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notes to flashcards year 2 - LCRS1 > Adverse drug reactions > Flashcards

Adverse drug reactions Flashcards

1
Q

what is an adverse drug reaction?

A
  • preventable or unpredicted medication event with harm to the patient
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2
Q

what can ARDs be classified based on?

A
  • onset
  • severity
  • type
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3
Q

explain the classification based on ONSET

A
  • acute: within 1 hour
  • sub-acute: 1 to 24 hours
  • latent: >2 days
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4
Q

describe the classification based on severity

A
  • mild: required no change in therapy
  • moderate: requires changes in therapy, additional therapy
  • severe: disabling or life threatening, result in death, requires hospitalisation
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5
Q

in classification based on type, what is type A?

A
  • extension of pharmacologic effect
  • usually predictable and dose dependent
  • responsible for 2/3rds ARDs
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6
Q

give 2 examples of type A

A
  • atenolol: slow heart down, give too much may cause complete heart block
  • NSAIDs: chronic use = peptic ulcers
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7
Q

why is paracetamol a type A?

A
  • up to certain dose, paracetamol is pretty harmless

- beyond certain point, get serious toxicity that affects liver

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8
Q

describe type B ARDs

A
  • idiosynchratic or immunologic reactions
  • allergy and pseudoallergy
  • rare and unpredictable
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9
Q

give 2 examples of type B

A
  • Chloramphenicol: can cause aplastic anaemia

- ACE inhibitor can cause angioedema

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10
Q

describe type C ADRs

A
  • associated w/ long term use

- involves dose accumulation

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11
Q

give 2 examples of type C

A
  • methotrexate: liver toxicity

- antimalarials: ocular toxicity

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12
Q

what is type D ADR?

A
  • delayed effects: sometimes dose independent
  • carcinogenicity: e.g. immunosuppression
  • teratogenicity: e.g. thalidomide
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13
Q

What is type E ADR?

A
  • withdrawal reactions: e.g. opiates, benzodiazepines, corticosteroids
  • rebound reactions e.g. clonidine, beta blockers, corticosteroids
  • adaptive reactions neuroleptics (major tranquilisers)
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14
Q

what is clonidine rebound?

A
  • alpha 2 agonist
  • reduces release of NA from sympathetic neurones
  • reduction in symp outflow = drop in BP
  • if miss one or 2 doses, can lead to substantial RISE in BP
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15
Q

explain why missing a couple of doses causes a rise

A
  • long term use causes long term suppression of peripheral NA production
  • leads to compensatory upregulation in adrenergic receptors on post-synaptic neurone
  • upregulation in receptors means that when inhibition of NA release by clonidine is removed, NA produces again
  • has more receptors to act on = much greater effect
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16
Q

what is the ABCDE classification of ADR?

A
  • augmented pharm effect
  • bizarre
  • chronic
  • delayed
  • end of treatment
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17
Q

what are 4 classifications of allergies?

A
  • Type 1: immediate, anaphylactic (IgE)
  • type 2: cytotoxic antibody (IgG and IgM)
  • type 3: serum sickness (IgM and IgG): antigen-antibody complex
  • type 4: delayed hypersensitivity (T cell)
18
Q

give an example of type 1

A

anaphylaxis with penicillins

19
Q

give an example of type 2

A

methyldopa and HA

20
Q

give an example of type 3

A

procainamide-induced lupus

21
Q

give an example of type 4

A

contact dermatitis

22
Q

what pseudoallergy can aspirin/NSAIDs cause?

A
  • bronchospasm
  • inhibit production of prostanoids (bronchodilators)
  • accompanied by inc. leukotriene production (bronchoconstrictors)
23
Q

what pseudoallergy can ACE inhibitors cause?

A
  • cough/angioedema
  • stops breakdown of kinins
  • if kinin accumulates, triggers coughing
  • angioedema similar to anaphylaxis but not allergic
24
Q

what are common causes of ARDs?

A
  • antineoplastics
  • CV drugs
  • NSAIDs
  • CNS drugs
  • antibiotics
  • anticoagulants
  • hypoglycaemia
  • anti-hypertensives
25
Q

what are the ways in which ADRs are detected?

A
  • subjective report: pt complaint
  • objective report: direct observation for event, abnormal findings
  • yellow card scheme: system for reporting ADR
26
Q

what does pharmacodynamic mean?

A

related to drugs effect in body

27
Q

what does pharmacokinetic mean?

A

related to body’s effect on drugs

28
Q

what does pharmaceutical mean?

A

drugs interacting outside body

29
Q

what are additive effects and examples?

A
  • 2 drugs add together

- overlapping toxicities of ethanol and benzodiazepines

30
Q

what are synergistic effects and an example?

A
  • 2 drugs potentiate each others actions to get a greater effect than expected
  • e.g. synergistic actions of antibiotics
31
Q

what are antagonist effects and an example?

A
  • drugs that antagonize each other’s actions

- e.g. amitriptyline and acetylcholinesterase inhibitors

32
Q

in pharmacokinetic drug interactions, what is alteration in absorption?

A
  • chelation
  • irreversible binding of drugs in GIT that makes it difficult to absorb
    e. g. tetracyclines, quinolone
33
Q

in pharmacokinetic drug interactions, describe the protein binding effects

A
  • competition b/ drugs for protein or tissue binding sites
  • inc. in free conc = enhances pharmacological effects
  • PB interactions not usually clinical significant but few are
34
Q

give an example where PB interactions are significant

A

warfarin

very heavily protein bound, small inc. in unbound warfarin = big difference

35
Q

in pharmacokinetic drug interactions, describe drug metabolism

A
  • drug metabolism can be inhibited or enhanced by coadmin of other drugs
  • some drugs metabolized by single isozyme
  • most metabolised by multiple isozymes
36
Q

why is being metabolized by more than one enzyme useful?

A

if one of the isozymes is inhibited, other isozymes could inc. their activity to compensate for inhibited ioszyme

37
Q

what family of enzymes are involved in drug metabolism?

A

CYP450

38
Q

give examples of CYP450 inhibitors?

A
  • cimetidine (H2 antagonist)
  • erythomycin
  • ketoconazole
  • ritonavir
  • fluxetine
  • grapefruit juice
39
Q

give examples of CYP450 inducers

A
  • rifampicin

- carbamazepine

40
Q

give examples of 4 deliberate interactions

A
  • levodopa and carbidopa
  • ACE inhibitors and thiazides
  • penicillins and gentamycin
  • salbutamol and ipratropium

notes to flashcards year 2 - LCRS1 (58 decks)

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