Chapter 5

Question 1

how many serious adverse drug reactions are reported annually

Answer 1

660,000 that result in ED visits, hospital admissions and 120,000 reported deaths.

Question 2

total cost associated with ADR

Answer 2

3.5 billion to 126 billion per year

Question 3

ADR

Answer 3

any undesirable or unintented effect after administration of a medical product, whter or not the effect is considered related to amedical product.

Question 4

Two basic types of ADRs

Answer 4

phamacological and idiosyncratic

Question 5

phamacological reaction

Answer 5

predictable baed on the drug’s MOA and is typically dose realted

Question 6

Idosyncratic reaction sare

Answer 6

unpredictable and may more lkely to result in moretality

Question 7

which type of reaction is more common

Answer 7

pharmacological

Question 8

Example of a pharmacological reaction

Answer 8

hypotention from a beta blocker, diarrhea from the fat-blocking drog orlistat, and insomnia from the stimulat methylphenidate. Seondary effects are included such as weight gain from atypical antipsycotics.

Question 9

Idiosyncratic reactions are

Answer 9

unpredictable, often serious and may result in death.

Question 10

Idiosyncratic reactions are mediated

Answer 10

mediated by the immune syste, receptor abnormaliteis, dug-durg-intractions, abnormailites in metabolisy, pharmaceutical variations or unmasking of abnormal biogical sytms.

Question 11

Hapten hypothesis

Answer 11

describes how drugs may cause an immune-mediated hypersensitivety reaction. The hypotheis suggests taht drugs are haptens, which are low-molecular weight chemcicals that can become antigenic when they covalently bind to a carrier molecule, usually a protein. Through this mechanism, individual patterns of metabolism may generat reactive metabolites that act as haptens to elicit an immune medicate reaction. Penicillin is an example of a haptin with low molecular weight that is able to bind to a protein and result in type I sensivity reaction.

Question 12

Medicatoins that rae not haptens may also eliciit an immune-medicate raction through a different mechanism called the

Answer 12

pharmacologic interaction with immune receptors

Question 13

an example of a phmacologic interaction with immune receptors

Answer 13

licocain, sulfamethoxazole, mepivacaine, celecoxib, carbamazepine, lamotrigine, and ciprofloxacin are chemcically inert drugs, unable to covalently bind to protins, howevier if amedication or its metabolite is able to bind covalently to a protein, it can form hapten-carrier complex and resutl in an immune response.

Question 14

These hapten carrier complexes that restul in immune mediate reactions are called

Answer 14

type I, II, III, or IV

Question 15

Type one are provoked by

Answer 15

exposure to an antigen

Question 16

type one reaction is an

Answer 16

acute hypersensitivety reaction that may be local or systemic involving the skin, or bronchpulmonary system, nasopharngeal tract, eyes and GI tract

Question 17

Typ one is caused by inducing the release of

Answer 17

mediators (histimine, leukotrienes and prosagrandins from mast cells, basophils, and recruited inflammatory cells after antigen exposure which then activates IGE.

Question 18

Type one reactions vary from mild to severe and can come one

Answer 18

within minutes or have delayed onset where it takes severl hours to present symptoms. can be life threatenting.

Question 19

Type one basics and examples

Answer 19

immunoglobulin E mediated, immediate type hpersensitivty. Eample angioedema and anaphylaxis

Question 20

Type two basics and examples

Answer 20

antibody-dependent cytotoxicity, example heparin-induced thrombocytopenia

Question 21

type three basics and examples

Answer 21

immune complex hypersensitivity, example arthus reaction to tetanus vaccine

Question 22

type four basics and examples

Answer 22

cell mediated or delayed hypersensitivty, example, drug rash eosinophilia, and systemic syndrome (DRESS)

Question 23

Type two hypersensitivy reactions may affect a variety of organs and tissues. In the bloodstreat

Answer 23

and on the surface of cells, antibodies unite with antigens or hapttens and induse destrcution of cells and tissues throguh activatio nof complent systems or through removal by macrophages.

Question 24

hapetns

Answer 24

a small molecule which, when combined with a larger carrier such as a protein, can elicit the production of antibodies which bind specifically to it (in the free or combined state).

