Major Drug Side-effects & Monitoring

Question 1

Major side effects of TB Treatment

Answer 1

Rifampicin – Hepatitis, rashes, febrile reaction, orange/red secretions (N.B. contact lenses),
many drug interactions including warfarin and
OCP

Isoniazid – Hepatitis, rashes, peripheral
neuropathy, psychosis

Pyrazinamide – Hepatitis, rashes, vomiting,
arthralgia

Ethambutol – Retrobulbar neuritis

Therefore, MUST do a baseline visual acuity test and LFT’s which must be monitored
closely

Question 2

Enzyme inhibitors

Answer 2

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Sodium valproate
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Alcohol..binge drinking
Chloramphenicol
Erythromycin
Sulfonamides
Ciprofloxacin
Omeprazole
Metronidazole

Question 3

Enzyme inducers

Answer 3

Barbituates
St. John’s wort
Carbamazepine
Rifampin
Alcohol (chronic)
Phenytoin
Griseofulvin
Phenobarbital
Sulfonylureas

Question 4

Amiodorone

Answer 4

Pulmonary fibrosis, liver and thyroid dysfunction, optic neuritis

Question 5

Azathioprine

Answer 5

More side effects if TPMT enzyme deficient

Can cause very severe bone marrow suppression if allele is deficient or absent

Drug interaction with allopurinol

Oftenusedasasteroidsparingagent

Question 6

Anti-TNF therapy

Answer 6

Needs DAS assessment (according to NICE)

All brands are parenteral

Increased risk of infection with intracellular pathogens

Reactivation of TB

Question 7

Drug contraindicated in psoriasis due to a recognised association with erythroderma

Answer 7

Chloroquine

Question 8

Chloroquine ADRs

Answer 8

Retinopathy and corneal opacities, deafness, photosensitivity, hair discolouration and alopecia

Question 9

Drug monitoring - Statins

Answer 9

LFTs at baseline, 3 months and 12 months

Question 10

ACE inhibitors drug monitoring

Answer 10

U&E prior to treatment
U&E after increasing dose
U&E at least annually

Question 11

Amiodorone drug monitoring

Answer 11

TFT, LFT, U&E, CXR prior to treatment

TFT, LFT every 6 months

Question 12

Methotrexate drug monitoring

Answer 12

FBC, LFT, U&E

Every week until stable and then every 2-3months

Question 13

Azathioprine drug monitoring

Answer 13

FBC, LFT before treatment
FBC weekly for the first 4 weeks
FBC, LFT every 3 months

Question 14

Lithium drug monitoring

Answer 14

TFT, U&E prior to treatment then every 6 months

Lithium levels weekly until stabilised then every 3 months

Question 15

Sodium valproate monitoring

Answer 15

Sodium valproate LFT LFT, FBC before treatment

LFT ‘periodically’ during first 6 months

Question 16

Morphine breakthrough dose

Answer 16

Breakthrough dose = 1/6th of daily morphine dose

Question 17

When to discontinue statins

Answer 17

Treatment with statins should be discontinued if serum transaminase concentrations rise to and persist at 3 times the upper limit of the reference range.

Question 18

Drugs to avoid in renal failure

Answer 18

antibiotics: tetracycline, nitrofurantoin
NSAIDs
lithium
metformin

Question 19

What must you check before starting azathioprine treatment and to prevent what?

Answer 19

Azathioprine - check thiopurine methyltransferase deficiency (TPMT) before treatment

Thiopurine methyltransferase (TPMT) deficiency is present in about 1 in 200 people and predisposes to azathioprine related pancytopaenia