Adverse drug reactions Flashcards
What does the Adverse Drug Reactions (ADR) section of the Prescribing Safety Assessment (PSA) assess?
Ability to recognize common drug side effects, manage adverse reactions safely, identify high-risk drugs and their monitoring requirements
What are the types of Adverse Drug Reactions?
- Type A (Augmented)
- Type B (Bizarre)
- Type C (Chronic)
- Type D (Delayed)
- Type E (End of use)
Describe Type A (Augmented) ADR.
Predictable and dose-dependent
Provide an example of Type A (Augmented) ADR.
- Hypotension with beta-blockers
- Hypoglycaemia with insulin
Describe Type B (Bizarre) ADR.
Unpredictable and not dose-dependent
Provide an example of Type B (Bizarre) ADR.
- Anaphylaxis with penicillin
- SJS with carbamazepine
Describe Type C (Chronic) ADR.
Occurs with long-term use
Provide an example of Type C (Chronic) ADR.
- Osteoporosis with steroids
- Tardive dyskinesia with antipsychotics
Describe Type D (Delayed) ADR.
Occurs after drug discontinuation
Provide an example of Type D (Delayed) ADR.
Carcinogenesis with chemotherapy
Describe Type E (End of use) ADR.
Withdrawal reactions
Provide an example of Type E (End of use) ADR.
- Seizures after stopping benzodiazepines
- Adrenal insufficiency after stopping steroids
What are common cardiovascular ADRs?
- Bradycardia
- Hypotension
- Hypertension
- QT prolongation → Torsades de Pointes
What drugs can cause bradycardia?
Beta-blockers, digoxin
What drugs can cause hypotension?
ACE inhibitors, diuretics
What drugs can cause QT prolongation leading to Torsades de Pointes?
- Antipsychotics
- Macrolides (e.g., clarithromycin)
- SSRIs
- Antiarrhythmics
What are common endocrine & metabolic ADRs?
- Hypoglycaemia
- Hyperglycaemia
- Hyperkalaemia
- Hypokalaemia
- Hyponatraemia
What drugs can cause hyperglycaemia?
Steroids, antipsychotics
What are common gastrointestinal ADRs?
- Peptic ulcers
- Diarrhoea
- Constipation
What drugs can cause peptic ulcers?
NSAIDs, steroids
What are common neurological ADRs?
- Seizures
- Drowsiness
- Parkinsonism
- Peripheral neuropathy
What drugs can cause seizures?
- Tramadol
- Bupropion
- Quinolones (e.g., ciprofloxacin)
What are common respiratory ADRs?
- Bronchospasm
- Pulmonary fibrosis
What drugs can cause bronchospasm?
Beta-blockers (especially in asthma)
What are common renal & hepatic ADRs?
- Acute kidney injury (AKI)
- Hepatotoxicity
What drugs can cause acute kidney injury (AKI)?
- NSAIDs
- ACE inhibitors
- Aminoglycosides (e.g., gentamicin)
What are common haematological ADRs?
- Aplastic anaemia
- Agranulocytosis
- Thrombocytopenia
What drugs can cause agranulocytosis?
- Clozapine
- Carbimazole
What are the steps in managing ADRs?
- Stop the drug (if safe to do so)
- Give supportive treatment
- Use antidotes when available
What is the antidote for paracetamol overdose?
N-acetylcysteine (NAC)
What is the monitoring requirement for Lithium?
Lithium levels, U&Es, TFTs every 3 months
What is the monitoring requirement for Methotrexate?
FBC, LFTs every 2 weeks for 6 weeks, then every 3 months
True or False: Beta-blockers can trigger asthma.
True
Fill in the blank: If a patient presents with new symptoms, check their __________ first.
medication list
What should be done if LFTs worsen after starting a statin?
Check ALT and consider stopping if >3x normal
