SE of drugs

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

Make a list of drugs that commonly cause diarrhoea

Answer 27

``` 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 ```

Question 28

Make a list of drugs that commonly cause constipation

Answer 28

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 29

Make a list of drugs that commonly cause hyperkalaemia

Answer 29

``` 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 30

Make a list of drugs that may cause diarrhoea

Answer 30

``` 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 31

Make a list of drugs that may cause constipation

Answer 31

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 32

Make a list of drugs that may cause hyperkalaemia

Answer 32

``` 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 33

Make a list of drugs that may cause hypokalaemia

Answer 33

``` 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 34

Make a list of drugs that may cause hypernatraemia

Answer 34

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

Question 35

Make a list of drugs that may cause hyponatraemia

Answer 35

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

Question 36

Make a list of drugs that may cause neutropenia*

Answer 36

``` 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 ```

Question 37

Make a list of drugs that may cause thrombocytopenia

Answer 37

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

Question 38

What pulmonary side effect can NSAIDs cause?

Answer 38

Bronchospasm

Question 39

What pulmonary side effects can amiodarone cause?

Answer 39

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

Question 40

What pulmonary side effects can methotrexate cause?

Answer 40

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

Question 41

What pulmonary side effects can nitrofurantoin cause?

Answer 41

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

Question 42

What pulmonary side effects can mitomycin C cause?

Answer 42

Interstitial pneumonitis, pulmonary fibrosis, bronchospasm

Question 43

What pulmonary side effects can bleomycin cause?

Answer 43

Interstitial pneumonitis, pulmonary fibrosis

Question 44

What pulmonary side effects can infliximab cause?

Answer 44

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

Question 45

Make a list of drugs that cause insomnia

Answer 45

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

Question 46

Is cetirizine a sedating antihistamine?

Answer 46

No

Question 47

Is acrivastine a sedating antihistamine?

Answer 47

No

Question 48

Is hydroxyzine a sedating antihistamine?

Answer 48

Yes

Question 49

Is promethazine a sedating antihistamine?

Answer 49

Yes

Question 50

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

Answer 50

• 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 51

What can G6PD deficiency lead to?

Answer 51

Haemolytic anaemia and can occur from taking certain drugs

Question 52

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

Answer 52

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

Question 53

What drug classes cause AKIs (CANDA)?

Answer 53

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

Question 54

``` Which of the following does not cause ulcers? A. Ciclosporin B. Alendronate C. Omeprazole D. Budesonide E. Prednisolone F. Aspirin ```

Answer 54

C. Omeprazole

Question 55

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?

Answer 55

European Plasma concentration for optimum response 4–12 mg/litre (20–50 micromol/litre) measured after 1–2 weeks. Test for HLA-B*1502 allele in individuals of Han Chinese or Thai origin (avoid unless no alternative—risk of Stevens-Johnson syndrome in presence of HLA-B*1502 allele).

Question 56

What is DRESS syndrome and what drugs may cause it?

Answer 56

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)

Question 57

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

Answer 57

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

Question 58

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

Answer 58

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

Question 59

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

Answer 59

NRLA- national reporting and learning system

Question 60

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?

Answer 60

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

Question 61

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

Answer 61

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

Question 62

Drugs which may cause taste disturbance? ``` A. Amlodipine B. Ibuprofen C. Metformin D. Linezolid E. Suxamethonium ```

Answer 62

``` metformin terbinafine (antifungal) lithium ACE inhibitors amiodarone metronidazole ```

Question 63

What drug can cause gingival hyperplasia (gum enlargement)? ``` A. Tetracyline B. Phenytoin C. Amiodarone D. Metronidazole E. Nifedipine F. Mesalazine G. Ciclosporin H. Allopurinol ```

Answer 63

Phenytoin | also less commonly Nifedipine and ciclosporin

Question 64

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

Answer 64

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

Question 65

What could cause brown staining of the teeth?

Answer 65

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

Question 66

What is Steven Johnsons Syndrome? What could cause it?

Answer 66

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

Question 67

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

Answer 67

The BNF states they do!! ALL of them

Question 68

What does the black triangle mean?

Answer 68

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

Question 69

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

Answer 69

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

Question 70

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 ```

Answer 70

E. Phenytoin