ADR's

Question 1

What % of admission to hospital are ADR’s?

Answer 1

5%

Question 2

What are type A ADR’s?

Answer 2

Predictable dose related effects

Question 3

What are type B ADR’s?

Answer 3

Non predictable/bizarre long term effects

Question 4

What are type A’s usually due to?

Answer 4

• A pharmacokinetic/pharmacodynamic abnormality

Question 5

What does this pharmacodynamic or kinetic abnormality result in?

Answer 5

An excess pharmacological effect

Question 6

What is an example of a type A ADR?

Answer 6

• Insulin induced hypoglycaemia

- Beta blocker induced bradycardia

Question 7

What can be the reason for the pharmacoKINETIC variation in type A?

Answer 7

• Altered metabolism through disease or pharmacogenetics

- Drug - drug interactions

Question 8

What can be the reason for the pharmacoDYNAMIC variation in type A?

Answer 8

• Hepatic disease

- Dehydration

Question 9

What is the nature of type B ADR’s?

Answer 9

• Unpredictable

- Immunological

Question 10

What are examples of delayed effects of type B

Answer 10

• Tardive dyskinesia (involuntary jerks of the face and trunk)
• Carcinogenesis

Question 11

What are examples of ADR surveillance methods?

Answer 11

• Anecdotal reporting
• Voluntary reporting
• Intensive event recording
• Cohort studies
• Pop statistics

Question 12

What percentage of inpatients get ADR’s?

Answer 12

10-20%

Question 13

How many deaths result from ADR’s?

Answer 13

5000-10000

Question 14

What are augmented ADR’s?

Answer 14

• Predictable
• Dose dependent
• Recognised before drug is available

Question 15

When do augmented ADR’s resolve?

Answer 15

When the drug is stopped

Question 16

What are bizarre ADR’s?

Answer 16

• Unpredictable
• Rare
• Unrelated to dose

Question 17

What can bizarre ADR’s result in?

Answer 17

Death

Question 18

What is an example of augmented ADR’s?

Answer 18

Galactorrhoea with domperidone

Question 19

What are chronic ADR’s related to?

Answer 19

• Dose

- Length of treatment

Question 20

Are chronic ADR’s predictable?

Answer 20

To a certain extent

Question 21

What are delayed ADR’s?

Answer 21

• Occur years after treatment

- Can occur in the children of the patient

Question 22

What is an example of a delayed ADR?

Answer 22

Cancer in immunosuppressed individuals

Question 23

End of treatment ADR example?

Answer 23

Seizure after anti-epileptics are stopped

Question 24

Example of a chronic ADR?

Answer 24

Latrogenic Cushings Disease

Question 25

What is the mechanism of a pharmacodynamic interaction?

Answer 25

• Antagonistic
• Additive or synergistic interaction
• Interactions from changes in drug transport
• Interactions due to fluid and electrolyte disturbances

Question 26

What is an additive/synergistic interaction?

Answer 26

Two drugs with the same pharmacological effect

Question 27

What are the 4 mechanisms of pharmacokinetic interactions?

Answer 27

• Absorption
• Distribution
• Metabolism
• Elimination

Question 28

When is an absorption pharmacokinetic interaction important?

Answer 28

• When the drugs have a short half life

- Rapid results needed

Question 29

What is the distribution mechanism a result of?

Answer 29

Another drug displacing the bound drug to increase the bioavailability

Question 30

What protects patients from distribution mechanisms usually?

Answer 30

Metabolism and excretion

Question 31

What is the process of metabolic mechanisms of ADR’s?

Answer 31

The drug influences the metabolism of another

Question 32

What drugs inhibit the Cytochrome P450 pathway?

Answer 32

• Cimetidine
• Ketoconazole
• Omeprazole

Question 33

What is the elimination pathway

Answer 33

Changes to GFR or tubular secretion

Question 34

What drugs inhibit excretion?

Answer 34

• Verepamil

- Digoxin

Question 35

What factors may make it easier for patients to have drug drug interactions

Answer 35

• More drugs
• Age
• Critical illness
• Surgery
• Chronic underlying conditions