Adverse drug reactions Flashcards
Which analgesic can have severe side effects? what is the side effect?
Analgesics: Among the OTC and prescription analgesics used in children, ibuprofen (MOTRIN, ADVIL) produced unexpectedly large numbers of cases of the most severe hypersensitivity and skin reactions, notably Stevens-Johnson syndrome and toxic epidermal necrolysis. ***These skin reactions were seldom reported for acetaminophen and naproxen.
Which asthma medication can have serious side effects in children? What are the Side effects?
Asthma medications: Although approximately 10% of children are treated for asthma, only montelukast (SINGULAIR) produced a high number of serious adverse event reports – predominantly of psychiatric side effects including suicidal behaviors, aggression, and depression.
Which class of Diabetic medications has 20 x incidence of pancreatitis? (which could be risk factor for later development of pancreatic CA)
We observed a marked signal for reported pancreatitis in all five GLP-1 agents compared to cases reported for the other diabetes drug controls. After adjusting for differences in report characteristics, the reporting odds ratio for the two injectable agents was 28.5 (95% CI 17.4-46.4) and for the three oral agents
*
was 20.8 (95% CI 12.6-34.5
What group of patients are subject to aluminum toxicity and why?
Chronic dialysis patients:
-municipal water supplies can have high aluminum
concentrations which find their way into dialysate
fluids
-aluminum containing phosphate binders are often
given
Which medications can cause aluminum toxicity?
- aluminum containing antacids
- sucrafate
What are the manifestations of chronic aluminum toxicity?
Chronic toxicity
Manifestations of chronic aluminum toxicity result from exposure to low concentrations over a period of years. Chronic manifestations include bone and muscle pain, proximal muscle weakness, osteomalacia, iron-resistant microcytic anemia, hypercalcemia, and slowly progressive dementia [11,12].
Certain antimicrobial drugs interact with sulfonylureas to increase the risk of hypoglycemia. Which ones?
The researchers found that clarithromycin carried the highest risk, with an odds ratio (OR) of 3.96, followed by levofloxacin (OR 2.60), sulfamethoxazole-trimethoprim (OR 2.56), metronidazole (2.11), and ciprofloxacin (1.62). The lowest number needed to harm was 71 with clarithromycin, and the highest was 337 for ciprofloxacin.
If a patient( particularly an older patient ) needs an antibiotic, but is on an ACE or an ARB, which antibiotic should be avoided and why?
Bactrim(TMP/SMX): Trimethoprim/Sulfamethoxazole Is Associated with Sudden Death in Patients Who Take Renin-Angiotensin Inhibitors»From hyperkalemia. Trimethoprim/sulfamethoxazole (TMP/SMX) also is associated with hyperkalemia, via trimethoprim-induced reduction in potassium excretion in the distal renal tubule.
From 1994 to 2012, 1.6 million older patients (age, ≥65) in Ontario were treated with ACE inhibitors or ARBs; 1110 and 1827 of these patients died suddenly within 7 or 14 days, respectively, after receiving outpatient prescriptions for one of five common antibiotics.
In older patients taking ACE inhibitors and ARBs, TMP/SMX use was associated with *37% excess risk for sudden death — presumably from trimethoprim-induced hyperkalemia. The authors estimate that the risk corresponds to approximately 3 sudden deaths with TMP/SMX versus 1 sudden death with amoxicillin per 1000 prescriptions. This finding is not trivial, given the large number of patients receiving ACE inhibitors and ARBs and how often TMP/SMX is prescribed. -
**Similar risk with combining TMP/SMX with Spironolactone.
What precautions should you take before prescribing a Quinolone? and why?
Which Quinolone is least likely to cause this?
Check to see if on a med that can cause QT prolongation. Also use caution in elderly and in those with Hx of bradycardia etc. Because Quinolones can prolong QT and induce Torsades de Pointes.
Cipro is much less likely to do this than the other Quinolones. **For non-respiratory indications use Cipro
For respiratory indications use Levafloxacin with caution in patients with risk factors for QT prolongation. Avoid Gatifloxacin in these patients.
> What are symptoms of Serotonin Syndrome>
> What is the typical clinical scenario for SS?
Serotonin syndrome encompasses a spectrum of disease where the intensity of clinical findings is thought to reflect the degree of serotonergic activity. Mental status changes can include anxiety, agitated delirium, restlessness, and disorientation [13]. Patients may startle easily. Autonomic manifestations can include diaphoresis, tachycardia, hyperthermia, hypertension, vomiting, and diarrhea [3]. Neuromuscular hyperactivity can manifest as tremor, muscle rigidity, myoclonus, hyperreflexia, and bilateral Babinski sign. Hyperreflexia and clonus are particularly common; these findings, as well as rigidity, are more often pronounced in the lower extremities
> Usually abrupt onset shortly after starting or increasing the dose of an SSRI type med. **OR when adding another SSRI type med to an initial SSRI med.
Regards TdP and QTc prolongation: who needs an ECG?
And what are the risk factors?
If an ECG is indicated, when should it be done?
Prolonged QTc by itself may not lead to torsades very often, or ever, in some people. The risk of TdP starts to grow when long QT is combined with other risk factors:
>bradycardia, especially with occasional “premature beats”
> CHF
>congenital QT prolongation
> ^K+ or low Mg
> on other drugs causing ^QT
>elderly
>family hx of sudden death, blackouts, long QT syndrome
>menstruating female (higher risk than male)
>anyone who has had an episode of (otherwise unexplained) cardiac arrest, blackouts or fainting, seizures
>*anyone complaining of episodes of (otherwise unexplained) lightheadedness, dizziness, palpitations or transient breathlessness
>anyone with a slow pulse (say, less than 50)
>any one on diuretics who might have low K or Mg
>anyone under STIMULANT conditions”stimulant” conditions such as *exercise, *emotion, or use of drugs like dopamine, epinephrine or even *albuterol.
If you’re starting a patient on a new drug known to be able to prolong the QT, and if the patient has any of the above risk factors, or if the drug in question is one of the very potent QT-prolonging drugs such as quinidine, procainamide, dofetilide, sotalol, or amiodarone, then you may wish to obtain an on-drug ECG a day or two later.
Which Drugs Can Cause Ototoxicity?
- Vancomycin parenteral
- Loop diuretics (mostly I.V.)
- Oral Antifungals: griseofulvin, itraconazole, terbinafine
- Viagra and similar: can be sudden and irreversible
- Uloric(febuxostat)
- ASA and NSAIDS
How serious if the problem of NSAID related gastrointestinal side effects and what are the statistics?
In the United States over 16,000 patients die each year due to NSAID-related gastrointestinal side-effects and a further 100,000 patients end up in hospital. That equates to nearly 50 NSAID-related deaths and 300 hospitalizations per day - this is a situation of epidemic proportion!!
What medication when added to Prandin(Repaglinide) can cause Prandin levels to elevate 5 X normal and cause severe hypoglycemia?
Plavix (clopidogrel)
