Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Clinical Pharmacology and Therapeutics (CPT) > Adverse Drug Reactions > Flashcards

Adverse Drug Reactions Flashcards

(65 cards)

Start Studying
1
Q

What is the key difference between ADRs and Side Effects?

A

difficult to distinguish
SEs may be good or bad
ADRs are bad

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is a key safety concept for prescribing?

A

benefits must outweigh drawbacks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the beneficial SE of old anti-histamines (give eg.)?

A

sedation, OTC sleep medication
promethazine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the adverse effect of old anti-histamines (give eg.)?

A

sedation for allergy
promethazine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What must you do when prescribing to patients?

A

indicate 2-3 common or key SEs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the most important ADR?

A

NSAIDs: GI bleeding, renal impairment, wheezing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the second most important ADR?

A

Diuretics: hypotension (incl. postural: falls - encourage not too give up too rapidly), electrolyte imbalances (thiazide-like: hypokalaemia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the third most important ADR?

A

Warfarin (bleeding + drug interactions)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the last 4-10 ADRs?

A

ACEIs/ATRAs (renal disfunction, measure eGFR during)
Antidepressants + lithium -in bipolar, narrow TW
Beta-blockers (avoid in asthma as risk of bronchospasm)
Opioids
Digoxin
Prednisolone
Clopidogrel (GI bleeding)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are type A ADRs?

A

Augmented response

dose-related
predictable
usually managed by dose adjustment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How can u predict a dry mouth?

A

inhibition of saliva such as in anti-muscarinic drugs, blurred vision, constipation due to slower GI, urinary retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How can you predict oesophageal erosion?

A

bisphosnates
osteeoporisis
corrosive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the most ADR of NSAIDs?

A

ulcerogenic effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what else alongside NSAIDs can be associated with peptic damage/ulceration?

A

corticosteroids, esp. when co-prescribed with NSAIDs
low-dose aspirin also carries 3-fold risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What anti-platelet drug may also cause GI bleeding?

A

clopidogrel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What NSAID has the lowest incidence of GI SEs?

A

ibuprofen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How do NSAIDs work?

A

inhibit production of prostaglandins (which contribute to inflammatory response, fever and pain)
prostaglandins are synthesized from arachnoid acid by COX action
COX1: always expressed in most cells, COX2 induced in inflammed tissues
different isoforms have diff fucntions in diff tissues
levels normally low but go up drastically in acute inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the difference between selective and non-selective NSAIDs?

A

non-selective, inhibit both COX-1 and COX-2
COX-2 selective

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what do all non-selective NSAIDs, except aspirin act as?

A

reversible COX inhibitors, compete with AA for binding to the enzyme
aspirin covalently modifies and permanently destroys COX enzymes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Where is the irreversible action of aspirin most notable?

A

blood platelets
cannot synthesize new COX enzymes as have no nucleus
enzyme inactivated = no production of Thromboxane A2 and hence no platelet aggregation for lifespan of platetels
aspirin is therefoe a potent anti-thrombotic agent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Can aspirin be taken with other non-selective NSAIDs?

A

no or at least 2 hours after aspirin as will compete with aspirin for common binding site on platelets COX-1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the contraindications of aspirin?

A

being anti-thrombotic, aspirin prolongs bleeding and is contra-indicated in patients with bleeding risks or hemorrhagic disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Why do NSAIDs cause GI irritation

A

COX-1-dependent prostaglandins suppress gastric acid secretion and help maintain gastric mucosal barrier, providing protection to the stomach lining because non-selective NSAIDs inhibit COX-1, they may cause gastric irritation, peptic ulcer disease and GI bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How can GI damage be reduced?

