Medication Side Effects, Adverse Effects & Allergies

1. Which side effect is a patient on chronic opioid therapy, such as oxycodone, most likely to experience and often needs a prophylactic bowel regimen for?

Opioids slow GI motility, and constipation is a near-universal, ongoing side effect of chronic opioid use, which is why patients are often started on a stimulant laxative or stool softener proactively. Opioids do not typically cause diarrhea, hypertension, or insomnia as characteristic effects.

2. What is the most serious adverse effect of opioid medications that pharmacy technicians should recognize could require naloxone reversal?

Respiratory depression is the most dangerous opioid adverse effect and can be fatal in overdose; naloxone is used to rapidly reverse it. Opioids are not characteristically associated with hypertension, hyperglycemia, or tinnitus.

3. A patient taking atorvastatin calls the pharmacy reporting unexplained muscle pain and dark-colored urine. What serious adverse effect should the technician relay to the pharmacist as a concern?

Statin-associated muscle pain that progresses to dark urine can indicate rhabdomyolysis, a breakdown of muscle tissue releasing myoglobin, which requires urgent evaluation. Angioedema is linked to ACE inhibitors, tardive dyskinesia to antipsychotics/metoclopramide, and photosensitivity to drugs like tetracyclines, not statins.

4. A patient on lisinopril reports a persistent dry, nonproductive cough. What is the most likely cause?

ACE inhibitors reduce the breakdown of bradykinin, and its buildup in the airways is thought to cause the characteristic dry cough seen in a notable portion of patients on this drug class. It is not an anaphylactic reaction, but a bothersome cough that persists should still be reported so the pharmacist and prescriber can consider a switch, such as to an ARB.

5. A patient taking lisinopril presents to the pharmacy with sudden swelling of the lips and tongue. This is most consistent with which serious ACE inhibitor adverse effect?

Angioedema is a rare but serious ACE inhibitor adverse effect that can cause sudden swelling of the lips, tongue, or throat and can compromise the airway, requiring immediate medical attention. Tardive dyskinesia, serotonin syndrome, and photosensitivity are unrelated to ACE inhibitor therapy.

6. An elderly patient asks about taking diphenhydramine nightly for sleep. What concern should the technician relay to the pharmacist regarding this population?

First-generation antihistamines like diphenhydramine have strong anticholinergic effects, and older adults are more sensitive to confusion, urinary retention, dry mouth, and fall risk from these effects, which is why they are flagged in geriatric prescribing guidance. This concern is heightened, not absent, in older adults, and it is not primarily about blood pressure or blood sugar.

7. A patient newly started on metformin reports diarrhea and stomach upset. What counseling point may help minimize this common side effect?

Taking metformin with food reduces the GI upset that is common when starting therapy, and this side effect often improves over the first few weeks of treatment. Taking it on an empty stomach would worsen GI symptoms, and doubling the dose or stopping permanently without pharmacist/prescriber input are not appropriate responses.

8. Besides GI upset, which side effect is commonly associated with SSRIs like sertraline that patients may be hesitant to bring up?

Sexual dysfunction, including decreased libido and delayed orgasm, is a common and often underreported side effect of SSRIs that patients may not volunteer without being asked. Muscle rigidity is more associated with antipsychotics, and hair loss or weight loss are not the primary or defining SSRI side effects.

9. Extrapyramidal symptoms (EPS), such as tremor, rigidity, and involuntary movements, are most associated with which drug class?

Antipsychotics, particularly first-generation agents, block dopamine receptors in the brain, which can cause extrapyramidal symptoms like tremor, rigidity, and dystonia. SSRIs, beta blockers, and diuretics act through entirely different mechanisms and are not characteristically linked to EPS.

10. A patient on long-term oral corticosteroid therapy, such as prednisone, should be monitored for which of the following adverse effects?

Long-term corticosteroid use raises blood glucose and contributes to bone density loss (osteoporosis), among other effects, so patients on extended therapy are monitored for both. Corticosteroids do not typically cause hypoglycemia, increased bone density, hyperkalemia, or bradycardia.

1. Long-term NSAID use, such as with ibuprofen, carries a notable risk of which adverse effect?

NSAIDs inhibit prostaglandins that normally protect the stomach lining, and chronic use raises the risk of ulcers and GI bleeding. NSAIDs are not associated with hypoglycemia, hair loss, or thyroid dysfunction.

