ADRs

Question 1

to be rational, drug therapy must include consideration of (3)

Answer 1

drug, host and disease factors

Question 2

a goal of successful drug therapy is to achieve effective _____________ of ___________________ at __________________ in __________________

Answer 2

concentrations; the appropriate drug; the site of drug action; the individual

Question 3

most drug therapies are based on

Answer 3

fixed dosage regimens

Question 4

what are some host factors that would necessitate adjusting the dosage regimen

Answer 4

neonatal patient, geriatric patient, pregnant/lactating patient, species/breeds

Question 5

what are some disease factors that would necessitate adjusting the dosage regimen

Answer 5

renal disease, hepatic disease, cardiovascular disease

Question 6

what are some drug factors that would necessitate adjusting the dosage regimen (think broad)

Answer 6

pharmaceutical interactions, pharmacokinetic interactions, pharmacodynamic interactions

Question 7

what is an ADR

Answer 7

unintended and usually noxious response to a drug that is unwanted

Question 8

T/F ADRs occur at drug doses used for prophylaxis, treatment, or diagnosis

Answer 8

T

Question 9

An estimated _____________ percentage of all hospitalized human patients are admitted due to an ADR

Answer 9

3-5%

Question 10

what are the 6 most common drug classes to produce ADRs

Answer 10

1) NSAIDS
2) vaccines
3) antimicrobials
4) ectoparasitides
5) antihelmintics
6) anesthetic agents

Question 11

what are the two types of ADRs? which is avoidable?

Answer 11

Type A and Type B; Type A is avoidable

Question 12

what is the most common type of ADR

Answer 12

Type A

Question 13

what are 3 characteristics of Type A ADRs

Answer 13

dose-dependent and predictable; experimentally reproducible; mechanism responsible is known

Question 14

why do Type A ADRs alter plasma drug levels

Answer 14

change in the drug disposition (absorption, distribution, metabolism, excretion)

Question 15

what are the 2 subtypes of Type A ADRs

Answer 15

pharmacological, intrinsic

Question 16

describe pharmacological Type A ADRs

Answer 16

exaggerated pharmacological effects of the drug due to too much of the drug on its intended target receptor, or an off-target receptor (the right receptor in the wrong location)

Question 17

an example of pharmacological type A ADRs is

Answer 17

propanolol (induced bradycardia in patients with higher than expected blood levels)

Question 18

xylazine-induced emesis, propanolol-induced bronchospasm, and NSAID induced GI ulcers are examples of

Answer 18

Type A pharmacological ADRs due to off-target effects

Question 19

describe intrinsic Type A ADRs

Answer 19

determined by the drugs physio-chemical properties, binding of metabolites to non-specific targets that disrupts organelles and membranes, nucleic acids and proteins

Question 20

T/F pharmacological Type A ADRs are often dependent on bioactivation

Answer 20

F; intrinsic Type A ADRs are

Question 21

the site of Type A intrinsic ADRs is dependent on (3)

Answer 21

cells/tissues that accumulate drug, location of metabolizing NZs, susceptibility of tissues

Question 22

describe Type B ADRs

Answer 22

dose independent and unpredictable; not experimentally reproducible; host dependent

Question 23

what are the two subtypes of Type B ADRs

Answer 23

immunological and idiosyncratic

Question 24

what is the main form of Type B ADRs

Answer 24

immunological

Question 25

describe immunological Type B ADRs

Answer 25

the drug (or metabolite) acts as a hapten on endogenous molecules, inciting type I-IV reactions

Question 26

penicillin-induced allergies in dogs are what type of ADR

Answer 26

immunological Type B ADRs

Question 27

how are intrinsic and idosyncratic ADRs similar

Answer 27

they usually involve bioactivation of the drug

Question 28

describe idiosyncratic Type B ADRs

Answer 28

mechanism of action is usually unrelated to the pharmacologic action, or is unknown; involves bioactivation and depends on the chemical property of the drug

Question 29

oral diazepam in cats and carprofen in dogs are examples of

Answer 29

Type B idiosyncratic ADRs

Question 30

clinical signs of an ADR are usually _____________ and rarely ___________________

Answer 30

non-specific; pathognomonic

Question 31

we diagnose ADRs based on

Answer 31

strength of association

Question 32

systemic effects are often seen with Type A or Type B ADRs

Answer 32

Type B

Question 33

T/F use of corticosteroids for all ADRs is well documented

Answer 33

F; only good for immunologic ADRs

Question 34

the most important step when treating an ADR is __________________; the rest of treatment is based on ________________ and _________________

Answer 34

drug withdrawal; clinical manifestation of the drug; supportive care

Question 35

In Canada, ADRs are reported on a (voluntary/involuntary) basis

Answer 35

voluntary

Question 36

most clinically significant ADRs are due to ___________________ in the target species

Answer 36

altered drug disposition

Question 37

what are some species differences that can lead to an ADR (4)

Answer 37

1) GI tract 2) body composition 3) blood volume 4) drug metabolism

Question 38

what are some differences between geriatric and neonatal patients that can predispose to an ADR

Answer 38

geriatric: diminished organ function, altered body composition neonatal: increased bioavailability, larger Vd, slower elimination

Question 39

the most profound changes in drug disposition are found with a decline in what organ function

Answer 39

renal function

Question 40

give 3 reasons why the kidneys are highly vulnerable to ADRs

Answer 40

1) kidneys receive 20-25% of cardiac output 2) kidneys concentrate drugs and toxins 3) kidneys have high metabolic activity

Question 41

T/F uremia can reduce protein binding and hepatic metabolism of some drugs

Answer 41

T

Question 42

you have a patient with CRF; what are 3 considerations when prescribing this patient medications

Answer 42

1) avoid drugs eliminated by the kidneys 2) avoid drugs that are toxic to the kidneys 3) dose adjustment

Question 43

what 2 classes of drugs are capable of renal ADRs

Answer 43

NSAIDs, aminoglycosides

Question 44

you have a patient with cardiac disease; what are 3 considerations before giving this patient medications

Answer 44

1) give critical drugs IV 2) give toxic drugs IV slowly 3) dose adjustments

Question 45

what are 3 consequences of liver disease that can predispose to ADRs

Answer 45

1) reduced renal blood flow 2) reduced enzyme function 3) increased fraction of plasma unbound drug

Question 46

you have a patient with liver disease; what are 3 considerations before prescribing this patient medication

Answer 46

1) dose adjustments 2) choose drugs that are mainly eliminated not by the liver (i.e. not in bile) 3) avoid the liver when possible

Question 47

what is a drug interaction

Answer 47

change in the magnitude or duration of a pharmacologic effect of a drug due to the presence of another drug, food or environment factor

Question 48

T/F drug interactions can occur before or after the drug is absorbed by the host

Answer 48

T

Question 49

drug interactions are classified as (3)

Answer 49

pharmaceutical, pharmacokinetic, pharmacodynamic

Question 50

pharmaceutical interactions occur __________________ and can be classified as (3)

Answer 50

before the drug is absorbed by the host; drug-drug; drug-diet; drug-environment

Question 51

what is the most common type of drug interaction

Answer 51

pharmacokinetic

Question 52

pharmacokinetic interactions depend on

Answer 52

changes in drug disposition

Question 53

pharmacodynamic interactions occur when

Answer 53

one drug directly alters the physiologic or cellular response to another drug

Question 54

pharmacodynamic interactions can be further classified as (3)

Answer 54

receptor interactions; post-receptor interactions; physiologic response interaction