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
