Adverse Effects Flashcards by Katy Conlon

Adrenaline

After Cardiac arrest —> adrenaline induced hypertension

Use in conscious pts —> anxiety, tremor, headaches, palpitations

In those with existing heart disease —> angina, MI, arrhythmias

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Corticosteroids (systemic)

1️⃣ Immunosuppression
2️⃣Metabolic - osteoporosis, diabetes mellitus, proximal muscle weakness, bruising, gastritis
3️⃣Mood changes - suicidal, insomnia, confusion
4️⃣Mineralocorticoid - hypertension, hypokalaemia, oedema
5️⃣Adrenal atrophy over time -> Addisonian crisis if rapidly withdrawn
6️⃣Chronic glucocorticoid deficiency (fatigue, weight loss, arthralgia)

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Thiazide like Diuretics

⚠️ Hyponatraemia
⚠️ Hypokalaemia (Na swapped for K in DCT) —> arrhythmias
⚠️ Increase plasma glucose, TGs, LDL-cholesterol
⚠️ Impotence in men

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Statins

⚠️Headaches and GI Distrubances
‼️ Muscle problems ranging from aches to myopathy to rhabdomyolysis
⚠️ Increase in ALT
‼️ Drug induced hepatitis (rare but serious)

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Clopidogrel

⚠️Bleeding
⚠️GI upset
⚠️Thrombocytopenia

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Antihistamines

First generation (e.g. chlorphenamine) cause sedation as act in the 🧠 
Second gen are fine

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5a-reductase inhibitors

Impotence
Reduced libido
Gynaecomastia
Hair growth
Breast cancer

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Alpha blockers

Doxazosin, tamsulosin, alfuzosin

Postural hypotension
Dizziness
Syncope

Particularly after first dose

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Acetylcholinesterase inhibitors

Donepezil, Rivastigmine

Increased cholinergic activity in peripheral nervous system ->
Nausea
Vomiting
Diarrhoea

Exacerbation of asthma/COPD
Peptic Ulcers and bleeding
Bradycardia and heart block

Central cholinergic effects ->
Hallucinations
Altered/aggressive behaviour

Extrapyramidal symptoms
Neuroleptic malignant syndrome

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B-blockers

Propanolol, bisoprolol, atenolol, metoprolol, carvedilol

Fatigue
Cold extremities
Headache
GI disturbance
Sleep disturbance
Impotence

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Acetylcysteine

Can cause anaphylactoid reaction - give antihistamine & bronchodilator, then restart acetylcysteine.

When inhaled can cause bronchospasm so give bronchodilator first

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Activated charcoal

Aspiration ➡️ pneumonitis, bronchospasm, airway obstruction

Intestinal obstruction

Black stools

Vomiting

💊 will reduce dose available for absorption of therapeutic drugs as well as poisons

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Adenosine

By interfering with SAN and AVN it can induce bradycardia and asystole accompanied with SOB and ‘sense of impending doom’ - this is all short lived

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Aldosterone antagonists

spironolactone, eplenerone

Hyperkalaemia –> muscle weakness, arrhythmias, cardiac arrest
Gynaecomastia (spironolactone)
Endocrine side effects (eplenerone)
Liver impairment and jaundice
Steven-Johnson syndrome (T-cell-mediated hypersensitivity reaction that causes bullous skin eruption)

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Alginates and antacids

Gaviscon, Peptac

Diarrhoea (Mg salts)

Constipation (Al salts)

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Allopurinol

Starting can trigger or worsen acute attack of gout therefore co-px with NSAID or colchicine in the initiation phase.
Skin rash (Stevens-Johnson syndrome, toxic epidermal necrolysis)
Allopurinol hypersensitivity syndrome = severe, fever, eosinophilia, lymphadenopathy and other organ involvement

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Aminoglycosides

gentamicin, amikacin, nneomycin

Ototoxicity (hearing loss, tinnitus, vertigo)
Nephrotoxicity (reduced eurine output, rising serum creatinine and urea)
(due to accumulation in cells –> apoptosis)

