Drugs AEs Flashcards
Loop diuretics - All Hypos
Adverse effects
hypotension
hyponatraemia
hypokalaemia, hypomagnesaemia
hypochloraemic alkalosis
ototoxicity
hypocalcaemia
renal impairment (from dehydration + direct toxic effect)
hyperglycaemia (less common than with thiazides)
gout
CCBs vs ACEIs
CCBs: Ankle odema not Angioedema
ACEIs: Angioedema not Ankle odema
Quick comparison: Drug adverse effects
Peripheral neuropathy
isoniazid
amiodarone
metronidazole
phenytoin
nitrofurantoin
Dry skin
isotretinoin
Tricyclic antidepressants
As well as 5-HT and NA, tricyclics interact with number of other receptors that contribute to their side-effect profile:
antagonism of histamine receptors
drowsiness
antagonism of muscarinic receptors
dry mouth
blurred vision
constipation
urinary retention
antagonism of adrenergic receptors
postural hypotension
lengthening of QT interval
Antibiotics: protein synthesis inhibitors
Aminoglycosides:
Binds to 30S subunit causing misreading of mRNA Nephrotoxicity,
Ototoxicity
Tetracyclines:
Binds to 30S subunit blocking binding of aminoacyl-tRNA
Discoloration of teeth, photosensitivity
Chloramphenicol:
Binds to 50S subunit, inhibiting peptidyl transferase
Aplastic anemia
Clindamycin:
Binds to 50S subunit, inhibiting translocation (movement of tRNA from acceptor site to peptidyl site)
Common cause of C. difficile diarrhea
Macrolides:
Binds to 50S subunit, inhibiting translocation (movement of tRNA from acceptor site to peptidyl site)
Nausea (especially erythromycin), P450 inhibitor, prolonged QT interval
Corticosteroids
Glucocorticoid side-effects
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
Mineralocorticoid side-effects
fluid retention
hypertension
Drug-induced impaired glucose tolerance
Drugs which are known to cause impaired glucose tolerance include:
Beta-blockers
thiazides, furosemide (less common)
steroids
tacrolimus, ciclosporin
interferon-alpha
nicotinic acid
antipsychotics
Beta-blockers cause a slight impairment of glucose tolerance. They should also be used with caution in diabetics as they can interfere with the metabolic and autonomic responses to hypoglycaemia
Drug-induced urinary retention
The following drugs may cause urinary retention:
tricyclic antidepressants e.g. amitriptyline
anticholinergics e.g. antipsychotics, antihistamines
opioids
NSAIDs
disopyramide
BPH/Prostatitis:
Tamsulosin: Alpha blockers can cause first dose hypotension
Finasteride: Oligospermia
Tamsulosin: Alpha blockers can cause first dose hypotension
Finasteride: Oligospermia
Tamsulosin is an alpha adrenergic blocker which preferentially acts on receptors in the prostate. This causes improved urine flow in benign prostatic hypertrophy. Alpha blockers can cause first dose hypotension - a reduction in blood pressure following the first dose, causing a vasovagal faint.
Finasteride: Oligospermia
Finasteride inhibits the enzyme 5 ɑ-redutase, reducing conversion of testosterone to dihydrotesterone. Dihydrotestosterone promotes prostate growth. Finasteride is licensed for benign prostatic hypertrophy, and can be used off-license in chronic prostatitis. It can cause infertility, sexual dysfunction, and abnormal breast growth
Trimethoprim + Methotrexate (bone marrow suppression)
Trimethoprim is an antifolate antibacterial. It inhibits the enzyme bacterial dihydrofolate reductase, which inhibits bacterial DNA synthesis. It can also inhibit the equivalent enzyme in humans, reducing folate levels. Trimethoprim interacts with Methotrexate, which also reduces folate levels, and can cause bone marrow suppression.
Antimalarial: with neuropsychiatric side effects
D. Mefloquine
Abnormal dreams
insomnia,
anxiety,
depression and
suicidal ideation have been reported
Contraindicated in those with a history of generalized anxiety disorder, depression, suicidal ideation and psychosis.
Mefloquine is also contraindicated in those with epilepsy, as it can lower seizure threshold and affect the metabolism of some antiepileptics.
Antimalarials should be taken before arrival in a malarial area, during the stay and for a period on return, to reduce the risk of developing malaria.
Proguanil is usually prescribed in combination with either chloroquine or atovaquone as a combination product, it is rarely prescribed alone. Proguanil is a folate antagonist and if use in pregnancy is unavoidable women should take 5mg of folic acid alongside.
Chloroquine is contraindicated in those with epilepsy and it can induce ventricular arrhythmias.
Atovaquone levels are reduced by rifampicin, metoclopramide and some antiretroviral medications used in HIV treatment, and should not be prescribed alongside these medications.
Doxycycline should be used with caution in those with hepatic or renal impairment, and increases photosensitivity.
Gastric bypass produces a malabsorptive state Contraception:
Gastric bypass produces a malabsorptive state, and can reduce the absorption of oral medications.
Copper IUD preferred:
Gastric bypass produces a malabsorptive state, and can reduce the absorption of oral medications. The Faculty of Sexual and Reproductive Health recommends that a copper intrauterine contraceptive device is used as emergency contraception (EC) in patients with a history of malabsorptive bariatric surgery.
Quick comparison: Drug adverse effects
Quick comparison: Drug adverse effects
Hypotension
diltiazem
verapamil
levodopa
isosorbide mononitrate
bromocriptine
Nasal congestion
sildenafil
Emedica done:
Cardio 1, 2
Resp 1, 2
Gastro 1,
ENT 1, 3
Pedia 1
Neuro 1
Obs/Gyn 3,
Genetics 1,
Pharma 1, 2
SJT:
Ranking 1, 2, 3, 4, 5, 6
Selection 1,
SJT Practice Paper 1 Answers & Rationale 15
