Common ADRs

Question 1

Gentamicin, Vancomycin

Answer 1

Nephrotoxicity and Ototoxicity

Question 2

Any antibiotic (more commonly broad spec like cephalosporins or ciprofloxacin)

Answer 2

Clostridium difficile colitis (pseudomembranous)

Question 3

ACE-i e.g. lisinopril

Answer 3

Hypotension, electyolyte abnormalities (hyperkalaemia), AKI, dry cough

Question 4

Beta-blockers, e.g. bisoprolol

Answer 4

Hypotension, bradycardia, wheeze in asthmatics (usually contraindicated), worsens acute HF (but helps chronic HF)

Question 5

Calcium-channel blockers e.g. diltiazem

Answer 5

Hypotension, bradycardia, peripheral oedema, flushing

Question 6

Diuretics, e.g. furosemide, bendroflumethiazide, spirinolactone

Answer 6

Hypotension, electrolyte abnormalities (hyperkalaemia with potassium sparing spirinolactone, hypokalaemia otherwise), AKI, sub-class dependent effects

Question 7

Heparins

Answer 7

Haemorrhage (esp. if renal failure or <50kg), heparin-induced thrombocytopenia

Question 8

Warfarin

Answer 8

Haemorrhage (note that warfarin has a pro-coagulant effect initially as well as taking a few days to work as an anti-coagulant, thus heparin prescribed alongside and continued until INR > 2).

Question 9

Aspirin

Answer 9

Haemorrhage, peptic ulcers and gastritis, tinnitus in large doses

Question 10

Digoxin

Answer 10

Nausea, vomiting, diarrhoea. Blurred vision, confusion, drowsiness, xanthopsia (yellow/green visual perception and halo vision).
Changes in serum K+ can compete with digoxin; low K+ augments digoxin effect, high levels limit effect. This is because digoxin works by competing with K+ at the Na+/K+ ATPase receptor, limiting Na+ influx. As Ca2+ outflow relies on Na+ influx, Ca2+ accumulates in the cell - lengthens action potential and slows hear rate.

Question 11

Amiodarone

Answer 11

Interstitial lung disease (pulmonary fibrosis).
Thyroid disease (both hypo and hyper - structurally similar to iodine)
Skin greying, corneal deposits.

Question 12

Lithium

Answer 12

Early - tremor
Intermediate - tiredness
Late - arrhythmias, seizures, coma, renal failure, diabetes insipidus

Question 13

Haloperidol

Answer 13

Dyskinesias, e.g. acute dystonic reactions, drowsiness

Question 14

Clozapine

Answer 14

Agranulocytosis (requires intensive monitoring of FBC)

Question 15

Dexamethasone and prednisolone

Answer 15

STEROIDS
Stomach ulcers
Thin skin
oEdema
Right and left heart failure
Osteoporosis
Infection (including candida)
Diabetes (commonly causes hyperglycaemia, uncommonly progresses to diabetes)
cushing's Syndrome

Question 16

Fludricortisone

Answer 16

Hypertension / sodium and water retention

Question 17

Ibuprofen

Answer 17

NSAID:
No urine (renal failure)
Systolic dysfunction (HF)
Asthma
Indigestion (any cause)
Dyscrasia (clotting abnormality)

Question 18

Simvastatin

Answer 18

Myalgia, abdo pain, increased AST/ALT (can be mild)

Rhabdomyolysis (can be just mildly increased creatine kinase though)