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0. Foundations of Medicine > Drug Therapy : Adverse Drug Reactions > Flashcards

Drug Therapy : Adverse Drug Reactions Flashcards

1
Q

<p>What are adverse drug reactions?</p>

A

<p>Any response to a drug which is noxious, unintended and occurs at doses used in man for prophylaxis (treatment to prevent disease), diagnosis or treatment</p>

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2
Q

<p>What is prophylaxis?</p>

A

<p>Treatment to prevent disease</p>

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3
Q

<p>Adverse drug reactions are the what cause of death (number)?</p>

A

<p>4th leading cause of death</p>

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4
Q

<p>How much hospital admissions occur due to adverse drug reactions?</p>

A

<p>6.5%</p>

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5
Q

<p>How many inpatients suffer adverse drug reactions?</p>

A

<p>10-20%</p>

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6
Q

<p>What are the 3 classifications of the onset of adverse drug reactions?</p>

A

<p>Acute</p>

<p>Sub-acute</p>

<p>Latent</p>

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7
Q

<p>When do acute adverse drug reactions occur?</p>

A

<p>Within 60 seconds</p>

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8
Q

<p>What is an example of an acute adverse drug reaction?</p>

A

<p>Bronchoconstriction</p>

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9
Q

<p>When do sub-acute adverse drug reactions occur?</p>

A

<p>1 to 24 hours</p>

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10
Q

<p>What are examples of sub-acute adverse drug reactions?</p>

A

<p>Rash</p>

<p>Serum sickness</p>

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11
Q

<p>When do latent adverse drug reactions occur?</p>

A

<p>More than 2 days later</p>

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12
Q

<p>What is an example of a latent adverse drug reaction?</p>

A

<p>Eczematous eruptions</p>

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13
Q

<p>What are the 3 classifications of the severity of adverse drug reactions?</p>

A

<p>Mild</p>

<p>Moderate</p>

<p>Severe</p>

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14
Q

<p>What is a mild adverse drug reaction?</p>

A

<p>Bothersome but requires no change in therapy</p>

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15
Q

<p>What is an example of a mild adverse drug reaction?</p>

A

<p>Metallic taste with metronidazole</p>

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16
Q

<p>What is a moderate adverse drug reaction?</p>

A

<p>One which requires a change in therapy and some additional treatment</p>

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17
Q

<p>What is an example of a moderate adverse drug reaction?</p>

A

<p>Amphotericin induced hypokalaemia</p>

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18
Q

<p>What is a severe adverse drug reaction?</p>

A

<p>Disabling or life threatening</p>

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19
Q

<p>What is an example of a severe adverse drug reaction?</p>

A

<p>Kidney failure</p>

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20
Q

<p>What are the classifications of adverse drug reactions?</p>

A

<p>Type A (augmented)</p>

<p>Type B (bizarre)</p>

<p>Type C (chronic)</p>

<p>Type D (delayed)</p>

<p>Type E (end of treatment)</p>

<p>Type F (failure of treatment)</p>

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21
Q

<p>How can type A (augmented) drug reactions be described?</p>

A

<p>Dose related</p>

<p>Predictable</p>

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22
Q

<p>How can type B (bizarre) adverse drug reactions be described?</p>

A

<p>Idiopathic</p>

<p>Unpredictable</p>

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23
Q

<p>What are predisposing factors of adverse drug reactions?</p>

A

<p>Multiple drug therapy (incidents increase exponentially with the number of medicaments)</p>

<p>Inter-current disease (renal and hepatic impairments)</p>

<p>Race and genetic polymorphisms</p>

<p>Age (elderly and neonates)</p>

<p>Sex (more common in woman)</p>

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24
Q

<p>What does predisposing mean?</p>

A

<p>Make more liable</p>

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25
Q

<p>What are some inter-current diseases that increases the risk of adverse drug reactions?</p>

A

<p>Renal and hepatic impairment</p>

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26
Q

<p>Who are more likely to experience adverse drug reactions out of men and woman?</p>

A

<p>Woman</p>

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27
Q

<p>What are type A (augmented) adverse drug reactions due to?</p>

A

<p>Excess pharmacological action</p>

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28
Q

<p>What are examples of excess pharmacological action that causes type A (augmented) adverse drug reactions?</p>

A

<p>Bradycardia with beta-blockers</p>

<p>Hypoglycaemia with insulin</p>

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29
Q

<p>What is the most common adverse reaction and what percentage of total reactions does this account for?</p>

