Iatrogenic Presentations Flashcards
Adverse drug reactions:
Define?
Why are they important?
Response to a drug that is noxious and unintended and that occurs at doses normally used for prophylaxis, diagnosis, or treatment of disease or for modification of physiological function.
Avoidable
Increases hospital stay
Cost to NHS for avoidable hospital stays
Most common drug and ADRs causing hospital admission:
(1) NSAIDs - 3 ADRs
(2) Diuretics - 2 obvious ADRs
- Electrolyte disturbances?
- What do thiazide D increase the risk of?
(3) Warfarin - bleeding - Clopidogrel - GI bleeding!
(4) ACE/AII inhibitors - same as diuretics:
- How do they cause renal impairment?
(5) BBlockers:
- 3 cardiac ADRs
- 1 more?
(6) Opiates - 4? - not overdose
(7) Digoxin - what is the main ADR?
(8) Prednisolone - list some SE?
Hypo/hyperkalaemia
GI complications - PUD
Renal impairment - prostoglandins - efferent - lack of constriction
Wheeze - worsens asthma and COPD
Renal impairment
Hypotension
Diuretics, particularly thiazide diuretics, are associated with an increase in serum urate levels
Reduced AII leading to dilation of afferent vessels - usually causes construction to maintain perfusion ======== Bradycardia Heart block Hypotension
Wheezing - worsens asthma ======== Constipation Vomiting Confusion Urinary retention ============= Digoxin toxicity ============= GI complications - Hyperglycaemia - DM Osteoporotic fracture =============
Classification:
What are the 5 types?
Type A - Augmented Type B - Bizarre (idiosyncratic) Type C - Chronic Rx effects Type D - Delated effects Type E - End-of-treatment
Classification:
Augmented - define and give an example?
Bizarre - not dose-related and not predictable - examples?
Chronic Rx effects - examples?
Delayed effects - define and give example?
End of Rx - occurs on withdrawal - examples?
Dose-related and predictable - avoidable
Insulin > hypoglycaemia Warfarin > bleeding Nitrates > headaches ============ Penicillin > anaphylaxis Carbimazole > agranulocytosis ============ Steroids > osteoporosis + Cushing's syndrome ============ Variable, occurs some time after discontinuation of Rx
Drug-induced fetal abnormalities ============ Adrenal insufficiency post steroids Drug withdrawal seizures Paroxetine
What drugs can cause gynecomastia?
What drugs can cause galactorrhoea?
Sprinonlactone Oestrogens Methyldopa Digoxin ====== Antipsychotics TCAs
{Oestrogens
Methldopa}
Pharmacovigilance:
Which special patient groups is there less data on?
What is the objective of pharmacovigilance?
Yellow Card Scheme:
ADR are reported
Voluntary
Patients report SE
https://yellowcard.mhra.gov.uk
Elderly Children Lactating women Pregnancy Multiple diseases Polypharmacy
Identify previously unrecognized hazards
Assess risk vs benefits
Promote safer use
