Adverse Drug Reactions

Question 1

What are adverse drug reactions?

Answer 1

Adverse effects in normal conditions of use, but also from uses outside of marketing authorisation including misuse and abuse, medication error, overdose and occupational exposure

Question 2

Important adverse drug reactions

Answer 2

1. Erythema multiforme - can lead to TEN (toxic epidermal necrolysis)
2. Drug-induced lupus
3. Torsades de Pointes (supraventricular tachycardia)
4. Gingival Hyperplasia

Question 3

Type A adverse drug reactions

Answer 3

Augmented reactions - dose dependent and predictable based on the pharmacology of the drug

Question 4

Type B adverse drug reactions

Answer 4

Bizzare - idiosyncratic and not predictable on the basis of the pharmacology

Question 5

Describing an adverse drug reaction

Answer 5

DoTS

1. Dose
2. Time course of the reaction
3. Relevant susceptibility factors

Question 6

Was it definitely the drug that caused the adverse reaction?

Answer 6

1. Challenge - at/after treatment started?
2. Dechallenge - stopped when treatment stopped?
3. Rechallenge - began again on restarting drug?
4. No alternative causes for the reacton

Question 7

How would you treat the following ADR’s?

1. ACE inhibitor –> angioedema
2. Dabigatrin (thrombin inhibitor) –> bleeding
3. LA toxicity

Answer 7

1. Icatibant - selective bradykinin B2 receptor antagonist - resolves angiodema
2. Idarucizumab - prevents patient bleeding out
3. IV lipid emulsion