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Aminosalicylates

mesalazine, sulfasalazine

GI upset
Headache
Blood abnormalities (leucopenia, thrombocytopenia)
Renal impairment
Oligospermia (sulfasalazine)
Serious hypersensitivity reaction

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Amiodarone

Acute = sometimes hypotension
Chronic use:
pneumonitis
bradycardia / AV block
hepatitis
photosensitivity / grey discolouration
thyroid abnormalities (as contains iodine)
V LONG t1/2

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ACE-i

ramipril, lisinopril, perindopril

First dose hypotension
Cough (due to increased bradykinin)
Hyperkalaemia (due to lower aldosterone level)
Renal failure (esp. in renal artery stenosis)
Angioedema and anaphylactoid reactions

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ARBs

loasartan, candesartan, irbesartan

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First dose hypotension
Hyperkalaemia
Renal Failure

Antidepressants - SSRI’s

citalopram, sertraline, fluoxetine, escitalopram

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GI upset
Changes in appetite and weight
Hypersensitivity rxn
Hyponatraemia
Suicidal thoughts and behaviour
Lower seizure threshold
Some can prolong the QT interval -> arrhythmias
Increase risk of bleeding
Serotonin syndrome (autonomic hyperactivity, altered mental state and neuromuscular excitation)
Sudden withdrawal can cause GI upset, neuro sx, flu like sx and sleep disturbance

Antidepressants - tricyclics

Amitriptyline, lofepramine

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Blocking antimuscarinic receptors causes -> dry mouth, constipation, urinary retention and blurred vision
Blockade of H1- and α1- receptors -> sedation and hypotension
Cardiac adverse effects
Brain adverse effects (convulsions, hallucinations and mania)
Blockade of dopamine receptors -> breast changes, sexual dysfxn and extrapyramidal effects (tremor and dyskinesia)
Dangerous in overdose
Sudden withdrawal can cause GI upset, neuro sx, flu like sx and sleep disturbance

Antidepressants - venlafaxine and mirtazapine

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GI upset
Neurological effects
Hyponatraemia
Serotonin syndrome
Suicidal thoughts
Prolong QT interval (venlafaxine)
Sudden withdrawal can cause GI upset, neuro sx, flu like sx and sleep disturbance

Antiemetics - D2 receptor antagonists domperidone, metoclopramide

``` Diarrhoea Extrapyramidal sx (metoclopramide) - mostly acute dystonic reaction QT interval prolonged + arrhythmias (domperidone) ```

Antiemetics - H1 receptor antagonists cyclizine, cinnarizine, promethazine

Drowsiness Dry throat and mouth (anti-cholinergic effects) Transient tachycardia (after IV infusion)

Antiemetics - 5-HT3 receptor antagonists ondansetron, granisetron

Rare

Antifungal drugs fluconazole, clotrimazole, nystatin

Topical - local irritation ``` Fluconazole (oral): GI upset headache hepatitis hypersensitivity Rare but life threatening = severe hepatic toxicity, prolonged QT interval, arrhythmias, cutaneous reactions, anaphylaxis ```

Antihistamines - H1 receptor antagonists cetirizine, loratidine, fexofenadine, chlorphenamine

1st gen = sedation 2nd gen = few adverse effects (do not cross blood brain barrier)

Antimotility drugs loperamide, codeine phosphate

``` GI effects (e.g. constipation, flatulence, abdo cramps) Opioid toxicity/dependence ```

Antimuscarinics, bronchodilators ipratropium, tiatropium, glycopyrronium, aclidinium

After inhalation antimuscarinic bronchodilators are absorbed from lungs into circulation where inactivated by hydrolysis - happens at different rates. Can cause irritation of respiratory tract GI disturbance Urinary retention Blurred vision Headaches

Antimuscarinics, cardiovascular and GI uses atropine, hyoscine butylbromide, glycopyrronium

``` Tachycardia Dry mouth Constipation Urinary retention Blurred vision Drowsiness Confusion ```

Antimuscarinics, GU uses oxybutynin, tolterodine, solifenacin

