Adverse reactions

Question 1

Adverse reaction of gentamicin + vancomycin?

Answer 1

otoxicity + nephrotoxicity

Question 2

Adverse reaction of antibiotics (broad-spec like cephalosporins or ciprofloxacin)?

Answer 2

C.diff colitis

Question 3

Adverse reaction of ACE inhibitors (lisinopril)

Answer 3

• hypotension
• electrolyte abnormalities - raised k, low na
• AKI
• dry cough

Question 4

Adverse reaction of beta-blockers

Answer 4

• hypotension
• bradycardia
• wheeze (asthmatics CI)
• worsens acute HF
  fatigue less recognised

Question 5

Adverse reaction of CCBs (diltiazem, verapamil)

Answer 5

• hypotension
• bradycardia
• flushing
• peripheral oedema

Question 6

Adverse reaction of diuretics (furosemide, bendro, spiro)?

Answer 6

• hypotension
• electrolyte abnormalities
• AKI

class dependent (spiro = gynaecomastia) (thiazide = gout)

Question 7

Adverse reaction of heparin?

Answer 7

• haemorrhage

- HIIT

Question 8

Adverse reaction of warfarin?

Answer 8

• haemorrhage –> note bridging with LMWH required until INR 2

Question 9

Adverse reaction of aspirin?

Answer 9

• haemorrge
• peptic ulcer + gastritis
• tinnitus in large dose

Question 10

Adverse reaction of digoxin

Answer 10

• nausea, vomiting, diarrhoea
• confusion, drowsiness
• blurred vision or yellow/green perception, halo vision

Question 11

Effect of K+ on digoxin effectiveness?

Answer 11

• low K+ increases effectiveness

- high K+ reduced effect

Question 12

Adverse reaction of amIOdarone?

Answer 12

• ILD (pulmonary fibrosis)
• thyroid disease (hypo + hyper)
• skin grey
• corneal deposits

Question 13

Adverse reaction of lithium

Answer 13

early = tremor
intermediate = tiredness
late = arrhythmias, seizures + coma, renal failure, diabetes insipidus

Question 14

Adverse reaction of haloperidol?

Answer 14

• dyskinesias (acute dystonic reactions)

- drowsiness

Question 15

Adverse reaction of clozapine?

Answer 15

• agranulocytosis - intensive FBC monitoring

Question 16

Adverse reaction of dexamethasone/prednisolone?

Answer 16

STEROIDS:

• Stomach ulcer
• Thin skin
• Edema
• Right an left sided HF
• Osteoporosis
• Infection
• Diabetes (commonly raises blood sugar, rarely DM)
• Cushing’s syndrome

Question 17

Adverse reaction of ibuprofen (NSAID)?

Answer 17

NSAIDS:

• No urine (renal failure)
• Systolic dysfunction (heart failure)
• Asthma
• Indigestion (any cause)
• Dyscrasia (clotting abnormalities)

Question 18

Adverse reaction of statins (e.g. simvastatin)?

Answer 18

• 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)

Question 19

Drugs with narrow therapeutic index?

Answer 19

Can lead to subtherapeutic or toxic levels:

• digoxin
• warfarin
• phenytoin
• theophylline

Question 20

Drugs requiring careful dosage control?

Answer 20

• antihypertensives

- antidiabetic drugs

Question 21

Examples of most common enzyme inhibitors?

Answer 21

• ketoconazole (anti-fungal for nails)
• ciprofloxacin
• erythromycin
• GRAPEFRUIT JOICE

Question 22

Drug that causes lactic acidosis?

Answer 22

metformin

Question 23

Drug that causes hypertensive crisis?

Answer 23

monoamine oxidase inhibitors (rasageline, selegiline)

Question 24

Increased anticoagulation can be caused by what?

Answer 24

Warfarin + acute alcohol

Any enzyme inhibitor (AO DEVICES)

Question 25

What can cause sweating, flushing, nausea and vomiting when patient drinks alcohol?

Answer 25

- metronidazole | - disulfiram

Question 26

Drugs causing sedation?

Answer 26

barbiturates opioids benzodiazepines

Question 27

Enzyme inducers? (therefore reducing effectiveness of other drugs)

Answer 27

``` PC BRAS Phenytoin Carbamezepine Barbiturates Rifampicin Alcohol - chronic Sulphonylureas ```

Question 28

Drugs causing hyperkalaemia?

Answer 28

ACEi | K+- sparing agents e.g. amiloride, eplerenone, spiro and

Question 29

Drugs causing reduced neutrophil count?

Answer 29

- methotrextate | - trimethorprim (co-trimoxazole)

Question 30

Is metformin or sulphonylureas more likely to cause hypogylcaemia?

Answer 30

SULPHONYLUREAS

Question 31

Abx contraindicated in pregnancy?

Answer 31

1) tetracyclines - doxycyline, tetracycline 2) aminoglycosides - neomycin, gentamicin 3) sulphonamides - sulfasalazine, sulfamethoxazole, sulfadiazine 4) trimethoprim 5) quinolones: ciprofloxacin, levofloxacin

Question 32

Drugs CI in pregnancy?

Answer 32

- ACE inhibitors, angiotensin II receptor antagonists - statins - warfarin - sulfonylureas (gliclazide) - retinoids (including topical) - cytotoxic agents

Question 33

Drugs CI in chronic HF?

Answer 33

- 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)

Question 34

Drugs that worsen psoriatic arthritis?

Answer 34

beta blockers, lithium - says in BNF antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors infliximab

Question 35

Specific drugs that worsen epilpepsy?

Answer 35

``` alcohol, cocaine, amphetamines ciprofloxacin, levofloxacin aminophylline, theophylline bupropion methylphenidate (used in ADHD) mefenamic acid ```

Question 36

3 drugs to avoid/CI in asthmatic patient?

Answer 36

NSAIDs beta-blockers adenosine