Drug SIde-Effects Flashcards
What are some side-effects of aminoglycoside antibiotics?
Ototoxicity
Nephrotoxicity
Neuromuscular blockade (skeletal muscle paralysis)
What are some common side-effects of macrolide antibiotics?
Nausea
Vomiting
Abdominal pain
Diarrhoea
What are some common side-effects of cephalosporin and penicillin antibiotics?
Nausea
Vomiting
Diarrhoea
Thrush
Rash
Abdominal pain
What are some potential side-effects of tetracycline antibiotics?
Teeth staining in children
Sun sensitivity
Stomach issues
Headache
What is a potentially severe side-effect of statins?
Rhabdomyolysis- breakdown of muscle tissue that can cause liver and kidney damage and death.
Statins cause muscle pain in 1/10 patients.
What is a potentially severe side-effect of ACE inhibitors?
Angioedema- the sudden swelling of the mouth, tongue and throat.
What is a potentially severe side-effect of biguanides (metformin)?
Lactic acidosis- build up of lactic acid in the blood that can lead to severe hypotension and hypothermia.
What are some potentially severe side-effects of fluoroquinolone antibiotics?
Severe irreversible tendon injuries, peripheral neuropathy (numbness and tingling) and ruptures or tears of the aorta.
What are some side-effects associated with diphenhydramine (Benadryl)?
Drowsiness and dry mouth
What are some examples of medications that can discolour your urine?
Senna
Sulfasalazine
Nitrofurantoin
Rifampicine
Entacapone
Levodopa-containing preparations
What are some potential side-effects of ACE inhibitors?
Hyperkalaemia
Persistent dry cough
Angioedema
Hypoglycaemia
Renal impairment
What are some potential side-effects of ARBs?
Hyperkalaemia
Angioedema
Hyponatraemia
Myalgia
Arthralgia
What are some potential side-effects of beta-blockers?
Bronchospasm
Coldness of extremities
Sleep disturbances
Exacerbation of psoriasis
Why should the abrupt withdrawal of CCBs be avoided?
Can cause exacerbation of myocardial ischaemia
What are some potential side-effects of cytotoxic drugs?
-Pregnancy and reproductive function
-Extravasation of IV drugs
-Nausea and vomiting
-Alopecia
-Tumour lysis syndrome
-Hyperuricaemia
-Bone marrow suppression
-Oral mucositis
Thromboembolism
What are corticosteroids?
Hormones inbolved in a wide array of physiological responses such as inflammation, stress, the immune response and carbohydrate/protein metabolism.
What are some side-effects of corticosteroids?
Cushing’s syndrome
Osteoporosis
Retardation of growth
Thin skin, easily bruised
Immunosuppression
Cataracts ang glaucoma
Oedema
Suppression of HPA axis
Teratogenic
Emotional disturbances
Rise in blood pressure
Obesity
Increased hair growth (hirsutism)
Diabetes mellitus
Striae
Which drugs can cause hypokalaemia?
Beta2 agonists
Laxative abuse
Insulin
Theophylline
Aminophylline
Diuretics
Fludrocortisone
Hydrocortisone
What are some potential side-effects of ACE inhibitors?
Renal Impairment
Hyperkalaemia
Dry cough
Angioedema
What are some potential side-effects of CCBs?
Gingival hyperplasia
Dizziness
Oedema
Flushing
What are some potential side-effects of thiazide-like diuretics?
Hyperuricaemia
Hyperglycaemia
Erectile dysfunction
Electrolyte changes
What are some potential side-effects of spironolactone?
Hyperkalaemia
Gynaecomastia
Changes in libido
Hepatotoxicity
What are some potential side-effects of alpha blockers? (e.g. doxazosin)
Floppy iris syndrome
Postural hypotension
Urinary disorders
What are some potential side-effects of aspirin?
Asthma
Skin reactions
Peptic ulceration
Increased bleeding time
Reye’s syndrome
Intestinal bleeding
Na retention
What are some common medicines known to cause GI bleeding and ulceration?
Antiplatelets
SSRIs
Anticoagulants
Corticosteroids
NSAIDs
Nicorandil (potassium-channel activator)
What are some rare but severe potential side-effects of macrolide antibiotics?
