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PSA > Adverse Effects of Drugs > Flashcards

Adverse Effects of Drugs Flashcards

1
Q

Which class of antibiotics are both nephrotoxic and ototoxic?

A

Aminoglycosides e.g. vancomycin, gentamycin

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2
Q

Name an adverse effect of broad spectrum antibiotics.

A

C.difficile colitis

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3
Q

Which antihypertensive drug can cause peripheral oedema and flushing?

A

Calcium channel blocker

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4
Q

Which antihypertensive drug can cause fatigue and erectile dysfunction?

A

Beta blocker

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5
Q

Name four adverse effects of ACE inhibitors.

A

Hypotension
Hyperkalaemia
AKI
Dry cough

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6
Q

In which patients are beta blockers contraindicated?

A

Asthma

Acute heart failure (helps chronic HF)

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7
Q

Name an adverse effect of trimethoprim, and the mechanism.

A

Bone marrow suppression

Folate antagonist

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8
Q

Which diuretics cause hyperkalaemia, and hypokalaemia?

A

Loop and thiazide: hypokalaemia

Spironolactone/amiloride: hyperkalaemia

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9
Q

Name three adverse effects of digoxin use.

A

Nausea and vomiting
Xanthopsia
Blurred vision

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10
Q

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

A

Amiodarone

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11
Q

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

A

Salbutamol

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12
Q

Name three side effects of lithium use.

A

Tremor
Tiredness
Diabetes Insipidus

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13
Q

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

A

First generation, e.g. haloperidol

But can occur in third generation.

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14
Q

What is the main adverse effect associated with clozapine?

A

Agranulocytosis

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15
Q

Name 8 side effects of corticosteroids.

A 
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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16
Q

Name two adverse effects of methotrexate use.

A

Bone marrow toxicity

Cirrhosis

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17
Q

Name four adverse effects of NSAID use.

A

Renal failure
Systolic dysfunction
Asthma
Indigestion

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18
Q

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

A

Statins.

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19
Q

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

A

First - as main organ systems form

Embryonic - abortion or replacement of damaged cells

Second and third - lower risk

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20
Q

Name 8 teratogenic drugs.

A 
ACEI and ARB
Anti-epileptics
Lithium salts
Warfarin
Sex hormones
Cytotoxic agents
Topical and oral isoretinoin
Also, avoid NSAIDs
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21
Q

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

A

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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22
Q

Name six nephrotoxic drugs.

A 
Aminoglycosides
Diuretics
Lithium salts
NSAIDs/COX-2 inhibitors
Metformin
ACEIs
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23
Q

How can use of ACEI or NSAIDs lead to AKI?

A

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

24
Q

Name four nephrotoxic pathological states.

A

Hypoperfusion
Sepsis
Rhabdomyolysis
Hepatorenal syndrome

25
Q

Which drugs should you stop in severe uncontrolled hyperkalaemia?

A 
ACEIs/ARBs
Laxatives
NSAIDs
K-sparing diuretics
BB
Digoxin
Heparins
Tacrolimus
26
Q

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

A

Cholestatic hepatitis

27
Q

Which drug causes liver injury through fibrosis and cirrhosis?

A

Methotrexate

28
Q

Name three other drugs which cause liver injury.

A

Amiodarone
Rifampicin
Paracetamol

29
Q

Name three drugs which need altered doses in liver disease.

A

Fluoxetine
Nifedipine
Phenytoin

30
Q

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

A

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.

31
Q

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

A

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

32
Q

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

A

Fluid retention

Increased sodium concentration

33
Q

Name six risk factors which amplify drug-drug interactions.

A 
Older age
Male gender
Polymorphic enzyme expression
Liver and renal dysfunction
Diet
Smoking
34
Q

What are the two types of drug interaction mechanisms?

A

Pharmacodynamic - drugs amplify or negate each other’s pharmacological effects

Pharmacokinetic - a drug impacts on the biotransformation of a drug or its distribution

35
Q

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

A

Cytochrome P450 enzyme system

36
Q

Name 7 enzyme inducers (decrease drug concentration).

A

PCBRAS

Phenytoin
Carbamazepine
Barbiturates
Rifampicin
Alcohol (chronic XS)
Sulphonylureas
37
Q

Name 4 enzyme inhibitors (increase drug concentration).

A

AODEVICES

Allopurinol
Omeprazole
Disulfiram
Erythromycin
Valproate
Isoniazid
Ciprofloxacin
Ethanol (acute)
Sulphonamides
38
Q

What is the effect of cytochrome P450 enzyme induction?

A

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

39
Q

What is the effect of erythromycin on warfarin?

A

Erythromycin inhibits CYP3A4

Some warfarin is metabolised by CYP3A4

Effect of warfarin is increased, INR increases.

40
Q

What is the effect of rifampicin on the COCP?

A

Rifampicin induces cytochrome P450

COCP effectiveness reduced

41
Q

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

A

Non-hormonal

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

42
Q

Name three interactions of St John’s Wort.

A

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

43
Q

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

A

Glucosamine

Garlic

44
Q

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

A

Both negatively ionotropic so risk of bradycardia and asystole

45
Q

Prophylactic SC heparin is contraindicated in which condition?

A

Acute ischaemic stroke.

46
Q

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

A

Cephalosporins

47
Q

Which drugs may exacerbate psoriasis?

A

Lithium
Beta blockers
Antimalarials
ACEIs

48
Q

Name four drugs that may exacerbate chronic heart failure.

A

Verapamil
NSAIDs/glucocorticoid
Flecainide
Pioglitazone

49
Q

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

A 
Ciprofloxacin/levofloxacin
Methylphenidate
Mefenamic acid
Buproprion
Alcohol
50
Q

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

A

Serum digoxin
ECG
U&Es

51
Q

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

A

Benzodiazepines

52
Q

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

A

Grapefruit

53
Q

Which group of antibiotics are cytochrome inhibitors?

A

Macrolides

54
Q

Name two drugs which can cause hyponatraemia.

A

Thiazide diuretics

SSRIs

55
Q

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

A

Beta-blockers

Cause peripheral vasoconstriction

56
Q

What is the main side effect of mirtazapine?

A

Sleep disturbances

57
Q

Which drug can exacerbate muscle toxicity when taking a statin?

A

Gemfibrozil

PSA (4 decks)

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