SE of drugs Flashcards
What colour does Senna cause your urine to be?
Red/yellow
What colour does sulfasalazine cause your urine to be?
Yellow-orange
What colour does phenindione cause your urine to be?
Pink/orange
What colour does levodopa preparations cause your urine to be?
Reddish/darker
What colour does entacapone cause your urine to be?
Reddish brown
What colour does nefopam cause your urine to be?
Pink
What colour does Clofazimine cause your urine to be?
Red
What colour does nitrofurantoin cause your urine to be?
Yellow/brown
What colour does rifabutin cause your urine to be?
Orange-red
What colour does rifampicin cause your urine to be?
Orange-red
What colour does dantrone medicines cause your urine to be? e.g. co-danthramer, co-danthrusate
Red
What colour does triamterene medicines cause your urine to be? e.g. Frusene, co-triamterzide
Blue in some lights
What colour does deferiprone cause your urine to be?
iron chelator
Reddish brown
True or false:
SSRIs are less sedating and are associated with fewer antimuscarinic and cardiotoxic side effects than tricyclic antidepressants
True
What are the side effects of antidepressants that could contribute to a fall?
Drowsiness, dizziness, confusion, postural hypotension, visual disturbances
What are the side effects of antipsychotics that could contribute to a fall?
Postural hypotension, drowsiness, unsteady gait (walking), confusion
What are the side effects of antimuscarinics that could contribute to a fall?
Drowsiness, dizziness, confusion, blurred vision
What are the side effects of benzos and hypnotics e.g. zopiclone that could contribute to a fall?
Drowsiness, unsteady gait (walking), confusion
What are the side effects of dopaminergic drugs used in Parkinson’s that could contribute to a fall?
Sudden onset of sleep, postural hypotension, confusion
What are the side effects of ACEi and ARBs that could contribute to a fall?
Dizziness, postural hypotension
What are the side effects of alpha blockers that could contribute to a fall?
Dizziness, postural hypotension
What are the side effects of anti-arrythmics that could contribute to a fall?
Bradycardia, arrhythmias, dizziness
What are the side effects of antiepileptic drugs that could contribute to a fall?
Dizziness, drowsiness, confusion, visual disturbances
What are the signs of phenytoin toxicity?
Confusion, visual disturbances, fever, drowsiness and ataxia
What is ataxia?
Group of disorders that affect co-ordination, balance and speech
What are the side effects of beta blockers that could contribute to a fall?
Dizziness, postural hypotension
Make a list of drugs that commonly cause diarrhoea
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
Make a list of drugs that commonly cause constipation
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
Make a list of drugs that commonly cause hyperkalaemia
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
Make a list of drugs that may cause diarrhoea
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
Make a list of drugs that may cause constipation
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
Make a list of drugs that may cause hyperkalaemia
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
Make a list of drugs that may cause hypokalaemia
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
Make a list of drugs that may cause hypernatraemia
Diuretics Sodium bicarbonate Sodium chloride Corticosteroids Anabolic steroids Adrenocorticotrophic steroids Androgens Oestrogens
Make a list of drugs that may cause hyponatraemia
ACEi, diuretics (loop/thiazide) Heparin Antidepressants, Antipsychotics Carbamazepine, Oxcarbazepine, Eslicarbazepine Atovaquone Amphotericin Trimethoprim Sulphonylureas e.g. gliclazide Desmopressin Cyclophosphamide Acetazolamide (carbonic anhydrase inhibitor)
Make a list of drugs that may cause neutropenia*
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
Make a list of drugs that may cause thrombocytopenia
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
What pulmonary side effect can NSAIDs cause?
Bronchospasm
What pulmonary side effects can amiodarone cause?
Interstitial pneumonitis or pulmonary fibrosis, pleural effusions, pulmonary infiltrate with eosinophilia, bronchiolitis obliterans organising pneumonia, postoperative ARDS (acute respiratory distress syndrome)
What pulmonary side effects can methotrexate cause?
Interstitial pneumonitis, pulmonary fibrosis, pulmonary oedema, pleuritic pain, pleural thickening
What pulmonary side effects can nitrofurantoin cause?
Interstitial pneumonitis, pulmonary fibrosis, hypersensitivity lung reactions, pleural effusion, bronchospasm
What pulmonary side effects can mitomycin C cause?