Cardiac arrhythmias
Abnormal liver function
What are some rare, but serious, side-effects of erythromycin?
-Arrhythmias
-Severe stomach pain, which can be a pancreas issue
-Jaundice, or pale stools with dark peak- liver or gallbladder issues
-Hallucinations
-Temporary hearing loss/ringing in ears/unsteady on feet
-Fever
Which drugs have a potential side-effect of causing hyponatraemia?
SSRIs
Carbamazepine
Thiazide-like diuretics
Loop diuretics
What is Stephen-Johnson Syndrome?
A rare but serious skin reaction that can be caused by taking certain medications
Which three medication types most commonly cause Stephen-Johnson syndrome?
Epilepsy medications (carbamazepine, lamotrigine, phenobarbital, phenytoin)
Antibiotics (sulfamethoxazole and other sulfa antibiotics)
Anti-inflammatory medications (oxicam anti-inflammatories such as meloxicam and piroxicam).
Also sulfasalazine and allopurinol
What are the symptoms of Stephens-Johnson Syndrome?
- Flu-like symptoms initially, such as a fever, sore throat, cough and joint pain.
-A rash, which is made up of circular patches that are darker in the middle and lighter around the outside. Usually starts on the upper body before spreading to the face, arms and legs. Not usually itchy.
-Blisters and sores (lips, mouth, urethra and eyes)
Which anti-epileptic is most likely to cause gingival hyperplasia (gingival overgrowth)?
Phenytoin- reported in up to 50% of patients that take the drug
How may a clopidogrel allergy manifest?
As a rash
Which drug is Idarucizumab used to reverse the effects of in overdose/toxicity?
Dabigatran
Carbamazepine can cause severe allergic reactions, affecting multiple organ systems. What are some symptoms?
Fever
Dark urine
Rash
Stomach pain
Tiredness
Yellow eyes/skin
Which drug type is linked to the side-effect of angioedema?
ACE inhibitors
Common ADR Topics in the Exam
-ACE inhibitors- first dose hypotension and dry cough
-NSAIDs causing ulceration
-Metformin causing a metallic taste in the mouth
-Taste disturbances: amiodarone, captopril, carbimazole, metronidazole and zopiclone
-Rifampicin can cause urine to go red, and discolour contact lenses
-Levodopa can make urine dark red
-Dry mouth/antimuscarinic side-effects- TCAs and antimuscarinics can cause this
-Atenolol does NOT pass through the BBB, unlike propranolol- avoids CNS side-effects such as bad dreams
Medications and Some Side-effects Worth Knowing
-Deafness and kidney failure: Gentamicin
-Depression or hepatic injury: Interferon
-Diabetes: Atypical antipsychotics
-Diarrhoea: Orlistat
-Erectile dysfunction: Many drugs, such as antidepressants
-Glaucoma: corticosteroid-based eye drops
-Lactic acidosis: Metformin
-Peripheral neuropathy: fluoroquinolone antibiotics
-Stroke/MI: sildenafil when used with nitroglycerine
-Tardive dyskinesia: long-term use of metoclopramide and many antipsychotics
-SPontaneous tendon rupture: fluoroquinolone antibiotics, even up to 6 months after treatment cessation.
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Yellow Card Scheme
-Report ALL black triangle drugs (intensely monitored)
-For established drugs and herbal remedies, report all SERIOUS ADRs in adults
-Report all serious AND minor ADRs reported in children (under 18s)
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Steroids can raise blood glucose levels.
True or False?
True
Diuretics can cause hypokalaemia.
True or False?
True
Skin necrosis is a rare but serious side-effect of which drug?
Warfarin
REMEMBER: Heparin can induce _, where you get a significant reduction in platelet count and a rash can also develop.
Thrombocytopenia
Why should metoclopramide not be used for N&V in Parkinson’s patients?
Can cause muscle spasms/worsen Parkinson symptoms
Diuretic Side-Effects
Thiazides: can cause hyponatreamia, hypokalaemia and HYPERcalcaemia
Loops: can cause hyponatraemia, hypokalaemia and hypocalcaemia
Which beta-blocker is most likely to cause cold extremeties?
