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Pharmacology > 22) Adverse Drug Reactions > Flashcards

22) Adverse Drug Reactions Flashcards

1
Q

What is an adverse drug reaction?

A

Preventable or unpredictable medication event with harm to the patient

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2
Q

Describe severe ADRs

A 
Results in death
Life-threatening
Requires or prolongs hospitalisation
Causes disability
Causes congenital anomalies
Requires intervention to prevent permanent injury
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3
Q

ABCDE CLASSIFICATION OF

ADVERSE DRUG REACTIONS

A 
A     Augmented pharmacological effect
B	Bizarre
C	Chronic
D	Delayed
E	End-of-treatment
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4
Q

Define Type A ADR.

A 
Extension of pharmacological effect  Predictable 
Dose-dependent  
Most common type of ADR (2/3) 
Example: 
atenolol --> heart block 
NSAIDS --> peptic ulcer
Anticholinergics --> dry mouth
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5
Q

Define Type B ADR.

A

‘Bizarre’ type of ADR
Idiosynchratic or immunologic reactions – Includes allergy or pseudoallergy
Rare
Unpredictable
e.g. chloramphenicol –> aplastic anaemia
ACE inhibitors –> angioedema

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6
Q

Define Type C ADR.

A

Associated with long-term use
Involves drug accumulation
E.g. methotrexate –> liver toxicity
antimalarials –> ocular toxicity

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7
Q

Define Type D ADR.

A

Delayed effects – sometimes dose independent

E.g. immunosuppressants –> carcinogenicity thalidomide –> teratogenicity

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8
Q

Define Type E ADR.

A

Withdrawal reactions
(opiates, corticosteroids, benzodiazepines)

Rebound reactions
(Clonidine, beta-blockers, corticosteroids)

Adaptive reactions
(Neuroleptics (major tranquillisers))

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9
Q

Describe and explain clonidine rebound.

A

Clonidine = alpha-2 agonist = suppresses NA release
Long-term Clonidine use –> upregulation in adrenergic receptors on the post-synaptic membrane
If the dose of clonidine is missed once or twice, it will cause an increase in NA release, which then acts on an increased number of receptors so has a greater effect
This causes a large increase in blood pressure

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10
Q

What is the ABCDE classification of adverse drug reactions?

A 
A – augmented pharmacological action   
B – bizarre 
C – chronic  
D – delayed  
E – end of treatment
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11
Q

Describe the classification of allergies.

A

Type 1 – immediate, anaphylaxis (IgE)
Type 2 – cytotoxic antibody (IgG + IgM)
Type 3 – serum sickness (IgG + IgM)
Type 4 – delayed hypersensitivity (T cell)

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12
Q

Give examples of pseudoallergies.

A

Aspirin/NSAIDs –> bronchoconstriction

Aspirin + NSAIDs inhibit prostanoid (bronchodilators) production & promote leukotrienes (bronchoconstriction) production

ACE inhibitors –> cough/angioedema

 ACEI prevent kinin breakdown–> Kinins accumulate in sensory nerves in the lungs and trigger cough

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13
Q

What are the most common causes of ADRs

A

Antineoplastics
Cardiovascular drugs
NSAIDs/analgesics
CNS drugs

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14
Q

What is the yellow card scheme?

A

A voluntary scheme allowing doctors, dentists, nurses, coroners and pharmacists to report SERIOUS adverse drug reactions

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15
Q

pharmacodynamic drug interaction?

A

Additive effects
Synergistic effects (antibiotics)
Antagonistic effects

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16
Q

What are the different types of pharmacokinetic drug interaction?

A

Alteration in drug absorption + metabolism _ excretion

+ Protein binding effects

17
Q

What is an example of alteration of absorption?

A

Chelation

18
Q

Which cytochrome P450 enzymes are responsible for over half of drug metabolism?

A

CYP2D6

CYP3A4

19
Q

Describe the difference in the speed of inhibition and the speed of induction of CYP450 enzymes.

A

Inhibition is RAPID

Induction takes hours/days

20
Q

Give an example of a deliberate drug interaction.

A

ACE inhibitors and thiazides

21
Q

classification of ADRs

A 
--------onset 
Acute = < 1 hour  
Sub-acute = 1-24 hours
Latent = > 2 days 
--------severity 
Mild – requires no change in therapy  
Moderate – requires change in therapy 
Severe – disabling or life-threatening 
--------type
ABCDE
22
Q

drug elimination interactions

A

almost always in renal tubule

  • lithium and thiazides = bad
  • probenecid and penicillin = good
23
Q

genetic differences influence individual response to drugs

polypharmacy, age, diet and renal function can effect drug reactions

A

genetic differences influence individual response to drugs

polypharmacy, age, diet and renal function can effect drug reactions

Pharmacology (32 decks)

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