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37 Cards in this Set
- Front
- Back
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What is a type A adverse drug reaction? |
Augmented Dose related, predictable, augmentation of the action of agent, may result from drug interactions E.g insulin causing hypoglycaemia, warfarin causing bleeding, nitrates causes headaches |
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What is a type B adverse drug reactions? |
Bizarre Not dose related, unpredicatable, uncommon but may be severe E.g anaphylaxis, halothane leading to hepatitis, chloramphenicol causing agranulocytosis |
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What is a type C adverse drug reaction? |
Chronic treatment effects e.g osteoporosis with steroids, steroid-induced Cushing's syndrome |
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What is a type D ADR? |
Delayed effect Occur some time after discontinuation of treatment e.g drug induced fetal abnormalities |
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What is a type E ADR? |
End of treatment effects Withdrawal syndromes: adrenocortical insufficiency after steroid treatment Drug withdrawal seizures |
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What are some methods of postmarketing surveillance? |
Phase IV studies Yellow card scheme Prescription event monitoring Cohort studies Case-control studies |
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What mark in the BNF represents that the drug is new? |
Black triangle |
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What ADRs are possible with NSAIDs? |
GI complications Cerebral haemorrhage Renal impairment Wheezing, rash
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What ADRs are possible with diuretics? |
Renal impairment Hypotension Electrolyte Disturbances Gout
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What ADRs are possible with warfarin? |
Bleeding |
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What ADRs are possible with ACE inhibitors? |
Renal impairment Hypotension Electrolyte disturbance Dry cough |
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What ADRs are possible with beta blockers? |
Bradycardia Heart block Hypotension Wheezing |
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What ADRs are possible with opiates? |
Constipation Vomiting Confusion Urinary retention |
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What ADRs are possible with digoxin? |
Toxicity
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What ADRs are possible with prednisolone? |
GI complications Hyperglycaemia Osteoporotic fracture |
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What ADRs are possible with clopidogrel? |
GI Bleeding |
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What are the different mechanisms of drug interactions and give examples |
Synergism: Rifampicin +isoniazid Alcohol + benzodiazepine Antagonism: Salbutamol + atenolol (bronchodilation vs constriction) Naloxone + morphine
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What can be fatal when combined with nitrates? |
Sildenafil (Viagra) due to hypotensive effects |
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What can lead to pancytopenia when given with methotrexate? |
Trimethoprim as both drugs interfere with folate metabolism |
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What drugs can slow the rate of gastric emptying? |
Opiates Antimuscarinics Tricyclic anti-depressants |
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What are the predictive factors for ADRs? |
Extremes of age Genetic factors Sex Comorbidity Multiple drug regimes Inappropriate use of medications Alcohol intake, poor cognitive function, depression |
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How can taking an antacid effect drug metabolism? |
Makes the stomach less pH so less of the drug is ionised and therefore less is absorbed |
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What can antacids bind with to form insoluble complexes? |
Tetracyclines Quinolones Iron Bisphosphonates |
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What is a possible reason for phenytoin toxicity to be present but the level of phenytoin is within normal range? |
The patient has a low albumin possibly from renal failure or liver failure and as the phenytoin measured in bound to albumin the test will not account for free phenytoin |
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Which drugs have high protein-binding? |
Warfarin Tolbutamide Phenytoin Sulponamides |
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What drug can alter the distribution of digoxin? |
Quinidine |
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What is the mechanism of the interaction between digoxin and quinidine? |
This interaction can lead to an increase in plasma concentration of digoxin as quinidine displaces it from binding sites in bodies tissues. Quinine also decrease renal and non-renal excretion rates of digoxin |
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What are some examples of induction (CYP 450) interactions? |
Barbiturates or griseofulvin reducing the effect of warfarin phenytoin reducing the effect of oral contraceptive Rifampicin reducing the effect of theophylline |
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What are some examples of CYP450 inducers? |
Phenytoin Carbamazepine Barbiturates Rifampicin Chronic ethanol St John's Wort |
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What are some examples of CYP450 inhibitors? |
Cimetidine Erthromycin Ciproflaxacin Sulphonamides Isoniazid Verapamil Metronidazole Omeprazole Grapefruit juice |
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What effect does an inhibitor have on CY450? |
Decreases the effectiveness (not the level) |
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What drugs can probenecid interact with and what are the effects? |
Probenecid inhibits tubular secretion of acid drugs: Penicillin: increased concentration and prolonged effect Methotrexate: increased concentration &TOXIC
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What is the interaction between lithium and thiazide? |
(probable mechanism) thiazides causes diuresis and initial sodium loss but compensatory sodium retention happens in proximal tubules. The proximal tubules do not distinguish sodium from lithium so lithium is retained and accumulates |
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What can you do to reduce a drug interaction? |
Avoid combination Adjust does Monitor therapy Continue medication (risk/benefit) |
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What is the danger of giving potassium chloride to someone on spironolactone? |
Hyperkalaemia |
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What can interact with theophylline to result in theophylline toxicitiy? |
ciprofloxacin |
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When should serotonin syndrome be considered? |
Patient with mental, autonomic or neuromuscular changes taking a medication that increases serotonin levels and with a recent change/increase in medication |
