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Drug side effects Flashcards

1
Q

Gaviscon - magnesium salts cause one & aluminium salts the other

A

Magnesium salts - diarrhoea

Aluminium salts - constipation

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2
Q

H2 antagonists (ranitidine)

A

Few side effects

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3
Q

PPIs (omeprazole)

A

GI disturbances, headaches

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4
Q

Anti-diarrhoeals (loperamide)

A

GI - constipation, abdominal cramps, flatulance

Loperamide does not penetrate CNS so no opioid toxicity or dependence

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5
Q

Laxatives (senna)

A

GI - diarrhoea, abdominal pain/cramps

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6
Q

Aminosalicylates (mesalazine)

A

GI - nausea, dyspepsia

Headache

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7
Q

Anti-emetics (domperidone)

A

Most common = diarrhoea

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8
Q

Loop diuretics (furosemide)

A

Losses of water & electrolytes:
-Dehydration
-Hypotension
-Low electrolyte states (increased urinary losses of sodium, potassium, chloride)
Other:
-Hearing loss & tinnitus (same co-transporter regulates endolymph composition)

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9
Q

Thiazide diuretics (bendroflumethiazide)

A

-Hyponatreamia & hypokalaemia
-Increased plasma glucose, LDL, triglycerides
Other:
-Impotence

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10
Q

Potassium-sparing diuretics (spironolactone)

A

Uncommon at low doses

Dizziness, hypotension & urinary symptoms only seen when used with other diuretics

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11
Q

B-blockers (atenolol)

A 
Fatigue
Coldness of the extremities
Sleep disturbances with nightmares
Glycaemic disturbances (affects carbohydrate metabolism)
Headache
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12
Q

Calcium channel blockers (amlodipine)

A

Common: headache, palpitations, ankle oedema, flushing

Verapamil commonly causes constipation

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13
Q

ACEi (Ramipril)

A

Common:

  • Hypotension (particularly after first dose)
  • Persistent dry cough (increased levels of bradykinin which is usually inactivated by ACE)
  • Hyperkalaemia (lower aldosterone level promotes K+ retention)
  • Renal failure (especially if patient has renal artery stenosis)
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14
Q

ARBs (losartan)

A

-Hypotension (particularly after first dose)
-Hyperkalaemia (lower aldosterone level promotes K+ retention)
-Renal failure (especially if patient has renal artery stenosis)
NO COUGH - do not inhibit ACE

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15
Q

Nitrates (GTN, ISMN)

A

Vasodilation - flushing, headaches, light-headedness, hypotension

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16
Q

Cardiac glycosides (digoxin)

A

Bradycardia, dizziness
Visual disturbance (blurred yellow vision)
GI disturbance

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17
Q

Anti-dysrhythmics (amiodarone)

A

Hypotension during IV infusion

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18
Q

Anti-platelets (aspirin)

A

GI - irritation, ulceration
Haemorrhage
Hypersensitivity reactions, e.g. bronchospasm
Tinnitus (in regular high dose therapy)

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19
Q

Thrombolytics (clopidogrel)

A

Most common - bleeding
Common - GI upset
Rare - thrombocytopenia

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20
Q

Heparins (LMWH - enoxaparin)

A

Most common - bleeding (lower risk with fondaparinux)
Injection site reactions
Rare - thrombocytopenia

21
Q

Oral anti-coagulants (warfarin)

A

Most common - bleeding (fine therapeutic index)
Slight excess = risk of bleeding from existing abnormalities or following minor trauma
Large excess = can trigger spontaneous haemorrhage

22
Q

Novel anticoagulants (rivaroxaban)

A 
GI - abdominal pain, constipation, diarrhoea, dyspepsia, N&V
Dizziness, headache
Hypotension
Pruritis, rash
Pain in extremeties
23
Q

Statins (simvastatin)

A

Generally safe & well tolerated:

  • Most common = headache, GI disturbances
  • More serious = myopathy, rhabdomyolysis
  • Rise in liver enzymes, e.g. ALT
24
Q

B2 agonists (salbutamol)

A

Activation of β2 receptors - Tachycardia, palpitations, anxiety & tremor
Increased serum glucose concentration – promote glucogenolysis
Rise in serum lactate levels
Muscle cramps

