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PSA > Side effects > Flashcards

Side effects Flashcards

1
Q

What causes hypoglycaemia

A

Insulin + Sulphonureas

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2
Q

What causes hyperglycaemia

A

Steroids, antipsychotics, thiazides, beta blockers, tacrolimus

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3
Q

What causes constipation

A

Opioids, iron, CCBs (amlodipine, verapamil), some diuretics, some antiemetics (ondansetron, metoclopramide), some antiepileptics, some Parkinson’s medications, antacids that contain calcium, anticholinergics (antidepressants, antihistamines, incontinence medications, antipsychotics)

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4
Q

What causes diarrhoea

A

Antibiotics (C. diff), colchicine, metformin, PPIs, antacids that contain magnesium, laxatives

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5
Q

Urinary retention

A

Opioids, anticholinergics, amitryptyline/trycyclic antidepressant, NSAID, dysopyramide

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6
Q

Urinary incontinence

A

Alpha blockers, anti cholinesterase inhibitors, diuretics, clozapine

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7
Q

Confusion

A

opioids, sedatives, anticholinergics

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8
Q

Falls

A

Benzodiazepines, TCA, SNRI, MAO, antipsychotics, antihypertensives, parkinson medication (ropinirole, selegiline), antiepileptics

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9
Q

Hypertension

A

NSAIDS, steroids oral contraceptives, mirabegron

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10
Q

High cholesterol

A

Steroids, thiazides

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11
Q

Hypokalaemia

A

Loop diuretics (furosemide, bumetanide)
Thiazides
Steroids
Salbutamol

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12
Q

Hyperkalemia

A

K+ sparing diuretics (spironolactone, eplerone, amiloride, triamterene)
ACE inhibitors (lisinopril)
ARBs (losartan, candesartan)
Unfractioned heparin/LMWH
Blood transfusion

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13
Q

Hyponatreamia

A

SSRIs (sertraline, citalopram, fluoxetine)
TCAs (amitriptyline)
Carbamazepine
Opiates
PPIs (omeprazole, lansoprazole)

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14
Q

Hypernatraemia

A

Lithium
Demeclocycline

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15
Q

What is continued in intercurrent illness

A

double dose steroid

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16
Q

What should be stopped in intercurrent illness

A

metformin, statins, -glifozins

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17
Q

What should be stopped when planning to have a child

A

isotretinoin, methotrexate, warfarin, phenytoin, sodium valproate

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18
Q

Contraindicated in breast feeding

A

antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
psychiatric drugs: lithium, benzodiazepines
aspirin
carbimazole
methotrexate
sulfonylureas
cytotoxic drugs
amiodarone

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19
Q

Safe for breast feeding mothers

A

antibiotics: penicillins, cephalosporins, trimethoprim
endocrine: glucocorticoids (avoid high doses), levothyroxine*
epilepsy: sodium valproate, carbamazepine
asthma: salbutamol, theophyllines
psychiatric drugs: tricyclic antidepressants, antipsychotics**
hypertension: beta-blockers, hydralazine
anticoagulants: warfarin, heparin
digoxin

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20
Q

Stop prior to surgery

A

DOACS (48h), CLOPIDPGREL (7d), warfarin bridging plan

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21
Q

Worsen parkinsons

A

antipsychotics (haloperidol), metoclopramide, antidepressants

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22
Q

To avoid in Myasthenia gravis

A

Antibiotics, Beta blockers, Local anaesthetics, sedating drugs

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23
Q

Worsens psoriasis

A

Beta blockers, lithium, abx

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24
Q

Worsens heart failure,

A

NSAIDS, CCBS, Pioglitazone

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25
Q

Steroid endorphins SEs

A

impaired glucose regulation
increased appetite/weight gain
hirsutism
hyperlipidaemia

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26
Q

MSK steroid SE

A

osteoporosis
proximal myopathy
avascular necrosis of the femoral head

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27
Q

Steroid Psych SE

A

insomnia
mania
depression
psychosis

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28
Q

GI Steroid side effects

A

Peptic ulceration
acute pancreatitis

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29
Q

Ophthalmic steroid side effects

A

glaucoma
cataracts

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30
Q

Mineralcorticoid side effects

A

Fluid retention
Hypertension

31
Q

What happens if steroids withdrawn abruptly

A

Addisonian crisis

32
Q

When should steroids be withdrawn gradually

A

received more than 40mg prednisolone daily for more than one week
received more than 3 weeks of treatment
recently received repeated courses

33
Q

What is mechanism of action of methotrexate

A

Methotrexate is an antimetabolite that inhibits dihydrofolate reductase, an enzyme essential for the synthesis of purines and pyrimidines.

