PSA: Common Drug Effects Flashcards
What are the complications of amiodarone use?
- thyrotoxicosis
- pulmonary fibrosis
What are the complications of digoxin use?
- drug induced gynaecomastia
What are the complications of carbimazole use?
Agranulocytosis (safety net for sore throat/fever)
What are the complications of lamotrigine use?
Rarely, Steven Johnson syndrome (safety net for viral prodrome, hypersensitivity rash which may spare scalp/hands/feet)
What drugs can cause gingival hyperplasia?
- ciclosporin
- phenytoin
- CCBs
(AML also associated…)
What are the complications of methotrexate use?
- mucositis
- folate deficiency
Which drugs can cause urinary retention?
- anticholinergics e.g. oxybutynin
- opioids
- TCAs
- NSAIDs
Statins are contraindicated in…
pregnancy
What are the side effects of corticosteroids?
a. STEROIDS:
i. Stomach ulcers
ii. Thin skin
iii. oEdema
iv. Right and left heart failure
v. Osteoporosis
vi. Infection (including Candida)
vii. Diabetes (mostly just hyperglycaemia alone)
viii. Cushing’s Syndrome
also: insomnia
What are the side effects of NSAIDs?
a. NSAID:
i. No urine (i.e. renal failure)
ii. Systolic dysfunction (i.e. heart failure)
iii. Asthma
iv. Indigestion (any cause)
v. Dyscrasia (clotting abnormality)
What are the side effects of anti-hypertensives generally and specifically?
- Anti-hypertensives
a. Hypotension
b. Bradycardia
i. With beta blockers, some CCBs
c. Electrolyte disturbance
i. ACEi and diuretics
d. Specifics
i. ACEi = dry cough
ii. Beta blockers = wheeze in asthmatics, can worsen ACUTE heart failure (improve in chronic!)
iii. CCBs = peripheral oedema, flushing
iv. Diuretics = renal failure, thiazide diuretics = gout, K+ sparing = gynaecomastia
RIPE side effects?
R: orange secretions, hepatotoxicity, P450 inducer e.g. can increase warfarin metabolism
I: peripheral neuropathy, drug induced lupus, B6 deficiency
P: GI symptoms (puke), gout
E: optic neuritis
You should never use verapamil with WHICH drug?
beta blockers
You should never use verapamil in which cardiac condition?
VT - blocks calcium current responsible for sinus and AV depolarisation - can cause haemodynamic deterioration in VT –> VF + cardiac arrest
Loop diuretics can cause…
ototoxicity
PDE5 inhibitors (e.g. sildenafil) and WHAT drug is contraindicated?
nitrates, due to risk of severe refractory hypotension
Name some immunomodulators safe for use in pregnancy
Azathioprine, hydroxychloroquine
Mesalazine can cause…
drug induced pancreatitis
Metaclopramide should be avoided in…
PD patients and young women (risk of dyskinesia)
Cyclizine is first line except in…
heart failure (can cause fluid retention)
Statins interact severely with….
macrolides!! (clarithromycin basically interacts with everything including warfarin)
What drugs cause erythema multiforme?
(circular target lesions, rapid onset but self limiting after 1-2 weeks)
- aminopenicillins e.g. co-amoxiclav, sulphonamides, carbamazepine, allopurinol, NSAIDs and the oral contraceptive pill
What drug is used for benzodiazepine toxicity + route?
IV flumazenil
What drug reverses heparin?
protamine sulfate
What is phytomenadione?
vitamin K used to reverse warfarin
What reverses dabigatran?
Idarucizuamb
A patient has minor bleeding and is on warfarin. Their INR is 7.0. What do you do?
- stop warfarin
- give IV vit K 1-3mg
- restart when INR <5.0
(Mx if minor bleeding and INR 5-8)
A patient has no bleeding and is on warfarin. Their INR is 7.0. What do you do?
- Withhold 1 or 2 doses of warfarin
- reduce subsequent maintenance dose
(no bleeding + INR 5-8 Mx)
A patient has no bleeding and is on warfarin. Their INR is 9.0. What do you do?
(mx for no bleeding and INR >8)
- stop warfarin
- PO vit K 1-5mg (use IV prep orally)
- repeat dose if INR still too high after 24 hours
- restart when INR <5.0
A patient has minor bleeding and is on warfarin. Their INR is 9.0. What do you do?
(mx when minor bleeding and INR >8)
- stop warfarin
- IV vit K 1-3mg
- repeat dose if INR still too high after 24 hours
- restart warfarin when INR <5.0
A patient has a variceal haemorrhage on warfarin. What do you do?
major bleed = also intracranial etc
STOP warfarin
IV vit K 5mg
and prothrombin complex concentrate (2nd line FFP)
Name drugs that can cause long QT syndrome:
- amiodarone, sotalol, class 1a antiarrhythmic drugs
- TCAs, SSRIs esp citalopram
- methadone
- chloroquine
- terfenadine
- erythromycin
- haloperidol
- ondansetron
Non drug causes of long QT syndrome:
- electrolytes e.g. hypocalcaemia, hypokalaemia, hypomagnesaemia
- acute MI
- acute myocarditis
- hypothermia
- SAH
- congenital cases e.g. jervell-lange-nielsen syndrome (deafness), romano-ward syndrome (no deafness)
What is a complication of long QT syndrome?
VT/TdP
normally QT <430ms in males, <450ms females
Draw out toxicity bear!
Asparagine = neurotoxicity
Cisplatin = oto/nephrotoxic
Vincristine/vinblastine = peripheral neuropathy
Bleomycin = pulmonary fibrosis
Doxorubicin = cardiotoxic
Cyclophosphamide (psi symbol) = haemorrhagic cystitis
Methotrexate = nephrotoxic + myelosuppression (tx = filgrastim)
A patient with previous MI and depression presents with erectile dysfunction. Which of his drugs is likely to have caused this?
bisoprolol, SSRIs
Treatment of cluster headaches can involve both high flow oxygen and triptans, however, triptans are contraindicated in patients
with CAD as they have the potential to cause coronary vasospasm
Name drugs associated with toxic epidermal necrolysis:
phenytoin, penicillins, sulphonamides, allopurinol, carbamazepine, NSAIDs
Name some side effects of phenytoin
- gingival hyperplasia + bleeding
- peripheral neuropathy
- lymphadenopathy
- megaloblastic anaemia
