Lecture 14: Adverse Drug Reactions Flashcards
(42 cards)
Define an adverse drug reaction.
Something occurring that was not intended as a result of a drug being given.
Define a medication misadventure.
Any sort of hazard or incident that occurred with a med or exam.
Examples:
Pt took wrong med.
Rash from an ABX.
This includes any mediccation error, ADE or ADR
Define a medication error.
PREVENTABLE event with POTENTIAL to lead to inappropriate med use or pt harm.
Examples:
Wrong order entered on pt that was caught.
Pt got 10x normal dose fentanyl.
MAY include ADR and ADE but the problem does not always reach the patient
Define an adverse drug event.
Any injury caused by a medication.
Examples:
Idiosyncratic thrombocytopenia
Pt got 10x normal dose fentanyl.
Includes ALL adverse drug reactions
Give some examples of an adverse drug reaction.
Anaphylaxis from PCN.
Angioedema from lisinopril.
What does an ADR fall under in terms of categories?
Is always a subgroup of ADEs and Medications misadventures
CAN be a subgroup of medication errors but not all ADR are medication errors
What are some differences between ADEs and ADRs?
ADE = dose can be diff from norm, may or may not be linked to med
ADR = given at proper dose, reaction always related to medication
What are some of the methods used to prove an ADR?
Expert judgment/global introspection.
Assessment algorithm.
Bayesian probability estimations of epidemiologic data.
What are some of the assessment algorithms used to track ADRs?
Naranjo algorithm
WHO Causality algorithm
Venulet algorithm
Liverpool ADR Causality Assessment Tool (CAT)
What are the gradings for an ADR?
Minor
Moderate
Severe
Lethal
What are the reaction types for an ADR?
Type A and Type B.
Define the characteristics of a Type A reaction.
DOSE DEPENDENT
Related to drug’s MOA.
Reaction comes in a wide range.
80% of all ADRs.
Define the characteristics of a Type B reaction.
NOT DOSE DEPENDENT
NOT RELATED to drug MOA.
Influenced by patient specific factors.
Includes allergies, intolerances, and idiosyncractic responses.
What are the 5 mechanisms of ADR classification?
Idiosyncratic
Hypersensitivity
Intolerance
Drug interaction
Pharmacologic
Define idiosyncratic reactions.
Uncharacteristic response.
Does not occur on admin.
Unpredictable.
Small cohort of patients.
Example:
Drug-induced hepatitis
Define hypersensitvity reactions.
reactions not explained by pharmacologic effects of the drug
caused by altered reactivity of patient
includes allergic reactions
Are all allergic reactions adverse reactions?
Yes, but not the other way around.
Define a type 1 hypersensitivity reaction.
True allergic reaction with immediate onset of 1-6 hrs.
MOA:
Allergen beinds to mast cells via IgE receptors.
Releases inflammatory and vasoactive markers.
Itching, hives, hypotension, swelling.
Define a type 2 hypersensitivity reaction.
Cytotoxic reaction with delayed onset > 72 hrs.
MOA:
Host cells perceived by immune system as foreign.
IgG or IgM antibody binds to host cell.
Cytolysis and destruction occur.
What are some examples of a type 2 hypersensitvity reaction?
Hemolytic anemia
Thrombocytopenia
Define a type 3 hypersensitivity reaction.
Immune complex formation with delayed onset > 72 hrs.
MOA:
IgG or IgM antibody binds to antigen, forming complex.
Larger number of complexes deposit on blood vessels.
Local inflammatory reaction, tissue destruction.
What are some examples of a type 3 hypersensitivity reaction?
Serum sickness
Joint pain
Lymphadenopathy
Define a type 4 hypersensitivity reaction.
T-cell mediated reaction with delayed onset > 72 hrs.
MOA:
Antigen activates T-cells, creating memory cells.
Antigen detection in the future activates memory cells.
Cytokine releases an inflammatory response.
What are some examples of a type 4 hypersensitivity reaction?
Variety of rashes
Contact dermatitis
