Section 6: Adverse drug reactions

Question 1

What are side effects of beta blockers?

Answer 1

Erectile dysfunction, bradycardia, fatigue, cold extremities, hyperkalemia

Question 2

What are side effects of CCBs?

Answer 2

Ankle swelling (arterial vasodilation is unmatched by venous system), headache, flushing

Question 3

What is the common electrolyte disturbance caused by diuretics?

Answer 3

Hypokalemia mostly, or hyperkalemia with K+ sparing diuretics e.g. spironolactone

Question 4

What drugs cause gynaecomastia?

Answer 4

Ketoconazole, finasteride, spironolactone, dopamine antagonists, anti-retrovirals e.g. lamivudine (HBV), ritonavir (HIV), prednisolone, oestrogens, cimetidine

Question 5

What drugs cause gum hypertrophy?

Answer 5

Phenytoin, ciclosporin, nifedipine, verapamil, diltiazem

Question 6

What are the side effects from SSRIs?

Answer 6

S - sickness/ nausea
S - SIADH and hyponatremia
R - reduced libido
I - insomnia

Question 7

What are the side effects of sulfalasazine?

Answer 7

Myelosuppression, hepatitis, rash, renal failure

Question 8

What do you have to monitor in patients taking chloroquine and hydroxychloroquine?

Answer 8

Eye health. Patients have regular eye checks as retinopathy is a side effect.

Question 9

What are the side effects of methotrexate?

Answer 9

Hepatotoxicity, pneumonitis, myelosuppression (MPH?)

Question 10

What are some of the toxicities of chemotherapies?

Answer 10

Cisplatin = ototoxicity and nephrotoxicity
Asparagine = neurotoxicity
Bleomycin = hypersensitivity pneumonitis
Vincristine = peripheral neuropathy
Doxorubicin = cardiotoxicity
Methotrexate = nephrotoxicity, myelosuppression
Cyclophosphamide = bladder/ nephrotoxicity, SIADH

Question 11

Which is the only TB drug that does not cause hepatitis and what are its side effects?

Answer 11

Ethambutol, optic neuritis

Question 12

What antipsychotic causes QTc prolongation?

Answer 12

Haloperidol - halos for cuties

Question 13

What are signs of digoxin toxicity?

Answer 13

Acute - nausea/ vomiting/ abdo pain, visual changes, tachycardia, confusion, irregular heartbeat/ VT/ VF/ SB/ PVCs, with ECG changes (reverse tick sign in ST segment) + hyperkalemia

Chronic - non specific symptoms

Question 14

What is a common side effect of liraglutide?

Answer 14

This is a GLP1 analogue, and commonly causes GI symptoms e.g. nausea/ vomiting/ change in bowel habit/ anorexia.

Question 15

What drugs reduce the contraceptive effect of oestrogens and progestogens?

Answer 15

These are metabolised by the liver, and accelerated by P450 inducers e.g. rifampicin

Question 16

What is the first line treatment of antipsychotic-induced parkinsonism? e.g. haloperidol

Answer 16

Procyclidine hydrochloride 2.5mg PO 8 hourly/ TDS

Question 17

Why do you monitor FBC for patients on methotrexate?

Answer 17

Risk of blood dyscrasias e.g. anaemia and leucopenia

Question 18

What drugs can cause C. difficile colitis?

Answer 18

Most commonly broad spectrum antibiotics e.g. cephalosporins or ciprofloxacin

Question 19

What are some early, intermediate and late effects of lithium toxicity?

Answer 19

Early: tremor
Intermediate: fatigue
Late: arrhythmias, seizures, renal failure, diabetes insipidus, coma

Question 20

What drugs cause a disulfiram-like reaction to alcohol? i.e. nausea, vomiting, flushing, dizziness, headache, chest and abdominal discomfort

Answer 20

Metronidazole, cephalosporins, co-trimoxazole

Question 21

Why do you avoid prescribing ACE inhibitors with NSAIDs, especially in elderly patients?

Answer 21

NSAIDs cause constriction of afferent renal vessels and can cause AKI, e.g AIN. ACE-is cause dilatation of efferent renal vessels and reduces GFR – exacerbates renal impairment, especialy in elderly.

Question 22

What happens when methotrexate and trimethoprim are prescribed together?

Answer 22

Both are folate antagonists, and together may cause rapid BM suppression, pancytopenia, neutropenic sepsis. They are both nephrotoxic.

Question 23

What asthma drug class most commonly causes dry mouth?

Answer 23

Muscarinic antagonists, short acting e.g. ipratropium or long acting e.g. tiotropium

Question 24

What asthma drug can cause oral thrush?

Answer 24

Inhaled corticosteroids e.g. fluticasone, beclomethasone, budesonide

Question 25

What drug classes cause falls?

Answer 25

Anticholinergics, antihypertensives, neuropathic painkillers, opioids, diuretics

Question 26

What antibiotics are P450 inhibitors?

Answer 26

Macrolides e.g. erythromycin, clarithromycin
Fluoroquinolones e.g. ciprofloxacin
Sulfonamides

Question 27

What are some symptoms of benzo withdrawal?

Answer 27

Tremor, anxiety, insomia

Question 28

When do you lower dose of enoxaparin?

Answer 28

For patients <50kg and eGFR <30