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Adverse drug reactions Flashcards

1
Q

What condition does thalidamide cause

A

phocomelia - shortened underdeveloped limbs etc

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2
Q

What is an adverse drug reaction

A

noxious, unintended reaction after normal dose OR abuse, medication error, overdose

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3
Q

Most common drug and ADRs causing hospital admission

A

NSAIDs
Diuretics
Warfarin
ACE/AII inhibitors
Beta blockers
Opiates
Digoxin
Prednisolone
Clopidogrel

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4
Q

Common adverse reactions of NSAIDs

A

Gi complications
Cerebral haemorrhage
Renal impairment
alletgic type - Wheezing, Rash

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5
Q

Diuretics adverse reactions common

A

Renal impairment
Hypotension
Electrolyte disturbance
Gout (uric acid accumulate)

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6
Q

Warfarin and clopidogrel adverse reactions

A

warfarin - bleeding
Clopidogrel - GI bleeding

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7
Q

beta blockers adverse reactions

A

Bradycardia
Heart block
HYpotnesion
Wheezing

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8
Q

Opiates common adverse reactions

A

Constipation
Vommitting
Confusion
Urinary retnetion

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9
Q

Digoxin adverse effect

A

Toxicity esp in renal impairment

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10
Q

Prednisolone adverse effects

A

GI complications, hyperglycaemia. osteoporotic fracture, worsening diabtees, skin bruising

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11
Q

ACE inhibitors/AII inhibitrs common adverse effects

A

renal impairment, hypotnesion, electrolyte disturbances

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12
Q

A-E of adverse drug reactions

A

Augmented
Bizarre
Chronic
Delayed effects
End of treatment

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13
Q

What is an augmented drug reaction

A

dose related and predictable
avoidable

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14
Q

examples of augmented drug reactions

A

insulin causing hypoglycaemia
Warfarin causing bleeding
Nitrates causing headaches (increased blood flow to cerebral vessels)

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15
Q

What are bizarre drug reactions

A

Not dose related, unpredicatable

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16
Q

What does digoxin toxicity cause

A

leading to N+V and arrhythmias

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17
Q

Examples of bizarre drug reactions

A

Penicllin anyphylaxis
Halothane -> hepattis
Chloramphenicol - agranulocytosis

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18
Q

Chronic adverse drug effects

A

Variable - only with prolonged use

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19
Q

Steroid ADRs from chronic use

A

Steroids -> osteoporosis, steroid cushings syndrome, metabolic syndromes

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20
Q

What drug used chronically can cause tardive dyskinesia

A

Phenothiazine

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21
Q

What drug used chronically can cause pulmonary hypertension

A

Fenfluramine

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22
Q

What are delayed ADRs

A

Effects that occur some time after drug discontinuation eg drug induced foetal abnormalities, durg induced cancers recipients or offspringeg immunosupressed, renal transplants sqamous cell carcinomas, dihydroestriol in pregnanc - female children -> vaginal cancer

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23
Q

What are end of treatment ADRs

A

Effects occur on withdrawal of drug

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24
Q

Examples of end of treatment ADRs

A

Adrenocortical insufficiency after steroid treatment
Drug withdrawal seizures
Withdrawal reactions following paroxetine

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25
Q

Drugs causing gynaecomastia

A

Spirinolactone
Oestrogens
Methyldopa
Digoxin

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26
Q

Drugs causing galactorrhea

A

Antipsychotics
Tricyclics
Metoclopramide
Oestrogens
Methyldopa

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27
Q

What condition is morbidiform skin rash seen in when cillin antibiotics are used

A

Glandular fever

28
Q

Severe skin reactions to drugs increasing in severity

A

Eytherma multiforme
Steven johnsons syndrome
Toxic epidermal necrolysis

29
Q

When does stevens johnson syndrome become toxic epidermal necrolysis

A

> 30% of skin surface involved and extensive mucous membrane damage

30
Q

What is steven johnsons syndrome

A

Flu like symptoms -> rash -> blisters -> top layer of skin sheds
hospitalisation for recovery

31
Q

What can corticosteroid use in childhood cause

A

Short statue - premature fusing of epiphyses

32
Q

What can tricycline antibiotics acuse in childhood

A

Yellow staining of enamel teeth

33
Q

What cancer is caused by long erm immunosupressant use after renal trnsplant

A

Squamous cell carcinoma

34
Q

What type of drug reaction is sus if improvement of condition after drug discontinued or dose reduced

A

Type A dose related ADR

35
Q

What is a rechallenge of a drug in ADR

A

Reinteoduce drug that suspect caused reaction to see if happens again

36
Q

What test result supports an ADR type A

A

High plasma drug concentrations (easy to measure in digoxin, theophylline)

37
Q

Criteria for ADR suspicion

A

Timing of symptoms with drug treatment
Improvement after discontinued or dose redued
Worsening after rechallenge
Ass w high plasma drug concentrations
Reaction prev recognised as side effect of drug patient on
Illness commonly result of ADR eg postural hypotension, confusion
Exclusion of other causes

