1⃣ Second generation antipsychotics include quetiapine, clozapine, risperidone and olanzapine. Side effects include sedation, weight gain and lipid changes, QT prolongation and the potential for arrhythmias. Risperidone is linked to breast effects and sexual dysfunction; clozapine is linked to agranulocytosis, hypersalivation (due to agonist activity at M4 receptors {found on salivary glands}), myocarditis and fecal impaction.
2⃣ Loperamide is a drug used to treat diarrhea. However, it should be avoided in patients with acute ulcerative colitis, Clostridium difficile colitis and bloody diarrhea (dysentery).
3⃣ 1st generation antihistamines are used to treat allergies, hay fever, itch, hives etc. Some, such as cyclizine, are used to treat nausea and vomiting. Other 1st generation drugs include chlorpheniramine and hydroxyzine. 2nd generation antihistamines include cetirizine, loratadine, fexofenadine and azelastine – 2nd generation antihistamines are not associated with sedation unlike their 1st generation counterparts.
4⃣ Side effects with fluconazole include skin rash, gastrointestinal upset, increased liver enzymes, potential for hepatotoxicity, QT prolongation and headache.
5⃣ Amitriptyline is a member of the tricyclic antidepressant (TCA) class of medicines; a drug used to treat depression, anxiety disorder and, in some cases, chronic pain. Side effects include dizziness, headache, weight gain, anticholinergic side effects, confusion, mood disturbances and loss of libido.
6⃣ Side effects of methotrexate include ulcerative stomatitis, gastrointestinal upset, hepatotoxicity, leukopenia (predisposing to infection) and pulmonary fibrosis. Methotrexate is also teratogenic. Its elimination is decreased by penicillins.
7⃣ Diuretics should be taken in the morning to reduce the effect of nocturia – urination at night.
Amiloride is a potassium-sparing diuretic usually administered alongside another diuretic, such as a loop diuretic or a thiazide, to reduce potassium loss while simultaneously enhancing diuresis. Amiloride works by inhibiting sodium reabsorption at the distal convoluted tubule.
8⃣ Carbamazepine is used in the treatment of epilepsy, trigeminal neuralgia and bipolar disorder. Side effects include gastrointestinal upset, dizziness, ataxia, mild skin rash (affects approx. 10% of patients). Severe skin reactions, such as Stevens-Johnson syndrome or toxic epidermal necrolysis, are known to occur in approximately 1 in every 5,000 patients. This reaction is accompanied by fever, hyponatremia and lymphadenopathy (a combined systemic syndrome known as anticonvulsant hypersensitivity syndrome).
9⃣ Calcium channel blockers include amlodipine, nifedipine, verapamil and diltiazem. Side effects with amlodipine and nifedipine include ankle swelling, flushing, headache and palpitations. Verapamil is linked to constipation, while diltiazem is linked to all the above side effects.
🔟 Z-drugs include zopiclone and zolpidem; used in the short-term treatment of insomnia. They are non-benzodiazepines that target the GABA A receptor. Side effects include fatigue (the next day), taste disturbances with zopiclone, gastrointestinal disturbances are more common with zolpidem.
1⃣1⃣ Side effects with valproate include gastrointestinal upset (take with food); tremor, ataxia and behavioral disturbances; thrombocytopenia; elevated liver enzymes (more rarely, severe hepatotoxicity). Valproate also causes birth defects.
1⃣2⃣ Trimethoprim is used to treat urinary tract infections. Side effects include gastrointestinal upset, skin rash (3-7%), hematological effects (as it works as a folate antagonist), hyperkalemia (it antagonizes the epithelial sodium channel of the distal convoluted tubule) and elevated creatinine concentrations.
1⃣3⃣ Quinine, a drug used to treat malaria, is associated with side effects such as tinnitus, deafness, blindness (which may be permanent), QT prolongation, gastrointestinal upset and hemolysis in patients with G6PD deficiency. Quinine is also teratogenic.
1⃣4⃣ Proton pump inhibitors, such as omeprazole, are linked to an increased risk of fractures (at high doses, or when used long-term). PPIs also disguise the effects of gastric cancer. Patients should know to monitor for difficulty swallowing or sudden weight loss.
1⃣5⃣ Beta-1 receptors are located in the heart whereas beta-2 receptors are located in the lung – for this reason, non-selective beta-blockers are contraindicated in patients with asthma.
1⃣6⃣ There are three main types of laxative: bulk-forming, osmotic and stimulant. Bulk-forming laxatives include isphagula husk, methylcellulose and sterculia. Osmotic laxatives include lactulose, macrogol and phosphate enema. Stimulant laxatives include senna, bisacodyl, glycerol suppositories and docusate sodium.
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