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Adverse drug reactions Flashcards

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1
Q

What condition does thalidamide cause

A

phocomelia - shortened underdeveloped limbs etc

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2
Q

What is an adverse drug reaction

A

noxious, unintended reaction after normal dose OR abuse, medication error, overdose

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3
Q

Most common drug and ADRs causing hospital admission

A

NSAIDs
Diuretics
Warfarin
ACE/AII inhibitors
Beta blockers
Opiates
Digoxin
Prednisolone
Clopidogrel

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4
Q

Common adverse reactions of NSAIDs

A

Gi complications
Cerebral haemorrhage
Renal impairment
alletgic type - Wheezing, Rash

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5
Q

Diuretics adverse reactions common

A

Renal impairment
Hypotension
Electrolyte disturbance
Gout (uric acid accumulate)

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6
Q

Warfarin and clopidogrel adverse reactions

A

warfarin - bleeding
Clopidogrel - GI bleeding

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7
Q

beta blockers adverse reactions

A

Bradycardia
Heart block
HYpotnesion
Wheezing

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8
Q

Opiates common adverse reactions

A

Constipation
Vommitting
Confusion
Urinary retnetion

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9
Q

Digoxin adverse effect

A

Toxicity esp in renal impairment

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10
Q

Prednisolone adverse effects

A

GI complications, hyperglycaemia. osteoporotic fracture, worsening diabtees, skin bruising

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11
Q

ACE inhibitors/AII inhibitrs common adverse effects

A

renal impairment, hypotnesion, electrolyte disturbances

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12
Q

A-E of adverse drug reactions

A

Augmented
Bizarre
Chronic
Delayed effects
End of treatment

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13
Q

What is an augmented drug reaction

A

dose related and predictable
avoidable

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14
Q

examples of augmented drug reactions

A

insulin causing hypoglycaemia
Warfarin causing bleeding
Nitrates causing headaches (increased blood flow to cerebral vessels)

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15
Q

What are bizarre drug reactions

A

Not dose related, unpredicatable

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16
Q

What does digoxin toxicity cause

A

leading to N+V and arrhythmias

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17
Q

Examples of bizarre drug reactions

A

Penicllin anyphylaxis
Halothane -> hepattis
Chloramphenicol - agranulocytosis

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18
Q

Chronic adverse drug effects

A

Variable - only with prolonged use

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19
Q

Steroid ADRs from chronic use

A

Steroids -> osteoporosis, steroid cushings syndrome, metabolic syndromes

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20
Q

What drug used chronically can cause tardive dyskinesia

A

Phenothiazine

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21
Q

What drug used chronically can cause pulmonary hypertension

A

Fenfluramine

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22
Q

What are delayed ADRs

A

Effects that occur some time after drug discontinuation eg drug induced foetal abnormalities, durg induced cancers recipients or offspringeg immunosupressed, renal transplants sqamous cell carcinomas, dihydroestriol in pregnanc - female children -> vaginal cancer

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23
Q

What are end of treatment ADRs

A

Effects occur on withdrawal of drug

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24
Q

Examples of end of treatment ADRs

A

Adrenocortical insufficiency after steroid treatment
Drug withdrawal seizures
Withdrawal reactions following paroxetine

