Side effects Flashcards

Question

Steroid endorphins SEs

Answer 1

impaired glucose regulation increased appetite/weight gain hirsutism hyperlipidaemia

Answer 2

osteoporosis proximal myopathy avascular necrosis of the femoral head

Answer 3

insomnia mania depression psychosis

Answer 4

Peptic ulceration acute pancreatitis

Answer 5

glaucoma cataracts

Answer 6

Fluid retention Hypertension

Answer 7

Addisonian crisis

Answer 8

received more than 40mg prednisolone daily for more than one week received more than 3 weeks of treatment recently received repeated courses

Answer 9

Methotrexate is an antimetabolite that inhibits dihydrofolate reductase, an enzyme essential for the synthesis of purines and pyrimidines.

Answer 10

mucositis myelosuppression pneumonitis the most common pulmonary manifestation similar disease pattern to hypersensitivity pneumonitis secondary to inhaled organic antigens typically develops within a year of starting treatment, either acutely or subacutely presents with non-productive cough, dyspnoea, malaise, fever pulmonary fibrosis liver fibrosis

Answer 11

women should avoid pregnancy for at least 6 months after treatment has stopped the BNF also advises that men using methotrexate need to use effective contraception for at least 6 months after treatment

Answer 12

FBC, U&E and LFTs need to be regularly monitored. The Committee on Safety of Medicines recommend 'FBC and renal and LFTs before starting treatment and repeated weekly until therapy stabilised, thereafter patients should be monitored every 2-3 months'

Answer 13

folic acid 5mg once weekly should be co-prescribed, taken more than 24 hours after methotrexate dose

Answer 14

avoid prescribing trimethoprim or co-trimoxazole concurrently - increases risk of marrow aplasia high-dose aspirin increases the risk of methotrexate toxicity secondary to reduced excretion

Answer 15

folinic acid

Answer 16

Amoxicillin and inhaled corticosteroids can cause oral thrush

Answer 17

Inhaled corticosteroid

Answer 18

nystatin drops

Answer 19

Canagliflozin – SGLT2s (e.g. dapagliflozin/empagliflozin) can cause DKA without marked hyperglycaemia

Answer 20

SGLT 2 inhibitors (gliflozins)

Answer 21

delayed repolarization of the ventricles. It is important to recognise as it may lead to ventricular tachycardia/torsade de pointes and can therefore cause collapse/sudden death. A normal corrected QT interval is less than 430 ms in males and 450 ms in females.

Answer 22

amiodarone, sotalol, class 1a antiarrhythmic drugs tricyclic antidepressants, selective serotonin reuptake inhibitors (especially citalopram) methadone chloroquine terfenadine** erythromycin haloperidol ondanestron

Answer 23

terfenadine- a non-sedating antihistamine and classic cause of prolonged QT in a patient, especially if also taking P450 enzyme inhibitor, e.g. Patient with a cold takes terfenadine and erythromycin at the same time

Answer 24

Serotonin syndrome

Answer 25

Excess serotonin (e.g. SSRI/SNRI in combination with another medication that will increase serotonin levels)

Answer 26

Confusion Agitation Muscle twitching Sweating/shivering Diarrhoea Seizures Arrythmias Unconsciousness

Answer 27

Treatment: supportive care, IV fluids, stop serotonergic agents, benzodiazepines, ITU etc. (it gets complicated!)

Answer 28

metoclopramide, domperidone phenothiazines haloperidol very rare: SSRIs, opioids (Citalopram, olanzapine)

Answer 29

Typical antipsychotics - Chlorpromazine - haloperidol D2 antagonists – worsens Parkinson’s disease symptoms Atypical antipsychotics - Clozapine - amisulpiride, - risperidone, - quetiapine, - olanzapine D2 and 5-HT antagonists - less extrapyramidal side effects than the typicals Antiemetics - Chlorpromazine - metoclopramide - prochlorperazine Antidepressants - Phenelzine, -tranylcypromine, - isocarboxazid, -amoxapine Act on different receptors but can have bad side effects when used in combination with Parkinson’s disease medications)

Answer 30

- myopathy: includes myalgia, myositis, rhabdomyolysis and asymptomatic raised creatine kinase. - liver impairment: the 2014 NICE guidelines recommend checking LFTs at baseline, 3 months and 12 months. Treatment should be discontinued if serum transaminase concentrations rise to and persist at 3 times the upper limit of the reference range

Answer 31

macrolides (e.g. erythromycin, clarithromycin) are an important interaction. Statins should be stopped until patients complete the course pregnancy

Answer 32

- all people with established cardiovascular disease (stroke, TIA, ischaemic heart disease, peripheral arterial disease) - anyone with a 10-year cardiovascular risk >= 10% - patients with type 2 diabetes mellitus should now be assessed using QRISK2 like other patients are, to determine whether they should be started on statins - patients with type 1 diabetes mellitus who were diagnosed more than 10 years ago OR are aged over 40 OR have established nephropathy

Answer 33

ondansetron palonosetron

Answer 34

prolonged QT interval constipation is common

Answer 35

--cough -angioedema: may occur up to a year after starting treatment -hyperkalaemia -first-dose hypotension: more common in patients taking diuretics

Answer 36

pregnancy and breastfeeding - avoid renovascular disease - may result in renal impairment aortic stenosis - may result in hypotension hereditary of idiopathic angioedema specialist advice should be sought before starting ACE inhibitors in patients with a potassium >= 5.0 mmol/L

Answer 37

urea and electrolytes should be checked before treatment is initiated and after increasing the dose a rise in the creatinine and potassium may be expected after starting ACE inhibitors acceptable changes are an increase in serum creatinine, up to 30% from baseline and an increase in potassium up to 5.5 mmol/l. significant renal impairment may occur in patients who have undiagnosed bilateral renal artery stenosis

Answer 38

Aminosalycilates - local anti inflammatory in colon

Answer 39

rashes, oligospermia, headache, Heinz body anaemia, megaloblastic anaemia, lung fibrosis

Answer 40

GI upset, headache, agranulocytosis, pancreatitis*, interstitial nephritis

Answer 41

agranulocytosis - FBC is a key investigation in an unwell patient taking them.

Answer 42

Pancreatitis

Answer 43

should ideally be given into central veins (causes thrombophlebitis)

Answer 44

has proarrhythmic effects due to lengthening of the QT interval interacts with drugs commonly used concurrently (p450 inhibitor) e.g. Decreases metabolism of warfarin

Answer 45

TFT, LFT, U&E, CXR prior to treatment TFT, LFT every 6 months

Answer 46

thyroid dysfunction: both hypothyroidism and hyper-thyroidism corneal deposits pulmonary fibrosis/pneumonitis liver fibrosis/hepatitis peripheral neuropathy, myopathy photosensitivity 'slate-grey' appearance thrombophlebitis and injection site reactions bradycardia lengths QT interval

Answer 47

bone marrow depression consider a full blood count if infection/bleeding occurs nausea/vomiting pancreatitis increased risk of non-melanoma skin cancer

Answer 48

Syncope, Angina, Dyspnoea

Side effects Flashcards

(73 cards)