Adverse Drug Reactions

Question 1

Answer 1

Diltiazem inhibits the metabolism of simvastatin: increasing the toxicity

Question 2

Which two CCBs should you be wary of when prescribing simvstatin? [2]

Answer 2

Amlodopine
Diltiazem
Max dose: 20mg per day

Question 3

[4]

Answer 3

Question 4

Describe the 6 types of ADR?

Old classification

Answer 4

Type A:
- Dose related
- Common, predictable
- Related to the pharmacology
- Unlikely to be fatal

Type B:
- Not dose dependent
- Uncommon, unpredictable
- Not related to pharmacoogy
- Often fatal

Type C:
- Chronic
- Uncommon
- Unrelated to cumulative dose

Type D:
- Delayed
- Uncommon
- Occurs after some time of use of drugs

Type E:
- End of treatment
- e.g. opiate withdrawal

Type F:
- Failure
- Common
- Often caused by polypharmacy
- e.g. failure of oral contraceptive in presence of an enzyme inducer

Question 5

Describe the DoTS classification of ADR

Answer 5

Dose
- Hypersusceptibility reactions (occurs at dose much lower than therapeutic)
- Collateral events: occur at therapeutic dose
- Toxic effects: occur at higher than therapeutic dose

Time:
- Time dependent
- Time independent

Susceptibilities:
- Immunological (allergies)
- Genetics
- Age
- Sex
- Physiology (pregnancy)
- Exogenous
- Disease states

Question 6

Answer 6

Harmful drug interactions are adverse drug reaction

Question 6

What type of reaction is major haemmorrhage after warfarin tx? [1]

Answer 6

Type A

Question 7

Why do children have an increased sensitivity to drugs like morphine? [1]

Answer 7

Immature BBB

Question 8

Why do children have increased effective concentrations of protein-bound drugs? [1]

Answer 8

Reduced albumin and total protein

Question 9

Which patient population should you consider before prescribing abacavir? [1]

Answer 9

Those with HLA-B-5701 gene
Causes hypersensitivity reaction

Question 10

Which patient population should you consider before prescribing carbamazapine, phenytoin and iamotrigine? [1]

Answer 10

HLA-B-1502: causes Stevens Johnsons Syndrome and toxic epidermal necrolysis

Question 11

What is porphyrias?

Answer 11

Porphyrias are diseases that occur when the body has problems making heme.

Patients with porphyrias require different dosing to avoid acute crisis

Question 12

Answer 12

All correct

Question 13

Clozapine is associated with which key significant risk? [1]

Answer 13

Agranulocytosis

Question 14

What parameter requires strict monitoring after warfarin prescription? [1]

Answer 14

INR: appropriate level of anticoagulation is maintained and risk of bleeding reduced

Question 15

What does this symbol mean? [1]

Answer 15

Question 16

Describe a common AE of ACEins [2]

Answer 16

Angioedema in Afro-Carribean populations. Often delayed reactions

Question 17

Answer 17

More than 10%

Question 18

Answer 18

1-10%

Question 19

Answer 19

0.1-1%

Question 20

Answer 20