Resource Pharm - side effects

Question 1

What colour does Senna cause your urine to be?

Answer 1

Red/yellow

Question 2

What colour does sulfasalazine cause your urine to be?

Answer 2

Yellow-orange

Question 3

What colour does phenindione cause your urine to be?

Answer 3

Pink/orange

Question 4

What colour does levodopa preparations cause your urine to be?

Answer 4

Reddish/darker

Question 5

What colour does entacapone cause your urine to be?

Answer 5

Reddish brown

Question 6

What colour does nefopam cause your urine to be?

Answer 6

Pink

Question 7

What colour does Clofazimine cause your urine to be?

Answer 7

Red

Question 8

What colour does nitrofurantoin cause your urine to be?

Answer 8

Yellow/brown

Question 9

What colour does rifabutin cause your urine to be?

Answer 9

Orange-red

Question 10

What colour does rifampicin cause your urine to be?

Answer 10

Orange-red

Question 11

What colour does dantrone medicines cause your urine to be? e.g. co-danthramer, co-danthrusate

Answer 11

Red

Question 12

What colour does triamterene medicines cause your urine to be? e.g. Frusene, co-triamterzide

Answer 12

Blue in some lights

Question 13

What colour does deferiprone cause your urine to be?

iron chelator

Answer 13

Reddish brown

Question 14

True or false:

SSRIs are less sedating and are associated with fewer antimuscarinic and cardiotoxic side effects than tricyclic antidepressants

Answer 14

True

Question 15

What are the side effects of antidepressants that could contribute to a fall?

Answer 15

Drowsiness, dizziness, confusion, postural hypotension, visual disturbances

Question 16

What are the side effects of antipsychotics that could contribute to a fall?

Answer 16

Postural hypotension, drowsiness, unsteady gait (walking), confusion

Question 17

What are the side effects of antimuscarinics that could contribute to a fall?

Answer 17

Drowsiness, dizziness, confusion, blurred vision

Question 18

What are the side effects of benzos and hypnotics e.g. zopiclone that could contribute to a fall?

Answer 18

Drowsiness, unsteady gait (walking), confusion

Question 19

What are the side effects of dopaminergic drugs used in Parkinson’s that could contribute to a fall?

Answer 19

Sudden onset of sleep, postural hypotension, confusion

Question 20

What are the side effects of ACEi and ARBs that could contribute to a fall?

Answer 20

Dizziness, postural hypotension

Question 21

What are the side effects of alpha blockers that could contribute to a fall?

Answer 21

Dizziness, postural hypotension

Question 22

What are the side effects of anti-arrythmics that could contribute to a fall?

Answer 22

Bradycardia, arrhythmias, dizziness

Question 23

What are the side effects of antiepileptic drugs that could contribute to a fall?

Answer 23

Dizziness, drowsiness, confusion, visual disturbances

Question 24

What are the signs of phenytoin toxicity?

Answer 24

Confusion, visual disturbances, fever, drowsiness and ataxia

Question 25

What is ataxia?

Answer 25

Group of disorders that affect co-ordination, balance and speech

Question 26

What are the side effects of beta blockers that could contribute to a fall?

Answer 26

Dizziness, postural hypotension

Question 27

What are the side effects of diuretics that could contribute to a fall?

Answer 27

Dizziness, postural hypotension

Question 28

Make a list of drugs that commonly cause diarrhoea

Answer 28

``` Magnesium containing antacids H2 antagonists PPIs Misoprostol Aminosalicylates Orlistat Digoxin Methlydopa ACEi SSRIs Antibiotics Sulphonylureas e.g. gliclazide, glipizide Metformin Acarbose Levothyroxine (usually at excessive dose) Cytotoxic drugs e.g. methotrexate Iron preparations NSAIDs Colchicine Leflunomide ```

Question 29

Make a list of drugs that commonly cause constipation

Answer 29

Aluminium containing antacids Antispasmodics (mebeverine, peppermint oil) Colestyramine Diuretics Antihypertensive drugs e.g. clonidine, methyldopa, propranolol, verapamil Sedating antihistamines e.g. chlorphenamine, promethazine Opioid analgesics Tricyclic antidepressants Monoamine-oxidase inhibitors (MAOIs) e.g. moclobemide, phenelzine Antipsychotics e.g. amisulpride, chlorpromazine, clozapine Antiparkinson drugs e.g. entacapone, pramipexole, procyclidine, selegiline Antiepileptic drugs e.g. carbamazepine, oxcarbazepine, phenytoin, pregabalin, Alpha blockers e.g. prazosin, tamsulosin Iron preparations Calcium supplements Bisphosphonates

Question 30

Make a list of drugs that commonly cause hyperkalaemia

Answer 30

