Exam 1: Adverse Drug Reactions & Pharmacogenetics Flashcards Preview

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Flashcards in Exam 1: Adverse Drug Reactions & Pharmacogenetics Deck (93):
1

What are the 2 types of drug effects?

1.Theraputic (desireable) 2.Adverse effect/reaction (undesirable)

2

What are the 2 types of Adverse reactions?

1.Side effects and 2.Toxicity reactions

3

A _______ is an undesired effect, but is tolerated and generally reversible upon drug discontinuation.

side effect

4

Which of our two types of adverse reactions is DOSE RELATED?

a side effect (more does = more side effect!)

5

A _______ is an adverse reaction where permanent cell and tissue damage occurs. It is generally intolerable as well.

A TOXICITY reaction

6

Which of our two types of adverse reactions is almost always associated with OverDose?

Toxicity reaction

7

Incidence of adverse drug reactions are 4th - 6th leading cause of ______.

death

8

_________ is the use of more then 5 medications. Its generally used to describe management of ______ adults.

PolyPharmacy...older

9

The _____ Criteria are 3 lists of medications that pose potential risks outweighing potential benefits for people 65 and older.

Beers

10

The FDA requires all adverse effects observed for the drug to be included in the ________ and it is reported in _______ of population effected.

monograph...percentage

11

The adverse effects of a drug are categorized according to a _____ system or an ______ system.

body or organ

12

Malaise (tiredness), Body pain, Lower extremity pain, Back pain are considered general side effects of the _____ as a whole.

body

13

Arthralgia (arthrodynia) – joint pain, Leg cramps, Myalgia (myodynia) – pain in muscle(s), Myastenia – muscular debility, Myositis – inflammation of a voluntary muscle, Tenosynovitis – inflammation of a tendon sheath are side effects on the _______ system.

skeletal muscle system

14

Adverse reactions caused by drugs on blood pressure and the heart, Palpitations, Angina, Hypotension/hypertension, Orthostatic hypotension, Arrhythmias are considered side effects on the ________ system.

cardiovascular

15

Dizziness, Drowsiness, Depression, Hallucinations, Hyperexcitability/hyperactivity

nervous system (CNS & PNS)

16

Shortness of breath, Cough, Pharyngitis, Cold symptoms, Sinusitis are considered side effects of the ______ system.

respiratory

17

These side effects are rare, but VERY dangerous because they can cause anemia and clotting.

hematologic side effects

18

Neutropenia – decreased neutrophils, Thrombocytosis – increased platelets, Agranulocytosis – extreme reduction of neutrophils (granulocytes) are considered ______ side effects.

hematologic side effects

19

What type of drugs are typically the culprit for the very rare, but very dangerous hematologic side effects?

Chemotherapy drugs

20

The "NVD's" (nausea, vomiting, diarrhea) are common ______ side effects.

digestive system

21

Drugs that effect the eyes (blurred or colored vision), ears (tinnitus), taste (metallic taste *dentistry) are side effects of the _______.

special senses

22

Unwanted effects on endocrine glands, Adrenal suppression, Symptoms of diabetes, Drug-induced thyroiditis are side effects of the _______ system.

endocrine system

23

Drugs that cause reactions of the uterus, ovaries, and testes have ________ system side effects.

reproductive

24

Drug-induced itching and redness, Acne, Alopecia, Herpes simplex, Sweating, Urticaria (localized edema with wheals), Skin ulcers are examples of _____ adverse reactions.

skin

25

Dysuria, Impotence, Urinary frequency, Vaginitis, Hematuria are example of side effects of the _____-_____ system.

genito-urinary system

26

In dentistry, we really want to pay attention to the drug monograph for _____ side effects, because we are administering drugs in the oral cavity.

G.I.

27

__________ reactions to drugs in susceptible individuals can lead to classic allergic manifestations such as skin rash, asthmatic syndromes, rhinitis and anaphylaxis.

Hypersensitivity

28

Person must have a ________ to a drug to manifest later with an allergic reaction!

previous exposure

29

What are the two WBC's that release HISTAMINE in hypersensitivity/allergic reactions???

1.Basophils 2.Mast Cells

30

What type of antibody does the allergenic antigen bind to on the basophil/mast cell?

IgEEEEEEE DAWG!!!

31

The "allergic release" of ________ results in the allergic manifestations.

HISTAMINE!!!

32

How do we stop allergic reactions? Can we stop histamine production?

Block histamine receptors, no we can not stop histamine production.