Propranolol
What electrolyte can be depleted in the body by prolonged use of PPIs?
Magnesium
Which steroid is most likely to cause hypertension as a side-effect?
Hydrocortisone
Atenolol and sotalol are the beta-blockers that are most likely to cause asleep disturbances and cold extremities.
True or False?
False
They are least likely to
What is a potential severe side-effect of vinca alkaloids (vincristine, vinblastine etc)?
Neurotoxicity
Remember: Certain antipsychotics such as olanzapine, quetiapine, risperidone and clozapine can exacerbate diabetes by causing _.
Hyperglycaemia
Which drug can cause ocular micro-deposits as a side-effect?
Amiodarone
Phenytoin can cause leucophenia. What are some potential side-effects?
Fever
Malaise
Swollen lymph nodes
The ‘Yasmin’ contraceptive pill can cause weight loss. How does this occur?
Drospirenone has a diuretic effect, which reduces fluid retention
How long does it take for the average person to excrete one unit of alcohol?
1 hour
What are some of the main adverse effects of amiodarone?
-Thyroid dysfunction, both hypo- and hyper-thyroidism
-Corneal deposits
-Pulmonary fibrosis/pneumonitis
-Liver fibrosis/hepatitis
-Peripheral neuropathy, myopathy
-Photosensitivity
-‘slate-grey’ appearance
-Thrombophlebitis and injection site reactions
-Bradycardia
-Lengthens QT interval
Characteristic Antibiotic Side-Effects
-Amoxicillin: Rash with infectious mononucleosis
-Co-amoxiclav: Cholestasis
-Flucloxacillin: Cholestasis (usually develops several weeks after use)
-Erythromycin: GI upset, QT interval prolongation
-Ciprofloxacin: Lowers seizure threshold, tendonitis
-Metronidazole: reaction following alcohol
-Doxycycline: Photosensitivity
-Trimethoprim: Rashes, photosensitivity, pruritus, suppression of haematopoiesis
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What are some characteristic side-effects of trimethoprim?
Rashes
Photosensitivity
Pruritis
Suppression of haematopoiesis
How would benzodiazepine overdose be treated?
Flumazenil
How would poisoning by organophosphate insecticides be treated?
Atropine
How would cyanide poisoning be treated?
Hydroxocobalamin
Retinoids Side-Effects
-Teratogenecity
-Dry skin, eyes and lips
-Low mood
-Raised triglycerides
-Hair thinning
-Nose bleeds
-Intracranial _ (should not be combined with tetracyclines for this reason).
-Photosensitivity
Hypertension
What are some potential side effects of retinoids?
-Teratogenecity
-Dry skin, eyes and lips
-Low mood
-Raised triglycerides
-Hair thinning
-Nose bleeds
-Intracranial hypertension (should not be combined with tetracyclines for this reason).
-Photosensitivity
What alterations in liver function tests are associated with phenytoin hepatotoxicity?
Elevations in serum aminotransferases, lactic dehydrogenase, alkaline phosphatase, bilirubin and prothrombin time
Monitoring Requirements: Cardiovascular Drugs
-Statins: LFT at baseline, 3 months and 12 months
-ACEi: U&E prior to treatment, after increasing dose and at least annually
-Amiodarone: TFT, LFT, U&E, CXR prior to treatment, then TFT and LFT every 6 months.
Digoxin: Serum concentration, U&E
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What are the monitoring requirements for amiodarone?
TFT, LFT, U&E, CXR prior to treatment, then TFT and LFT every 6 months.
Monitoring Requirements: Rheumatology Drugs
-Methotrexate: FBC, U&E and LFT before starting treatment, repeat weekly until stabilised. Then, every 2-3 months.
-Azathioprine: FBC and LFT before treatment, FBC weekly for the first 4 weeks. Then FBC and LFT every 3 months.
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What are the monitoring requirements for methotrexate?
FBC, U&E and LFT before starting treatment, repeat weekly until stabilised. Then, every 2-3 months.
Monitoring Requirements: Neuropsychiatric Drugs
-Lithium: TFT and U&E prior to treatment, then lithium levels weekly until stabilised and then every 3 months. TFT and U&E every 6 months.
-Sodium Valproate: LFT and FBC before treatment, then LFT periodically during first 6 months of treatment.
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What are the monitoring requirements for lithium?
TFT and U&E prior to treatment, then lithium levels weekly until stabilised and then every 3 months. TFT and U&E every 6 months.
Long term use of which diuretic has been linked to the development of non-melanoma skin cancer?
Hydrochlorthiazide
LMWH can cause hypokalaemia.
True or False?
False
They can cause HYPERkalaemia
SSRIs can cause hyponatraemia but aren’t commonly associated with hyperkalaemia.
Which category of antihypertensives is most commonly associated with postural hypotension?
Alpha-blockers, e.g. doxazosin.
Managing High INR in Warfarin Patients
Target is 2.5 in most patients, but 3.5 in patients with a mechanical heart valve.
-INR between 5-8, no signs of bleeding; temporarily withold warfarin, measure INR 2-3 days later and restart when <5.
-In life threatening bleeding/minor bleeding with an INR 8<, administer IV phytomenadione- correction usually takes 6-8 hours.
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How should a situation be handled if a patient taking warfarin has an INR of 5.0-8.0, but has no signs of bleeding?
Withhold warfarin, measure INR 2-3 days later and restart when INR <5.
Which TCA is considered safer in overdose than other TCA’s?
Lofepramine
What are some rare, but more serious, adverse effects of sulfonylureas?
Hyponatraemia
Bone marrow suppression
Hepatotoxicity
Peripheral neuropathy
What is a potential electrolyte disturbance that can come from overuse of salbutamol?
Hypokalaemia
Which laxative can make urine pink?
Co-danthramer
Drug induced colitis is a potential severe side-effect of which antibiotic?
Clindamycin
Carbamazepine can cause hepatic disorders.
True or False?
True
Heparins and LMWHs can cause hypokalaemia.
True or False?
False
They can cause HYPERkalaemia
Drugs That Cause Hyperkalaemia
-ACEi/ARBs
-Aldosterone antagonists
-Trimethoprim
-Co-trimoxazole
-Amiloride
-Heparin/LMWH
Potassium-sparing diuretics
-Beta blockers
-Digoxin (at toxic levels)
-Ciclosporin
-Tacrolimus
-NSAIDs
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Drugs That Cause Hypokalaemia
-Laxatives
-Diuretics
-High doses of beta-2 agonists
-Theophylline
-High doses of penicillin
-Gentamicin
-Amphotericin
-High doses of insulin
-Corticosteroids
-Sodium bicarbonate
-Echinocandin antifungals
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Drugs That Cause Hyponatraemia
-ACEi
-Heparin
-Diuretics
-Antidepressants
-Antipsychotics
-Carbamazepine
-Atovaquone
-Amphotericin
-Sulfonylureas
-Desmopressin
-Cyclophosphamide
-Acetazolomide
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Drugs That Cause Hypernatraemia
-Diuretics (sometimes)
-Sodium bicarbonate
-Sodium chloride
-Corticosteroids
-Anabolic steroids
-Androgens
-Oestrogens
Hyperglycaemia in diabetes can also lead to hypernatraemia
What are some examples of drugs that can cause hyperkalaemia?
-ACEi/ARBs
-Aldosterone antagonists
-Trimethoprim
-Co-trimoxazole
-Amiloride
-Heparin/LMWH
Potassium-sparing diuretics
-Beta blockers
-Digoxin (at toxic levels)
-Ciclosporin
-Tacrolimus
-NSAIDs
What are some drugs that can cause hyponatraemia?
-ACEi
-Heparin
-Diuretics
-Antidepressants
-Antipsychotics
-Carbamazepine
-Atovaquone
-Amphotericin
-Sulfonylureas
-Desmopressin
-Cyclophosphamide
-Acetazolomide
What are some drugs that can cause hypokalaemia?
-Laxatives
-Diuretics
-High doses of beta-2 agonists
-Theophylline
-High doses of penicillin
-Gentamicin
-Amphotericin
-High doses of insulin
-Corticosteroids
-Sodium bicarbonate
-Echinocandin antifungals
What are some symptoms of hyperkalaemia?
