Common S/Es

Question 1

patient is in HF, do you give them either cyclizine or metoclopramide?

Answer 1

metoclopramide

cyclizine S/E fluid retention

Question 2

S/E cyclizine?

Answer 2

fluid retention
urinary retention
constipation
dry mouth
↑ doses: agitation

Question 3

S/E fluoxetine?

Answer 3

rash

Question 4

S/E COCP?

Answer 4

irritability
new headaches
weight ↑
acne

Question 5

S/E enoxaparin?

when to adjust dose?

Answer 5

all heparins ↑K+

adjust if <50kg or GFR<30

Question 6

S/E aspirin?

Answer 6

Fe def anaemia
(loss of protective gastric mucosa)
dyspepsia, haemorrhage

Question 7

S/E morphine?

Answer 7

urinary retention
renally excreted so can accumulate in renal failure
beware dependence and respiratory depression

Question 8

S/E citalopram?

Answer 8

can precipitate bleeding with dabigatran

Question 9

S/E antihypertensives?

Answer 9

↓ BP
↓ HR
wheeze
oedema

Question 10

major S/E of anticoagulants?

S/E warfarin?

Answer 10

haemorrhage obvss

warfarin procoagulant at 1st

Question 11

S/E digoxin?

Answer 11

seeing “yellow, green halos” around objects (xanthopsia)
N, D, confusion, drowsiness
arrhythmias

low K+ augments digoxin effect
high levels limit the effect

Question 12

S/E

statins?

Answer 12

↑ 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

Question 13

S/E anticholinergic drugs?

Answer 13

can cause DELIRIUM; check anticholinergic burden - still essential if catheterised?

• blurred vision
• tachycardia
• dry mouth
• urinary retention

Question 14

how do anticholinergics basically work?

examples of anticholinergic drugs?

Answer 14

block neurotransmitter Ach

antimuscarinics: oxybutynin, tolterodine, darifenacin

Question 15

S/E amitriptyline?

Answer 15

anticholinergic syndrome
(dry mouth, blurred vision, tachycardia, urinary retention)
drowsiness/ delirium in elderly
QT interval ↑
toxic in OD (TCA)

Question 16

citalopram given with clarithromycin?

Answer 16

↑ QT

Question 17

which drugs can cause serotonin syndrome and what are its major types of Sx? (3)

Answer 17

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

Question 18

S/E ACEi?

Answer 18

cough
renal failure
teratogen

Question 19

S/E ARBs?

Answer 19

nephrotoxic

Question 20

S/E NSAIDs?

Answer 20

indigestion
ulcers
↓ kidney function

Question 21

S/E carbamazepine?

Answer 21

↓ Na+

rare: agranulocytosis

Question 22

S/E tamoxifen?

Answer 22

VTE

endometrial proliferation

Question 23

S/E SSRIs?

Answer 23

serotonin syndrome obvs
sexual dysfunction
GI
initial anxiety

Question 24

S/E amiodarone?

Answer 24

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)

Question 25

what does omeprazole ↑ risk of?

Answer 25

C.diff

Question 26

what drugs to beware with epilepsy?

Answer 26

alcohol, cocaine, ket ciprofloxacin theo/aminophylline ↑ SEIZURE RISK

Question 27

basic S/E of anticholinergic excess?

Answer 27

MAD - delirium (elderly), confusion RED - flushing, tachycardia DRY - dry mouth + eye, constipation, urinary retention BLIND - blurred vision

Question 28

which drugs have anticholinergic S/Es?

Answer 28

``` AMITRIPTYLINE antimuscarinics paroxetine antipsychotics (clozapine) cyclizine ```

Question 29

dystonia with a fixed upward gaze - what drugs are likely causing it?

Answer 29

"oculogyric crisis" | neuroleptics - (haloperidol, chlorpromazine, olanzapine, carbamazepine, levodopa, lithium, metoclopramide, domperidone)

Question 30

new D in a pt on any Abx (but most commonly the broad-spectrum antibiotics like cephalosporins or ciprofloxacin)?

Answer 30

C. diff colitis

Question 31

S/E heparins?

Answer 31

bleeding (especially If <50kg or renal impairment) | thrombocytopenia

Question 32

S/E aspirin

Answer 32

bleeding peptic ulcers gastritis tinnitus in large doses

Question 33

S/E Fludrocortisone?

Answer 33

Hypertension/sodium and water retention

Question 34

if a DM pt is having Sx of ↓ GCS or has acidotic behaviour?

Answer 34

look out for metformin

Question 35

how long does it take for enzymes to be induced?

Answer 35

days - weeks

Question 36

how long does it take for enzymes to be inhibited?

Answer 36

hours - days

Question 37

example drugs with a narrow therapeutic range?

Answer 37

warfarin, digoxin, phenytoin, theophylline

Question 38

β-blockers and verapamil together?

Answer 38

may cause profound hypotension and asystole

Question 39

most common enzyme inhibitors?

Answer 39

ketoconazole, ciprofloxacin and erythromycin (and grapefruit juice!)

Question 40

main drugs to beware alcohol with?

Answer 40

``` 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 ```

Question 41

S/E β-blockers?

Answer 41

``` bradycardia bronchospasm cold extremities fatigue nightmares hypotension ```

Question 42

what to never prescribe alongside an ACEi?

Answer 42

NSAIDs (inhibit prostaglandins) prostaglandins dilate afferent vessels ('a’fferent/’a’pproaching) NSAIDs ↓ inward flow + ↓ pressure and perfusion ↓ flow = ischaemia

Question 43

what to never prescribe alongside an NSAID?

Answer 43

ACEi (relax efferent blood flow - ‘(e)F off’) ↓ pressure, protects vasculature from hypertension P but also ↓ GFR

Question 44

drugs which commonly cause urinary retention?

Answer 44

- 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

Question 45

drugs that commonly cause confusion?

Answer 45

- 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)

Question 46

max dose citalopram for elderly/those >65?

Answer 46

20 mg | bc QT prolongation

Question 47

if ACEi and spirinolactone prescribed together?

Answer 47

raised K+ (need monitoring) | but could be legitimate prescription in HF

Question 48

ciclosporin S/E?

Answer 48

- nephrotoxicity - renal function measurements are required before starting ciclosporin - during Tx, monitor serum creatinine every 2 weeks for the first 3 months, then monthly

Question 49

important S/E of tramadol?

Answer 49

Serotonin syndrome