Chapter 5 Deck 2

Question 1

one distinuguishing feature for ADRs

Answer 1

Is the relation between administration and tissue exposure times of the reaction.

Question 2

The world allergy organization classifiesimmunolgogical reactions as

Answer 2

immediate or delayed

Question 3

symptom presentations that occur within one hour after exposure is classified as a

Answer 3

Immediate reaction

Question 4

A delayed reaction occurs more than

Answer 4

One hour after reaction

Question 5

Rapid reaction

Answer 5

Occurred during or immediately after the ministration of the medication

Question 6

Vancomycin can cause an adverse reaction known as

Answer 6

Red man syndrome, when administered to rapidly

Question 7

Phenytoin can cause an adverse reaction known as

Answer 7

purple glove syndrome

Question 8

first dose reactions

Answer 8

occur after the first dose of the medication

Question 9

an example of the first dose reduction

Answer 9

orthostatic hypotension is a common reaction occurs after the first dose of doxazosin

Question 10

early reactions

Answer 10

occur early in treatment and generally resolve the continued treatment as the patient develops tolerance.

Question 11

Is often useful to initiate drugs likely to cause early reactions with

Answer 11

low starting doses and sequentially titrate the dose upward to mitigate the severity and duration of adverse effects

Question 12

examples of early reactions

Answer 12

gastrointestinal upset after initiation of metformin or selective serotonin reuptake inhibitors

Question 13

immediate reactions

Answer 13

occur after repeated exposure to medication examples include hyperuricemia from furosemide

Question 14

late reactions occur

Answer 14

after prolonged exposure to an offending agent. Examples include osteoporosis or thinning of the skin due to prolonged corticosteroid use in hypogonadism after prolonged use of opioids. It may be possible to symptomatically treat plate ADRs, but most predictable and occur after repeated exposures. Thus it is often recommended to remove the offending agent for the reaction is predicted to occur to manage this type of adverse effect.

Question 15

Delayed reactions

Answer 15

occur at variable points in time after drug exposure and can even occur after discontinuation of a drug. For example, drug-induced tardive dyskinesia may occur after prolonged exposure to antipsychotics, with symptoms persisted for months to years after discontinuation of the precipitating drug.

Question 16

The FDA defined serious ADRs as those tab and result in death, or life-threatening, resulting hospitalization, are disabling Orkin incapacitating, produce congenital abnormality or birth defect, require an intervention to prevent one of these outcomes.

Answer 16

that result in death, or life-threatening, resulting hospitalization, are disabling Or incapacitating, produce congenital abnormality or birth defect, require an intervention to prevent one of these outcomes.

Question 17

Any ADR that meets FDA criteria should be reported to

Answer 17

the FDA Medwatch program

Question 18

mild adverse events can typically be managed by

Answer 18

dose reduction

Question 19

moderate adverse events often require

Answer 19

discontinuation of the drug and minimal medical intervention

Question 20

severe ADRs may be

Answer 20

life-threatening and result in hospitalization, disability, birth defects, or even death, and require intensive medical intervention

Question 21

approximately one third of ADRs result from

Answer 21

medication errors and up to one third from allergic reactions.

Question 22

top five drug classes responsible for ADRs

Answer 22

insulin, opioid -containing analgesics, anticoagulants, amoxicillin containing medications, antihistamines or cold remedies

Question 23

top five drug classes indicated in precipitating hospitalizations after admission to the ED include

Answer 23

anticoagulants, insulins, opioid containing analgesics, oral hypoglycemic medications, and antineoplastic agents

Question 24

in older adult population, more than half of all ADRs require treatment in the ED are due to

Answer 24

drugs influencing blood clotting, predominantly warfarin

Question 25

Steven Johnson syndrome

Answer 25

(SJS) is a rare, serious disorder of the skin and mucous membranes. It’s usually a reaction to medication that starts with flu-like symptoms, followed by a painful rash that spreads and blisters. Then the top layer of affected skin dies, sheds and begins to heal after several days.

Question 26

Of the top 10 drugs linked to skin reactions the majority are

Answer 26

Antibiotics, amoxicillin, ampicillin, the date, blood products, cephalosporins, erythromycin, diatribe losing hydrochloride, penicillin G,

Question 27

Risk factors for ADRs include

Answer 27

Genetic abnormalities, age, sex, polypharmacy, and con commitment medical conditions.

Question 28

Genetic factors that affect the bodies ability to

Answer 28

Metabolize medications can contribute to pharmacological and idiosyncratic reactions. Although rare, some people have DNA mutations that predispose them to develop ADRs. For example, an individual has an alteration in liver enzyme activity secondary to a gene mutation, the rate at which effective medications are metabolized may be increased or decreased, thus altering the concentration of active, inactive, and potentially toxic drug products in the circulation.

Question 29

A common mediator for immune responses is variations in the

Answer 29

HLA – B allele. For example, patients who express the HLA – B5701 allele are not at a significantly increased risk of severe T cell mediated hypersensitivity reactions to the HIV medication abcavir. Additionally, Han Chinese, who express HLA – B15024 HLA – B*5801 alleles, are at higher risk of hypersensitivity reactions to carbamazepine and allopurinol, respectively.

