Exam #02a

Question 1

Name the 5 criteria the ASHP use to define an adverse drug reaction (ADR)?

Answer 1

1. causes hospital admission
2. prolongs hospitalization
3. leads to drug discontinuation/dose modification
4. complicates a disease state
5. patient needs supportive therapy (ex. patient must be moved to ICU)

Question 2

What % of hospitalized patients incur a serious ADR?

Answer 2

7%

Question 3

What % of hospital admissions are due to an ADR? Which population of patients may be hospitalized due to an ADR more than any other population? What %?

Answer 3

3 - 6%
elderly
up to 20%

Question 4

What % of ADR are considered preventable?

Answer 4

50%

Question 5

True or False - ADR is a category of an adverse drug event (ADE)?

Answer 5

True

Question 6

This term is defined as an injury resulting from administration of a drug?

Answer 6

ADE

Question 7

Name the 5 types of ADE?

Answer 7

1. ADRs
2. Medication errors
3. Adverse drug withdrawal events (taking patient off benzodiazepine too quickly)
4. Therapeutic failures & non-compliance (taking Levoquin with iron - iron decreases Levoquin absorption by up to 90%
5. Intentional/accidental poisonings

Question 8

Are preventable ADRs medication errors?

Answer 8

YES!!

Question 9

List 7 actions by a pharmacist that, if done, would be considered a preventable ADR?

Answer 9

1. Giving an inappropriate drug for a patient’s condition or contraindicated drug
2. giving a patient an inappropriate dose
3. giving a patient a drug with known drug interactions to patient’s other meds
4. incomplete monitoring
5. patient has history of allergy or previous ADR and patient still receives the drug
6. a toxic blood level/abnormal lab documented
7. Poor patient compliance

Question 10

What are the two types of ADRs?

Answer 10

Type A

Type B

Question 11

Which ADR is related to the pharmacologic activity of the drug?

Answer 11

Type A ADR

Question 12

Which ADR is predictable, usually preventable, and represents 70-80% of ADRs?

Answer 12

Type A ADR

Question 13

Which ADR is related to allergic, immunologic reactions?

Answer 13

Type B ADR

Question 14

Which ADR is unpredictable, often not preventable, and represents 20% of ADRs?

Answer 14

Type B ADR

Question 15

True or False - both Type A and Type B ADRs can be life threatening?

Answer 15

True

Question 16

True or False - drug allergies have no correlation with pharmacologic properties of the drug?

Answer 16

True

Question 17

True or False - drug allergies are dose related?

Answer 17

False - they are not!

Question 18

Name 6 signs/symptoms of a drug allergy?

Answer 18

1. rash
2. hives
3. angioedema
4. fever
5. serum sickness
6. anaphylactic shock

Question 19

According to the Gell and Coombs classification of allergic reactions, what are Types I - IV?

Answer 19

I - anaphylactic (IgE)
II - Cytotoxic (Ab dependent prim. IgG, then IgM - ex blood binds to cell membrane causing immune response at that cell)
III - Immune complex (Prim. IgM, then IgG b/c IgM has multiple binding sites)
IV - Cell mediated (antigen binds to sensitized T lymphocyte, contact dermatitis)

Question 20

For each mediator describe its effect during anaphylactic reaction:

1. leukotrienes
2. histamine
3. prostaglandin
4. bradykinin
5. platelet activating factor

Answer 20

1. leukotrienes - bronchoconstriction
2. histamine - itching
3. prostaglandin - vasodilator
4. bradykinin - vasodilator
5. platelet activating factor - vasodilator and bronchoconstriction

Question 21

True or False - a Type I allergic reaction requires an initial sensitization?

Answer 21

True

Question 22

True or False - pseudoallergy can occur with 1st exposure to drug?

Answer 22

True - does not need sensitization

Question 23

Why is it called a pseudoallergy?

Answer 23

It looks like an allergic reaction, but the immune system is not involved

Question 24

What does the degree of pseudoallergy seen depend on (2 things)

Answer 24

1. dose dependent

2. ROA dependent

Question 25

True or False - a pseudo allergy is sometimes related to incipient and not the drug itself?

Answer 25

True | Ex. emulsifiers used to deliver lipid soluble drugs

Question 26

Name 3 properties of drugs that can cause a pseudoallegy?

Answer 26

1. large molecular structure (most drugs are small and can't elicit an allergy themselves) 2. protein based drug 3. hyperosmolar drug

Question 27

What type of allergy would angioedema from an ACE inhibitor be considered?

Answer 27

pseudoallergy - the immune system is not involved

Question 28

What protein in latex are some people allergic to? What does this have some cross sensitivity with?

Answer 28

HEVb protein | fruits (bananas, mango, papaya, guava)

Question 29

What races are prone to hemolytic anemia due to G6PD deficiency?

Answer 29

1. Mediterranean 2. African 3. Asian

Question 30

Which race is a fast acetylator? Which is a slow acetylator?

Answer 30

fast - East Asian | slow - Mediterranean

Question 31

FDA announced that manufacturers of which drug has to be labeled that before patient starts therapy on this drug, patients with Asian ancestry get a genetic blood test to identify a significantly increased risk of developing Stevens Johnson syndrome?

Answer 31

Carbamazepine (anticonvulsant used in epilepsy and bipolar disorder)

Question 32

What population are most prone to ADRs?

Answer 32

elderly

Question 33

Which pregnancy category represents a drug that is absolutely contraindicated and known to cause birth defects?

Answer 33

Category X

Question 34

Which pregnancy category represents a drug that is proven to be teratogenic in humans, but the benefit of therapy might outweigh the risk to the child developing birth defects?

Answer 34

Category D

Question 35

Would Valproic acid for epilepsy be considered Category X or D?

Answer 35

category D b/c the seizures may be more damaging to the child than the drug