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Side effects and contraindications Flashcards

1
Q

Aspirin, warfarin and heparin

A

Do not give to patients with bleeding risk (e.g. prolonged prothrombin time due to liver disease).
Remember prophylactic heparin is contraindicated in acute ischaemic stroke due to bleeding risk.

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2
Q

Steroid side effects?

A 
Stomach ulcers
Thin skin
Oedema
Right and left heart failure
Osteoporosis
Infection (including candida)
Diabetes (more often hyperglycaemia)
Cushing's syndrome
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3
Q

NSAID side effects and contraindications?

A 
NSAID
No urine (renal failure)
Systolic dysfunction (heart failure)
Asthma
Indigestion (any cause)
Dyscrasia (clotting abnormality)
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4
Q

Antihypertensives side-effect

A

Hypotension

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5
Q

Beta blockers

A

Bradycardia, wheeze in asthmatics, worsening of acute heart failure (but effective in chronic heart failure)

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6
Q

Calcium channel blockers

A

Bradycardia, peripheral oedema, flushing

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7
Q

ACE inhibitors

A

Electrolyte disturbance (hyperkalaemia) and dry cough

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8
Q

Diuretics - loop and K sparing

A

Electrolyte disturbance, renal failure.

Loop (e.g. furosemide) can cause gout. K sparing (e.g. spironolactone) can cause gynaecomastia.

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9
Q

Thiazide diuretics

A

Cause hypokalaemia by increasing potassium excretion by the kidneys.

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10
Q

Metoclopramide

A

Passes blood brain barrier and can exacerbate parkinsonian symptoms. Domperidone does not pass the BBB and is therefore safer.

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11
Q

Methotrexate

A

Withhold in potential sepsis!

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12
Q

Trimethoprim and methotrexate

A

Both are folate antagonists and cannot be taken together. This can lead to pancytopenia and neutropenic sepsis, due to bone marrow toxicity.

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13
Q

Prophylactic enoxoparin

A

Contraindicated following acute stroke (approximately for 2 months but varies by trust)

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14
Q

Clozapine

A

Agranulocytosis resulting in neutropenia

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15
Q

Digoxin toxicity effects

A

Confusion, nausea, visual halos, arrythmias

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16
Q

Lithium toxicity effects

A

Early - tremour
Intermediate - tiredness
Late - arrythmias, seizures, coma, renal failure, diabetes insipidus

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17
Q

Phenytoin toxicity side effects

A

Gum hypertrophy, atazia, nystagmus, peripheral neuropathy, teratogenicity

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18
Q

Gentamicin and vancomycin toxicity side effects

A

Ototoxicity and nephrotoxicity

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19
Q

Side effect of carbamazapine

A

Can lead to SIADH and therefore hyponatraemia

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20
Q

Slow AF

A

Withold digoxin

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21
Q

SIADH as a side effect

A 
sulfonylureas*
    SSRIs, tricyclics
    carbamazepine
    vincristine
    cyclophosphamide
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22
Q

Drugs to be avoided during breastfeeding

A 
antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
    psychiatric drugs: lithium, benzodiazepines
    aspirin
    carbimazole
    methotrexate
    sulfonylureas
    cytotoxic drugs
    amiodarone
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23
Q

Drugs which can be given for women who are breastfeeding

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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24
Q

What is tramadol notorious for?

