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Flashcards in Adverse Drug reactions Deck (25)
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1
Q

What is the frequency of ADRs in hospital in patients

A

10-20%

2
Q

What is the 3 onsets for ADRs and their timings

A

acute - 60mins
sub-acute - within 24hrs
latent - >2days

3
Q

what is the severity of ADRs range from

A

Mild requiring - no change in therapy
Moderate - additional therapy
severity - life threatening / disabling

4
Q

What is the classification of ADRs divided into

A
Type A 	Augmented
	Type B	Bizarre
	Type C	Chronic
	Type D	Delayed
	Type E	End of treatment   
	Type F	Failure of treatment
5
Q

What are the features of a type A reaction

A

predictable
dose dependant
resolved when drug therapy is stopped

6
Q

what are the reasons for type A reaction

A

Too high a dose
Pharmaceutical variation
Pharmacokinetic variation
Pharmacodynamic variation

7
Q

In type A reactions what factor in the ADMEs result in the greatest therapeutic failure

A

absorption

8
Q

What effects absorption

A

Gut motility
formulation
first pass metabolism
dose

9
Q

What condition can effect absorption from the gut

A

oedema

10
Q

Why is liver disease particularly important when considering drug therapy

A

Has a very narrow therapeutic index

11
Q

What two factors need to be considered in the elimination of drug therapies and why?

A

If patient has renal impairment or a reduced glomerular filtrate rate, these two factors in drug therapy can result in increased toxicity

12
Q

What is the outcome if a patient is a slow metaboliser

A

metabolise drugs by acetylation therefore more prone to drug toxicity

13
Q

What is the secondary effect of type A reactions

A

when ADRs is not related to the therapeutic effect of the drug

14
Q

What is an example of a pharmogenetic variation

A

isoniazid used to treat tuberculosis can induces peripheral neuropathy in some people

15
Q

What is the result of cardiac failure with regards to ADR

A

Oedema prevents absorption from the gut
poor renal perfusion and decreased GFR
Hepatic congestion

16
Q

What is the features of type B ADRS

A

rare
unpredictable
unidentified

17
Q

What is the immunological features of type B ADRs

A

No relation to the pharmacological action of the drug
Delay between exposure and ADR
No dose response curve
Manifests as rash, asthma, serum sickness

18
Q

What are some important factors in type B ADRs

A

More common with macromolecules
Patients with asthma and eczema
Patients HLA status

19
Q

What are the features of type C ADRs

A

semi predictable
related to duration of treatment as well as dose
not due to single dose

20
Q

Example of chronic ADRs

A

steroid dependancy eg coristol steroid
opiate dependancy
antipsychotic medications

21
Q

What is the features of type D ADRs

A

Can occur a long time since treatment has been given in the patient or the patients children

22
Q

Give an example of a type D ADRs affecting a patient child

A

Tetratogeneic agents e.g. phalidamide disrupt growth of fetus

23
Q

What causes type E ADRs

A

sudden stop of treatment following long term use resulting in rebound phenomena

24
Q

Examples of drugs causing rebound phenomena

A

Steroids - addisonian
beta blockers - unstable angina
alcohol - withdrawal seizures

25
Q

How are ADRs diagnosed

A

differential diagnosis
past medical history
time of onset and drug dosage
lab investigations

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