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[Ther 201] 2nd Exam Transes > Adverse Drug Reactions (Godofreda Vergeire-Dalmacion, MD) > Flashcards

Adverse Drug Reactions (Godofreda Vergeire-Dalmacion, MD) Flashcards

1
Q

How many % of hospital admissions can be attributed to adverse drug reactions?

A

3 - 11%

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2
Q

ADRs are the (1) leading cause of death and (2) source of malpractice payouts in the US.

A

(1) 4th

(2) single largest

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3
Q

T/F: 4 out of 5 ADRs are dose-dependent.

A

False

3 out of 4!

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4
Q

T/F: ADRs may occur in standard doses.

A

True

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5
Q

Define: Adverse Drug Reaction (ADR)

A

Noxious and unintended response to a drug in recommended doses.

Overdose/toxicity goes beyond the recommended dose.

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6
Q

T/F: Causality has been determined in ADR.

A

True

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7
Q

T/F: In an adverse drug event, there is an unintended response in any dose and causality has been established.

A

False

Causality has not been established for an adverse drug EVENT.

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8
Q

Adverse drug event is the summation of what?

A
  1. ADR
  2. Unknown causes (preclinical trials or complication/side effect)
  3. Idiosyncratic causes (regardless of dose)
  4. Medication errors (information passing)
  5. Treatment failure (counterfeit drugs)
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9
Q

Lasix, a diuretic, is commonly confused with what drug?

A

Losec (Omeprazole)

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10
Q

What are the types of ADRs?

A

Dose-related and non dose-related

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11
Q

Dose-related ADRs are also known as?

A

Type A or Augmented

This category covers non-immune ADRs!

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12
Q

T/F: Non dose-related ADRs are due to pharmacokinetic and pharmacodynamic abnormalities that produce an excess of pharmacologic effect

A

False

Dose-related ADRs!

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13
Q

Define: Extension Effect

A

Predictable physiological changes beyond what is normal caused by following intended use

Solution is dose reduction or shifting to another drug.

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14
Q

What is the extension effect of taking aspirin?

A

GI bleeding and erosions due to inhibition of prostaglandins

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15
Q

Define: Side Effects

A

Predictable physiological changes caused by the drug other than intended use

Drug attacks different receptors

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16
Q

T/F: All beta-mimetics are cardiotoxic with the side effect of palpitation.

A

True

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17
Q

T/F: Anti-platelet action of aspirin prevents thrombus formation.

A

True

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18
Q

What is carbamazepine (tegretol) used for?

A

Controlling seizures

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19
Q

What are forms of pharmaceutical variation?

A

Changes in formulation
Outdated formulation
Presence of contaminants, pyrogens or bacteria

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20
Q

Describe the relationship between rate of acetylation and isoniazid side effects

A

Slow acetylators (caucasians): peripheral neuropathy (prescribe vitamin B6)

Fast acetylators (Filipinos): liver toxicity

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21
Q

What is succinylcholine used for?

A

Anesthesia

It induces prolonged apnea.

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22
Q

T/F: Pseudocholinesterase deficiency is a form of pharmacologic variation.

A

True

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23
Q

What are the forms of pharmacokinetic variation?

A
  1. Pharmacogenetic variation
  2. Hepatic disease
  3. Renal disease
  4. Cardiac disease
  5. Thyroid disease
  6. Decreased plasma albumin
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24
Q

T/F: Reduced clearance always results in increased adverse reactions.

