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Medicines, Patients and Public Health > ADRs and drug interactions > Flashcards

ADRs and drug interactions Flashcards

1
Q

What are the types of drug-disease interactions?

A

1) drug-herbal medicine interactions
2) drug-disease interactions
3) drug-food/drink interactions

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2
Q

What herbal medicine used for the treatment of depression interacts with a lot of medicines?

A

St John’s Wort

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3
Q

cautions

A

when a drug can be used in a patient with another specific medical condition but with caution

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4
Q

contraindications

A

when a drug must not be used in patients with another specific medical condition

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5
Q

What resources can you use to check whether a drug interacts with food or drink?

A

1) Stockley’s Drug Interactions
2) Cautionary and Advisory labels that appear on dispensing labels
3) summary of product characteristics (SPC) on medicines.org.uk/emc#gref

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6
Q

monoamine oxidase inhibitors (MAOIs)

A

a type of specialist use only antidepressant

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7
Q

Give some examples of MAOIs.

A

1) phenelzine
2) moclobemide
3) tranylcypromine
4) isocarboxazid
5) linezoid (antibiotic)

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8
Q

What do MAOIs interact with?

A

tyramine-containing foods

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9
Q

sympathomimetic

A

producing physiological effects characteristic of the sympathetic nervous system by promoting the stimulation of sympathetic nerves

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10
Q

How does tyramine act in the body?

A

liberates stored catecholamines

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11
Q

What are the effects of tyramine?

A

1) potentially fatal hypertensive crisis
2) arrhythmias
3) hyperthermia
4) cerebral haemorrhage
5) severe headache

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12
Q

What foods should patients on MAOIs avoid as they contain a high tyramine content?

A

1) aged meat/fish
2) stale
3) fermented
4) overly ripe
5) pickled
6) mature cheeses
7) yeast extracts
8) fermented soya bean products
9) offal
10) game
11) yoghurt
12) sour cream
13) cured meats
14) sauerkraut
15) miso soup
16) OXO
17) bovril
18) marmite
19) broad beans
20) excessive amounts of chocolate

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13
Q

What drinks should patients on MAOIs avoid?

A

1) undistilled alcoholic beverages
2) wine
3) beer
4) lager
5) excessive amounts of tea and coffee

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14
Q

How long does the interaction between food/drink + MAOIs persist after treatment is stopped?

A

2 weeks

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15
Q

Why does grapefruit/grapefruit juice interact with lots of different drugs?

A

grapefruit juice can block the action of CYP3A4 (by which many drugs are metabolised) leading to higher levels of the drug in the bloodstream

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16
Q

How does Natto, a japanese food made from fermented soya bean, reduce the effects of warfarin?

A

high levels of vitamin K2 are produced in the fermentation process

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17
Q

How does cranberry juice affect the anticoagulant effect of warfarin?

A

cranberry juice increases the INR of patients taking warfarin

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18
Q

How does alcohol affect warfarin?

A

heavy drinkers of alcohol may have a reduced response to coumarins + binge drinking may increase the risk of bleeding. this is because continuous heavy drinking stimulates the hepatic enzymes concerned with the metabolism of warfarin, leading to more rapid elimination

19
Q

bisphosphonates

A

drugs that help to strengthen bones + reduce the risk of a bone breaking

20
Q

What can impair absorption of bisphosphonates?

A

bisphosphonates can form complexes with a number of polyvalent metallic ions in food

21
Q

How should bisphosphonates be taken?

A

1) after an overnight fast
2) patients should wait at least 30 minutes to take any other drug/food
3) with plain water only while sitting/standing
4) tablets swallowed whole
5) oral solution swallowed as a single dose

22
Q

Why do bisphosphonates need to be taken with plenty of water whilst the patient is upright?

A

to reduce the risk of ulcers + bleeding

23
Q

How does dairy affect tetracyclines?

A

it binds calcium and iron, forming insoluble chelates, reducing its bioavailability

24
Q

How does dairy affect quinolones?

A

milk + yoghurt reduce the concentrations of ciprofloxacin by up to about 50%

25
Q

How does dairy affect bisphosphonates

A

it reduces the absorption of bisphosphonates

26
Q

Why do some medicines need to be taken with food?

A

to reduce the risk of adverse drug reactions (side-effects(

27
Q

Why do NSAIDs need to be taken with food?

A

to protect the stomach as NSAIDs can cause stomach ulcers + GI bleeding

28
Q

Why do corticosteroids need to be taken with food?

