Adverse drug reactions

Question 1

Main concept in prescribing

Answer 1

Benefits must be better than drawbacks

Question 2

Main adverse drug reaction

Answer 2

NSAIDs

Question 3

Adverse effects of NSAIDs

Answer 3

GI bleeding
Renal impairment
Wheezing

Question 4

adverse effects of diuretics and how to monitor

Answer 4

Hypotension

Electrolyte imbalance = monitor K+ as can cause hypokalaemia

Question 5

What are type A drug reactions

How to manage

Answer 5

Augmented response

• Dose related
• Managed by dose adjustment

Question 6

What NSAID also carries a risk of GI bleeding

Answer 6

Aspirin

Question 7

What anti platelet drug may also cause GI bleeding

Answer 7

Clopidogrel

Question 8

How to minimise GI damage

Answer 8

paracetamol use instead

Identify patients at risk e.g. >65yo, history of ulcers, infection with H. pylori

Prophylaxis with PPI

Give in combination with misoprostol (acts on prostanoid receptors to inhibit gastric H+ secretion)

Question 9

Side effect of antibiotics

Answer 9

Diarrhoea

Question 10

Side effects of PPIs on the older patient

Answer 10

Increase risk of food poisoning

Question 11

Side effects of opioids and antimuscarinics and how to overcome

Answer 11

Constipation

-laxatives

Question 12

What drugs are contraindicated in asthma and why

Answer 12

beta-blockers

-They block bronchial B2 adrenoceptors and may cause bronchospasm

Question 13

can beta blockers be used in COPD

Answer 13

Yes, but caution

Question 14

Can drugs which are selective B1 antagonists be used in asthma

Answer 14

No- as they have poor selectivity

Question 15

What can fibrosis be induced by

Answer 15

Amiodarone

Question 16

Why are some people allergic to penicillin

Answer 16

Penicillins couple to proteins, forming immunogens. Causes a hypersensitivity reaction

Question 17

What should also be avoided in those with a penicillin allergy

Answer 17

cephalosporins

Question 18

What can drugs which cause QT prolongation do

Answer 18

Cause arrythmias

Question 19

Which drugs are cardio toxic

Answer 19

Some anti cancer drugs

Question 20

Which drugs can worsen chronic heart failure

Answer 20

Fluid retaining drugs: NSAIDs, corticosteroids

Rate limiting CCIs: verapamil and dilkazem (reduce force of contraction)

High dose beta blockers: atenolol

GLitazones: worsen oedema

Question 21

Which drugs increase CV disease

Answer 21

Some NSAIDs: Diclofenac, Rofecoxib

Question 22

What can cause postural hypotensive

Answer 22

Diuretics

Question 23

What drugs can cause hypertension

Answer 23

Some anti depressant

NSAIDs because of fluid retaining factor

Question 24

Symptoms of neutropenia

Answer 24

Increased infections

Question 25

Symptoms of thrombocytopenia and why

Answer 25

Increased bleeding and bruising because of decreased platelet count

Question 26

Cause of myelosuppression

Answer 26

Anticancer chemotherapy

Question 27

Issue with anticoagulants

Answer 27

Bleeding

Question 28

Symptoms of agranulocytosis

Answer 28

Absence of neutrophils -Mouth ulcers, severe sore throat; infections

Question 29

What can worsen renal function

Answer 29

NSAIDs Aminoglycosides ACEis/ATRAs

Question 30

What can increase fluid retention

Answer 30

NSAIDs | Steroids

Question 31

What drugs can cause - Hypokalaemia - Hyperkalaemia

Answer 31

Hypo: thiazide and loop diuretics Hyper: ACEi

Question 32

What is erythematous eruptions

Answer 32

ADR where there is reddening, and may resemble measles ommaculopapular

Question 33

What is toxic epidermal necrolysis

Answer 33

rare bye often fatal blistering and skin peels off

Question 34

What is Stevens Johnson syndrome

Answer 34

Fever, rash, blisters

Question 35

What drugs to be cautious about that cause Stevens Johnson syndrome and how to stop this occurring

Answer 35

Carbamazepine and phenytoin -Screen patients of Han Chinese, Hong Kong Chinese and Thai origin before use for allele

Question 36

What ADR can statins have and how can this ADR be increased

Answer 36

Can cause myopathy which may progress to rhabdomyolysis (breakdown of muscles) which may result in renal damage. Chance increases through drug reactions

Question 37

What can the antipsychotic drug clozapine cause

Answer 37

Neutropenia

Question 38

What can anti epileptic drug carbamazepine cause

Answer 38

NEutropenia | Stevens Johnson syndrome

Question 39

What can the aminoglycoside gentamicin cause

Answer 39

renal toxicity