Exam #02a Flashcards
Name the 5 criteria the ASHP use to define an adverse drug reaction (ADR)?
- causes hospital admission
- prolongs hospitalization
- leads to drug discontinuation/dose modification
- complicates a disease state
- patient needs supportive therapy (ex. patient must be moved to ICU)
What % of hospitalized patients incur a serious ADR?
7%
What % of hospital admissions are due to an ADR? Which population of patients may be hospitalized due to an ADR more than any other population? What %?
3 - 6%
elderly
up to 20%
What % of ADR are considered preventable?
50%
True or False - ADR is a category of an adverse drug event (ADE)?
True
This term is defined as an injury resulting from administration of a drug?
ADE
Name the 5 types of ADE?
- ADRs
- Medication errors
- Adverse drug withdrawal events (taking patient off benzodiazepine too quickly)
- Therapeutic failures & non-compliance (taking Levoquin with iron - iron decreases Levoquin absorption by up to 90%
- Intentional/accidental poisonings
Are preventable ADRs medication errors?
YES!!
List 7 actions by a pharmacist that, if done, would be considered a preventable ADR?
- Giving an inappropriate drug for a patient’s condition or contraindicated drug
- giving a patient an inappropriate dose
- giving a patient a drug with known drug interactions to patient’s other meds
- incomplete monitoring
- patient has history of allergy or previous ADR and patient still receives the drug
- a toxic blood level/abnormal lab documented
- Poor patient compliance
What are the two types of ADRs?
Type A
Type B
Which ADR is related to the pharmacologic activity of the drug?
Type A ADR
Which ADR is predictable, usually preventable, and represents 70-80% of ADRs?
Type A ADR
Which ADR is related to allergic, immunologic reactions?
Type B ADR
Which ADR is unpredictable, often not preventable, and represents 20% of ADRs?
Type B ADR
True or False - both Type A and Type B ADRs can be life threatening?
True
True or False - drug allergies have no correlation with pharmacologic properties of the drug?
True
True or False - drug allergies are dose related?
False - they are not!
Name 6 signs/symptoms of a drug allergy?
- rash
- hives
- angioedema
- fever
- serum sickness
- anaphylactic shock
According to the Gell and Coombs classification of allergic reactions, what are Types I - IV?
I - anaphylactic (IgE)
II - Cytotoxic (Ab dependent prim. IgG, then IgM - ex blood binds to cell membrane causing immune response at that cell)
III - Immune complex (Prim. IgM, then IgG b/c IgM has multiple binding sites)
IV - Cell mediated (antigen binds to sensitized T lymphocyte, contact dermatitis)
For each mediator describe its effect during anaphylactic reaction:
- leukotrienes
- histamine
- prostaglandin
- bradykinin
- platelet activating factor
- leukotrienes - bronchoconstriction
- histamine - itching
- prostaglandin - vasodilator
- bradykinin - vasodilator
- platelet activating factor - vasodilator and bronchoconstriction
True or False - a Type I allergic reaction requires an initial sensitization?
True
True or False - pseudoallergy can occur with 1st exposure to drug?
True - does not need sensitization
Why is it called a pseudoallergy?
It looks like an allergic reaction, but the immune system is not involved
What does the degree of pseudoallergy seen depend on (2 things)
- dose dependent
2. ROA dependent
True or False - a pseudo allergy is sometimes related to incipient and not the drug itself?
True
Ex. emulsifiers used to deliver lipid soluble drugs
Name 3 properties of drugs that can cause a pseudoallegy?
- large molecular structure (most drugs are small and can’t elicit an allergy themselves)
- protein based drug
- hyperosmolar drug
What type of allergy would angioedema from an ACE inhibitor be considered?
pseudoallergy - the immune system is not involved
What protein in latex are some people allergic to? What does this have some cross sensitivity with?
HEVb protein
fruits (bananas, mango, papaya, guava)
What races are prone to hemolytic anemia due to G6PD deficiency?
- Mediterranean
- African
- Asian
Which race is a fast acetylator? Which is a slow acetylator?
fast - East Asian
slow - Mediterranean
FDA announced that manufacturers of which drug has to be labeled that before patient starts therapy on this drug, patients with Asian ancestry get a genetic blood test to identify a significantly increased risk of developing Stevens Johnson syndrome?
Carbamazepine (anticonvulsant used in epilepsy and bipolar disorder)
What population are most prone to ADRs?
elderly
Which pregnancy category represents a drug that is absolutely contraindicated and known to cause birth defects?
Category X
Which pregnancy category represents a drug that is proven to be teratogenic in humans, but the benefit of therapy might outweigh the risk to the child developing birth defects?
Category D
Would Valproic acid for epilepsy be considered Category X or D?
category D b/c the seizures may be more damaging to the child than the drug