A

<p>80% of adverse drug reactions are type A (augmented)</p>

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30
Q

<p>What are the 2 types of type A (augmented) adverse drug reactions?</p>

A

<p>Augmentation of the primary effect</p>

<p>Secondary effect</p>

31
Q

<p>What are some common type A adverse reactions?</p>

A

<p>Galactorrhoea with domperidon</p>

<p>Dry mouth with tricylic antidepressants</p>

<p>Glynaecomastia with spironolactone</p>

<p>Bronchospasm with beta blockers</p>

32
Q

<p>What could some reasons for type A (augmented) adverse drug reactions be?</p>

A

<p>Too high a dose</p>

<p>Pharmaceutical variation</p>

<p>Pharmacokinetic variation</p>

<p>Pharmacodynamic variation</p>

33
Q

<p>What are examples of pharmacodynamic variations?</p>

A

<p>Variations in:</p>

<p>Dose<br></br>Distribution<br></br>Metabolism<br></br>Elimination</p>

34
Q

<p>What is pharmacogenetics?</p>

A

<p>The study of inherited genetic differences in drug metabolic pathways</p>

35
Q

<p>What are a number of drugs metabolised via, which is under genetic control?</p>

A

<p>Acetylation</p>

36
Q

<p>What are people who are slow metabolisers of drugs prone to?</p>

A

<p>Drug toxicity</p>

37
Q

<p>What diseases increase the likeliness of adverse drug reactions?</p>

A

<p>Renal and hepatic impairment</p>

<p>Cardiac failure</p>

38
Q

<p>Why do renal and hepatic impairments increases the risk of adverse drug reactions?</p>

A

<p>Not excreted or metabolised so will build up and be toxic</p>

39
Q

<p>Why does cardiac failure lead to increased risk of adverse drug reactions?</p>

A

<p>Reduced drug absorption from gut so it builds up and becomes toxic</p>

40
Q

<p>What are most type A adverse drug reactions in nature?</p>

A

<p>Pharmacokinetic</p>

41
Q

<p>What can you say about type B (bizarre) adverse drug reactions and dose?</p>

A

<p>Type B reactions are unrelated to dose</p>

42
Q

<p>What can you say about the reversibility of type A and type B adverse drug reactions?</p>

A

<p>Type A are readilly reversible whereas type B are not</p>

43
Q

<p>What are type B adverse drug reactions common with?</p>

A

<p>Macromolecules</p>

<p>Patients with a history of asthma</p>

<p>HLA status (presence of particular HLA increases risk)</p>

44
Q

<p>What are some macromolecules associated with type B (bizarre) adverse drug reactions?</p>

A

<p>Proteins</p>

<p>Vaccines</p>

<p>Polypeptides</p>

45
Q

<p>What are the 2 mechanisms of type B adverse drug reactions?</p>

A

<p>Idiosyncratic (peculiar, individual)</p>

<p>Drug allergy or hypersensitivity</p>

46
Q

<p>What are idiosyncritic type B adverse drug reactions due to?</p>

A

<p>Genetic abnormality such as enzyme dificiency or abnormal receptor activity</p>

47
Q

<p>What are the properties of hypersensitive type B adverse drug reactions?</p>

A

<p>No relation to the pharmacological action of the drug</p>

<p>Delay between exposure and adverse drug reaction</p>

<p>No dose response curve</p>

48
Q

<p>What is pharmacodynamics?</p>

A

<p>Branch of pharmacology concerned with the effects of drugs and the mechanisms of their actions</p>

49
Q

<p>What may a difference in the response to a drug, in terms of pharmogenetics, be considered as?</p>

A

<p>Genetic</p>

<p>Immunological</p>

50
Q

<p>What are the kinds of genetic abnormalities that lead to unpredictable responses to drugs?</p>

A

<p>Enzyme abnormality</p>

<p>Receptor abnormality</p>

51
Q

<p>What are type C (chronic) adverse drug reactions related to?</p>

A

<p>Duration of treatment as well as the dose</p>

52
Q

<p>What do type C (chronic) adverse reactions not occur with?</p>

A

<p>A single dose</p>

53
Q

<p>What are examples of type C adverse drug reactions?</p>

A

<p>Iatrogenic Cushings disease</p>

<p>Steroid induced osteoporosis</p>

<p>Opiate dependance</p>

54
Q

<p>What are type D adverse drug reactions?</p>

A

<p>Delayed, occuring a long time after treatment</p>

55
Q

<p>What are examples of type D (delayed) adversed drug reactions?</p>

A

<p>Teratogenesis</p>

<p>Carcinogenesis</p>

<p></p>

56
Q

<p>What is an example of teratogenesis type D adverse drug reaction?</p>

A

<p>Craniofacial malformations in children whose mothers were treated with isotreoin</p>

