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Prescribing - PSA > Contraindications and Adverse Drug Reactions > Flashcards

Contraindications and Adverse Drug Reactions Flashcards

1
Q

Contraindications of drugs that increase bleeding

A
  • Aspirin, heparin and warfarin should not be given to patients who are bleeding, suspected of bleeding or at risk of bleeding (e.g. those with a prolonged prothrombin time due to liver disease).
  • Pharmacological blood clot prohpylaxis is contraindicated if they are at risk of bleeding!!!
  • Mechanical blood clot prohpylaxis is contraindicated in peripheral arterial dosease (usually indicated by absent foot pulses) which may cause acute limb ischemia
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2
Q

What is contraindicated in acute ischaemic stroke

A
  • Heparin Thromboprphylaxis for around 2 months (depending on trust)
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3
Q

Contraindications of steroids

A

STEROIDS

Stomach ulcers

Thin skin

oEdema

Right and left heart failure

Osteoperosis

Infection (including candida)

Diabetes - Commonly causes hyperglycemia and uncommonly progresses to diabetes

cushings Syndrome

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4
Q

Contraindications of NSAIDs

A

NSAID

No urine (renal failure)

Systolic dysfunction (HF)

Asthma

Indigestion (any cause)

Dyscrasia (clotting abnormality)

While aspirin is technically an NSAID, it is not contraindicated in renal or heart failure, or in asthma

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5
Q

Contraindications of antihypertensives

A
  1. Hypotension
  2. Bradycardia with beta blockers and some calcium channel blockers
  3. Electrolyte disturbance can occur with ACEi and diuretics
  4. Specific drug class effects:
    1. ACEi can result in dry cough
    2. Beta blockers can cause wheeze in asthamtics; worserning of acute HF (but helps in chronic HF)
    3. CCB can cause preipheral oedema and flushing
    4. Diuretics can cause renal failure. Loop diuretics (e.g. furosemide) can also cause gout, and potassium-sparring diuretics (spironolactone) can cause gynaecomastia
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6
Q

When should metoclpramide be avoided?

A

Metoclopramide (a dopamine antagonist) should be avoided in:

  • Patients with Parkinson’s disease due to the risk of exacerbating symptoms
  • Young women due to the risk of dyskinesia, i.e. unwanted movemenrs especually acute dystonia
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7
Q

What is a contraindication for charcoal use?

A
  • Absent bowel sounds (obstruction)
  • Absent gag reflex/unsafe swallow
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8
Q

What are the complications of NSAIDs?

A
  1. GI complications
  2. Cerebral haemorrhage
  3. Rash (same location each time)
  4. Increase bleeding risk with citalopram
  5. Impairs aspirin, renal impairment, interstitial nephritis and Li excretion
  6. Worsens sodium and water retention - avoid in severe liver failure
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9
Q

What are the complications of diuretics?

Loop and Thiazide

A
  1. Furosemide
    1. low K+, Na+ and Ca2+
    2. Hypotension, metabolic alkalosis (low H+ and K+)
    3. Ototoxic
  2. Thiazides
    1. low K+, Na+, High Ca2+
    2. Na/Cl inhibitor at the distal convulated tubule - hyoercalaemia, gout, lithium toxicity, impotence
  3. Profound diuresis if together.
  4. NSAIDs inhibit effects of diuretics
  5. Profound hypotension if with ACEi.
    1. Can actually cause hypernatraemia if water loss exceeds that of sodium
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10
Q

What are the complications of warfarin?

A
  1. Bleeding if with enzyme inhibitor (SAMJuiceFail.COM)
  2. Clots if with inducer (BS CRAP GP)
  3. Avoid with NSAIDs/aspirin as bleeding risk increases
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11
Q

What are the complications of ACE/AII inhibitors?

A
  1. Raisued Urea and creatinne if in - check U&Es
    1. Expect a 20% rise in creatinine, this is normal
  2. Hyperkalaemia. DOnt combine with NSAIDS. Exacerbates anaemia (inhibits EPO)
    1. Before titrating a dose - check creatinine and potassium
    2. ACEi relax efferents, NSAIDs constric afferents, so together have a multiplicative effect
  3. IF PVD, they probable have renal artery stenosis so avoid
  4. Profound Hypertension if + diuretics
  5. Prodrug, so reduced effectiveness in hepatic failure
  6. Delayed angioedema many months later (bradykinin must accumulate)
    1. Acoid if hx of angioedema
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12
Q

What are the complications of betablockers and its contraindications?