A

Confusion in the elderly

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25
What does cyclizine cause as a side effect?
Drowsiness and confusion can occur
26
When is methotrexate contraindicated?
In active infection
27
What are the rules surrounding use of NSAIDS and methotrexate
Use with caution as there is a risk of nephrotoxicity
28
What do loop diuretics and thiazide diuretics cause?
Hyponatramia and hypokalcaemia
29
When should heparin prophylaxis not be taken?
Following acute stroke
30
Why should beta blockers and verapamil not be mixed?
This causes severe bradycardia
31
What are the causes of hypernatreamia?
Dehydration Drips Drugs Diabetes insipidus
32
Side-effects of lamotrigine?
Rash, | Rarely stephens-johnson syndrome
33
Carbamazepine side-effects?
``` Hyponatraemia Rash Dysarthria Ataxia Nystagmus ```
34
Phenytoin side-effects?
Ataxia, peripheral neuropathy, gum hyperplasia, hepatotoxicity
35
Side effects of sodium valproate?
Tremour, teratogenicity, weight gain
36
Levetiracetam side-effects
Fatigue, mood disorders, and agitation
37
When should a laxative never be given?
Obstruction
38
Gentamicin and vancomycin side effects
Nephrotoxicity, ototoxicity
39
Any antibiotics, but particularly broad spectrum like cephalosporins or ciprofloxacin ADR
C. diff colitis
40
ACE inhibitor ADR
Hypotension, electrolyte abnormalities, acute kidney injury, dry cough
41
Beta-blockers
Hypotension, bradycardia, wheeze in asthmatics, worsens acute heart failure (but helps chronic heart failure)
42
Calcium channel blockers (e.g. diltiazem)
Hypotension, bradycardia, peripheral oedema, flushing
43
Diuretics
Hypotension, electrolyte abnormalities, acute kidney injury, subclass-dependent effects, e.g. spironolactone causes gynaecomastia
44
Heparin
Haemorrhage (particularly renal failure or <50 kg) | Heparin induced thrombocytopaenia
45
Warfarin
Haemorrhage (through has a procoagulant effect initially and takes a few days to work, thus need to prescribe heparin initially alongside until INR is 2)
46
Aspirin
Haemorrhage, peptic ulcers, gastritis, tinnitus in large doses
47
Digoxin
Nausea, vomiting, diarrhoea, Blurred vision, confusion, drowsiness, Xanthopsia (disturbed yellow/green visual perception, including 'halo' vision)
48
How does low potassium affect digoxin?
Augments the effect
49
How does high potassium affect digoxin?
Reduces the effect
50
Amiodarone
Interstitial lung disease (pulmonary fibrosis) Thyroid disease (both hypo and hyperthyrodism are reported, it is structurally related to iodine, hence its name amIODarone) Skin graying Corneal deposits
51
Lithium
Early - tremour Intermediate - tiredness Late - arrythmias, seizures, coma, renal failure, diabetes insipidus
52
Haloperidol
Dyskinesias, e.g. acute dystonic reactions, drowsiness
53
Clozapine
Agranulocytosis (requires intensitve monitoring of FBC)
54
Dexamethasone and prednisolone
STEROIDS ``` Stomach ulcers Thin skin Oedema Right and left heart failure Osteoporosis Infection (including candida) Diabetes (commonly causes hyperglycaemia, rarely progresses to diabetes) Cushing's syndrome ```
55
Fludrocortisone
Hypertension/ sodium and water retention
56
Ibuprofen
NSAID ``` No urine (renal failure) Systolic dysfunction (heart failure) Ashma Indigestion (any cause) Dyscrasia (clotting abnormality) ```
57
Simvastatin
Myalgia, abdominal pain, increase ALT/AST (can be mild), rhabdomyolysis (can be just mildly increased creatinine kinase though) Management of statin-induced myalgia - exclude rhabdomyoltsis with creatinine kinase and urine dip. Otherwise, if symptoms unacceptable or CK very high (>2000), 1. ensure needs statin 2. reduce the dose 3. switch to other statin with lower risk of myalgia (risk of myalgias: simvastain > atorvastatin > pravastatin ?(fluvastatin) or a fibrate.
58
If the scenario refers to low GCS or acidotic behaviour ,look for metformin in the question
59
What can iodinated contrast media cause?
Renal failure This may then be associated with increased risk of metformin induced lactic acidosis or ACE inhibitor associated kidney injury
60
What are the most common enzyme inhibitors?
Ketoconazole, ciprofloxacin, erythromcyin, grapefruit juice
61
What do beta blockers and verapamil cause?
Profound hypotension and asystole
62
What happens if alcohol is drunk with metronidazole
Nausea and vomiting
63
Metformin causes
lactic acidosis
64
NSAIDS cause
GI bleeding
65
Monoamine inhibitors cause
hypertensive crisis
66
Warfarin and acute alcohol causes
Increased anticoagulation
67
Warfarin and chronic alcohol causes
decreased anticoagulation
68
Metronidazole and disulfiram cause
Sweating, nausea, flushing, vomiting
69
Barbituates, opioids and benzodiazepines cause
Sedation

emergency drugs and doses (6 decks)

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