A

False

Not if there’s compensatory excretion

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25
What are the uses and side effects of theophylline?
Used for asthma May cause hypotension and cardiac failure
26
What are the uses and side effects of phenytoin?
Anti-convulsant Can induce sedation and coma
27
What are the uses and side effects of warfarin?
Anti-coagulant Causes more bleeding
28
T/F: When there is decreased plasma albumin, drugs with low Vd are affected.
True
29
T/F: Warfarin, diazepam and salicylic acid are examples of protein-bound drugs.
True
30
What are the forms of pharmacodynamic variation?
Reduced blood clotting Hepatic encephalopathy Sodium and water retention Altered fluid and electrolyte imbalance
31
When there is reduced blood clotting due to liver disease, these drugs should be avoided or changed in terms of dosage.
Anticoagulants Aspirin, phenylbutazone, indomethacin and paracetamol
32
When there is hepatic encephalopathy, these drugs should be avoided.
``` Opiates Narcotic analgesics Barbiturates Chlorpromazine Short-acting benzos Diuretics ```
33
When there is sodium and water retention, these drugs should be avoided.
Corticosteroids Carbenoxolone Indomethacin Antacids
34
T/F: In cases of hypokalemia and hypercalcemia, cardiac glycoside effects are depressed.
False Potentiated! In fact, this leads to heart failure.
35
What drug effects are reduced when there is hypokalemia?
Class 1 anti-arrythmic effects (lignocaine, quinidine and procainamide)
36
What drug effects are prolonged when there is hypercalcemia?
Tubocurarine and succinylcholine
37
Describe: Cyclosporine
1. Predisposing factor for renal transplant 2. Increases potassium by impairment of excretion 3. Immunosuppressant needs to be taken for life
38
When is the hypotensive effect of anti-hypertensives enhanced?
Fluid depletion
39
T/F: Non dose-related ADRs are explained by immunology or pharmacogenetic variation.
True
40
Non-dose related ADRs are described as Type B for?
Bizarre
41
Drug allergy or hypersensitivity reactions are elicited by?
High MW proteins Polypeptides Dextrans
42
Drug allergies occurs occur in what type of people?
Inherently atopic | Deficiency in MHC
43
What anti-retroviral drug is involved in the abacavir hypersensitivity reaction?
HLA B57
44
T/F: Drug allergies occur in incidental diseases.
True
45
Describe: Type I Reaction
IgE-mediated | Rapid
46
Give an example of a Type I reaction
Anaphylaxis from beta-lactam antibiotics
47
Describe: Type II Reaction
Cytotoxic
48
Give an example of a Type II reaction
Hemolytic anemia from penicillin
49
Describe: Type III Reaction
Immune-complex
50
Give an example of a Type III reaction
Serum-sickness from anti-thymocyte globulin
51
Describe: Type IV Reaction
Delayed and cell-mediated
52
Give an example of a Type IV reaction
Contact dermatitis from topical cell-antihistamine
53
What is it called when a single drug can cause more than one type of reaction?
Cross reaction or cross sensitivity
54
Give an example of specific T-cell activation
Morbilliform rash from sulfonamides
55
Give an example of Fas/Fas-Ligand-induced
Steven-Johnson syndrome apoptosis; toxic epidermal necrolysis
56
What family of molecules does the Fas ligand belong to?
Tumor necrosis factor (TNF)
57
Give examples of other types of reactions under the Gell-Coombs Classification.
Drug-induced lupus-like syndrome | Anticonvulsant hypersensitivity syndrome
58
What are the three different situations that can be identified based on the Gell-Coombs classification?
Pseudo-allergic reactions Primarily antibody-mediated reactions Cell-mediated reactions
59
What is the time of onset of the different hypersensitivity classifications?
Type I - immediate Type II - within minutes or hours Type III - within 1 - 3 weeks Type IV - 2 to 7 days after cutaneous exposure (shorter when oral)
60
Differentiate Type IIA and Type IIB hypersensitivity reactions
Type IIA - cytotoxic | Type IIB - antibody-mediated cell stimulating
61
T/F: Grave's disease and chronic idiopathic urticaria are examples of Type II hypersensitivity reactions.
False They're Type III!
62
Differentiate Types IVA - D
Type IVA - CD4+ Th1 w/ activation of macrophages Type IVB - CD4+ Th2 w/ eosinophils Type IVC - Cytotoxic CD8+ w/ perforin-granzyme B Type IVD - T lymphocyte-driven neutrophilic inflammation
63
Give examples of Type IVA - D hypersensitivity reactions
Type IVA - granuloma and type I DM Type IVB - persistent asthma and allergic rhinitis Type IVC - Steven-Johnson syndrome and toxic epidermal necrolysis Type IVD - pustular psoriasis and acute generalised exanthemous pustulosis
64
T/F: Clinical features of allergic drug reactions have correlations with known properties of the drug.
False
65
T/F: Allergy will only manifest on subsequent use of ciprofloxacin.
True
66
T/F: Allergic drug reactions can occur at doses below therapeutic range.
True
67
70% of patients with allergic rhinitis develop what?
Bronchial asthma
68
What is the typical manifestation of a type I reaction?
Urticaria
69
What is the most common dermatologic manifestation of a drug allergy?
Morbilliform rash
70
What are the most common drug causes of morbilliform rashes?
``` Beta-lactam antibiotics (penicillins and cephalosporins) Sulfonamide antibiotics Allopurinol Anti-epileptics NSAIDs ```
71
Type of rash caused by thiol and non-thiol-containing drugs (i.e. enalapril, cephalosporins and piroxicam)
Pemphigus
72
Caused by oestrogen in oral contraceptive pills
Melasma
73
Caused by omeprazole; can occur in bronchial passages and mucosal membranes
Angioedema
74
What is the only dermatologic emergency where all mucous membranes are affected?
Steven-Johnson Syndrome
75
Is contact dermatitis a manifestation of drug allergy?
No
76
Is viral exanthem a manifestation of drug allergy?
No Drug allergies usually manifest as patches on the skin.
77
What are long term effects of drugs?
1. Adaptive Changes | 2. Rebound Phenomena
78
Describe the adaptive changes of the body to beta-blockers
Development of tachyphylaxis and eventually tolerance when all receptors are blocked. RECALL: Beta-blocker in heart decreases blood pressure and cardiac output
79
Describe anti-hypertensives and rebound phenomena
There is extreme lowering then rising up again of blood pressure.
80
What are delayed effects of drugs?
1. Carcinogenesis | 2. Effects on Reproduction
81
Describe (1) carcinogenesis and anti-cancer drugs and (2) carcinogenesis and fertility drugs
(1) Anti-cancer drugs may produce a second cancer | (2) Ovulation induction drugs may cause ovarian cancer
82
Enumerate delayed effects of drugs in connection with reproduction
Impaired fertility Teratogenesis Drugs in breast milk
83
Enumerate common predisposing factors for immune and non-immune ADRs
Female gender HIV Systemic lupus erythematosus
84
Enumerate generic drug reaction (non-immune) risk factors
``` Serious illness Renal insufficiency Liver disease Polypharmacy Herpes infection Alcoholism ```
85
Enumerate immune hypersensitivity drug reaction risk factors
``` Age (adult) Concomitant viral infection Previous hypersensitivity to chemically-related drug Asthma Use of beta-blockers Specific genetic polymorphisms ```
86
T/F: Myocarditis is a common adverse drug reaction to Cefaclor.
False It's very rare.

[Ther 201] 2nd Exam Transes (5 decks)

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