``` Potassium-sparing diuretics and aldosterone antagonists Beta blockers Angiotensin-converting enzyme inhibitors (ACE inhibitors) Angiotensin receptor antagonists Aliskiren (renin inhbitor) Digoxin at toxic levels Heparin Trimethoprim and co-trimoxazole Ciclosporin Tacrolimus Potassium supplements or salts NSAIDs ```

Question 31

Make a list of drugs that may cause diarrhoea

Answer 31

``` Magnesium containing antacids H2 antagonists PPIs Misoprostol Aminosalicylates Orlistat Digoxin Methlydopa ACEi SSRIs Antibiotics Sulphonylureas e.g. gliclazide, glipizide Metformin Acarbose Levothyroxine (usually at excessive dose) Cytotoxic drugs e.g. methotrexate Iron preparations NSAIDs Colchicine Leflunomide ```

Question 32

Make a list of drugs that may cause constipation

Answer 32

Aluminium containing antacids Antispasmodics (mebeverine, peppermint oil) Colestyramine Diuretics Antihypertensive drugs e.g. clonidine, methyldopa, propranolol, verapamil Sedating antihistamines e.g. chlorphenamine, promethazine Opioid analgesics Tricyclic antidepressants Monoamine-oxidase inhibitors (MAOIs) e.g. moclobemide, phenelzine Antipsychotics e.g. amisulpride, chlorpromazine, clozapine Antiparkinson drugs e.g. entacapone, pramipexole, procyclidine, selegiline Antiepileptic drugs e.g. carbamazepine, oxcarbazepine, phenytoin, pregabalin, Alpha blockers e.g. prazosin, tamsulosin Iron preparations Calcium supplements Bisphosphonates

Question 33

Make a list of drugs that may cause hyperkalaemia

Answer 33

``` Potassium-sparing diuretics and aldosterone antagonists Beta blockers Angiotensin-converting enzyme inhibitors (ACE inhibitors) Angiotensin receptor antagonists Aliskiren (renin inhbitor) Digoxin at toxic levels Heparin Trimethoprim and co-trimoxazole Ciclosporin Tacrolimus Potassium supplements or salts NSAIDs ```

Question 34

Make a list of drugs that may cause hypokalaemia

Answer 34

``` Laxatives (excessive use) Diuretics High dose beta 2 agonists Theophylline High dose penicillins Gentamicin Amphotericin Echinocandin antifungals High dose insulin Corticosteroids Cisplatin Sodium bicarbonate Parecoxib ```

Question 35

Make a list of drugs that may cause hypernatraemia

Answer 35

``` Diuretics Sodium bicarbonate Sodium chloride Corticosteroids Anabolic steroids Adrenocorticotrophic steroids Androgens Oestrogens ```

Question 36

Make a list of drugs that may cause hyponatraemia

Answer 36

``` ACEi Heparin Diuretics Antidepressants Antipsychotics Carbamazepine Eslicarbazepine Oxcarbazepine Atovaquone Amphotericin Sulphonylureas Desmopressin Cyclophosphamide Acetazolamide ```

Question 37

Make a list of drugs that may cause neutropenia

Answer 37

``` Aminosalicylates Captopril Hydralazine Phenothiazines Clozapine Imipramine Valproic acid Carbamazepine Ethosuximide Phenytoin Atovaquone Cephalosporins Chloramphenicol Chloroquine Ciprofloxacin Metronidazole Sulphonamides Carbimazole Propylthiouracil Deferiprone Ibuprofen Indometacin Anakinra Allopurinol Colchicine Gold Methotrexate Penicillamine ```

