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Adverse Drug Effects Flashcards

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1
Q

methotrexate AEs

A

mucositis (e.g. ulcers)
myelosuppression
interstitial pneumonitis
pulmonary fibrosis
liver fibrosis
GI disturbance
folate deficiency anaemia
immunosuppression
liver toxicity
neutropenia
rash
teratogenecity

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2
Q

exam: ?
dyspnoea
bilateral fine crackles

A

pulmonary fibrosis

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3
Q

etanercept AEs

A

anti-tnf drugs classically cause TB reactivation and vulnerability to severe infections

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4
Q

leflunomide AEs

A

mouth ulcers
peripheral neuropathy
bone marrow suppression

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5
Q

sulfasalazine AEs

A

oligospermia
Stevens-Johnson syndrome
pneumonitis / lung fibrosis
myelosuppression, Heinz body anaemia, megaloblastic anaemia
may colour tears → stained contact lenses

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6
Q

indications for methotrexate?

A

inflammatory arthritis esp RA
psoriasis
some chemo - e.g. ALL

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7
Q

how long should women avoid pregnancy for after stopping treatment for methotrexate?

A

at least 6 months

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8
Q

methotrexate drug interactions?

A

trimethoprim or co-trimoxazole - increases risk of marrow aplasia

high-dose aspirin increases risk of methotrexate toxicity secondary to reduced excretion

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9
Q

treatment of methotrexate toxicity?

A

folinic acid

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10
Q

how to monitor methotrexate?

A

FBC, U&E, LFTs before starting treatment and weekly until therapy stabilised, thereafter every 2-3 months

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11
Q

methotrexate starting dose?

A

weekly 7.5mg
only one strength of tablet should be given

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12
Q

azathioprine AEs?

A

bone marrow suppression
nausea/vomiting
pancreatitis
increased risk of non-melanoma cancer

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13
Q

what may azathioprine interact with to cause bone marrow suppression?

A

allopurinol (they’re both xanthine oxidase inhibitors)

so use lower doses of azathioprine in this instance

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14
Q

indications of azathioprine in pregnancy?

A

safe to use in pregnancy

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15
Q

what type of ulcers do NSAIDs cause?

A

peptic

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16
Q

what type of ulcers do bisphosphonates cause?

A

oesophageal

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17
Q

AEs of bisphosphonates?

A

oesophageal reactions: oesophagitis, oesophageal ulcers, erosions and strictures
osteonecrosis of the jaw or auditory canal
atypical stress fractures of proximal FEMORAL shaft
acute phase response (fever, myalgia, arthralgia)
hypocalcaemia (due to reduced ca efflux from bone)

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18
Q

how may bisphosphonate associated oesophageal AEs present?

A

odynophagia, dysphagia or new/worsening dyspepsia

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19
Q

is bisphosphonate-associated hypocalcaemia a clinical concern?

A

usually clinically unimportant

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20
Q

what should be corrected before giving bisphosphonates?

A

hypocalcaemia/vit d deficiency

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21
Q

how does sulfasalazine work?

A

decreases neutrophil chemotaxis
suppresses lymphocyte proliferation and pro-inflammatory cytokines

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22
Q

cautions for sulfasalazine?

A

G6PD deficiency
allergy to aspirin or sulphonamides - cross-sensitivity

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23
Q

patients who are allergic to aspirin may also react to ?

A

sulfasalazine (aspirin is a salicylate)

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24
Q

is sulfasalazine safe to use in pregnancy and breastfeeding?

A

yes (unlike other DMARDs)

