Adverse Drug Reactions

Question 1

what is an adverse drug reaction

Answer 1

Adverse drug reaction= any undesirable drug reaction, whether expected, predictable or not that results in a detriment to the wellbeing of the patient in any way- whether symptomatic, detectable or not in the absence of another biologically plausible explanation that can be proven (not same as side effect)

Question 2

who is more likely to get ADRs

Answer 2

elderly/ frail
mutlimorbid (renal/ hepatic clearance)
polypharmacy

Question 3

what is the theraputic index formula

Answer 3

toxic dose 50/ effective dose 50

Question 4

name 10 drugs will a narrow theraputic window

Answer 4

warfarin 
vancomycin 
lithium 
digoxin 
gentamicin 
phenytoin 
cyclosporin 
carbamazepine 
theophylline 
levothyroxine

Question 5

what happens in phase 1 of drug metabolism

Answer 5

usually through cyp p450
oxidation, reduction and hydrolysis
when must ADRs happen

Question 6

what happens in phase 2 of drug metabolism

Answer 6

coagulation (making it water soluble) so it can be excreted in urine/ bile

Question 7

what is a type A ADR

Answer 7

dose dependent and predictable (higher doses more likely to cause ADRs)

Question 8

what are the type A drug reaction in drugs used for pre renal failure

Answer 8

hypotension and hypovolaemia caused by:

• duiretics (cause dehydration)
• ACEi/ ARBs (cause D&V)

Question 9

what drugs can cause acute interstitial necrosis/ tubular necrosis via type A ADRs

Answer 9

gentamicin
sulphonamides (used in RA)
aspirin (for CVD)

Question 10

what drugs can cause retroperitoneal fibrosis, cyrstaluria, urinary calculi

Answer 10

methysergide (used for cluster headaches)

chemotherapy

Question 11

drug drug interactions:

theophylline and

Answer 11

macrolides

Question 12

drug drug interactions:

statins and

Answer 12

macrolides
or
fibrates

Question 13

drug drug interactions:

tricyclic antidepressants and

Answer 13

type 1 anti arrhythmic drugs (ST/ vent repolarisation)

Question 14

drug drug interactions:

warfarin and

Answer 14

lots of drugs

Question 15

drug drug interactions: what can ACEi increase the hypoglycaemic effects of

Answer 15

sulphonylureas

Question 16

drug drug interactions:

clopidogrel and

Answer 16

PPIs

Question 17

what are the different types of drug interactions

Answer 17

drug drug
drug herbal
drug disease
drug food

Question 18

what can grapefruit interact with

Answer 18

inhibits cyp p450 (breaks down simvastatin) so increases simvastatin levels

Question 19

drug herbal interactions:
ginko biloba (for dementia) 
saw palmetto (for BPH)

Answer 19

act as anticoagulant

Question 20

drug herbal interactions:
saw palmetto (for BPH)

Answer 20

act as anticoagulants

Question 21

drug herbal interactions:

glucosamine for OA

Answer 21

causes hyperglycaemia and is an anticoagulant

Question 22

drug herbal interactions:

ST johns wort (for depression)

Answer 22

reduces the effectiveness of the combined oral contraceptive pill

Question 23

drugs disease interactions:

patients with parkinsons

Answer 23

have increased risk of drug induced confusion

Question 24

drugs disease interactions:

NSAIDs/ COX 2/ TSDs

Answer 24

can exacerbated CHF as all cause sodium retention

Question 25

drugs disease interactions: | urinary retention in BPH is more likely in patients on...

Answer 25

decongestants or anticholingerics

Question 26

what drugs worsen constipation

Answer 26

calcium, anticholinergics, CCBs

Question 27

what drugs lower seizure thresholds

Answer 27

neuroleptics, tramadol and quinolones

Question 28

what drugs must you NEVER give in patients with poorly controlled epilepsy

Answer 28

neuroleptics, tramadol or quinolones

Question 29

drugs disease interactions: | asthma and

Answer 29

beta blockers (especially if not specific to beta 1 receptors) can cause bronchoconstriction

Question 30

drug food interactions: | bananas, oranges, green leafy veg

Answer 30

all these high in potassium | interact with ACEi. ARBs and K sparing duiretics as these cause hyperkalaemia

Question 31

drug food interactions: | apples, chickpeas, spinach, nuts, kiwi and brocolli

Answer 31

high in vit E and vit K | interact with warfarin

Question 32

drug food interactions: | chicken, turkey, milk, soy, cheese and yoghurt

Answer 32

alter body's pH | affect absorption of antibiotics, thyroid meds, digoxin, diuretics

Question 33

drug food interactions: | grapefruit, apple, orange, cranberry

Answer 33

have cytochrome p450 | interact with statins and antihistamines

Question 34

what are type B ADRs- give 3 examples

Answer 34

bizarre effects, dose independent and unpredictable | e.g. drug rashes, bone marrow aplasia (chloramphenicol antibiotic), hetaptic necrosis (halothane)

Question 35

do type B ADRs have a high mortality

Answer 35

yes very high

Question 36

what are type C ADRs, give 3 examples

Answer 36

``` chronic in prolonged treatment e.g steroids= cushing beta blockers= diabetes NSAIDs= hypertension (fluid retention) ```

Question 37

what must be done in type A drug reactions

Answer 37

dont dismiss patients with strange side effects from drugs that arent expected

Question 38

what should be done in type C ARDs

Answer 38

emphasise drug monitoring, must warn patient before starting drug

Question 39

what are type D ADRs give 2 examples

Answer 39

delayed- remote form treatment/ often many years after stopping therapy e.g. tetratogenc/ carinogenic effects from chemo isoretinoin (for acne) can cause craniofacial abnormalities in babies

Question 40

what must be done for type D ADRS

Answer 40

rigorous pre clinical assessment

Question 41

what is a type E ADR give 3 examples

Answer 41

end of treatment - due to abrupt withdrawal, rebound effect e.g. beta blockers= angina and rebound tachycardia steroids= addisonian crisis anticonvulsants= changes in epilepsy frequency

Question 42

what is a type F ADR

Answer 42

failure of theraputic treatment

Question 43

what does the black triangle in the BNF mean

Answer 43

new medicine that have new active ingredient so have to be very vigilant to any SE and fill in yellow card report. Black triangle removed when safety established

Question 44

when do you fill in yellow cards

Answer 44

when your patient has an unexpected SE even is only suspected that drug is causing it