Mrs Kelly is a 66 year old lady who has systolic heart failure.

She has been taking perindopril (Coversyl) 5 mg mane, hydrochlorothiazide (Dithiazide) 25 mg mane and potassium chloride (Slow-K) 600 mg mane. Two weeks ago she became breathless and experience ankle oedema and she was commenced on spironolactone (Aldactone) 25 mg mane. Today you heard that Mrs Kelly had collapsed and had been admitted to hospital with profound muscle weakness and irregular cardiac rhythm

Describe the common, or serious, unwanted side effects of each of the medications that Mrs Kelly is taking. Comment on whether the adverse effects are predictable or not, and how they are best managed or avoided. The most common side effects for Coversyl are hypotension, coughing, hyperkalaemia, headache, nausea and muscle cramps (MIMS). As Mrs Kelly is taking 5mg mane, it is likely to see more of these side effects as the dose for elderly is 2.5 mg mane. She is also taking potassium chloride, which is meant to be taken with food. It should not be taken on an empty stomach because of its potential for gastric irritation also increasing the chances of seeing other side effects such rash and pruritus. The use of Conversyl and a potassium sparring drug have a drug interaction causing adverse effects and should not be taken in conjuction. Mrs Kelly is also taking Dithiazide which have common side effects including blurred vision, weakness, restlessness, nausea and hypokalaemia. Doses are recommended to be low due to the vasodilator effects which helps reduce the chance of adverse side effects. Unfortunately Mrs Kelly is combining Diathiazide with Coversyl, an ACE inhibitor, which have adverse drug interaction causing these common side effects.
Aldactone was commenced before she had collapsed and been admitted to hospital with profound muscle weakness and irregular cardiac rhythm. Some common side effects of aldactone are hyperkalaemia, hyponatraemia, hypochloraemia (especially when combined with thiazide diuretics) and weakness (AMH). With the combination of all these drugs Mrs Kelly are taking it is predictable, and could of easily been avoided by managing her dose intake, and not combining drugs that interact with each other whch further

AMH

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Aldosterone may contribute to the pathophysiology of heart failure; by reducing aldosterone activity, aldosterone antagonists improve outcome.

Common (>1%)
hyperkalaemia, hyponatraemia, hypochloraemia (especially when combined with thiazide diuretics), weakness, headache, nausea, vomiting, mastalgia

Infrequent (0.11%)
GI cramps, diarrhoea, ataxia, drowsiness, confusion, impotence, gynaecomastia, menstrual irregularities, mild acidosis, renal impairment

Rare (<0.1%)
agranulocytosis, hepatotoxicity, rash, lichen planus, lupus-like syndrome, cutaneous vasculitis, urticaria, alopecia, chloasma, osteomalacia