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eLCRS - 팜 > pharm 22: adverse drug effects > Flashcards

pharm 22: adverse drug effects Flashcards

1
Q

By what 3 methods is Adverse drug Reactions classified by?

A

a) onset
- acute / subacute / latent
(< 1hr) (1 - 24hrs) (> 2days)

b) severity
- mild / moderate / severe

c) type
- A / B / C / D / E

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2
Q

What is meant by adverse drug event?

A
  • preventable or unpredicted medication event with harm to the patient
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3
Q

What might be some consequences of Severe ADR ?

A
  • death
  • life threatening
  • causes disability
  • requires intervention to prevent permanent injury
  • requires / prolongs hospitalization
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4
Q

What is meant by type A ADR?

A
  • extension of pharmacologic effect
  • usually predictable and dose dependent
  • -> responsible for at least two-thirds of ADRs

e.g atenolol –> heart block
NSAIDS –> Peptic ulcer

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5
Q

What is meant by type B ADR?

A
  • idiosyncratic or immunologic reactions
  • includes allergy and “pseudoallergy”
  • Unpredictable
  • rare

e.g ACE i –> Angioedema

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6
Q

What is meant by type C ADR?

A
  • associated with long-term use
  • involves dose accumulation

e.g., methotrexate –> liver fibrosis
(dependent on amount of drug given)

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7
Q

What is meant by type D ADR?

A

delayed effects

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8
Q

What is meant by type E ADR?

A
  • Withdrawal reactions (e.g opiate)
  • Rebound reactions (e.g corticosteroids/ beta blockers )
  • “Adaptive” reactions (neuroleptics - abnormal movements )
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9
Q

What are the 4 classifications of allergies:

Type 1 =
Type 2 =
Type 3 =
Type 4 =

A

Type 1 = immediate, anaphylactic (IgE)
Type 2 = cytotoxic antibody (IgG, IgM)
Type 3 = serum sickness (IgG, IgM)
Type 4 = delayed hypersensitivity (T cell) - e.g dermatitis

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10
Q

What is meant by pseudo allergies ?

A

Aspirin/NSAIDs – bronchospasm
- leukotrienes = proinflammatory –> causes bronchospasm

ACE inhibitors – cough/angioedema

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11
Q

What are common causes of ADR?

A
  • Antibiotics
  • Antineoplastics*
  • Anticoagulants
  • Cardiovascular drugs*
  • Hypoglycemics
  • Antihypertensives
  • NSAID/Analgesics*
  • CNS drugs*
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12
Q

How does ACE inhibitors cause angioedema?

A

angioedema = less severe anaphylaxis

- occurs due to build up of bradycardia –> pro inflammatory –> cause swelling in some patients )

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13
Q

How would you detect adverse drug reactions?

A
  • subjective report (Patient complaint)

- objective report (Abnormal findings in tests or examinations / direct observation of event e.g in ward)

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14
Q

What is the yellow card scheme with regards to adverse drug effects?

A

-

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15
Q

Note:

  • Usually rare events will probably not be detected before drug is marketed
A

-

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16
Q

define

  • Pharmacodynamic
  • Pharmacokinetic
  • Pharmaceutical
A

Pharmacodynamic = the drug’s effects in the body

Pharmacokinetic = Related to the body’s effects on the drug

Pharmaceutical = drugs interacting outside the body

17
Q

What are examples of Pharmacodynamic Drug Interactions?

A
  • Additive
  • synergistic (e.g antibiotics)
  • antagonistic effects
  • -> from co-administration of two or more drugs
18
Q

What is meant by Pharmacokinetic Drug Interactions?

A
  • Alteration in absorption (e.g chelation –> binding of drugs to GIT)
  • Alteration of Protein binding effects ( Competition btw drugs for protein or tissue binding sites e.g warfarin - highly protein bound)
  • Changes in drug metabolism
  • Alteration in elimination
19
Q

note:
determining drug interaction is:
- Difficult in determining contribution of drug interaction in complicated patients
- Lack of availability of comprehensive databases
- difficult to determine true incidence

A

-

20
Q

what are the 3 main methods of drug metabolism + elimination?

A
  • straight through kidney –> out
  • phase 1 reaction –> out
  • Phase 1 –> phase 2 –> out
  • phase 2 reaction –> out
21
Q

note: CYP 450 =
most drugs metabolized by more than 1 isozymes
- so interruption to CYP450 –> not very important clinically

A

-

22
Q

What are some of the usual suspects for CYP 450 Inhibitors?

A
  • Cimetidine
  • Erythromycin and related antibiotics
  • Ketoconazole etc
  • Ciprofloxacin and related antibiotics
  • Ritonavir and other HIV drugs
  • Fluoxetine and other SSRIs
  • Grapefruit juice

–> inhibition = very rapid

23
Q

What are some of the usual suspects for CYP 450 INDUCERS?

induction = production of genes

A
  • Rifampicin
  • Carbamazepine
  • St John’s Wort

–> induction = takes hours/ days

24
Q

Drug elimination interaction usually occurs in :

A

renal tubule !

  • thiazide increase excretion of sodium at the expense of lithium (BAD)
  • Probenecid when given with penicillin –> Increases pharmacological effect –> so you can use lower dose / prolongs effect etc.
25
Q

What are the 4 major deliberate drug interactions?

A
  • levodopa + carbidopa
  • ACE inhibitors + thiazides
  • penicillins + gentamicin
  • salbutamol + ipratropium
26
Q

How is giving probenecid with penicillin a good thing?

A

Probenecid when given with penicillin –> Increases pharmacological effect –> so you can use lower dose / prolongs effect etc.

27
Q

How is giving lithium with thiazide a bad thing?

A
  • thiazide increase excretion of sodium at the expense of lithium (BAD)

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