Drug side effects

Question 1

Glucocorticoid

Answer 1

endocrine: impaired glucose regulation, increased appetite/weight gain, hirsutism, hyperlipidaemia
Cushing’s syndrome: moon face, buffalo hump, striae
musculoskeletal: osteoporosis, proximal myopathy, avascular necrosis of the femoral head
immunosuppression: increased susceptibility to severe infection, reactivation of tuberculosis
psychiatric: insomnia, mania, depression, psychosis
gastrointestinal: peptic ulceration, acute pancreatitis
ophthalmic: glaucoma, cataracts
suppression of growth in children
intracranial hypertension
neutrophilia

Question 2

Mineralocorticoid

Answer 2

fluid retention

hypertension

Question 3

Verapamil

Answer 3

Heart failure, constipation, hypotension, bradycardia, flushing

Question 4

Diltiazem

Answer 4

Hypotension, bradycardia, heart failure, ankle swelling

Question 5

Nifedipine, amlodipine, felodipine

dihydropyridines

Answer 5

Flushing, headache, ankle swelling

Question 6

Tamoxifen

Answer 6

Adverse effects
menstrual disturbance: vaginal bleeding, amenorrhoea
hot flushes - 3% of patients stop taking tamoxifen due to climateric side-effects
venous thromboembolism
endometrial cancer*

Tamoxifen is typically used for 5 years following removal of the tumour.

Question 7

Ivabradine

Answer 7

Anti0anginal that reduces heart rate

visual effects, particular luminous phenomena, are common. Headache. Bradycardia, due to the mechanism of action, may also be seen

Question 8

Bisphosphonates

Answer 8

oesophageal reactions: oesophagitis, oesophageal ulcers (especially alendronate)

osteonecrosis of the jaw

increased risk of atypical stress fractures of the proximal femoral shaft in patients taking alendronate

acute phase response: fever, myalgia and arthralgia may occur following administration

hypocalcaemia: due to reduced calcium efflux from bone. Usually clinically unimportant