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DEN303 - IHD > Drug Interactions - Adverse Effects > Flashcards

Drug Interactions - Adverse Effects Flashcards

1
Q

Drug allergy - characteristics

A

Delay after initial exposure
Precipitated with small doses of drug
Does not resemble normal pharmacology
Classic symptoms of allergic response

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2
Q

Drug allergy factors can be

A

Host related

Drug related

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3
Q

Drug related factors

A

Nature of drug
Degree of exposure
Route of admin.
Cross sensitisation i.e reactivity to similar drugs

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4
Q

Degree of exposure

A

Dose, duration, frequency, repeated administration

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5
Q

Penicillins rate of reaction

A

More frequent parenteral rather than orally

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6
Q

Host related factors

A 
Age (20-49 at higher risk)
Sex - more common in women
Genetic factors
Diseases
Previous exposure
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7
Q

Anaphylaxis

A

Acute response

Potentially fatal

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8
Q

Incidence of anaphylaxis (drug related)

A

3/100000 - deaths are 1-2/100000

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9
Q

Mechanisms of anaphylaxis

A

release of inflammatory mediators from mast cells –> oedema and tissue damage

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10
Q

Inflammatory mediators

A

Histamines and prostaglandins

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11
Q

Signs of anaphylaxis

A

Skin
Swelling
Runny nose

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12
Q

Symptoms of anaphylaxis

A

Gastrointestinal
Respiratory
Incontinence
CNS

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13
Q

Anaphylaxis in dentistry

A

Deaths occur from penicillin, aspirin, LA

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14
Q

Treatment of anaphylaxis in dentistry

A

Adrenaline
Anti histamine
Steroids
Bronchodilator

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15
Q

Stephen Johnson syndrome

A

Bizarre type B reaction e.g to anti-gout med (allopurinol)
Pain relievers
Antibiotics
Anti-epileptic medication

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16
Q

Drug-drug interaction mechanisms (3)

A

Pharmaceutical
Pharmacodynamic
Pharmacokinetic (Absorption, Distribution, Metabolism, Excretion)

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17
Q

e.g 1 LA and vasoconstrictor e.g Lidocaine and adrenaline

A

Adrenaline enhances effect of lidocaine by slowing absorption from site of action into circulation

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18
Q

Result of LA and VC interaction

A

Prolonged anaesthesia
Reduced bleeding
Reduced system toxicity

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19
Q

Pharmacodynamics e.g warfarin

A

Increased risk of anticoag - inhibits Vit K recycling by depleting active form in liver

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20
Q

Pharmacokinetic

A

Not for water soluble drugs
Drugs usually metabolised in liver and are digested by cytochrome P450 enzymes
Involves enzyme inhibitors which increase blood levels and inducers which reduce blood levels

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21
Q

Adverse events occur in

A

10-20% of hospitalised patients

22
Q

Type A reaction

A

Pharmacological/toxic effect of a drug

23
Q

Type B reaction

A

Idiosyncrasy and drug allergy

24
Q

Types of pharmaceutical in dentistry (4)

A

Sedative
LA
Analgesic
Antibiotics

25
Q

Therapeutic index

A

A ratio that compares the blood concentration at which a drug becomes toxic and the concentration at which the drug is effective.

26
Q

Higher TI

A

Drug is safer

27
Q

Lower TI

A

Drug needs to be monitored more carefully

28
Q

Circumstances of adverse drug effects (2)

A

Accidental/deliberate overdose

Normal therapy side effects

29
Q

Site of action (2)

A

Localised e.g aspirin –> ulcers, GI irritation

Systemic - most reactions

30
Q

Time Course (3) and give examples

A

Acute toxicity - single intake e.g morphine
Sub-acute toxicity - repeated exposure for hrs/days - tetracycline
Chronic toxicity - repeated exposure for m/y - carcinogenesis

31
Q

Factors affecting adverse effects (3)

A

Circumstances
Site of action
Time course

32
Q

Type A mechanism (Augmented)

A 
Exaggerated therapeutic response
Secondary unwanted actions
More predictable effects
Dose dependent 
Low mortality 
Decrease dose to stop run
33
Q

Type B mechanism (bizarre)

A

Pharmacologically unpredictable/idiosyncratic
Immunologic (allergic/anaphylactic)
Idiosyncratic (abnormal adverse reactions where mechanism not understood)

34
Q

Type A concerns - major/minor and examples of cause

A 
Resp. depression (narcotics)
Cardiac toxicity (overdose of IV)

Diarrhoea (antibiotics)
Dry mouth (antidepressants)
Drowsiness (CNS drugs)

35
Q

Risk factors of reaction (6)

A 
Childhood
Elderly 
Pregnancy 
Lactation 
Renal failure (poor filtration) 
Haemodialysis
36
Q

Pharmacokinetic stages (4)

A

Absorption
Distribution
Metabolism
Excretion

37
Q

Absorption e.g tetracycline is reduced by

A

chelation of drugs/foods/vitamins/divalent cations e.g Ca2+

38
Q

Distribution (abnormal)

A

Sequestration of tetracycline in bone leads to depression of bone growth in children and irreversible staining of enamel

39
Q

Metabolism

A

Interactions are usually due to effects on drug metabolising enzymes
Results in inhibition or induction of that enzyme

40
Q

Metabolism can be altered by (give example) (2)

A

Disease e.g renal/hepatic dysfunction

Inherited factors

41
Q

Excretion (controlled by, factors affecting, results)

A

Glomerular filtration, tubular secretion and tubular reabsorption
Kidney function, protein binding, urine pH and urine flow
Accumulation of drugs eliminated by kidneys

42
Q

Type B reaction characteristics

A 
No dose relation 
Uncertain mechanism 
Pseudo allergy
Not reproducible e.g anaphylaxis 
Immunoallergic reactions 
Cause uncertain 
Low incidence 
High mortality 
Treatment needs to stop if occurs
43
Q

Anaphylaxis signs and symptoms

A 
Swelling of lips/tongue/throat
CNS dysfunction 
Fast/slow heart rate and low BP 
Skin itching, hives and flushing 
Respiratory - shortness of breath, wheezing 
GI - cramping, vomiting, diarrhoea
44
Q

Erythromycin example
Increases effect of?
Mechanism?

A

Warfarin, carbamazepine, theophylline, cyclosporin

Inhibit CYP450

45
Q

Midazolam example

Increased plasma conc by

A

Erythromycin, grapefruit juice, omeprazole

Inhibits CYP3A –> sedation

46
Q

St John’s Wort

A 
Herbal drug for anxiety 
Enhances metabolism and reduces plasma levels therefore efficacy 
Affects oral contraceptive
Immunosuppressant 
Midazolam
47
Q

Lidocaine and liver

A

Lidocaine is CYP3A4 substrate
Clearance limited by hepatic blood flow
HBF reduced by propranolol
Hepatic enzyme metabolism inhibited by cimetidine

48
Q

LA
Safety
Mechanism
XS

A

Safe is used within dosage
Inhibits neuronal activity
Initially stimulates CNS then depresses (in XS)
XS leads to addictive effect

49
Q

Mortality due to LA - max dose

A

MD more rapidly reached with 3% mepivacaine than 2% lidocaine

50
Q

Adrenaline a/beta agonists
a1
b2

A

vasoconstriction - skin and mucous membrane

vasodilation - skeletal muscles

51
Q

Benzodiazepines (examples)

A

Diazepam/Temazepam

52
Q

Benzodiazepines

Mechanism

A 
Inhibit CYP3A4
Increased plasma 
or 
Induction 
decreased plasma

DEN303 - IHD (58 decks)

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