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4th yr- CMS- Pharmacology and drugs > Adverse drug reactions > Flashcards

Adverse drug reactions Flashcards

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Introductory Sommelier Exam (CMS) flashcards
1
Q

What does ADR stand for

A

Adverse drug reactions

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2
Q

What can adverse drug reactions be classified as

A
  1. Overdosing
  2. Side effects
  3. Secondary effects
  4. Idiosyncratic reactions
  5. Teratogenic effects
  6. Allergic reaction
  7. DRUG INTERACTIONS
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3
Q

The elderly are usually on how many drugs

A

frequently on 7+ drugs

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4
Q

What can overdosing occur due to

A
  1. Sucidal intent
  2. Failure to calculate paediatric or elderly persons dose correctly
  3. Failure to alter dose in renal or hepatic impairment/ disease
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5
Q

What do we define side effect as

A

An unwanted effect attributable to the known pharmacological action of the drug

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6
Q

What do secondary effects occur as a result of

A

A consequence of prescribing the due but are not a direct pharmacological action of the drug

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7
Q

What are idiosyncratic reactions

A

Genetic predisposition to a rare reaction to a medication

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8
Q

What are teratogenic effects

A

When drugs given to pregnant women cause damage or death to the foetus

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9
Q

What can the teratogenic effect of phenytoin be

A

Cleft lip, learning impairments

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10
Q

What can the teratogenic effect of valproate be

A

Serious developmental disorders in uptown 40% of cases

Congenital disorders in 10% cases

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11
Q

What can the teratogenic effect of MYCOPHENOLATE be

A

Congenital heart disease

Eye abnormalities

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12
Q

What can the teratogenic effect of tetracycline be

A

Mottling of teeth and bones

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13
Q

What are hypersensitivity reactions not dependent on

A

NOT DOSE dependent

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13
Q

What are hypersensitivity reactions

A

Drug molecules when bound to plasma porins can act as happens and trigger immunological responses

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13
Q

What are hypersensitivity reactions usually due to

A

Due to a metabolite rather than the drug itself

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13
Q

How do we classify hypersensitivity reactions

A

Type I, II, III, IV

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14
Q

What is a type I hypersensitivity reaction

A

Anaphylaxis

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15
Q

What is a type II hypersensitivity reaction

A

Cytotoxic

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16
Q

What is a type III hypersensitivity reaction

A

Antibody antigen complex

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17
Q

What is a type IV hypersensitivity reaction

A

Cell mediated delayed

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18
Q

What accounts to the most ADRs

A

Drug interactions account for uptown 20% of all ADRs

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19
Q

What are drug interactions

A

Administration of drug A which modifies behaviour of drug B

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20
Q

Name the 2 types of drug interactions

A
  1. Pharmacodynamics

2. Pharmacokinetic

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21
Q

What is pharmacodynamic drug interaction

A

The effect occurs without the concentration of drug B changing in the tissue fluid

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22
Q

What is a pharmacokinetic drug interaction

A

The effect changes due to an alteration in the concentration of drug B at its target tissue/cell

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23
Q

Who are most likely to experience drug interaction

A

Patients on multiple drugs especially the elderly

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23
Q

To what can alcohol have a drug itneraction with and what type of drug interaction is it

A

Can interact with antihistamines, opioids and benzodiazepines causing increased somnolence

Pharmacodynamic drug interactions

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23
Q

What can aspirin interact with and what type of drug interaction is it

A

Warfarin or clopidogrel increasing risk of haemorrhage

Pharmacodynamic drug interactions

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23
Q

What can NSAIDs and antihypertenisce lead to and what type of drug interaction is this

A

Lead to paradoxical hypertension

Pharmacodynamic drug interactions

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24
Q

What is penicillin antagonised by

A

Tetracylcine

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25
Q

What does ADME stand FOR

A

Absorption
Distribution
Metabolism
Excretion

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26
Q

Give an example of drug interactions that interfere with absorption

A

Loocal anaesthetic and a vasoconstrictor - reduced blood flow to the tissue leads to prolonged effect of the anaesthetic agent giving a bloodless field

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27
Q

Give an example of a drug interaction that interfered with albumin

A

Main type is where 2 drugs compete for binding to albumin eg aspirin is 50% bound to albumin and warfarin is 99% bound so administering both radically increases the risk of life-threatening bleeds

28
Q

Give an example of a drug interaction that interferes with metabolism

A
  1. Enzyme inducers

2. Enzyme inhibitors

29
Q

Give an example of a drug that acts as a enzyme inducer

A

Soem drugs increase P450 production eg carbamazepine, rifampicin, ethanol, phenobarbitone all induce enzymes

30
Q

Give example of enzyme inhibiting drugs

A
  1. Erythromycin
  2. Metronidazole
  3. Azole antifungal
31
Q

What can erythromycin react with

A
  1. Warfarin (increased risk bleeding)
  2. Carbamazepine (ataxia)
  3. Calcium channel blockers (hypotension)
  4. Simvastatin (increase in muscle breakdown)
  5. Clopidogrel (increased risk of bleeding)
32
Q

What drugs can metronidazole affect

A
  1. Ethanol (nausea, dizziness due to the antibiotic inhibiting alcohol’s metabolism)
  2. Warfarin (increased risk bleeding)
  3. Phenytoin (metronidazole raises the plasma concentration of phenytoin due to inhibited metabolism increasing risk of toxicity)
33
Q

What drugs can Azole antifungal affect

A

Warfarin (increased risk bleeding)

34
Q

Why might drugs interfere with excretion

A

May be due to one agent not being excreted by the kidney due to another agent blocking tubular secretion

