Side effects of common drugs Flashcards
Common side effects with beta-blockers
- Fatigue
- Coldness of extremities
- Sleep disturbance with nightmares
- May exacerbate asthma so should be avoided in asthma or bronchospasm
- Bradycardia
- Hypotension
- Sexual dysfunction
Which beta-blockers are less likely to cause sleep disturbances with nightmares?
Water soluble ones:
- Atenolol
- Celiprolol
- Nadolol
- Sotalol
Which beta-blockers can be given in asthma is there is no alternative?
Cardioselective beta-blockers:
- Atenolol
- Bisoprolol
- Metoprolol
- Nebivolol
- Acebutolol
Beta-blockers and diabetes
Beta-blockers are not contraindicated in diabetes but can cause a small deterioration of glucose tolerance.
- Cardioselective beta-blockers are prefered or avoided altogether in those with frequent episodes of hypoglycaemia
ACEinhibitor common side effects
- Dry cough (change to ARB)
- Rash
- Hyperkalaemia
- Hypotension
- Renal impairment
- Altered LFT
- Angioedema
When do statins have an increased incidence of myopathy?
- Statins given at high doses
- Statins given with a fibrate with lipid lowering doses of nicotinic acid or with immunosuppressants such as ciclosporin
- Family history of muscular disorders
- Previous history of muscular toxicity
- High alcohol intake
- Hypothyroidism
- Females
- Elderly
- Renal impairment
Statins and LFT’s
They alter LFTs
- Use in caution in those with history of liver disease or with high alcohol intake
- AST and ALT
- LFT carried out before and within 3 months of starting and at 1 year if normal
Statins common side effects
- Abdominal pain
- Flatulence
- Rash
Simvastatin is contraindicated with which drugs?
- Ciclosporin
- Danazol
- Gemfibrozil
Simvastatin should be given at 20mg max with which drugs?
- Amiodarone
- Verapamil
- Diltiazem
- Amlodipine
When should simvastatin 80mg be given?
- Severe hypercholesterolemia
- High risk of cardiovascular complications who have not achieved benefits at lower doses
What is first line statin and dose in primary and secondary CVD prevention?
Primary prevention = Atorvastatin 20mg
Secondary prevention = Atorvastatin 80mg
Common side effects of anti-muscarinic
- Dry mouth
- Blurred vision
- Urinary retention
- Drowsiness
- Constipation
- Increased risk of fall
- Confusion and memory loss
What drugs cause anti-muscarinic side effects?
- Antihistamines
- Antispasmodics
- Narcotic analgesics
- Anti depressants
Common side effects of SSRI’s
- Agitated, shaky or anxious
- Nausea and vomiting
- Indigestion, diarrhoea or constipation
- Loss of appetite and weight loss
- Dizziness
- Blurred vision
- Dry mouth
- Low sex drive
- Erectile dysfunction in men
First choice of SSRI in younger people or those with CVD?
- Sertraline
- Fluoxetine
- Paroxetine
Common side effects of quinolone antibiotics
- Caution in patients with epilepsy
- Tendon damage
- Tendon rupture may occur within 48 hours of starting treatment
- Not recommended in children or growing adolescents as it can cause arthropathy (Lyme’s disease)
What other drug class is not used in children?
- Tetracyclines
- Can cause yellowing of teeth
- Has interaction with milk and antacids
Common antibiotic side effects/interactions
- Aminoglycosides - ototoxicity and nephrotoxicity
- Metronidazole and alcohol can worsen side effects
- Clindamycin and diarrhoea
- Isoniazid and peripheral neuropathy
Tuberculosis treatment regime
- Rifampicin, ethambutol hydrochloride, pyrazinamide and isoniazid (with pyridoxine hydrochloride) in the initial phase continued for 2 months.
- After initial phase, offer standard continuation treatment with rifampicin and isoniazid (with pyridoxine hydrochloride) for a further 4 months
Common side effects of hypoglycaemia
- Sweating
- Shaking
- Anxiety
- Palpitations
- Feeling weak
- Nauseated
- Confusion
- Poor concentration
In severe cases, convulsions and coma
Metformin common side effects
Metformin is first line in obese diabetic patients as it does not increase appetite
- Anorexia
- Nausea and vomiting
- Diarrhoea
- Metallic taste
- Decreases vitamin B12 absorption
When is metformin contraindicated
- Severe hepatic or renal disease as it can cause lactic acidoses
- Stop if renal function is below 30mL/min
Pioglitazone common side effects
Risk of heart failure and bladder cancer
Gliptins common side effects
Pancreatitis risk
Flozins comon side effects
UTIs
Diabetic ketoacidosis
Fourniers gangrenes
Amputations with canagliflozin
Medicine sick leave rule
If patient experiences fever, sweats, shakes, vomiting, diarrhoea then consider temporarily stopping the medicines and restart after 24-48 hours of eating and drinking normally.
- ARBs
- ACE inhibitors
- NSAIDs
- Diuretics
- Metformin
Which drugs cause AKI?
- Aminoglycosides
- NSAIDs
- ACE inhibitors
Who is at risk of AKI?
- Aged 65 years or over
- Kidney problems
- Heart failure
- Liver disease
- Diabetes
In CKD, what is there a disruption in the regulation of?
- Phosphate- increased phosphorus in blood
- Calcium - phosphate binds to calcium in the blood causing lower levels of calcium
- Vitamin D - low levels found
- Parathyroid hormone - increased
Which antipsychotics cause erectile dysfunction?
Risperidone and other typical antipsychotics
First generation antipyschotics
Chlorpromazine, Levomepromazine, Flupentixol, Haloperidol
Second generation antipsychotics
Clozapine, quetiapine, olanzapine, Risperidone, Amisulpride, Aripiprazole
Which antipsychotics cause tardive dyskinesias?
First generation
Which antipsychotics cause hyperprolactinaemia?
Risperidone