34
Q

What are adverse effects of methotrexate

A

mucositis
myelosuppression
pneumonitis
the most common pulmonary manifestation
similar disease pattern to hypersensitivity pneumonitis secondary to inhaled organic antigens
typically develops within a year of starting treatment, either acutely or subacutely
presents with non-productive cough, dyspnoea, malaise, fever
pulmonary fibrosis
liver fibrosis

35
Q

How long should pregnancy be avoided if taking methotrexate

A

women should avoid pregnancy for at least 6 months after treatment has stopped
the BNF also advises that men using methotrexate need to use effective contraception for at least 6 months after treatment

36
Q

What should be routinely monitored when taking methotrexate

A

FBC, U&E and LFTs need to be regularly monitored. The Committee on Safety of Medicines recommend ‘FBC and renal and LFTs before starting treatment and repeated weekly until therapy stabilised, thereafter patients should be monitored every 2-3 months’

37
Q

What should be co prescribed with methotrexate

A

folic acid 5mg once weekly should be co-prescribed, taken more than 24 hours after methotrexate dose

38
Q

What should be avoided with methotrexate

A

avoid prescribing trimethoprim or co-trimoxazole concurrently - increases risk of marrow aplasia
high-dose aspirin increases the risk of methotrexate toxicity secondary to reduced excretion

39
Q

Methotrexate toxicity treatment

A

folinic acid

40
Q

What causes oral thrush

A

Amoxicillin and inhaled corticosteroids can cause oral thrush

41
Q

What is Symbicort

A

Inhaled corticosteroid

42
Q

Treatment for oral thrush

A

nystatin drops

43
Q

What causes euglycemic DKA

A

Canagliflozin – SGLT2s (e.g. dapagliflozin/empagliflozin) can cause DKA without marked hyperglycaemia

44
Q

What is associated with fourniers gangrene

A

SGLT 2 inhibitors (gliflozins)

45
Q

What is long QT syndrome

A

delayed repolarization of the ventricles. It is important to recognise as it may lead to ventricular tachycardia/torsade de pointes and can therefore cause collapse/sudden death. A normal corrected QT interval is less than 430 ms in males and 450 ms in females.

46
Q

What drugs prolong QT interval

A

amiodarone, sotalol, class 1a antiarrhythmic drugs
tricyclic antidepressants, selective serotonin reuptake inhibitors (especially citalopram)
methadone
chloroquine
terfenadine**
erythromycin
haloperidol
ondanestron

47
Q

What combination of drugs can cause QT prolongation

A

terfenadine- a non-sedating antihistamine and classic cause of prolonged QT in a patient, especially if also taking P450 enzyme inhibitor, e.g. Patient with a cold takes terfenadine and erythromycin at the same time

48
Q

What can happen when you take ondansetron and serotonin together

A

Serotonin syndrome

49
Q

what is serotonin syndrome

A

Excess serotonin (e.g. SSRI/SNRI in combination with another medication that will increase serotonin levels)

50
Q

What are the symptoms of serotonin syndrome

A

Confusion
Agitation
Muscle twitching
Sweating/shivering
Diarrhoea
Seizures
Arrythmias
Unconsciousness

51
Q

Serotonin syndrome treatment

A

Treatment: supportive care, IV fluids, stop serotonergic agents, benzodiazepines, ITU etc. (it gets complicated!)

