60 Side Effects Every Pharmacist Should Know
Introduction
Pharmacists are expected to have an intimate knowledge of both side effects and adverse effects. Here, we’ve put together a great range of both effects that every pharmacist should know.
If you are a pharmacy student, graduate or perhaps a student of medicine in other fields, you too will appreciate how challenging it can be to commit side effects or adverse effects to memory. After all, there are many hundreds upon hundreds to recall.
Of course, side effects and adverse effects are not the same thing. These terms are often used interchangeably, even though they are different.
Put simply, side effects can be positive or negative – they are simply the consequence of the effect of drug action. In contrast, adverse effects have a wholly negative impact. There is no conceivable benefit to experiencing an adverse effect.
For example, metformin is associated with weight loss; a side effect. It cannot be considered an adverse effect because, considering the condition the patient has – type 2 diabetes – losing weight is a positive side effect. In contrast, drugs – such as ifosfamide and cyclophosphamide – are associated with hemorrhagic cystitis, or bladder bleeding, which cannot be considered a positive effect. Therefore, it is considered an adverse effect.
We can summarize this relationship by saying that all adverse effects are side effects, but not all side effects are adverse effects.
With this distinction in mind, let’s review the top 50 side effects that every pharmacist should know.
Top 60 Side Effects to Know
Take your time to review the tabled side effects below. If you’re not sure about any of these side effects, take the time to learn why. Anything that contributes to your knowledge of drugs and medicines is never a bad thing.
Of course, many NAPLEX questions focus on common side effects. As part of your pharmacy license exam training, you must have a thorough, detailed and intimate knowledge of these side effects and others.
Let’s get started.
| Medicine | Side Effects |
|---|---|
| Aminoglycosides | Ototoxicity Nephrotoxicity |
| Tetracyclines | Tooth discoloration Photosensitivity Esophageal irritation Intracranial hypertension |
| Bisphosphonates | Esophageal irritation Hypophosphatemia Osteonecrosis of the jaw Atypical femoral fracture |
| Cyclophosphamide Ifosfamide | Hemorrhagic cystitis |
| PDE5 inhibitors | Hypotension Nasal congestion Headache Dizziness Tachycardia |
| Statins | Rhabdomyolysis Diabetes Elevated liver enzymes |
| Lamotrigine | Skin rash, sometimes SJS/TEN |
| Isoniazid | Pyridoxine deficiency Peripheral neuropathy Hepatotoxicity |
| Amiodarone | Blue-gray skin discoloration Pulmonary toxicity Thyroid abnormalities Photosensitivity Corneal microdeposits |
| Vancomycin | Ototoxicity Nephrotoxicity Hepatotoxicity Blood disorders – thrombocytopenia Red man syndrome |
| Quinine | Conchonism Deafness Blindness QT prolongation |
| Fluoroquinolones | Tendon rupture QT prolongation Lowering seizure threshold |
| Corticosteroids | Steroid-induced diabetes Osteoporosis Mood / behavioral changes Hypertension, hypokalemia Edema Immunosuppression |
| Opioids | Constipation Euphoria Respiratory depression Itch Pupillary constriction |
| Metformin | Weight loss Lactic acidosis Vitamin B12 deficiency Gastrointestinal upset |
| Trimethoprim | Gastrointestinal upset Hyperkalemia Elevated creatinine levels Megaloblastic anemia |
| Phenytoin | Gingival enlargement Hirsutism Osteomalacia Skin coarsening / acne Nystagmus / ataxia Purple glove syndrome |
| ACE inhibitors | Persistent, dry cough Hyperkalemia Hypotension Renal failure |
| Aspirin | Bleeding Stomach ulcers Reye syndrome (under 16s) Tinnitus (high doses) |
| Iron supplements | Black stools |
| Bismuth subgallate | Black tongue, black stools |
| Amphotericin B | ‘Shake and bake’ reaction Hypokalemia Myocarditis Hepatotoxicity Kidney damage |