Interstitial pneumonitis, pulmonary fibrosis, bronchospasm
What pulmonary side effects can bleomycin cause?
Interstitial pneumonitis, pulmonary fibrosis
What pulmonary side effects can infliximab cause?
Respiratory tract infection, pulmonary oedema, bronchospasm, pleurisy, pleural effusion, pulmonary fibrosis
Make a list of drugs that cause insomnia
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
Is cetirizine a sedating antihistamine?
No
Is acrivastine a sedating antihistamine?
No
Is hydroxyzine a sedating antihistamine?
Yes
Is promethazine a sedating antihistamine?
Yes
Make a list of drugs that require patient counselling on reporting sore throats due to risk of blood dyscrasias?
• 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.
What can G6PD deficiency lead to?
Haemolytic anaemia and can occur from taking certain drugs
What drugs have a risk of haemolysis in G6PD deficient individuals?
- Dapsone
- Methylene blue
- Nitrofurantoin
- Primaquine
- Quinolones
- Sulphonamides
- Aspirin
- Chloroquine
- Menadione
- Quinine
What drug classes cause AKIs (CANDA)?
Contrast Media ACEi NSAIDs Diuretics ARBs
Which of the following does not cause ulcers? A. Ciclosporin B. Alendronate C. Omeprazole D. Budesonide E. Prednisolone F. Aspirin
C. Omeprazole
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?
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).
What is DRESS syndrome and what drugs may cause it?
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)
When must the herbal remedy Echinacea be avoided, and why?
Should not be given to children under 12 yrs due to risk of severe allergic reaction outweighing any benefits
In the case of an anaphylactic reaction, where should adrenaline auto-injector pens be administered?
Outer thigh!
NB: the MHRA advise that an ambulance is called after every use of an auto-injector, even if symptoms are improving
Medication errors, especially those that have gone out to the patient, even if they do not cause harm, should be reported to who?
NRLA- national reporting and learning system
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?
Bioavailability of the drug as a parenteral solution given by IV bolus or IV infusion- this would show its complete absorption bioavailability
What laboratory test is needed to confirm someone is suffering from a hypersensitivity reaction?
Full Blood Count and differential- to look for presence of IgE?
Drugs which may cause taste disturbance?
A. Amlodipine B. Ibuprofen C. Metformin D. Linezolid E. Suxamethonium
metformin terbinafine (antifungal) lithium ACE inhibitors amiodarone metronidazole
What drug can cause gingival hyperplasia (gum enlargement)?
A. Tetracyline B. Phenytoin C. Amiodarone D. Metronidazole E. Nifedipine F. Mesalazine G. Ciclosporin H. Allopurinol
Phenytoin
also less commonly Nifedipine and ciclosporin
Osteonecrosis of the jaw can results from Bisphosphonate use. This is more common with IV or Oral?
IV
But all patients on bisphosphonates should have a dental check-up before starting therapy
What could cause brown staining of the teeth?
Most common cause: Chlorhexidine mouthwash
Iron salts
Intrinsic staining: tetracyclines (usually only in children)
What is Steven Johnsons Syndrome? What could cause it?
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
Do all ADR’s in children have to be reported?
The BNF states they do!! ALL of them
Endocrine disorders Anaphylaxis Jaudine Heamorrhage Renal impairment Eye disorders Fertility effects
Are all examples of what and should they be reported in all cases?
‘Serious’ reactions that must be reported to MHRA in all circumstances.
Any pro-longed hospitalisation, disabling, fatal, teratogenicity all must be reported.
What does the black triangle mean?
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
Pt is starting therapy on warfarin for 1st time what are the key counselling points
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
Which of the following are linked to bradycardia? A. Lithium B. Fluoxetine C. Rivastigmine D. Amlodipine E. Bisoprolol F. Omeprazole G. Terbinafine
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
Symptoms of ____________ toxicity include nystagmus, diplopia, slurred speech, ataxia, confusion, and hyperglycaemia.
A. Lithium
B. Theophylline
C. Carbamazepine
D. Phenytoin
Symptoms of phenytoin toxicity include nystagmus, diplopia, slurred speech, ataxia, confusion, and hyperglycaemia.
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
E. Phenytoin
