Adverse Effects Flashcards by Hussain Azizi

Adverse Effects

Drug Name

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Slows A-V conduction

Non-DHP: Diltiazem, Verapamil

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Arrhythmias; Hypotension

Milrinone

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Hypotension (α1 blockade)

Bradycardia (due to exaggerated β1 block); bronchoconstriction (due to β2-block)
May worsen heart failure or cause hypotension during 1st 2-4 weeks – titrate dosage up

Carvedilol

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Bradycardia (due to exaggerated β1 block); bronchoconstriction (due to β2-block)
May worsen heart failure or cause hypotension during 1st 2-4 weeks – titrate dosage up

Metoprolol

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cardiac arrhythmias, conduction disturbances and CNS (confusion, visual disturbances)

Digoxin

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Cough & angioedema

due to bradykinin breakdown

ACE Inhibitors:

Captopril, Enalapril, Lisinopril

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Hyperkalemia
Antiandrogenic → Painful gynecomastia
Menstrual irregularity & ↓libido

Spironolactone

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Ototoxicity (manifest as: tinnitus, hearing impairment, deafness, vertigo)
Hypokalemia; hypomagnesemia

Furosemide

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Tachycardia, arrhythmia, angina (all due to β receptor agonism)
Hypertension (due to α1 receptor agonism)
Development of tolerance

Dobutamine

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A-V block; Acute heart failure; Sedation (CNS side effect); Bradycardia; Bronchospasm (less with cardio-selective)

Metoprolol, atenolol (cardio-selective)

Propranolol

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– Muscle aches, myopathy, muscle
inflammation, rhabdomyolysis –> check
creatine kinase level to monitor
muscle breakdown
– Peripheral neuropathies
– Hepatotoxicity (↑Transaminase) – get
baseline transaminase level before
starting medication
– GI upset
– Rash &amp; itching

Statins

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– Myopathy/rhabdomyolysis; Pain & headache
– Cholelithiasis (gallstones) due to ↑cholesterol excretion into bile
– Elevated liver function tests
– ↓WBC → Disposition to infections (influenza)

Fibrates

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(1) Suppression of the hypothalamic-pituitary-adrenal axis
(2) Growth suppression
(3) Osteoporosis
(4) Increased intraocular pressure and cataracts

Prednisone (Oral)

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(a) Cough
(b) Nasal and throat discomfort
(c) Rarely bronchospasm and decreased lung function

Zanamivir (inhalation)

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(a) Nausea and vomiting (relieved if taken with food)
(b) Headache
(c) Neuropsychiatric events including suicide (children &
adolescents)

Oseltamivir (oral)

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• Mostly GIT disturbances (nausea,
constipation, & flatulence)
• High doses: ↓Absorption of
fat soluble vitamins

Bile acid sequestrants (resins)

Cholestyramine, Colestipol, and Colesevelam

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“Red-neck” or “red-man” syndrome (caused by release of histamine from
cutaneous mast cells)
Ototoxicity
Nephrotoxicity

Vancomycin

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Dry nose and mouth
Pharyngeal irritation
Urinary retention
Increased intraocular pressure (with inadvertent instillation in the eye)

Ipratropium (intranasal)

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a. CNS excitation (Insomnia, excitability, headache, nervousness)
b. Cardiovascular stimulation (palpitations, tachycardia, hypertension)
c. GI (nausea, vomiting)
d. Urinary retention

Pseudoephedrine (oral)

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a. Crystalluria
b. Acute hemolytic anemia in G6PD deficiency
c. Stevens-
Johnson Syndrome
d. Kernicterus in newborns

Trimethoprim-sulfamethoxazole

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a. Dryness and irritation or burning of the nasal mucosa
b. Sore throat
c. Epistaxis
d. Headache

Fluticasone (intranasal)

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a. Gastrointestinal
i. Distress, nausea and vomiting
ii. Pseudomembranous colitis
b. Photosensitivity
c. Permanent brown discoloration of the teeth

Tetracyclines - Doxycycline

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a. Gastrointestinal*
i. Nausea, vomiting, cramps, and diarrhea
b. QT prolongation*
c. Cholestatic jaundice*

Azithromycin, clarithromycin and erythromycin (Macrolides)

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a. GI: nausea, vomiting, abdominal discomfort b. CNS: headache, dizziness c. Musculoskeletal: increased risk of tendonitis and tendon rupture usually involving the Achilles tendon

Fluoroquinolone- Levofloxacin

a. Hypersensitivity reactions b. Local reactions at the site of administration c. Nephropathy

Ceftriaxone

a. Hypersensitivity reactions b. Phlebitis (parenteral); GI upset (oral) c. Interstitial nephritis d. Neurotoxicity

Penicillin G and V

a. Hypersensitivity reactions b. Phlebitis (parenteral); GI upset (oral) c. Neurotoxicity

Piperacillin + tazobactam | Amoxicillin + clavulanate

a. Ototoxicity: Vestibular and auditory b. Nephrotoxicity c. Neuromuscular blockade

Aminoglycosides - Gentamicin

Angina Anxiety, headache N/V

Epinephrine

Anxiety, tremor, restlessness, | tachycardia, and hypokalemia

Albuterol (Inhaled & oral)

Arrhythmia, asystole | Chest pain, MI

Vasopressin

As effective as codeine without GI or CNS effects at usual doses

Dextromethorphan

Bleeding

Ticagrelor

Bleeding | Heparin-induced thrombocytopenia

Heparin low-molecular-weight heparin [enoxaparin]

Bleeding Skin necrosis Fetal toxicity

Warfain

Bleeding | Thrombocytopenia

Abciximab

bleeding - no specific antidote

Fondaparinux Rivaroxaban Bivalirudin Dabigatran

bronchoconstriction, cough, wheezing

Cromolyn (Inhaled)

can cause allergic or | hypersensitivity reactions as well as coagulopathic effects

