PED1003/L09 Variation to Drugs & Reactions Flashcards

1
Q

What is an adverse drug reaction?

A

Noxious or unpleasant unintended consequence of medicinal therapy at a dose intended for therapeutic effect and warrants a withdrawal of a drug

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2
Q

What must be taken into account regarding drug safety? (4)

A

Severity of adverse drug reaction
Disease
Therapeutic alternatives
Individual perception and acceptance of risk

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3
Q

Name 4 features suggesting a cause and effect relationship between drug administration and adverse drug reaction.

A

Time sequence between taking drug and adverse reaction
Reaction corresponds to known pharmacology of drug
Reaction stops on cessation of drug
Reaction returns on restarting the drug

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4
Q

What is The Yellow Card/

A

Documentation regarding adverse drug reactions

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5
Q

How is a side effect different from an adverse effect?

A

Unavoidable consequence of drug administration (less harmful than adverse drug reaction)

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6
Q

What is a secondary adverse effect?

A

Indirect causation, secondary to the drug e.g., opportunistic infections due to glucocorticoid therapy

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7
Q

What are the risk factors for adverse drug reactions? (3)

A

Age
Pregnancy
Co-morbidities
Polypharmacy
Lifestyle
History of allergies
Unknown/unpredictable

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8
Q

What percentage of global trial participants are white, Asian and Black?

A

76% white
11% Asian
7% black

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9
Q

Describe a type A adverse drug reaction.

A

Augmented pharmacological effect
Adverse effect that is known to occur from the primary pharmacology of the drug and is usually dose dependent

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10
Q

Describe a type B adverse drug reaction.

A

Bizarre effects
Adverse effects that are unpredictable from the pharmacology of the drug

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11
Q

Describe a type C adverse drug reaction.

A

Chronic effects
Occur as a result of chronic treatment of the drug

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12
Q

Describe a type D adverse drug reaction.

A

Delayed effects
Occur remote from treatment, either in children of treated patients or in patient themselves

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13
Q

Describe a type E adverse drug reaction.

A

End of treatment effects
Adverse effects occur as a result of stopping the treatment (withdrawal effects)

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14
Q

Give an example of a type A adverse drug reaction.

A

Bradycardia from treatment with B blocker
Hypoglycaemia from insulin injection
Tachycardia from muscarinic antagonist ipratropium

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15
Q

Give an example of a type B adverse drug reaction.

A

Anaphylaxis due to penicillin
Bone marrow suppression due to chloramphenicol
TGN1412 Northwick Park - drop in BP, nausea, pain, soft tissue damage, multi-organ failure due to excess cytokine release ‘cytokine storm’

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16
Q

Give an example of a type C adverse drug reaction.

A

Latrogenic Cushing syndrome from chronic glucocorticoid therapy

17
Q

Give an example of a type D adverse drug reaction.

A

Diethylstilbestrol given to pregnant mothers - high incidence of vaginal cancers in offspring in 20s
Isotretinoin (accutane) causes birth defects
Second cancers in response to Hodgkin’s disease treatment

18
Q

Give an example of a type E adverse drug reaction.

A

Adrenal insufficiency after glucocorticoid therapy

19
Q

Describe the normal regulation of metabolism by corticosteroids. (3)

A

Hypothalamic nuclei releases CRH
Anterior pituitary releases ACTH
Adrenal cortex releases cortisol

20
Q

Describe adrenal atrophy in response to glucocorticoid treatment. (4)

A

Exogenous glucocorticoids used for anti-inflammatory or immunosuppressives act on HPA axis
Negative feedback disturbed
Cause adrenal atrophy
Termination of treatment, decreased cortisol

21
Q

What 2 forms can adverse drug interaction modifications take?

A

Potentiation
Attenuation

22
Q

Describe pharmacodynamic interaction of drugs. (2)

A

Similar or opposing pharmacological effects
E.g., ethanol increasing the sedative effect of antihistamine drugs or certain antidepressants

23
Q

Describe pharmacokinetic interaction of drugs.(2)

A

One drug interferes with disposition (e.g., metabolism or excretion of drug) of the other
Monoamine oxidase inhibitors blocking metabolism of dietary amine

24
Q

What drug inhibits CYP450 and interferes with metabolism of other drugs?

A

Fluvoxamine

25
Q

Describe carbamazepine metabolism. (2)

A

CBZ parent drug -> CBZ-Epoxide via CYP3A3/4
CBZ-Epoxide metabolite -> CBZ-diol metabolite (inactive) via Epoxide hydrolase