BP8 – Adverse drug reactions

Question 1

What is an adverse drug reaction?

Answer 1

Harmful/ seriously unpleasant event occurring at a dose intended for therapeutic effect and that calls for a reduction of the dose or withdrawal of the drug

Question 2

Why are antibiotics not commonly prescribed by dentists?

Answer 2

Increase resistance, and tooth may be better off being removed

Question 3

How can you work out the drug administered has caused an adverse reaction?

Answer 3

• Time sequence between them
• Reaction corresponds to the known pharmacology of the drug
• Reaction stops when drug stops being taken
• Reaction returns when restarting drug

Question 4

What is the use of yellow cards in practice?

Answer 4

Used to report adverse drug reactions

Question 5

What is a secondary adverse effect?

Answer 5

Indirect cause, secondary to the drug, possibly causing further opportunistic infections to occur

Question 6

Why are the elderly likely to have increased adverse drug effects?

Answer 6

• 3x more ADR in over 60s as to under 30s
• Maybe because of increased medications
• Pharmacokinetic factors also contribute – filtration decreases after 20s

Question 7

Why are the children likely to have increased adverse drug effects?

Answer 7

Difference in pharmacokinetic factors

Question 8

What are the types of ADR classification?

Answer 8

A - Augmented pharmacological effects
B - Bizarre effects 
C - Chronic effects 
D - Delayed effects
E - End of treatment effects

Question 9

What is the definition of the ADR type: augmented pharmacological effects?

Answer 9

Adverse effect that is known to happen from the primary pharmacology of the drug and is usually dose dependent

Question 10

What is the definition of the ADR type: bizarre effects?

Answer 10

Adverse effects that are unpredictable from the drug pharmacology

Question 11

What is the definition of the ADR type: chronic effects?

Answer 11

Occurs as a result of chronic drug treatment

Question 12

What is the definition of the ADR type: delayed effects?

Answer 12

Occurs remote from the treatment, either in children of the treated patients or in the patient themselves

Question 13

What is the definition of the ADR type: end of treatment effects?

Answer 13

Adverse effects occurring as a result of stopping treatment - withdrawal effects

Question 14

What happens in the PNS?

Answer 14

• Pupils constrict
• Lens of eye readjust for closer vision
• Airways in lungs constrict
• Heart rate decrease
• Blood vessels to limb muscles constrict
• Blood vessels to visceral organs more dilated
• Salivary secretions normalise

Question 15

What can happen in bizarre adverse drug reactions?

Answer 15

High death rate as unpredictable

Anaphylaxis can occur

Question 16

What is Cushing’s syndrome?

Answer 16

Hypercortisolaemia

Question 17

What causes Cushing’s syndrome?

Answer 17

Adrenal/pituitary tumour - glands that produce cortisol

Question 18

What are the symptoms of Cushing’s syndrome?

Answer 18

• Round red face
• Increased abdominal fat
• Thin arms and legs due to muscle wasting
• Poor wound healing
• Increased susceptibility to infection
• Easy bruising

Question 19

What are the adverse drug interactions causing modification?

Answer 19

• Potentiation – increase of effectiveness

- Attenuation – reduction of effectiveness

Question 20

What are the effects of the ADR pharmacodynamic interaction between the ethanol and antihistamines/ certain antidepressants?

Answer 20

Increased sedative effect

Question 21

What is the ADR pharmacodynamic interactions?

Answer 21

1 drug interferes with disposition (e.g. metabolism/excretion of drug) of the other

Question 22

What is the use of carbamazepine?

Answer 22

Used to control and prevent seizures

Question 23

What is the metabolism of carbamazepine (CBZ)?

Include enzymes present

Answer 23

CBZ is broken down by CYP3A3/4 into CBZ-epoxide metabolite

CBZ-epoxide metabolite is broken down by epoxide hydrolase into CBZ-diol metabolite (which is inactive)