Adverse Drug Effects

• What are the types of adverse drug effects?

  Type A (Augmented)

  • dose-depending, predictable from drug pharmacology (e.g. hypoglycaemia from insulin)

  Type B (Bizarre)

  • not dose-dependent, unpredictable (e.g. anaphylaxis to penicillin)
• How can we minimise the risk of adverse drug effects?

  Thorough pt Hx

  Identifying past adverse reactions & allergies

  Considering comorbidities & concurrent meds
• Side effects of digoxin

  AKI

  Electrolyte imbalance

  Toxicity (esp with CKD, dose > 125 micrograms daily)
• Side effects of spironolactone

  Hyperkalaemia
• Side effects of beta-blockers

  Bradycardia

  -> increased risk if also taking verapamil, digoxin & amiodarone
• Side effects of ACEis & ARBs

  AKI

  Hyperkalaemia

  Hyponatraemia
• Side effects of opioids

  Constipation

  Resp depression

  Cognitive impairment

  Dependency

  Immunosuppression
• Side effects of metformin

  Lactic acidosis

  AKI

  Contraindicated if eGFR < 30 ml/min
• Side effects of sulfonylurea

  Hypoglycaemia
• Side effects of acetylcholinesterase inhibitors

  Agitation

  Decreased appetite

  Diarrhoea

  Dizziness

  Fatigue

  GI disorders

  Hallucination

  Nausea

  Syncope

  Urinary incontinence

  Vomiting