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RENAL > Adverse Drug Reactions > Flashcards

Adverse Drug Reactions Flashcards

1
Q

What is meant by an adverse drug reaction

A

an undesirable effect causing detriment to the patient

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2
Q

What is the difference between a side effect of a drug and an adverse effect?

A

Side effects are a sub-type of ADR

They are related to the pharmacological properties of the drug

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3
Q

Give examples of drugs which were previously used but could cause well known adverse drug effects?

A

Arsenic - used for syphilis - causes jaundice

Chloroform - used as anaesthetic - causes arrythmias

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4
Q

Why are patients with hepatic and renal failure more at risk of adverse drug reactions?

A

They are unable to excrete medicines effectively from the body
=> they have higher concentrations of drug left in their body
=> More likely to suffer ADR due to toxicity

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5
Q

Why does polypharmacy increase the risk of an adverse drug reaction?

A

Patients can be on multiple different drugs (e.g. 12-13) which makes it very difficult to assess the risk of interactions between all of them

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6
Q

What drugs have a narrow therapeutic index?

A 
Theophylline
Warfarin 
Lithium
Digoxin
Gentamicin
Vancomycin
Phenytoin
Cyclosporin
Carbamazepine
Levothyroxine
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7
Q

What is considered a Narrow Therapeutic Index

A

<2

=> it is easy to reach a toxic dose

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8
Q

Why are ADRs often not identified in clinical trials?

A
  • Limited sample size
  • They present later than the clinical trial runs
  • ADRs often present in the elderly/frail pts who are excluded from clinical trials
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9
Q

When are rarer ADRs identified and why?

A
  • During post-marketing surveillance
  • Most data is available at this point
  • Drugs need tested on a LARGE number of patients to identify rare ADRs
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10
Q

Describe the two phases of drug metabolism

A

Phase 1 - Cyp450 breaks drug down in liver via Oxidation/Reduction/Hydrolysis

Phase 2 - Converts drug to water soluble to allow excretion in urine and bowel

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11
Q

Describe the different categories of ADR

A 
Type A - Predictable and dose dependent
Type B - Bizarre and dose independent
Type C - Chronic Effects
Type D - Delayed Effects
Type E - End of Tx Effect
Type F - Failure of Tx
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12
Q

What predictable ADRs can be caused by a Type A reaction?

A

Pre-renal AKI due to hypotension/hypovolaemia
Renal AKI - AIN/Tubular Necrosis
Post-renal AKI - fibrosis, calculi

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13
Q

What drugs can cause a hypotension/hypovolaemia that can lead to a pre-renal AKI?

A
  • Large diuretic dose

- Taking ACEi/ARBs during sick days of diarrhoea and vomiting

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14
Q

What drugs can cause a renal AKI and how?

A

Gentamicin in SEPSIS

  • causes lysosomes to enlarge and burst
  • Mitochondria swell
  • Destroy apical brush border
  • Induces apoptosis
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15
Q

What drugs can cause a post-renal AKI?

A

Methylsergide (for cluster headaches) causes retroperitoneal fibrosis

Chemotherapy releases purine into system => predisposes to renal/urinary stones

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16
Q

What are the 3 possible Type A reactions?

A

Drug-Drug Interactions
Drug-Disease Interactions
Drug-Food Interactions

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17
Q

What class of antibiotics interact with Theophylline and why?

A

Macrolides - they inhibit Cyp450 which breaks down Theophylline

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18
Q

When is it important to be aware of theophylline and macrolide antibiotics interacting?

A

If an asthmatic or COPD patient develops pneumonia

- macrolides are used if pt is penicillin allergic

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19
Q

What drug-drug interaction occurs between ACEi and sulphonylureas?

A

ACEi increase the ability of suplhonylureas to cause HYPOglycaemia
(especially at high dose)

20
Q

With which drug class does clopidogrel experience a well known drug-drug interaction?

A

PPIs

21
Q

What drug-disease interaction is thought to occur in Parkinson’s disease?

A

Increased drug induced confusion

22
Q

What can be done in order to help drug induced confusion in parkinson’s disease?

A

Start drugs at low concentrations if they are lipid soluble as this releases less into the CNS

23
Q

Why should NSAIDs, COX2 inhibitors and TZDs be avoided in heart failure?

A

They cause Na retention (increases preload)

24
Q

Patients with what condition should NOT be given Beta-blockers?

A

Asthma

25
Q

What drugs are known to cause a drug-disease interaction in epilepsy by lowering the seizure threshold?

A

Tramadol

Quinolones

26
Q

Why is it important to watch K+ intake in food?

A

Pts can become hyperkalaemic if they are on drugs which retain K+
e.g potassium sparing diuretics

27
Q

What foods are high in Vitamin K and therefore cause a drug-food interaction with warfarin?

A

Apples, Nuts, Chickpeas, Spinach

28
Q

What foods can alter the pH of the stomach and what drugs does this affect?

A

Chicken, Turkey, Milk, Cheese, Yoghurt
=> makes stomach less acidic
=> antibiotics need acidic environment of stomach to act fully

29
Q

What fruits are involved in inhibiting Cyp450 and therefore preventing the breakdown of drugs such as statins or antihistamines?

A

Grapefruit, oranges, apples, cranberries

30
Q

Why are Type B drug reactions so important?

A
  • They are completely unpredictable and ADRs cant be controlled
  • Can result in death of patients
  • Drug can be removed from market if reactions are so severe
31
Q

Give examples of Type B drug reactions which are completely unrelated to the drug metabolism.

A

Drug rashes
Bone Marrow aplasia (chloramphenicol)
Hepatic necrosis (halothane - general anaesthetic)

32
Q

What is a Type C chronic drug reaction?

A

Prolongued therapy of a drug causes a long term effect

33
Q

Give examples of Type C drug reactions which can occur from steroids?

A

Cushing’s

Osteoporosis

34
Q

What Type C reaction occurs due to use of NSAIDs?

A

Fluid retention

=> hypertension

35
Q

Should we tell patients about chronic drug reactions when they begin a drug?

A

Yes
We should tell them about the common chronic side effects to make them aware
This allows us to remind them that we will follow them up

36
Q

What is a Type D drug reaction?

A

appears many years after stopping a drug

37
Q

Give an example of a Type D drug reaction?

A

Chemotherapy in teenage leukaemia is often teratogenic/carcinogenic

=> predisposes to secondary malignancy later in life

38
Q

What is a Type E drug reaction?

A

Occurs when a drug is suddenly stopped in a patient

=> produces a rebound effect

39
Q

What Type E drug reaction occurs when a Beta Blocker is stopped?

A

Rebound tachycardia

=> predisposing to angina

40
Q

Steroid withdrawal can cause what Type E drug reaction?

A

Addisonian crisis

- high dose steroids should be tapered down to avoid adrenals giving up

41
Q

How are ADRs reported?

A

Yellow card system

42
Q

Give examples of drugs which interact with HLA genes?

A

Abacavir interacts with HLA-B5701

Allopurinol interacts with HLA-B5801
- produces Steven-Johnson syndrome (rash)

43
Q

What genetic mutation predisposes to an abnormally fast metabolism which affects how drugs are absorbed into the body?

A

CYP2D6

=> larger doses are required for clinical effects in these pts

44
Q

What does a black triangle in the BNF mean?

A
  • New drug with new active ingredient

- Indicates something has been identified during clinical trials that could be a potential rare side effect

45
Q

How long does a black triangle remain in the BNF?

A

2 years (unless a potential side effect is identified - then it may remain in longer)

RENAL (24 decks)

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