Adverse Drug Reactions Flashcards
relation between therapeutic indec and side effects
lower the Ti higher the rick of side effects
contraindication meaning
contraindication is a specific situaiton in which a drug should not be used because t may be harmful to the persons
special precautions meaning
condition that may increase te risk of adverse reactions
adverse drug reaction meaning
unwanted and unintended and undesired effect of a drug at doses normally used in man for therapy
in cases of adverse drug reaction it requires us to
discontinue the drug
modify the dose
hospital adminssion
termporary ot permaney harm, disability to death
adverse drug event meanign
untoward/unexpected medical occurrence of a drug that do not necessarily have a causal relationship with the treatment
ADR vs ADE
adr - type of ADE whose casue can be directly attributed to a drug
adr - occur despite appropriate prescribing and dosing
ade could be due to inappropriate use of the drug(overdose and drug abuse)
ade may be caused by medication error, drug durg interaction
what does TYPE A ADR means?
augmented
- common, dose dependent, predictable, low mortality,
drug examples of Type A ADR
antihypertensive drug: orthostatic hypotension
blood thinner: bleeding
tricyclic antidepressant : dry mouth
anti-diabetic drugs: hypoglycemia
antihistamine: drowsiness
cox-2 selective inhibitors: thromboebolism
what does TYPE B ADR means?
Bizarre
uncommon,
dose independent - as soon as taken may have reactions
unpredictable - not related to pharmacology rxn– related to drug itself
high mortality
unrelated to pharmacological action
hypersensitivity - relate to immune response
idosyncratic - doesn’t require immune response
drug examples for Type B ADR
penicillin, cephalosporin: anaphylaxis
aromatic anticonvulsant phenytoin and carbamazepine: fever , rash , hepatitis
sulfonamide(sulfa) drugs: stevens- johnsons syndrome
angiotensin0 Converting Enzyme(ACE) inhibitors: angioedema
what is type I type B ADR reaction and what is the mechanism
IgE- medicated
Drug-IgE complex binding to mast cells with release of histamine
Clinical Manifestation of Type I Type B ADR
urticaria, angioedema, pruritus, anaphlaxis
what is type II type B ADR reaction and what is the mechanism
cytokine
Ig G or IgM directed at drug hapten coated cells
what is type III type B ADR reaction and what is the mechanism
immune complex
Drug antibody complex deposition with complemttart activation and inflammation
what is type IV type B ADR reaction and what is the mechanism
delayed cells medicated
drugs molecules presentation to T cells with cytokine and mediator release
clinical manifestation of type II Type B ADR
Hemolytic anemia
thrombocytopenia
clinical manifestations of type III Type B ADR
serum sickness
fever
rash
glomerulonephritis
vasculitis
clinical manifestations of type IV Type B ADR
contact dermatisis
rash
stevens-johnsons syndrome
what are the risk factor of drug hypersensitivity
- large molecualr with greater structual complexity are more likely immunogenic
- small molecule drugs forming simple chemical carrier complexes become immunogenic
- route of administration: likeliness to induce hypersensitivity: topical» IM, IV(more serious)» oral
examples of large molecules with greater structure complexity
non human source of antisera
protein(streprokinase, insulin)
carbohydrates(heparin)
examples of small molecules
antibiotics(penicillin, cephalosporin)
anti hypersensitivity(methyldopa)
CVD drugs(procainamide)
what is idiosyncratic ADRs
it is a ADR that is not exactly drug hypersensitivity
- resemels immediate hypersensitivity reaction but are not mediated by allergen Ig E interaction
- occurs when the mast cells, responsible primarily for becoming activated in the allergy and anaphylaxis are activated(eg mas-related G protein coupled reactors X2 has been identified)
- it is also called pseudoallergic or anaphylactoid reaction
name some readtions that are idiosyncratic ADR
opiates(morphin, codeine): flushing, urticarial, redman syndrome
vancomycin: similar to opiates
radiocontrast media: similar to opiates
names other types of idioscncratic ADRs
general anesthetic gas halothane: melignat hyperthermia
anti malarial drug: promaquine: hemolytic anemia in glucose 6 phosphate dehydrogenase deficient patients
what are type c ADRs called
chronic
- related to both dose and time
uncommon
cumulative dose
long time use
what are some examples of Type C ADRS
NSAID: NEPHROTOXICITY
BISPHOSPHONATES: osteonecrosis of the jaw
what are type D ARDs called
delayed
time related ,
uncommon
dose related,
apparent sometimes after use of drugwh
what are some exampels of type D ADRS
cytokine drugs: carcinogenic
tthalidomide, warfarin: teratogenic
what are type E ADRs
End of Dose( eg end of the drug use)
withdrawal syndome
types of Type E ADRs
benzodiazepines(sedative-hypnotic): insomnia, anxiety, perceptual disturbance
carticosteroids: hypothalamus - pituitary adrenal axis insufficiency crisis
list the populations that are greatest risk for ADR
- Pediatrics(newborns, infants and children)
- because new drugs are tested on adults and may need adjustment before given to kids - geriatrics
- v old
decreased renal/hepatic clearance, increased half life of drugs - renal or hepatic impairment
adjuet dosing to prevent ADRS - genetic variation
personlaised drugs and medicine with genotyping services to prevent ADRs: pharmacogenetics
drugs that were withdrawn due to cariovascular events
rofecoxib. and valdecoxib
