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Stage 3 > Medication side effects & complications > Flashcards

Medication side effects & complications Flashcards

1
Q

Which drug can induce thyrotoxicosis?

A

Amiodarone

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2
Q

What is a well recognised complication of amiodarone?

A

Thyrotoxicosis

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3
Q

What type of drug is amiodarone?

A

An anti-arrhythmic agent

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4
Q

Which blood test is important to do as part of regular drug monitoring for patients on amiodarone?

A

TFTs

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5
Q

What is important to tell the patient when starting them on amiodarone?

A

Make them aware about the potential risks of thyrotoxicosis

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6
Q

What is the similarity between amiodarone and thyroid hormone?

A

They both have a high iodine component

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7
Q

What are the two forms of thyrotoxicosis that amiodarone can induce?

A

1) Direct toxic consequence of the drug itself (thyroiditis)
2) Trigger of underlying thyroid autoimmunity

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8
Q

What investigations need to be done to correctly diagnose the type of amiodarone induced thyrotoxicosis?

A

1) Check patient’s antibody status
2) Specialist imaging of thyroid gland e.g. thyroid uptake scan and colour flow Doppler ultrasound

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9
Q

Imaging characteristics on amiodarone induced thyrotoxicosis (AIT) type 1?

A

1) Normal thyroid uptake on scans
2) Increased vascularity on Doppler imaging

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10
Q

Imaging characteristics on amiodarone induced thyrotoxicosis (AIT) type 2?

A

1) Decreased thyroid uptake
2) Reduced vascularity on Doppler imaging

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11
Q

How do you manage amiodarone induced thyrotoxicosis?

A

Depends on underlying type
1) Anti-inflammatories e.g. steroids
2) Anti-thyroid drugs e.g. carbimazole
3) Close discussion with cardiology to decide whether amiodarone needs to be stopped or substitute

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12
Q

What % of patients taking amiodarone can have abnormalities in thyroid function?

A

Up to 50%

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13
Q

Which antidepressant can affect TSH secretion (full blown thyrotoxicosis much less common)?

A

Sertraline

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14
Q

Which antidepressant causes a reduction in TSH production and hypothyroidism?

A

Paroxetine

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15
Q

Which drug can have an effect on T3/T4 binding, leading to hypothyroidism and a reduction in metabolic processes?

A

Aspirin

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16
Q

What are the features of digoxin toxicity?

A

1) Nausea/vomiting
2) Diarrhoea
3) Blurred vision
4) Yellow/green discolouration of vision (strange green tint)
5) Haloes in vision
6) Confusion
7) Fatigue
8) Palpitations
9) Syncope
10) Arrhythmias
11) Abdo pain

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17
Q

What are the effects of digoxin on ECG?

A

1) Downsloping ST depression
2) T-wave changes (inversion)
3) Biphasic/flattened and shortened QT interval
4) Slight PR interval prolongation
5) Prominent U-waves
- these are NOT signs of digoxin toxicity

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18
Q

What are characteristic side effects of amiodarone?

A

1) Thyroid dysfunction
2) Corneal deposits
3) Pulmonary fibrosis
4) Grey skin discolouration

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19
Q

What can be used in the management of digoxin toxicity?

A

Digibind

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20
Q

What are common side effects of bisoprolol?

A

1) Dizziness
2) Headaches
3) Cold peripheries

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21
Q

What are the side effects of penicillins?

A

1) Allergy
2) Rash
3) N&V
4) Diarrhoea
5) Cholestasis
6) C. difficile

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22
Q

What is the additional side effect (to the penicillin side effects) in amoxicillin and co-amoxiclav?

A

Rash with EBV

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23
Q

What is a rare side effect with prolonged use of Piptaz?

A

Myelosuppression

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24
Q

When patients are on cephalosporins what can be false positive?

A

1) Urinary glucose
2) Coomb’s test

25
Q

What are the side effects of cephalosporins?

A

1) Allergy
2) Rash
3) N&V
4) Cholestasis

26
Q

What is a specific side effect of ceftriaxone and why?

A

Pseudolithiasis (symptoms of renal or gallstones) - ceftriaxone can precipitate in urinary tract and biliary tree

27
Q

What are the side effects of carbapenems?

