S3M1 Pharmacology Babbini Adverse Effects Of Drugs

Front 1

Answer the following about
-Adverse drug effects:
Time of appearance?
Predisposing factors?
Most frequent sites affected?
Mechanism?

Back 1

-Time of appearance is mainly during the first 10 days of therapy.
-Predisposing factors are age, female sex, serious kidney or liver disease
-Most frequently affected sites are nervous system, digestive system, blood and skin.
-Mechanism is 70% pharmacological, 5-15% cytotoxic, and 5-15% immunological

Front 2

An unintended, non deleterious drug effect occurring after administration of doses normally used in humans and related to the pharmacological properties of the drug?

Back 2

Side effects
These are often synonymous with "unwanted" or "adverse drug effects."

Front 3

Answer the following about
-Side effects of drugs:
Incidence?
Seriousness?
Dose-response relationship?
Mechanisms?
Therapeutic measures?

Back 3

-Incidence is higher than that of other unwanted effects (2-5%) but it varies from drug to drug.
-Seriousness is generally low
-Dose dependent
-Mechanism: usually drug-receptor interaction
-Therapeutic measures: Change the dose or administration schedule. You could also switch to another drug.

Front 4

What is an adverse effect appearing after the administration of doses definately higher than therapeutic doses?

Back 4

Overdose toxicity

All chemical compounds, if introduced into the body in excessive amount, can lead to toxic effects that may be very serious or even lethal.

Front 5

What is a therapeutic window?

Back 5

The range of doses which have a high probability of success with a low probability of dose-related unwanted effects.

Front 6

Answer the following about
-Overdose toxicity of drugs
Seriousness?
Dose-response relationship?
Mechanisms?
Therapeutic?

Back 6

Seriousness: Can be high
Dose-response: Dose-dep
Mechanism: Drug-receptor interaction or cellular damage.
Therapeutic: Reduce the dosage or use antagonists

Front 7

If a drug has a very low therapeutic index, what does this mean?

Give some examples.

Back 7

These drugs have a small margin for error. It would be very easy to overdose on these medications.

Drugs like lithium, anesthetic drugs have very low TI's. Digoxin has a TI of 3-5 which means a plasma concentration 3-5 times of therapeutic concentration is fatal.

Front 8

This is a genetically based, abnormal response to a drug.

Back 8

Idiosyncrasy

An unusual response can be named idiosyncratic only if its genetic origin is known. Therefore, if an immunological mechanism underlies a given drug effect, this is NOT an idiosyncratic response. That would be defined as an allergic response.

Front 9

What is the best way to minimize the risk of an idiosyncratic reaction?

Back 9

A detailed personal and familiar history before administering a drug known for its idiosyncratic potential.

Front 10

Answer the following about
-Drug idiosyncrasy
Incidence?
Seriousness?
Dose-response?
Mechanism?
Therapeutic measures?

Back 10

Incidence: generally low and only in genetically abnormal subjects
Seriousness: Can be high
Dose-response: Dose Dep
Mechanism: Drug-receptor
Therapeutic measures: Stop the drug, or use antagonists

Front 11

What is a drug induced idiosyncratic disorder involving nitrates and sulfonamides?

Back 11

Methemoglobinemia
-Caused by NADH-methemoglobin reductase deficiency

Front 12

What is a drug induced idiosyncratic disorder involving succinylcholine?

Back 12

Prolonged apnea caused by cholinesterase deficiency

Front 13

What is a drug induced idiosyncratic disorder involving Primaquine, salicylates, and quinolones?

Back 13

Hemolytic anemia caused by G6PDH deficiency

Front 14

Idiosyncratic disorder involving Isoniazid?

Back 14

Neurotoxicity caused by N-acetyltransferase deficiency

Front 15

Idiosyncratic disorder involving Barbiturates, phenytoin, ethanol, griseofulvin and estrogens?

Back 15

Porphyrias (acute intermittent) caused by a def of enzymes of the heme biosynthetic pathway.

Front 16

What is the difference between hypersensitivity and supersensitivity?

Back 16

Hypersensitivity is used to describe an allergic state.

