Adverse drug reactions

Question 1

Type A

Answer 1

Augmented pharmacological effects

-dose dependent and predictable

Question 2

Type B

Answer 2

Bizarre effects - dose independent and unpredictable

Question 3

Type C

Answer 3

Chronic effects

Question 4

Type D

Answer 4

Delayed effects

Question 5

Type E

Answer 5

End of treatment effects

Question 6

Type F

Answer 6

Failure of therapy

Question 7

Type A diuretic effect

Answer 7

Pre-renal failure, hypotension, hypovolemia

Question 8

Type A ACEi/ARB effect?

Answer 8

Pre-renal failure, hypotension, hypovolemia

Question 9

Type A gentamicin effect

Answer 9

Renal - ATN

Question 10

Type A sulphonamide effect

Answer 10

Renal - ATN

Question 11

Type A aspirin effect

Answer 11

Renal - ATN

Question 12

Type A side effect of methysergide and chemotherapy

Answer 12

Post renal - retroperitoneal fibrosis, crystaluria, urinary calculi

Question 13

What is methysergide used to treat?

Answer 13

Cluster headaches

Question 14

Examples of type B drug effects?

Answer 14

1) Drug rashes
2) Bone marrow aplasia –Chloramphenicol antibiotic
3) Hepatic necrosis - halothane

Question 15

Side effect of chloramphenicol (type B)

Answer 15

Bone marrow aplasia

Question 16

Side effect of halothane

Answer 16

Hepatic necrosis

Question 17

Type B reactions and mortality

Answer 17

High mortality

Question 18

Type C effect of steroid therapy

Answer 18

Cushings

Question 19

Type C effect of beta blockers

Answer 19

Diabetes

Question 20

Type C effect of NSAIDs

Answer 20

Hypertension

Question 21

Type C reactions emphasise the need for what?

Answer 21

Drug monitoring

-these effects can be anticipated but the patient MUST be warned before starting therapy!

Question 22

Examples of Type D reactions

Answer 22

Secondary malignancies post chemotherapy

Craniofacial abnormalities in children of women taking isotretinoin

Question 23

Delayed side effect of isotretinoin?

Answer 23

Craniofacial abnormalities in children of mothers taking isotretinoin

Question 24

Type E Beta blocker effect

Answer 24

Angina following rapid withdrawal

• abrupt withdrawal
• rebound effects

Question 25

Type E Steroid effect

Answer 25

Steroid withdrawal and Addisonian crisis -loss of physiological "coping"

Question 26

Type E effect of Anticonvulsant withdrawal

Answer 26

Changes in epilepsy frequency -mechanism dependent biological activity

Question 27

Theophylline reacts with...

Answer 27

Macrolide abx

Question 28

Statins react with...

Answer 28

Statins and macrolides | Statins and fibrates

Question 29

TCAs react with

Answer 29

Type 1 anti-arrythmics

Question 30

ACEi and sulfonylureas

Answer 30

ACEis increase hypoglycemic effect of sulfonylureas

Question 31

Clopidogrel reacts with...

Answer 31

PPIs

Question 32

Grapfruite juice inhibits which enzyme

Answer 32

Cyp P450

Question 33

Ginko biloba (used to treat dementia) reacts with which type of drug?

Answer 33

Anti-coagulant

Question 34

Saw palmetto is used for BPH, it may react with which type of drug?

Answer 34

Anticoagulant

Question 35

Glucosamine is used for OA, it may react with which type of drug

Answer 35

Anticoagulant | ?hyperglycemia

Question 36

St John's wort is used for depression, which drug may it interact with?

Answer 36

The pill

Question 37

Patients with which disease have an increased risk of drug induced confusion?

Answer 37

Parkinsons

Question 38

Which drugs can exacerbate CHF?

Answer 38

NSAIDs/COX-2/TZDs

Question 39

Urinary retention in BPH patients can be caused by which type of drug?

Answer 39

Anti-cholinergics

Question 40

Constipation is worsened by which drugs?

Answer 40

Calcium, anti-cholinergics, CCBs

Question 41

Which drugs lower seizure thresholds?

Answer 41

Neuroleptics, tramadol and quinolones

Question 42

Bananas,oranges, green leafy vegetables (K+-rich) interact with

Answer 42

ACEis, ARBs, K-sparing diuretics

Question 43

Apples, chickpeas, spinach, nuts, spinach, kiwi, broccoli | Vitamin E & K

Answer 43

Warfarin

Question 44

Chicken, turkey, milk, soy,cheese, yogurt (alter PH) – Interacts with:

Answer 44

Antibiotics, thyroid meds | Digoxin, diuretics

Question 45

Grapefruit, Apple, Orange, & Cranberry (Cytochrome P450) interact with

Answer 45

Statins, anti-histamines

Question 46

Yellow card scheme?

Answer 46

Yellow card with suspected drug reactions etc

Question 47

Drug-drug interactions, which part of the BNF would you use to check?

Answer 47

Appendix 1