Pharmacology

Question 1

What is adverse drug event

Answer 1

Any untoward medical occurrence that may present during treatment with a pharmaceutical product which does necessarily have causal relationship with this treatment

Question 2

Adverse drug rxn

Answer 2

Response to drug which is noxious and unintended

Occurs at doses normally used in man for prophylaxis, diagnosis, therapy or modification of physiological function

Question 3

What is a significant ADR

Answer 3

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

Question 4

Can you have ADR if prescription and dosage are correct

Answer 4

Yes

Question 5

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

Answer 5

True

Question 6

Is causal relation required for ADE

Answer 6

No

Question 7

Which can be caused by medication errors , ADE or ADR ?

Answer 7

ADE

Question 8

Medication error definition

Answer 8

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

Question 9

Pharmacovigilance définition

Answer 9

Study of drug related injuries and making warning or withdrawal recommendation for pharmaceutical agents through detection, assessment, understanding and prevention of ADRs

Question 10

Classification of ADRs

Answer 10

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

Question 11

Is augmented type rxn dose related

Answer 11

Yes

Question 12

Characteristics of augmented type rxn

Answer 12

Common

Exaggerated pharmacological response of drug

Question 13

Is augmented type rxn predictable

Answer 13

Yes

Question 14

Mortality level of augmented type response

Answer 14

Low mortality

Question 15

Example of augmented rxn

Answer 15

TCA dry mouth 
Opioids respiratory depression 
Warfarin bleeding 
SSRI serotonin syndrome 
Digoxin toxicity

Question 16

Management of augmented rxn

Answer 16

Reduce dose
Withhold drug
Consider effect of concomitantt therapy

Question 17

Is bizarre type rxn dose related

Answer 17

No

Question 18

Is bizarre type rxn common

Answer 18

Uncommon

Question 19

Is bizarre type rxn related to pharmacology of drug

Answer 19

No

Question 20

Is bizarre type rxn predictable

Answer 20

Unpredictable

Question 21

Mortality level in bizarre type rxn

Answer 21

High

Question 22

Example of bizarre type rxn

Answer 22

Anaphylaxis to penicillin

Malignant hyperthermia with general anesthetics

Question 23

Bizarre type rxn management

Answer 23

Withhold

Avoid in future

Question 24

Chronic type rxn dose related ?

Answer 24

Yes

Question 25

Is chronic type rxn common

Answer 25

Uncommon

Question 26

How is chronic type rxn related to dose

Answer 26

Related to cumulative dose

Question 27

Example of chronic rxn

Answer 27

HPA axis suppression by corticosteroids | Osteonecrosis of jaw by biphosphonates

Question 28

Is delayed type rxn dose related

Answer 28

Usually

Question 29

Is delayed type relation time related

Answer 29

Yes

Question 30

Is delayed type rxn common

Answer 30

Uncommon

Question 31

Example of time delayed rxn TPE

Answer 31

Crcinogenesis estrogen Tardive dyskenisia levodopa Tératogénies is thalidomide Leucopenia lomustine

Question 32

Management of delayed rxn

Answer 32

Intractable

Question 33

Withdrawal rxn occur at which moment in treatment

Answer 33

At the end of use

Question 34

Is withdrawal rxn common

Answer 34

Uncommon

Question 35

Example of withdrawal rxn

Answer 35

Opiates | Benzodiazepines

Question 36

Management of withdrawal rxn

Answer 36

Reintroduce drug and withdraw slowly

Question 37

Failure of therapy rxn common ?

Answer 37

Common

Question 38

Is unexpected failure of therapy dose related

Answer 38

Yes

Question 39

Main cause of failure of therapy rxn

Answer 39

Drug interactions

Question 40

Example of unexpected failure of therapy

Answer 40

Inadequate dosage of oral contraceptive with enzyme inducer Resistance to anti microbial agents

Question 41

Management of unexpected failure of treatment

Answer 41

Increase dosage | Concomitant therapy consideration

Question 42

Another way to classification ADR

Answer 42

Non immunologic | Immunologic

Question 43

What are predictable non immunologic rxn

Answer 43

``` Side effects ( antihistamine dry mouth ) Drug toxicity (hepatotoxicity methotrexate ) Drug drug interaction ( theophylline seizure with erythromycin ) Drug overdose ( seizure from excessive lidocaine ) ```

Question 44

Unpredictable non immunologic rxn

Answer 44

Pseudoallergic ( anaphylaxis avec radio contrast ) Idiosyncratic ( hemolytic anemia in G6PD deficiency after primaquine therapy ) Intolerance ( tinnitus after single small dose of aspirin )

Question 45

Immunologic rxn

Answer 45

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

Question 46

Example of cutaneous ADRS

Answer 46

drug reaction with eosinophilia and systemic symptoms Acute geenralized exanthématiques pustulosis Toxic epidermal necrolysis

Question 47

Drug classes most responsible for ADRs

Answer 47

``` Corticosteroids Antibiotics Anticoagulants Antineoplastic Immunosuppressive drugs Cardiovascular drugs NSAIDs Opiates ```

Question 48

Children most prevalent classes drugs for ADRs

Answer 48

Anti infective drugs Respiratory drugs Vaccines

Question 49

Grading of ADRs

Answer 49

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

Question 50

Name of assessment done to each ADRs to find future drug therapies

Answer 50

Causality assessment