How to learn side effects?

[dexilant]

Hey guys,
I am really having trouble in memorizing adverse effects of drugs. There are so many of them. I don't which ones to remember and they overlap making it very difficult to recall. I was told to memorize most common ones but does that mean above a certain percent ?

Example: Pioglitazone HCl
Upper respiratory tract infection (13%), headache (9%),
sinusitis (6%), myalgia (5%), tooth disorder (5%),
aggrevation of diabetes (5%), and phatyngitis (5%).

Upper respiratory tract infection is most common so just memorize that ? or all of them.

Glimepiride
Dizziness (1.7%), asthenia (1.6%), headache,
(1.5%), and nausea (1.1%).

What to learn here ? The percentages are pretty close.

In most other cases, the percentages aren't given. Like this one -
Imitrex:

Abnormal sensations including tingling, warmth, burning, feeling
of heaviness, pressure, tightness, numbness, tight feeling in
head, flushing, tightness in chest, bad taste, discomfort of the
throat, nose, tongue, or mouth, muscle weakness, neck pain/stiffness, dizziness/vertigo, diarrhea, drowsiness.

The dosage strengths/forms are difficult enough to memorize. How did you tackle side-effects ?

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[dexilant]

Looks like I posted in the Pharmacy class threads sub-forum. MODS - Please move this to the Pharmacy forum.

 

[1800callsaul]

IMO there are only 2 ways to memorize side effects:

1. Know how the drug works very very well.

Example: glimepiride is an insulin secreter. Insulin lowers blood glucose. Ergo, the most common (and most important) side effect would be hypoglycemia. Further, you should be telling patients to take this drug before meals and not on an empty stomach due to this potential side effect.

Another example would be NSAIDs. MOA = type 1 and 2 COX inhibitor, which decreases prostaglandins. Prostaglandins have a gastroprotective effect and also increase perfusion to kidneys. That's why you have GI bleeding and the acute renal damage as possible side effects.

And another: Skeletal muscle relaxants. These tend to be both anti-cholenergic and serotonergic. So you can expect your typical side effects (dry mouth, sedation, dizziness, etc) knowing those characteristics.

You can do this sort of thing for many many many drugs and classes of drugs. This also helps predicting drug interactions to an extent.

2. Some drugs just have weird side effects that you need to commit to memory.

Examples: pioglitazone. Fluid retention, liver damage, and exacerbation of heart failure are the big ones.
Rifampin: colors the sweat red. Liver damage.
hydroxychloroquine: optic nerve damage.

Many of the psych drugs and cancer drugs have similar class side effects that just need to be memorized.

You can't know everything. Those lists in lexicomp are really only useful when a patient calls the pharmacy and asks a question about some bizarre side effect thats not familiar to you. After some time and enough of these calls, you get to know some of the less common and less serious side effects.

Hope this helps.

 

[aldolase]

You can't know everything. Those lists in lexicomp are really only useful when a patient calls the pharmacy and asks a question about some bizarre side effect thats not familiar to you. After some time and enough of these calls, you get to know some of the less common and less serious side effects.

Hope this helps.

So instead of looking at the lists of side effects from lexicomp or drug cards, read through goodman & gilman for most important adverse effects ?

 

[owlegrad]

Moving to pharmacy

 

[type b pharmD]

Hey guys,
I am really having trouble in memorizing adverse effects of drugs. There are so many of them. I don't which ones to remember and they overlap making it very difficult to recall. I was told to memorize most common ones but does that mean above a certain percent ?

Example: Pioglitazone HCl
Upper respiratory tract infection (13%), headache (9%),
sinusitis (6%), myalgia (5%), tooth disorder (5%),
aggrevation of diabetes (5%), and phatyngitis (5%).

Upper respiratory tract infection is most common so just memorize that ? or all of them.

Glimepiride
Dizziness (1.7%), asthenia (1.6%), headache,
(1.5%), and nausea (1.1%).

What to learn here ? The percentages are pretty close.

In most other cases, the percentages aren't given. Like this one -
Imitrex:

Abnormal sensations including tingling, warmth, burning, feeling
of heaviness, pressure, tightness, numbness, tight feeling in
head, flushing, tightness in chest, bad taste, discomfort of the
throat, nose, tongue, or mouth, muscle weakness, neck pain/stiffness, dizziness/vertigo, diarrhea, drowsiness.

