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Adverse Drug reactions Flashcards

1
Q

Define adverse drug reactions

A

Any response to a drug which is noxious, unintended and occurs at doses used in man for prophylaxis, diagnosis or treatment.

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2
Q

How frequent are adverse reactions and consequences ?

A
  • 4th leading cause of death
  • 60% of ADRs are preventable
  • primary care ADRs leads to hospital admission
  • secondary care ADRs lead to longer hospital stay
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3
Q

What causes avoidable ADRs and what is their frequency?

A
  • non-steroidal drugs
  • anti-inflammatory drugs
  • anti coagulants
  • antiplatelets

-they cause a third of admissions

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4
Q

What are the top 5 contributors to adverse drug reactions?

A
  • surgery
  • medication errors
  • medical errors (nonsurgical)
  • patient falls
  • nosocomial infections
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5
Q

What is the classification of onset of adverse drug reactions?

A
  • Acute
  • Sub acute
  • Latent
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6
Q

In what cases are ADRs not preventable?

A

nausea in chemo treatment for cancer

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7
Q

What is the classification of acute ADRs?

A
  • occurs within 60 minutes

- bronchoconsitrction

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8
Q

What is the classification of sub-acute ADRs?

A
  • 1-24 hours

- rash, serum sickness

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9
Q

What is the classification of latent ADRs?

A
  • 2 days

- excematous eruptions

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10
Q

Classification of severity of ADRs?

A

-Mild
-Moderate
Severe

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11
Q

Classification of mild ADRs?

A
  • Bothers some but requires no change in therapy

- Metallic taste with metronidazole

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12
Q

Classification of moderate ADRs?

A
  • Requires change in therapy, additional treatment or hospitalization
  • Diuretic induced hypokalemia
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13
Q

Classification of severe ADRs?

A
  • Disabling or life-threatening

- Kidney failure

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14
Q

How do we classify the different types of ADRs?

A 
Type A- Augmented 
Type B- Bizarre
-	Idiosyncratic and unpredictable 
Type C-Chronic
Type D- Delayed
Type E- End of treatment
Type F- Failure of treatment
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15
Q

What are predisposing factors for ADRs?

A
  • multiple drug therapy
  • inter-current disease (renal and hepatic impairment)
  • race and genetic polymorphisms
  • age (elderly and neonates)
  • sex
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16
Q

What gender is ADRs most common in and why?

A

Women due to different liver functions and pharmacokinetics

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17
Q

Describe Type A ADRs

A
  • Augmented response to the pharmacological actions of a drug
  • Dose dependent
  • Entirely Predictable
  • not usually life threatening
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18
Q

What are the 2 types of ADRs?

A

o Augmentation of the primary effect

o Secondary effect

19
Q

Examples of Type A ADRs.

A
  • Due to excess pharmacological action
    o Bradycardia with beta-blockers
    o Hypoglycaemia with sulphonylureas or insulin
20
Q

Describe the secondary effect of type A ADRs

A
  • Due to the secondary pharmacology of a drug unrelated to the therapeutic effect.
  • Still rationalizable form the known pharmacology of the drug.
21
Q

Examples of secondary effect of Type A ADRs

A
  • Galactorrhoea with domperidone

- Dry mouth with tricyclic antidepressants

22
Q

Causes for Type A ADRs?

A
  • Too high a dose
  • Pharmaceutical variation
    o Pharmacokinetic variation
     Absorption
    • Dose
    • Formulation
    • GI motility
    • First pass metabolism
    o Pharmacodynamic variation
23
Q

Describe Type B ADRs.

A
  • Bizarre, unpredictable, rare, cause serious illness or death
  • Unidentified for months or years
  • Unrelated to the dose or concentration
  • Not readily reversed
24
Q

What factors increase the chances of Type B ADRs?

A
  • More common with macromolecules
    o Proteins
    o Vaccines
    o Polypeptides
  • Patients with history of asthma, excema
  • HLA status
    o Presence of particular HLA increases risk of a Type B reaction
25
What are the mechanisms of type B ADRs?
- Idiosyncratic | - Drug allergy or hypersensitivity
26
Describe the idiosyncratic mechanism of Type B ADRs.
- inherent abnormal response to a drug | - occurs due to genetic abnormality to a drug or abnormal receptor activity
27
Describe the drug allergy or hypersensitivity mechanisms of Type B ADRs. How does it manifest?
- immunological - has no relation to the pharmacological action of the drug - delay been exposure and ADR - manifests as rash, asthma, serum sickness
28
Describe Type C Chronic ADRs.
- Related to the duration of treatments and the dose - Does not occur with a single dose - semi predictable
29
Examples of tYPE C chronic disease
o Latrogenic Cushings disease o Opiate dependence o Steroid induced osteoporosis
30
Describe Type D Delayed ADRs
- adverse effects occur a long time after treatment - teratogenesis - carcinogenesis
31
What is teratogenesis?
seen in type d delayed ADRs o Children of treated patients o Abnormal congenital malformations in the fetus following in utero exposure due to maternal medication use during 1st trimester of pregnancy
32
Example of teratogenesis?
o Craniofacial malformaitons in childrens whose mothers were treated with isotretinoin
33
What are teratogenic agents?
 Cytotoxics  Vitamin A  Antithyroid drugs  Steroids
34
How to prevent teratogensis
o All drugs should be avoided during pregnancy unless they are safe or the benefit out-weigh potential risk.
35
What is carcinogenesis in Type D ADRs?
o In treated patients years after treatment has stopped
36
What is Type E End of treatment ADRs?
- Occurs when a drug treatment is stopped especially suddenly following long term use
37
Examples of Type E End of treatment ADRs?
o Unstable angina and MI - when beta blockers are stopped o Alcohol o Withdrawal seizures when anti-epileptics are stopped o Addisonian crisis when long term steroids are suddenly stopped
38
When does rebound phenomena occur?
When a drug is suddenly withdrawn. - Alcohols - Benzodiazepines - Beta-blockers - Corticosteroids
39
What is Type F ADRs?
- Failure of therapy - Frequently caused by drug interactions - Common - Dose related - Most worrying- failure of the OCP when administered with hepatic enzyme inducers/antibiotics
40
How do we diagnosis ADRs?
1. Differential diagnosis- be suspicious 2. Medication history (past and present) 3. Assess time of onset and dose relationship 4. Laboratory investigations o Plasma concentration measurement o Allergy tests
41
Who is most at risk of ADRs?
- Age (children and elderly) - Multiple medications - Multiple co-morbid conditions - Inappropiate medication prescribing, use or monitoring - End-organ dysfunction - Altered physiology - Prior history of ADRs - Extent (dose) and duration of exposure - Genetic predisposition
42
What are drugs commonly involved?
Drugs that we are very used to. - Antibiotics - Painkillers- NSAID, Opiates - Cardiovascular drugs - Hypogycemics
43
Surveilance methods for ADRs
Anecdotal reporting | Most common is using yellow card scheme

Principles of Disease (53 decks)

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