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A13THP @ UoN > Drug Safety - ADRs and Drug Interactions > Flashcards

Drug Safety - ADRs and Drug Interactions Flashcards

1
Q

What is the difference between ADRs & Side Effects?

A

Side effects can be adverse or beneficial, ADRs are only adverse

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2
Q

What proportion of hospital admissions are ADR related?

A

5%

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3
Q

What are the most common causes of hospital admissions for ADRs?

A

NSAIDs
Diuretics
Warfarin

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4
Q

Define Type A ADRs

A

Adverse
Normal pharmacological response is undesirable
Dose-related & predictable
Managed by dose adjustment

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5
Q

Describe several common antimuscarinic side effects

A

Dry Mouth
Blurred Vision
Constipation
Urinary Retention

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6
Q

Describe several common beta blocker side effects

A

Cold Extremities
Bradycardia
Nightmares
Bronchospasm

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7
Q

Describe the main side effect of cimetidine/spironolactione

A

Gynaecomastia

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8
Q

Describe the main side effect of opioids/antimuscarinics

A

Constipation

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9
Q

Describe the most common side effect of antibiotics

A

Diarrhoea

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10
Q

Describe the side effects of NSAIDs/Beta Blockers in Asthma sufferers

A

NSAIDs - Wheezing

B-blocker - Fatal Bronchospasm

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11
Q

Describe several common side effects of Digoxin

A

Nausea
Vomiting
Visual Disturbances

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12
Q

Describe the main side effect of cytotoxics

A

Myelosuppression

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13
Q

Describe the most common side effect of NSAIDs

A

Gastric Damage

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14
Q

Changes in what two pharmacokinetic factors most commonly lead to ADRs?

A

Absorption

Elimination (R+H)

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15
Q

What value can be used to estimate renal function?

A

GFR/eGFR

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16
Q

Why do neonates/elderly conjugate drugs at a slower rate?

A

Microsomal enzyme activity decreases at extremes of age

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17
Q

How can LFTs be used to predict liver metabolic function?

A

They cannot - poorly predict metabolic activity

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18
Q

Define Type B ADRs

A 
Bizarre (Idiosyncratic)
Unpredictable
Rare
Often severe
Related to genetics/immunology
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19
Q

What is the pathophysiology underlying a penicillin allergy?

A

Penicillins couple to proteins, form immunogens

Type 1 Hypersensitivity reaction

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20
Q

How should penicillin allergies be treated?

A

H1-antagonist

21
Q

What are the two most common haematological ADRs?

A

Agranulocytosis

Thrombocytopenia

22
Q

Describe Agranulocytosis

A 
Absence of neutrophils (mouth ulcers, severe sore throat, infections)
Caused by:
-Clozapine
-Carbimzole
-Carbamazepine
23
Q

Describe Thrombocytopenia

A

Low platelet count (bruising/bleeding)

24
Q

What patients are particularly at risk for gastric damage when treated with NSAIDs?

A

Over 65

History of ulcers

25
Q

What treatment is available to reduce the risk of gastric damage when treating with NSAIDs?

A

Prophylaxis w/ PPIs

Misoprostol

26
Q

In what group is treatment w/ Misoprostol contraindicated?

A

Pregnant women (all women of child bearing age not proven non-pregnant)

27
Q

What ADRs may NSAIDs cause in patients suffering from CVD?

A

Fluid retention

Exacerbated hypertension/CHF

28
Q

How do NSAIDs cause renal damage?

A

Inhibit renal PGs
Reduced renal blood flow
Reduced GFR

29
Q

Why are beta-blockers contraindicated in asthma?

A

Block bronchial B2 adrenoceptors

Cause bronchospasm

30
Q

What ADR are statins associated with most commonly?

A

Muscle damage/myopathy

Progresses to Rhabdomyolysis

31
Q

What are the most common skin ADRs?

A

Urticaria
Erythematous Eruptions - reddening, maculopapular
Toxic Epidermal Necrolysis - blistering, peeling skin
Stevens-Johnson Syndrome - fever, rash, blisters

32
Q

Define Drug Interactions

A

An interaction occurs when the effects of one drug are changed by the presence of another drug, food, drink or an environmental chemical agent

33
Q

Alterations in which pharmacokinetic mechanisms may lead to drug interactions?

A

Absorption - 2 drugs may interact, alter rate of uptake
pH - passive absorption of drugs best in uncharged form (rises in pH influence absorption)
Binding - ie. colestyramine
GI Motility - changes in motility/gastric emptying affect absorption (Metoclopramde acc. absorption)

34
Q

What are the two CYP-mediated mechanisms of drug interaction?

A

Inhibition

Induction

35
Q

Describe CYP Inhibition

A

Inhibition of CYP enzymes resulting in decreased metabolism
Occurs immediately
Reverses quickly
ie. Erythromycin

36
Q

Describe CYP Induction

A

Induction of CYP enzymes resulting in increased metabolism
May take a week or 2
Persist on stopping
ie. Rifampicin, Carbamazepine

37
Q

What drugs are contraindicated with Simvastatin?

A

Macrolides (complete contraindication)

Amlodipine, Verapamil, Diltiazem (lower statin dose)

38
Q

Describe the interaction between NSAIDs and Methotrexate

A

Compete for elimination

Leads to myelosuppression

39
Q

What effect does pH have on renal elimination?

A

Increased pH = Increased Excretion of Weak Acids

40
Q

Describe the interaction between Diuretics and ACEi

A

Diuretics lead to volume depletion

w/ ACEi risk of severe first dose hypotension

41
Q

Describe the interaction between loop and thiazide diuretics

A

Cause hypokalaemia (increase digoxin toxicity)

42
Q

In what situation might K-sparing diuretics cause hyperkalaemia?

A

Concordant treatment w/ K supplements or ACEis

43
Q

Define Pharmacological Interactions

A

When the actions of one drug opposes/augments the effect of another

44
Q

Describe the interaction between Beta Blockers and RL Ca Channel Blockers

A

Risk of potentially fatal bradycardia/asystole

AVOID

45
Q

Describe the interaction between Warfarin and NSAIDs

A

Increased bleeding

Monitor w/ INR

46
Q

What is St. John’s Wort?

A

A herbal medicine that is a potent inducer

47
Q

What drugs should St. John’s Wort not be taken with?

A 
Oral contraceptives
Antiepileptics
HIV drugs
Ciclosporin
Warfarin
Simvastatin
MAOIs/SSRIs (Serotonergic syndrome)
48
Q

Which drugs have significant interactions with Alcohol?

A

Labels 2/4
CNS depressant
Few antibiotics (Metronidazole = nausea)
Gastric effects

49
Q

What are the most clinically important drug interactions?

A

Warfarin w/ NSAIDs (bleeding)
Warfarin w/ Erythromycin/Ciprofloxacin (bleeding)
NSAIDs w/ Methotrexate (methotrexate toxicity)
ACEis w/ K+ sparing diuretics (hyperkalaemia)
Verapamil w/ B-Blockers (asystole)
Digoxin w/ Amiodarone (digoxin toxicity)
Digoxin w/ Verapamil (digoxin toxicity)
Oral Contraceptives w/Inducers (failure of OC)

A13THP @ UoN (19 decks)

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