25
Anticholinergics (tiotropium)
``` Uncommon as low systemic absorption Dry mouth (inhalation) ```
26
Tricyclic antidepressants (amitriptyline)
Blockade of receptors causes: -mACh - dry mouth, constipation, urinary retention, blurred vision -H1, a1 - sedation, hypotension -D2 - breast changes, sexual dysfunction, extrapyramidal symptoms (tremor, dyskinesia) Other: Cardiac - arrhythmias, ECG changes Brain - convulsions, hallucinations, mania
27
Overdose of amitryptiline
Severe hypotension, arrhythmias, convulsions, coma, respiratory failure
28
Sudden withdrawal of amitriptyline
GI upset, neurological & flu-like symptoms, sleep disturbance
29
SSRIs (citalopram)
GI upset, appetite, weight changes Suicidal thoughts & behaviour might be increased Hypersensitivity reactions Hyponatraemia - confusion, reduced consciousness
30
Sudden withdrawal of SSRIs
GI upset, neurological & flu-like symptoms, sleep disturbance
31
Serotonin syndrome (high doses, overdose, combination with other antidepressant) = triad of...
1. Autonomic hyperactivity 2. Altered mental state 3. Neuromuscular excitation
32
Benzodiazepines (diazepam)
Drowsiness, sedation, coma (dose dependent) Dependence if used for more than a few weeks Withdrawal reaction if abrupt cessation (similar to alcohol)
33
Overdose of benzodiazepines
Airway obstruction caused by loss of airway reflexes
34
NSAIDs (diclofenac)
GI toxicity Renal impairment Increased risk of CV events
35
Opioids (morphine)
``` N&V - activates chemoreceptor trigger zone (settles with use) Respiratory depression Euphoria & detachment Pupillary constriction Neurological depression (at high doses) Vasodilation & sweating Itching, urticaria ```
36
Withdrawal reaction of morphine
Anxiety, pain, breathlessness, pupil dilation, cool dry skin with piloerection (cold turkey) I.e. opposite to clinical effects
37
Opioids (codeine)
Nausea, constipation Dizziness & drowsiness Neurological & respiratory depression Anaphylaxis if given IV - never do this!!!!!
38
Which pain killers should never be given IV due to anaphylaxis?
Codeine + dihydrocodeine
39
Dopaminergic drugs
Nausea, drowsiness, confusion, hallucinations, hypotension | Wearing-off effect - symptoms worsen towards the end of the dosage interval of L-dopa
40
What is the 'on-off effect' with DAergic drugs?
Increasing the dose/frequency of L-dopa can partially overcome the wearing off effect, but this can have the opposite effect and cause dyskinesias (excessive & involuntary movements)
41
Phenytoin (4)
1. Changes in appearance - skin coarsening, acne, hirsutism, gum hypertrophy 2. Neurological effects - cerebellar symptoms + impaired cognition 3. Haematological disorders - osteomalacia 4. Hypersensitivity - mild or life-threatening
42
Overdose of phenytoin
Death through CV collapse & respiratory depression
43
Sodium valproate (5)
1. GI upset 2. Neurological - tremor, ataxia, behavioural 3. Haematological - thrombocytopenia 4. Transient increases in liver enzymes 5. Hypersensitivity reactions - hair loss or life-threatening
44
Carbamazepine (4)
1. GI upset 2. Neurological - dizziness, ataxia 3, Hypersensitivity (10%) - mild rash 4. Oedema & hyponatraemia due to ADH effect
45
Anti-epileptic hypersensitivity syndrome (1 in 5000) - phenytoin, sodium valproate, carbamazepine
Usually occurs within 2 months of starting treatment | Features: SJS skin reaction or ttoxic epidermal necrolysis, fever, lymphadenopathy and systemic involvement
46
Paracetamol
At treatment doses it is very safe
47
Paracetamol overdose
The toxic metabolite that paracetamol is metabolised to (NAPQI) accumulates and causes hepatocellular necrosis
48
Treatment for paracetamol overdose
Glutathione precursor (acetylcysteine) - this conjugates with the toxic metabolite NAPQI to allow elimination, thereby preventing accumulation
49
Allopurinol
Generally well tolerated Most common AE = skin rash (mild or serious) Even though it is a gout preventative, starting allopurinol for the first time can worsen an acute attack of gout

Drugs (6 decks)

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