Adverse Effects

Question 1

what is a type A adverse drug reaction?

Answer 1

type A adverse drug reaction is an explainable/predictable adverse drug reaction

Question 2

what is a type B adverse drug reaction?

Answer 2

unexplainable/idiosyncratic adverse drug reaction

Question 3

what is a type C adverse drug reaction?

Answer 3

Chronic adverse drug reaction

Question 4

what is a type D adverse drug reaction?

Answer 4

Delayed adverse drug reaction

Question 5

which adverse drug reaction is most common?

Answer 5

Type A ADR’s account for approx. 80% of all reported ADR’s

Question 6

name 4 examples of type A ADR’s

Answer 6

1. toxicity of overdose
   
   • hepatic failure caused by high doses of acetaminophen
2. side effects
   
   • sedation with the use of antihistamines
3. secondary effects
   
   • development of diarrhea with antibiotic therapy
4. drug interaction
   
   • theophylline toxicity in the presence of erythromycin therapy

Question 7

describe the following example of type B ADR’s

1. intolerance
2. hypersensitivity
3. pseudoallergic
4. idiosyncratic

Answer 7

intolerance

• patients that are intolerant to certain drugs cannot be predicted; a number of patients are intolerant to aspirin and can experience tinnitus if they take the drug

Question 8

describe the following example of type B ADR’s

1. intolerance
2. hypersensitivity
3. pseudoallergic
4. idiosyncratic

Answer 8

hypersensitivity

• anaphylaxis with penicillin administration; hypersensitivity is not dose-dependent or predictable through knowledge of the mechanism of action of the drug

Question 9

describe the following example of type B ADR’s

1. intolerance
2. hypersensitivity
3. pseudoallergic
4. idiosyncratic

Answer 9

pseudoallergic

• radiocontrast dye reaction; pseudoallergic reactions occur on first exposure to a drug/agent in patients that are sensitive
  
  • they do not need prior exposure as with type 1 hypersensitivity

Question 10

describe the following example of type C ADR’s

1. dependence
2. chronic use

Answer 10

dependence

• some drugs such as benzodiazepines and B-blockers are known to induce physiological dependence if used chronically

Question 11

describe the following example of type C ADR’s

1. dependence
2. chronic use

Answer 11

chronic use

some adverse effects only appear if drugs are used for months/years, e.g. steroids are associated with a risk of osteoporosis only if they are used chronically

Question 12

type D ADR’s are delayed adverse effects that are normally ___ and ___ in nature; they are very rare and most commonly associated with the use of ____

Answer 12

type D ADR’s are delayed adverse effects that are normally carcinogenic and teratogenic in nature; they are very rare and most commonly associated with the use of chemotherapeutic agents

Question 13

describe an on-target effect

Answer 13

exaggeration of the desired pharmacologic action of a drug

Question 14

the increase in biological response in on-target effects can occur by which 3 mechanisms?

Answer 14

• deliberate of accidental dosing error
• alterations in the pharmacokinetics of the drug (e.g. decrease in liver of kidney function)
• alterations in the pharmacodynamics of the drug-receptor interaction (e.g. an increase in receptor number occurring during treatment)

Question 16

another type of on-target effect is activation of the intended receptor but in a ____

Answer 16

another type of on-target effect is activation of the intended receptor but in a non-target tissue

ex: antihistamines target histamine receptors in the CNS causing sedation

Question 17

an off-target effect is the activiation of ____ in either a target or non-target tissue

Answer 17

an off-target effect is the activation of an incorrect in either a target or non-target tissue

Question 18

Gingko biloba is an herb that inhibits ____, and therefore, if it is used simultaneously with NSAIDs, there may be an increased risk of ____

Answer 18

Gingko biloba is an herb that inhibits platelet aggregation, and therefore, if it is used simultaneously with NSAIDs, there may be an increased risk of bleeding

Question 20

fibrosis can result from the use of certain drugs; pulmonary fibrosis can be caused by the antiarrhythmic drug ____ and the chemotherapeutic agent ____

Answer 20

fibrosis can result from the use of certain drugs; pulmonary fibrosis can be caused by the antiarrhythmic drug amiodarone and the chemotherapeutic agent bleomycin