OPIC Drugs

Question 1

Haloperidol

Answer 1

D2 antagonist
Schizphrenia, delirium, anti-emetic
Dry mouth, nausea, constipation/diarrhoea, nervousness
increases risk of falls

Alcohol  = hypotension
Amiodarone = QT prolongation
Beclometasone  = hypokalaemia

Question 2

Macrogol

Answer 2

Osmotic laxative (increases water retention in bowel)
Constipation
SFx Flatulence, GI discomfort, nausea, vomiting
Increases risk of falls
Contraindication = ileus/obstruction
Reduces absorption of soluble medicine (anti-epileptics) = avoid medicine 1hr before or after

Question 3

Alendronate

Answer 3

Bisphosphonate
Osteoprosis/osteopenia
Headache, oesophagi’s, GI disturbance, renal impairment
Reduces risk of fracture if fall
Interactions = GI irritation with Naproxen + aspirin, calcium gluconate + antacids decreasesalendronate absorption

Question 4

Adcal D3

Answer 4

Calcium + vitamin D
Prevention of osteoporosis + osteopenia
Abdominal pain, constipation, diarrhoea, headache, hypercalcaemia
Reduces risk of fracture with fall
Calcium carbonate-containing antacids may impair absorption
Antacids might damage enteric coatings
Bendroflumethiazide = increased risk of hypercalemia

Question 5

Strontium ranelate

Answer 5

Dual action bone agent (DABA): Increases deposition of new bone + reduces resorption of bone, strengthens bone tissue
Severe Osteoporosis
Dizziness, headache, GI discomfort, diarrhoea, constipation, peripheral oedema
Reduces risk of fracture with fall
Antacids decrease absorption of it, fluorouracil + tamoxifen increases risk of DVT

Question 6

Colchicine

Answer 6

Alkaloid, inhibits inflammation caused by tubular disruption
Acute gout
Abdo pain, diarrhoea, nausea, vomiting
Contraindication = eGFR <10
No effect on falls
CYP3A4 inhibitors = increase exposure to colchicine
Atorvastatin = rhabdomyolysis

Question 7

Allopurinol

Answer 7

Xanthine oxidase inhibitor
Gout, calcium oxalate renal stones
Initiation/up-titration may cause acute attack
Rash, hypersensitivity, nausea, vomiting
Reduces BP?
ACEi = increased risk of hypersensitivity + haematological reactions
Amoxicillin = increased risk of skin rash
Pyrazinamide = increased risk of hyperuricaemia

Question 8

Prednisolone

Answer 8

Glucocorticoid
Decrease leucocyte migration to inflammation, decrease vasodilation of capillaries, alter gene expression
Inflammatory conditions, adrenocortical insufficiency

Anxiety, GI discomfort, headache, fluid retention, cataracts, increased weight
Reduce bone density = increase fracture risk with fall
Amiodarone = hypokalaemia
Aspirin = increased risk of GI bleeding
Live vaccines

Question 9

Pizotifen

Answer 9

Serotonin + tryptamine antagonist for migraine prophylaxis
Prevention of migraine/cluster headache
Increased appetite + weight
Dizziness, drowsiness
Dry mouth
Fatigue
Nausea
Causes dizziness = may increase risk of falls
Alcohol, amitrityline, codeine, lorazepam = increased risk of CNS depressant
Isocarboxazid = increased risk of antimuscarinic adverse effects

Question 10

Zopiclone

Answer 10

Non-benzodiazepine hypnotic
Insomnia
Dry mouth, taste bitter, anxiety, dizziness, fatigue, headache, nausea, sleep disorders, vomiting
Increases risk of falls through cognitive + psychomotor impairment
Alcohol, fentanyl, ketamine = CNS Depressant

Question 11

Entacapone

Answer 11

Selective reversible COMT inhibitor
Adjunct to co-beneldopa/careldopa in PD with ‘end-of-dose’ motor fluctuations
Abdominal pain, confusion dizziness, diarrhoea, movement disorder, red-brown urine
Increase risk of falls a make drowsy
Increased risk of CV events when give with adrenaline, dobutamine
Increases exposure to levo + methyldopa

Question 12

Ropinirole

Answer 12

Non-ergoline dopamine agonist
Parkinson’s disease (alone/adjunct to levodopa), Restless Legs Syndrome
Confusion, dizziness, GI discomfort, hallucination, movement disorders, compulsive behaviour
?orthostatic hypotension, fall asleep suddenly
Bisoprolol, captopril, chlorpromazine = increased risk of hypotension

