Adverse reactions Flashcards
Adverse reaction of gentamicin + vancomycin?
otoxicity + nephrotoxicity
Adverse reaction of antibiotics (broad-spec like cephalosporins or ciprofloxacin)?
C.diff colitis
Adverse reaction of ACE inhibitors (lisinopril)
- hypotension
- electrolyte abnormalities - raised k, low na
- AKI
- dry cough
Adverse reaction of beta-blockers
- hypotension
- bradycardia
- wheeze (asthmatics CI)
- worsens acute HF
fatigue less recognised
Adverse reaction of CCBs (diltiazem, verapamil)
- hypotension
- bradycardia
- flushing
- peripheral oedema
Adverse reaction of diuretics (furosemide, bendro, spiro)?
- hypotension
- electrolyte abnormalities
- AKI
class dependent (spiro = gynaecomastia) (thiazide = gout)
Adverse reaction of heparin?
- haemorrhage
- HIIT
Adverse reaction of warfarin?
- haemorrhage –> note bridging with LMWH required until INR 2
Adverse reaction of aspirin?
- haemorrge
- peptic ulcer + gastritis
- tinnitus in large dose
Adverse reaction of digoxin
- nausea, vomiting, diarrhoea
- confusion, drowsiness
- blurred vision or yellow/green perception, halo vision
Effect of K+ on digoxin effectiveness?
- low K+ increases effectiveness
- high K+ reduced effect
Adverse reaction of amIOdarone?
- ILD (pulmonary fibrosis)
- thyroid disease (hypo + hyper)
- skin grey
- corneal deposits
Adverse reaction of lithium
early = tremor intermediate = tiredness late = arrhythmias, seizures + coma, renal failure, diabetes insipidus
Adverse reaction of haloperidol?
- dyskinesias (acute dystonic reactions)
- drowsiness
Adverse reaction of clozapine?
- agranulocytosis - intensive FBC monitoring
Adverse reaction of dexamethasone/prednisolone?
STEROIDS:
- Stomach ulcer
- Thin skin
- Edema
- Right an left sided HF
- Osteoporosis
- Infection
- Diabetes (commonly raises blood sugar, rarely DM)
- Cushing’s syndrome
Adverse reaction of ibuprofen (NSAID)?
NSAIDS:
- No urine (renal failure)
- Systolic dysfunction (heart failure)
- Asthma
- Indigestion (any cause)
- Dyscrasia (clotting abnormalities)
Adverse reaction of statins (e.g. simvastatin)?
- abdo pain
- increased AST/ALT
- rhabdomyolysis (raised CK)
- myalgia: exclude rhabdo with CK and urine dip. if excluded, but symptoms unacceptable + Sx still high then
1. ensure needs statin
2. reduce risk
3. switch to statin with lower risk of myalgia (simvastatin > atorvastatin > pravastatin > fluvastatin)
Drugs with narrow therapeutic index?
Can lead to subtherapeutic or toxic levels:
- digoxin
- warfarin
- phenytoin
- theophylline
Drugs requiring careful dosage control?
- antihypertensives
- antidiabetic drugs
Examples of most common enzyme inhibitors?
- ketoconazole (anti-fungal for nails)
- ciprofloxacin
- erythromycin
- GRAPEFRUIT JOICE
Drug that causes lactic acidosis?
metformin
Drug that causes hypertensive crisis?
monoamine oxidase inhibitors (rasageline, selegiline)
Increased anticoagulation can be caused by what?
Warfarin + acute alcohol
Any enzyme inhibitor (AO DEVICES)
What can cause sweating, flushing, nausea and vomiting when patient drinks alcohol?
- metronidazole
- disulfiram
Drugs causing sedation?
barbiturates
opioids
benzodiazepines
Enzyme inducers? (therefore reducing effectiveness of other drugs)
PC BRAS Phenytoin Carbamezepine Barbiturates Rifampicin Alcohol - chronic Sulphonylureas
Drugs causing hyperkalaemia?
ACEi
K+- sparing agents e.g. amiloride, eplerenone, spiro and
Drugs causing reduced neutrophil count?
- methotrextate
- trimethorprim (co-trimoxazole)
Is metformin or sulphonylureas more likely to cause hypogylcaemia?
SULPHONYLUREAS
Abx contraindicated in pregnancy?
1) tetracyclines - doxycyline, tetracycline
2) aminoglycosides - neomycin, gentamicin
3) sulphonamides - sulfasalazine, sulfamethoxazole, sulfadiazine
4) trimethoprim
5) quinolones: ciprofloxacin, levofloxacin
Drugs CI in pregnancy?
- ACE inhibitors, angiotensin II receptor antagonists
- statins
- warfarin
- sulfonylureas (gliclazide)
- retinoids (including topical)
- cytotoxic agents
Drugs CI in chronic HF?
- pioglitazone is contraindicated as it causes fluid retention
- verapamil - negative inotropic effect
- NSAIDs/glucocorticoids- should be used with caution as they cause fluid retention, low-dose aspirin is an exception
- flecainide (negative inotropic and proarrhythmic effect)
Drugs that worsen psoriatic arthritis?
beta blockers,
lithium - says in BNF
antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors
infliximab
Specific drugs that worsen epilpepsy?
alcohol, cocaine, amphetamines ciprofloxacin, levofloxacin aminophylline, theophylline bupropion methylphenidate (used in ADHD) mefenamic acid
3 drugs to avoid/CI in asthmatic patient?
NSAIDs
beta-blockers
adenosine
