generation, e.g. haloperidol

But can occur in third generation.

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What is the main adverse effect associated with clozapine?

Agranulocytosis

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Name 8 side effects of corticosteroids.

S - stomach ulcers
T - thin skin
E - oedema
R - right and left HF
O - osteoporosis
I - infection
D - diabetes
S - Cushing's Syndrome

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Name two adverse effects of methotrexate use.

Bone marrow toxicity

Cirrhosis

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Name four adverse effects of NSAID use.

Renal failure
Systolic dysfunction
Asthma
Indigestion

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Rhabdomyolysis, myalgia, and elevated transaminases, can occur with use of which drug?

Statins.

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Which trimester has the highest risk for malformation after exposure to a teratogenic drug?

First - as main organ systems form

Embryonic - abortion or replacement of damaged cells

Second and third - lower risk

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Name 8 teratogenic drugs.

ACEI and ARB
Anti-epileptics
Lithium salts
Warfarin
Sex hormones
Cytotoxic agents
Topical and oral isoretinoin
Also, avoid NSAIDs

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If a patient with diabetes becomes pregnant, what changes must be made to her prescriptions?

Stop all oral hypoglycaemic agents, except metformin - insulin can be started if required
Change ACEI/ARB to alternative hypertensive
Statins CI

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Name six nephrotoxic drugs.

Aminoglycosides
Diuretics
Lithium salts
NSAIDs/COX-2 inhibitors
Metformin
ACEIs

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How can use of ACEI or NSAIDs lead to AKI?

Prostaglandins produced within the kidney maintain renal blood flow and eGFR

RAS system produces angiotensin II in response to hypovolaemia or reduced renal perfusion, causing efferent arteriolar vasoconstriction

NSAIDs inhibit prostaglandins, ACEIs inhibit angiotensin II

Name four nephrotoxic pathological states.

Hypoperfusion
Sepsis
Rhabdomyolysis
Hepatorenal syndrome

Which drugs should you stop in severe uncontrolled hyperkalaemia?

``` ACEIs/ARBs Laxatives NSAIDs K-sparing diuretics BB Digoxin Heparins Tacrolimus ```

Co-amoxiclav, flucloxacillin and NSAIDs cause liver injury through what mechanism?

Cholestatic hepatitis

Which drug causes liver injury through fibrosis and cirrhosis?

Methotrexate

Name three other drugs which cause liver injury.

Amiodarone Rifampicin Paracetamol

Name three drugs which need altered doses in liver disease.

Fluoxetine Nifedipine Phenytoin

Why do some drugs have up to a 100% oral bioavailability in patients with cirrhosis??

Collaterals that have developed mean that blood bypasses the liver, resulting in a decrease in first pass metabolism. Drugs that usually have a high first pass metabolism will have a higher plasma concentration, as if they had been administered parenterally. Therefore, prescribe a reduced dose to avoid toxicity.

Which drugs have the potential to cause encephalopathy in liver disease?

Benzodiazepines Anti-psychotics Opioids (constipation) Diuretics (electrolyte disturbances)

Ascites can be precipitated by drugs that have the potential to cause what?

Fluid retention | Increased sodium concentration

Name six risk factors which amplify drug-drug interactions.

``` Older age Male gender Polymorphic enzyme expression Liver and renal dysfunction Diet Smoking ```

What are the two types of drug interaction mechanisms?

Pharmacodynamic - drugs amplify or negate each other's pharmacological effects Pharmacokinetic - a drug impacts on the biotransformation of a drug or its distribution

Alterations in which system is the major cause of pharmacokinetic drug interactions?

Cytochrome P450 enzyme system

Name 7 enzyme inducers (decrease drug concentration).

PCBRAS ``` Phenytoin Carbamazepine Barbiturates Rifampicin Alcohol (chronic XS) Sulphonylureas ```

Name 4 enzyme inhibitors (increase drug concentration).

AODEVICES ``` Allopurinol Omeprazole Disulfiram Erythromycin Valproate Isoniazid Ciprofloxacin Ethanol (acute) Sulphonamides ```

What is the effect of cytochrome P450 enzyme induction?

Increased enzyme activity, leading to lower levels of a drug.

What is the effect of erythromycin on warfarin?

Erythromycin inhibits CYP3A4 Some warfarin is metabolised by CYP3A4 Effect of warfarin is increased, INR increases.

What is the effect of rifampicin on the COCP?

Rifampicin induces cytochrome P450 COCP effectiveness reduced

What method of emergency contraception should be prescribed in women who have used cytochrome P450 inducers in the last four weeks?

Non-hormonal If not, then double the dose of levonorgestrel from 1.5mg to 3mg.

Name three interactions of St John's Wort.

Anti-depressants - serotonin syndrome Warfarin - induces metabolism COCP - induces metabolism

Name a herbal preparation that may interact with warfarin and increase INR.

Glucosamine | Garlic

Why must non-dihydropyridine CCB and beta blockers not be taken together?

Both negatively ionotropic so risk of bradycardia and asystole

Prophylactic SC heparin is contraindicated in which condition?

Acute ischaemic stroke.

Which other antibiotic should be used with caution in patients who are allergic to penicillin?

Cephalosporins

Which drugs may exacerbate psoriasis?

Lithium Beta blockers Antimalarials ACEIs

Name four drugs that may exacerbate chronic heart failure.

Verapamil NSAIDs/glucocorticoid Flecainide Pioglitazone

Name four drugs that may worsen seizure control in epileptic patients.

``` Ciprofloxacin/levofloxacin Methylphenidate Mefenamic acid Buproprion Alcohol ```

What three blood tests are required when digoxin toxicity is suspected?

Serum digoxin ECG U&Es

Which class of drug may interact with opioids to exacerbate respiratory depression?

Benzodiazepines

Which fruit contains substances that inhibit CYP3A4, increasing the risk of statin toxicity?

Grapefruit

Which group of antibiotics are cytochrome inhibitors?

Macrolides

Name two drugs which can cause hyponatraemia.

Thiazide diuretics | SSRIs

Which anti-hypertensive drug is contra-indicated in peripheral vascular disease?

Beta-blockers Cause peripheral vasoconstriction

What is the main side effect of mirtazapine?

Sleep disturbances

Which drug can exacerbate muscle toxicity when taking a statin?

Gemfibrozil