33

The more histamine = the _____ the blood pressure, because histamine ______ the blood vessels.

LOWER.... dilates

34

What are the other two antibodies involved in hypersensitivity/allergic reactions besides IgE?

IgGGGG-UNIT! and IgMMMMMasacistic

35

Allergic manifestations are classically characterized according to the _______- factors involved

antibody

36

Type I hypersensitivity reactions are mediated by the ____ antibody.

IgEEEEE DAWG

37

Which hypersensitivity type reaction is MOST SEVERE?? (Anaphylaxis, Asthma syndrome, Rhinitis, Dermatitis)

Type I

38

Type II hypersensitivity reactions are mediated by the ____ and _____ antibodies.

IgGGGGG UNIT & IgMMMMast cells

39

Which hypersensitivity reaction only shows up on a BLOOD TEST because RBCs are lysed during the reaction?

Type II

40

Type III hypersensitivity reactions are mediated by ____ antibodies.

IgGGGGG UNIT

41

Arthralgia (muscle/joint pain), Fever, Lymphadenopathy (swollen glands) are all indicative of a Type ___ hypersensitivity reaction involving the ___ antibody.

Type III, IgGGGG UNIT

42

Hypersensitivity reactions are frightening because they are _______ and NOT _____ related!!

unpredictable...NOT DOSE related!

43

Many hypersensitivity reactions occur frequently with the antibiotic _______.

penicillin

44

Interesting!!! Someone could take penicillin 100 times without ______, then experience reaction and approx ___% of the population is allergic to penicillin!

hypersensitivity...10%

45

A drug effect on fetal development is a "_______" effect.

teraTogenic effect

46

When is the most susceptible time for a teratogenic effect to take place?

the 1st trimester (esp. first month, WHEN most women don't know they're prego!!)

47

Interesting...teratogen comes from the greek word for ______.

monster

48

What is our PRIME example of a teratogen that EVERYONE should know?? What was it used for?

Thal-id-O-mide...1960's drug for morning sickness

49

What was the result of the teratogen thalidomide, and what % teratogenic is it?

major limb defects...99% teratogenic

50

Isotretioin (______) is another example of a 99% teratogenic drug. It is used for severe cystic acne.

accutane

51

Drugs that are teratogenic may still be approved by the FDA: therapeutic _____ outweighs their _____. For example some teratogenic drugs can help with _____ by treating ulcers and "wasting".

benefit...risk...AIDS

52

What are the 5 FDA Teratogenic/Pregnancy Risk Factors given to a drug? Which one is safest, which is most dangerous?

A safest,B,C,D, and X most dangerous

53

Which category of pregnancy risk factor? Controlled studies in pregnant women failed to demonstrate a risk to the fetus.

A

54

Which category of pregnancy risk factor? Animal-reproduction studies have not demonstrated a fetal risk.

B

55

Which category of pregnancy risk factor? Studies in animals have revealed adverse effects on the fetus, but no data in humans exist.

C

56

Which category of pregnancy risk factor? There is positive evidence of human fetal risk, but the benefits of use in pregnant women may be acceptable.

D

57

Which category of pregnancy risk factor? Studies in animals or humans have demonstrated fetal abnormalities. Contraindicated in women who are or who may become pregnant.

X

58

What is are two examples of 'B' pregnancy risk drugs in dentistry? What is an example of an 'X' pregnancy risk dry in dentistry?

B: Lidocane & Tylenol X:Tetracycline

59

________ are when 2 or more drugs are taken at the same time by a patient, the resultant effects may often be different from the effects produced by each drug when given alone.

Drug Interactions

60

There are three effects of drug interactions: 1. The net drug response may result from ________ of the effects of one or the other drug.

enhancement

61

There are three effects of drug interactions: 2. The development of _____ effects that are not observed with the drug alone.

NEW

62

There are three effects of drug interactions: 3. The _______ of the effect of one drug by another.

inhibition

63

Drug interactions: In patients taking 2 or 3 medications at the same time, ____ out of 100 will experience a significant drug interaction.

5 out of 100

64

Drug Interactions: In patients taking 8 to 10 medications together, ___ out of 100 will experience an interaction

20 out of 100!!

65

BIG TOPIC!!!! 4 Basic Mechanisms of Drug Interactions: 1.Drugs having ______ effects. Additive, synergistic, and potentiation. Like giving tylenol and ibuprofen to quickly reduce fever.

