Adverse Reactions to Drugs Flashcards
Which of the following is NOT associated with Lichenoid eruptions?
ACEi NSAIDs Methyldopa Nicorandil Gold
Lichenoid eruptions: Methyldopa Chloroquine Thiazide diuretics (BendroFLUmethiazide - agranulocytosis) Antidiabetics
Lichenoid eruptions + Oral ulceration:
ACEi
Gold
NSAIDs
Oral Ucleration: NICORANDIL (and anal) Pancreatin Penicillamine Proguanil HCl Protease inhibitors
Which of the following is NOT associated with oral ulceration?
ACEi Gold Penicillamine Chloroquine Proguanil HCl Thiazide diuretics
Lichenoid eruptions: Methyldopa Chloroquine Thiazide diuretics (BendroFLUmethiazide - agranulocytosis) Antidiabetics
Lichenoid eruptions + Oral ulceration:
ACEi
Gold
NSAIDs
Oral Ucleration: NICORANDIL (and anal) Pancreatin Penicillamine Proguanil HCl Protease inhibitors
Which of the following IS associated with oral ulceration?
Methyldopa Chloroquine Thiazide diuretics Gold Oral antidiabetics
Lichenoid eruptions: Methyldopa Chloroquine Thiazide diuretics (BendroFLUmethiazide - agranulocytosis) Antidiabetics
Lichenoid eruptions + Oral ulceration:
ACEi
Gold
NSAIDs
Oral Ucleration: NICORANDIL (and anal) Pancreatin Penicillamine Proguanil HCl Protease inhibitors
NB: Stevens-Johnsons can present with extensive ulceration of the oral mucosa but usually not the only symptom.
Which of the following IS associated with Lichenoid eruptions ONLY?
NSAIDs
ACEi
Chloroquine
Gold
Lichenoid eruptions: Methyldopa Chloroquine Thiazide diuretics (BendroFLUmethiazide - agranulocytosis) Antidiabetics
Lichenoid eruptions + Oral ulceration:
ACEi
Gold
NSAIDs
Oral Ucleration: NICORANDIL (and anal) Pancreatin Penicillamine Proguanil HCl Protease inhibitors
What drug used for copper poisoning/too much copper can also cause oral ulceration?
Penicillamine.
Lichenoid eruptions: Methyldopa Chloroquine Thiazide diuretics (BendroFLUmethiazide - agranulocytosis) Antidiabetics
Lichenoid eruptions + Oral ulceration:
ACEi
Gold
NSAIDs
Oral Ucleration: NICORANDIL (and anal) Pancreatin Penicillamine Proguanil HCl Protease inhibitors
What drug which can be used for hypertension in pregnancy can also cause lichenoid eruptions?
Lichenoid eruptions:
Methyldopa «_space;(Also labetolol and nifedipine [used less] when managing hypertension in pregnancy but they dont cause lichenoid eruptions)
Chloroquine
Thiazide diuretics (BendroFLUmethiazide - agranulocytosis)
Antidiabetics
Lichenoid eruptions + Oral ulceration:
ACEi
Gold
NSAIDs
Oral Ucleration: NICORANDIL (and anal) Pancreatin Penicillamine Proguanil HCl Protease inhibitors
What antimalarial can cause oral ulceration?
Lichenoid eruptions: Methyldopa Chloroquine Thiazide diuretics (BendroFLUmethiazide - agranulocytosis) Antidiabetics
Lichenoid eruptions + Oral ulceration:
ACEi
Gold
NSAIDs
Oral Ucleration: Nicorandil (and anal) Pancreatin Penicillamine Proguanil HCl <<< Protease inhibitors
What drug which might be used for exocrine pancreatic defiency in CF may cause oral ulcerations?
Lichenoid eruptions: Methyldopa Chloroquine Thiazide diuretics (BendroFLUmethiazide - agranulocytosis) Antidiabetics
Lichenoid eruptions + Oral ulceration:
ACEi
Gold
NSAIDs
Oral Ucleration: Nicorandil (and anal) Pancreatin <<<<< Penicillamine Proguanil HCl Protease inhibitors
What antimalarial (which is not used in many areas due to resistance) can cause lichenoid eruptions?
Lichenoid eruptions: Methyldopa Chloroquine <<<< Thiazide diuretics (BendroFLUmethiazide - agranulocytosis) Antidiabetics
Lichenoid eruptions + Oral ulceration:
ACEi
Gold
NSAIDs
Oral Ucleration: Nicorandil (and anal) Pancreatin Penicillamine Proguanil HCl Protease inhibitors
What drug class commonly used in the management of hypertension could cause oral ulceration and/or lichenoid eruptions?
Lichenoid eruptions: Methyldopa Chloroquine Thiazide diuretics (BendroFLUmethiazide - agranulocytosis) Antidiabetics
Lichenoid eruptions + Oral ulceration:
ACEi ««
Gold
NSAIDs
Oral Ucleration: Nicorandil (and anal) Pancreatin Penicillamine Proguanil HCl Protease inhibitors
Which OTC antiplatelt/antipyretic/analgesic can cause oral ulceration?