Colloidal solutions

CNS depression | Diminished alertness, slow reaction times, somnolence

Cetirizine

CNS depression Diminished alertness, slow reaction times, somnolence CNS stimulation is a sign of poisoning Gastrointestinal side effects include: anorexia, nausea, vomiting, diarrhea or constipation Antimuscarinic side effects include: dry mouth, urinary retention

Chlorpheniramine | Diphenhydramine

``` CNS depression (manifested as drowsiness), constipation, and potential for abuse ```

Codeine

Conjunctival irritation, wheezing and occasional reversible | deterioration in pulmonary function

Ribavirin

Dizziness and headache Constipation Nausea

Ranolazine

dyspnea, pharyngitis, rhinitis

Dornase α

``` Flushing Headache Hypotension Peripheral edema Reflex tachycardia Constipation Gingival hyperplasia ```

Dihydropyridines: Amlodipine, Nifedipine

Flushing → Headache and pruritus of the trunk, face and arms can occur due to release of prostaglandins Hyper‐urecemia (↑Uric acid); can precipitate gout Hyperglycemia Myopathy Gastrointestinal disturbances Hepatotoxicity – monitor with liver function tests Peptic ulcer reactivation

Niacin (Vit B3)

generally devoid of sedative effects, antimuscarinic effects and GI effect

Fexofenadine

generally devoid of sedative effects, antimuscarinic effects and GI effect

Loratadine

GI upset

Montelukast

GI, upper respiratory tract infection, increased ALT/AST

Ivacaftor | Lumacaftor

GI: Nausea, diarrhea, weight loss

Roflumilast

headache and injection site reactions

Omalizumab (Intravenous or subcutaneous)

Hemorrhage: a. Lysis of fibrin at sites of vascular injury b. The systemic lytic state

tPA; alteplase

hepatitis and upset stomach

Zileuton

Hypersensitivity Nephrotoxicity: Risk of tubular necrosis in patients with underlying renal disease or who are taking potentially nephrotoxic drugs

Cephalosporins: Ceftriaxone

Hypersensitivity Neurotoxicity: myoclonus or seizures, agitation, confusion and hallucinations, or lethargy and stupor progressing to coma Ampicillin rash

Ampicillin

i. Common: Rash, fever, nausea and vomiting ii. Increased liver enzymes iii. Hepatotoxicity iv. Turns urine orange-red, may stain contact lenses.

Rifampin

i. Diarrhea, abdominal pain ii. Bleeding (intracranial, gastrointestinal) iii. Skin rash, urticaria

Clopidogrel

i. Gastrointestinal disturbances ii. Hepatotoxicity iii. Arthralgias

Pyrazinamide

i. Gastrointestinal: Anorexia nausea | ii. CNS: Nervousness, insomnia, difficulty concentrating, ataxia

Amantadine

i. GI effects: Epigastric distress, nausea and vomiting; Ulceration and GI bleeding ii. Renal failure iii. Impaired platelet function iv. Hypersensitivity reactions v. Salicylate poisoning

Acetylsalicylic acid (aspirin)

i. Increased liver enzymes ii. Hepatotoxicity iii. Peripheral neuropathy: numbness or tingling in the feet or hands-can be prevented by concurrent administration of pyridoxine

Isoniazid

i. Infusion reactions (fever, chills); prevented with antiinflammatory drugs or meperidine ii. Nephrotoxicity; reversible iii. Normochromic, normocytic anemia caused by decreased erythropoietin; reversible

Amphotericin B

i. Nausea, vomiting ii. Rash iii. Hepatitis, increase in liver enzymes

Fluconazole & Itraconazole (triazoles)

i. Nausea, vomiting ii. Rash iii. Hepatitis, increase in liver enzymes Endocrinologic abnormalities, e.g., women, menstrual irregularities; men, gynecomastia; due to inhibition of steroid biosynthesis

Ketoconazole (imidazole)

i. Suppression of the hypothalamic-pituitary-adrenal axis ii. Growth suppression iii. Osteoporosis iv. Increased intraocular pressure and cataracts

Prednisone (oral)

Interstitial nephritis: fever, rash, and eosinophilia with hematuria and proteinuria; reversible

Penicillin G

Irreversible Ototoxicity: Vestibular and auditory Reversible Nephrotoxicity Neuromuscular blockade

Aminoglycosides: Gentamicin

Minimal adverse reactions - cough, wheezing on inhalation; irritation to nasal mucosa and eye

Cromolyn

N, V, headache, nervousness, insomnia Sinus tachycardia & occasional PVCs Serious arrhythmias, seizures, death

Theophylline | Aminophylline

Optic neuritis; change in visual acuity, difficulty in seeing the color green

Ethambutol

oral candidiasis | hoarseness

Beclomethasone; budesonide, flunisolide, | fluticasone (Inhaled)

Rebound vasodilation and congestion (rhinitis medicamentosa) when used for long periods Nasal irritation

Phenylephrine (intranasal)

``` Reflex bradycardia (due to absence of β-adrenergic effects) Hypertension Angina Headache, anxiety N/V ```

Phenylephrine

Regular use can lead to drug tolerance and an increase in | exacerbations

Salmeterol (Inhaled)

Side effects: GI upset

Montelukast

``` Skin necrosis (extravasation) Anxiety and headache ```

Norepinephrine

Skin necrosis (Extravasation) Palpitations; angina Headache N/V

Dopamine

Tachycardia | Tolerance

Dobutamine

Tolerance Headache Facial flushing & Postural hypotension

Nitroglycerin | Isosorbide dinitrate; Isosorbide mononitrate

Adverse Effects Flashcards

(82 cards)