Quiz 24

Select the drug that matches the side effect:

1. Diarrhea Please select Amiodarone Quinidine Captopril Verapamil Flecainide Labetalol Adenosine
   Answer is Quinidine. It also is well known to prolong QT interval. Other drugs that prolong QT are Amiodarone and other class1A anti-arrhythmics.
2. Increased mortality after MI Please select Amiodarone Quinidine Captopril Verapamil Flecainide Labetalol Adenosine
   Answer is Flecainide. CAST trial proved this fact on patients who after an MI received Flecainide to suppress arrhythmias (Cardiac arrhythmia suppression trial)
3. Angio-edema Please select Amiodarone Quinidine Captopril Verapamil Flecainide Labetalol Adenosine
   Answer is Captopril. I have seen this in at least 2 of my patients who are now banned from taking ACE inhibitors (an absolute contra-indication). ACE has a second function and behaves as a Kininase (Kininase 3)that breaks down Bradykinin. If inhibited, Bradykinin levels rise. This mediates Angio-edema and the well known side effect of cough.
4. Hyponatremia Please select Amiodarone Quinidine Captopril Verapamil Flecainide Labetalol Adenosine
   Answer is Captopril. It inhibits the ACE and thus Aldosterone. This is the mechanism for hyperkalemia and hyponatremia.
5. Constipation Please select Amiodarone Quinidine Captopril Verapamil Flecainide Labetalol Adenosine
   Answer is Verapamil. It is notorious for this side effect.
6. Skin discoloration Please select Amiodarone Quinidine Captopril Verapamil Flecainide Labetalol Adenosine
   Answer is Amiodarone. Nasal bluish/grey discoloration  is typical of it. When you see it, think of 2 diagnoses. Amiodarone induced (Photosensitivity) or Sarcoidosis (lupus pernio)
7. Hypothyroidism Please select Amiodarone Quinidine Captopril Verapamil Flecainide Labetalol Adenosine
   Answer is Amiodarone. Amiodarone is almost 27% Iodine (not sure). This can have an inhibitory or a stimulating effect on the Thyroid. There is no way to predict which one could happen.