Side Effects Flashcards
Gentamicin, vancomycin
Ototoxic + Nephrotoxic
ACE inhibitors
Cough
Hyperkalaemia
Ankle swelling
Avoid NSAIDs
Avoid in pregnancy, breastfeeding, and renal impairment
Beta-blockers
Bronchospasm
Confusion
Cold hands/feet
Erectile Dysfunction
Fatigue, sleep disturbance (nightmares)
Avoid in ASTHMA
Avoid VERAPAMIL - can cause fatal heart block
Avoid in uncontrolled/acute HF (only used for CHRONIC HF)
Avoid in Peripheral Vascular Disease - can cause ischaemia due to vasoconstriction
Statins
- MYALGIA
- Abdo pain
- Raised ALT/AST
Exclude rhabdomyolysis with serum CK + Urine Dip.
If Sx too much OR CK >2000:
1st = Temporarily STOP statin
2nd = Switch to another statin w/ lower risk (Simvastatin has highest risk)
Statins contraindicated in pregnancy
Haloperidol, Chlorpromazine
EPSEs
* Akathisia (severe restlessness)
* Tardive Dyskinesia (chewing/pouting of jaw)
* Acute dystonia: Torticollis, oculogyric crisis. Tx = Procyclidine
* Parkinsonism
Increased risk of Stroke + VTEs in the elderly
Anti-muscarinic SEs
Hyperprolactinaemia (results in gynaecomastia, sexual dysfunction)
Neuroleptic Malignant Syndrome = Fever + Muscle stiffness
Reduced seizure threshold
Prolonged QT
Fludrocortisone
Hypertension
Lithium
Early = COURSE Tremor (fine tremor is normal)
Mid = Fatigue, confusion
Late = Arrhythmias, seizures/coma, renal failure, polyuria (DI)
Amiodarone
- THYROID (hypo/hyper)
- HEART (bradycardia, prolonged QT)
- LUNG (fibrosis/pneumonitis)
- LIVER (fibrosis/hepatitis)
- Eyes (photosensitivity, corneal deposits)
- Skin (Slate-grey appearance)
- Nerves (peripheral neuropathy)
ENZYME INHIBITOR - can increase INR
Can precipitate DIGOXIN TOXICITY as it binds to K+ channels. Dose should be reduced if both are being taken
Monitoring:
TFT, LFT, CXR, U&Es before starting Tx
TFT, LFT every 6 months
Need to monitor thyroid, lung, and liver
Digoxin
EARLY Signs
* N+V, Diarrhoea
* BRADYCARDIA
LATE Signs
* Blurry vision (double vision)
* Seeing ‘halos’
Added as 2nd line drug for rate-control in AF
Digoxin competes with serum K+ at sodium pumps and limits Na2+ influx, thus slowing HR.
LOW serum K+ will INCREASE effect of digoxin
HIGH serum K+ will REDUCE effect of digoxin
Heparin
- Haemorrhage (esp. in renal failure or weight <50kg)
- Heparin-induced Thrombocytopenia (HIT)
OSTEOPOROSIS
HYPERKALAEMIA
HIT = Low pt, BUT it is a PRO-THROMBOTIC state
Antidote = protamine sulfate
Replacement anti-coagulant = Argatroban (Direct thrombin inhibitor)
Aspirin
- Haemorrhage
- Stomach upset (Peptic ulcers/Gastritis)
- Tinnitus (at very high doses)
Spironolactone
- Hyperkalaemia
- Gynaecomastia
For gynaecomastia, use Eplerenone instead
Metformin
GI Upset - intolerable in 20%
Lactic acidosis
DOESN’T cause weight gain or hypoglycaemia (unlike sulphonylureas)
Lactic acidosis can happen in severe renal failure
eGFR <45 = REVIEW
eGFR <30 = STOP
Can also happen in tissue hypoxia (recent MI, sepsis, AKI, severe dehydration)
If SEs intolerable, consider MODIFIED-RELEASE metformin
PPIs
Hyponatraemia
Hypomagnesaemia
Osteoporosis
Diarrhoea
Increased risk of C.diff
Levodopa
- Dry mouth
- Anorexia
- Palpitations
- Postural hypotension
- Psychosis
- End-of-dose wearing off - Sx get worse
- “On-off” variation in motor performance
- Dyskinesias at peak dose (dystonia, chorea, athetosis [writhing movements])
NB: Levodopa and other anti-parkinsons drugs should NEVER BE ACUTELY STOPPED.
If pt can’t tolerate oral meds, give Dopamine Agonist PATCH to prevent acute dystonia
