prescription review/adverse drug reactions

What medications are often prescribed in mcg

Levothyroxine 1.6mcg/kg

Tamsulosin 400 mcg OD

Digoxin

Naloxone

Fludracortisone

GTN spray

Inhalers

Ipatropium/Tiatropium nebulisers

Which medications are often prescribed in grams (g)

Paracetamol

Lithium

Calcium Carbonate

NAC

Which medications are usually taken in morning

Diuretics e.g. furosemide

Steroids e.g. dexamethasone

Which medications are usually taken at night

Statins

Night sedation e.g. zopiclone

Which medications are usually taken weekly

Bisphosphonates

Methotrexate

Folic acid patches

Which medications can impair hepatic function

Statins

Co-amoxiclav (cholestatic jaundice)

Isoniazid (hepatitis)

Paracetamol overdose

Methotrexate

Which drugs impair renal function (consider holding in patients who have AKI)?

DAMN

• Diuretics

• ACEi/ARBs - candesaratan, amlodipine - Will worsen hypotension while dehydrated

• Metformin

• NSAIDs: ibuprofen, naproxen - Nephrotoxic

• Also aminoglycosides and e.g. gentamicin

• Lithium (chronic toxicity)

Beta blocker: bisoprolol - Will worsen hypotension while dehydrated

Causes of AKI

Which drinks can cause confusion?

Opioids

Sedatives - benzodiazepines

anticholinergics

Steroids

Which drugs can cause falls?

Benzodiazepines?

Antidepressant

Antipsychotic

Opiates

Antihypertensive

Parkinson’s medication (ropinrole, selegiline)

Antiepileptics

Drugs that cause hypoglycaemia

Which drugs can cause gout?

Diuretics e.g. furosemide, Indapamide

Which drugs cause oral thrush?

Antibiotics e.g. Amoxicillin

Inhaled corticosteroids e.g. symbicort

Other steroids

Immunosuppressants

Which drugs can cause osteoporosis/increase risk of bone fractures?

steroids

PPI’s

LHRH agonists (bureslin, goreslin)

Which drugs can cause dry cough

ACE inhibitors

Which drugs can cause bradycardia

SSRIs (sertraline)

Beta blockers

Non-FHO CCBs e.g. verspamil, diltiazem

Digoxin

Which drugs cause hypertension?

NSAIDs

Steroids

Oral contraceptives

mirabegron

Which drugs can cause high cholesterol?

Steroids

Thiazides

Which drugs cause constipation?

Opioids

Iron

CCBs e.g. amlodipine, verapamil

Some diuretics

Some antiemetics e.g. ondansetron, metoclopramide

Sone anti-epileptics

Some Parkinson’s meds

Anticholinergics

Antacids that contain calcium

Which drugs can cause diarrhoea?

Antibiotics (C.diff from co-amoxiclav)

Colchicine

Metformin

PPIs

Antacids that contain magnesium

Laxatives

Which drugs can cause urinary retention?

Opioids

Anticholinergics

Oxybutynin

Amitryptiline

Cyclizine

Antihistamines

Which drugs can cause urinary incontinence?

Alpha blockers e.g. tamsulosin

Diuretics

Clozapine

Which drugs can cause hyponatraemia

• diuretics (thiazides)

• Anticonvulsants e.g. carbamezapine

• SSRIs e.g. sertraline, fluoxetine, citalopram

• TCAs e.g. amitriptylinr

• COX2 inhibitors

• PPI e.g. omeprazole, lansoprazole

• ACE inhibitors - small risk of SIADH

• Oxytocin

• Desmopressin

• Sulphonylureas

• Temazapam

Which drugs can cause hypernatraemia?

• Lithium

• Demeclocycline

Which drugs can cause hypokalaemia?

• Loop diuretics e.g. furosemide, bumetanide

• Thiazides e.g. bendroflumethiazide

• Steroids

• High dose Salbutamol

Which drugs can cause hyperkalaemia?

• K+ sparing diuretics e.g. spironolactone, eplerone, amiloride, triamterene

• ACE inhibitors e.g. lisonipril

• ARBs e.g. losartan, candesartan

• Unfractionated heparin, LMWH

• Blood transfusion

• Trimethoprim

Which drugs can cause hypoglycaemia?

Insulin

Sulphonylureas (gliclazide)

Which drugs can cause hyperglycaemia?

