Common S/Es Flashcards
patient is in HF, do you give them either cyclizine or metoclopramide?
metoclopramide
cyclizine S/E fluid retention
S/E cyclizine?
fluid retention urinary retention constipation dry mouth ↑ doses: agitation
S/E fluoxetine?
rash
S/E COCP?
irritability
new headaches
weight ↑
acne
S/E enoxaparin?
when to adjust dose?
all heparins ↑K+
adjust if <50kg or GFR<30
S/E aspirin?
Fe def anaemia
(loss of protective gastric mucosa)
dyspepsia, haemorrhage
S/E morphine?
urinary retention
renally excreted so can accumulate in renal failure
beware dependence and respiratory depression
S/E citalopram?
can precipitate bleeding with dabigatran
S/E antihypertensives?
↓ BP
↓ HR
wheeze
oedema
major S/E of anticoagulants?
S/E warfarin?
haemorrhage obvss
warfarin procoagulant at 1st
S/E digoxin?
seeing “yellow, green halos” around objects (xanthopsia)
N, D, confusion, drowsiness
arrhythmias
low K+ augments digoxin effect
high levels limit the effect
S/E
statins?
↑ CK
symptomatic muscle pain (myalgia)
↑ ALT/AST (can be mild)
myopathy, myositis, rhabdomyolysis (can be just mildly ↑CK though)
abdominal pain
GI disturbances
sleep disturbance
headache
S/E anticholinergic drugs?
can cause DELIRIUM; check anticholinergic burden - still essential if catheterised?
- blurred vision
- tachycardia
- dry mouth
- urinary retention
how do anticholinergics basically work?
examples of anticholinergic drugs?
block neurotransmitter Ach
antimuscarinics: oxybutynin, tolterodine, darifenacin
S/E amitriptyline?
anticholinergic syndrome (dry mouth, blurred vision, tachycardia, urinary retention) drowsiness/ delirium in elderly QT interval ↑ toxic in OD (TCA)
citalopram given with clarithromycin?
↑ QT
which drugs can cause serotonin syndrome and what are its major types of Sx? (3)
MAOi! + SSRIs, TRAMADOL, TCAs, Li+, metoclopramide, opioids, mirtazapine, RIMA, SNRI
Sx =
1) NM ↑ (tremor, ↑ reflexes, rigidity)
2) autonomic (↑ HR, BP, ↑T, sweating, shivering, D, pupil dilation)
3) agitation, confusion, mania
S/E ACEi?
cough
renal failure
teratogen
S/E ARBs?
nephrotoxic
S/E NSAIDs?
indigestion
ulcers
↓ kidney function
S/E carbamazepine?
↓ Na+
rare: agranulocytosis
S/E tamoxifen?
VTE
endometrial proliferation
S/E SSRIs?
serotonin syndrome obvs
sexual dysfunction
GI
initial anxiety
S/E amiodarone?
ILD/pulmonary fibrosis
thyroid dysfunction
grey skin/blue rash
cornea deposits (yellow flashes whilst driving at night)
(bc 1/2 life is 42 days can get side effects well after drug is stopped)
what does omeprazole ↑ risk of?
C.diff
what drugs to beware with epilepsy?
alcohol, cocaine, ket
ciprofloxacin
theo/aminophylline
↑ SEIZURE RISK
basic S/E of anticholinergic excess?
MAD - delirium (elderly), confusion
RED - flushing, tachycardia
DRY - dry mouth + eye, constipation, urinary retention
BLIND - blurred vision
which drugs have anticholinergic S/Es?
AMITRIPTYLINE antimuscarinics paroxetine antipsychotics (clozapine) cyclizine
dystonia with a fixed upward gaze - what drugs are likely causing it?
“oculogyric crisis”
neuroleptics - (haloperidol, chlorpromazine, olanzapine, carbamazepine, levodopa, lithium, metoclopramide, domperidone)
new D in a pt on any Abx (but most commonly the broad-spectrum antibiotics like cephalosporins or ciprofloxacin)?
C. diff colitis
S/E heparins?
bleeding (especially If <50kg or renal impairment)
thrombocytopenia
S/E aspirin
bleeding
peptic ulcers
gastritis
tinnitus in large doses
S/E Fludrocortisone?
Hypertension/sodium and water retention
if a DM pt is having Sx of ↓ GCS or has acidotic behaviour?
look out for metformin
how long does it take for enzymes to be induced?
days - weeks
how long does it take for enzymes to be inhibited?
hours - days
example drugs with a narrow therapeutic range?
warfarin, digoxin, phenytoin, theophylline
β-blockers and verapamil together?
may cause profound hypotension and asystole
most common enzyme inhibitors?
ketoconazole, ciprofloxacin and erythromycin (and grapefruit juice!)
main drugs to beware alcohol with?
benzos etc - sedation NSAIDS (inc aspirin) - GI bleeds metformin - lactic acidosis MAOis - hypertensive crisis acute intake with warfarin - inhibition therefore ↑ bleed metro/disulfiram - bad N and V
S/E β-blockers?
bradycardia bronchospasm cold extremities fatigue nightmares hypotension
what to never prescribe alongside an ACEi?
NSAIDs
(inhibit prostaglandins)
prostaglandins dilate afferent vessels (‘a’fferent/’a’pproaching)
NSAIDs ↓ inward flow + ↓ pressure and perfusion
↓ flow = ischaemia
what to never prescribe alongside an NSAID?
ACEi
(relax efferent blood flow - ‘(e)F off’)
↓ pressure, protects vasculature from hypertension P
but also ↓ GFR
drugs which commonly cause urinary retention?
- morphine and other opioid analgesics (especially in early postoperative period)
- anticholinergics (eg, antipsychotic drugs, antidepressant agents, anticholinergic respiratory agents, detrusor relaxants)
- GA
- Alpha-adrenoceptor agonists (glaucoma Tx)
- Benzodiazepines (e.g. diazepam)
- NSAIDs (e.g. ibuprofen)
- CCB
- Antihistamines
- Alcohol
drugs that commonly cause confusion?
- morphine
- metoclopramide
- anticholinergics (eg, antipsychotic drugs, antidepressant agents, anticholinergic respiratory agents, detrusor relaxants),
- antipsychotics,
- antidepressants,
- anticonvulsants.
- less common causes (histamine H2 receptor antagonists, digoxin, beta-blockers, corticosteroids, NSAID and Abx)
max dose citalopram for elderly/those >65?
20 mg
bc QT prolongation
if ACEi and spirinolactone prescribed together?
raised K+ (need monitoring)
but could be legitimate prescription in HF
ciclosporin S/E?
- nephrotoxicity
- renal function measurements are required before starting ciclosporin
- during Tx, monitor serum creatinine every 2 weeks for the first 3 months, then monthly
important S/E of tramadol?
Serotonin syndrome
