wk 6- ADR

Question 1

types of adverse reactions

Answer 1

type A- augumented reactions

type B- hypersensitivity/bizzare

type C- chronic

type. D- delayed

type E - end of use

Question 2

top 4 meds associated with Es

Answer 2

opioids
nsaids
aspirin
beta blockers

Question 3

define ADR

Answer 3

any reaction to a drug that is harmful to a patient

Question 4

things that contribute to ADRs (outside of patient factors)

Answer 4

-failing of clinical trials- not enough subjects to detect ADRs until in population

-medication errors (at the level of prescribing, dispensing, taking, adherence, monitoring)

-small therapeutic window

Question 5

examples of low therapeutic index drugs

Answer 5

anticoagulants
insulin
cardiac glycosides
antiarrhythmics
TCA
anti cancer
immunosuppressants

Question 6

ED50

Answer 6

effective dose required to produce 50% of max desired effect

Question 7

LD50

Answer 7

lethal dose required to kill 50% of animals that receive it

Question 8

What predisposes people to a TYPE A ADR

Answer 8

1. very young or old- metabolism and excretion not as efficient
2. distribution - affected by changes in body comp and availability of plasma protein for binding
3. disease - liver, kidney, GI motility, plasma protein concentrations
4. genetics- differences in enzyme activity which changes how the drugs are metabolised
5. drug to drug interactions
   - one drug can increase or decrease the other
   - drugs that have opposite actions can cancel eachother out
   - drugs with same actions can potentiate one another

Question 9

type B ADRs

Answer 9

-rare but unpredictable and not dose related

can be due to allergy or other causes

Question 10

type B - idiosyncrasy

Answer 10

an effect unrelated to the action of the drug

Question 11

type B - insensitivity and intolerance

Answer 11

outliers that respond differently to the vast majority

Question 12

hypersensitivity reactions

Answer 12

immunological reaction to drugs

type 1 -
- type 4 hypersensitvity reactions

Question 13

type 1 hypersensitvity reaction

Answer 13

anaphylaxis
allergen- IgE

antibodies attach to mast cells - release mediators (eg histamine)

local effects- hayfever, asthma, urticaria
systemic effects- swelling/anaphylaxis

occurs, minutes to hours after exposure

Question 14

type 2

Answer 14

cytotoxic reaction

drug bind to blood cell membranes

IgG and IgM antibodies activate complement system and autolysis of RBCS

Question 15

type 3 hypersensitivity reaction

Answer 15

immune complex reaction

drugs for immune complexes with antibodies which circulate in blood and can be deposited in particular areas of the body

occurs 1-3 weeks after exposure

Question 16

type 4 hypersensitvity

Answer 16

drugs combine with proteins in the skin to form antigen

t cells activitated and cause damage to skin cells (rashes, lumps, itchy, weeping)

occurs 2-7 days after drug exposure

Question 17

teratogenesis

Answer 17

drugs causing abnormal foetal development

Question 18

carcinogenesis

Answer 18

drug induced tumours

Question 19

risk of a drug to drug interaction for patients taking 2-5 drugs

Answer 19

19%

Question 20

risk of drug to drug interactions for patients taking 6 drugs

Answer 20

80%

Question 21

drug enzyme induction

Answer 21

drugs that increase the metabolism enzyme activity

increase removal of drug and decrease effectiveness

Question 22

drug enzyme inhibition

Answer 22

drugs that inhibit and cause accumulation of other drugs in the body

not removing the drug and therefore increases risk of side effects

Question 23

what do cyp450 enzymes do

Answer 23

found in liver and also small intestine, lungs, placenta nd kidneys and are responsible for metabolising 90% of drugs

Question 24

what do you need to be mindful of drugs that inhibit or induce cyp450

Answer 24

changes the removal/metabolism of drugs and can lead to ineffectiveness or side effects/toxicity

Question 25

review inducer/inhibitor table

Question 26

people at risk of ADRs

Answer 26

older people children chronic conditions HF, DM, anaemia, asthma changes in renal/hepatic function genetic predisposition

Question 27

difference between women and men with ADRs

Answer 27

women are more likely to experience ADRs

Question 28

polypharmacy

Answer 28

increase in adverse drug reactions when more than 5 drugs are taken

Question 29

what age related changes occur in distribution in elderly

Answer 29

Distribution body comp: more fat, less body water plasma protein concentration: less with age blood flow: after 30, CO, renal and hepatic blood flow fall

Question 30

what age related changes occur in metabolism in elderly

Answer 30

- decreased size and cells of liver -decreased metabolism of drugs (1st pass metabolism reduced by 40%)

Question 31

other age related changes

Answer 31

-decreased renal clearance of drugs -renal blood flow, GFR, active tubular secretory processes decline -drugs excreted by kidneys are more likely to accumulate

Question 32

pharmacodynamic age related changes in elderly

Answer 32

increased sensitivity to drug receptors with age renal/hepatic disease can affect drug response unclear

Question 33

NSAIDs and the elderly

Answer 33

more likely induce gastric ulceration in older patients due to: 1. reduced gastric mucosal prostaglandins 2. drug induced inhibition

Question 34

differences in ADME in infants and children

Answer 34

1. reduced gastric pH 2. delayed gastric emptying 3. irregular GI motility 4. more body water and less body fat 5. reduced plasma proteins 6. lower liver capacity to metabolise drugs 7. delayed renal clearance

Question 35

how can drugs be transferred to the foetus in pregnancy

Answer 35

by diffusion

Question 36

biggest risk of malformation is up to

Answer 36

8 weeks post conception, avoid drugs during this time

Question 37

pregnancy category

Answer 37

category A- no risk B- no risk in animal studies, women not studied C- fetal harm in animals, no studies in women D- evidence of human fetal risk but benefits > risk in life threatening situations X- contraindicated in pregnant women

Question 38

what drugs can harm feotus

Answer 38

1. Male hormones 2. Female hormones 3. Iron preparations 4. Aspirin-like drugs 5. Alcohol 6. Barbiturates

Question 39

NSAID and pregnancy

Answer 39

-associated with spontaneous abortion -not dose dependent, may be time/ duration dependent -non aspirin NSAID (prescription and OTC)

Question 40

ADR risk factors

Answer 40

1. polypharmacy 2. Multiple comorbid conditions 3. Drug dose and duration of exposure 4. Extremes of age (neonates, children, elderly) 5. Female sex 6. Genetic predisposition 7. Prior history of drug reactions and hypersensitivity 8. End organ dysfunction 9. Altered physiology 10. Inappropriate medication prescribing, use or monitoring 11. Lack of patient education and other system failures

Question 41

who do you report ADR to

Answer 41

TGA on OTC, prescription, complementary

Question 42

elderly and adrs

Answer 42

polypharmacy aging process (renal/hepatic function decreased) adherence/cognitive impairment multimorbidity

Question 43

what is the gold standard for offloading a diabetic forefoot lesion?

Answer 43

contact cast -shouldnt use with infection -shouildnt use in neuropathy

Question 44

non pharamcological magement for a dibaetic wound

Answer 44

-wound care/debridement -dressing (antimicrobial, absorbant, etc) -offloading (donut pads, insoles, rockers)

Question 45

when is clindamycin indicated

Answer 45

when theres an allergy to penicillin and cepholosporin

Question 46

what pharmacological options do you have for pain

Answer 46

non drug- immobilise, othroses, footwear, exercises drug- NSAID (oral or topical) opioid corticosteroid (inject/topical) antidepressents - chronic neuropathic pain or depression.