Other and Adverse Drug Reactions

Question 0

Dose of folic acid

Answer 0

Macro anaemia- 5-15mg/day for 4mo
Pregnancy- 400 micrograms
High risk individuals eg SCD- 5mg/day

Question 1

Thiamine (B1) dose

Answer 1

Mild: 25-100mg daily
Severe: 200-300mg daily in divided doses

Question 2

Dose of prednisolone

Answer 2

Maintenance-2.5-15mg
Start-10-40mg (depending on indication)
Max- 60mg
BONE PROTECT!

Question 3

Dose of ferrous sulphate

Answer 3

Anaemia: 200mg TDS
Prophylaxis: 200mg OD

Question 4

Dose of chlorphenamine

Answer 4

PO: 4mg 4-6hrly, max 24mg /day

IM/Slow IV: 10mg, max 4 times/24hours

Question 5

Dose of cetirizine

Answer 5

10mg OD

Question 6

Dose of allopurinol

Answer 6

100mg OD after food increased to 100-300mg maintenance

Severe: 700-900mg/day

Question 7

Mechanism of action of latanoprost

Answer 7

Prostaglandin F2a analogue to reduce intraocular pressure

Question 8

Drugs to be therapeutically monitored

Answer 8

Digoxin
Theophylline
Lithium
Phenytoin
Gentamicin

Question 9

Type A drug reactions

Answer 9

Predictable and dose related
Often part of the main action or a side effect (eg N/V)
Caused by wrong dose/route of admin or individual variation

Question 10

Type B drug reactions

Answer 10

Idiosyncratic and unpredictable
Not dose related
Severe 
Uncommon
Caused by allergies or genetics (eg G6PD)

Question 11

Type I allergic ADR

Answer 11

IgE mediated eg anaphylaxis to penicillin

Question 12

Type II allergic ADR

Answer 12

IgG/IgM mediated eg quinine/platelets or methyldopa/red cells

Question 13

Type III allergic ADR

Answer 13

Immune complex mediated eg co-trimoxazole drug fever, lymphadenopathy, glomerulonephritis

Question 14

Type IV allergic ADR

Answer 14

Delayed hypersensitivity eg contact dermatitis to topical antibiotic

Question 15

Causes of type B ADR w/rash

Answer 15

Stevens-Johnson syndrome to penicillin, sulfonamides, phenytoin

Question 16

Cause of type B ADR lymphadenopathy

Answer 16

Phenytoin

Question 17

Causes of type B ADR blood dyscrasias

Answer 17

Agranulocytosis with carbimazole or clozapine

Thrombocytopenia with heparin and thiazides

Question 18

Cause of type B ADR nephropathy

Answer 18

Aminoglycosides

Question 19

Cause of type B ADR hepatic disease

Answer 19

Chlorpromazine
halothane
statins

Question 20

Causes of type B ADR SLE

Answer 20

Hydralazine

Isoniazid

Question 21

Causes of type B ADR neuropathy

Answer 21

Amiodarone

Nitrofurantoin

Question 22

Definition of type C ADR

Answer 22

Long term damage occurring with continued drug use

Question 23

Examples of type C ADRs

Answer 23

Corticosteroids = osteoporosis
Neuroleptics = dyskinesia 
Dexfenfluramine = pulmonary HTN/valve stenosis 
Methotrexate = cirrhosis
Amiodarone = pulmonary fibrosis 
HRT = endometrial Ca

Question 24

Definition of type D ADR

Answer 24

Delayed reaction or congenital issues

Question 25

Definition of type E ADRs

Answer 25

Reaction which occurs when drug is ceased

Question 26

Examples of type E ADR

Answer 26

``` Prednisolone = addisonian crisis Atenolol = tachycardia/angina Diazepam = insomnia/seizures Alcohol = DTs Opioids = withdrawal syndrome ```

Question 27

Drugs not to use in penicillin allergy

Answer 27

``` Penicillins (obv) Tazocin Meropenem Aztreonam Use cephalosporins with caution ```

Question 28

CYP450 enzyme inducers

Answer 28

``` Rifampicin Phenytoin Barbiturates Carbamazepine Ethanol Sulphonylureas Nevirapine ```

Question 29

CYP450 enzyme inhibitors

Answer 29

``` Abx Cimetidine Ethanol Ketoconazole Diltiazem/verapamil Omeprazole/lansoprazole Sodium valproate Quinidine 5HT reuptake blockers Protease inhibitors ```

Question 30

Effect of cimetidine on warfarin

Answer 30

Increased INR

Question 31

Effect of Abx (eryth, clarith, cipro, cimetidine) on theophylline

Answer 31

Theophylline toxicity

Question 32

Effect of ketoconazole on cyclosporine

Answer 32

Cyclosporine toxicity

Question 33

Effect of cimetidine or omeprazole on phenytoin

Answer 33

Phenytoin toxicity

Question 34

Important nephrotoxic drugs

Answer 34

``` NSAIDs Diuretics Amphotericin B Cisplatin Gold Penicillamine Aminoglycosides Lithium ```

Question 35

Drugs which cause dose dependent hepatitis

Answer 35

Paracetamol, alcohol, azathioprine

Question 36

Drug causes of dose independent hepatitis

Answer 36

Isoniazid, pyrazinamide, amiodarone, nifedipine, halothane

Question 37

Drug causes of fatty liver diseases

Answer 37

Alcohol, tetracyclines

Question 38

Drug cause of decreased bilirubin excretion

Answer 38

Oestrogens

Question 39

Drug causes of choleostasis

Answer 39

Chlorpromazine, chlorpropamide, erythromycin/clarithromycin, nitrofurantoin, nifedipine, co-amoxiclav

Question 40

Cause of a drug induced raised INR

Answer 40

Inhibited P450 enzyme (see card)

Question 41

Sildenafil and nitrates?

Answer 41

Nooooooooooooo | Too much vasodilation

Question 42

Monitoring parameters for statins

Answer 42

LFT at baseline, 3mo and 12mo

Question 43

Monitoring parameters for ACE inhibitors

Answer 43

U&E prior, after increasing dose and annually

Question 44

Monitoring parameters for amiodarone

Answer 44

TFT LFT U&E and CXR prior to treatment | TFT AND LFT every 6mo

Question 45

Monitoring parameters for methotrexate

Answer 45

FBC, LFT, U&E before treatment, weekly until stabilised therapy, every 2-3mo after

Question 46

Monitoring parameters for azathioprine

Answer 46

FBC, LFT before treatment FBC weekly for 4 weeks FBC, LFT every 3mo

Question 47

Monitoring parameters for lithium

Answer 47

TFT, U&E before treatment Lithium levels weekly until stabilised then 3monthly TFT, U&E every 6mo

Question 48

Monitoring parameters of sodium valproate

Answer 48

LFT, FBC before treatment | LFT "periodically" during first 6mo

Question 49

Monitoring parameters of glitazones

Answer 49

LFT before treatment | "Regularly" during