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Flashcards in Adverse drug reactions Deck (34):
1

What is an adverse drug reaction?

Any undesirable reaction that results in a detriment to the wellbeing of a patient in any way in the absence of another plausible explanation that can be proven

2

What is a side effect?

An undesirable secondary reaction that results when using a medication within its normal dose

3

How does digoxin toxicity present?

Nausea & vomiting
Visual disturbance (including colour vision)
Bradycardia
Sweats
Convulsions
Death

4

Adverse drug reactions are more common in which groups of people?

Elderly
Multi-morbidity (reduced renal or hepatic clearance)
Polypharmacy

5

What is the therapeutic index?

50% of lethal dose / 50% of effective dose

6

What is the problem with drugs with a low therapeutic index?

The become toxic very quickly

7

List some drugs with low therapeutic indexes?

Theophylline
Warfarin
Vancomycin
Lithium
Digoxin
Gentamicin

8

When might acute drug reactions be detected?

Drug development phase
Clinical trial phase
Post-marketing

9

Describe the two phases of drug metabolism

Phase 1 - cytochrome P450 system oxidises/reduces/hydrolysis
Phase 2 - conjugation allowing for excretion in bile/urine

10

What are the classifications of adverse drug reactions?

Type A - dose dependent and predictable
Type B - bizzare effects (dose independent and unpredictable)
Type C - chronic effects
Type D - delayed effects
Type E - end of treatment effects
Type F - treatment failure (inappropriate prescription)

11

Which type of drug reaction is the most dangerous?

Type B because they are unpredictable

12

Which drugs can cause type A drug reactions resulting in pre-renal failure?

Diuretics - if taken when dehydrated
ACE/ARBs - if taken during episodes of diarrhoea and vomiting

13

Which drugs can cause type A drug reactions resulting in renal failure (AIN/ATN)?

Gentamicin - given to treat sepsis
Sulphonamides - given to treat rheumatoid
Aspirin - given in certain CVS diseases

14

Which drugs can cause type A drug reactions resulting in post-renal failure?

Methysergide - given to treat cluster headaches
Chemotherapy - given to treat acute leukaemia

15

When should a patient not take their ACE/ARBs?

If they have diarrhoea and vomiting

16

Give three examples of type B drug reactions

Drug rashes
Bone marrow aplasia
Hepatic necrosis

17

Type A drug reactions have a high mortality. T/F

False - type B drug reactions

18

When do type C drug reactions occur?

When the patient has been on drug therapy for a long time

19

Which drugs can cause type C drug reactions?

Steroids - cause Cushing's
Beta-blockers - cause diabetes
NSAIDs - cause hypertension

20

Can type C drug reactions be anticipated? What is it important to do?

Yes
Warn patient of possible side effects

21

When do type D drug reactions occur?

Often many months/years after stopping drug treatment

22

Give two examples of type D drug reactions

Carcinogenic - post chemotherapy
Teratogenic - isotretinoin

23

What is isotretinoin used for? What can it cause?

Acne
Craniofacial abnormalities

24

How do type E drug reactions occur?

Abrupt withdrawal causing rebound effects

25

Give three examples of type E drug reactions

Beta-blocker withdrawal - angina
Steroid withdrawal - addisionian crisis
Anti-convulsant withdrawal - increased frequency of seizures

26

Type A drug reactions can result from three types of interactions, name these

Drug to drug interactions
Drug to disease interactions
Drug to food interactions

27

The majority of adverse drug reactions are of which type?

Type A

28

Give some examples of drug to drug type A interactions

Statins and macrolide antibiotics or fibrates increase risk of rhabdomyolysis
ACEi and sulphonylureas increase risk of hypoglycaemia

29

Which drugs can exacerbate chronic heart failure?

NSAIDs

30

Which drugs can increase risk of urinary retention in patients with BPH?

Decongestants
Anticholinergics

31

Which drugs worsen calcium?

Calcium
Anticholinergics
Calcium channel blockers

32

Which drugs lower seizure thresholds in patients with epilepsy?

Tramadol
Quinolone antibiotics

33

Which drugs can worsen asthma?

Beta blockers

34

A high sodium diet can interfere with the effectiveness of which drugs?

ACE/ARB
Diuretics (potassium sparing)

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