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25
Drugs causing gynaecomastia
Spirinolactone Oestrogens Methyldopa Digoxin
26
Drugs causing galactorrhea
Antipsychotics Tricyclics Metoclopramide Oestrogens Methyldopa
27
What condition is morbidiform skin rash seen in when cillin antibiotics are used
Glandular fever
28
Severe skin reactions to drugs increasing in severity
Eytherma multiforme Steven johnsons syndrome Toxic epidermal necrolysis
29
When does stevens johnson syndrome become toxic epidermal necrolysis
>30% of skin surface involved and extensive mucous membrane damage
30
What is steven johnsons syndrome
Flu like symptoms -> rash -> blisters -> top layer of skin sheds hospitalisation for recovery
31
What can corticosteroid use in childhood cause
Short statue - premature fusing of epiphyses
32
What can tricycline antibiotics acuse in childhood
Yellow staining of enamel teeth
33
What cancer is caused by long erm immunosupressant use after renal trnsplant
Squamous cell carcinoma
34
What type of drug reaction is sus if improvement of condition after drug discontinued or dose reduced
Type A dose related ADR
35
What is a rechallenge of a drug in ADR
Reinteoduce drug that suspect caused reaction to see if happens again
36
What test result supports an ADR type A
High plasma drug concentrations (easy to measure in digoxin, theophylline)
37
Criteria for ADR suspicion
Timing of symptoms with drug treatment Improvement after discontinued or dose redued Worsening after rechallenge Ass w high plasma drug concentrations Reaction prev recognised as side effect of drug patient on Illness commonly result of ADR eg postural hypotension, confusion Exclusion of other causes
38
How to avoid anaphylaxis from drugs - notes, administering, what patient group
Careful drug history PUT IN NOTES - record on drug charts and hospital and GP notes Doubel check before administering drugs Inject first dose slowly Particular care in atopic patients
39
Methods for avoiding ADRs
Only prescribe when clear indication Use drug with most favourable risk-benefit Check for prev ADRs/allergu Careful paitent educations Monitor therapy Particular care in susceptibel patients eg elderly, prev ADR
40
What patient education need ot give around drugs prescribed
Appropriate use of drug Common an/or important adverse effects - BNF/SPC
41
What skin reaction can anticonculsants cause
Steven johnsons syndrome/toxic epidermal necrolysis
42
What % of hospital admissions are caused by ADRs?
5-7%
43
Annual cost of ADR to NHS
250M
44
Most common drugs causes of ADRs
NSAIDs : GI complications, cerebral haemorrhage, renal impairment, wheezing, rash Diuretics: renal impairment, hypotension, electrolyte disturbances, gout Warfarin: bleeding ACE inhibitors /Angiotensin II receptor antagonists: renal impairment, hypotension, electrolyte disturbances Beta blockers: Bradycardia, heart block, hypotension, wheezing Opiates: Constipation, vomiting, confusion, urinary retention Digoxin: Nausea, vomiting, confusion, bradycardia Prednisolone: GI complications, hyperglycaemia, osteoporotic fracture Clopidogrel: GI bleeding
45
How to treat gynaecomastia if causing psychological distress
Surgery
46
Common side effect of nicorandil
Anal ulceration and anal fissures
47
What is foetal valproate syndrome
Delayed reaction following valproate exposure in utero -> broad forehead, thin arched eyebrows, flat nsala bridge, low set ears, short nose, thin upper lips. more likely to develop autism and ADHD
48
When can valproate be prescribed to women
When they are not of child bearing age or on the pregnancy prevention programme - annual check ups, highly effective contraception
49
What anticonvulsants are less teratogenic than phenytoin, carbamazepine and valproate
Lamotrigine, levetiracetam
50
Exapmples of teratogenic drugs
warfarin, lithium , valproate, thalidomide, phenytoin, isotretinoin
51
What gene is Stevens Johnsons syndrome more likely with
HLA-B1502 allele - thai or han chinese ethnic origin - esp carbamazepine or phenytoin
52
What idiosyncratic reaction can abacavir cause
Serious hypersenstivity
53
What idiosyncratic reaction can flucloxacillin cause
hepatits
54
What idiosyncratic reaction can chloramphenicol cause
aplastic anaemia
55
what idiosyncratic reaction can simvastatin cause
Rhabdomyolysis - SCLO1B1
56
Rare ADRs picked up by yellow card scheme
1 in 6,000 - Chloramphenicol-induced aplastic anaemia 1 in 10,000 - Halothane-induced jaundice 1 in 10,000 - DVT with oral contraceptives 1 in 10,000 - MI with oral contraceptives 1 in 20,000 - VT with terodiline 1 in 50,000 - VT with terfenadine
57
Common drugs with narrow therapeutic index
Carbamazepine Cyclosporine Digoxin Levothyroxine Lithium carbonate Phenytoin Tacrolimus Theophylline Warfarin
58
What neuro features may a patinet get when chronically taking metaclopramide for gastroparesis
Parkinsonian features
59
What drugs delay gastric emptying
Tricyclic antidepressants, opiates and anti-muscarinic drugs
60
Why does metaclopramide increase rate of absorpiton of other drugs
Increase gastric emptying
61
What antibiotics are made less orally available when taken with antacids
Tetracyclines, quinolones Form complex w antacids
62
What drugs worry about with lithium -> poisonning
Any drugs causing sodium loss eg diuretics - proximal tubules donet differentiate between sodiuma nd lithium
63
Why can ACEis cause angio-oedema
Accumulation of bradykinin
64
What drug should be administerd in an iron overdose
Deserrioxamine - chelates iron
65
When should paracetemol levels be measured after an overdose/
If overdose >75mg/kg Determine if need acetylcysteine If present after 8 hrs acetylcysteine started before results received
66
What test is best indicator of prognosis in paracetamol overdose
INR
67
Antichoinergic vs stimulant overdose
Same - low BP, tachycardia, dilated pupils Anticholinergic - dry skin, absent bowel sounds Stimulant - sweating, increased bowel sounds

errors and drugs (8 decks)

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