A

1) N&V
2) Rash
3) Eosinophilia
4) Thrombocytopenia
5) Raised LFTs
6) Seizures
7) C difficile

28
Q

What are the key side effects of carbapenems?

A

1) Eosinophilia
2) Thrombocytopenia
3) Raised LFTs
4) Seizures

29
Q

What are the side effects of vancomycin and teicoplanin (lipo/glycopeptides)?

A

1) Nephrotoxic
2) Ototoxic
3) Thrombocytopenia

30
Q

What should you do bc of nephrotoxicity with vancomycin?

A

1) Monitor creatinine
2) Care with other nephrotoxic agents

31
Q

What are the side effects of aminoglycosides?

A

1) Nephrotoxic
2) Ototoxic
3) Vestibular toxicity

32
Q

What should you do bc of nephrotoxicity with aminoglycosides?

A

1) Monitor drug levels
2) Monitor serum creatinine

33
Q

Which macrolide causes the most side effects?

A

Erythromycin

34
Q

What are the side effects of macrolides?

A

1) Long QT
2) GI upset
3) Cholestasis

35
Q

What enzyme action do macrolides have (least with azithromycin)?

A

Cytochrome P450 inhibition

36
Q

What are the effects of cytochrome P450 inhibition when taking macrolides?

A

1) Increase in warfarin
2) Increase in calcineurin inhibitor levels e.g. cyclosporin, tacrolimus
3) Rhabdomyolysis with statins

37
Q

In which patients are tetracycline and doxycycline contraindicated?

A

1) Pregnancy
2) Children < 8 years (teeth/bones)

38
Q

What are the side effects of tetracycline and doxycycline?

A

1) Fatty liver
2) Idiopathic intracranial hypertension
3) N&V
4) C. difficile

39
Q

What are the side effects of tigecycline?

A

1) N&V
2) Photosensitivity
3) Raised LFTs

40
Q

Which antibiotic causes particular risk of C difficle?

A

Clindamycin

41
Q

What are the side effects of linezolid?

A

1) Can interact with MAOIs
2) Myelosuppression
3) Optic neuropathy

42
Q

Why is systemic use of chloramphenicol limited?

A

Bc of the risk of myelosuppression

43
Q

What are the side effects of fusidic acid?

A

1) GI upset
2) Raised LFTs

44
Q

What effect does trimethoprim have on renal function bloods?

A

Raised serum creatinine with low GFR (inhibits creatinine secretion)

45
Q

What are the side effects of co-trimoxazole?

A

1) Folate deficiency
2) Hyperkalaemia
3) Myelosuppression
4) Haemolysis with G6PD deficiency
5) Rash

46
Q

Which antibiotic cause haemolysis in G6PD deficiency?

A

Co-trimoxazole

47
Q

Which antibiotic causes folate deficiency?

A

Co-trimoxazole

48
Q

Which antibiotic causes hyperkalaemia?

A

Co-trimoxazole

49
Q

What are the side effects of fluoroquinolones?

A

1) CNS effects - reduced seizure threshold, headache, drowsiness, mood change
2) Peripheral neuropathy
3) Tendinopathy (Achilles)
4) Long QT
5) C difficile
6) GI irritation

50
Q

Which antibiotic class causes CNS effects?

A

Fluoroquinolone e.g. ciprofloxacin

51
Q

Which antibiotic causes peripheral neuropathy?

A

Fluoroquinolone e.g. ciprofloxacin

52
Q

Which antibiotic causes Achilles tendinopathy?

A

Fluoroquinolone e.g. ciprofloxacin

53
Q

What are the side effects of metronidazole?

A

1) Disulfiram reaction with alcohol
2) Inhibits warfarin metabolism

54
Q

Which antibiotic can cause a reaction with alcohol?

A

Metronidazole

55
Q

Which two antibiotics affect warfarin levels (increase them)?

A

Metronidazole (inhibits Warfarin metabolism) and macrolides (increased levels of Warfarin)

56
Q

Which antibiotic do you have to dose adjust for liver function?

A

Metronidazole

57
Q

What are the side effects of rifamycins e.g. rifampicin?

A

1) Red secretions (urine, saliva, sweat, sputum, tears)
2) Hepatitis (monitor LFTs)
3) GI upset
4) CNS effects
5) Myelosuppression

58
Q

Which antibiotics cause eosinophilia?

A

Carbapenems

Stage 3 (61 decks)

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