Supersensitivity is used if the increased sensitivity to a drug has not an immunological basis.

Front 17

What is the most common allergenic drug on the market?

Back 17

Penicillin

Front 18

Which of the following drugs with high probability of allergic reactions is the most reactive?
Tetracyclines, cephalosporins, Sulfonylureas, Thiazides, Methyldopa, Heparin, isoniazid, Beta-blockers, Streptokinases, Thioamides?

Back 18

This is the order:
-Streptokinases
-Cephalosporins
-Tetracyclines
-Sulfonylureas
-Thioamides
-Thiazides
-Methyldopa
-Heparin
-Isoniazid
-Beta-blockers
-Phenytoin
-Barbiturates
-Allopurinol

Front 19

In order to induce an allergic response the drug must have immunogenic properties such as:

Back 19

MW higher than 6000
If it is a hapten, it must be capable of binding firmly to a protein to form a product that has immunogenic properties

Since most drugs have a MW lower than 1000, the hapten case occurs most frequently

Front 20

Answer the following about
-Drug allergy
Incidence?
Seriousness?
Dose response relationship?
Mechanism?
Therapeutic measures?

Back 20

-Incidence: Generally low
-Dose-response: NOT DOSE DEP
-Mechanism: Immunological
-Therapeutic measures: Stop the drug or use antiallergic drugs

Front 21

Regarding the incidence of drug allergy, the relative frequency of drug allergy is related to :
1.) the structure of the drug
2.) the route
and what other 2 things?

Back 21

3.) the associated illness
4.) the individual predisposition

Front 22

What type of allergic reaction is the following:

Production of IgE antibodies on the first exposure. On the second exposure the An:Ab rxn causes release of inflammatory mediators. Allergic diseased of this group includs anaphylaxis, allergic asthma, atopic dermatitis, etc. It is an immediate reaction.

Back 22

Type 1 (immediate reaction)

Front 23

Which type of allergic reactions is the following:

Drug binds to a cell and it appears to be foreign. This evokes the production of Ab IgG or IgM that can react with the cell bound drug. This An:Ab reaction may trigger the activation of the complement system or permit attack by mononuclear killer cells. Either way, the ultimate result is the death of the target cell. This type of reaction is Antibody-dependent.

Back 23

Type 2 (antibody-dependent cytotoxicity)

Hemolytic anemia, granulocytopenia, tubulointerstitial nephritis.

Front 24

Name the following type of allergic reaction:

An immune complex that may remain soluble in the blood and eventually may deposit on BV or BM, causing complement activation and local inflammation. Complement activating IgG or IgM classes are usually involved.

Back 24

Type 3 (immune complex-mediated reaction)

Ex: hepatitis, nephritis, arthritis or serum sickness

Front 25

Which type of allergy is the following:

Antigen sensitizes T cells to produce T cell receptors. On second exposure, T cells release lymphokines that produce inflammation and occur hours or days after exposure to the antigen or drug. The skin is the chief site of allergic response.

Back 25

Type 4 (delayed or cell-mediated reaction)

Ex: contact dermatitis is most common, eczema, Stevens-Johnson syndrome

Front 26

Treatment of an allergic drug reaction is related to the seriousness of the disease. In more serious cases the administration of what two things is advisable?

Back 26

Corticosterioids and antihistamines. A lethal allergy drug can be treated with epinephrine administered subcutaneously (or IV).

Front 27

In some cases drug administration causes a type 1-like allergic reaction but circulating AB's cannot be detected. Symptoms are usually due to direct release of histamine. What is this called and what drugs can cause this?

Back 27

This is a pseudoallergic reaction.

Drugs like opioids, vancomycin, curare-like drugs, dextran.

Front 28

Are pseudoallergic reactions dose-related?

Back 28

Yes, unlike true anaphylaxis and allergy, pseudoallergic reactions are DOSE dependant.

Front 29

What is the best way to minimize the risk of an allergic reaction?

Back 29

Getting a detailed personal and familiar history should be the first procedure to undertake to avoid allergic reactions.

