Classifications of adverse drug effect

Question 1

Type A

Answer 1

(augmented) - relates to the pharmacologic effect and cytotoxicity of the drug and its metabolites to the site of metabolism, predictable and dose-related. E.g. paracetamol hepatotoxicity - hepatic CYP2E1, alkylating intermediates, glutathione, covalent binding, N-acetylcysteine; gentamicin nephrotoxicity - aminoglycoside antibacterial ribosomal protein

Question 2

Type B

Answer 2

(bizarre) - not pharmacological action related, not predictable nor dose related, allergic reactions (acute hypersensitivity, skin rash, haematological reaction) or pharmacogenetic variability. E.g. benzylpenicillin allergy - penicilloyl-protein complex or penicillin polymers; carbamazepine skin reaction, genotyping

Question 3

Type C

Answer 3

(chronic) - due to long term treatment, alter receptor expression and/or tissue sensitivity, reaction occur during or after therapy. E.g. haloperidol-induced dyskinesia - psychosis, dopamine, involuntary movement

Question 4

Type E

Answer 4

(end) - withdrawal reaction after abrupt cessation. E.g. dexamethasone-induced adrenocorticoid insufficiency - adrenal atrophy

Question 5

Type D

Answer 5

(delayed) - E.g. doxorubicin or cyclophosphamide-induced secondary cancers - combination chemotherapy, mutagenic, carcinogenic; doxycycline-induced tooth discolouration and malformation

Question 6

Type F

Answer 6

(failure)