When would this happen?
Aspirin tablets allowed to dissolve in the sulcus for the treatment of toothache can lead to a white patch followed by ulceration.
What can stain the teeth?
- Brown staining of the teeth frequently follows the use of chlorhexidine mouthwash, spray or gel, but can readily be removed by polishing.
- Iron salts in liquid form can stain the enamel black.
- Superficial staining has been reported rarely with co-amoxiclav suspension.
- Intrinsic staining of the teeth is most commonly caused by tetracyclines. They will affect the teeth if given at any time from about the fourth month in utero until the age of twelve years; they are contra-indicated during pregnancy, in breast-feeding women, and in children under 12 years. All tetracyclines can cause permanent, unsightly staining in children, the colour varying from yellow to grey.
The risk of osteonecrosis of the jaw is substantially greater for patients receiving intravenous bisphosphonates in the treatment of cancer than for patients receiving oral bisphosphonates for osteoporosis or for what disease?
The risk of osteonecrosis of the jaw is substantially greater for patients receiving intravenous bisphosphonates in the treatment of cancer than for patients receiving oral bisphosphonates for osteoporosis or Paget’s disease.
Paget’s disease of bone interferes with your body’s normal recycling process, in which new bone tissue gradually replaces old bone tissue.
Patients with cancer may also be at risk of osteonecrosis of the jaw if they use which treatments?
Bevacizumab: VEGF targeter.
Sunitinib: RTK inhibitor
Gingival overgrowth is a side effect seen most commonly caused by what three drugs?
- Phenytoin
- Sometimes ciclosporin
- Sometimes Nifedipine (and other CCB)
Which of the following drugs may cause an INCREASE in saliva production?
Baclofen Bupropion Clonidine Clozapine Opioids Tizanidine.
Xerostomia (decreased salivia): Antimuscarinics (anticholinergics) Antidepressants (including TCAs and SSRIs) Alpha-blockers Antihistamines Antipsychotics Baclofen Bupropion Clonidine Hydrochloride 5HT1-agonists Opioids Tizanidine Excessive use of diuretics.
Increased saliva production:
Clozapine
Neostigmine
Which antipyschotic is associated with increased saliva production?
Xerostomia (decreased salivia): Antimuscarinics (anticholinergics) Antidepressants (including TCAs and SSRIs) Alpha-blockers Antihistamines Antipsychotics Baclofen Bupropion Clonidine Hydrochloride 5HT1-agonists Opioids Tizanidine Excessive use of diuretics.
Increased saliva production:
Clozapine
Neostigmine
Which drug used in the treatment of myasthenia gravis can cause increased saliva production?
Xerostomia (decreased salivia): Antimuscarinics (anticholinergics) Antidepressants (including TCAs and SSRIs) Alpha-blockers Antihistamines Antipsychotics Baclofen Bupropion Clonidine Hydrochloride 5HT1-agonists Opioids Tizanidine Excessive use of diuretics.
Increased saliva production:
Clozapine
Neostigmine
Which of the following drugs that can cause decreased saliva production (Xerostomia) is/are used as muscle relaxants?
Baclofen Bupropion Clonidine Hydrochloride 5HT1-agonists Opioids Tizanidine
Xerostomia (decreased salivia):
Antimuscarinics (anticholinergics)
Antidepressants (including TCAs and SSRIs)
Alpha-blockers
Antihistamines
Antipsychotics
Baclofen: inhibits transmission at spinal level and also depresses the central nervous system. The dose should be increased slowly to avoid the major side-effects of sedation and muscular hypotonia (other adverse events are uncommon).
Bupropion Clonidine Hydrochloride 5HT1-agonists Opioids Tizanidine:an alpha2-adrenoceptor agonist indicated for spasticity associated with Multiple sclerosis or spinal cord injury.
Excessive use of diuretics.
Increased saliva production:
Clozapine
Neostigmine
Why might you see a patient prescribed clozapine also prescribed either glycopyrronium or even atropine eye drops under the tongue?
Clozapine can increase saliva production.
Pain in the salivary glands has been reported with what? (3)
Some antihypertensives: Clonidine HCl, Methyldopa.
Vinca alkaloids.
Swelling of the salivary glands can occur with what? (4)
Iodides
Antihyroid drugs
Phenothiazines
Sulfonamides (also NB sumatriptan is Cautioned in those with sensitivity to sulphonamides…. dont know why)
Which one of the following is the least appropriate thing to do when you suspect an adverse drug reaction?
Consider alternative therapy if treatment of the original condition is still required.
Consider altering the dose or temporarily stopping drug treatment if the benefit to harm balance of drug treatment is favourable.
Consider the effects of concomitant therapy (drug interactions)
Consider the possibilty of withdrawal effects if drug treatment is stopped suddenly.
