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Drugs > Drug side effects > Flashcards

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
Q

Anticholinergics (tiotropium)

A 
Uncommon as low systemic absorption
Dry mouth (inhalation)
26
Q

Tricyclic antidepressants (amitriptyline)

A

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
Q

Overdose of amitryptiline

A

Severe hypotension, arrhythmias, convulsions, coma, respiratory failure

28
Q

Sudden withdrawal of amitriptyline

A

GI upset, neurological & flu-like symptoms, sleep disturbance

29
Q

SSRIs (citalopram)

A

GI upset, appetite, weight changes
Suicidal thoughts & behaviour might be increased
Hypersensitivity reactions
Hyponatraemia - confusion, reduced consciousness

30
Q

Sudden withdrawal of SSRIs

A

GI upset, neurological & flu-like symptoms, sleep disturbance

31
Q

Serotonin syndrome (high doses, overdose, combination with other antidepressant) = triad of…

A
  1. Autonomic hyperactivity
  2. Altered mental state
  3. Neuromuscular excitation
32
Q

Benzodiazepines (diazepam)

A

Drowsiness, sedation, coma (dose dependent)
Dependence if used for more than a few weeks
Withdrawal reaction if abrupt cessation (similar to alcohol)

33
Q

Overdose of benzodiazepines

A

Airway obstruction caused by loss of airway reflexes

34
Q

NSAIDs (diclofenac)

A

GI toxicity
Renal impairment
Increased risk of CV events

35
Q

Opioids (morphine)

A 
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
Q

Withdrawal reaction of morphine

A

Anxiety, pain, breathlessness, pupil dilation, cool dry skin with piloerection (cold turkey)
I.e. opposite to clinical effects

37
Q

Opioids (codeine)

A

Nausea, constipation
Dizziness & drowsiness
Neurological & respiratory depression
Anaphylaxis if given IV - never do this!!!!!

38
Q

Which pain killers should never be given IV due to anaphylaxis?

A

Codeine + dihydrocodeine

39
Q

Dopaminergic drugs

A

Nausea, drowsiness, confusion, hallucinations, hypotension

Wearing-off effect - symptoms worsen towards the end of the dosage interval of L-dopa

40
Q

What is the ‘on-off effect’ with DAergic drugs?

A

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
Q

Phenytoin (4)

A
  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
Q

Overdose of phenytoin

A

Death through CV collapse & respiratory depression

43
Q

Sodium valproate (5)

A
  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
Q

Carbamazepine (4)

A
  1. GI upset
  2. Neurological - dizziness, ataxia
    3, Hypersensitivity (10%) - mild rash
  3. Oedema & hyponatraemia due to ADH effect
45
Q

Anti-epileptic hypersensitivity syndrome (1 in 5000) - phenytoin, sodium valproate, carbamazepine

A

Usually occurs within 2 months of starting treatment

Features: SJS skin reaction or ttoxic epidermal necrolysis, fever, lymphadenopathy and systemic involvement

46
Q

Paracetamol

A

At treatment doses it is very safe

47
Q

Paracetamol overdose

A

The toxic metabolite that paracetamol is metabolised to (NAPQI) accumulates and causes hepatocellular necrosis

48
Q

Treatment for paracetamol overdose

A

Glutathione precursor (acetylcysteine) - this conjugates with the toxic metabolite NAPQI to allow elimination, thereby preventing accumulation

49
Q

Allopurinol

A

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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