QuestionSBA
QuestionChoice
Bisorprolol does not commonly cause gynaecomastia
34254
e
Bisoprolol fumarate 10mg OD PO
QuestionChoice
Ramipril does not commonly cause gynaecomastia
34253
d
Ramipril 5mg BD PO
QuestionChoice
Warfarin does not commonly cause gynaecomastia
34252
c
Warfarin 5mg OD PO
QuestionChoice
Gaviscon does not commonly cause gynaecomastia
34251
b
Sodium alginate with potassium bicarbonate 10ml PRN PO
QuestionChoice
Spironolactone, an aldosterone antagonist decreases testosterone production and increases the peripheral conversion of testosterone to estradiol. This results in an increase in the levels of estrogen which causes gynecomastia. This adverse effect is seen in many antihypertensive medication but is more common with spironolactone. PPIs can cause gynecomastia but is not as commonly seen as with spironolactone
34250
a
Spironolactone 50mg OD PO
Concept
Chapter
#### Monitoring

The BNF advises to monitor lung function (in patients with a history of obstructive airway disease).

#### Overdoses

Overdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).
Non-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.

Management
 - Airway protection 
 - Activated charcoal within 1 hour
 - IV Fluids
 
IV glucagon is the first-line management.
 
For symptomatic bradycardia, IV atropine may be used.

2618
2793
Spironolactone side effects
Topic
9
Internal Medicine
6861
Case Presentation: A 55-year-old man was admitted to the Cardiology Ward for recovery following a PCI for his STEMI. PMH Heart Failure, Hypertension, GORD, AF. DH His current regular medicines are listed (below).

**On Examination**

BP 125/85mmHg, RR 12, HR 75/min, Temp 37.2oC.
HS I + II + S3
No radio-radial delay noted, CRT 2s, gynaecomastia noted.
Fine inspiratory crackles heard bilaterally.
Weight 85kg

Question: Select the prescription that is most likely to contribute to his gynaecomastia.
a