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SE of drugs Flashcards

1
Q

What colour does Senna cause your urine to be?

A

Red/yellow

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2
Q

What colour does sulfasalazine cause your urine to be?

A

Yellow-orange

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3
Q

What colour does phenindione cause your urine to be?

A

Pink/orange

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4
Q

What colour does levodopa preparations cause your urine to be?

A

Reddish/darker

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5
Q

What colour does entacapone cause your urine to be?

A

Reddish brown

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6
Q

What colour does nefopam cause your urine to be?

A

Pink

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7
Q

What colour does Clofazimine cause your urine to be?

A

Red

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8
Q

What colour does nitrofurantoin cause your urine to be?

A

Yellow/brown

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9
Q

What colour does rifabutin cause your urine to be?

A

Orange-red

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10
Q

What colour does rifampicin cause your urine to be?

A

Orange-red

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11
Q

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

A

Red

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12
Q

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

A

Blue in some lights

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13
Q

What colour does deferiprone cause your urine to be?

iron chelator

A

Reddish brown

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14
Q

True or false:

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

A

True

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15
Q

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

A

Drowsiness, dizziness, confusion, postural hypotension, visual disturbances

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16
Q

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

A

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

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17
Q

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

A

Drowsiness, dizziness, confusion, blurred vision

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18
Q

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

A

Drowsiness, unsteady gait (walking), confusion

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19
Q

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

A

Sudden onset of sleep, postural hypotension, confusion

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20
Q

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

A

Dizziness, postural hypotension

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21
Q

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

A

Dizziness, postural hypotension

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22
Q

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

A

Bradycardia, arrhythmias, dizziness

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23
Q

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

A

Dizziness, drowsiness, confusion, visual disturbances

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24
Q

What are the signs of phenytoin toxicity?

A

Confusion, visual disturbances, fever, drowsiness and ataxia

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25
Q

What is ataxia?

A

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

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26
Q

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

A

Dizziness, postural hypotension

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27
Q

Make a list of drugs that commonly cause diarrhoea

A 
Mg containing antacids, H2 antagonists, PPIs
Misoprostol
ASAs 
Orlistat
Digoxin, Methlydopa, ACEi
SSRIs
Antibiotics
Metformin, Sulphonylureas e.g. gliclazide, glipizide, Acarbose
Levothyroxine (usually at excessive dose)
Cytotoxic drugs e.g. methotrexate
Iron preparations
NSAIDs
Colchicine
Leflunomide
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28
Q

Make a list of drugs that commonly cause constipation

A

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

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29
Q

Make a list of drugs that commonly cause hyperkalaemia

A 
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
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30
Q

Make a list of drugs that may cause diarrhoea

A 
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
31
Q

Make a list of drugs that may cause constipation

A

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

32
Q

Make a list of drugs that may cause hyperkalaemia

A 
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
33
Q

Make a list of drugs that may cause hypokalaemia

A 
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
34
Q

Make a list of drugs that may cause hypernatraemia

A 
Diuretics
Sodium bicarbonate
Sodium chloride
Corticosteroids
Anabolic steroids
Adrenocorticotrophic steroids
Androgens
Oestrogens
35
Q

Make a list of drugs that may cause hyponatraemia

A 
ACEi, diuretics (loop/thiazide)
Heparin
Antidepressants, Antipsychotics
Carbamazepine, Oxcarbazepine, Eslicarbazepine
Atovaquone
Amphotericin
Trimethoprim
Sulphonylureas e.g. gliclazide
Desmopressin
Cyclophosphamide
Acetazolamide (carbonic anhydrase inhibitor)
36
Q

Make a list of drugs that may cause neutropenia*

A 
ASA
Captopril, Hydralazine
Phenothiazines
Clozapine
Imipramine
AED: Carbamazepine, Ethosuximide, Phenytoin, Valproic acid
Atovaquone
Antibiotics; Cephalosporins, Chloramphenicol, Ciproflox, Metronidazole, sulphonamides, 
Chloroquine
Carbimazole
Propylthiouracil
Deferiprone
Ibuprofen, Indometacin
Anakinra
Allopurinol, Colchicine, Gold
MTX
Penicillamine
37
Q

Make a list of drugs that may cause thrombocytopenia

A

Digoxin
Heparin, Abciximab, Eptifibatide, Tirofiban
Carbamazepine, Phenytoin, Sodium Valproate
Chloramphenicol, Linezolid, Penicillins, Sulphonamides
Propylthiouracil
Interferon alfa and beta
Phenylbutazone (nsaid)
Azathioprine, MTX, Ciclosporin
Gold, sulfasalazine
Infliximab, Rituximab
Penicillamine

38
Q

What pulmonary side effect can NSAIDs cause?