The dosage strengths/forms are difficult enough to memorize. How did you tackle side-effects ?

We were taught to memorize only the most severe and the most common for each drug.

For example, for an opioid, we tell patients it most likely will cause them constipation. .. but that a rarer worry is decreased breathing . For an ssri .. it will probably cause dizziness or nausea, which is fine.. but that there is a very small chance it could cause changes in thoughts/behaviors or serotonin syndrome (when applicable).. for amox, you memorize nausea/diarrhea. .. and inform pt about colitis or anaphylaxis risk as appropriate. Not sure these are the best examples but it was what I could come up with last minute.

Goal being to make sure you can tell the pt: 1. what to expect and how to deal with it. And 2. What to look out for just in case.

That way you both cover your legal bases and help improve the customer/patient experience . Other stuff you can look up.

2nd the idea of moa .. it will almost always guide you to the common SE's .. rarer ones should be memorized only if severe or threatening ..

 

[PriorAuth]

When I'm not sure about a side effect I usually say "I don't believe that the side effect you are experiencing is from medication X. But let me double check for you." and then look it up.
Most of the times, my initial advice is correct but once in awhile I'll have to correct myself and say "Actually, it can cause that side effect."
Regardless of what the answer is, most people appreciate that I took the time to look it up to make sure.

 

[Rockinacoustic]

If you know the pharmacology, you will know the side effects.

Glimepiride is a great example- it can cause hypoglycemia. What are the S/Sx of hypoglycemia? There's half your side effects to counsel on.

You know exogenous insulin causes increased weight gain, so which oral anti-diabetics cause weight gain as well? The ones that cause insulin release- including glimepiride.

That being said, school loves to make you know all of the one in a million adverse effects, but in the real world you won't be effective telling patients that their Bactrim can cause SJS, or their Zoloft can make them feel suicidal. I've found the best way is to approach the really rare and serious ones is something along the lines of: "Now this is a really uncommon side effect, but just in case xyz happens, I want you to know what look out for or what to do."

Don't dwell on knowing every single detail about a a drug and it's side effects- a patient can search online for that, and there's no shame in you doing so as well. Your value as a pharmacist will be knowing how to manage or intervene if and when a patient comes to you with a drug related problem.

 

[farmadiazepine]

Three things

1) don't memorize every single side effect. Assume every drug has "nausea, vomiting, stomach upset, dizziness, headache"

2) side effects are an extension of the pharmacology. Assume whatever the drug is meant to do, now if it overdoes it, what will happen? like the above poster said.. glimepiride is used to lower sugar, if it overdoes it, then a patient will get way too low sugars which is hypoglycemia.... blood pressure drugs are used to lower the pressure, but if they overdo it, then patient will get hypotension.. if beta blockers slow down heart rate, then if they overdo it then patient will get bradycardia or very low pulse rate.

3) Know very special side effects or very rare side effects or side effects that belong to one particular drug, things that just don't seem normal or usual.. for example, lamotrigine is knows to cause stevens johnson's syndrome is titrated way too fast .... or statins are know to cause muscle pain or weakness and very rarely rhabdomylysis (spelling?) ... the prostaglandin eye drops can cause change of color of the iris

 

[ucrx]

Many of the psych drugs and cancer drugs have similar class side effects that just need to be memorized.

I would argue that cancer drugs really fall into method 1 (understanding pharmacology). The majority of effects have explanations that make sense based on mechanism or structure (especially important for things like monoclonal antibodies). There are other effects that are less understood, but I don't think there's really any more "unexplainable" effects than other medications. I just think that many people don't understand chemotherapy nearly as well as they do other classes of medications.

To the OP, keep in mind that some of the list you'll find in DI resources are the most common in general and others are the most common when taking placebo into account. I have seen side effects listed that happened less frequently than in the placebo group and could have been part of the disease process instead of an effect of the drug. I would agree with other posters, understand the pharmacology (and disease pathophysiology) and you'll be able to predict many of the side effects.