Front 30

T/F
-Drugs with a MW of 800 can cross the placenta easily.

Back 30

TRUE
Drugs with a MW less than 800-1000 can cross the placenta easily (depending upon their lipid solubility and the degree of ionization) while those with MW larger than 1000 cross poorly.

Front 31

Drugs given during preg may have direct and indirect effects.

The direct Effects can be toxic or teratogenic. Briefly describe eeach example.

Back 31

1.) Toxic: Generally reversible and produce similar effects in adults if given too high a dose.

2.)Teratogenic: Irreversible. May consist in morphological damage as well as functional damage.

Front 32

Drugs given during pregnancy may have a direct as well as indirect effects on the fetus.

What are the causes of indirect effects on the fetus?

Back 32

1.) A decrease of blood flow to the placenta

2.) a disease of the mother

Front 33

Which stage of pregnancy is the mother MOST sensitive to morphological teratogenic effects.
Which stage is the most sensitive to function teratogenic effects?

Back 33

In the first stage called blastogenesis(0-16 days), cells are resistant to teratogens.

The second stage of organogenesis(17-80) is the most sensitive to morphological malformations

The third is Histogenesis and is the most vulnerable to functional teratogenic effects.

Front 34

Fetal alcohol syndrome consists of CNS dysfunction, slowness in growht, facial abnormalities, and other malformations.
Describe the immune system of children with FAS.

Back 34

Children with FAS have a greatly increased susceptibility to infectious diseases due to an extensive impairment of their immune system.

Front 35

T/F
Teratogenesis and fetal toxicity are caused by many drugs, occur at the same time, are permanent disfunctions and are dose dependent?

Back 35

False
Fetal toxicity can be caused by many drugs and usually occur after day 81 while teratogenesis is caused by fewer drugs and more likely between days 17 to 80.

Fetal toxicity is not always permanent but they are both dose-dependent disfunctions.

Front 36

which FCA category carries the highest risk to the fetus?

Back 36

Category D and X, X being proven drugs that suggest the risks outweigh the benefits.

Front 37

What are some common drugs with a high risk of teratogenesis?
Th
Anti-
Anti-c
W
Et
Tri
Li
Tetra
Bar
Ben
Vitamin

Back 37

In order of toxicity:
-Thalidomide
-Anticancer drugs
-Anti-convulsants
-Warfarin
-Ethanol
-Tricyclic antidepressants
-Lithium
-Tetracyclines
-Barbiturates
-Benzodiazepines
-Vitamin A in high doses

Front 38

The effects of carcinogens are usually dose-dependent, additive and irreversible.
What are some proven carcinogenic drugs?
A
E
A
A
Phenacetin
Phenytoin
Chloramphenicol

Back 38

-Antineoplastic and immunosuppressant drugs
-Estrogens
-Androgens
-Alcohol

Front 39

What is the difference between drug abuse, drug dependence and drug addiction?

Back 39

Drug abuse: non medical
Drug dependence: compulsion to take a drug on a continuous basis to experience effects or avoid withdrawal

Drug addiction: A disease process characterized by continued use of a drug despite harm to yourself and others.

Front 40

What are the main variables that affect pswychologic dependence to a drug?
D
T
R
F

Back 40

Dose
Tolerance
Route of administration
Frequency of use

Front 41

The mechanism of psychologic dependence is controlled by the median forebrain bundle and the nucleus accumbums which is your reward system.
What drugs activate the reward system well and what causes the euphoric effets?

Back 41

Nicotine, cocaine, amphetamine, ethanol and opioids increase dopamine extracellular levels in the nucleus accumbens reward system

Front 42

This is a type of drug dependence is caused by repeated administration of a drug, which necessitates the continued administration of the drug to prevent abstinence syndrome (withdrawal)?

Back 42

Physical dependence

Front 43

Physical dependence (withdrawal) is strongly associated with tolerance. What are two examples of how tolerance occurs in these patients?

Back 43

1.) Drug that produces tolerance by upregulating the cAMP pathway

2.) Drug that causes tolerance by downregulating certain receptors may also produce physical dependence.