A

Bronchospasm

39
Q

What pulmonary side effects can amiodarone cause?

A

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

40
Q

What pulmonary side effects can methotrexate cause?

A

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

41
Q

What pulmonary side effects can nitrofurantoin cause?

A

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

42
Q

What pulmonary side effects can mitomycin C cause?

A

Interstitial pneumonitis, pulmonary fibrosis, bronchospasm

43
Q

What pulmonary side effects can bleomycin cause?

A

Interstitial pneumonitis, pulmonary fibrosis

44
Q

What pulmonary side effects can infliximab cause?

A

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

45
Q

Make a list of drugs that cause insomnia

A

MAOIs e.g. phenelzine, tranylcypromine
SSRIs e.g. fluoxetine, citalo., sert., paroxetine
Bupropion
Pseudoephedrine
Highly lipid soluble BB e.g. propranolol, labetalol and metoprolol => BBB
AEDs e.g. lamotrigine, phenytoin
Lipophilic BBB statins (simvastatin and atorvastatin)
Methylphenidate
Corticosteroids
Levothyroxine (usually due to excessive dosage)
Griseofulvin
Theophylline
Beta2 agonists e.g. salbutamol, salmeterol
Oxycodone

46
Q

Is cetirizine a sedating antihistamine?

A

No

47
Q

Is acrivastine a sedating antihistamine?

A

No

48
Q

Is hydroxyzine a sedating antihistamine?

A

Yes

49
Q

Is promethazine a sedating antihistamine?

A

Yes

50
Q

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

A

• 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.

51
Q

What can G6PD deficiency lead to?

A

Haemolytic anaemia and can occur from taking certain drugs

52
Q

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

A
  • Dapsone
  • Methylene blue
  • Nitrofurantoin
  • Primaquine
  • Quinolones
  • Sulphonamides
  • Aspirin
  • Chloroquine
  • Menadione
  • Quinine
53
Q

What drug classes cause AKIs (CANDA)?

A 
Contrast Media
ACEi
NSAIDs
Diuretics
ARBs
54
Q 
Which of the following does not cause ulcers?
A. Ciclosporin
B. Alendronate
C. Omeprazole
D. Budesonide
E. Prednisolone
F. Aspirin
A

C. Omeprazole

55
Q

The risk of serious skin related adverse drug reactions occurring with Carbamazepine (plus Oxcarbazepine and Esilcarbazepine) may be increased by the HLA-A*3101 allele found in patients of what ethnicity?

A

European

Plasma concentration for optimum response 4–12 mg/litre (20–50 micromol/litre) measured after 1–2 weeks.

Test for HLA-B1502 allele in individuals of Han Chinese or Thai origin (avoid unless no alternative—risk of Stevens-Johnson syndrome in presence of HLA-B1502 allele).

56
Q

What is DRESS syndrome and what drugs may cause it?

A

Drug Rash with Eosinophilia and Systemic Symptoms. Characterised by rash, fever and patients should be advised to stop taking medication and seek medical attention.

  • Carbamazepine (+ Steven Johnsons)
  • Oxcarbazepine
  • Esilcarbazepine
  • Strontium (a bisphosphonate)
57
Q

When must the herbal remedy Echinacea be avoided, and why?

A

Should not be given to children under 12 yrs due to risk of severe allergic reaction outweighing any benefits

58
Q

In the case of an anaphylactic reaction, where should adrenaline auto-injector pens be administered?

A

Outer thigh!

NB: the MHRA advise that an ambulance is called after every use of an auto-injector, even if symptoms are improving

59
Q

Medication errors, especially those that have gone out to the patient, even if they do not cause harm, should be reported to who?

A

NRLA- national reporting and learning system

60
Q

If you want to work out bioavailability of a drug as an Oral M/R prep, IR prep, oral solution etc, what should you always compare against?

A

Bioavailability of the drug as a parenteral solution given by IV bolus or IV infusion- this would show its complete absorption bioavailability

61
Q

What laboratory test is needed to confirm someone is suffering from a hypersensitivity reaction?

A

Full Blood Count and differential- to look for presence of IgE?

62
Q

Drugs which may cause taste disturbance?

A. Amlodipine
B. Ibuprofen
C. Metformin
D. Linezolid
E. Suxamethonium
A 
metformin
terbinafine (antifungal)
lithium
ACE inhibitors
amiodarone
metronidazole
63
Q

What drug can cause gingival hyperplasia (gum enlargement)?

A. Tetracyline
B. Phenytoin
C. Amiodarone
D. Metronidazole
E. Nifedipine
F. Mesalazine
G. Ciclosporin
H. Allopurinol
A

Phenytoin

also less commonly Nifedipine and ciclosporin

64
Q

Osteonecrosis of the jaw can results from Bisphosphonate use. This is more common with IV or Oral?

A

IV

But all patients on bisphosphonates should have a dental check-up before starting therapy

65
Q

What could cause brown staining of the teeth?

A

Most common cause: Chlorhexidine mouthwash
Iron salts
Intrinsic staining: tetracyclines (usually only in children)

66
Q

What is Steven Johnsons Syndrome? What could cause it?

A

Severe hypersensitivity reaction:
Ulcers and other lesions begin to appear in the mucous membranes, almost always in the mouth and lips, but also in the genital and anal regions. Rash usually appears all over the body bar the scalp.

Drugs causing it examples: a lot of the anti-epileptics
Lamotrigine (most common!)
Phenytoin
Carbamazepine

67
Q

Do all ADR’s in children have to be reported?

A

The BNF states they do!! ALL of them

68
Q 
Endocrine disorders
Anaphylaxis
Jaudine
Heamorrhage
Renal impairment
Eye disorders
Fertility effects

Are all examples of what and should they be reported in all cases?

A

‘Serious’ reactions that must be reported to MHRA in all circumstances.

Any pro-longed hospitalisation, disabling, fatal, teratogenicity all must be reported.

69
Q

What does the black triangle mean?

A

Means this drug is recently on the market- so it prompts people that all ADR’s need to be reported with these drugs.
Usually kept for 5 years

70
Q

Pt is starting therapy on warfarin for 1st time what are the key counselling points

A

WARFARINISED
W - WHEN to take; same time each day
A - Alcohol; can ^anticoagulant effect
R - Risk of bleeding; blood takes longer to clot. Nosebleed, gums, stool blood go to A&E
F - Followup; appts to check INR
A - Aspirin; avoid taking unless prescriber issued it
R - Reason: slow down blood clot rate
I - Interactions; OTC meds, green leafy veg w Vit K oppose warfarin effects, avoid eating large amounts
N - notify HCP before further tx
I - INR; AF range 2-3 target 2.5
S - skipped doses, do not take double dose
E - End of course; durations can vary
D - Dose; yellow book. 1mg brown, 3mg blue, 5mg pink

71
Q 
Which of the following are linked to bradycardia?
A. Lithium
B. Fluoxetine
C. Rivastigmine 
D. Amlodipine 
E. Bisoprolol 
F. Omeprazole 
G. Terbinafine
A

A. Lithium - @therapeutic doses, blocks cardiac Ca channels => sinus node dysfunction and bradycardia
B. Fluoxetine - SSRIs minor reductions in HR
C. Rivastigmine - Acetylcholinesterase inhibitors can cause AV node suppression via parasympathetic innervation of myocardium. Normally OK but may precipitate complete heart block w preexisting conduction delay eg BBB, 2nd deg HB, combo drugs
D. Amlodipine Xno
E. Bisoprolol - Betablockers, eye drops systemic also
F. Omeprazole Xno
G. Terbinafine Xno

Fingolimod - known to cause transient reduction in HR and reduce AV conduction after 1st dose including occurrence of heart block 🚫
TCAs - dose dependent, normally OK. 
Ivabradine
Digoxin
Antiarrhythmic drugs
Rare limiting CCB, normally ok
Opioid antagonist eg naloxone
Amiodarone x Antivirals 
Carbamazepine - rarely assc. With bradycardia
72
Q

Symptoms of ____________ toxicity include nystagmus, diplopia, slurred speech, ataxia, confusion, and hyperglycaemia.

A. Lithium
B. Theophylline
C. Carbamazepine
D. Phenytoin

A

Symptoms of phenytoin toxicity include nystagmus, diplopia, slurred speech, ataxia, confusion, and hyperglycaemia.

73
Q

HLAB* 1502 allele in individuals of Han Chinese or Thai origin—avoid unless essential (increased risk of Stevens- Johnson syndrome).

A. Citalopram
B. Methotrexate
C. Pregabalin
D. Carbocysteine
E. Phenytoin
A

E. Phenytoin

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