Heart palpitations
SOB
Chest pain
Nausea
Vomiting
Muscle weakness
What are some symptoms of hyponatraemia?
Fatigue
Low BP
Headache
Muscle weakness/cramps
If someone taking theophylline smokes and then stops smoking, how will that impact the dose?
Smoking significantly increases theophylline clearance; after stopping smoking, the dose may need to be significantly decreased.
Digoxin
-Serum concentration and U&E/renal function should be monitored.
Signs of toxicity include confusion, nausea, disturbed colour vision and bradycardia.
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Montelukast can cause neuropsychiatric side-effects. What are some examples?
Sleep disturbances/nightmares
Behaviour changes
Speech impairment, e.g. stuttering
These are not severe side-effects; they are fairly common and not dangerous
Pioglitazone can cause fluid retention and precipitate congestive heart failure. This can occur more frequently when used alongside which antidiabetic drug?
Insulin
Sulfasalazine can cause agranulocytosis, and should therefore report symptoms of a sore throat, malaise and a fever.
Amiodarone can cause photosensitivity.
True or False?
True
Which antibiotic can prolong the QT interval?
Clarithromycin
Which biochemical tests can phenytoin increase the results of?
Increase in serum aminotransferases, bilirubin and prothrombin time
How does isosorbide mononitrate work, and what side-effects can this cause?
Works by dilating blood vessels to reduce blood pressure- can cause dizziness and headaches.
Throbbing headaches are a very common side-effect of nitrate drugs
Why should patients receive a chest X-ray prior to starting treatment with amiodarone?
Can cause severe lung toxicity- required prior to starting treatment, and then annually to monitor changes
Which drug can cause thinning skin, dry skin and chapped lips as a side effect?
Isotretinoin- can also cause intracranial hypertension, hair thinning, raised triglycerides, nose bleeds and photosensitivity
Thiazides can cause hyperuricaemia and hyperglycaemia.
True or False?
True
Linezolid is an antibiotic used to treat gram-positive infections. What is a potentially severe side-effect of use?
Optic neuropathy
Vancomycin treatment can cause a severe increase in platelet levels.
True or False?
False
It can cause thrombocytopenia (low platelets)
What are some main side-effects of mineralocorticoid use?
Calcium loss
Potassium loss
Water retention
Sodium retention
Hypertension
What are some main side-effects of glucocorticoids?
Diabetes
Osteoporosis
Weight gain
Muscle wasting
Psychiatric reactions
Peptic ulceration potentially
High doses are also linked avascular necrosis of the femoral head
What effect does buprenorphine have on other opioids?
It blocks/antagonises the effects of other opioids.
Desmopressin can cause hyponatraemia.
Bezafibrate is not linked to muscle pain as a side-effect, unlike statins.
True or False?
False
Bezafibrate can cause muscle oain
Which supplement can cause GI upset and darkened stools as a side-effect?
Iron supplements
Zonisamide is used to treat epilepsy. It is important to avoid overheating and exercising too much. Why is this the case?
Zonisamide makes you sweat less and you are therefore more prone to overheating
Baclofen can cause drowsiness. What ‘drug’ when used alongside this medication can worsen this effect?
Alcohol
Which antidiabetic drug increases your risk of developing heart failure?
Pioglitazone
Drugs which can cause photosensitivity (SAN LIGHT)
Sulfonamides
Amiodarone
NSAIDs
Loop diuretics
Isotretinoin
Griseofulvin
Hydrochlorothiazide
Tetracycline
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What are some side-effects of levodopa-containing preparations?
Dementia
Abnormal dreams
Depression
Taste disturbances
Sulfasalazine can cause temporary infertility as a side-effect.
What are some common adverse effects of levodopa-containing preparations?
common adverse effects:
dry mouth
anorexia
palpitations
postural hypotension
psychosis
NSAIDs and their Bleed Risk
Low Risk:
-Naproxen 1000mg a day or less
-Ibuprofen 1200mg a day or less
Moderate Risk:
-Indometacin, Diclofenac, Naproxen (>1g/day), ibuprofen (>1.2g/day)
High Risk:
-Piroxicam
-Ketoprofen
-Ketorolac trometamol
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