Adverse drug events Flashcards
Adverse event
Harm caused by the medication → no scientific basis, poor quality and failed to deliver, improper exposure → exaggerated or therapeutic effects
Adverse reaction
Unintended response to a drug that occurs at dose intended causing an expected effect/ toxicity (type A) or bizarre effect (type B)
Avoiding adverse drug events
Recognize: know what to look for
Reduce: Understand risk factors
Report
Non IV durgs
Nothing white goes IV except for propofol (slow release)
Type A (1): Augmented (adverse drug reactions)
Reflects plasma drug concentrations
Expected pharm. response (primary, secondary, toxic)
Predictable
Avoidable
At risk tissues/ organs
Protective barriers (skin, GI, resp.)
Organs that concentrate drugs (liver and kidney, bone, fat)
High blood flow (heart, brain)
Metabolically active (brain, kidney, eye)
Type A adverse drug reaction medications
Propranolol
Gentamicin (aminoglycoside)
Analgesics (Acetaminophen and carprofen)
Propanolol adverse drug reaction
Exaggerated primary response: cardiac → - chrono and inotrope (hypotension)
Secondary: respiratory→ bronchoconstriction (B2)
Gentamicin (aminoglycoside) adverse reaction
Low dose: reduced response → therapeutic failure → septicemia and infection
High dose → toxic response → tubular nephrosis and renal disease
Carprofen
Normal to overdose → type A ADE→ GI ulceration and hepatotoxicity
Acetaminophen
Over dose →Type A ADE → methemoglobinemia (cat) and acute hepatic necrosis (dogs and humans)
Type B (2) adverse reaction
Bizarre reaction from allergies type 1-5, idiosyncrasy, and genetics
Unexpected, small % of patients
Type 1 drug allergy (anaphylaxis)
Mast cell degranulation
CS: skin locally, GI affects (dog/ horse), Lungs (cat/cow)
Immediate CS
Anaphylactoid reaction
Direct, dose dependent, mast cell degranulation
No Ag
Basic (catonic) drugs: amphotericin B, radiocontrast materials and morphine derivatives
Avoiding anaphylactoid reactions
Pre-test with small dose
Slow administration
Pre-treat
Type 2 and 3 drug allergies
IgG, IgM
Ab based
Organs damage: BM, skin, blood, joint, liver
Minutes to hrs
Ex: phenobarbital
Type 4 drug allergies
Cell mediated
Delayed hypersensitivity (days)
Pharmacological factors that increase risk of adverse drugs
Drug interactions
Modified release products
Compounded products
Physiologic factors that increase risk of adverse drugs
Age differences
Species/ breed
Genetic polymorphisms/ mutations
Pathologic factors that increase risk of adverse drugs
Renal, liver, or cardiovascular disease
