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Linking structures to Properties ☆ > Adverse drug reactions > Flashcards

Adverse drug reactions Flashcards

1
Q

What is an ADR (5)

A
  1. a drug-related event that is noxious and unintended and occurs at doses used in humans for prophylaxis, diagnosis or therapy of disease or for the modification of physiological function
  2. Overdose, including prescribing and administration errors
  3. Therapeutic failure
  4. Drug interactions
  5. Drug withdrawal
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2
Q

Where do we find information on ADR (2)

A
  1. BNF
  2. EMC
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3
Q

What are the drug factors that predispose to ADRs (7)

A
  1. Chemical characteristics
  2. Chemical similarity
  3. Bioavailability
  4. Drug degradation
  5. Route of administration
  6. Drug dose and duration of treatment
  7. Combination of drug and adjuvants
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4
Q

How can you ensure the safety of medicines (5)

A
  1. right patient
  2. right route
  3. right time
  4. right dose
  5. right drug
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5
Q

What patient factors influence ADRs (5)

A
  1. Age
  2. Sex
  3. Multiple diseases/polypharmacy
  4. Weight
  5. Genetics
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6
Q

What social and disease factors affect ADRs (3)

A
  1. Affects metabolism
  2. e.g. smoking and taking theophylline or beta-blockers
  3. e.g. alcohol and taking paracetamol
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7
Q

What are the PK effects of disease (5)

A
  1. Pharmacogenetic variations: fast and slow acetylators
  2. Hepatic disease: hepatitis or cirrhosis
  3. Renal disease: accumulation and toxicity
  4. Cardiac disease: oedema - reduced liver blood flow
  5. Thyroid disease: thyroid hormone regulates metabolism by CYP450
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8
Q

What are the PD effects of disease (6)

A
  1. Hepatic disease:
    1. reduced blood clotting
    2. Hepatic encephalopathy - sensitivity to sedatives
    3. Sodium and water retention
  2. Altered fluid & electrolyte balance:
    1. Cardiac glycosides potentiated in hypokalaemia and hypercalcaemia.
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9
Q

What are the classifications of ADRs (4)

A
  1. Onset of event
  2. Type of reaction
  3. Severity
  4. Other
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10
Q

What are the subcategories of the onset of event classification of ADRs (3)

A
  1. Acute
  2. Sub-acute
  3. Latent
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11
Q

What are the subcategories of the type of reaction classification of ADRs (5)

A
  1. A - augmented
  2. B - bizzare
  3. C - chronic
  4. D - delayed
  5. E - end-of-use
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12
Q

What are the subcategories of the severity classification of ADRs (4)

A
  1. Minor
  2. Moderate
  3. Severe
  4. Lethal
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13
Q

What are the subcategories of the other classification of ADRs (6)

A
  1. SE
  2. Toxicity
  3. Intolerance
  4. Drug allergy
  5. Drug withdrawal/dependence
  6. iatrogenic-drug induced disease
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14
Q

What are Type A ADRs (8)

A
  1. Augmented
  2. Occur early in treatment.
  3. Common- result of PK / PD abnormality
  4. Response to therapy is exaggerated but otherwise normal pharmacological action, e.g. beta-blockers- bradycardia,
  5. An example of type A ADR unrelated to therapeutic effects ototoxicity in patients treated with aminoglycoside antibiotics
  6. Predictable
  7. Dose-dependent so alleviated by
  8. Relatively low risk
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15
Q

What are Type B ADRs (5)

A
  1. Bizzare
  2. Not based on the known action of a drug.
  3. Unpredictable, e.g. allergic reactions
  4. Inherited abnormalities (genes) and immunological response
  5. High mortality, e.g. anaphylaxis following penicillin
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16
Q

What is the immunological response to Type B ADRs (6)

A
  1. Delay between first exposure & ADR
  2. No dose-response relationship
  3. The reaction goes when treatment is stopped.
  4. The patient may present with a rash, asthma-like symptoms…
  5. Drugs: penicillins, sulphonamides, protein-based drugs
  6. Viral disease-associated response
17
Q

What are the mechanisms of Type B ADRs (4)

A
  1. Anaphylaxis: immediate hypersensitivity: IgE
  2. Cytotoxicity: cell destruction: IgG IgM
  3. Immune complexes: damaged capillary endothelium
  4. Delayed hypersensitivity: antigen-specific receptors develop on T-lymphocytes
18
Q

What are Type C ADRs (4)

A
  1. Chronic
  2. Due to long-term exposure
  3. This can be due to the accumulation.
  4. Persist once the drug has been stopped, e.g. bisphosphonate-induced osteonecrosis of the jaw.
19
Q

What are Type D ADRs (5)

A
  1. Delayed
  2. It may be dose-dependent
  3. Become apparent some time after the drug has been used.
  4. This can be due to the accumulation.
  5. e.g. thalidomide teratogenicity
20
Q

What are Type E ADRs (4)

A
  1. End-of-use
  2. Occur as a result of drug being stopped.
  3. It might include withdrawal effects by stopping benzodiazepines/ opioids.
  4. Reflex hyperacidity stops PPIs
21
Q

What are pseudo-allergenic reactions (5)

A
  1. Occur on first contact with drug
  2. Allergic reaction mimicked without the same immunological mechanisms occurring
  3. Histamine released from mast cells
  4. Genetic & environmental factors
  5. Itching, bronchospasm, vasodilation
22
Q

What is a common pharmaceutical predictable ADR (3)

A
  1. Example = phenytoin
  2. Toxicity = Phenytoin toxicity (Ataxia, nystagmus etc)
  3. Mechanism = Increase in bioavailability as a result of a change in formulation
23
Q

What is a common pharmacokinetic predictable ADR (3)

A
  1. Example = Digoxin
  2. Toxicity = Digoxin toxicity (Nausea, arrhythmias etc)
  3. Mechanism = Decreased elimination if renal function impaired
24
Q

What is a common pharmacodynamic predictable ADR (3)

A
  1. Example = Indomethacin
  2. Toxicity = Left ventricular failure
  3. Mechanism = Water & sodium retention
25
Q

What is a common genetically predictable ADR (3)

A
  1. Example = Nortriptyline
  2. Toxicity = Confusion
  3. Mechanism = Reduced hepatic elimination as a result of deficiency of CYP2D6
26
Q

What is a common drug-drug interaction predictable ADR (3)

A
  1. Example = Lithium + NSAIDs
  2. Toxicity = Lithium toxicity
  3. Mechanism = Inhibition of excretion of lithium
27
Q

When do you report ADRs (4)

A
  1. Serious reaction
  2. Black triangle drug
  3. The patient is a child.
  4. Unsure whether to report

Linking structures to Properties ☆ (22 decks)

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