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Renal > Adverse Drug Reactions > Flashcards

Adverse Drug Reactions Flashcards

1
Q

what is an adverse drug reaction

A

Adverse drug reaction= any undesirable drug reaction, whether expected, predictable or not that results in a detriment to the wellbeing of the patient in any way- whether symptomatic, detectable or not in the absence of another biologically plausible explanation that can be proven (not same as side effect)

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2
Q

who is more likely to get ADRs

A

elderly/ frail
mutlimorbid (renal/ hepatic clearance)
polypharmacy

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3
Q

what is the theraputic index formula

A

toxic dose 50/ effective dose 50

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4
Q

name 10 drugs will a narrow theraputic window

A 
warfarin 
vancomycin 
lithium 
digoxin 
gentamicin 
phenytoin 
cyclosporin 
carbamazepine 
theophylline 
levothyroxine
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5
Q

what happens in phase 1 of drug metabolism

A

usually through cyp p450
oxidation, reduction and hydrolysis
when must ADRs happen

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6
Q

what happens in phase 2 of drug metabolism

A

coagulation (making it water soluble) so it can be excreted in urine/ bile

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7
Q

what is a type A ADR

A

dose dependent and predictable (higher doses more likely to cause ADRs)

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8
Q

what are the type A drug reaction in drugs used for pre renal failure

A

hypotension and hypovolaemia caused by:

  • duiretics (cause dehydration)
  • ACEi/ ARBs (cause D&V)
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9
Q

what drugs can cause acute interstitial necrosis/ tubular necrosis via type A ADRs

A

gentamicin
sulphonamides (used in RA)
aspirin (for CVD)

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10
Q

what drugs can cause retroperitoneal fibrosis, cyrstaluria, urinary calculi

A

methysergide (used for cluster headaches)

chemotherapy

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11
Q

drug drug interactions:

theophylline and

A

macrolides

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12
Q

drug drug interactions:

statins and

A

macrolides
or
fibrates

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13
Q

drug drug interactions:

tricyclic antidepressants and

A

type 1 anti arrhythmic drugs (ST/ vent repolarisation)

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14
Q

drug drug interactions:

warfarin and

A

lots of drugs

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15
Q

drug drug interactions: what can ACEi increase the hypoglycaemic effects of

A

sulphonylureas

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16
Q

drug drug interactions:

clopidogrel and

A

PPIs

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17
Q

what are the different types of drug interactions

A

drug drug
drug herbal
drug disease
drug food

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18
Q

what can grapefruit interact with

A

inhibits cyp p450 (breaks down simvastatin) so increases simvastatin levels

19
Q 
drug herbal interactions:
ginko biloba (for dementia) 
saw palmetto (for BPH)
A

act as anticoagulant

20
Q 
drug herbal interactions:
saw palmetto (for BPH)
A

act as anticoagulants

21
Q

drug herbal interactions:

glucosamine for OA

A

causes hyperglycaemia and is an anticoagulant

22
Q

drug herbal interactions:

ST johns wort (for depression)

A

reduces the effectiveness of the combined oral contraceptive pill

23
Q

drugs disease interactions:

patients with parkinsons

A

have increased risk of drug induced confusion

24
Q

drugs disease interactions:

NSAIDs/ COX 2/ TSDs

A

can exacerbated CHF as all cause sodium retention

25
Q

drugs disease interactions:

urinary retention in BPH is more likely in patients on…

A

decongestants or anticholingerics

26
Q

what drugs worsen constipation

A

calcium, anticholinergics, CCBs

27
Q

what drugs lower seizure thresholds

A

neuroleptics, tramadol and quinolones

28
Q

what drugs must you NEVER give in patients with poorly controlled epilepsy

A

neuroleptics, tramadol or quinolones

29
Q

drugs disease interactions:

asthma and

A

beta blockers (especially if not specific to beta 1 receptors) can cause bronchoconstriction

30
Q

drug food interactions:

bananas, oranges, green leafy veg

A

all these high in potassium

interact with ACEi. ARBs and K sparing duiretics as these cause hyperkalaemia

31
Q

drug food interactions:

apples, chickpeas, spinach, nuts, kiwi and brocolli

A

high in vit E and vit K

interact with warfarin

32
Q

drug food interactions:

chicken, turkey, milk, soy, cheese and yoghurt

A

alter body’s pH

affect absorption of antibiotics, thyroid meds, digoxin, diuretics

33
Q

drug food interactions:

grapefruit, apple, orange, cranberry

A

have cytochrome p450

interact with statins and antihistamines

34
Q

what are type B ADRs- give 3 examples

A

bizarre effects, dose independent and unpredictable

e.g. drug rashes, bone marrow aplasia (chloramphenicol antibiotic), hetaptic necrosis (halothane)

35
Q

do type B ADRs have a high mortality

A

yes very high

36
Q

what are type C ADRs, give 3 examples

A 
chronic in prolonged treatment 
e.g
steroids= cushing 
beta blockers= diabetes 
NSAIDs= hypertension (fluid retention)
37
Q

what must be done in type A drug reactions

A

dont dismiss patients with strange side effects from drugs that arent expected

38
Q

what should be done in type C ARDs

A

emphasise drug monitoring, must warn patient before starting drug

39
Q

what are type D ADRs give 2 examples

A

delayed- remote form treatment/ often many years after stopping therapy
e.g.
tetratogenc/ carinogenic effects from chemo
isoretinoin (for acne) can cause craniofacial abnormalities in babies

40
Q

what must be done for type D ADRS

A

rigorous pre clinical assessment

41
Q

what is a type E ADR give 3 examples

A

end of treatment - due to abrupt withdrawal, rebound effect
e.g.
beta blockers= angina and rebound tachycardia
steroids= addisonian crisis
anticonvulsants= changes in epilepsy frequency

42
Q

what is a type F ADR

A

failure of theraputic treatment

43
Q

what does the black triangle in the BNF mean

A

new medicine that have new active ingredient so have to be very vigilant to any SE and fill in yellow card report. Black triangle removed when safety established

44
Q

when do you fill in yellow cards

A

when your patient has an unexpected SE even is only suspected that drug is causing it

Renal (27 decks)

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