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C. Year 3: Clinical Pharmacology, Therapeutics and SBOM > Adverse Drug Reactions and Interactions > Flashcards

Adverse Drug Reactions and Interactions Flashcards

1
Q

What is an adverse drug reaction?

A
  • a noxious and unintended response to a drug
  • occurs at a normal therapeutic dose
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2
Q

What is a side effect?

A
  • undesirable secondary effect
  • administered under normal drug conditions
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3
Q

What is an adverse drug event?

A
  • undesirable event
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4
Q

What % of hospital admissions are caused by adverse drug reactions?

1 - 0.65%
2 - 2.5%
3 - 6.5%
4 - 65%

A

3 - 6.5%

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5
Q

Why can the prescribing cascade be dangerous?

A
  • new drug to treat adverse event then comes with more interactions and more risk of ADR
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6
Q

What is the Rawlins Thinposon classification of ADR?

A
  • system to classify ADR
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7
Q

What does A, B, C, D, E, F, G relate to in relation to the Rawlins-Thompson Classification?

A

A - Augmented reactions
B – Bizarre
C – Continuing
D – Delayed
E - End of use
F – (Unexpected) Failure
G – Genetics

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8
Q

A in the Rawlins-Thompson Classification system relates to an augmented ADR. What does this mean?

A
  • augmentation of the medicine’s normal effect when given at the usual dose
  • hypotension with ACE inhibitors
  • bleeding with warfarin
  • constipation with opiods
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9
Q

What are some of the most common predisposing factors causing augmented reactions?

A
  • genetics
  • age
  • polypharmacy
  • concurrent disease states
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10
Q

B in the Rawlins-Thompson Classification system relates to a bizarre ADR. What does this mean?

A
  • effects that are not pharmacologically predictable
  • anaphylaxis with β-lactam antibiotics such as penicillins
  • stevens-Johnson syndrome - caused by sulfonamides, trimethoprim, NSAIDs, penicillins
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11
Q

C in the Rawlins-Thompson Classification system relates to a continuing/chronic ADR. What does this mean?

A
  • ADR continue for a long time
  • generally linked with long-term use / dose accumulation
  • bisphosphonates, NSAID-related GI haemorrhage; hypothalamic-pituitary-adrenal axis suppression by corticosteroids
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12
Q

D in the Rawlins-Thompson Classification system relates to delayed ADR. What does this mean?

A
  • Become apparent some time after the use of a medicine
  • e.g., leucopenia can occur up to 6 weeks after a dose of lomustine; carcinogenic and teratogenic effects; tardive dyskinesia caused by antipsychotics
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13
Q

E in the Rawlins-Thompson Classification system relates to end of use reactions ADR. What does this mean?

A
  • associated with withdrawal of a medicine
  • e.g., insomnia, anxiety and perceptual disturbances following withdrawal of benzodiazepines such as midazolam; antidepressants; corticosteroids
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14
Q

F in the Rawlins-Thompson Classification system relates to failure ADR. What does this mean?

A
  • failure of drug to have its intended effect

e.g., failure of oral contraceptive pill in the presence of enzyme inducer

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15
Q

Using the Rawlins-Thompson Classification for adverse drug reactions, is anaphylaxis following penicillin prescriptions either:

1 - A - augmented ADR
2 - B - bizarre ADR

A

2 - B - bizarre ADR

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16
Q

Using the Rawlins-Thompson Classification for adverse drug reactions, is a constipation with calcium channel blockers prescriptions either:

1 - A - augmented ADR
2 - B - bizarre ADR

A

1 - A - augmented ADR

17
Q

Using the Rawlins-Thompson Classification for adverse drug reactions, is skin rash with flucloxacillin prescriptions either:

1 - A - augmented ADR
2 - B - bizarre ADR

A

2 - B - bizarre ADR

18
Q

Using the Rawlins-Thompson Classification for adverse drug reactions, is an unpredictable event following a drug prescription either:

1 - A - augmented ADR
2 - B - bizarre ADR

A

2 - B - bizarre ADR

19
Q

How can we reduce the effect of an adverse drug reaction

A
  • lower dose 1st
20
Q

What is the best way often used to stop an adverse drug reaction?

A
  • stop offending drug
  • ABCDEs
  • supportive treatment
21
Q

Reporting of adverse drug reactions?

A
  • UK yellow card scheme
  • involves reporting an ADR
22
Q

Are drug interactions always bad?

A
  • no
  • good or bad
23
Q

When looking at drug interactions in the BNF, what colour are the extremely clinically significant?

A
  • in bold with pink background
24
Q

What does P-glycoprotein do to absorption?

A
  • actively transports drugs out of the cell
  • so a drug may get absorbed, but then returned back to the lumen by the P-glycoprotein

C. Year 3: Clinical Pharmacology, Therapeutics and SBOM (25 decks)

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