Adverse Effects & Contraindications Flashcards
(40 cards)
Barbiturates
A/E: Somnolence, Hypoventilation, Nausea, Bradycardia, agitation, confusion, nightmares, lethargy, vomiting, diarrhea, hypotension.
Contraindicated in patients with hepatic impairment, nephritic patients, dyspnea or airway obstruction, porphyria. Not recommended to be given SUBQ or intra-arterially.
Antianxiety drugs (benzos/non-benzos)
A/E: Withdrawal syndrome after 4-6 weeks. Never discontinue abruptly. Decrease over 4-6 weeks.
Symptoms of withdrawal: Fatigue, metallic taste, HA, numbness in extremities, sweating, dry mouth.
Contraindications: Do not use in patients that are comatose or CNS depressed. Pregnancy Class D. Acute narrow-angle glaucoma.
Buspirone hydrochloride is pregnancy class B.
TCAs
A/E: Dry mouth, blurred vision, postural hypotension, urinary retention, constipation, orthostatic hypotension.
Contraindication: Do not prescribe with MAOIs or within 14 days of MOAI use. Recovery phase after a myocardial infarction.
MAOI
A/E: Food interactions, vertigo, nausea, constipation, dry mouth, headache, and over-activity.
Contraindications: CVA Disease, hypertension, CHF, and elderly.
SSRI
A/E: Nausea, vomiting, sexual dysfunction, insomnia, and weight gain.
Contraindications: Fluoxetine is less effective in patients who smoke.
Burpropion
Contraindicated in patients with a seizure disorder as it reduces the seizure threshold.
Antipsychotic
Anticholinergic: Dry mouth, hypotension, sedation, photophobia, photosensitivity, headache
Extrapyramidal: Parkinson like symptoms; facial grimacing
Tardive dyskinesia: Irreversible, involuntary dyskinetic movements, rhythmic, movements of face mouth or jaw. Tongue may protrude.
Neuroleptic malignment syndrome: Immediately stop.
Contraindications: Not recommended in use of severely depressed patient or hypotensive.
CNS Stimulants (Amphetamines/Anorexiants)
A/E: Headache, dizziness, apprehension. Can cause overstimulation of CNS. Insomnia, tachycardia, and blurred vision.
Contraindications: Hypertension, stroke, glaucoma.
Amphetamines has a risk of dependence.
Anticonvulsants
A/E: Nausea, vomiting, constipation, bradycardia, hypoventilations, agitation, bleeding, fever, sore throat, and nystagmus. Steven-Johnson syndrome.
Contraindications: In patients with CNS depression. Pregnancy D. Psychoses, acute narrow-angle glaucoma.
Avoid Alcohol.
Antiemetic
A/E: Drowsiness
Contraindications: Severe CNS Depression, Pregnancy X, Do not use with alcohol, makes sedation worse.
Ketamine
Ischemic heart disease. May increase HR and BP which may be detrimental due to imbalance between myocardial oxygen supply and demand.
12% experience side effects from prolonged emergence from anesthesia.
Hypertension (ketamine raises BP)
Schizophrenia
May increase the risk of laryngospasm
Salicylate
A/E: Gastric upset, heartburn, nausea, vomiting, anorexia, GI Bleeding
Reye syndrome in children with chickenpox or influenza
Pregnancy D
Not recommended for patients with bleeding disorders
Non-salicylate
A/E: Urticaria, hemolytic anemia, hepatotoxicity, hepatic impairment or severe liver disease
Warning: Acetaminophen can cause hepatotoxicity. Do not exceed the maximum dose (>4g daily). Chronic daily use may result in liver damage.
Pregnancy B, Mostly safe.
NSAIDs
A/E: GI nausea and vomiting, may increase risk of heart attack or stroke.
Celecoxib: may cause Dyspepsia, contains sulfa
Ibuprofen: May cause Peptic ulcer, GI Bleed, and Hypertension
Phenazopyridine
A/E: Causes patients urine to turn reddish-orange, headaches, dizziness, stomach cramps.
Contraindications: Renal insufficiency
Pregnancy B
Narcotic analgesics
A/E: Respiratory Depression, light-headedness, constipation, nausea/vomiting
Contraindication: Head injury or increased intra-cranial pressure (ICP), hypoxia, hepatic impairment.
Naloxone (Narcotic Antagonist)
A/E: Acute opioid withdrawal: Pain, tachycardia, hypertension, fever, sweating, abdominal cramps, diarrhea, nausea, vomiting, agitation, irritability.
Use with caution in patients with Coronary Artery Disease (CAD), pregnant women, and opioid dependent patients.
Antihistamines (H1 & H2)
Anticholinergic effects: Drying effect may increase thickening of bronchial secretions, dizziness, fatigue, hypotension, headache.
Some antihistamines are Pregnancy C/D; Diphenhydramine is class B. May result in jaundice, hyperreflexia extrapyramidal symptoms in infants whose mothers received antihistamines (particularly promethazine)
Decongestants
A/E: Sleeplessness, anxiety, dizziness, excitability, nervousness. Topical nasal or Opthalmic decongestants can develop tachyphylaxis; thus long term use is not recommended. Agents lose effectiveness after a few days.
Contraindications: Hypertension, Diabetes, increased intraocular pressure. Worsen prostatic hyperplasia/urinary obstruction. Elderly more sensitive.
Pregnancy C. Not recommended.
Beta2 agonists
A/E: Paradoxical bronchospasm, nausea, vomiting, restlessness, tachycardia, increased respirations, nervousness, headache, palpitations, hyperglycemia.
Contraindications: Do not use with beta blockers, cardiac arrhythmias, narrow angle glaucoma.
Use albuterol with caution in diabetic patients (may increase serum blood glucose levels)
Muscarinic Antagonists
Anticholinergic effects.
Contraindications: Peptic ulcer, seizure, arrhythmias, hyperthyroid.
Caution with >60 year old patients.
Pregnancy C. Use only if benefit outweighs the risk.
Leukotriene Antagonists & Mast Cell Stabilizers
A/E: Headache, dizziness, unpleasant taste, fatigue.
Not FDA approved for the use in reversal of bronchospasm in acute asthma attacks.
Montelukast will not interrupt bronchoconstrictor response to aspirin or other NSAIDs.
Inhale Corticosteroids
A/E: Throat irritation, cough
Contraindication: Acute bronchospasm, caution with compromised immune system.
Antitussives
Codeine = respiratory depression, euphoria, and sedation.
Contraindication: Premature infants, caution with persistent or chronic cough