SIMILAR

66

BIG TOPIC!!!! 4 Basic Mechanisms of Drug Interactions: 2. _______ effects c/o altered CYP enzymes they are going to promote induction AND inhibition!

metabolism

67

BIG TOPIC!!!! 4 Basic Mechanisms of Drug Interactions: 3.______ effects like altered pH in the stomach.

Absorption

68

BIG TOPIC!!!! 4 Basic Mechanisms of Drug Interactions: Displacement of _______: leads to more 'free' drug in circulation. Elderly people have less.

Plasma Proteins

69

BIG TOPIC!!!! 4 Basic Mechanisms of Drug Interactions: What are they? :)

1. Drugs with similar effects 2.Metabolsim Effects 3.Absorption Effects 4.Displacement of Plasma Proteins

70

_________ is defined as the range of response per
dose....An individual may require a higher/lower dose to produce the desired effect.

Biological variation---genetics to explain the effectiveness

71

_________ is a greater-than-normal reaction to a
drug. Ex. tranquilizer: small dose has mild effect on one person, while small does has major effect on another

HyperSusceptibility

72

Drug ________ is the response of the patient to the drug is QUALITATIVELY different from the usual or expected response.. Ex. stimulant to overcome sedation, but it makes Pt fall asleep (me & caffeine at times :))

Idio-syncracy (usually a genetic defect)

73

Age effect on safety/effectiveness of drugs: Pedo-many drugs are given in a much _____ dose because children have increased _________. Dosing of a child is based on their _______.

smaller....membrane permeability!!....WEIGHT

74

Age effect on safety/effectiveness of drugs: the Poison protection act of 1970 brought about child-resistant _______.

containers

75

Age effect on safety/effectiveness of drugs: PEDO-Calculate dose according to body ______, _____ and total body _______.

WEIGHT, AGE, and total body SURFACE AREA

76

Age effect on safety/effectiveness of drugs: Typically, children receive _____ of the adult dose.

HALF

77

Age effect on safety/effectiveness of drugs: Elderly- Decreased _______ due to increased stomach acidity.

absorption

78

Age effect on safety/effectiveness of drugs: Elderly- Decreased _____ function; more drug unchanged (more “active” drug).

LIVER

79

Age effect on safety/effectiveness of drugs: Elderly-Decreased _____ body mass & Increased body _____ (drug storage).

lean...FAT

80

Age effect on safety/effectiveness of drugs: Elderly- Decreased total body ______ (drug more concentrated in blood).

water

81

Age effect on safety/effectiveness of drugs: Elderly- Decreased _________ (more unbound “active” drug).

plasma proteins

82

Age effect on safety/effectiveness of drugs: Elderly- Less binding capacity (decreased _________), less metabolism (decreased _____ function) and decreased _____ function allow for normal doses of drug to act at overdose levels in the geriatric patient SO WE GIVE A ______ DOSE!!!

plasma proteins....liver...renal....LOWER

83

With liver diseases = in most cases, drug metabolism is reduced due to diminished function of the ________ system; dosing must be ______.

cytochrome P-450....reduced

84

With renal diseases (DIABETES!!!) = results in renal impairment of drug ________; dosing must be modified on the basis of renal clearance values of the drug.

excretion

85

Drug _______ is associated with increasing amounts of drug required to produce a consistent effect and it's usually associated with drugs which cause physical dependence (addiction).

Tolerance

86

________ is a RAPID development of tolerance, like 1-2 doses.

TACH-y-phyl-axis ("TACK-E-FLACK-SIS)

87

What is an example of Dental Tachyphylaxis?

Re-adminsiter anesthetic IMMEDIATELY when pt tells you it is wearing off! (a tolerance has been built to the drug with the 1st dose!)

88

________ studies the genetic variability of drug effects.

PharmacoGenetics

89

Differences in genetic sequences are called _________.

polymorphisms

90

Polymorphisms (differences in gentic sequences) include both Pharmaco_______ AND Pharmaco_______ effects!

PharmacoKinetic (plasma) AND PharmacoDynamic (target genes) effects

91

A Pharmacogenetic ________ helps prevent drug side effects by looking for "_______" genes that encode for messed up receptors/CYP enzymes.

screening..."misspelled"

92

Genetic resistance to dental anesthetic (via plasma cholinesterase alteration) is found in 2% of the global population, BUT ZERO people of ________, ________, _______, or ________ have had the alteration!

Japanese, Black, Eskimo, or Filipino

93

G-6-P deficiency is quite common which leads to less Glutathione (an anti-oxidant). It effects 200 million people world wide and leads to hemolytic _______.

anemia