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Principles of Pharmacology > Drug Reactions > Flashcards

Drug Reactions Flashcards

1
Q

what is an adverse drug reaction?

A

any response to a drug which is noxious, unintended and occurs at doses used in man for prophylaxis, diagnosis or therapy

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2
Q

what are the predisposing factors of drug reactions?

A

age, gender, genetics, sex related, physiological, exogenous, diease-related

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3
Q

what is type A drug reaction?

A

augmented

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4
Q

what is type B drug reaction?

A

bizarre

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5
Q

what is type C drug reaction?

A

chronic

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6
Q

what is type D drug reaction?

A

delayed

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7
Q

what is type F drug reaction?

A

failure of therapy

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8
Q

what drug reactions are dose-related?

A

A, D and F

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9
Q

what are the features of type A?

A

common, related to pharmacological action, predictable, low mortality

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10
Q

how do you manage type A?

A

reduce dose or withhold, consider concomitant therapy

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11
Q

what is concomitant therapy?

A

occurring of existing at same time as something else

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12
Q

what are the causes of type A?

A

pharmaceutical variation, pharmacokinetic variation, pharmacodynamic variation

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13
Q

what is pharmaceutical variation?

A

changes in bioavailability, out of date formulations, contamination

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14
Q

what is an example of outdated drug use?

A

outdated tetracycline breaks down to produce anhydrotetracycline which is toxic and leads to Fanconi’s syndrome

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15
Q

what is fanconi’s syndrome?

A

impairment of the proximal tube function, substances normally reabsorbed into the blood are lost in urine

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16
Q

what is pharmacokinetic variation caused by in type A?

A

liver disease, renal disease, cardiac disease and drug interactions

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17
Q

how does liver failure effect pharmacokinetic variation?

A

severe hepatitis or advanced cirrhosis can reduce the clearance of drugs

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18
Q

what drugs have a low therapeutic ratio?

A

phenytoin, theophylline and warfarin

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19
Q

what does pharmacodynamic variation effect for type A?

A

changes in fluid/electrolyte balance and drug interactions

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20
Q

what is an example of a negative drug interaction that causes pharmacodynamic variation?

A

digoxin which is used to treat heart failure blocks the pump and competes with K, yet when K levels are low, the digoxin can bind more easily and have a dangerous level of effect

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21
Q

what are the features of type B?

A

uncommon, not related to the pharmacological action of the drug, unpredictable and high mortality

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22
Q

how is type B reaction managed?

A

withhold and avoid in future

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23
Q

what are the two negative effect that come with type B reactions?

A

immunological and pseudo allergic reactions

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24
Q

what is an example of an immunological reactions?

A

allergy to penicillin which happens as a result of degradation products combining with body proteins and become antigenic

25
Q

what is a pseudoallergic reaction?

A

reactions that resemble allergic reactions but for which no immunological basis has been found

26
Q

what is an example of pseudo allergic action?

A

aspirin-sensitive asthmatics where aspirin triggers attacks or ampicillin rash

27
Q

what are the adaptive effects of type C?

A

tolerance, adrenal suppression and tar dive dyskinesia

28
Q

what drugs cause tolerance?

A

narcotic analgesics

29
Q

what drugs cause adrenal suppression?

A

corticosteroids such as hydrocortisone

30
Q

what is tardive dyskinesia?

A

repetitive facial movements as a result of long term antipsychotic drug use

31
Q

how are glucocorticoid hormones controlled?

A

negative feedback

32
Q

what are glucocorticoids used to treat?

A

chronic inflammatory conditions such as rheumatoid arthritis

33
Q

what does prolonged treatment using glucocorticoids cause?

A

suppression of glucocorticoid synthesis by the adrenal cortex

34
Q

how can the adrenal cortex be allowed to recover?

A

gradual withdrawal of exogenous corticoids

35
Q

what are the features of type D?

A

uncommon, usually dose related, occurs of becomes apparent sometime after use of the drug

36
Q

how is type D managed?

A

often untreatable

37
Q

how is type D related to carcinogenesis?

A

increased risk with oestrogen such as in contraceptives and HRT

38
Q

what are the effects on reproduction for type D?

A

impaired fertility and teratogenesis

39
Q

how is fertility effected by drugs that show type D reactions?

A

cytotoxic drugs such as cyclophosphamide that are used in chemotherapy effect fertility

40
Q

what is teratogenesis and how is it effected by type D drugs?

A

thalidomide effecting the development of limbs

41
Q

what is type E drug reactions?

A

end of treatment

42
Q

what are the features of type E drug reaction?

A

uncommon and occurs soon after withdrawal of the drug

43
Q

what are examples of reactions associated with type E?

A

opiate withdrawal syndrome, mycardial ischaemia which is beta blocker withdrawal

44
Q

how are type E reactions managed?

A

reintroduce and withdraw slowly

45
Q

what disease can be caused by type E?

A

rebound phenomena

46
Q

what is rebound phenomena?

A

withdrawal of beta blockers that causes rebound tachycardia which then can cause a myocardial infarction

47
Q

what are the features of type F, failure of therapy?

A

common, dose-related and often caused by drug interactions

48
Q

what is an example of a type F reaction?

A

inadequate dosage of oral contraceptive, particularly when used with specific metabolism enzyme inducers e.g. rifampicin

49
Q

how is type F managed?

A

increase the dosage and consider effects of concomitant therapy

50
Q

how is pharmacogenetic variation caused in type F?

A

variation in receptor structure and pseudocholinesterase deficiency

51
Q

what is an example of phamacogenetic variation in type F?

A

pseudocholinesterase deficiency

52
Q

what is pseudocholinesterase deficiency?

A

succinylcholine which is used as a muscle relaxant can cause prolonged apnoea in patients who lack the enzyme to break it down

53
Q

what is an example of receptor variation in type F?

A

different variants of the beta-2 receptor in the lungs show a reduction in the response to agonists so less bronchodilation

54
Q

how can pharmacokinetic interactions interfere with absorption?

A

tetracycline binds to calcium and iron and so leads to reduced absorption

55
Q

what interactions cause an effect on pharmacokinetic action?

A

interference of absorption, competition for plasma protein, inhibition of metabolic enzymes and competition for elimination pathways

56
Q

how does competition for plasma protein binding occur?

A

warfarin vs aspirin

57
Q

how does inhibition of metabolic enzymes occur?

A

probenecid slows excretion of penicillin, NSAIDS inhibit excretion of lithium

58
Q

what is an example of pharmacodynamic interaction?

A

proponalol which is used to treat angina, can reduce the effect of salbutamol which is used to treat asthma

59
Q

how do levodopa and antipsychotics interact?

A

levodopa works by increasing synaptic dopamine levels in Parkinson’s disease yet antipsychotics block dopamine receptors to reduced the effect of levodopa

Principles of Pharmacology (12 decks)

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