ADR

Question 1

Adverse drug reactions

Answer 1

Unwanted or harmful reaction experienced following the administration of a drug, combination of drugs under normal conditions of use and which is suspected to be related to the drug.

Question 2

Reporting ADRs

Answer 2

Yellow card scheme
Anyone can report including HCP, patient, carers, coroners etc
For bio similar medicines and vaccines need to state the brand name and batch number

Question 3

When to report an ADR?

Answer 3

Newer drugs and vaccines; indicated by a black triangle
Medication errors (also report to national reporting learning system)
Medical devices e.g IUD, contact lens fluid, dental/surgical materials
Defective medicines or suspected fake medicine

Question 4

Defective medicine

Answer 4

Not same as an ADR where a product conforms to its specification
Defective during manufacture or distribution an error occurs where the finished product doesn’t conform to its specification
Report to defective medicine report centre division of MHRA

Question 5

Side effects

Answer 5

> 1 in 10 very common
1 in 100 common
1 in 1000 uncommon
1 in 10,000 rare
<1 in 1,000 very rare

Question 6

Drug allergy

Answer 6

Suspected drug reaction; to a drug allergy if possible non-drug cause or only GI symptoms present
Suspected drug allergy; clinical features of immune reaction, consider stopping, severe symptoms, document and advice patient to avoid drug and share allergy status
REFER to specialist if severe
Immediate (rapid reaction from drug exposure; anaphylaxis, urticaria, angioedeama, bronchospasm)
Non-immediate reactions WITHOUT systemic involvement (onset 6-10 days, pa pulse, maculae’s etc)
Non-immediate reactions WITH systemic involvement (onset 3 day to 6 wks; SJS, toxic epidermal necrolysis)

Question 7

Drugs that can cause oral ulcers?

Answer 7

ACEi
NSAIDs
Nicorandil
Cytotoxic e.g methotrexate
Pancreatin

Question 8

Drugs that can cause oral candidiasis?

Answer 8

Corticosteroid inhalers

Question 9

Drugs that stain the teeth?

Answer 9

Chlorohexadine (brown)
Liquid iron (black)
Tetracyclines (yellow/brown)

Question 10

Drugs that can cause Osteonecrosis of the jaw

Answer 10

Biphospohonates

Question 11

Drugs that can cause gingival hypertrophy?

Answer 11

Phenytoin
Nifedipine
Ciclosporin

Question 12

Drugs that can cause dry mouth?

Answer 12

Antimuscarinics
Opioids
Antihistamines
Antidepressants

Question 13

Drugs that can cause taste disturbances?

Answer 13

ACEi
Amiodarone
Clarithromycin
Metformin
Zopiclone

Question 14

Drugs that can cause myelosuppresion?

Answer 14

Low blood count (low WBC - infection risk, low RBC - anaemia, low platelet - thrombocytopenia)
DMARDs; methotrexate, penicillamine, gold
Anti-epileptics; carbamazepine, lamotrigine, phenytoin, ethosuximide
Antibiotics; linzolid, chloramphenicol, dapsone, co-trimoxazole, trimethoprim
Immunosuppressants; azathioprine and cytotoxics (except vincristine and bleomycin)
Anti-folates; phenytoin, methotrexate, trimethoprim
Others; aminosalicylates,, carbimazole, clozapine and mirtazipien

Question 15

Drugs that cause photosensitivity?

Answer 15

Antimicrobials; antifungals, doxy/tetracyclines, antimalarials, quinolones, co-trimoxazole
Amiodarone, vitamin A, isotrerinoin, phenothiazine, antispychotics, tacrolimus, topical NSAIDs

Label; protect from sunlight even bright or cloudy days dont use sunbeds

Question 16

Drugs causing contact sensitisation?

Answer 16

Methotrexate
Chlorpromazine
Cytotoxic drugs

Question 17

Drugs that cause QT prolongations?

Answer 17

Increases the risk of ventricular arrhythmias
Antipsychotics - pimazole, haloperidol, Quetta pine
Antidepressants - citalopram, escitalopram, TCAs, venlaflaxine
Anti arrhythmics - sotalol, amiodarone
CNS - methadine, lithium, sumatriptan, domperidone, quinine, metoclopramide
Antimicrobials - macrolides, chloroquine, quinolones

Question 18

What are the pre-disposing factors for QT prolongation?

Answer 18

Increased age
Female
Cardiac disease
Bradycardia
Electrolyte disturbances (hypokalaemia, HYPOmagnesium, hypocalcaeria)

Question 19

Drugs that cause HYPOkalaemia?

Answer 19

Loop or thiazide like diuretics
B2 agonists
Corticosteroids
Stimulant laxative abuse

Question 20

Drugs that increase risk of bleeding?

Answer 20

Anti platelets - NSAIDs, SSRIs, venlaflaxine, clopidogrel, prasugrel
Anti-coagulants - warfarin, heparins, NOACs, fibrinolytics heparinoids

Question 21

Drugs that cause thromboembolism?

Answer 21

Cytotoxics - bleomycin, vinca alkaloids, tamoxifen, cyphosphamide
Other drugs; epoitin alpha, oestrogens (COC or HRT), tranexamic acid

Question 22

Drugs that cause first dose bradycardia?

Answer 22

CVS drugs - BB, amiodarone, rate limiting CCB, clonidine
CNS drugs - antimuscarinics, AchI

Question 23

Drugs that cause first dose hypotension?

Answer 23

Alpha blockers, ACEi, ARBs, nitrates, indometacin (NSAID)

Question 24

Drugs that cause hypotension?

Answer 24

Antihypertensives; BB, CCB, ACEi, ARBs, alpha blockers
Alcohol, nitrates, sildenafil, antipsychotics, dopamine receptor antagonists

Question 25

Drugs that cause antimuscarinic effects?

Answer 25

Atropine, TCAs, antihistamines, clozapine, Antimuscarinics

Question 26

CNS depressant effects?

Answer 26

Alcohol, anti-epileptics antihistamines, antipsychotics, baclofen, opioids, melatonin, z-drugs

Question 27

Drugs that cause peripheral neuropathy?

Answer 27

Asplatin, phenytoin, amiodarone, metronidazole, isosoniazid

Question 28

Drugs that cause serotonin syndrome?

Answer 28

5HT1A agonist (sumatriptan, Buspirone), antidepressants (TCAs, SSRI, MOAI, selegiline
St John’s wart

Question 29

Drugs that cause ototoxicity?

Answer 29

Loop diuretics
Vancomycin
Amino-glycosides (gentamicin)

Question 30

Drugs that reduce seizure threshold

Answer 30

SSRI
Lithiums
Quinolones
Tramadol
Antipsychotics
Theophylline