Medication side effects & complications

Question 1

Which drug can induce thyrotoxicosis?

Answer 1

Amiodarone

Question 2

What is a well recognised complication of amiodarone?

Answer 2

Thyrotoxicosis

Question 3

What type of drug is amiodarone?

Answer 3

An anti-arrhythmic agent

Question 4

Which blood test is important to do as part of regular drug monitoring for patients on amiodarone?

Answer 4

TFTs

Question 5

What is important to tell the patient when starting them on amiodarone?

Answer 5

Make them aware about the potential risks of thyrotoxicosis

Question 6

What is the similarity between amiodarone and thyroid hormone?

Answer 6

They both have a high iodine component

Question 7

What are the two forms of thyrotoxicosis that amiodarone can induce?

Answer 7

1) Direct toxic consequence of the drug itself (thyroiditis)
2) Trigger of underlying thyroid autoimmunity

Question 8

What investigations need to be done to correctly diagnose the type of amiodarone induced thyrotoxicosis?

Answer 8

1) Check patient’s antibody status
2) Specialist imaging of thyroid gland e.g. thyroid uptake scan and colour flow Doppler ultrasound

Question 9

Imaging characteristics on amiodarone induced thyrotoxicosis (AIT) type 1?

Answer 9

1) Normal thyroid uptake on scans
2) Increased vascularity on Doppler imaging

Question 10

Imaging characteristics on amiodarone induced thyrotoxicosis (AIT) type 2?

Answer 10

1) Decreased thyroid uptake
2) Reduced vascularity on Doppler imaging

Question 11

How do you manage amiodarone induced thyrotoxicosis?

Answer 11

Depends on underlying type
1) Anti-inflammatories e.g. steroids
2) Anti-thyroid drugs e.g. carbimazole
3) Close discussion with cardiology to decide whether amiodarone needs to be stopped or substitute

Question 12

What % of patients taking amiodarone can have abnormalities in thyroid function?

Answer 12

Up to 50%

Question 13

Which antidepressant can affect TSH secretion (full blown thyrotoxicosis much less common)?

Answer 13

Sertraline

Question 14

Which antidepressant causes a reduction in TSH production and hypothyroidism?

Answer 14

Paroxetine

Question 15

Which drug can have an effect on T3/T4 binding, leading to hypothyroidism and a reduction in metabolic processes?

Answer 15

Aspirin

Question 16

What are the features of digoxin toxicity?

Answer 16

1) Nausea/vomiting
2) Diarrhoea
3) Blurred vision
4) Yellow/green discolouration of vision (strange green tint)
5) Haloes in vision
6) Confusion
7) Fatigue
8) Palpitations
9) Syncope
10) Arrhythmias
11) Abdo pain

Question 17

What are the effects of digoxin on ECG?

Answer 17

1) Downsloping ST depression
2) T-wave changes (inversion)
3) Biphasic/flattened and shortened QT interval
4) Slight PR interval prolongation
5) Prominent U-waves
- these are NOT signs of digoxin toxicity

Question 18

What are characteristic side effects of amiodarone?

Answer 18

1) Thyroid dysfunction
2) Corneal deposits
3) Pulmonary fibrosis
4) Grey skin discolouration

Question 19

What can be used in the management of digoxin toxicity?

Answer 19

Digibind

Question 20

What are common side effects of bisoprolol?

Answer 20

1) Dizziness
2) Headaches
3) Cold peripheries

Question 21

What are the side effects of penicillins?

Answer 21

1) Allergy
2) Rash
3) N&V
4) Diarrhoea
5) Cholestasis
6) C. difficile

Question 22

What is the additional side effect (to the penicillin side effects) in amoxicillin and co-amoxiclav?

Answer 22

Rash with EBV

Question 23

What is a rare side effect with prolonged use of Piptaz?

Answer 23

Myelosuppression

Question 24

When patients are on cephalosporins what can be false positive?

Answer 24

1) Urinary glucose
2) Coomb’s test

Question 25

What are the side effects of cephalosporins?

Answer 25

1) Allergy 2) Rash 3) N&V 4) Cholestasis

Question 26

What is a specific side effect of ceftriaxone and why?

Answer 26

Pseudolithiasis (symptoms of renal or gallstones) - ceftriaxone can precipitate in urinary tract and biliary tree

Question 27

What are the side effects of carbapenems?

Answer 27

1) N&V 2) Rash 3) Eosinophilia 4) Thrombocytopenia 5) Raised LFTs 6) Seizures 7) C difficile

Question 28

What are the key side effects of carbapenems?

