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Principles of Disease BJ > Adverse Drug Reactions (ADRs) > Flashcards

Adverse Drug Reactions (ADRs) Flashcards

1
Q

Define an adverse drug reaction?

A

Any noxious or unintended response to a drug occuring at doses used for prophylaxis, diagnosis or treatment.

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2
Q

What are the 3 criteria of an adverse drug reactions? (definition)

A

The response must be:
Noxious
Unintended
The dose must be one used for prophylaxis, diagnosis or treatment (i.e. not a known unsafe dose)

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3
Q

How many inpatients suffer ADRs?

A

Around 10-20% (1/10th to 1/5th) of inpatients suffer an ADR

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4
Q

How many hospital deaths are due to ADRs?

A

0.2-3% of hospital deaths are due to ADRs

roughly 5-10k deaths/yr

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5
Q

How many hospital admissions are ADR related?

A

6.5% of hospital admissions are related to ADRs

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6
Q

What are the 3 time periods of ADRs?

A

Acute
Sub-Acute
Latent

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7
Q

How quickly does an acute ADR occur?

A

Within an hour of administration

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8
Q

How quickly does a sub-acute ADR occur?

A

1-24 hours after administration.

Basicall within a day

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9
Q

How long does a latent ADR take to manifest?

A

Greater than 2 days before the ADR occurs makes it a latent ADR

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10
Q

What are the 3 levels of ADR?

A

Mild
Moderate
Severe

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11
Q

Define a mild ADR?

A

ITs bothersome to the patient but they dont need to change treatmetn

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12
Q

Define a moderate ADR?

A

Pateint either needs hospitalization, changed treatment or additional treatment to solve it.

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13
Q

How bad is a severe ADR?

A

Disabling or life-threatening

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14
Q

How are ADRs categorised?

A

Into Types A-F

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15
Q

What do the types of ADR stand for?

A 
Augmented
Bizarre
Chronic
Delayed
End of Treatment
Failure of Treatment
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16
Q

Why are Type A ADRs called augmented?

A

They are a normal repsonse to a the drug but augmented (exaggeratd)

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17
Q

Example of Type A ADRs?

A

Beta blockers causing bradycardia

Insulin causing hypoglycaemia

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18
Q

Are type A ADRs predictable?

A

Type A adrs are predictable & related to dosage

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19
Q

What cause a type A ADR?

A

Excess pharmacological action.

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20
Q

What causes excess pharmacological action in a TYpe A ADR?

A

Too high a dose
Pharmaceutical Variation
Pharmacokinetic Variation
Pharmacodynamic Variation

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21
Q

What 4 aspects of a pateint make up their pharmacokinetic variation?

A 
Theyre drug:
Absorption
Distribution
Metabolism
Elimination
22
Q

What 4 factors affect drug absorption?

A

The dose
The drugs formulation
GI motility
First pass metabolism

23
Q

What effects drug metabolism?

A

altered hepatic function.

24
Q

In what type of drus is liver disease a particularly important consideration?

A

Those with a narrow therapeutic range

25
Q

What effects drug elimination?

A

Altered renal function, particularly reduced GLomerular Filtration Rate (GFR)

26
Q

How does pharmacogenetics trigger Type A ADRs?

A

10% of people are slow metabolizers making them prone to drug toxicity due to their lower first pass metabolism.

27
Q

What effects pharmacodynamic variation?

A
  • Natural variability between individuals

- Disease states (particularly renal/hepatic disease)

28
Q

Why are Type B ADRs called bizarrre?

A

Theyre unpredictable & rare

29
Q

How serious can type B ADRs be?

A

Severe af, they can kill you

30
Q

How are some Type B ADRs immunological?

A

Some TypeB ADRs are drug allergys, i.e. examples of type 1 hypersensitivity

31
Q

What are TYPE C ADRs related to?

A

Dosage & treatment duration

32
Q

example of a type C ADR?

A

Iatrogenic Cushing’s disease

33
Q

When does a TYPE D ADR occur?

A

Years after the treatment.

34
Q

Whats unique about a Type D ADR?

A

Type D ADRs can occur in the pateints children

35
Q

What sort of Type D ADRs can immunosuppresive agents cause?

A

Patients treated with immunosuppresive agents can develop secondary cancers

36
Q

If a mother is treated with isotretinoin, what ADR can occur?

A

Mother given isotretinoin.
Child born with craniofacial malformation
Type D ADR

37
Q

What ADR are thalidimide babies an example of?

A

Type D ADRs

38
Q

When does a Type E ADR occur

A

When a treatment is stopped

39
Q

Alcohol withdrawel is an example of what ADR?

40
Q

What are some type E ADRs known as ?

A

Rebound phenomenom

41
Q

what type E ADR can occur when beta blockers are stopped?

A

Beta blockers stopped

Unstable Angina & myocardial infarction can occur

42
Q

What type E ADR occurs when long term steroid are suddenyl stoppped?

A

Sudden stop of long term steroid treatment can cause addisonian crisis

43
Q

What frequently causes Type F ADRs?

A

Drug interaction

44
Q

Is dose related to Type F ADR?

A

Yes dose influences type F ADRs

45
Q

What are the 4 steps for diangosing an ADR?

A
  • Differential Diagnosis
  • Medication history
  • Asses time of onset & dose relationship
  • Lab investigations
46
Q

What lab investiations are used to diagnose an ADR?

A

Plasma conc. measurments

Allergy tests

47
Q

What is step 2 of ADR diagnosis?

A

Medication History

48
Q

Whats step 3 of ADR diagnosis?

A

Assessing the relationship between dose & time of onset

49
Q

Whats step 1 of diagnosing an ADR?

A

Differential diagnosis

50
Q

Whats step 4 of ADR diagnosis?

51
Q

How are ADRs reported?

A

To the yellow card scheme

52
Q

What does the yellow card scheme collect info on?

A

ADRs (side effects)
Defective Meds
Counterfeit meds
Medical device incidents

Principles of Disease BJ (47 decks)

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