ADR Flashcards
Adverse drug reactions
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.
Reporting ADRs
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
When to report an ADR?
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
Defective medicine
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
Side effects
> 1 in 10 very common
1 in 100 common
1 in 1000 uncommon
1 in 10,000 rare
<1 in 1,000 very rare
Drug allergy
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)
Drugs that can cause oral ulcers?
ACEi
NSAIDs
Nicorandil
Cytotoxic e.g methotrexate
Pancreatin
Drugs that can cause oral candidiasis?
Corticosteroid inhalers
Drugs that stain the teeth?
Chlorohexadine (brown)
Liquid iron (black)
Tetracyclines (yellow/brown)
Drugs that can cause Osteonecrosis of the jaw
Biphospohonates
Drugs that can cause gingival hypertrophy?
Phenytoin
Nifedipine
Ciclosporin
Drugs that can cause dry mouth?
Antimuscarinics
Opioids
Antihistamines
Antidepressants
Drugs that can cause taste disturbances?
ACEi
Amiodarone
Clarithromycin
Metformin
Zopiclone
Drugs that can cause myelosuppresion?
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
Drugs that cause photosensitivity?
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
Drugs causing contact sensitisation?
Methotrexate
Chlorpromazine
Cytotoxic drugs
Drugs that cause QT prolongations?
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
What are the pre-disposing factors for QT prolongation?
Increased age
Female
Cardiac disease
Bradycardia
Electrolyte disturbances (hypokalaemia, HYPOmagnesium, hypocalcaeria)
Drugs that cause HYPOkalaemia?
Loop or thiazide like diuretics
B2 agonists
Corticosteroids
Stimulant laxative abuse
Drugs that increase risk of bleeding?
Anti platelets - NSAIDs, SSRIs, venlaflaxine, clopidogrel, prasugrel
Anti-coagulants - warfarin, heparins, NOACs, fibrinolytics heparinoids
Drugs that cause thromboembolism?
Cytotoxics - bleomycin, vinca alkaloids, tamoxifen, cyphosphamide
Other drugs; epoitin alpha, oestrogens (COC or HRT), tranexamic acid
Drugs that cause first dose bradycardia?
CVS drugs - BB, amiodarone, rate limiting CCB, clonidine
CNS drugs - antimuscarinics, AchI
Drugs that cause first dose hypotension?
Alpha blockers, ACEi, ARBs, nitrates, indometacin (NSAID)
Drugs that cause hypotension?
Antihypertensives; BB, CCB, ACEi, ARBs, alpha blockers
Alcohol, nitrates, sildenafil, antipsychotics, dopamine receptor antagonists