Question 13

Amitriptyline

Answer 13

TCA
Neuropathic pain, depression, migraine prophylaxis
Anticholinergic syndrome, drowsiness, QT interval prolongation
Increased risk of falls
Increases effect of adrenaline
Alcohol = increased risk hypotension
Alfentanil = CNS depressant

Question 14

Co-beneldopa/carelodopa

Answer 14

CC = levodopa + carbidopa (Sinemet)
CB = levodopa + benserazide (Madopar)

Levodopa = dopamine precursor
Carbidopa/benserazide =  dopa-decarboxylase inhibitor

Anxiety, arrhythmia, depression, diarrhoea, hallucination, dizziness, movement disorders, postural hypotension, compulsive behaviour
High risk of falls
Alcohol, BP medication = risk of hypotension

Question 15

Trimethoprim

Answer 15

Antifolate antibiotic
UTI
(Co-trimoxazole = trimethoprime/sulfamethoxazole)
Diarrhoea, electrolyte imbalance, headache, skin reaction, vomiting
No impact on falls?
Nephrotoxicity with aciclovir
Hyponatraemia with amitriptyline

Question 16

Tamsulosin

Answer 16

Alpha-1 adrenergic receptor antagonist
BPH
Dizziness, postural hypotension/micturition syncope, sexual dysfunction, asthenia, constipation, palpitations
Increases risk of falls
Basically all drugs increase risk of hypotension!

Question 17

Oxybutynin

Answer 17

Antimuscarinic which reduces detrusor muscle activity = relaxes bladder = prevents urgency
Urinary frequency, urgency, incontinence
STOPP: delirium/dementia, narrow-angle glaucoma, chronic prostates, treating extrapyramidal side-effects of antipsychotics
Constipation, dizziness, dry mouth, flushing, headache, palpitations, skin reactions, vision disorders, vomiting
May cause dizziness/confusion = increased risk of falls
Cyclizine, haloperidol, hyoscine, nortryptiline, = antimuscarinic effect

Question 18

Cinnarizine

Answer 18

Antihistamine + CCB
Vestibular disorders: vertigo, tinnitus, N+V in Meniere’s
Drowsiness, GI discomfort, nausea, increased weight
Risk of falls as sedating
Aripiprazole, bupivacaine, codeine, lorazepam = CNS depressant

Question 19

Baclofen

Answer 19

GABA-ergic agonist
Severe spasticity of cerebral/spinal origin, esp in palliative care
Conusion, constipation, dry mouth, hallucination, headache, hyperhidrosis, hypotension, paraesthesia, vision disorders, vomiting, bradycardia
Sedative + reduced muscle tone = increases risk of falls
Many many drugs= hypotension/CNS Depressant

Question 20

Digoxin

Answer 20

Cardiac glycoside, increases force of myocardial contraction + reduces AV node conductivity
Atrial flutter
HF
Risk of toxicity if eGFR<30
Arrythmia, cerebral impairment, diarrhoea, dizziness, skin reactions, vision disorders, vomiting
Increased risk of falls as causes bradycardia or other arrhythmia
Azithromycin, betamethasone, calcitriol, hydrocortisone = increases conc of digoxin + toxicity risk

Question 21

Doxazocin

Answer 21

Alpha-1 antagonist
HTN
BPH
Arrythmias, chest pain, cough, cystitis, dizziness, dry mouth, headache, oedema, increased risk of infection, palpitations, vertigo
Cause severe orthostatic hypotension = increased risk of falls
Many many drugs increase risk of hypotension

Question 22

Simvastatin

Answer 22

Competitively inhibit HMG CoA reductase, reducing cholesterol synthesis, especially in the liver
Primary/familial hypercholesterolaemia
Asthenia, constipation, diarrhoea, muscle toxicity (don’t start if CK>5x upper limit of normal), thrombocytopenia, sleep disorders
Increased risk of falls due to worsened muscle performance
Ciclosporin, grapefruit juice, verapamil = large increase in exposure to statin
Ciprofibrate, colchicine = increased risk of rhabdomyolysis
Paracetamol = increased risk of hepatic toxicity

Question 23

Clopidogrel

Answer 23

P2Y12 ADP receptor inhibitor antiplatelet
ACS
TIA if aspirin contraindicated
Diarrhoea, GI discomfort, Haemorrhage, Skin reactions
Increased risk of haemorrhage after fall
Increased risk of bleeding with other anti-thrombotic
Grapefruit juice decreases the exposure to clopidogrel

Question 24

Ibuprofen

Answer 24

NSAID and non-selective COX inhibitor
Pain
GI discomfort, skin reactions, asthma, hypersensitivity
Increased risk of falls as dizziness/vision impairment
Bendroflumethiazine = increased risk of hypoatrameia
Candesartan = increasesd risk of hyerkalaemia
Ceftriaxone = increased risk of nephrotoxicity
Dexamethasone = increased risk of GI bleeding

