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 nebulisersh

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 should be stopped during illness/hospital stays

SADMAN

• S – SGLT2 inhibitors (e.g., dapagliflozin, empagliflozin). Risk: Euglycaemic diabetic ketoacidosis.

• A – ACE inhibitors (e.g., ramipril, lisinopril). Risk: AKI due to reduced renal efferent vasoconstriction.

• D – Diuretics (e.g., furosemide, bendroflumethiazide, spironolactone). Risk: AKI due to dehydration.

• M – Metformin. Risk: Lactic acidosis, which is serious and potentially life-threatening.

• A – ARBs (Angiotensin Receptor Blockers, e.g., losartan, candesartan). Risk: AKI.

• N – NSAIDs (Non-steroidal anti-inflammatory drugs, e.g., ibuprofen, naproxen, diclofenac). Risk: AKI due to reduced renal afferent vasodilation.

• S – Sulfonylureas (e.g., gliclazide, glimepiride). Risk: Hypoglycemia, which may occur if the patient is eating and drinking less than normal. 

Which medications can impair hepatic function

SCIMP mnemonic;

Statins

Co-amoxiclav (cholestatic jaundice)

Isoniazid (hepatitis)

Methotrexate

Paracetamol overdose

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

DAMN GAL

• Diuretics

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

• Metformin

• NSAIDs: ibuprofen, naproxen - Nephrotoxic

• Also aminoglycosides and e.g. gentamicin

• allopurinol

• Lithium (chronic toxicity)

Beta blocker: bisoprolol - Will worsen hypotension while dehydrated

Causes of AKI

Which drugs can cause confusion?

SOAS (sus) mnemonic

Sedatives - benzodiazepines

Opioids

anticholinergics

Steroids

Which drugs can cause falls?

B A S H  P O A H (bash head)

• B – Benzodiazepines

• A – Antidepressants - SSRI, TCA

• S – Sedatives / Antipsychotics

• H – Hypotensives → Antihypertensives - ARB, ACEi

• P – Parkinson’s meds (ropinirole, selegiline)

• Opiates

• A – Antiepileptics

• H – Hypoglycaemics (insulin, sulfonylureas)

Which drugs can cause gout?

Diuretics e.g. furosemide, Indapamide

which drugs can cause ankle oedema

amlodipine

naproxen

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 e.g. omeprazole

LHRH agonists (bureslin, goreslin)

Which drugs can cause dry cough

ACE inhibitors

Which drugs can cause bradycardia

SSRIs (sertraline)

Beta blockers e.g. bisoprolol

Non-DHP 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?

I C A N T  P O O P

• I – Iron

• C – CCBs (verapamil > amlodipine), calcium containing antacids

• A – Anticholinergics

• N – Neuro drugs

  • Anti-epileptics

  • Parkinson’s meds

• T – —

• P – Parkinson’s meds

• O – Opioids

• O – Ondansetron / other antiemetics e.g. metaclopramide

• P – Potassium-related / some diuretics

Which drugs can cause diarrhoea?

C L A M P – P

• C – Colchicine

• L – Laxatives

• A – Antibiotics (🚩 C. diff esp. co-amoxiclav)

• M – Metformin

• P – PPIs

• P – Phosphate / magnesium containing antacids
  (Mg²⁺ causes osmotic diarrhoea)

Which drugs can cause urinary retention?

C A N ’ T  P E E

• C – Cyclizine

• A – Anticholinergics
  

  • Oxybutynin

  • Amitriptyline

• N – (sedating) aNti-histamines

• T – Tricyclic antidepressants
  (amitriptyline)

• P – Pain meds → Opioids

• E – Excess antimuscarinic effect

• E – Elderly / BPH risk (exam context)

Which drugs can cause urinary incontinence?

A D C

• A – Alpha-blockers
  (e.g. tamsulosin → ↓ urethral sphincter tone)

• D – Diuretics
  (↑ urine volume → urgency)

• C – Clozapine
  (sedation + anticholinergic effects)

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

Which drug can cause intravenous-operative floppy iris syndrome

Tamsulosin

Should be stopped before all cataract surgery

Which drug can cause pancreatitis

FATSHEEP

• Furosemide

• Azathioprine/asparaginase

• Thiazides/tetracyline

• Statins/sulfonamides/sodium valproate

• Hydrochlorothiazide

• (O)Estrogens

• Ethanol

• Protease inhibitors & NRTIs (antiretroviral medications)

which drugs can cause dydpepsia

NSAIDs

bisphosphonates e.g. alendronic acid

corticosteroids e.g. prednisolone

CCBS

Common adverse effects of ACE inhibitors

Angiodema

small rise in creatinine <20% can be expetced - dont need to change prescription

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 and tendonitis e.g. Achilles tendonitis (causing acute left sided calf and foot pain)

QT prolongation

common adverse effects of flucloxacillin

cholestatic jaundice

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 affects of GTN spray

Headache

Hypotension

Dizziness

Arrhythmias

With sublingual use: Tongue blistering (frequency not known)

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 e.g. carbamazepine

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

Which medications can cause gynaecomastia

DISCO

• digoxin

• Isoniazid

• Spironolactone

• Cimetidine

• Oestrogen

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

Which medications can cause QT prolongation

Antidepressants: citalopram, escitalopram, Amitriptyline, Sertraline

Antiemetics: Ondansetron, domperidone

Antibiotics: azithro/clarithro/erythromycin, cipro/levofloxacin

Antipsychotics: haloperidol, quetiapine,

Antifungals: fluconazole, ketaconazole

Other: lithium, methadone