Consider stopping the use of the suspected drug with all ADRs
Only stop use of the suspected drug if ADR is serious or at the request of the individual, and avoid its use in future.
A patient commenced on enalapril 5mg OD two days ago, she tells you she has developed a rash all over her arms and legs and it is very itchy.
Over the past few hours she has become breathless and feels like this is becoming progressively worse.
Which of the following is most appropriate advice:
The symptoms are not known to be caused by enalapril.
She should see her GP as the dose of enalapril may need to be increased.
She should stop taking the enalapril until she sees her GP.
She is experiencing a side effect of enalapril, which is likely to disappear after continued use.
She should seek urgent medical attention.
Urgent medical attention needed - progressive breathlessness - symptoms of angioedema which is a recognised side effect of ACEi
What high risk drugs are associated with taste disturbances?
Antibiotics: Clarithromycin, metronidazole.
Antifungals: Terbinafine, griseofulvin.
DMARDs: gold, penicillamine.
High risk: Amiodarone, lithium,
CVD: ACEi
Endocrine: calcitonin, carbimazole, metformin
Other: Protease inhibitors, zopiclone, phenidione.
What antifungals can cause taste disturbance?
Antibiotics: Clarithromycin, metronidazole.
Antifungals: Terbinafine, griseofulvin.
DMARDs: gold, penicillamine.
High risk: Amiodarone, lithium,
CVD: ACEi
Endocrine: calcitonin, carbimazole, metformin
Other: Protease inhibitors, zopiclone, phenidione.
What antibiotics can cause taste disturbance?
Antibiotics: Clarithromycin, metronidazole.
Antifungals: Terbinafine, griseofulvin.
DMARDs: gold, penicillamine.
High risk: Amiodarone, lithium,
CVD: ACEi
Endocrine: calcitonin, carbimazole, metformin
Other: Protease inhibitors, zopiclone, phenidione.
What DMARDs can cause taste disturbance?
Antibiotics: Clarithromycin, metronidazole.
Antifungals: Terbinafine, griseofulvin.
DMARDs: gold, penicillamine.
High risk: Amiodarone, lithium,
CVD: ACEi
Endocrine: calcitonin, carbimazole, metformin
Other: Protease inhibitors, zopiclone, phenidione.
What antidiabetic can cause taste disturbance?
Antibiotics: Clarithromycin, metronidazole.
Antifungals: Terbinafine, griseofulvin.
DMARDs: gold, penicillamine.
High risk: Amiodarone, lithium,
CVD: ACEi
Endocrine: calcitonin, carbimazole, metformin
Other: Protease inhibitors, zopiclone, phenidione.
What anxiolytic can cause taste disturbance?
Antibiotics: Clarithromycin, metronidazole.
Antifungals: Terbinafine, griseofulvin.
DMARDs: gold, penicillamine.
High risk: Amiodarone, lithium,
CVD: ACEi
Endocrine: calcitonin, carbimazole, metformin
Other: Protease inhibitors, zopiclone, phenidione.
The black triangle symbol identifies newly licensed medicines that require additional monitoring by the EMA. Products usually retain a black triangle for how long?
Usually 5 years but this can be extended if required.
ALL suspected ADR should be reported for black triangle drugs.
Very common side effect means
greater than 1 in 10
Common side effect means
1 in 100 to 1 in 10
Uncommon side effect means
1 in 1000 to 1 in 100
Rare side effect means
1 in 10,000 to 1 in 1000
Very rare side effect means
Less than 1 in 10,000
Patients need to advice their doctor if they develop a painful skin rash with this medicine and it may need to be discontinued (oral anticoagulant)
Warfarin
OTC medicine associated with reports of QT prolongation and torsades de pointes, patients should not exceed 12mg daily.
Loperamide
Serious risk of chlororetinopathy typically occuring in one eye which these class of medicines
Corticosteroids
https://www.gov.uk/drug-safety-update/corticosteroids-rare-risk-of-central-serous-chorioretinopathy-with-local-as-well-as-systemic-administration
Risk of potentially fatal paralytic ilues with this medicine, patients should tell their Dr before next dose (antipsychotic)
Clozapine
Male patients or their female partners are advised to use effective contraception during treatment and for 90 days after stopping this medicine used to prevent organ transplant rejection.
Mycophenolate:
Women should use at least 1 method of effective contraception before and during treatment, and for 6 weeks after discontinuation—2 methods of effective contraception are preferred. Male patients or their female partner should use effective contraception during treatment and for 90 days after discontinuation.
Women using this medication to prevent organ transplant rejection should use at least 1 method of effective contraception before and during treatment and for 6 weeks after discontinuation.
Women should use at least 1 method of effective contraception before and during treatment, and for 6 weeks after discontinuation—2 methods of effective contraception are preferred. Male patients or their female partner should use effective contraception during treatment and for 90 days after discontinuation.
Live vaccines should be postponed for at least how long after high-dose (>7.5mg pred daily) are stopped?
3 months
