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YR3S2- clinical therapeutics > wk 6- ADR > Flashcards

wk 6- ADR Flashcards

1
Q

types of adverse reactions

A

type A- augumented reactions

type B- hypersensitivity/bizzare

type C- chronic

type. D- delayed

type E - end of use

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2
Q

top 4 meds associated with Es

A

opioids
nsaids
aspirin
beta blockers

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3
Q

define ADR

A

any reaction to a drug that is harmful to a patient

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4
Q

things that contribute to ADRs (outside of patient factors)

A

-failing of clinical trials- not enough subjects to detect ADRs until in population

-medication errors (at the level of prescribing, dispensing, taking, adherence, monitoring)

-small therapeutic window

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5
Q

examples of low therapeutic index drugs

A

anticoagulants
insulin
cardiac glycosides
antiarrhythmics
TCA
anti cancer
immunosuppressants

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6
Q

ED50

A

effective dose required to produce 50% of max desired effect

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7
Q

LD50

A

lethal dose required to kill 50% of animals that receive it

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8
Q

What predisposes people to a TYPE A ADR

A
  1. very young or old- metabolism and excretion not as efficient
  2. distribution - affected by changes in body comp and availability of plasma protein for binding
  3. disease - liver, kidney, GI motility, plasma protein concentrations
  4. genetics- differences in enzyme activity which changes how the drugs are metabolised
  5. drug to drug interactions
    - one drug can increase or decrease the other
    - drugs that have opposite actions can cancel eachother out
    - drugs with same actions can potentiate one another
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9
Q

type B ADRs

A

-rare but unpredictable and not dose related

can be due to allergy or other causes

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10
Q

type B - idiosyncrasy

A

an effect unrelated to the action of the drug

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11
Q

type B - insensitivity and intolerance

A

outliers that respond differently to the vast majority

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12
Q

hypersensitivity reactions

A

immunological reaction to drugs

type 1 -
- type 4 hypersensitvity reactions

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13
Q

type 1 hypersensitvity reaction

A

anaphylaxis
allergen- IgE

antibodies attach to mast cells - release mediators (eg histamine)

local effects- hayfever, asthma, urticaria
systemic effects- swelling/anaphylaxis

occurs, minutes to hours after exposure

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14
Q

type 2

A

cytotoxic reaction

drug bind to blood cell membranes

IgG and IgM antibodies activate complement system and autolysis of RBCS

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15
Q

type 3 hypersensitivity reaction

A

immune complex reaction

drugs for immune complexes with antibodies which circulate in blood and can be deposited in particular areas of the body

occurs 1-3 weeks after exposure

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16
Q

type 4 hypersensitvity

A

drugs combine with proteins in the skin to form antigen

t cells activitated and cause damage to skin cells (rashes, lumps, itchy, weeping)

occurs 2-7 days after drug exposure

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17
Q

teratogenesis

A

drugs causing abnormal foetal development

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18
Q

carcinogenesis

A

drug induced tumours

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19
Q

risk of a drug to drug interaction for patients taking 2-5 drugs

A

19%

20
Q

risk of drug to drug interactions for patients taking 6 drugs

A

80%

21
Q

drug enzyme induction

A

drugs that increase the metabolism enzyme activity

increase removal of drug and decrease effectiveness

22
Q

drug enzyme inhibition

A

drugs that inhibit and cause accumulation of other drugs in the body

not removing the drug and therefore increases risk of side effects

23
Q

what do cyp450 enzymes do

A

found in liver and also small intestine, lungs, placenta nd kidneys and are responsible for metabolising 90% of drugs

24
Q

what do you need to be mindful of drugs that inhibit or induce cyp450

A

changes the removal/metabolism of drugs and can lead to ineffectiveness or side effects/toxicity

25
Q

review inducer/inhibitor table

A
26
Q

people at risk of ADRs

A

older people
children
chronic conditions
HF, DM, anaemia, asthma
changes in renal/hepatic function
genetic predisposition

27
Q

difference between women and men with ADRs

A

women are more likely to experience ADRs

28
Q

polypharmacy

A

increase in adverse drug reactions when more than 5 drugs are taken

29
Q

what age related changes occur in distribution in elderly

A

Distribution

body comp: more fat, less body water
plasma protein concentration: less with age
blood flow: after 30, CO, renal and hepatic blood flow fall

30
Q

what age related changes occur in metabolism in elderly

A
  • decreased size and cells of liver
    -decreased metabolism of drugs (1st pass metabolism reduced by 40%)
31
Q

other age related changes

A

-decreased renal clearance of drugs

-renal blood flow, GFR, active tubular secretory processes decline

-drugs excreted by kidneys are more likely to accumulate

32
Q

pharmacodynamic age related changes in elderly

A

increased sensitivity to drug receptors with age

renal/hepatic disease can affect drug response

unclear

33
Q

NSAIDs and the elderly

A

more likely induce gastric ulceration in older patients

due to:
1. reduced gastric mucosal prostaglandins
2. drug induced inhibition

34
Q

differences in ADME in infants and children

A
  1. reduced gastric pH
  2. delayed gastric emptying
  3. irregular GI motility
  4. more body water and less body fat
  5. reduced plasma proteins
  6. lower liver capacity to metabolise drugs
  7. delayed renal clearance
35
Q

how can drugs be transferred to the foetus in pregnancy

A

by diffusion

36
Q

biggest risk of malformation is up to

A

8 weeks post conception, avoid drugs during this time

37
Q

pregnancy category

A

category A- no risk
B- no risk in animal studies, women not studied
C- fetal harm in animals, no studies in women
D- evidence of human fetal risk but benefits > risk in life threatening situations
X- contraindicated in pregnant women

38
Q

what drugs can harm feotus

A
  1. Male hormones
  2. Female hormones
  3. Iron preparations
  4. Aspirin-like drugs
  5. Alcohol
  6. Barbiturates
39
Q

NSAID and pregnancy

A

-associated with spontaneous abortion

-not dose dependent, may be time/ duration dependent

-non aspirin NSAID (prescription and OTC)

40
Q

ADR risk factors

A
  1. polypharmacy
  2. Multiple comorbid conditions
  3. Drug dose and duration of exposure
  4. Extremes of age (neonates, children, elderly)
  5. Female sex
  6. Genetic predisposition
  7. Prior history of drug reactions and hypersensitivity
  8. End organ dysfunction
  9. Altered physiology
  10. Inappropriate medication prescribing, use or monitoring
  11. Lack of patient education and other system failures
41
Q

who do you report ADR to

A

TGA

on OTC, prescription, complementary

42
Q

elderly and adrs

A

polypharmacy

aging process (renal/hepatic function decreased)

adherence/cognitive impairment

multimorbidity

43
Q

what is the gold standard for offloading a diabetic forefoot lesion?

A

contact cast
-shouldnt use with infection
-shouildnt use in neuropathy

44
Q

non pharamcological magement for a dibaetic wound

A

-wound care/debridement
-dressing (antimicrobial, absorbant, etc)
-offloading (donut pads, insoles, rockers)

45
Q

when is clindamycin indicated

A

when theres an allergy to penicillin and cepholosporin

46
Q

what pharmacological options do you have for pain

A

non drug-
immobilise, othroses, footwear, exercises

drug-
NSAID (oral or topical)
opioid
corticosteroid (inject/topical)
antidepressents - chronic neuropathic pain or depression.

47
Q
A

YR3S2- clinical therapeutics (12 decks)

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