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Pharmacology & Anesthesiology > ADRs > Flashcards

ADRs Flashcards

1
Q

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

A

drug, host and disease factors

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2
Q

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

A

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

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3
Q

most drug therapies are based on

A

fixed dosage regimens

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4
Q

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

A

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

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5
Q

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

A

renal disease, hepatic disease, cardiovascular disease

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6
Q

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

A

pharmaceutical interactions, pharmacokinetic interactions, pharmacodynamic interactions

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7
Q

what is an ADR

A

unintended and usually noxious response to a drug that is unwanted

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8
Q

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

A

T

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9
Q

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

A

3-5%

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10
Q

what are the 6 most common drug classes to produce ADRs

A

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

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11
Q

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

A

Type A and Type B; Type A is avoidable

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12
Q

what is the most common type of ADR

A

Type A

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13
Q

what are 3 characteristics of Type A ADRs

A

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

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14
Q

why do Type A ADRs alter plasma drug levels

A

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

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15
Q

what are the 2 subtypes of Type A ADRs

A

pharmacological, intrinsic

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16
Q

describe pharmacological Type A ADRs

A

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)

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17
Q

an example of pharmacological type A ADRs is

A

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

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18
Q

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

A

Type A pharmacological ADRs due to off-target effects

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19
Q

describe intrinsic Type A ADRs

A

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

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20
Q

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

A

F; intrinsic Type A ADRs are

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21
Q

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

A

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

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22
Q

describe Type B ADRs

A

dose independent and unpredictable; not experimentally reproducible; host dependent

23
Q

what are the two subtypes of Type B ADRs

A

immunological and idiosyncratic

24
Q

what is the main form of Type B ADRs

A

immunological

25
Q

describe immunological Type B ADRs

A

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

26
Q

penicillin-induced allergies in dogs are what type of ADR

A

immunological Type B ADRs

27
Q

how are intrinsic and idosyncratic ADRs similar

A

they usually involve bioactivation of the drug

28
Q

describe idiosyncratic Type B ADRs

A

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

29
Q

oral diazepam in cats and carprofen in dogs are examples of

A

Type B idiosyncratic ADRs

30
Q

clinical signs of an ADR are usually _____________ and rarely ___________________

A

non-specific; pathognomonic

31
Q

we diagnose ADRs based on

A

strength of association

32
Q

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

A

Type B

33
Q

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

A

F; only good for immunologic ADRs

34
Q

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

A

drug withdrawal; clinical manifestation of the drug; supportive care

35
Q

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

A

voluntary

36
Q

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

A

altered drug disposition

37
Q

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

A

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

38
Q

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

A

geriatric: diminished organ function, altered body composition

neonatal: increased bioavailability, larger Vd, slower elimination

39
Q

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

A

renal function

40
Q

give 3 reasons why the kidneys are highly vulnerable to ADRs

A

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

41
Q

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

A

T

42
Q

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

A

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

43
Q

what 2 classes of drugs are capable of renal ADRs

A

NSAIDs, aminoglycosides

44
Q

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

A

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

45
Q

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

A

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

46
Q

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

A

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

47
Q

what is a drug interaction

A

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

48
Q

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

A

T

49
Q

drug interactions are classified as (3)

A

pharmaceutical, pharmacokinetic, pharmacodynamic

50
Q

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

A

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

51
Q

what is the most common type of drug interaction

A

pharmacokinetic

52
Q

pharmacokinetic interactions depend on

A

changes in drug disposition

53
Q

pharmacodynamic interactions occur when

A

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

54
Q

pharmacodynamic interactions can be further classified as (3)

A

receptor interactions; post-receptor interactions; physiologic response interaction

Pharmacology & Anesthesiology (12 decks)

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