Steroids

Antipsychotics

Thiazides

Beta blockers

Tacrolimus

Common adverse effects of ACE inhibitors

Angiodema

AKI

Cough

Common adverse effects of Beta blockers

Hypotension

Peripheral vasoconstriction

Common adverse effects of Statins

Myalgia

Rhabdomyolysis

Hepatitis

Common adverse effects of Carbamazepine

Agranulocytosis

Rash (SJS)

Common adverse effects of Gentamicin

Nephrotoxic

Ototoxic

Common adverse effects of Ciprofloxacin

Tendon rupture

QT prolongation

Common adverse effects of SSRIs

GI upset

Sexual dysfunction

Hyponatraemia

Common adverse effects of CCBs: DHP e.g.amlodipine

Ankle oedema

Flushing

Headache

Dizziness

Common adverse effects of CCBs: non-DHP e.g. verapamil, diltiazem

Bradycardia

Heart block

Constipation

Worsening heart failure

Common adverse effects of Clozapine

Agrnulocytosis

Common adverse effects of Amiodatone

Thyroid dysfunction

Liver toxicity

Pulmonary fibrosis

Common adverse effects of Methotrexate

Bone marrow suppression

Pulmonary toxicity

Hepatotoxicity

Common adverse effects of NSAIDs

GI irritation

GI bleeding

Renal impairment

Bronchospasms (asthma)

Common adverse effects of Beta-2 agonists

Tremor

Tachycardia

Palpitations

Common adverse effects of Steroids

Hyperglycaemia

Cushing symptoms

Anxiety

What are sick rules regarding insulin?

Keep same dose but check BM more frequently

What are sick rules regarding steroids?

double the dose

Which medications should be stopped if trying to conceive?

Isotretinoin

Methotrexate

Warfarin

Some antiepileptics

Some antipsychotics

Which medications are most likely to worsen Parkinson’s?

Antipsychotics: typical antipsychotics like haloperidol, chlopromazine, atypical less likely e.g. olanzapine, clozapine, quetiapine

Antiemetics w.g. Metaclopramide

Antidepressants e.g. apoxapine, phenelzine, tranylcypromine

Which medications are most likely to worsen Myasthenia Gracie

Antibiotics

Beta blockers

Local anaesthetic

Sedating drugs

Which medications are most likely to worsen Psoriasis

Beta blockers

Lithium

Some antibiotics

Which medications are most likely to worsen Heart failure

CCBs

NSAIDs

Thiazolidinediones (pioglotazone)

Which medications can cause galactorrhoea

olanzapine

Metaclopramide

Citalopram

What drug interaction happens between warfarin & antibiotics (macrolides e.g. clarithromycin / metronidazole)

Raises INR - bleeding risk

What drug interaction happens between Macrolides e.g. clarithromycin & statins

Inhibits metabolism - rhabdomyolysis

What drug interaction happens between ACEinhibitors & K-sparing diuretics e.g. ramipril + spironolactone

Severe hyperkalaemia

What drug interaction happens between Lithium & ACEi/NSAIDs/Thazides

Lithium toxicity

I.e. GI upset, tremor, ataxia

What drug interaction happens between SSRIs & tramadol

Seratonin syndrome

What drug interaction happens between Warfarin & NSAIDs

Additive bleeding risk

What drug interaction happens between Methotrexate & NSAIDs

Methotrexate toxicity

What drug interaction happens between CCBs & beta blockers

Severe bradycardia/heart block

What drug interaction happens between ACE-I/ARB & diuretic & NSAID

Very high AKI risk

Why are typical drug triggers of acute anaphylaxis

Penicillin/ beta lactams

NSAIDs

IV contrast

Morphine/opioids

What are typical drug triggers of excessive anticoagulation (INR too high)

Warfarin & clarithromycin/metronidazole/fluconazole

Increased warfarin dose

Liver disease

Escitalopram dose for depression

Max 10mg in elderly

Clomitrazole route

Vaginal pessary

200mg for vaginal candidias

Omeprazole dose for acid reflux

10mg

Nebivolol dose for hypertension

2.5mg or 5mg

Prednisolone dose

30mg

Risperidone injection

Depot injection ( IM)

humalog (insulin lispro) frequency

Rapid acting

So TDS (with meals)

Levemir (insulin determine) frequency

Long acting

So Nightly

zopiclone dose

7.5mg

Which medications can cause QT prolongation

Sertraline

Ondansetron

Amitriptyline