Question 25

Gabapentin

Answer 25

Anti-convulsant, inhibits release of excitatory neurotransmitters Neuropathic pain Seizure Muscular sx in MND Anxiety, altered appetite, confusion, constipation, drowsiness, GI discomfort, cognitive impairment, respiratory depression Some potential impact on falls Many drugs cause CNS depression

Question 26

Phenytoin

Answer 26

Sodium-channel blocker anti-epileptic Tonic-clonic/focal seizures, status epilepticus Nystagmus, decreased coordination, tremor, slowed cognition and movement, memory problems, slurred speech, poor concentration Big risk of falls as drowsiness, dizziness Amiodarone = peripheral neuropathy CYP450 inducer = decreases exposure to many drugs (clozapine, edoxaban, fentanyl etc)

Question 27

Amiodarone

Answer 27

Class III antiarrythmic (K+ blocker) Arrythmias, VF/pulseless VT SFx = arrhythmia, hepatic disorders, hyperthyroidism, nausea, respiratory disorders, skin reactions Big impact on fall risk = STOPP (higher risk than beta-blocker, digoxin, verapamil, diltiazem) Avoid in Sino-atrial heart block/bradycardia, thyroid dysfunction, acute porphyrias, HF, hypokalaemia, severe bradycardia

Question 28

Levetiracetam

Answer 28

Anti-epileptic Focal seizures, adjunct for myoclonic/tonic-clonic seizures Dizziness, headache, irritability, loss of strength + energy, mood + behaviour change, sleepiness Increase risk of falls Many drugs, morphine etc = CNS depressants too Decreases clearance of methotrexate

Question 29

Sodium valproate

Answer 29

Anti-epileptic which increases GABA transmission Nausea, diarrhoea, swollen gums, tremors, nystagmus, sleepiness, headache, weight gain hair thinning, irregular periods Increased risk of falls Atorvastatin, isoniazid = increased risk of hepatotoxicity CYP450 inhibitor = increases exposure to many drugs

Question 30

Isosorbide mononitrate

Answer 30

Prodrug for nitric oxide, which is a vasodilator gas released when IM is metabolised = relaxation of smooth muscle cells GTN spray/tablet/patch is similar Angina STOPP: long-acting nitrate with persistent postural hypotension = risk of syncope and falls Headaches, dizziness, weak/sleepy, nausea, flushing, oedema, acute angle closure glaucoma May cause falls due to syncope BP tablets and others = increased risk of hypotension

Question 31

Gliclazide

Answer 31

Sulphonylurea T2DM STOPP if long-acting in T2DM as risk of prolonged hypoglycaemia Abdo pain, diarrhoea, hypoglycaemia, nausea Can cause hypoglycaemia = falls Other DM medication = hypoglycaemia Chloramphemicol = increases exposure to gliclazide Rifampicin = decreases exposure to gliclazide

Question 32

Codeine phosphate

Answer 32

Selective agonist at mu opined receptor (weaker affinity than morphine) Pain STOPP: if without laxative/no need/long-acting without breakthrough relief Respiratory depression, arrhythmia, confusion, palpitations, urinary retention, vertigo, dependence = taper, biliary spasm, postural hypotension, sexual dysfunction Big impact on falls Most impact on CNS depression Buprenorphine = increases risk of opiate withdrawal when given with morphine Clozapine = constipation

Question 33

Ramipril

Answer 33

ACEi HTN Dry cough, dizziness, headaches, diarrhoea, vomiting, rash, blurred vision Risk of falls, check for postural hypotension Many drugs = risk of hypotension Ramipril + aliskiren/amiloride = hyperkalaemia risk Azathioprine = risk of anaemia/leucopenia

Question 34

Furosemide

Answer 34

Loop diuretic Oedema, resistent hypertension STOPP: use other antihypertensive, urinary incontinence (may make it worse), oedema without HF (compression stockings instead) Increased urinary frequency Thirst, dry mouth, headache, confusion, dizziness, nausea/vomting, electrolyte imbalance, muscle spasm, deafness Increases risk of falls - orthostatic hypotension, weakness (hyponatraemia + hypokalaemia) Cardiac glycosides (digoxin), Amiodarone, clarithromycin, flecainide = hypokalaemia Indometacin = hyponatraemia Many drugs = hypotension