38
Q

How to avoid anaphylaxis from drugs - notes, administering, what patient group

A

Careful drug history
PUT IN NOTES - record on drug charts and hospital and GP notes
Doubel check before administering drugs
Inject first dose slowly
Particular care in atopic patients

39
Q

Methods for avoiding ADRs

A

Only prescribe when clear indication
Use drug with most favourable risk-benefit
Check for prev ADRs/allergu
Careful paitent educations
Monitor therapy
Particular care in susceptibel patients eg elderly, prev ADR

40
Q

What patient education need ot give around drugs prescribed

A

Appropriate use of drug
Common an/or important adverse effects - BNF/SPC

41
Q

What skin reaction can anticonculsants cause

A

Steven johnsons syndrome/toxic epidermal necrolysis

42
Q

What % of hospital admissions are caused by ADRs?

A

5-7%

43
Q

Annual cost of ADR to NHS

A

250M

44
Q

Most common drugs causes of ADRs

A

NSAIDs : GI complications, cerebral haemorrhage, renal impairment, wheezing, rash
Diuretics: renal impairment, hypotension, electrolyte disturbances, gout
Warfarin: bleeding
ACE inhibitors /Angiotensin II receptor antagonists: renal impairment, hypotension, electrolyte disturbances
Beta blockers: Bradycardia, heart block, hypotension, wheezing
Opiates: Constipation, vomiting, confusion, urinary retention
Digoxin: Nausea, vomiting, confusion, bradycardia
Prednisolone: GI complications, hyperglycaemia, osteoporotic fracture
Clopidogrel: GI bleeding

45
Q

How to treat gynaecomastia if causing psychological distress

A

Surgery

46
Q

Common side effect of nicorandil

A

Anal ulceration and anal fissures

47
Q

What is foetal valproate syndrome

A

Delayed reaction following valproate exposure in utero -> broad forehead, thin arched eyebrows, flat nsala bridge, low set ears, short nose, thin upper lips.
more likely to develop autism and ADHD

48
Q

When can valproate be prescribed to women

A

When they are not of child bearing age or on the pregnancy prevention programme - annual check ups, highly effective contraception

49
Q

What anticonvulsants are less teratogenic than phenytoin, carbamazepine and valproate

A

Lamotrigine, levetiracetam

50
Q

Exapmples of teratogenic drugs

A

warfarin, lithium , valproate, thalidomide, phenytoin, isotretinoin

51
Q

What gene is Stevens Johnsons syndrome more likely with

A

HLA-B1502 allele - thai or han chinese ethnic origin - esp carbamazepine or phenytoin

52
Q

What idiosyncratic reaction can abacavir cause

A

Serious hypersenstivity

53
Q

What idiosyncratic reaction can flucloxacillin cause

A

hepatits

54
Q

What idiosyncratic reaction can chloramphenicol cause

A

aplastic anaemia

55
Q

what idiosyncratic reaction can simvastatin cause

A

Rhabdomyolysis - SCLO1B1

56
Q

Rare ADRs picked up by yellow card scheme

A

1 in 6,000 - Chloramphenicol-induced aplastic anaemia
1 in 10,000 - Halothane-induced jaundice
1 in 10,000 - DVT with oral contraceptives
1 in 10,000 - MI with oral contraceptives
1 in 20,000 - VT with terodiline
1 in 50,000 - VT with terfenadine

57
Q

Common drugs with narrow therapeutic index

A

Carbamazepine
Cyclosporine
Digoxin
Levothyroxine
Lithium carbonate
Phenytoin
Tacrolimus
Theophylline
Warfarin

58
Q

What neuro features may a patinet get when chronically taking metaclopramide for gastroparesis

A

Parkinsonian features

59
Q

What drugs delay gastric emptying

A

Tricyclic antidepressants, opiates and anti-muscarinic drugs

60
Q

Why does metaclopramide increase rate of absorpiton of other drugs

A

Increase gastric emptying

61
Q

What antibiotics are made less orally available when taken with antacids

A

Tetracyclines, quinolones
Form complex w antacids

62
Q

What drugs worry about with lithium -> poisonning

A

Any drugs causing sodium loss eg diuretics - proximal tubules donet differentiate between sodiuma nd lithium

63
Q

Why can ACEis cause angio-oedema

A

Accumulation of bradykinin

64
Q

What drug should be administerd in an iron overdose

A

Deserrioxamine - chelates iron

65
Q

When should paracetemol levels be measured after an overdose/

A

If overdose >75mg/kg
Determine if need acetylcysteine

If present after 8 hrs acetylcysteine started before results received

66
Q

What test is best indicator of prognosis in paracetamol overdose

A

INR

67
Q

Antichoinergic vs stimulant overdose

A

Same - low BP, tachycardia, dilated pupils
Anticholinergic - dry skin, absent bowel sounds
Stimulant - sweating, increased bowel sounds

errors and drugs (8 decks)

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