Adverse drug reactions and interactions

Question 1

Adverse drug reactions, 2 types?

Answer 1

Augmented

Bizarre

Question 2

Type a adr?

Answer 2

Exaggeration of intended therapeutic effect e.g.
- hypotension with antihypertesinves
- dehydration with diuretics

Unrelated to intended therapeutic effect e.g.
- hyponatraemia with thiazides
- brethlessness with. Beta blockers

Question 3

Increased risk of type A ADR?

Answer 3

Drug concentrations - higher dose

Patient factors

Question 4

Management of the A ADR?

Answer 4

Reduce dose

Try alternative

Keep on if necessary and treat the ADR

Question 5

What are high risk clinical scenarios for augmented ADRs?

Answer 5

Liver impairment

Heart failures

Elderly/frail

Dehydration

Renal impairment

Question 6

What drugs make to at high risk of ADR when pt has heart failure?

Answer 6

Nsaids

Glitazones

Question 7

What drugs make out at high risk of ADR if pt has renal impairment?

Answer 7

Nsaids

ACE/ARBS

Metaformin

LMWH

Digoxin

Antibiotics

Opiates

Question 8

What drugs make you at higher risk of ADR if ou have liver impairment?

Answer 8

Nsaids

Metoformin

Warfarin

Benzodiazepines

Question 9

Can you predict type B ADR?

Answer 9

No, immune or genetic factors

Question 10

Management of type B ADR?

Answer 10

Stop causative agent

Deal with the ADR

Question 11

What is type C ADR?

Answer 11

Chronic

Question 12

Are type C ADR predictable?

Answer 12

Predictable form known pharmacology

Question 13

What are examples of type C chronic ADR?

Answer 13

Osteoporosis of the jaw with bisphosphonates

Osteoporosis with long-term high dose steroids

Question 14

When can you notic type C chronic ADR?

Answer 14

Effects require prolonged period of exposure to develop

Question 15

Management of type C ADR?

Answer 15

Use prophylaxis

Monitoring

Question 16

What is type D ADR?

Answer 16

DELAYED

Question 17

What is type d ADR?

Answer 17

Effects do not arise until prolonged period of exposure

Even though drug withdrawn it may still have effects in the future

E.g. chemo therapy… increased risk of lymphomas in later life

Question 18

Type E ADR?

Answer 18

End of use

Question 19

What is type e ADR?

Answer 19

Effect seen on medicines withdrawal: withdraw reactions

Question 20

What drugs do you see type E ADR with?

Answer 20

Benzodiazepine

Opiates

SSRI

Steroids

Beta blockers

Question 21

General prophylaxis for ADR?

Answer 21

Avoid certain medicines for high risk pt

Consider reducing dose - check BNF

Monitor side effects

Offer prophylaxis

Avoid known drug interactions

Question 22

What is pharmacovgilance?

Answer 22

The process involving detection, assessment, understanding and prevention of ADRs

Continual assessment o the risk and benefits of each drug resulting in th best drug therapy for pt

Question 23

Main metho for post-marketing surveillance of ADR in UK?

Answer 23

Yellow card scheme

Question 24

What does the yellow card scheme for collect information on? (5)

Answer 24

Side effects (AKA ADR)

Medical device adverse incidents

Defective medicines (those that are not of an acceptable quality)

Counterfeit or fake medicines or medical devices

Safety on Erin’s e.g. e-cigarettes or their refill containers

Question 25

Information to include on a red card report?

Answer 25

Question 26

Cytochrome P450 inhibitors?

Answer 26

Omeprazole Erthyromycin Isoniazid Ethanol Sulphonamides Disulfiram Valproate

Question 27

Cytochrome p450 inducers?

Answer 27

Alcohol Barbiturates Carbamezepine Phenytoin Rifampicin

Question 28

Pts susceptible to ADR?

Answer 28

Elderly Renal impairment Diabetes mellitus Epilepsy Young Critically ill Pts undergoing complicated surgical procedures Due to polypharmacy

Question 29

Agonistic interactions of drugs?

Answer 29

Blood pressure of ramipril and idapamide Increased sedative effect wen ethanol and diazepam are combined

Question 30

Antagonistic effect of drugs example?

Answer 30

Atenolol and salbutamol Naloxone and morphine

Question 31

Pharmacokinetic drug interactions?

Answer 31

When one drug affects the absorption istrinution, metabolism or exertion of another

Question 32

Drug interaction which affects proetin binding and distribution?

Answer 32

E.g. drug A displaces drug B from the carrier proetin then there is an increase in active drug B E.g. amiodarone displaces digoxin and can lead to digitoxicity

Question 33

Drug interactions in relation to metabolism?

Answer 33

Drug A induces/inhibits the enzyme metabolism of drug b E.g. metabolism of warfarin is inhibited by amiodarone leading to an increase in anticoagulan effect of warfarin

Question 34

Cytochrome p450?

Answer 34

Microbial enzyme found in the liver and gut Metabolises many dugs

Question 35

Where are the majority fo drugs excreted?

Answer 35

Kidneys

Question 36

What drug can make increase risk of methotrexane toxicity and why?

Answer 36

NSAIDS Competition for renal tubular excretion