Chapter 5, 6, 7 - lots of side effects

Question 1

Antimuscarinic side effects would be associated with

1) which antiemetic
2) which painkiller
3) which drug used in acute asthma
4) which drug used to treat bradycardia
5) which drugs used to treat urinary symptoms
6) which drug used to treat IBS
7) which drug used to treat IBS + used in palliative care

Answer 1

Cyclizine
Amitriptylline
Ipratropium bromide
Atropine
Oxybutinine, tolterodine
Mebeverine
Hyoscine butylbromide

Question 2

Name 2 dopamine antagonists NEVER to be used in Parkinson’s disease as they can exacerbate symptoms

Answer 2

Haloperidol

Metoclopramide

Question 3

Which type of blood pressure lowering drug can be teratogenic?

Answer 3

ACEinhibitors

Question 4

Tamoxifen - 3 cautions to make patients aware of

1 main side effect

Answer 4

1. Risk of VTE
2. Increased risk of endometrial cancer
3. Increases effect of warfarin - high INR readings

Hot flushes

Question 5

Which diabetic drug can increase risk of lactic acidosis?

Answer 5

Metformin

Question 6

When should you take gliclazide & why?

Answer 6

With breakfast. To reduce risk of nocturnal hypoglycaemia

Question 7

Methotrexate - 5 things to make patients aware of

1 drug never to use with

Answer 7

1. Take once weekly
2. 1-2 weekly blood tests are needed
3. Folic acid should be used alongside methotrexate to limit its toxicity to bone marrow
4. Risk of infection is increased
5. Must report any features of blood disorders, liver disease and respiratory effects

Trimethoprim - folate antagonist

Question 8

What colour are the warfarin tablets?

Answer 8

0.5mg - White
1mg - Brown
3mg - Blue
5mg - Pink

Question 9

Steroids - 2 drugs that you would consider starting someone on when they start long-term steroids
7 other things that people on steroids are at increased risk of

Answer 9

Bisphosphonates (alendronic acid) - osteoporosis
Omeprazole/ranitidine - peptic ulcers

Infection
Oedema
Thin skin
Heart failure
Diabetes
Cushing's 
Hypertension

Question 10

Bisphosphonates like alendronic acid - 2 things to make the patient aware of
1 drug not to take at same time - why?

Answer 10

1. Sit upright for 30 minutes afterwards and swallow with a full glass of water to reduce gastric SEs
2. Take on an empty stomach otherwise absorption is reduced

Calcium salts like calcium carbonate - they reduce the absorption of bisphosphonates

Question 11

How often do you have to take methotrexate?

Answer 11

Once weekly

Question 12

What drug should you be careful of taking tamoxifen with?

Answer 12

Warfarin- increases effect

Question 13

How should you take alendronic acid?

Answer 13

1. empty stomach
2. with full glass of water
3. sit upright for 30 minutes after

Question 14

Side effect of citalopram

Answer 14

Photosensitivity

Question 15

3 symptoms of serotonin syndrome to make people aware of who are taking SSRIs - emergency

Answer 15

Agitation
Temperatures
Hallucinations

Question 16

5 drugs to stop on sick days

2 drugs to increase on sick days

Answer 16

1. Metformin - lactic acidosis
2. Diuretics
3. ACEinhibs
4. NSAIDs
5. ARBs
6. Insulin
7. Steroids - double dose for 2 days then return to normal

Question 17

When should ACE inhibitors be taken and why? Which is the exception?

Answer 17

At night due to risk of postural hypotension.

Perindopril

Question 18

First line treatment of hyperkalaemia (dosing)

Second line?

Answer 18

1. Insulin and glucose
2. 10 units of novorapid in 100ml of 20% dextrose over 30 minutes IV
3. salbutamol

Question 19

Who should metformin be avoided in?

Answer 19

People who aren’t fat - it causes appetite suppression

People with creatinine >150 - it causes lactic acidosis

Question 20

First line treatment for T2DM if
overweight
creatinine >150
normal weight
creatinine <150

Answer 20

metformin
gliclazide
gliclazide
metformin

Question 21

Which antibiotic can cause antibiotic associated colitis?

Answer 21

Clindamycin