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pharm 5018 ETSU
Ch 5 Adverse Drug Reactions
Question | Answer |
---|---|
Incidence of ADRs | The World Health Organization Drug Monitoring Program •Pharmacovigilance centers worldwide evaluate data and allow for rapid dissemination of information/Under-reporting is still common/Prevalence/Populations at higher risk /Children/Elderly /Patients with renal impairment |
Adverse Drug Reactions | Every drug has the potential to cause harm. ADRs are unintended/may be unpredictable/may be predictable |
Predicting ADRs | Age: extremes of age – young and old Body mass /Adult dosing is based on average weight of 150 lbs./Lean and obese patients/Children dosed in mg/kg |
Predicting ADRs | Morbidly obese patients need dosing adjustment of some medications due to distribution/Gender/Women tend to be smaller/Different fat distribution/Pregnancy changes |
Predicting ADRs | Environment/Drugs affecting mood and behavior/Physical /environment: low O2, temperature/Time of administration/Timing with food/Biorhythms may affect drug absorption and excretion. |
Predicting ADRs | Pathological state/Pain intensifies need for opioids; anxiety may produce resistance to antianxiety drugs/Renal or hepatic dysfx/Genetic factors/Psychological factors/Cultural or faith-based attitudes toward drug |
Dose-Related ADRs | Secondary effects: drugs have intended effect, but may also have secondary effects Hypersusceptibility: Even at usual doses some patients are more susceptible to the drug, probably due to altered pharmocokinetics. Overdose: intentional or accidental Latrogenic effects: ADRs may mimic pathological disorders. |
Type A ADRs | Type A reactions are predictable from a drug’s known pharmacological properties. May be exaggeration of pharmacological effect of drug/Hypoglycemia from insulin/Hypotension from antihypertensives/May be a drug’s secondary effect/Diarrhea from antibiotics/Anticholinergic effects with antidepressants |
Type I Allergic Response | Anaphylactic reaction/Immediate response/Previously sensitized person/Reaction mediated by the IgE antibodies on the mast cells/May be fatal if not treated immediately |
Type III Allergic Response | Arthus reaction or immune complex reaction/Also called “serum sickness”/Angioedema, arthralgia, fever, swollen lymph nodes, and splenomegaly /Occurs 1 to 3 weeks after drug exposure |
Type IV Allergic Response | Cell-mediated, delayed hypersensitivity/Common skin reaction that occurs 24 to 48 hours after drug contact with skin |
Type C ADRs | Cumulative effects of a drug from chronic use/Dose-related and time-related/Example: hypothalamic-pituitary-adrenal axis suppression with chronic corticosteroid use/Treatment is to reduce dose or withdraw the medication. |
Type D ADRs | Delayed ADRs that are not apparent for some time after the drug is taken/Teratogens/Effects may be seen at or before birth/Effects may manifest years later/Carcinogens/May be due to activation of oncogenes or inactivation of suppresser genes |
Drugs During Pregnancy | Teratogens/Exposure during first trimester/Some drugs are known to cause teratogenesis/Category X/Category C/Exposure later in pregnancy/Fetal effects/Abortificants |
Pregnancy Labeling Change | After July 1, 2015 all new drugs will have new pregnancy labeling. /Older drug relabeling will be phased in. |
Carcinogenic Drugs | Immunomodulators/Antineoplastic drugs/Androgens/Estrogens/Ethanol |
Type B ADRs: Allergic Response | Drug allergy or hypersensitivity/A drug allergy occurs when a patient’s immune system identifies a drug, a drug metabolite, or a drug contaminate as a foreign substance./The body mounts an immune response. Type I, II, III, IV allergic responses |
Type II Allergic Response | Cytotoxic reaction /Sometimes called an autoimmune response/ Hemolytic anemia, thrombocytopenia, lupus erythematosus/Improves with removal of drug |