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29 Cards in this Set
- Front
- Back
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What are the 4 categories of adverse drug reactions?
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1. ADRs from drug binding to intended receptor but at inappropriate concentration, suboptimal kinetics, or in incorrect tissue
2. ADR from drug binding to an unintended receptor 3. ADR mediated by immune system 4. Idiosyncratic (unknown mech) |
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Describe a type I hypersensitivity.
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- immediate, results from IgE after first exposure.
- antigen could be a foreign protein or endogenous protein modified by a hapten |
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Describe a type II hypersensitivity.
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- Antibody dependent cytotoxic hypersensitivity
- drug binds to cells and is then recognized by immune system (IgG) |
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Describe a type III hypersensitivity.
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- Immune-complex mediated,
- antibodies formed against soluble antigens - antigen-antibody complex gets deposited into tissues and brings serum sickness (inflammation) |
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Describe a type IV sensitivity.
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Delayed reaction, result of activation of cytotoxic T-cells
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Methydopa is a ____ agonist that can initiate ___
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- a-2 agonist, initiates hemolytic anemia
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Autoimmune reactions caused by ______, ____, and ____ can cause a lupus like syndrome
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Hydralazine, Isonazid, procainamide
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Stevens-Johnson is a skin rash reaction reported with what medications?
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barbiturates, sulfonamides, phenytoin, carbamazepine, allopurinal, NSAIDs
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The most common skin reaction to a drug is ___
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erythema multiforme
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Immune toxicity is commonly caused by what?
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Cytotoxic chemotherapy agents - target any proliferating cells, including WBCs
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The most frequent reason for drug withdrawals from the market in the US is __
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hepatotoxicity.
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The mechanism of fulminant hepatitis is usually ____
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idiosyncratic (unknown)
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Renal toxicity may manifest in what ways?
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Alterations in renal hemodynamics, tubular damage or obstruction, glomerular nephropathy, interstitial nephritis.
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What medications cause progressive renal failure?
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- NSAIDs, ACE inhibitors, Antineoplastic agents, immunomodulators
- Gentamicin (renal tubule injury - reversible) - Amphotericin B (frequent b/c mechanism for efficacy is same as toxicity) - Contrast-media (dose related) |
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What are the three major mechanisms of cardiovascular toxicity?
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- Interactions with potassium channels cause QT prolongation, delayed repolarization, and arrhythmia
- Directly cytotoxic to myocytes (doxorubicin = increased free radicals) - Toxic to heart valves |
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Bleomycin and Amiodarone can cause ___ toxicity.
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Pulmonary
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An example of acute reversible exacerbation of pulmonary toxicity is:
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Methylcholine - used to induce asthma attack for diagnostic purpose
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A ____ is a substance that induces defects in a developing fetus.
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Teratogen
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Exposure to a teratogen prior to the 3rd week of pregnancy usually results in ___
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Death of embryo
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Teratogens in weeks ___ to ___ have the most profound effects on developng organs to fetuses
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3 to 8
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Teratogens after organogenesis may result in ___
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Growht or maturation problems in organs, but not developmental plan
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How does carbon monoxide result in poisoning?
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Binds to heme in hemoglobin more strongly than oxygen, resulting in hypoxia.
- also shifts carboxyhemoglobin to the left, making oxygen dissociate less readily |
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Describe symptoms of carbon monoxide poisoning.
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Non-specific - HA, dizziness, irritability
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What would you see in the following CO toxicity levels?
- 30-40% - 50-60% -70+ |
- 30-40: HA, vomiting, visual disturbance
- 50-60: collapse, convulsions - 70+: death |
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CO poisoning is treated by ___
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hyperpbaric oxygen therapy
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Describe the effects of lead poisoning on the body.
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- Causes disruption of blood/brain barrier, resulting in lead and other toxins to access brain
- Lead encephalopathy results in lethargy, vomiting, irritability, dizziness, AMS, coma, death - interferes with sythesis of hemoglobin - reversible and irreversible kidney damage |
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What is the treatment for lead poisoning?
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- Chelators:
- EDTA - binds lead - Dimercaprol - binds lead, arsenic, mercury - Succimer - binds lead, arseinc and mercury |
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Describe how pesticides result in toxicity.
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- organophosphates = acetylcholinesterase inhibitors
- produce muscarinic and nicotinic toxicity |
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What is the treatment for pesticide toxicity?
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Atropine (muscarinic antagonist)
Pralidoxime - regenerated ACHE (reactivates it!) |
