Flashcards in Adverse Drug reactions Deck (25):
1
What is the frequency of ADRs in hospital in patients
10-20%
2
What is the 3 onsets for ADRs and their timings
acute - 60mins
sub-acute - within 24hrs
latent - >2days
3
what is the severity of ADRs range from
Mild requiring - no change in therapy
Moderate - additional therapy
severity - life threatening / disabling
4
What is the classification of ADRs divided into
Type A Augmented
Type B Bizarre
Type C Chronic
Type D Delayed
Type E End of treatment
Type F Failure of treatment
5
What are the features of a type A reaction
predictable
dose dependant
resolved when drug therapy is stopped
6
what are the reasons for type A reaction
Too high a dose
Pharmaceutical variation
Pharmacokinetic variation
Pharmacodynamic variation
7
In type A reactions what factor in the ADMEs result in the greatest therapeutic failure
absorption
8
What effects absorption
Gut motility
formulation
first pass metabolism
dose
9
What condition can effect absorption from the gut
oedema
10
Why is liver disease particularly important when considering drug therapy
Has a very narrow therapeutic index
11
What two factors need to be considered in the elimination of drug therapies and why?
If patient has renal impairment or a reduced glomerular filtrate rate, these two factors in drug therapy can result in increased toxicity
12
What is the outcome if a patient is a slow metaboliser
metabolise drugs by acetylation therefore more prone to drug toxicity
13
What is the secondary effect of type A reactions
when ADRs is not related to the therapeutic effect of the drug
14
What is an example of a pharmogenetic variation
isoniazid used to treat tuberculosis can induces peripheral neuropathy in some people
15
What is the result of cardiac failure with regards to ADR
Oedema prevents absorption from the gut
poor renal perfusion and decreased GFR
Hepatic congestion
16
What is the features of type B ADRS
rare
unpredictable
unidentified
17
What is the immunological features of type B ADRs
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
What are some important factors in type B ADRs
More common with macromolecules
Patients with asthma and eczema
Patients HLA status
19
What are the features of type C ADRs
semi predictable
related to duration of treatment as well as dose
not due to single dose
20
Example of chronic ADRs
steroid dependancy eg coristol steroid
opiate dependancy
antipsychotic medications
21
What is the features of type D ADRs
Can occur a long time since treatment has been given in the patient or the patients children
22
Give an example of a type D ADRs affecting a patient child
Tetratogeneic agents e.g. phalidamide disrupt growth of fetus
23
What causes type E ADRs
sudden stop of treatment following long term use resulting in rebound phenomena
24
Examples of drugs causing rebound phenomena
Steroids - addisonian
beta blockers - unstable angina
alcohol - withdrawal seizures
25