Answer 28

1) Eosinophilia 2) Thrombocytopenia 3) Raised LFTs 4) Seizures

Question 29

What are the side effects of vancomycin and teicoplanin (lipo/glycopeptides)?

Answer 29

1) Nephrotoxic 2) Ototoxic 3) Thrombocytopenia

Question 30

What should you do bc of nephrotoxicity with vancomycin?

Answer 30

1) Monitor creatinine 2) Care with other nephrotoxic agents

Question 31

What are the side effects of aminoglycosides?

Answer 31

1) Nephrotoxic 2) Ototoxic 3) Vestibular toxicity

Question 32

What should you do bc of nephrotoxicity with aminoglycosides?

Answer 32

1) Monitor drug levels 2) Monitor serum creatinine

Question 33

Which macrolide causes the most side effects?

Answer 33

Erythromycin

Question 34

What are the side effects of macrolides?

Answer 34

1) Long QT 2) GI upset 3) Cholestasis

Question 35

What enzyme action do macrolides have (least with azithromycin)?

Answer 35

Cytochrome P450 inhibition

Question 36

What are the effects of cytochrome P450 inhibition when taking macrolides?

Answer 36

1) Increase in warfarin 2) Increase in calcineurin inhibitor levels e.g. cyclosporin, tacrolimus 3) Rhabdomyolysis with statins

Question 37

In which patients are tetracycline and doxycycline contraindicated?

Answer 37

1) Pregnancy 2) Children < 8 years (teeth/bones)

Question 38

What are the side effects of tetracycline and doxycycline?

Answer 38

1) Fatty liver 2) Idiopathic intracranial hypertension 3) N&V 4) C. difficile

Question 39

What are the side effects of tigecycline?

Answer 39

1) N&V 2) Photosensitivity 3) Raised LFTs

Question 40

Which antibiotic causes particular risk of C difficle?

Answer 40

Clindamycin

Question 41

What are the side effects of linezolid?

Answer 41

1) Can interact with MAOIs 2) Myelosuppression 3) Optic neuropathy

Question 42

Why is systemic use of chloramphenicol limited?

Answer 42

Bc of the risk of myelosuppression

Question 43

What are the side effects of fusidic acid?

Answer 43

1) GI upset 2) Raised LFTs

Question 44

What effect does trimethoprim have on renal function bloods?

Answer 44

Raised serum creatinine with low GFR (inhibits creatinine secretion)

Question 45

What are the side effects of co-trimoxazole?

Answer 45

1) Folate deficiency 2) Hyperkalaemia 3) Myelosuppression 4) Haemolysis with G6PD deficiency 5) Rash

Question 46

Which antibiotic cause haemolysis in G6PD deficiency?

Answer 46

Co-trimoxazole

Question 47

Which antibiotic causes folate deficiency?

Answer 47

Co-trimoxazole

Question 48

Which antibiotic causes hyperkalaemia?

Answer 48

Co-trimoxazole

Question 49

What are the side effects of fluoroquinolones?

Answer 49

1) CNS effects - reduced seizure threshold, headache, drowsiness, mood change 2) Peripheral neuropathy 3) Tendinopathy (Achilles) 4) Long QT 5) C difficile 6) GI irritation

Question 50

Which antibiotic class causes CNS effects?

Answer 50

Fluoroquinolone e.g. ciprofloxacin

Question 51

Which antibiotic causes peripheral neuropathy?

Answer 51

Fluoroquinolone e.g. ciprofloxacin

Question 52

Which antibiotic causes Achilles tendinopathy?

Answer 52

Fluoroquinolone e.g. ciprofloxacin

Question 53

What are the side effects of metronidazole?

Answer 53

1) Disulfiram reaction with alcohol 2) Inhibits warfarin metabolism

Question 54

Which antibiotic can cause a reaction with alcohol?

Answer 54

Metronidazole

Question 55

Which two antibiotics affect warfarin levels (increase them)?

Answer 55

Metronidazole (inhibits Warfarin metabolism) and macrolides (increased levels of Warfarin)

Question 56

Which antibiotic do you have to dose adjust for liver function?

Answer 56

Metronidazole

Question 57

What are the side effects of rifamycins e.g. rifampicin?

Answer 57

1) Red secretions (urine, saliva, sweat, sputum, tears) 2) Hepatitis (monitor LFTs) 3) GI upset 4) CNS effects 5) Myelosuppression

Question 58

Which antibiotics cause eosinophilia?

Answer 58

Carbapenems