| Lithium | Hypothyroidism Diabetes type 2 Kidney damage Weight gain Myoclonus |
| Clofazimine | Hyperglycemia Brown-pink skin discoloration Skin dryness, rash |
| Ethambutol | Red-green color blindness Optic neuritis Hepatotoxicity Peripheral neuropathy Hyperuricemia |
| Clozapine | Agranulocytosis Myocarditis Hypersalivation CNS effects Urinary incontinence GI hypomotility Bone marrow suppression |
| SSRIs | Weight disturbance Gastrointestinal upset QT prolongation Hyponatremia Bone fractures Serotonin syndrome Lower seizure threshold |
| Antimuscarinics | Tachycardia Dry mouth Blurred vision Urinary retention Constipation Drowsiness |
| Beta-2 agonists | Tachycardia Palpitations Anxiety Tremors Muscle cramps Hypokalemia Sweating Insomnia Agitation |
| Typical antipsychotics | Extrapyramidal side effects QT prolongation Sexual dysfunction |
| Atypical antipsychotics | Weight gain Diabetes type 2 Lipid abnormalities Extrapyramidal effects |
| Benzodiazepines | Drowsiness, sedation Respiratory depression Amnesia Decreased concentration |
| NSAIDs | Gastrointestinal bleeding Renal impairment Fluid retention Photosensitivity |
| Beta blockers | Bronchospasm Vivid dreams / nightmares Cold extremities Hypoglycemia |
| Methimazole | Agranulocytosis |
| Calcium channel blockers | Constipation Gingival overgrowth Ankle swelling Flushing |
| Rifampin | Hepatotoxicity Red urine, sweat, tears |
| Methotrexate | Hepatotoxicity Ulcerative stomatitis Infections Pulmonary fibrosis |
| Irinotecan | Extreme diarrhea |
| Cisplatin | Hearing loss Kidney damage High risk of vomiting |
| Flucytosine | Bone marrow suppression Loss of appetite Psychosis Renal damage |
| Macrolides | QT prolongation GI effects Ototoxicity (high doses) Cholestatic jaundice |
| Heparin Warfarin Antiplatelets Anticoagulants | Bleeding Thrombocytopenia (heparin) |
| Levothyroxine | Weight loss Trouble sleeping Tachycardia Anxiety Difficulty tolerating heat Palpitations |
| Thalidomide | Phocomelia / limb deformities |
| Carmustine Busulfan | Pulmonary toxicity |
| Iron dextran | Severe anaphylaxis |
| Capecitabine | Hand-foot syndrome |
| Tamoxifen | Uterine cancer Pulmonary embolism Reduced cognition Irregular periods Hot flashes |
| Nitrates | Flushing Headache Light-headedness Hypotension |
| Nitrofurantoin | Gastrointestinal upset Pulmonary fibrosis Brown discolored urine Peripheral neuropathy Elevated liver enzymes Hemolyticanemia |
| Thiazolidinediones | Anemia Dizziness, headache Edema Bladder cancer Bone fractures Hepatotoxicity |
| Valproate | Gastrointestinal upset Tremor, ataxia, behavioral effects Increased liver enzymes Thrombocytopenia Hair loss Pancreatitis |
| Itraconazole | Vision disturbances Heart failure Skin rash Hepatotoxicity |
| Linezolid | Thrombocytopenia Peripheral neuropathy Serotonin syndrome |
| Metronidazole | Metallic-like taste Seizures Thrombophlebitis (IV use) Dark urine Peripheral / optic neuropathy Encephalopathy (high doses) Disulfiram-reaction (with alcohol) |
| Loop diuretics | Dehydration Hypotension Low electrolyte state Hearing loss / tinnitus (high doses) Kidney failure (w/ NSAID + ACE inhibitor) Hyperuricemia |
| Aldosterone antagonists | Gynecomastia Hyperkalemia |
| Allopurinol | Skin rash, sometimes SJS/TEN Hypersensitivity reaction Bone marrow suppression |
| Colchicine | Rhabdomyolysis Bone marrow suppression Gastrointestinal upset |
Conclusion
Of course, this list of side effects is by no means exhaustive.
There are many drugs / drug classes we’ve omitted. That said, this is an exceptional learning table to help you recall some of the most well associated side effects of some of the most commonly used medicines.
Your pharmacy license exam is replete with questions that ask you to identify side effects / risks with drugs and medicines. Take the time to learn these side effects and build upon that detail in the weeks and months ahead.
It can make all the difference to your exam result.
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