A

to protect the stomach as corticosteroids can cause stomach ulcers + GI bleeding

29
Q

Why do sulfonylureas need to be taken with food?

A

to reduce the risk of hypoglycaemia

30
Q

What are the possible effects of metronidazole/tinidazole and alcohol?

A

flushing + tachycardia (can occur up to 72 hours after stopping metronidazole)

31
Q

What is the effect of methotrexate/leflunomide + alcohol?

A

increased risk of methotrexate/leflunomide-induced hepatic cirrhosis + fibrosis

32
Q

What effect does alcohol have on other sedative drugs

A

increase of sedative effects

33
Q

How does tobacco affect theophylline/aminophylline?

A

the drug is cleared more quickly in those who use tobacco/those who are heavily exposed to passive smoking

34
Q

How does tobacco affect clozapine?

A

tobacco reduces clozapine concentrations

35
Q

How does tobacco affect combined hormonal contraceptives?

A

smoking increases the risk of cardiovascular disease in women given oral combined hormonal contraceptives

36
Q

ADRs

A

adverse drug reactions

37
Q

Where can you find out what adverse drug reactions/side-effects a drug can cause?

A

1) undesirable effects section of the SPC on medicines.org.uk/emc#gref
2) BNF side-effects section in each drug monograph

38
Q

What drugs are most frequently implicated in ADR-related hospital admissions?

A

1) NSAIDs and aspirin (anti-inflammatory painkillers)
2) Diuretics (used for oedema and heart failure)
3) Systemic corticosteroids (used for inflammatory conditions and steroid replacement therapy)
4) Inhaled beta-agonists (used for asthma and COPD)
5) Penicillins (a type of antibiotic)
6) Cephalosporins (a type of antibiotic)
7) Compound analgesia (painkillers that include more than one drug)
8) Macrolides (a type of antibiotic)
9) Heparins (used to thin the blood to prevent blood clots)
10) Warfarin and other anti-coagulants (used to thin the blood to prevent blood clots)
11) Antiplatelets (thin the blood to prevent heart attacks or strokes)
12) ACE inhibitors (used for high blood pressure and heart conditions)
13) Anti-depressants
14) Beta-blockers (used for heart conditions and anxiety)
15) Opiates (painkillers)
16) Digoxin (used for heart conditions)
17) Benzodiazepines

39
Q

What factors increase susceptibility to adverse drug reactions (ADRs)?

A

1) liver or kidney disease (reduced clearance of the drug)
2) polypharmacy (being on lots of different medicines)
3) alcohol consumption (particularly for drugs that interact with alcohol see earlier)
4) patients taking high risk drugs or drugs which are commonly implicated in hospital admissions.
5) multimorbidity (having lots of different medical conditions)
6) being prescribed drugs that are contraindicated because of the patient’s medical conditions or cautioned
7) being prescribed interacting drugs
8) variable bioavailability between different formulations (especially important for narrow therapeutic range drugs)
9) formulations affecting the risk of an ADR (sometimes MR formulations carry a lower risk of ADRs compared to immediate release but not always)
10) genetic polymorphisms may increase susceptibility to ADRs (such as polymorphisms in: cytochrome P450 enzymes; efflux transporter genes; HLA genes that can trigger an immune-mediated response such as SJS in Han Chinese patients; TPMT activity with azathioprine). G6PD (glucose-6-phosphate dehydrogenase) deficiency: increased risk of haemolytic anaemia with antimalarial drugs and sulphonamides
11) children (reduced metabolic capacity)
12) elderly (multiple co-morbidities; Impaired metabolism or excretion; Altered sensitivity of some organs; Poor compliance; Polypharmacy).
13) females tend to have more ADRs than males.

40
Q

List some drugs that cause hypokalaemia (low potassium).

A

1) beta-2-agonists
2) insulin
3) diuretic
4) mineralocorticoids + glucocorticoids
5) laxatives
6) (vomiting + diarrhoea)

41
Q

List some drugs that cause hyperkalaemia (high potassium).

A

1) ACE inhibitors + ARBs
2) potassium-sparing diuretics
3) trimethoprim
4) potassium supplements
5) heparins

42
Q

What mechanisms lead to falls?

A

1) sedation
2) hypotension
3) bradycardia/tachycardia/periods of asystole

43
Q

What drugs cause falls?

A

almost any drug that acts on the brain or on the circulation

Medicines, Patients and Public Health (5 decks)

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