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1
Q

Macrolides eg

A

Clarithromycin, Azithromycin, Erthyromycin

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2
Q

Clarithromycin & pregnancy?

A

Avoid in pregnancy.

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3
Q

Macrolides SEs?

A
  • QT interval prolongation
  • Nausea & Vomiting
  • Diarrhoea
  • GI Side effects
  • Hepatotoxicity
  • Ototoxicity - hearing loss, tinnitus(uncommon)
  • Rash
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4
Q

Prolonged diarrhoea when taking an antibiotic can lead to…

A

Increased risk of c.difficile when using clindamycin

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5
Q

Macrolide interaction with statins can lead to?

A
  • Increased blood levels of statins
  • Increase risk of muscle disorders: Rhabdomyolysis, Myopathy
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6
Q

Which CYP enzyme does Macrolide antibiotics?

A

CYP450 3A4

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7
Q

Rivaroxaban and erythromycin interaction

A

Increased risk of bleeding due to erythromycin inducing CYP3A4

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8
Q

Macrolides and indigestion remedies?

A

Avoid indigestion remedies 2 hours before or after.

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9
Q

Macrolides and Myasthenia gravis

A

May aggravate myasthenia gravis

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10
Q

Cephalosporins egs

A

Cefalexin, cefaclor

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11
Q

Cephalosporins cross sensitivity?

A

Cross sensitivity with other Beta-lactam (penicillin) antibacterials.

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12
Q

Cephalosporins SEs:

A

Antibiotic-associated colitis (rare but more common with the 2nd and 3rd generation cephalosporins)

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13
Q

Indications for using cephalosporins (cephalexin)

A
  • Pseudomembrane
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14
Q

Cyclosporins SE?

A
  • Increase fluid retention
  • Hyperkalaemia
  • Excessive hair growth
  • gingival hyperplasia
  • hyperglycaemia
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15
Q

Flucloxacillin Adverse effects?

A
  • Rare: Cholestasis (bile flow from liver reduced/stopped); can lead to jaundice
  • If allergic: Urticaria
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16
Q

Tetracycline example?

A

Doxycycline

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17
Q

Penicillin Flucloxacillin SE?

A
  • Hepatic disorders
  • hepatitis
  • Jaundice
  • hypokalaemia
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18
Q

One common SE with ampicillin and amoxicillin?

A

Maculopapular rashes common with ampicillin and amoxicillin.

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19
Q

Penicillin SE?

A
  • Hypersensitivity
  • antibiotic-associated colitis
  • diarrhoea
  • CNS toxicity
  • Rare: encephalopathy due to cerebral irritation.
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20
Q

Flucloxacillin Patient advice?

A

Taken on empty stomach. An hour before or 2 hours after food.

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21
Q

An example of when to discontinue Tetracycline treatment?

A

Headache and visual disturbances indicate benign intracranial hypertension.

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22
Q

When to avoid tetracycline?

A
  • <12 yr
  • Pregnant or breast-feeding women (deposition in growing bone and teeth staining)
  • Hepatic and renal impairment.
  • CKD stage 4
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23
Q

Tetracyclines examples?

A

Tetracyclines, doxycyclines, minocycline

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24
Q

Tetracyclines SE?

A
  • N&V
  • antibiotic-associated colitis
  • dysphagia
  • hepatotoxicity
  • photosensitivity
  • blood disorders
  • oesophagitis/ oesophageal irritation
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25
Tetracyclines can exacerbate...?
- increase muscle weakness in pt with Myasthenia gravis - systemic lupus erythematosus
26
When can the absorption of tetracyclines be decreased?
- Antacids and Aluminium - Calcium - Iron - Magnesium and Zinc salts
27
Milk reduces the absorption of which tetracyclines?
- Tetracycline - oxytetracycline - demeclocycline
28
Azithromycin and SE?
- Prolonged QT (check ECG) - hearing loss - Tinnitus (uncommon)
29
Erythromycin (severe) contra-interactions with 3 drugs?
Warfarin - erythro increases anticoagulant effect of warfarin Amiodarone - both erythro & amio prolong QT interval. Avoid using >2 drugs associated with QT prolongation. Simvastatin - Erythro increases exposure to simvastatin. Avoid.
30
Trimethoprim Warnings
- blood dyscrasias - risk of folate deficiency - avoid in first-trimester of pregnancy - hyperkalaemia (monitor renal function)
31
Trimethoprim SEs
- Allergic reactions - anaphylaxis - photosensitivity - aseptic meningitis - GI disturbances - N&V
32
Trimethoprim long term therapy monitoring?
Blood Counts
33
Trimethoprim SE?
- Neural tube defect in first trimester - Pruritis - Rashes
34
Aminoglycosides SEs?
- Auditory disorders - increased risk of deafness. - tinnitus - ototoxicity - nephrotoxicity - muscular weakness - C/I in myasthenia gravis
35
Aminoglycosides eg
Gentamicin Neomycin
36
Clindamycin SEs?
* Antibiotic-associated colitis * GI side effects * Oesophageal disorders * Discontinue immediately if diarrhoea develops
37
Clindamycin monitoring?
* Monitor liver & renal function
38
Quinolones examples?
- Ciprofloxacin - Levofloxacin - Ofloxacin
39
Quinolones SE?
- Increased risk of seizures. - Haemolytic anaemia - prolongs QT interval - GI effects - avoid in pregnancy - tendon damage (rare, within 48h)
40
Quinolones pt advice
- avoid exposure to excessive sunlight - avoid with use of NSAIDs (as may increase risk of convulsions)
41
Cautions with Quinolones
- exposure to sunlight - G6PD deficiency - epilepsy - psychiatric disorders
42
Nitrofurantoin cautions
- Renal function: avoid if eGFR <45 mL/min - Caution in anaemia, diabetes, electrolyte imbalances, folate deficiency - Pregnancy – avoid at third trimester, can use in first. - May discolour urine - harmless - MHRA advice: risk of pulmonary and hepatic adverse drug reactions.
43
Nitrofurantoin SEs
- pulmonary reactions (acute, chronic) - nausea and anorexia - hypersensitivity reactions - peripheral neuropathy - blood disorders
44
Bisphosphonates SEs
- oesophagitis - dyspepsia
45
Anti-psychotics - Clozapine/ Olanzapine SEs
- Increased CVD risk - Olanzapine = increased risk of VTE
46
Phenytoin SEs
- Blood dyscrasias - Hypersensitivity reactions - SJS (skin rash) - Risk of suicidal behaviours - Hepatotoxicity - Severe cardiac reactions & CNS depression with IV phenytoin - Seizure exacerbation - carer advice on blood, hepatic and skin disorders
47
Sodium valproate SEs
- Teratogenicity - oral cleft - weight gain/ increase appetite - alopecia - hyponatraemia - thrombocytopenia - Nausea (GI)
48
Can testosterone be given in a pregnant trans male?
No. Can cause abnormal urogenital development.
49
Topimarate SE?
- oral cleft - foetal malformations - acute myopia with 2º angle-closure glaucoma - reduces efficacy of contraception
50
Lamotrigine SE
- Stevens-Johnsons syndrome
51
Chlorpromazine
- Rhinitis - Galactorrhoea - Amenorrhoea
52
Carbamazepine SE
- Blood dyscrasias - Hypersensitivity reactions - SJS (skin rash) - Hepatotoxicity - Hyponatraemia - Seizure exacerbation - carer advice on blood, hepatic and skin disorders
53
Carbamazepine toxicity
- GI disturbances - Hyponatraemia - Drowsiness - Blurred vision - Ataxia - Rash - Arrhythmias - Thrombocytopenia
54
NSAIDs SE
- rhinitis - otoxicity - dyspepsia - oesophagitis - tinnitus - Avoid in Heart Failure; causes fluid retention
55
Anti-depressants rare SE
Galactorrhea
56
Amitriptyline
- Urinary retention (avoid in BPH/prostate) - delirium - dry mouth - reduce BP (postural)
57
Sildenofil SE
- blue-tinted vision - contraindicated with nitrates & nicorandil
58
Omeprazole SE
- enteric infection - hypomagnesaemia - increased risk of C.difficile - hyponatremia - Vit B12 deficiency
59
Increase INR (warfarin interaction)/ inhibitors of P450
- Fluconazole, Ketoconazole - SSRI: Fluoxetine, sertraline - Sodium Valproate - Amiodarone - Itraconazole - Omeprazole - Cranberry juice - Ciprofloxacin - Erythromycin - Clarithromycin - acute alcohol intake? *wheres the evidence for this i couldn't find
60
Decrease INR (warfarin interaction)/ Inducers of P450
- Anti-epileptic: phenytoin, carbamazepine - Barbiturates: phenobarbital - Rifampicin - St John's wort - chronic alcohol intake
61
Triptans ie. Sumatriptan
- Tightness of throat & chest (discontinue) - Avoid in CVD
62
Opioids
- Galactorrhea (rare) - urticaria
63
Galactorrhea causing drugs?
- Metaclopramide, Domperidone - phenothiazides - haloperidol - SSRIs, opioids - citalopram - chlorpromazine
64
ARB examples
Losartan, Valsartan
65
ARB Side effects
Angioedema
66
SGLT-2 eg Dapagliflozin SE?
- UTI/genital infection - Fournier's gangrene (rare) - increased risk of lower-limb amputation - weight loss
67
Metformin SE?
- lactic acidosis - GI upsets - decrease Vit B12 - eGFR <30 -> don't use
68
Digoxin SE?
- Yellow-green vision - Gynecomastia - Digoxin toxicity: renal failure, reduce K+ - Nausea
69
A/B Blockers SE? *Not sure what is meant by this one but followed the box.
- Rhinitis - Erectile dysfunction - Exacerbate myasthenia crisis - cold peripheries - fatigue - branchospasm - doxazosin (a-blocker) - Postural hypotension; hypoglycaemia awareness
70
ACE inhibitors (Ramipril, Lisinopril)
- cough - angiodema - hyperkalaemia - Not use in: - aortic stenosis - Renovascular disease/renal artery stenosis - 1st dose leads to hypotension/ reduced BP
71
Pioglitazone SE
- Fluid retention - Not Used in HF - Weight gain - Liver dysfunction - Fractures - increase osteoporosis - Bladder
72
Diltiazem (CCB) SEs
- increase digoxin toxicity (Verapamil, +flushes, constipation) - hypotension, bradycardia - HF - ankle swelling
73
Nicorandil SE
- Anal ulceration (GI ulcer) - headache - flushing - skin, mucosal ulceration - bowel perforation
74
CCBs SEs and egs
eg. - Nifedipine - amlodipine - felodipine SEs - Flushing - headache - ankle swelling Verapamil & diltiazem - negative isotropic - avoid in HF
75
Gliptins/ DPP4 inhibitors SE
- Pancreatitis (sitagliptin)
76
Furosemide SE
77

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