4: Adverse drug reactions

Question 1

What is an adverse drug reaction?

Answer 1

Illness caused by medication

Question 2

What’s the difference between a side effect and an adverse drug reaction?

Answer 2

Side effects are caused by normal doses; subset of ADR (which may be caused by inappropriate doses e.g digoxin toxicity)

Question 3

Which group of patients commonly suffer ADRs?

Answer 3

Elderly

Those with co-morbidities

Those on loads of drugs already

Question 4

What is the therapeutic index of a drug?

Answer 4

Space between effective dose and toxic dose

Question 5

The greater the therapeutic index of a drug, the ___ it is.

Answer 5

safer

and vice versa

Question 6

How is therapeutic index calculated?

Answer 6

Therapeutic index = Toxic dose / Effective dose

Question 7

Which enzyme family usually metabolises drugs in the liver?

Answer 7

CYP450

Question 8

Where are most drugs excreted?

Answer 8

Bile

Urine

Question 9

What process usually goes wrong to cause an ADR?

Answer 9

CYP450 - oxidation, reduction or hydrolysis

Question 10

What are

Type A

Type B

ADRs?

Answer 10

Type A - predictable, dose-dependent reactions

Type B - unpredictable, dose-indepedent (weird reactions)

Question 11

What is a

Type C

Type D

Type E

ADR?

Answer 11

Type C - chronic reactions

Type D - delayed reactions

Type E - reactions seen when the drug is withdrawn

Question 12

What is a Type A ADR?

Answer 12

Predictable, dose-dependent reaction

Question 13

What type of ADR is dehydration associated with diuretic overdose?

Answer 13

Type A

Question 14

What type of ADR is ischaemic nephropathy associated with ACE inhibitor use during acute illness in someone with kidney disease?

Answer 14

Type A

Question 15

What antibiotic has a very low therapeutic index?

What does it damage in toxic doses?

Answer 15

Gentamicin

CN VIII, kidney tubules

Question 16

What can different drugs do to cause a Type A ADR?

Answer 16

Interact with one another

Question 17

Where can you find drug interactions before prescribing them for patients?

Answer 17

BNF

Question 18

Which family of antibiotics cause drug interactions?

Answer 18

Macrolides

(e.g azithromycin, clarithromycin, erythromycin)

WITH theophylline, statins

Question 19

What is a common

a) side effect
b) interaction

of ACE inhibitors?

Answer 19

a) Dry cough

b) Amplify hypoglycaemia caused by sulphonylureas

Question 20

What should you always ask about when taking a drug history?

Why?

Answer 20

Medication

OTC drugs

Herbal remedies

Because they may interact with certain drugs

Question 21

Patients with which disorder have an increased risk of drug-induced confusion?

Answer 21

Parkinson’s

Question 22

Which cardio condition can NSAIDs exacerbate?

Answer 22

Heart failure

Question 23

Anticholinergic drugs may cause which renal condition in men with BPH?

Answer 23

Urine retention

because they constrict the ureters (usually used to TREAT incontinence)

Question 24

Which drugs commonly exacerbate constipation?

Answer 24

Calcium

Anticholinergics

CCBs

Question 25

Which drugs classically exacerbate **asthma**? Why?

Answer 25

**Beta blockers** may non-selectively BLOCK beta2 adrenoceptors

Question 26

Foods which are rich in **potassium** interact with which drugs?

Answer 26

**ACE inhibitors** **ARBs** **Spironolactone and eplerenone**

Question 27

Foods rich in **Vitamin K** interact with which drug?

Answer 27

**Warfarin**

Question 28

What electrolyte should be restricted in those on ACE inhibitors, ARBs and K-sparing diuretics?

Answer 28

**Potassium** bananas!!!

Question 29

What is a Type B ADR?

Answer 29

**Dose-independent, unpredictable reactions**

Question 30

Out of Type A and Type B, which ADR is more dangerous?

Answer 30

**Type B**

Question 31

What is a **derm** presentation of potentially any drug?

Answer 31

**Rash**

Question 32

What is a **haem** presentation of potentially any drug?

Answer 32

**Bone marrow suppression**

Question 33

What is a **Type C** ADR?

Answer 33

**Chronic, predictable drug reaction**

Question 34

Long term **steroid** therapy can cause which ADRs?

Answer 34

**Cushing's** **Osteoporosis**

Question 35

**Long term beta blocker** use can cause which disease?

Answer 35

**Diabetes**

Question 36

What is a **Type D** ADR?

Answer 36

**Delayed reaction** not the same as chronic, often many years after stopping

Question 37

What kinds of disease are caused by **Type D** ADR?

Answer 37

**Congenital malformations, growth/developmental delay** - teratogenic drugs **Malignancy** - carcinogenic drugs

Question 38

What treatments FOR cancer can cause cancer?

Answer 38

**Radiotherapy** **Chemotherapy** **Phototherapy**

Question 39

What is a **Type E** ADR brought on by abruptly stopping beta blockers?

Answer 39

**Rebound tachycardia**

Question 40

What is a Type E ADR brought on by abruptly stopping long-term steroids?

Answer 40

**Addison's (disease or crisis)**

Question 41

What is found next to newly licensed drugs (which may have ADRs) in the BNF?

Answer 41

**Black triangle**

Question 42

How do you report ADRs of drugs?

Answer 42

**Yellow Card**