adverse drug reaction and drug interactions

Question 1

an injury resulting from medical intervention related to a drug and includes ADRs

Answer 1

adverse drug event

Question 2

TRUE OR FALSE

the result of the intrinsic properties of the drug and can be prevented

Answer 2

false

cannot be prevented

Question 3

types of ADR

Answer 3

1. Augmented
2. Bizarre
3. Continuous
4. Delayed
5. End-of-use
6. Failure of efficacy

Question 4

the way the drug is handled by the body during absorption, distribution, metabolism and excretion may affect humans in an adverse manner

Answer 4

pharmacokinetic

Question 5

the most common type of ADR

Answer 5

augmented

Question 6

TYPE OF ADR

• predictable and dose-related
• responsible for the majority of ADRs
• usually caused by concomitant dx states, drug-drug interaction or drug interactions

Answer 6

augmented

Question 7

subtypes of augmented ADR

Answer 7

1. extension effects – related to pharmacological activity
2. side effects – unrelated to pharmacological activity

Question 8

TYPE OF ADR

• very uncommon
• unpredictable and not dose-related
• have no relation to the pharmacological action of the drug

Answer 8

bizarre

Question 9

TYPE OF ADR

• reaction disappers upon discontinuation
• illness often recognizable as immunological response
• reaction is undetectable during conventional testing

Answer 9

bizarre

Question 10

subtypes of bizarre ADR

Answer 10

1. idiosyncrasy – genetically determined
2. hypersensitivity reactions – response to environmental antigens

Question 11

a rare and serious skin and mucous membrane disorder and is usually a medication reaction that begins with flu-like symptoms and progresses to a painful rash that spreads and blisters

Answer 11

Steven Johnson’s Syndrom

Question 12

examples of drugs that can cause SJS

Answer 12

• carbamazepine
• phenytoin
• sulfonamides
• sulfasalazine
• paracetamol
• naproxen
• allopurinol

Question 13

HYPERSENSITIVY REACTIONS

• most common category of allergic reaction
• occurs after antigen binds onto IgE found on the surfaces of mast cells

Answer 13

type I

Immediate or Anaphylactic Immune Response

Question 14

drug of choice for anaphylactic shock

Answer 14

epinephrine

Question 15

a life-saving drug that treats the symptoms of a severe allergic reaction by stopping the airway from swelling

Answer 15

epinephrine

Question 16

HYPERSENSITIVITY REACTIONS

initiated by antibody directed against antigens found on the cell membrane of a given target cell

Answer 16

type II

Cytotoxic Reactions

Question 17

HYPERSENSITIVY REACTIONS

• tissue deposition of antigen-antibody complexes with complement activation and tissue damage

Answer 17

type III

Immune Complex Hypersensitivity

Question 18

HYPERSENSITIVY REACTIONS

examples are:
* hemolytic anemia (Methyldopa)
* aplastic anemia (Chloramphenicol)
* blood transfusion reactions

Answer 18

type II

Question 19

HYPERSENSITIVY REACTIONS

examples are:
* blood dyscrasias or serum sickness
* Arthus reaction
* SLE (Hydralazine, Phenytoin, INH, Procainamide)

Answer 19

type III

Question 20

an autoimmune disease in which the body’s immune system mistakenly attacks healthy tissue; can affect the skin, joints, kidneys, brain, and other organs

Answer 20

SLE - butterfly rashes

Question 21

a nonspecific term that refers to a disease or disorder, especially of the blood

Answer 21

blood dyscrasias

Question 22

can occur with many drugs, and in many but not all instances the mechanism is direct suppression of the megakaryocytes rather than immune processes

decrease platelets = bleeding

Answer 22

thrombocytopenia

Question 23

a small molecule that, when combined with a larger carrier such as a protein, can stimulate the production of antibodies that bind to it specifically

Answer 23

hapten

Question 24

the drug function as hapten

Answer 24

hapten model

Question 25

the drug **functions as an antigen**

Answer 25

immune-complex

Question 26

the drug **stimulates the production of antibody** that attacks RBC causing its hemolysis