``` Tachycardia Dry mouth Constipation Blurred vision Urinary retention may occur if there is bladder outflow obstruction ```

Antipsychotics - first generation haloperidol, chlorpromazine, prochlorperazine

Extrapyramidal side effects - acute dystonia/akathisia/neuroleptic malignant syndrome (rigidity, confusion, autonomic dysregulation, pyrexia)/tardive dyskinesia drowsiness hypotension QT interval prolongation -> arrhythmias erectile dysfunction hyperprolactinaemia -> galactorrhoea, menstrual disturbances, breast pain

Antipsychotics - second generation olanzapine, risperidone, clozapine

sedation EPSE (less common that 1st gen) Metabolic disturbance (weight gain, DM, lipid changes) prolong QT interval -> arrhythmias Sexual dysfunction and breast symptoms Clozapine -> agranulocytosis and myocarditis

Antiviral drugs aciclovir

``` headache dizziness GI disturbances Skin rash phlebitis ast injection site acute renal failure (minimise risk with good hydration and slow infusion) ```

Antiplatelet drugs - ADP receptor antagonists clopidogrel, ticagrelor, prasugrel

Bleeding GI upset thrombocytopenia

Antiplatelet drugs - aspirin

``` GI irritation Peptic ulceration and haemorrhage Hypersensitivity (bronchospasm) Tinnitus in regular high-dose Fatal in overdose (hyperventilation, hearing changes, metabolic acidosis, confusion, convulsions, cardiovasular collapse and respiratory arrest) ```

Azathioprine

Bone marrow suppression -> leukopenia and increased risk of infection Nausea Hypersensitivity (diarrhoea, rash, vomiting, fever, myalgia, hypotension and pancreatitis) Veno-occlusive disease hepatotoxicity lymphoma risk

β-blockers propanolol, bisoprolol, metoprolol, atenolol, carvediol

``` Fatigue cold-extremities headache GI disturbance Sleep disturbance Impotence in men ```

β2-agonists salbutamol, terbutaline, salmeterol, formoterol, indacaterol

fight or flight effects, e.g. tachycardia, palpitations, anxiety and tremor Increased serum glucose, lactate and muscle cramps

Benzodiazepines diazepam, temazepam, lorazepam, chlordiazepoxide, midazolam

drowsiness, sedation and coma overdose -> loss of airway reflexes -> death dependence withdrawal reaction

Bisphosphonates alendronic acid, zolendronic acid, disodium pamidronate

oesophagitis hypophosphataemia jaw osteonecrosis atypical femoral fracture

Calcium and Vitamin D calcium carbonate, calcium gluconate, colecalciferol, alfacalcidol

dyspepsia constipation cardiovascular collapse (if administered too quickly) local tissue damage (if accidentally given subcut)

Calcium channel blockers amlodipine, nifedipine, verapamil, diltiazem

``` A&N: swelling flushing headache palpitations V: constipation bradycardia heart block cardiac failure D: all the above ```

Carbamazepine

GI upset and neurological effects hypersensitivity (skin rash) Antiepileptic hypersensitivity syndrome (10% mortality) Oedema and hyponatraemia due to an ADH effect

Cephalosporins and carbapenems cefalexin, cefotaxime, meropenem, ertapenem

GI upset Antibiotic-associated colitis Hypersensitivity Neurological toxicity inc seizures

Chloramphenicol

Topical: burning, itching, stinging Systemic: bone marrow suppression or aplastic anaemia Grey baby syndrome Optic and peripheral neuritis

Corticosteroids (inhaled) beclometasone, budesonide, fluticasone

oral thrush hoarse voice In COPD may cause pneumonia

Corticosteroids (topical) hydrocortisone, betamethasone

Potent steroids can cause local adverse effects - skin thinning, striae, telangiectasia use on face - dermatitis or exacerbate acne withdrawal can cause rebound worsening adrenal suppression

Digoxin

``` Bradycardia GI disturbance Rash Dizziness Visual disturbance Arrhythmias with toxic level (narrow therapeutic range) ```

Adverse Effects Flashcards

(51 cards)