ADR's Flashcards

1
Q

What % of admission to hospital are ADR’s?

A

5%

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2
Q

What are type A ADR’s?

A

Predictable dose related effects

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3
Q

What are type B ADR’s?

A

Non predictable/bizarre long term effects

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4
Q

What are type A’s usually due to?

A
  • A pharmacokinetic/pharmacodynamic abnormality
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5
Q

What does this pharmacodynamic or kinetic abnormality result in?

A

An excess pharmacological effect

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6
Q

What is an example of a type A ADR?

A
  • Insulin induced hypoglycaemia

- Beta blocker induced bradycardia

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7
Q

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

A
  • Altered metabolism through disease or pharmacogenetics

- Drug - drug interactions

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8
Q

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

A
  • Hepatic disease

- Dehydration

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9
Q

What is the nature of type B ADR’s?

A
  • Unpredictable

- Immunological

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10
Q

What are examples of delayed effects of type B

A
  • Tardive dyskinesia (involuntary jerks of the face and trunk)
  • Carcinogenesis
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11
Q

What are examples of ADR surveillance methods?

A
  • Anecdotal reporting
  • Voluntary reporting
  • Intensive event recording
  • Cohort studies
  • Pop statistics
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12
Q

What percentage of inpatients get ADR’s?

A

10-20%

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13
Q

How many deaths result from ADR’s?

A

5000-10000

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14
Q

What are augmented ADR’s?

A
  • Predictable
  • Dose dependent
  • Recognised before drug is available
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15
Q

When do augmented ADR’s resolve?

A

When the drug is stopped

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16
Q

What are bizarre ADR’s?

A
  • Unpredictable
  • Rare
  • Unrelated to dose
17
Q

What can bizarre ADR’s result in?

18
Q

What is an example of augmented ADR’s?

A

Galactorrhoea with domperidone

19
Q

What are chronic ADR’s related to?

A
  • Dose

- Length of treatment

20
Q

Are chronic ADR’s predictable?

A

To a certain extent

21
Q

What are delayed ADR’s?

A
  • Occur years after treatment

- Can occur in the children of the patient

22
Q

What is an example of a delayed ADR?

A

Cancer in immunosuppressed individuals

23
Q

End of treatment ADR example?

A

Seizure after anti-epileptics are stopped

24
Q

Example of a chronic ADR?

A

Latrogenic Cushings Disease

25
What is the mechanism of a pharmacodynamic interaction?
- Antagonistic - Additive or synergistic interaction - Interactions from changes in drug transport - Interactions due to fluid and electrolyte disturbances
26
What is an additive/synergistic interaction?
Two drugs with the same pharmacological effect
27
What are the 4 mechanisms of pharmacokinetic interactions?
- Absorption - Distribution - Metabolism - Elimination
28
When is an absorption pharmacokinetic interaction important?
- When the drugs have a short half life | - Rapid results needed
29
What is the distribution mechanism a result of?
Another drug displacing the bound drug to increase the bioavailability
30
What protects patients from distribution mechanisms usually?
Metabolism and excretion
31
What is the process of metabolic mechanisms of ADR's?
The drug influences the metabolism of another
32
What drugs inhibit the Cytochrome P450 pathway?
- Cimetidine - Ketoconazole - Omeprazole
33
What is the elimination pathway
Changes to GFR or tubular secretion
34
What drugs inhibit excretion?
- Verepamil | - Digoxin
35
What factors may make it easier for patients to have drug drug interactions
- More drugs - Age - Critical illness - Surgery - Chronic underlying conditions