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25
is leflunomide safe to use in pregnancy?
NO
26
is methotrexate safe to use in pregnancy?
no
27
patients who are allergic to sulphonamides may be allergic to?
sulfasalazine (cross-sensitivity)
28
in what situations should use of sulfasalazine be cautioned?
allergy: aspirin, sulphonamide G6PD deficiency
29
why would acei not be a/w urticaria?
they cause angioedema (which can cause difficulty breathing) but the mech for drug-induced angioedema is driven by bradykinin, not histamine
30
what is used to relieve symptoms like urticaria, histamine-mediated angioedema, anaphylactic rxr?
cetirizine (anti-histamine)
31
when is azathioprine use CI?
in pt with hypersensitivity to mercaptopurine
32
is hydroxychloroquine safe to use in pregnancy in pt with RA?
yes it crosses the placenta, but doesn't cause fetal toxicity with doses used for RA treatment
33
AEs of hydroxychloroquine?
rash bull's eye retinopathy (-> severe + permanent vision loss) baseline optho exam + annual screening (ask pt about visual sx + monitor visual acuity annually with a reading chart)
34
streptomycin AEs?
aminoglycoside toxic to kidney and ears
35
isoniazid AEs?
CYP450 enzyme inhibitor drug-induced lupus peripheral neuropathy (so give w pryidoxine, vit B6) drug-induced hepatitis
36
rifampicin AEs?
CYP450 enzyme inducer stain secretions orange-red (sweat, urine) hepatitis flu-like symptoms
37
ethambutol AEs?
optic neuritis (check visual acuity before and during treatment)
38
pyrazinamide AEs?
gout due to increased uric acid levels drug-induced hepatitis
39
patients with a documented allergy to a sulfa drug should not take?
sulfasalazine
40
example of a sulfa drug?
co-trimoxazole sulfasalazine
41
why does TPMT need to be checked before starting azathioprine?
metabolises azathioprine if deficiency -> azathioprine toxicity
42
what is a dihydropyrimidine dehydrogenase deficiency?
body can't break down thiamine and uracil - AVOID 5-FLUOROURACIL or use with extreme caution
43
methotrexate use is a/w deficiency in what nutrient?
folate
44
pt with galactosaemia (Gal-1-put) should avoid what?
galactose
45
g6pd deficiency puts pt at risk of?
haemolytic crises in response to different triggers - incl some meds like antimalarials, antibiotics
46
gold AEs?
Myelosuppression Renal toxicity (Nephrotic syndrome) Mouth ulcers Photosensitivity Chrysiasis (skin discolouration)
47
gold AEs?
Myelosuppression Renal toxicity (Nephrotic syndrome) Mouth ulcers Photosensitivity Chrysiasis (skin discolouration)
48
nsaids AEs?
vasoconstriction of afferent arterioles -> nephrotoxicity Indigestion Peptic ulcer disease, Increased risk of venous thrombo-embolus Peripheral oedema Slight increased risk of stroke and heart attack
49
corticosteroids AEs?
Cushing's syndrome Osteoporosis Retardation of growth Thin skin, easy bruising Immunosuppression Cataracts and glaucoma Oedema Suppression of HPA axis Teratogenic Emotional disturbance (including psychosis Rise in BP Obesity (truncal) Increased hair growth (hirsutism) Diabetes mellitus Striae
50
which blood test abnormalities are commonly associated with Methotrexate use?
bone marrow suppression -> - thrombocytopenia - anaemia - leucopenia - agranulocytosis
51
how to monitor methotrexate AEs?
- Cytopenia - FBC + report ?infections and bruising. - Hepatotoxicity - LFTs. Mild elevation is normal, but discontinue if they rise to more than 3x normal. - Renal impairment - Monitor renal function. - Pulmonary fibrosis - baseline CXR + report any respiratory symptoms eg. dyspnoea/dry cough.
52
what drug should be avoided in antiphospholipid syndrome?
COCP - contains oestrogen, increasing risk of thromboembolism
53
anti-tuberculous treatment with pyrazinamide and ethambutol is known to reduce ___ and precipitate ____?
renal urate excretion attacks of gout
54
colchicine AEs?
diarrhoea
55
does allopurinol cause diarrhoea?
no
56
does ramipril cause diarrhoea?
no
57
does simvastatin cause diarrhoea?
no
58
does amlodipine cause diarrhoea?
no
59
how does osteonecrosis of the jaw present?
jaw feeling heavy jaw pain trouble chewing
60
how does tmj dysfunction present?
usually affects jaw movement can cause jaw locking/getting stuck
61
digoxin AE?
yellow-green vision
62
levodopa AEs?
reddish discolouration of urine upon standing dyskinesia 'on-off' effect hypotension
63
sildenafil AEs?
visual disturbances such as blue discolouration or non-arteritic anterior ischaemic neuropathy
64
nitrofurantoin AEs?
pulmonary fibrosis hepatitis peripheral neuropathy haemolytic anaemia in neonates
65
gentamicin AEs?
nephrotoxicity ototoxicity narrow therapeutic index, plasma conc should be regularly monitored
66
cefalexin AE
a/w c. diff colitis
67
ciprofloxacin AEs
increased risk of achilles tendinopathy/rupture - rare lowering of seizure threshold prolonged qt interval c. diff colitis
68
trimethoprim AEs?
allergic reactions leading to erythema multiforme, stevens-johnson syndrome, blood dyscrasias, nephrotoxicity, hepatotoxicity

Pharmacology (3 decks)

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