Adverse drug reactions Flashcards
What is an adverse drug reaction?
Any undesirable reaction, whether expected, predicted 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
Describe digoxin toxicity
Sickness Vomiting Confusion Green/ yellow vision Slow pulse Sweats Convulsion
What drugs have a narrow therapeutic index?
Theophylline Warfarin Lithium Gentamicin Vancomycin Phenytoin Cyclosporin Carbamazepine Levothyroxine
What is phase one of drug metabolism?
Phase 1: cyp P450
Oxidation, reduction and hydrolysis
What is phase 2 of drug metabolism?
Conjugation (water soluble)
Enables excretion in urine and bile
What drugs can precipitate pre-renal failure AKI?
Diuretics in heart failure: causes dehydration
ACEi/ ARB - if continued in diarrhoea and vomiting can precipitate
What drugs can precipitate renal AKI?
Gentamicin - used in sepsis
Sulphonamides - RA
Aspirin - CV disease
What drugs can precipitate post-renal AKI?
Methysergide - cluster headaches
Chemotherapy - purine release, can cause urinary stones
What are common drug-drug reactions?
Theophylline and macrolides Statins, macrolides TCAs and type 1 antiarrhythmics Warfarin and multiple drugs ACEi can increase the hypoglycemic effects of sulphonylurea Clopidogrel and PPI
What are some common drug - OCT reactions?
Grapefruit juice inhibits cyp P450, to increase the conc of simvastatin
Gingko bilboa increaes anticoags
Saw palmetto increases anticoags
Glucosamine - can induce hyperglycaemia, anticoag
St johns wort can reduce the effectivness of OCP
What are people with parkinsons at an increased risk of?
Drug induced confusion
What can NSAIDs/ COX-2 and TZDs exacerbate?
CHF
What can decongestants/ anticholinergics induce in those with BPH?
Acute urinary retention
What can worsen constipation?
Calcium
Anticholinergics
CCBs
What drugs can worsen asthma?
Beta blockers
What foods can interact with ACEi, ARBs and potassium sparing diuretics?
Bananas
Oranges
Green leafy veg
What drug interacts with food such as apples, chickpeas, spinach, nuts, kiwi and broccoli?
Warfarin
What are common type B drug reactions?
Drug rashes
Bone marrow aplasia - chloramphenicol
Hepatic necrosis - halothane
What type C reaction is associated with steroid therapy?
Cushing’s syndrome
Osteoporosis
What type C reaction is associated with beta blockers?
Diabetes
What type C reaction is associated with NSAIDs?
Hypertension (fluid retention)
What is a type D reaction?
Teratogenic
Carcinogenic
What is an example of a type E reaction associated with beta blockers?
Tachycardia
Angina
What is an example of a type E reaction associated with steroids?
Addisonian crisis
What is an example of a type E reaction associated with anticonvulsants?
Changes in epilepsy frequency
