QuestionMultiA
QuestionChoice
33921
g
Senna;15 mg;Oral (PO);Nightly
QuestionChoice
33918
d
Pioglitazone;45 mg;Oral (PO);Daily
QuestionChoice
33917
c
Gliclazide (Modified release);120 mg;Oral (PO);Daily
QuestionChoice
33916
b
Metformin hydrochloride;500 mg;Oral (PO);Three times daily
QuestionChoice
33915
a
Mirtazapine;30 mg;Oral (PO);Daily
QuestionChoice
33920
f
Alendronic acid;70 mg;Oral (PO);Once weekly
QuestionChoice
33919
e
Omeprazole;20mg;Oral (PO);Daily
QuestionComment
mirtazapine only causes drowsiness at lower doses 
60272
QuestionComment
Why only at low doses and not higher ones?
61173
User
subscriber
DJnR
User
subscriber
Fever Lumbar
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
2729
Drugs causing weight gain & drowsiness
Topic
92
General Practice
1. Mirtazapine is a presynaptic alpha2-adrenoreceptor antagonist that is used to treat depression. It works by increasing central noradrenergic and serotonergic neurotransmission. Weight gain is a common or very common side effect of mirtazapine. Gliclazide is a sulfonylurea that works by increasing insulin secretion. Gliclazide is also known to cause weight gain. Pioglitazone is a peroxisome proliferator-activated receptor gamma (PPAR-γ) agonist that works by reducing peripheral insulin resistance. Weight gain is a common or very common side effect of pioglitazone.
2. Drowsiness is a common or very common side effect of mirtazapine. Drowsiness is also listed as an uncommon side effect of omeprazole in BNF.
6796
a c d
a
Case presentation: A 56-year old woman visits her GP for medication review. She reports that she has been putting on weight despite following a healthy diet and exercising regularly. She also complains of feeling drowsy PH: Type 2 Diabetes Mellitus, Depression, GORD, Osteoporosis, Constipation DH: Her current regular prescriptions are listed below


**On examination**: Chest is clear with no added lung sounds. Heart sounds I + II + 0. Abdomen soft and non tender.

**Investigation**:

- Weight 71kg (66kg 6 months ago)
- BMI: 27
- HbA1c: 53 mmol/mol

Question 1: Select the THREE prescriptions that are most likely to be contributing to the weight gain (mark them with a tick in column A)
Question 2: Select the ONE prescription that is most likely be contributing to the drowsiness (mark it with a tick in column B)