Question 35

Bisoprolol

Answer 35

Beta-blocker HTN STOPP: bradycardia, type II heart block, DM with lots of hypos, asthma + non-selective one Headaches, dizziness, cold hands/feet, n/v, constipation Increases risk of falls (bradycardia, hypotension, carotid sinus hypersentivitiy, orthostatic HTN, vasovagal syncope) Many drugs, esp anti-hypertensives = hypotension Amiodarone = cardiovascular events Diltiazem/digoxin = bradycardia

Question 36

Mirtazapine

Answer 36

Tetracyclic antidepressant Major depression, OCD, anxiety Dry mouth, increased appetite + weight gain, headaches, sleepiness, n/v, diarrhoea, constipation High risk of falls, due to drowsiness, blurred vision, dizziness, constipation, urinary retention Consider alternative if possible, to SSRI Many drugs = CNS depressants Bupropion, Citalopram, fentanyl = risk of serotonin syndrome Carbamazepine = decreases exposure to mirtazapine

Question 37

Sertraline

Answer 37

SSRI Depression, panic disorder, PTSD Nausea, headaches, unable to sleep, sleepiness, diarrhoea, dry mouth, dizziness, tiredness, weakness May cause falls with orthostatic hypotension + bradycardia, but rare Aspirin and many others = risk of bleeding Bendroflumethiazide = hyponatraemia Bupropion, tramadol = serotonin syndrome

Question 38

Aspirin

Answer 38

Acetylsalicylic acid, blocks prostaglandin synthesis, non-selective for COX-1 and 2 Secondary prevention of CVD Unstable angina, NSTEMI STEMI TIA AF if anticoagulation risk too high Migraine, pre-eclampsia Indigestion, bleeding, dyspnoea, SCARs, skin reactions, aplastic anaemia Risk of bleeding after fall NSAID, anti-platelets etc = increased risk of bleeding

Question 39

Dabigatran etexilate

Answer 39

direct thrombin inhibitor with rapid onset of action Prophylaxis of VTE Prophylaxis of AF if have risk factors for stroke Not if anti-phospholipid syndrome as warfarin better STOPP: bleeding risk/severe HTN, DVT/PE without continuing risk factors, dual therapy in CVD as no proven added benefit, eGFR <30 Anaemia, diarrhoea, GI discomfort, haemorrhage, abnormal LFTs, nausea Risk of bleeding if fall? Aspirin etc = risk of bleeding Phenytoin, St John's wort = decreases exposure to Dabigatran (CYP450 inducer)

Question 40

Warfarin

Answer 40

Vitamin K antagonist Prophylaxis after VTE/PE TIA STOPP: bleeding risk/severe HTN, DVT/PE without continuing risk factors, dual therapy in CVD as no proven added benefit Haemorrhage (mild or serious), rash, hair loss, nausea/vomiting Increases bleeding risk if fall Green vegetables, green tea, alcohol consumption = can alter anticoagulant control Pomegranate juice = increases INR Many medications inc anticoagulants + sertraline = increased bleeding risk Prednisolone = increases effect of warfarin Rifampicin = decreases effect of warfarin

Question 41

Senna

Answer 41

Stimulant laxative Constipation Contraindicated = intestinal obstruction, undiagnosed abdo pain Stomach cramps, diarrhoea, red-brown urine, anaphylaxis Senna may increase rushing to toilet = falls (?) Furosemide/digoxin = Senna can decrease K+ Warfarin/COCP = diarrhoea from Senna stops absorption of drug

Question 42

Selegiline hydrochloride

Answer 42

Monoamine-oxidase-B inhibitor = enhances dopaminergic activity as less dopamine broken down Parkinson's disease HTN if take with tyrosine-rich foods (mature cheese, salami, Bovril, Oxo, Marmite, beers/wines etc) Arrythmias, confusion, constipation, depression, dry mouth, muscle cramps, nasal congestion, tremor, vertigo, hypotension, sudden daytime sleepiness Increases risk of falls Amantadine, anti-hypertensives etc = hypotension Bisoprolol etc = bradycardia COCP = increase selegiline exposure Dopamine, dobutamine = hypertensive crisis Duloxetine = serotonin syndrome

Question 43

Lorazapam

Answer 43

Short-acting benzodiazepine Anxiety, difficulty sleeping, panic attacks, status epilepticus STOPP: 4 weeks or longer (no need, withdraw over 2 weeks) Acute/chronic T1/2 resp failure If prone to falls (as sedative = reduce sensorium + impair balance) Sleepy/tired, muscle weakness, coordination problems, respiratory depression, hallucinations, mood changes, amnesia Increases risk of falls (as can cause drowsiness which can last into next day, confusion, lightheadedness, amnesia) Many drugs inc opioids, lamotrigine, amitriptyline, zopiclone = CNS depressant