2. A patient with a documented severe penicillin allergy is prescribed a cephalosporin. What should the technician flag for the pharmacist?

Penicillins and cephalosporins share a similar beta-lactam ring structure, and while the actual cross-reactivity risk is lower than once believed, it is not zero — especially with certain side chains — so a documented severe allergy still warrants pharmacist assessment. The two drug classes are related but not chemically identical.

3. A patient with a documented sulfa allergy is being considered for a new prescription. Which of the following medications should be flagged as containing a sulfonamide moiety?

Sulfamethoxazole/trimethoprim contains a sulfonamide group and is a classic drug to avoid in patients with a documented sulfa allergy. Amoxicillin, azithromycin, and doxycycline belong to entirely different antibiotic classes and do not contain a sulfonamide structure.

4. A patient on apixaban reports easy bruising and occasional nosebleeds. How should the technician characterize this to the pharmacist?

Easy bruising and minor bleeding are expected pharmacologic effects of anticoagulant therapy given how the drug works, but they should still be reported to the pharmacist, especially if they worsen or a more serious bleed occurs. This is not an allergic reaction, and it is not a sign that the dose should be increased.

5. Patients taking furosemide, a loop diuretic, should be monitored for which electrolyte abnormality?

Loop diuretics like furosemide promote potassium excretion, putting patients at risk of hypokalemia, which can cause muscle weakness and arrhythmias. Potassium-sparing diuretics, such as spironolactone, carry the opposite risk of hyperkalemia instead.

6. Long-term use of metoclopramide carries a boxed warning for which adverse effect?

Metoclopramide, a dopamine antagonist used for GERD and nausea, carries an FDA boxed warning for tardive dyskinesia (involuntary, often irreversible movements) with prolonged use, generally beyond about 12 weeks. It is not primarily known for causing liver toxicity, kidney toxicity, or bone density loss.

7. Isotretinoin carries a boxed warning and requires enrollment in the iPLEDGE program due to which severe risk?

Isotretinoin is highly teratogenic, and the iPLEDGE program exists to prevent pregnancy exposure through mandatory contraception counseling and pregnancy testing. It is not primarily associated with kidney toxicity, hearing loss, or agranulocytosis.

8. A patient taking clindamycin develops severe, watery diarrhea. What serious adverse effect should be considered?

Clindamycin and other broad-spectrum antibiotics disrupt normal gut flora, allowing C. difficile to overgrow and cause severe, potentially serious colitis presenting as watery diarrhea. This presentation is not consistent with anaphylaxis, tardive dyskinesia, or serotonin syndrome.

9. Why are tetracyclines generally avoided in children under 8 years old and in pregnant women?

Tetracyclines bind to calcium in developing teeth and bone, which can cause permanent tooth discoloration and affect bone growth in young children and fetuses, so the class is generally avoided in these populations. Hearing loss, hypoglycemia, and hair loss are not the defining concerns with tetracyclines.

10. A patient is counseled to take alendronate first thing in the morning with a full glass of water and to remain upright for at least 30 minutes. What adverse effect is this instruction meant to prevent?

Bisphosphonates like alendronate can irritate or ulcerate the esophagus if the tablet lingers there; taking it with a full glass of water and staying upright helps ensure it reaches the stomach and reduces reflux back into the esophagus. This instruction is unrelated to blood sugar, sun sensitivity, or potassium levels.

1. A patient on insulin therapy reports sweating, shakiness, and confusion. What should the technician recognize this as a possible sign of?

Sweating, shakiness, and confusion are classic signs of hypoglycemia (low blood sugar), which requires prompt treatment with a fast-acting source of glucose. Hyperglycemia typically presents differently (thirst, frequent urination), and these symptoms are not consistent with an allergic reaction or an injection-site skin change.

2. Which combination of symptoms in a patient who just received an injectable medication should prompt the technician to immediately alert the pharmacist and treat it as a medical emergency?

Hives together with difficulty breathing and facial swelling are hallmark signs of anaphylaxis, a life-threatening allergic reaction requiring immediate emergency response, often with epinephrine. Mild drowsiness, dry mouth, or slight nausea alone are far more common, lower-severity effects that do not indicate an emergency.