Pharmacology Flashcards
What is adverse drug event
Any untoward medical occurrence that may present during treatment with a pharmaceutical product which does necessarily have causal relationship with this treatment
Adverse drug rxn
Response to drug which is noxious and unintended
Occurs at doses normally used in man for prophylaxis, diagnosis, therapy or modification of physiological function
What is a significant ADR
Any unexpected, unintended, undesired or excessive response to drug that requires discontinuing drug , changing drug, modifying the dose significantly , admission to the hospital, prolong stay in healthcare supportive treatment,, complicate diagnosis , affect prognosis negatively, temporary or permanent harm , disability or death
Can you have ADR if prescription and dosage are correct
Yes
T or F ? ADE are associated with inappropriate use of drug or other confounded occurring during drug therapy but not necessarily caused by drug pharmacology
True
Is causal relation required for ADE
No
Which can be caused by medication errors , ADE or ADR ?
ADE
Medication error definition
Any preventable event that may cause or lead to inappropriate use or patient harm while medication is in the control of the health care professional, paient or consumer
Pharmacovigilance définition
Study of drug related injuries and making warning or withdrawal recommendation for pharmaceutical agents through detection, assessment, understanding and prevention of ADRs
Classification of ADRs
Type A - augmentation effect Type B - bizarre effect Type C - chronic effect Type D - delayed effect Type E- withdrawal effect Type D - unexpected failure of therapy
Is augmented type rxn dose related
Yes
Characteristics of augmented type rxn
Common
Exaggerated pharmacological response of drug
Is augmented type rxn predictable
Yes
Mortality level of augmented type response
Low mortality
Example of augmented rxn
TCA dry mouth Opioids respiratory depression Warfarin bleeding SSRI serotonin syndrome Digoxin toxicity
Management of augmented rxn
Reduce dose
Withhold drug
Consider effect of concomitantt therapy
Is bizarre type rxn dose related
No
Is bizarre type rxn common
Uncommon
Is bizarre type rxn related to pharmacology of drug
No
Is bizarre type rxn predictable
Unpredictable
Mortality level in bizarre type rxn
High
Example of bizarre type rxn
Anaphylaxis to penicillin
Malignant hyperthermia with general anesthetics
Bizarre type rxn management
Withhold
Avoid in future
Chronic type rxn dose related ?
Yes
Is chronic type rxn common
Uncommon
How is chronic type rxn related to dose
Related to cumulative dose
Example of chronic rxn
HPA axis suppression by corticosteroids
Osteonecrosis of jaw by biphosphonates
Is delayed type rxn dose related
Usually
Is delayed type relation time related
Yes
Is delayed type rxn common
Uncommon
Example of time delayed rxn TPE
Crcinogenesis estrogen
Tardive dyskenisia levodopa
Tératogénies is thalidomide
Leucopenia lomustine
Management of delayed rxn
Intractable
Withdrawal rxn occur at which moment in treatment
At the end of use
Is withdrawal rxn common
Uncommon
Example of withdrawal rxn
Opiates
Benzodiazepines
Management of withdrawal rxn
Reintroduce drug and withdraw slowly
Failure of therapy rxn common ?
Common
Is unexpected failure of therapy dose related
Yes
Main cause of failure of therapy rxn
Drug interactions
Example of unexpected failure of therapy
Inadequate dosage of oral contraceptive with enzyme inducer
Resistance to anti microbial agents
Management of unexpected failure of treatment
Increase dosage
Concomitant therapy consideration
Another way to classification ADR
Non immunologic
Immunologic
What are predictable non immunologic rxn
Side effects ( antihistamine dry mouth ) Drug toxicity (hepatotoxicity methotrexate ) Drug drug interaction ( theophylline seizure with erythromycin ) Drug overdose ( seizure from excessive lidocaine )
Unpredictable non immunologic rxn
Pseudoallergic ( anaphylaxis avec radio contrast )
Idiosyncratic ( hemolytic anemia in G6PD deficiency after primaquine therapy )
Intolerance ( tinnitus after single small dose of aspirin )
Immunologic rxn
Type I -IgE mediated (b-lactam)
Type II - cytotoxic ( hemolytic anemia penicillin )
Type III- immune complex (serum sickness form antithymocyte globulin complex)
Type IV- delayed cell mediated ( contact dermatitis topical antihistamine )
Specific T cell activation (morbiliform rash from sulfonamides)
Fas / Fas ligand induced apoptosis (Steven Johnson syndrome )
Drug induced
Anticonvulsant
Hypersensitivity syndrome
Lupus like syndrome
Example of cutaneous ADRS
drug reaction with eosinophilia and systemic symptoms
Acute geenralized exanthématiques pustulosis
Toxic epidermal necrolysis
Drug classes most responsible for ADRs
Corticosteroids Antibiotics Anticoagulants Antineoplastic Immunosuppressive drugs Cardiovascular drugs NSAIDs Opiates
Children most prevalent classes drugs for ADRs
Anti infective drugs
Respiratory drugs
Vaccines
Grading of ADRs
Minor -> no therapy nothing
Moderate -> change in drug therapy , specific treatment /prolong hospital stay
Severe -> life threatening , permanent damage , intensive medical treatment
Lethal -> direct or indirect contribution to death
Name of assessment done to each ADRs to find future drug therapies
Causality assessment
