Adverse drug reactions

Question 1

What is an adverse drug reaction?

Answer 1

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

Question 2

Describe digoxin toxicity

Answer 2

Sickness
Vomiting 
Confusion 
Green/ yellow vision 
Slow pulse
Sweats
Convulsion

Question 3

What drugs have a narrow therapeutic index?

Answer 3

Theophylline
Warfarin
Lithium
Gentamicin 
Vancomycin
Phenytoin
Cyclosporin 
Carbamazepine 
Levothyroxine

Question 4

What is phase one of drug metabolism?

Answer 4

Phase 1: cyp P450

Oxidation, reduction and hydrolysis

Question 5

What is phase 2 of drug metabolism?

Answer 5

Conjugation (water soluble)

Enables excretion in urine and bile

Question 6

What drugs can precipitate pre-renal failure AKI?

Answer 6

Diuretics in heart failure: causes dehydration

ACEi/ ARB - if continued in diarrhoea and vomiting can precipitate

Question 7

What drugs can precipitate renal AKI?

Answer 7

Gentamicin - used in sepsis
Sulphonamides - RA
Aspirin - CV disease

Question 8

What drugs can precipitate post-renal AKI?

Answer 8

Methysergide - cluster headaches

Chemotherapy - purine release, can cause urinary stones

Question 9

What are common drug-drug reactions?

Answer 9

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

Question 10

What are some common drug - OCT reactions?

Answer 10

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

Question 11

What are people with parkinsons at an increased risk of?

Answer 11

Drug induced confusion

Question 12

What can NSAIDs/ COX-2 and TZDs exacerbate?

Answer 12

CHF

Question 13

What can decongestants/ anticholinergics induce in those with BPH?

Answer 13

Acute urinary retention

Question 14

What can worsen constipation?

Answer 14

Calcium
Anticholinergics
CCBs

Question 15

What drugs can worsen asthma?

Answer 15

Beta blockers

Question 16

What foods can interact with ACEi, ARBs and potassium sparing diuretics?

Answer 16

Bananas
Oranges
Green leafy veg

Question 17

What drug interacts with food such as apples, chickpeas, spinach, nuts, kiwi and broccoli?

Answer 17

Warfarin

Question 18

What are common type B drug reactions?

Answer 18

Drug rashes
Bone marrow aplasia - chloramphenicol
Hepatic necrosis - halothane

Question 19

What type C reaction is associated with steroid therapy?

Answer 19

Cushing’s syndrome

Osteoporosis

Question 20

What type C reaction is associated with beta blockers?

Answer 20

Diabetes

Question 21

What type C reaction is associated with NSAIDs?

Answer 21

Hypertension (fluid retention)

Question 22

What is a type D reaction?

Answer 22

Teratogenic

Carcinogenic

Question 23

What is an example of a type E reaction associated with beta blockers?

Answer 23

Tachycardia

Angina

Question 24

What is an example of a type E reaction associated with steroids?

Answer 24

Addisonian crisis

Question 25

What is an example of a type E reaction associated with anticonvulsants?

Answer 25

Changes in epilepsy frequency