 

[dexilant]

Three things

1) don't memorize every single side effect. Assume every drug has "nausea, vomiting, stomach upset, dizziness, headache"

2) side effects are an extension of the pharmacology. Assume whatever the drug is meant to do, now if it overdoes it, what will happen? like the above poster said.. glimepiride is used to lower sugar, if it overdoes it, then a patient will get way too low sugars which is hypoglycemia.... blood pressure drugs are used to lower the pressure, but if they overdo it, then patient will get hypotension.. if beta blockers slow down heart rate, then if they overdo it then patient will get bradycardia or very low pulse rate.

3) Know very special side effects or very rare side effects or side effects that belong to one particular drug, things that just don't seem normal or usual.. for example, lamotrigine is knows to cause stevens johnson's syndrome is titrated way too fast .... or statins are know to cause muscle pain or weakness and very rarely rhabdomylysis (spelling?) ... the prostaglandin eye drops can cause change of color of the iris

I am only starting to learn pharmacology now that I started second year now. The trouble is differentiating between side-effects that are counseling worthy that I should I actually remember while practicing vs million others. The school just gave us drug cards and told us to memorize the heck out of them.

 

[positivesign]

With side effects, I always look at the most severe ones first like "boxed warnings" and "contraindications."
And then I try to think about the mechanism of action. So if this drug act on this pathway/receptor in this way, what is the flip side of the story? What else is being affected? Most of the times, SE's make sense because of the drug's MOA's. Another good thing with this is that you can sorta guess SE's of the entire class of drug. For example, 1st gen. histamines cause drowsiness..go figure.
And then there are random/unclear/rare ones that are either very common or very serious. This should be just memorized...for example, cetirizine is a 2nd gen. histamine but in some patients it still causes drowsiness...I go like (what???) Aspirin use in children-->increased risk of Reye's syndrome, etc.

 

[LearnerSharer]

Example: Pioglitazone HCl
Upper respiratory tract infection (13%), headache (9%),
sinusitis (6%), myalgia (5%), tooth disorder (5%),
aggrevation of diabetes (5%), and phatyngitis (5%).
Upper respiratory tract infection is most common so just memorize that ? or all of them.

In my pharmacy school, professor told us to memorize side effect that are over 10 percent because they are most common.

In most other cases, the percentages aren't given. Like this one -
Imitrex:
Abnormal sensations including tingling, warmth, burning, feeling of heaviness, pressure, tightness, numbness, tight feeling in head, flushing, tightness in chest,

The way I was explained was: Imitrex shrinks blood tube, you get less pressure in brain, less headache. That looks like signs and symptoms of OVER SHRINK of blood tube. In the brain, OVER SHRINK of blood tube will cause blockage and therefore, stroke. In the heart, OVER SHRINK of blood tube will cause blockage and therefore, heart attack. I learned those signs and symptoms of STROKE or HEART ATTACK. Why? you will see those signs and symptoms again and again in many medications. Our job is to GROUP SIGNS AND SYMPTOMS and define them as STROKE or as HEART ATTACK.

Same with signs and symptoms of liver damage: we learn to recognize ALL this as LIVER DAMAGE:
fatigue, anorexia, right upper abdominal discomfort, pale poop, dark urine, yellow eye, yellow skin, or jaundice.

Based on that, for board exam, I made list of:
Med that damage brain, cause dizziness, mental issue: I hung this list high near ceiling.
Med that damage eye: I hung this list at top of door.
Med that damage lung: I hung this list at window.
Med that damage heart: I hung this list at middle of door.
Med that damage stomach: I hung this list at kitchen.
Med that damage liver: I hung this list at top of fridge.
Med that damage kidney: I hung this list in restroom.
.....
And we cover most common side effects in pharmacy...
Whenever I tried to answer the question "Does this med cause heart problem?", my brain amazingly brought me to the location of list of med that damage heart (the middle of door), and I can see quickly if the med name appeared in the list. If I can recall the name of the med at such location, then, I have confident the med can cause such problem (heart problem) and can answer quickly right away.

Hope that helps...

 

[Digsbe]

Rule 1, everything causes nausea and stomach upset.

Medications in similar classes typically have similar adverse effects. Once you memorize one you've memorized them all with you only having to remember specifics about each drug. If you know how the drug works you can almost predict what the principal adverse effects will be too.