52
Q

Causes of Galactorrhoea

A

metoclopramide, domperidone
phenothiazines
haloperidol
very rare: SSRIs, opioids (Citalopram, olanzapine)

53
Q

What to avoid in Parkinson’s

A

Typical antipsychotics
- Chlorpromazine
- haloperidol
D2 antagonists – worsens Parkinson’s disease symptoms

Atypical antipsychotics
- Clozapine
- amisulpiride,
- risperidone,
- quetiapine,
- olanzapine
D2 and 5-HT antagonists - less extrapyramidal side effects than the typicals

Antiemetics
- Chlorpromazine
- metoclopramide
- prochlorperazine

Antidepressants
- Phenelzine,
-tranylcypromine,
- isocarboxazid,
-amoxapine
Act on different receptors but can have bad side effects when used in combination with Parkinson’s disease medications)

54
Q

Adverse effects of statins

A
  • myopathy: includes myalgia, myositis, rhabdomyolysis and asymptomatic raised creatine kinase.
  • liver impairment: the 2014 NICE guidelines recommend checking LFTs at baseline, 3 months and 12 months. Treatment should be discontinued if serum transaminase concentrations rise to and persist at 3 times the upper limit of the reference range
55
Q

Statin contraindications

A

macrolides (e.g. erythromycin, clarithromycin) are an important interaction. Statins should be stopped until patients complete the course
pregnancy

56
Q

Who should receive statin

A
  • all people with established cardiovascular disease (stroke, TIA, ischaemic heart disease, peripheral arterial disease)
  • anyone with a 10-year cardiovascular risk >= 10%
  • patients with type 2 diabetes mellitus should now be assessed using QRISK2 like other patients are, to determine whether they should be started on statins
  • patients with type 1 diabetes mellitus who were diagnosed more than 10 years ago OR are aged over 40 OR have established nephropathy
57
Q

What are the 5HT3 antagonists

A

ondansetron
palonosetron

58
Q

adverse effects of 5HT3 antagonists

A

prolonged QT interval
constipation is common

59
Q

ACE inhibitor side effects

A

–cough
-angioedema: may occur up to a year after starting treatment
-hyperkalaemia
-first-dose hypotension: more common in patients taking diuretics

60
Q

Who should avoid ace INHIBITORS

A

pregnancy and breastfeeding - avoid
renovascular disease - may result in renal impairment
aortic stenosis - may result in hypotension
hereditary of idiopathic angioedema
specialist advice should be sought before starting ACE inhibitors in patients with a potassium >= 5.0 mmol/L

61
Q

What must be monitored when taking ace inhibitors

A

urea and electrolytes should be checked before treatment is initiated and after increasing the dose
a rise in the creatinine and potassium may be expected after starting ACE inhibitors
acceptable changes are an increase in serum creatinine, up to 30% from baseline and an increase in potassium up to 5.5 mmol/l.
significant renal impairment may occur in patients who have undiagnosed bilateral renal artery stenosis

62
Q

WHAT ARE 5ASA

A

Aminosalycilates - local anti inflammatory in colon

63
Q

Sulphasalazine side effects

A

rashes, oligospermia, headache, Heinz body anaemia, megaloblastic anaemia, lung fibrosis

64
Q

mesalazine side effects

A

GI upset, headache, agranulocytosis, pancreatitis*, interstitial nephritis

65
Q

What are aminosalycalates associated with

A

agranulocytosis - FBC is a key investigation in an unwell patient taking them.

66
Q

WHAT IS mOrE coMMON IN MESALAZINE THAN SULFASALAZINE

A

Pancreatitis

67
Q

How should amiodarone be administered

A

should ideally be given into central veins (causes thrombophlebitis)

68
Q

Amiodarone interactions

A

has proarrhythmic effects due to lengthening of the QT interval
interacts with drugs commonly used concurrently (p450 inhibitor) e.g. Decreases metabolism of warfarin

69
Q

What to monitor in amiodarone [patients

A

TFT, LFT, U&E, CXR prior to treatment
TFT, LFT every 6 months

70
Q

Adverse effects of amiodarone

A

thyroid dysfunction: both hypothyroidism and hyper-thyroidism
corneal deposits
pulmonary fibrosis/pneumonitis
liver fibrosis/hepatitis
peripheral neuropathy, myopathy
photosensitivity
‘slate-grey’ appearance
thrombophlebitis and injection site reactions
bradycardia
lengths QT interval

71
Q

aZAthioPRINe

A

bone marrow depression
consider a full blood count if infection/bleeding occurs
nausea/vomiting
pancreatitis
increased risk of non-melanoma skin cancer

72
Q

tamsulosin side effects

A

Syncope, Angina, Dyspnoea

73
Q
A

PSA (12 decks)

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