Question 38

Make a list of drugs that may cause thrombocytopenia

Answer 38

``` Digoxin Heparin Abciximab Eptifibatide Tirofiban Carbamazepine Phenytoin Sodium Valproate Chloramphenicol Linezolid Penicillins Sulphonamides Propylthiouracil Interferon alfa and beta Phenylbutazone Azathioprine Ciclosporin Gold Infliximab Rituximab Methotrexate Penicillamine Sulfasalazine ```

Question 39

What pulmonary side effect can NSAIDs cause?

Answer 39

Bronchospasm

Question 40

What pulmonary side effects can amiodarone cause?

Answer 40

Interstitial pneumonitis or pulmonary fibrosis, pleural effusions, pulmonary infiltrate with eosinophilia, bronchiolitis obliterans organising pneumonia, postoperative ARDS (acute respiratory distress syndrome)

Question 41

What pulmonary side effects can methotrexate cause?

Answer 41

Interstitial pneumonitis, pulmonary fibrosis, pulmonary oedema, pleuritic pain, pleural thickening

Question 42

What pulmonary side effects can nitrofurantoin cause?

Answer 42

Interstitial pneumonitis, pulmonary fibrosis, hypersensitivity lung reactions, pleural effusion, bronchospasm

Question 43

What pulmonary side effects can mitomycin C cause?

Answer 43

Interstitial pneumonitis, pulmonary fibrosis, bronchospasm

Question 44

What pulmonary side effects can bleomycin cause?

Answer 44

Interstitial pneumonitis, pulmonary fibrosis

Question 45

What pulmonary side effects can infliximab cause?

Answer 45

Respiratory tract infection, pulmonary oedema, bronchospasm, pleurisy, pleural effusion, pulmonary fibrosis

Question 46

Make a list of drugs that cause insomnia

Answer 46

Monoamine-oxidase inhibitors (MAOIs) e.g. phenelzine, tranylcypromine Selective serotonin re-uptake inhibitors (SSRIs) e.g. fluoxetine, citalopram, sertraline, paroxetine Bupropion Pseudoephedrine Highly lipid soluble beta-blockers such as propranolol, labetalol and metoprolol are more likely to cross the blood-brain barrier and cause insomnia Antiepileptics e.g. lamotrigine, phenytoin Lipophilic statins (simvastatin and atorvastatin) are more likely to cross the blood-brain barrier and cause insomnia Methylphenidate Corticosteroids Levothyroxine (usually due to excessive dosage) Griseofulvin Theophylline Beta2 agonists e.g. salbutamol, salmeterol Oxycodone

Question 47

Is cetirizine a sedating antihistamine?

Answer 47

No

Question 48

Is acrivastine a sedating antihistamine?

Answer 48

No

Question 49

Is hydroxyzine a sedating antihistamine?

Answer 49

Yes

Question 50

Is promethazine a sedating antihistamine?

Answer 50

Yes

Question 51

Make a list of drugs that require patient counselling on reporting sore throats due to risk of blood dyscrasias?

Answer 51

• Aminosalicylates (e.g. Mesalazine, Sulfasalazine) Full blood count should be performed and the drug stopped immediately if there is suspicion of a blood dyscrasias. • Mirtazapine • Carbamazepine • Ethosuximide • Phenytoin • Sodium valproate • Co-trimoxazole • Trimethoprim • Carbimazole • Gold (Drug for rheumatic disease) • Penicillamine (Drug for rheumatic disease) • Methotrexate • Azathioprine (transplant recipient) Bone marrow suppression – patients should be warned to report any signs or symptoms of bone marrow suppression e.g. inexplicable bruising, bleeding or infection.

Question 52

What can G6PD deficiency lead to?

Answer 52

Haemolytic anaemia and can occur from taking certain drugs

Question 53

What drugs have a risk of haemolysis in G6PD deficient individuals?

Answer 53

* Dapsone * Methylene blue * Nitrofurantoin * Primaquine * Quinolones * Sulphonamides * Aspirin * Chloroquine * Menadione * Quinine

Question 54

What drug classes cause AKIs (CANDA)?

Answer 54

``` Contrast Media ACEi NSAIDs Diuretics ARBs ```