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Drugs In Healthcare > Focus On ADR > Flashcards

Focus On ADR Flashcards

1
Q

Adverse DRUG REACTION ADR

A

Any reaction that is ‘noxious, unintended and occurs at doses normally used in man’, where there is reasonable probability that it is caused by a drug

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2
Q

Adverse drug event ADE

A

Any untoward medical occurrence in someone administered a drug which doesn’t necessarily have a casual relationship with this treatment

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3
Q

Allergy is ADR or ADE

A

A type of ADR
Relatively uncommon e.g affecting 1 in 100 to 1 in 1000

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4
Q

Allergy cause:

A

Immunologically mediated: Immediate (IgE) hypersensitivity or Delayed (IgG) hypersensitivity

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5
Q

Allergy is triggered by?

A

An interaction between the drug and host protein- generating a ‘hapten’ which drives and immune response

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6
Q

Sensitisation

A

A mild allergic reaction could be more sever next time around

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7
Q

Side effects

A

Any effect of a drug that occurs in addition to the intended effect

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8
Q

ADR defined in terms of side effect

A

ADR is any harmful/unpleasant effect that occurs in addition to the intended effect

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9
Q

Prostaglandin eye drop : use and side effect

A

Used to treat glaucoma, a condition of raised pressure inside the eyeball
Side effect= longer eyelashes

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10
Q

Why are ADR important?

A

Major problem in clinical reactive and DD
Represent 7% of acute hospital admissions
Commonest reason for drug withdrawal and failure of new drugs to reach the market

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11
Q

Classification of ADRS

A

A- augumented/dose dependent
B- bizarre
C- continued use
D- delayed onset
E- end of treatment
F- failure of treatment

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12
Q

How are ADRs classified?

A

Depending on time of onset and relationship with dose

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13
Q

NAPQI

A

Highly reactive, oxidises key enzymes, causing cell death (apoptosis)
Can also bind renal cells to cause renal failure

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14
Q

Overdose of paracetamol explained=

A

Phase 2 metabolism = saturated
More in phase 1 = increased NAPQI = hepatotoxic/ nephrotoxic

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15
Q

Role of N- acetylcysteine in paracetamol overdose

A

Replenishes glutathione to mop up excess NAPQI

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16
Q

Describe TYPE A ADR

A

AUGUMENTED
Dose related: will affect everyone if they take enough of the drug

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17
Q

Examples of drug causing type A toxicity:

A

Opiates (morphine, codeine)
Carbon tetrachloride (dry cleaner) =liver necrosis
Acute alcohol ingestion = hepatitis

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18
Q

38 year old. Recent diagnosis of epilepsy. Started on carbamazepine. 7 days later develops a fever, sore throat and painful eyes. Then develops painful ulcers in mouth and rash all over body. What TYPE OF ADR IS THIS?

A

Type B reactions- Bizarre
Not dose related, may occur at therapeutic doses

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19
Q

Describe Type B reactions- Bizarre

A

Unpredictable , ‘idiosyncratic’ e.g allergic reactions
Caused by some unusual characteristic of the patient and the drug in combination
NOt related to PD of drug or metabolite

20
Q

Stevens-Johnson syndrome is a from of what?

A

Form of allergic reaction = TYPE IV (delayed/ IgG mediated) hypersensitivity

21
Q

Stevens-Johnson syndrome stimulates?

A

Cytotoxic T cells ( I.e CD8+ T cells) and T helper cells (I.e CD4+ T cells) to initiate autoimmune reactions that attack the skim and mucous membranes

22
Q

Stevens-Johnson syndrome allele is prevalent in?

A

Han Chinese and Thai people

23
Q

Stevens-Johnson syndrome associated with what allele?

A

HLA-B*1502 allele, gene variant that codes for the immune system

24
Q

CT Scans measure?

A

Density - black is not dense
White= very dense I.e bones and sometimes blood shows white is ‘contrast’ dye injected into blood

25
Q

Alcohol metabolism explain

A

Alcohol dehydrogenase- (transforms ethanol into toxic compound =by product ) acetylaldehyde
CYP450- changes in oxidation/ reduction

26
Q

Alcohol liver injury

A

Fatty change (alcohol steatosis)
Hepatitis

27
Q

Alcohol cirrhosis

A

Destruction and fibrosis with regenerating nodules

28
Q

Scarring of the liver caused by cirrhosis increases?

A

The pressure in the portal vein, causing fluid to leak into the abdomen

29
Q

Type C reaction - continued use explained

A

Caused by dose accumulation or long term use

30
Q

Examples of Type C reaction

A

Steroids- impaired insulin sensitivity, weight gain, reduction in bone density
Methotrexate- fibrosis (scarring) of lungs and liver
Amiodarone - fibrosis( scarring) of lungs and liver, grey tinge to skin
Spironolactone (aldosterone antagonist) - gynaecomastia (breast growth) and reduced libido

31
Q

Type D reaction is?

A

Delayed onset due to prolonged use in drug which doesn’t tend to accumulate
May occur even if drug has been stopped
Liver damage may not be apparent until some years after drug is taken

32
Q

Examples of Type D reaction

A

Tardive dyskinesia (abnormal facial movement) from antipsychotics
Hepatocellular carcinoma from alcohol
Mesothelioma from asbestos

33
Q

Type E reactions are typically caused by?

A

End of treatment
Typically caused by withdrawal or rebound effects

34
Q

Examples of Type E:

A

Opiates (recurrence of pain)
Benzodiazepines (recurrence of agitation and potentially seizure)
Corticosteroids (loss of psychological production of steroids can lead to addisonian crisis)

35
Q

Type F reactions is? Define?

A

Failure of treatment
Unexpected failure o treatment, despite normal dosing
Can occur at any stage of treatment

36
Q

The F reactions often involve?

A

Drug-drug reaction

37
Q

St John’s wort is?

A

An enzyme inducer- it increases activity of CYP450 enzymes that metabolise contraceptive hormones

38
Q

General principles to treat ADRs-

A

Look at what clarification of ADR
AND report the reaction - yellow card scheme

39
Q

What can increased ADRs?

A

Co-morbidities
Drug interactions
Special groups (pregnant women, children and the elderly)

40
Q

General principles to treat ADRs- Augumented

A

Reduce dose o withhold

41
Q

General principles to treat ADRs- bizarre

A

Stop drug- depending on severity, often reaction is a ‘absolute contraindication’
May need drugs to treat allergy (antihistamines, steroids, adrenaline)

42
Q

General principles to treat ADRs- continued use

A

Recognition of potential for this and use drug sparingly/for shortens amount of time if possible
If ADR develops, stop drug or reduce dose

43
Q

General principles to treat ADRs- delayed onset

A

Recognition for potential for this ; balance risks and benefits of drug and discuss with patient

44
Q

General principles to treat ADRs- end of treatment

A

May need to restart treatment
If need to stop this should be done slowly reducing the dose over weeks/months

45
Q

General principles to treat ADRs- failure to treatment

A

Prevent by clinician and patient being aware of drug-drug interactions and what to avoid
Stop any new rugs causing interactions
Increase dose of initial drug if safe to do so, or switch to a different treatment

Drugs In Healthcare (12 decks)

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