Answer 26

autoimmune or cytotoxic model

Question 27

combination of the drug with the red-cell membrane, with the conjugate acting as an antigen --- **non-specific binding of plasma** protein to red cells, and thus **causing hemolysis**

Answer 27

hemolytic anemia

Question 28

believed to **occur with cephalosporins**

Answer 28

hemolytic anemia

Question 29

**T-lymphocytes sensitized by an antigen** release lymphokines after subsequent contact with the same antigen

Answer 29

type IV | **Cell-Mediated or Delayed Type**

Question 30

# TYPE OF ADR * **uncommon and dose- & time-related** * **associated with** the **cumulative dose** of the drug

Answer 30

continuous

Question 31

# TYPE OF ADR examples are: * tolerance * addiction * dependence

Answer 31

continuous

Question 32

**compulsion** to take the drug repeatedly & experiences unpleasant symptoms **if discontinued**

Answer 32

dependence

Question 33

condition where a person takes a drug compulsively, **despite potential harm** to themselves, or their desire to stop

Answer 33

addiction

Question 34

occurs when a drug has been **used habitually** & **the body has become accustomed** to its effects

Answer 34

physical dependence

Question 35

occurs when a drug has been **used habitually** & **the mind has become emotionally reliant** on its effects, either to elicit pleasure or relieve pain, and does not feel capable of functioning without it

Answer 35

psychological dependence

Question 36

# TYPE OF ADR **caused by long term effects of drug** and is related to dose and duration of the treatment

Answer 36

delayed

Question 37

# TYPE OF ADR * uncommon * **withdrawal symptoms** * generally occur shortly **after stopping** the drug

Answer 37

end-of-use

Question 38

# TYPE OF ADR * common, dose-related * unexpected **failure of efficacy**

Answer 38

failure of efficacy

Question 39

the **demonstration of transformation** occurring when the patient’s lymphocytes are exposed to a drug ex vivo suggests that the patient’s T-lymphocytes are sensitized to the drug. In this type of reaction, the hapten itself will often provoke lymphocyte transformation, as well as the conjugate

Answer 39

serological testing

Question 40

the best approach in patients on multiple drug therapy is to **stop all potentially causal drugs** and reintroduce them one by one until the drug at fault is discovered

Answer 40

control drug administration

Question 41

a measurable modification of the action of one drug by p**rior or concomitant administration of another** substance

Answer 41

drug interactions

Question 42

explain the mechanism of actions & pharmacologic effects of drugs

Answer 42

pharmacodynamics

Question 43

a branch of pharmacology that focuses on the study of the **biochemical and physiologic effects of drugs** and the mechanisms by which they produce such effects

Answer 43

pharmacodynamics

Question 44

# PHARMACODYNAMIC INTERACTION 1 + 1= 2

Answer 44

additive

Question 45

# PHARMACODYNAMIC INTERACTION * 1 + 1 = 0 * drugs that** inhibits the effect of the other**

Answer 45

antagonism

Question 46

# PHARMACODYNAMIC INTERACTION * 1 + 0 = 2 * a drug with no inherent activity will **enhance the effect of another drug**

Answer 46

potentiation

Question 47

# PHARMACODYNAMIC INTERACTION * 1 + 1 > 2 * **response is greater than the combined** effects of the individual drugs

Answer 47

synergisitc

Question 48

# TYPE OF ANTAGONISM * utilizes the **same receptor** * produce an effect **opposite of agonist** by binding to same receptor

Answer 48

pharmacologic antagonism

Question 49

# TYPE OF ANTAGONISM occurs when the drugs act independently at **different receptor sites**, often yielding **opposing actions**

Answer 49

physiologic antagonism | ex. histamine + epinephrine; vit. K + warfarin

Question 50

# TYPE OF ANTAGONISM * **no receptor** or opposing effect that is involved * occurs when **2 drug binds** with each other to form an **inactive compound**

Answer 50

chemical antagonism | ex. protamine SO4 + heparin SO4

Question 51

# TYPE OF ANTAGONISM inInhibit the endogenous ligand from binding the receptor but possess some **intrinsic activity**

Answer 51

partial antagonism | ex. nalorphine in opiate receptor