Question 25

Immune mediated thrmboocytopenia also called

Answer 25

drug-induced immune thrombocytopenia (DITP) is generally cuaed by medications, but foods or herble products

Question 26

thrombocytopenia

Answer 26

a condition characterized by abnormally low levels of platelets, also known as thrombocytes, in the blood. A normal human platelet count ranges from 150,000 to 450,000 platelets per microliter of blood.

Question 27

Most DITP reactions are assoicated with the formation of

Answer 27

drug dependent antibodies that bind to glycoprotein and cause an antibody-platelet reaction resulting in thrombocytopenia.

Question 28

examples of medications presenting a risk of DITY include

Answer 28

abciximab, argatroban, bata-lactam antibiotics, carbamazepine, eptifibatide, linezolid, phenytoin,

Question 29

DITP can also occur when heparin binds to

Answer 29

platelet factor 4 proetins resulting in the formation of antigenic complex where IgG antibodies bond to the pltelet. Teh atnibody-coated platelets are viewed by the body as foreign and the body destroys the platelets visa complement activation, causing thromboycytopenia.

Question 30

Hemolytic anemai accurs when

Answer 30

a drug binds to antigens on the surface of red blood cells resulting in complement activation and cell lysis. Examples of medications that cause hemolytic anemia include cephalosporins, penicillin, NSAIDs,

Question 31

Neutropenia or agranulocytosis

Answer 31

can occur when antibodyies unite with antigens on the surface of neutrophils. the reaction time is minutes to hours

Question 32

Examples of durts that can cause neutropenia.

Answer 32

clozapine, anithyroid medications, sulfasalazone, clompipramine, trimethoprism sulfatheoxazole, angiotensin-converting enzyme inhibitors and H2 receptor antagoints.

Question 33

treatment for drugs that cuase neutropenia

Answer 33

anti-inflamatory drugs

Question 34

Type III hyperseitivty reactions occur

Answer 34

when aggregates of antigens IgG and IgM antibodies create insoluble immune complexes in vessesl or the blood that may be deposited in tissues (joints, kidnes)

Question 35

The type three reaction generally takes

Answer 35

a week or more to occur and may present as serum sickness, drug fever, or vasculitis.

Question 36

The arthus reaction is a

Answer 36

locla vasculitis reaction that causes severe pain, swelling, edema, induration, hemorrhage, and possibly necrosis which can occur after tenanus/diptheria toxoid vaccination (type three)

Question 37

The risk of arthrus reaction from TD vaccine is elevated when a patient receives

Answer 37

vaccinatin more frequently than every 10 eyears.

Question 38

It is recomended that patients who have expereinced an arthus reaction after vaccination with tetanus toxoid do

Answer 38

not receive TD more frequently than every 10 years even if the vaccine is part of ap rotocol for wound managment

Question 39

Type iV

Answer 39

are unlike others because they are not an ntibody-mediated reaction, but rather cell-mediated response that results in activation an dporliferation of T cells.

Question 40

Typ four hypersesitivty reaction are the result of atuoimmune and infectoius disease or contact dermatitis. These reactions generally occur witthin

Answer 40

2 to three days, but may take days or weeks to occur

Question 41

The type four reaction may be in the form of

Answer 41

contact dermatitis, morbillifom or maculopapular euptious, sevents jhonsome syndrome, toxic epidermal necrolysis, or drug inducsed hyperseitivty sindrom.

Question 42

DIHS is a

Answer 42

severe reaction that not only causes rash but also is frequetly associated with fever, esoinophilia, and organ failure.

Question 43

DIHS is also known as

Answer 43

DRESS, drug rash eosinophilia, and systemic symptoms.

Question 44

Examples of drugs that cuase DRESS

Answer 44

abacavir, allopurinol, carbamazepine, dapsone, minocycline, nevirapine, and phenobarbital.

Question 45

treatment for DRESS

Answer 45

corticosteroids and other immunosupressive gents

Question 46

adverse drug reactions have also been categorized as types

Answer 46

a through f

Question 47

Type A reactions are equivalent to

Answer 47

pharacological reactions and account of r85% to 90 % of ADRs, are dose dependent, and are not predeicable

Question 48

Adverse reactions have been further stratified by letters

Answer 48

C through F, reactions that result from chronic medication use

Question 49

Type D reactions

Answer 49

are delayed

Question 50

Type F reactions result from

Answer 50

treament failures