57
Q

<p>What is an example of carcinogenesis type D adverse drug reaction?</p>

A

<p>Second cancers in those treated with alkylating agens or immunosuppresive agents</p>

58
Q

<p>What is teratogenesis?</p>

A

<p>Abnormal congenital malformations in the foetus following in utero exposure due to maternal medications use during 1st trimester of pregnancy</p>

59
Q

<p>What are some teratogenic agents?</p>

A

<p>Cytotoxics</p>

<p>Vitamin A</p>

<p>Antithyroid drugs</p>

<p>Steroids</p>

<p>Oral anticoagulants</p>

60
Q

<p>What drugs should be avoided during pregnancy?</p>

A

<p>All drugs unless they are safe or the benifits outweight the potential risks</p>

61
Q

<p>What are type E adverse drug reactions?</p>

A

<p>Adverse effects that occur when a drug treatment is stopped especially suddenly following long term use</p>

62
Q

<p>What are examples of things that can cause type E adverse drug reactions?</p>

A

<p>Unstable angina and MI when beta blockers are stopped</p>

<p>Addisonian crises when long term steroids are suddenly stopped</p>

<p>Withdrawal seizures when anti-epileptics are stopped</p>

<p>Alcohol</p>

63
Q

<p>When does rebound phenomena occur?</p>

A

<p>When adverse drugs are suddenly withdrawn</p>

64
Q

<p>What are some drugs that can cause a rebound phenomena?</p>

A

<p>Alcohol</p>

<p>Benzodiazepines</p>

<p>Beta blockers</p>

<p>Corticosteroids</p>

65
Q

<p>What are type F adverse drug reactions?</p>

A

<p>A failure of therapy</p>

66
Q

<p>What is the frequency of type F adverse drug reactions and what are they related to?</p>

A

<p>They are common and are dose related</p>

67
Q

<p>What are type F adverse drug reactions often caused by?</p>

A

<p>Drug interactions</p>

68
Q

<p>What is the process of diagnosing adverse drug reactions?</p>

A

<p>1) Differential diagnosis</p>

<p>2) Medication history (past and present)</p>

<p>3) Assess time of onset and dose relationship</p>

<p>4) Laboratory investigations (plasma concentration measurements and allergy tests)</p>

69
Q

<p>What are laboratory tests used to diagnose adverse drug reactions?</p>

A

<p>Plasma concentration measurements</p>

<p>Allergy tests</p>

70
Q

<p>Who are some people most at risk from adverse drug reactions?</p>

A

<p>Age (children and elderly)</p>

<p>Multiple medications</p>

<p>Multiple co-morbid conditions</p>

<p>Inappropriate prescribing, use, or monitoring</p>

<p>End-organ dysfunction</p>

<p>Altered physiology</p>

<p>Prior history of adverse drug reactions</p>

<p>Extent (dose) and duration of exposure</p>

<p>Genetic predisposition</p>

71
Q

<p>What are some drugs commonly involved in adverse drug reactions?</p>

A

<p>Antibiotics</p>

<p>Antineoplastic</p>

<p>Anticoagulants</p>

<p>Cardiovascular drugs</p>

<p>Hypoglycaemic</p>

<p>Antihypertensive</p>

<p>NSAID/analgesics</p>

<p>Diagnostic agents</p>

<p>CNS drugs</p>

<p>Opiates</p>

72
Q

<p>What are some body systems commonly involved in adverse drug reactions?</p>

A

<p>Haematologic</p>

<p>CNS</p>

<p>Dermatologic/Allergic</p>

<p>Metabolic</p>

<p>Cardiovascular</p>

<p>Gastrointestinal</p>

<p>Renal/genitourinary</p>

<p>Respiratory</p>

<p>Sensory</p>

73
Q

<p>What can adverse drug reactions be reported to?</p>

A

<p>Yellow card scheme which collects information about:</p>

<p>Side effects<br></br>Medical device adverse incidents<br></br>Defective medicines<br></br>Counterfeit or fake medicines or medical devices</p>

74
Q

<p>What does the yellow card scheme collect information about?</p>

A

<p>Side effects</p>

<p>Medical device adverse incidents</p>

<p>Defective medicines</p>

<p>Counterfeit or fake medicines or medical devices</p>

0. Foundations of Medicine (167 decks)

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