A
  1. Bradycardia, heart block (if use with verapamil change to nifedipine), hypotension, cold limbs, impotence, disturbed sleep. Fatigue
  2. CI:
    1. ​asthma - causes wheeze and bronchospasm
    2. acute heart failure
  3. Uses: HTN, angina (atenolol), CHF (bisoprolol), Hyperthyroid (propanolol)
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13
Q

What are the complications of opiates?

A
  1. Constipation, vomiting, confusion, urinary retention
  2. Accumulates in renal failure, use alfentanil, burenorphine or fenatnyl
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14
Q

What are the complications of digoxin?

A
  • Positive inotrope which slows conduction through AV node
    • CI in WPW and heart block
  • Competes with potassium on Na/K ATPase:
    • High K+ limits the effect of digoxin
    • Low K+ increases the effect of digoxin
  • Toxicity: N&V, confusion, yellow-green vision, arrhthymias, gynaecomastia
    • By low K+, high Ca2+ or low Mg2+ - loop and thiazides
    • BY increasing concentration (MACS)
      • Macrolides
      • Amiodarone
      • Calcium (containers and CCBs)
      • Spironolactone
  • Precipitated by hypokalaemia or renal insufficiency. Tx with Ab fragments
  • Reduced in renal failure
  • Asses with ECG, U+Es (K+level) and digoxin level
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15
Q

What are the complications of prednisolone?

A

GI complication

Hyperglycaemia

Osteoporotic fracture

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16
Q

What are the contraindications of Amiodarone?

A

K+ blocker and takes months to eliminate from body

  • CI: Thyroid disease, heart block, severe hypotension

Side effects:

  • Heart: Bradycardia, prolongs QT
  • Lung: Fibrosis, Pneumonitis
  • Liver: Fibrosis, Hepatitis
  • Bowels: constipation
  • Skin greying, photosensitivity and corneal deposits
  • Thyroid: Hyper and Hypo
  • During IV indusion: thrombophlebitis and low BP
17
Q

What are the complciations of lithium?

A
  • Toxicity:
      1. Tremor -> 2. Lethargy -> 3. Arrhythmias, seizures, renal failure
  • GI and neurological side effects (cerebellar dysfunction) hyperthermia, hypernatremia.
  • Termor then tiredness then renal, cardiac and neurological problems
  • Nephrotic syndrome, nephrotic diabetes insipidus
  • Antipsychotics increase neurotoxicity
  • ACEi, NSAIDs, THiazides, metronidazole increase levesl
18
Q

What are the complications of clozapine and its interactions?

A
  1. Use as a last resort antipsychotic - you cannot prescribe this
  2. Adverse effects:
    1. Collapse: Sedation, seizure, hypotension
    2. Parkinsonism, hyperpolactomenia - not as common as other antipsychotics
    3. Dry eyes, mouth, constipation, retention
    4. Insulin resistance - weight gain, diabetes. Not dose-related
    5. Neutropenia/agranulocytosis
    6. intestinal obstruction/ ileus
  3. Interactions:
    1. smoking increases requirement
19
Q

What are the complications of PPI?

A
  • Diahhroea, C - diff, low Mg2+, fracture risk
  • May disguise gastric cancer symptoms
  • Avoid lansoprazole in pregnancy
  • Hold PPI 2 weeks before H.Pylori test
20
Q

What is hydroxychloroquine and what are its complications?

A
  1. Is a medication used for the prevention and treatment of certain types of malaria
  2. Retinopathy, Screening required if taen longer than 5years
21
Q

What are the side effects of sodium valporate?

A

VALPORATE

  • Vomiting and nausea (GI) - take with food
  • Appetitie increased - weight gain
  • Liver failure
  • Pancreatitis
  • Reversible hair loss - curly
  • Oedema
  • Ataxia
  • Tremor, Thrombocytopenia
  • Encephalopathy
22
Q

What are the side effects of ACE inhibitors?

A
  1. Cause a dry cough through the accumulation of bradykinin via reduced degradation by ACE
  2. Cause HYPERkalaemia through reduxed aldosterone production and thus reduced potassium excretion in the kidneys
23
Q

Which antihypertensives cause hyperkalaemia or hypokalaemia?

A

HYPERkalaemia:

  • ACE inhibitors - Cause HYPERkalaemia through reduxed aldosterone production and thus reduced potassium excretion in the kidneys
  • Aldosterone anagonists e.g. spironolactone

Hypokalaemia:

  • Loop and thiazide diuretics (including bendroflumethiazide) - Causes hypokalaemia by increasing potassium excretion by the kidney.
24
Q

Which diuretics cause hyponatraemia?

A

All diuretics, however, if they contribute to dehydration, sodium levels can increase.

25
Q

What are the side effects of calcium channel blockers?

A

E.g. Amlodipine, Verapamil

  1. Peripheral oedema

Prescribing - PSA (9 decks)

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