35
Q

What clinical manifestations of ADRs can be seen in and around the oral cavity

A
  1. Infections
  2. Lichenoid drug reactions
  3. Lupus like drug reactions
  4. Vesicullobullous drug reactions
  5. Erythema multiform and Steven Johnsons syndrome
  6. Other drug induced ulceration
  7. Fixed drug reactions
  8. Hyper/hypo-pigmentation
  9. Ulticaria and angioedema
  10. Gingival enlargement
  11. Salivary gland involvement
  12. Sensory abnormalities
  13. Motor abnormalities
  14. Abnormalities of mineralised tissues
36
Q

Why can ADRs present as infection to oral cavity

A

Either beducase the normal immune response is suppressed or there is damage to the mucosal surfaces

37
Q

What drugs can cause a fungal infection

A

Corticosteroids (topical, oral or inhaled)

Broad spectrum antibiotics

38
Q

Give an example of a fungal infection caused by ADR

A

Candidosis

39
Q

Give examples of viral infections that can result due to ADRs

A
  1. Herpetic stomatitis (HSV 1 or 2),
    2, Oral Hairy Leukoplakia (EBV)
  2. Kaposi’s sarcoma (HHV 8)
    4 .Papillomata (HPV)
40
Q

Give examples of drugs that can cause viral ADRs

A

Anti rejection drugs in past transplant patients

41
Q

What is lichen planus (OLP)

A

The disease in the absence of an identifiable cause

42
Q

Why might a lichenoid reaction occur

A

Due to exposure to a triggering agent (dental materials and various drugs included)

43
Q

List soem common drugs implicated in lichenoid reactions

A
  1. NSAIDs
  2. ACE-inhibitors
  3. Beta blockers
  4. Thiazide diuretics
  5. Carbamazepine
44
Q

What can vesicullobullous drug reactions produce

A

Vesicles and bullae

45
Q

What are erythema multoforne and Steven Johnsons syndrome involved with

A

Immune related ulcerations of the skin and mucosa

45
Q

What can trigger erythema multiform and Steven johns syndrome

A

NSAIDs
Penicillins
Sulphonamides
Carbamepine

45
Q

Give examples of other drug induced ulcerations

A
  1. Chemical burn
  2. Sloughing and ulceration
  3. Ocular ulceration
46
Q

What can cause chemical burs

A

Placing an aspirin next to a tooth which is hurting

47
Q

What can cytotoxic agents cause

A

severe mucosal sloughing and ulceration - ‘oral mucositis’ is well known during this phase of cancer treatment

48
Q

What is nicorandil a treatment for

A

Angina

49
Q

What side effects can nicorandil cause

A

persistent oral, rectal and ocular ulceration

50
Q

What are fixed drug reactions

A

Characteristic finding of a development of a rash at the same anatomical site each time the causative drug is given

51
Q

What can vesicullobullous drug reactions be provoked by

A

Pencillamine
NSAIDs
Furosemide
Capropril

52
Q

What can hyperpigmentation be

A

Extrinsic

Intrinsic

53
Q

When might Hypopigmentation occur

A

on the facial skin if corticosteroids are applied regularly or at too high a dose (can be permanent- ometimes see a ‘halo’ of depigmentation peri- orally after prolonged use of potent topical corticosteroid creams or ointments

54
Q

What is Angioedema due to

A

Leaky capillaries resulting in increased permeability

55
Q

What can Angioedema lead to

A

Protein leaching out into tissues taken fluid within —> orofacial swelling
This can compromise the airway

56
Q

What is Angioedema an example of

A

Type I hypersensitivity reaction

57
Q

What does Urticaria refer to

A

Raised wheals of concentric red and pale tissue swellings which are often itchy

58
Q

What is gingival enlargement

A

Overgrowth of fibrous tissue of the gingival

59
Q

Give examples of drugs that can cause gingival enlargement

A
  1. Phenytoin
  2. Calcium channel blockers
  3. Valproate
60
Q

A combination of causative drug and what can lead to a dramatic gingival reaction

A

Poor plaque control

61
Q

What is hypo salivation

A

The objective reduction in saliva production

62
Q

What is xerostomia

A

Percieved dry mouth

63
Q

What is sialosis

A

enlargement of the major salivary glands

64
Q

give examples of sensory abnormalities that can be caused by drugs

A
  1. Dysaesthesia
  2. Paraesthesia
  3. Halitosis
65
Q

What is Dysaesthesia

A

Abnormal sensation

66
Q

Which drugs can cause Dysaesthesia

A

Metronidazole, metformin and sertraline which cause a metallic taste
ACE-inhibitors can cause an impairment in taste perception or oral mucosal burning

67
Q

What is Paraesthesia

A

the feeling of pins and needles

68
Q

What can cause Paraesthesia

A
  1. Chemotherapy agents like vincristine

2. Labetalol- a beta blocker

69
Q

What is Halitosis

A

Smelly breath

70
Q

What drugs can cause Halitosis

A
  1. Isosorbide dinitrate tablets

2. General impairment of saliva production leads to drying and overgrowth of organisms which give off an odour

71
Q

Give examples of motor abnormalities that arise as a result of ADRs

A
  1. Dyskinesia

2. Dystonia

72
Q

What is Dyskinesia

A

An abnormality of voluntary movement

73
Q

What is Dystonia

A

abnormal muscle tone

74
Q

What does a full drug history include

A
  1. When the drug was started and why
  2. How symptoms of the suspected ADR developed in relation to taking the drug
  3. Whether drug dose changes

4th yr- CMS- Pharmacology and drugs (7 decks)

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