Question 30

Children are at higher risk primarily because

Answer 30

Medication dosages must be tailored to their specific weight or body mass index.

Question 31

Hospitalizations in individuals over 65 due to ADRs are most commonly a result of

Answer 31

Unintentional overdose. More than half of ADRs and hospitalized patients 70 years of age or older are considered to be preventable. Therefore all prescriptions working with these population should take care to minimize polypharmacy, unless clinically necessary, to reduce the risk of drug to drug interactions, confusion between medications, and drug accumulation with insufficient renal and hepatic function.

Question 32

It is been estimated that 90% of pediatric ADRs might be prevented by

Answer 32

Prescriber computer order entry and clinical decision support and clinical pharmacist consultation in this high-risk population

Question 33

Women have more ADRs than men in part due to

Answer 33

Differences in body composition. Furthermore ADRs may be related to pregnancy and lactation.

Question 34

Induction

Answer 34

Liver enzymes speed up the effects of a drug

Question 35

Inhibition

Answer 35

Liver enzymes slow down the rate of metabolism and clearance of drugs that flow through the same enzyme pathway.

Question 36

Carbamazepine does want to oral contraceptives

Answer 36

Make some less effective due to the induction of the medication increasing metabolism and clearance

Question 37

Amlodipine does what to simvastatin

Answer 37

Inhibits liver enzymes that metabolize it and can result in myopathy and possibly rhabdomyolysis.

Question 38

Most drug interactions can be identified by

Answer 38

Reviewing patient medication profiles and using computerized drug interaction screening tool such as micro medics, online facts and comparisons, orthodoxy can’t.

Question 39

The best example of food drug interactions is

Answer 39

Grapefruit reducing the clearance of simvastatin and increasing risk of myopathy, or herbal products such as St. John’s wort reducing clearance of cyclosporine.

Question 40

Trimethoprim-sulfamethoxazole does what to warfarin

Answer 40

Metabolism is reduced, resulting in an increase in the international normalized ratio and prothrombin time. Ultimately this increases the risk of bleeding and should be avoided if possible,

Question 41

Medications that are extensively cleared from the body through the kidneys have,

Answer 41

specific dosage adjustments or contraindications for use based on creating clearance or estimated communal or filtration rate

Question 42

Ranitidine requires a dose reduction to hundred and 50 mg per 24 hours when

Answer 42

Creatine clearances less than 50 mL a minute and Metformin is contraindicated when estimated globular filtration rate is less than 30.

Question 43

Heart failure decreases

Answer 43

Liver and kidney perfusion and can reduce metabolism and clearance. Similarly thyroid dysfunction can alter drug metabolism

Question 44

It’s important to remember that most (90%) identify drug interactions will

Answer 44

not have clinical consequences for an individual patient but to represent a warning to monitor the patient for a potential problem.

Question 45

Smaller number (perhaps 2%) of identified drug interactions will

Answer 45

Have profound clinical consequences, thus identifying and preventing these ADRs are crucial.

Question 46

Many drug suspected of causing an ADR are

Answer 46

Probably discontinued and should be if the offending drug can be safely stopped, if the event is life-threatening or intolerable, if continuing the medication will worsen the patient’s condition, and if there is a reasonable alternative treatment.

Question 47

Drugs responsible for an ADR may be continued in

Answer 47

A patient if the drug is medically necessary and there is no acceptable alternative treatment or if the adverse reactions tolerable and reversible. Most adverse reactions related to dose and pharmacological effects or respond favorably to dosage adjustment.

Question 48

If the ADR resolves after discontinuation of the medication and the adverse event was

Answer 48

Likely caused by the discontinuation medication. The only definitive indicator for casualty is the recurrence of an adverse event after re-challenge, which is three administration of the potential for new drug. As long as no other medication changes are made and no change in the patient’s health status occurs, the reappearance of an ADR after rechallenge confirms casualty. Rechallenge is not a common practice and is generally not appropriate, especially for life-threatening ADRs.

Question 49

Naranjo ADR probability scale

Answer 49

Developed framework for assessing the probability that an adverse reaction is related to administration of a particular drug. The Naranjo protocol, based on timing partner history and reports, rechallenge, alternative causes, dose dependency, and objective evidence, defines relationship between drug and adverse reaction as definite probable possible or doubtful based on scoring.

Question 50

FDA post marketing reporting program seek to identify

Answer 50

Problems not identified before approval, as well as many problems that may arise related to drug labeling manufacturing.

Question 51

The FDA maintains the

Answer 51

Adverse event reporting system, a computerized database of adverse events for approved drugs and biologicals.

Question 52

Medwatch is the FDA’s

Answer 52

Safety information and adverse event reporting program that provides health care professionals with medical product information on prescription and nonprescription drugs, biologicals, medical devices, and nutritional products,

Question 53

A separate program used to report adverse events related to vaccinations unlike Medwatch allows voluntary reporting of adverse events by both healthcare professionals and consumers

Answer 53

Vaccine adverse event reporting system