A
  • paracetamol for analgesia
  • identify patients at risk eg. 65+, ulcer history, H.Pylori infection
  • prophylaxis with PPI
  • give in combo with misoprostol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
How does misoprostol minimise GI damage?
It is a stable PGE1 analogue, acts on prostanoid receptors to inhibit gastric H+ secretion
25
What are Antibiotics associated with?
- diarrhoea - bacteria levels in the gut can unbalance causing diarrhoea - mild is fine but if severe and bloody: urgent
26
What is the key side effect of PPIs?
very safe and used to manage peptic ulcer disease prevent acid secretion -> stomach no longer has an acidic pH -> acid no longer sterilises the food -> incr. risk of food poisoning whilst on PPIs
27
what do antimuscarinic drugs tend to do to the patient?
- constipation - opioids, codeine, morphine - reduce contractility of the lower GI tract - consider the need for laxatives when prescribing opioids -
28
Why is the liver important in ADRs?
- many drugs metabolised there - many drugs can cause significant liver damage - LFT monitoring during treatment - eg. statins, anti epileptic drugs
29
What are signs of liver damage?
derangements of liver enzymes signs of jaundice signs of hyperbilirubinemia
30
What is the key adverse effect of beta-blockers?
-bronchospasm - as they take out beta2 mediated bronchodilation - b1 blockers can still affect b2adrenoreceptors - contraindicated in asthma as block bronchial b2 adrenoreceptors and may cuase - can worsen COPD, use with caution monitoring resp
31
When are beta-blockers contraindicated?
- asthma - as they block bronchial b2 adrenoreceptors and may cause bronchospasm - caution in COPD - also applies to 'selective' b1-antagonists - poor selectivity
31
Give an example of a drug which may induce fibrosis?
- amiodarone - antiarrhythmic - be cautious for cough or change in resp function - chest XRay if suspecting damage
32
What is the medical emergency ADR?
- anaphylaxis - severe allergic response
33
how is anaphylaxis managed?
- with adrenaline and histamine one receptor antagonists and steroids
34
What is the penicillin hypersensitivity response?
- penicillins couple to proteins - forming immunogens or haptan - hypersensitivity reaction
35
What drugs have cross-recativity with pencillin
- cephalosporins - similar structure
36
What should you always check on a patients drug chart?
aleergy secrion always confirm if there is NKA
37
What can some drugs do to the heart electrically?
- cardiac arrythmias - QT prolongation - older antipsychotics
38
What is another cardiac ADR?
- cardiotoxicity - some cytotoxic anti-cancer drugs
39
40
What drugs can cause congestive HF?
- worse by fluid retaining drugs (NSAIDs, corticosteroids) - rate limiting CCIs contraindicated in HF - High dose beta-blockers - Glitazones
41
How are NSAIDs linked to CVD?
- some incr. CV events - eg. diclofenac, rofecoxib - may cause fluid retention - may exercerbate hypertension and chronic HF - low dose aspirin not as bad
42
What drugs can cause postural hypotension?
- some antihypertensives - diuretics - difficult to maintain blood pressure when changing posture - falls partic. in elderly
43
What drugs can cause hypertension?
- antidepressant venlafaxine/venofacine - shouldn't be used in patients with hypertension - measure BP - NSAIDs could also worsen hypertension due to fluid retention
44
What is a site of very severe ADRs?
bone marrow
45
What is neutropenia?
- drug kills off production of white cells - incr. infections - eg. atypical antipsychotic closopene, end line, WBC monitoring
46
What is thrombocytopenia?
- kills off production of platelets - incr. bleeding and bruising
47
What is myelosuppression?
- overall suppression of BM - consequence of most cytotoxic anticancer chemotherapies - carried out in cycles to let BM recover
48
What is aplastic anaemia?
- failure of BM
49
How do certain drugs cause bleeding problems?
- affect coagulation system anti-coagulants - can cause cerebral haemorrhage, haemorrhagic stroke
50
What is agranulocytosis?
- another term for neutropenia - absence of neutrophils - mouth ulcers, severe sore throat - eg. clozapine, carbimazole, carbamazepine
51
What is the usual response when there is haematological affects?
stop drug
52
What drugs can cause renal damage?
- NSAIDs - Aminoglycosides (gentamycin: cancer) - ACEis/ATRAs (but protective of kidney in diabetes, prevent diabetic methopety)
53
if there is a significant drop in eGFR using ACEi or ATRA what should u do?
drop dose or stop drug
54
What drugs can cause fluid retention?
- NSAIDs - steroids
55
What drugs can cause potassium issues?
hypokalaemia -thiazide and loop diabetics hyperkalaemia - ACEi
56
how can NSAIDs lead to renal failure?
- inhibit renal PGs - reduce renal blood flow - reduce GFR - esp. in CHF pts may lead to acute renal failure may also cause acute interstitial nephritis
57
What can drugs acting on the central nervous system cause?
- sedation (prescribe at night) - parkinsonism (dopamine receptor antagonists, stop the drug, sometimes give antimuscarninic to manage those symptoms) - depression - addiction (opiods) - nausea (use anti emetics)
58
How can skin be affected by drugs?
- most commonly affected - urticaria (nettle rash) - erythematous eruptions (reddening, may resemble measles or maculopapular) - toxic epidermal necrolysis: rare but often fatal with blistering and skin peels off - stevens-johnson syndrome: fever, rash, blisters
59
how are skin reactions managed?
- stop drugs - relieve with anti-histamines and creams
60
What drugs can induce stevens-johnsons syndrome in pateints with a speicifc allele.
- carbamazepine and phenytoin - screen patients from chinese + thai origin before use
61
What drugs can result in myopathy?
- statins - myopathy may rarely progress to rhabdomyolysis, may result in renal damage - often due to drug interactions
62
What should you look out for?
Changes in renal & liver functions Blood counts (associated symptoms) Rashes Allergy/anaphylaxis CNS effects Visual disturbances Muscle pain (e.g. statins + fibrates)
63
What are some alarm bells?
- NSAIDs in elderly (even low dose aspirin) - NSAIDs with ulcers (consider protecting with PPI) - beta-blockers in COPD/asthma - corticosteroids

Clinical Pharmacology and Therapeutics (CPT) (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions