Side Effects

Question 1

What are anti-cholinergic side effects?

Answer 1

• Dilated pupils
• Blurred vision
• Dry mouth
• Flushed skin
• Urinary retention
• Constipation

Eg. TCAs, antihistamines, hyposcine, atropine, antipsychotics, incontinence meds

Question 2

What are anti-histaminergic side effects?

Answer 2

• Weight gain
• Sedation

eg. TCAs, anti-psychotics, antihistamines

Question 3

What are anti-alpha-adrenergic side effects?

Answer 3

• Postural hypotension
• Sexual dysfunction
• Nasal congestion
• Headache

Eg. TCAs, antipsychotics, a-blockers

Question 4

What are anti-dopaminergic side effects?

Answer 4

• Extrapyramidal side → tardive dyskinesias, parkinsonism
• Hyperprolactinaemia → galactorrhoea, oligomenorrhoea, subfertility
• Neuroleptic malignant syndrome
• Oculogyric crisis

Eg. metoclopramide, anti-psychotics

Question 5

Rifampicin

Answer 5

• Orange-red tears/urine
• Hepatitis

Question 6

Isoniazid

Answer 6

• Neuropathy
• Hepatitis

Question 7

Pyrazinamide

Answer 7

• Gout
• Hepatitis

Question 8

Ethambutol

Answer 8

• Colour blindness
• Optic neuritis

Question 9

Phenytoin

Answer 9

• Toxicity (→ cerebellar syndrome)
• Acne
• Coarse face
• Gum hypertrophy
• Hirsuitism
• Inhibits COCP

Question 10

Carbamazepine

Answer 10

• Rash
• Dizziness
• Hyponatraemia
• Hair thinning
• Inhibits COCP

Question 11

Sodium Valproate

Answer 11

• Tremor
• Weight gain
• Hair thinning
• Teratogenic (avoid if child-bearing age)

Question 12

Lamotrigine

Answer 12

Rash (Stevens-Johnson syndrome)

Question 13

SSRI

Answer 13

Eg. fluoxetine, citalopram, sertraline

• Nausea
• Low libido
• Withdrawal
• Insomnia
• Hyponatraemia

Question 14

TCAs

Answer 14

eg. amitryptiline

• Anti-cholinergic effects
• Anti-histaminergic effects
• Anti-a-adrenergic effects
• Hyponatraemia (SIADH)
• Arrhythmias

Question 15

MAOIs

Answer 15

eg. selegiline

• Hypertension
• Hepatocellular jaundice
• Hyperthermia

Question 16

ACEi

Answer 16

• Dry cough
• Postural hypotension
• Renal failure in renal artery stenosis (check U+Es before + 2wks after)
• Angioedema of tongue
• Hyperkalaemia
• Profound hypotension when started

Question 17

CCBs

Answer 17

• Ankle oedema
• Headache
• Flushing
• Dizziness

Question 18

B-blockers

Answer 18

• Diabetes risk
• Impotence
• Bradycardia
• Fatigue
• Cold peripheries
• Sleep disturbance

Question 19

Alpha-blockers

Answer 19

• Postural hypotension
• Sexual dysfunction
• Nasal congestion
• Headache

Question 20

ALL diuretics

Answer 20

• Dehydration
• Hypotension
• Hyperuricaemia
• Hypokalaemia (except K+ sparing)
• Hyponatraemia
• Hypomagnesaemia

Question 21

Apart from the all diuretic side effects, what is one specific loop diuretic side effect?

Answer 21

• Hypocalcaemia

Used in treatment of hypercalcaemia

Question 22

Apart from all diuretic side effects, what is a thiazide specific side effect?

Answer 22

• Hypercalcaemia

Question 23

Apart from all diuretic side effects, what are K+ sparing specific side-effects?

Answer 23

• Hyperkalaemia
• Gynaecomastia

Question 24

Sulfasalazine

Answer 24

• Myelosuppression
• Oligospermia
• Hepatitis
• Rashes (SJS, erythema nodosum)
• Renal problems
• Discoloured urine

Question 25

Choloroquine

Answer 25

* Retinopathy * Tinnitus * Myopathy

Question 26

Methotrexate

Answer 26

* Hepatic toxicity * Pulmonary toxicity * Myelosuppression * Mucositis

Question 27

TNF inhibitors (-mabs)

Answer 27

* Infusion rxns (anaphylaxis) * Infections (TB reactivation) * Autoimmune rxns * Blood disorders

Question 28

Cyclophosphamide

Answer 28

* Haemorrhagic cystitis * Myelosuppression * Alopecia

Question 29

Insulin

Answer 29

* Hypoglycaemia * Fat-hypertrophy at injection site * Hypokalaemia (used in Rx of hyperkalaemia) * Weight gain

Question 30

Metformin

Answer 30

* Weight loss * Lactic acidosis * Metallic taste * GI disturbance * B12 deficiency

Question 31

Sulphonylureas (gliclazide)

Answer 31

* Hypoglycaemia * Weight gain

Question 32

Thiazolidinediones (glitazones eg. pioglitazone)

Answer 32

* Fluid retention → HF, oedema * Hepatotoxicity * Fractures

Question 33

DPP4 inhibitors (gliptins)

Answer 33

Pancreatitis

Question 34

SGLT2 inhibitors (flozins)

Answer 34

* UTIs/thrush * Ketoacidosis * Weight loss * May increase risk of amputations

Question 35

What are side-effects of **ALL** antipsychotics?

Answer 35

* Anti-dopaminergic * Anti-cholinergic * Anti-histaminergic * Anti-alpha-adrenergic

Question 36

Clozapine

Answer 36

Agranulocytosis

Question 37

Chlorpomazine

Answer 37

Cholestatic jaundice

Question 38

Haloperidol

Answer 38

* Prolonged QT interval * Interference w/ temp regulation

Question 39

Lithium

Answer 39

* Toxicity (tremor/ataxia/dysarthria) → coma, convulsions, hypotension * Diarrhoea * Hypothyroidism * Diabetes insipidus

Question 40

Steroids

Answer 40

* Diabetes risk + hyperglycaemia * Cushingoid appearance * Psychosis * Osteoporosis * Hypokalaemia * Infections + Leukocytosis * Risk of avascular necrosis

Question 41

Azathioprine

Answer 41

Myelosuppression

Question 42

Ciclosporin

Answer 42

* Tremor * Chronic interstitial nephritis * Hypertrichosis * Gum hyperplasia * Burning sensation in hands/feet

Question 43

Levodopa

Answer 43

* Nausea * Red urine + other body fluids * Postural hypotension * Dyskinesias * "on-off" and "wearing off" effects

Question 44

PPIs

Answer 44

* Tinnitus * GI disturbance * Headache * Hyponatraemia * Hypomagnesaemia

Question 45

Amiodarone

Answer 45

* Thyroiditis * Pulmonary fibrosis * Peripheral neuropathy * Myopathy * Blue-grey skin pigmentation * Skin photosensitivity * Hepatitis * Metallic taste

Question 46

Digoxin

Answer 46

Signs of toxicity: * Xanthopsia (yellow/orange tinge to vision) * GI distress * Any arrhythmia

Question 47

Adenosine

Answer 47

* Flushing * Sense of impending doom