adverse drug reactions Flashcards
drugs with narrow therapeutic index
warfarin lithium digoxin gentamicin vancomycin theophylline carbamazepine levothyroxine
which phase of drug metabolism do ADRs most commonly occur?
Phase I = through Cyp P450 - oxidation, reduction, hydrolysis
(phase 2 = conjugation(water soluble - excretion in urine/bile)
classification of adverse drug reactions (ADRs)
type A = dose dependent + predictable B = bizarre effects - dose dependent + UNpredictable C = chronic effects D = delayed effects E = end of treatment effects F = failure of therapy
which drugs can cause pre-renal failure
diuretics - HF - dehydration
ACEi/ARBs - D+V
which drugs can cause renal failure (ATN)
gentamicin - sepsis
–> low dose = lysosomal enlarge, high dose = lysomal rupture
sulphonamides - RA
aspirin - CV disease
drugs which can cause post renal ADRs (retroperitoneal fibrosis, urinary calculi)
methysergide - cluster headaches
chemo (cakculi from purine breakdown) - acute luekaemias
which CVS drug can increase hypoglycaemic effect of sulphonylureas
ACEi
which GI medication does clopidegrel interact with
PPI’s - omeprazole
effect of grapefruit juice on drugs
inhibits the CYP3A4 enzyme of the cytochrome P450 system in the intestinal mucosa, increasing the bioavailability of drugs with a high first pass metabolism
–> Therapeutic doses of the affected drugs may produce serious adverse reactions.
(statins + antihistamines)
drugs that can cause urinary retention in BPH
anticholinergics
foods high in vit E+K interact with what drug
warfarin
apples, chickpeas, kiwi, spinach, nuts, brocolli
foods rich in potassium affect which drugs
ACEi / ARBs
spirinolactone/eplerone
foods which alter pH of stomach affect which drugs
antibiotics
thyroid meds
digoxin
diruretics
(yogurt, milk, soy, chicken, turkey, cheese)
mortality rates in type B drug reactions? examples?
HIGH mortality
- drug rashes
- bone marrow aplasia - chloramphenicol
- hepatic necrosis
examples of type C ADRs
prolonged therapy
- steroid –> cushings
- beta blockers –> diabetes
- NSAIDs –> hypertension
monitor + warn patients
