Adverse drug reactions

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Questions and Answers

What differentiates drug abuse from drug addiction?

Drug abuse involves self-medication that deviates from accepted societal norms, while drug addiction is a compulsive pattern of drug use. (correct)

Drug abuse involves compulsive behavior while drug addiction is more controlled.

Drug abuse is characterized by overwhelming drug involvement, whereas drug addiction has less intense usage.

Drug abuse leads to physical dependence, while drug addiction does not.

What are the potential adverse effects of sudden withdrawal from certain drugs?

No significant effects unless the drug has been used for an extended period.

Worsening of the clinical condition for which the drug was prescribed. (correct)

Immediate physical harm regardless of the drug type.

Exclusively psychological effects with no impact on physical conditions.

During which stage of fetal development is an embryo most vulnerable to teratogenic effects?

Growth and development stage.

Fertilization and implantation stage.

All stages are equally vulnerable.

Organogenesis stage. (correct)

What is the primary concern when a drug is classified as having mutagenic properties?

It causes genetic defects. Signup and view all the answers

What differentiates drug habituation from physical dependence?

Habituation is less intense involvement without physical dependence symptoms. Signup and view all the answers

Which of the following drugs is known to cause teratogenic effects?

ACE inhibitors Signup and view all the answers

What is one of the major characteristics of drug-induced diseases?

They are also referred to as iatrogenic diseases. Signup and view all the answers

How long can chemical carcinogenesis generally take to develop?

10-40 years Signup and view all the answers

Which type of allergic reaction is characterized by an immunologically mediated response that produces predictable symptoms?

Drug allergy Signup and view all the answers

What is a defining feature of intolerance concerning drug reactions?

It leads to toxic effects at therapeutic doses. Signup and view all the answers

Which type of drug reaction could potentially manifest as either therapeutic or side effects depending on the context?

Side effects Signup and view all the answers

What distinguishes drug-induced diseases from other adverse drug reactions?

They result from direct interactions leading to iatrogenic disorders. Signup and view all the answers

Which example best illustrates idiosyncrasy in drug reactions?

Aplastic anemia from chloramphenicol Signup and view all the answers

What is a primary feature of both phototoxicity and photoallergy?

They can both occur upon exposure to sunlight. Signup and view all the answers

Which of the following describes drug dependence?

A condition where the body adapts to a drug's continued presence. Signup and view all the answers

Which of the following accurately describes the difference between an adverse drug reaction and a side effect?

ADRs are harmful responses that are generally more unexpected than side effects. Signup and view all the answers

Which of the following is true regarding secondary effects of drugs?

They are indirect consequences of the primary actions of drugs. Signup and view all the answers

In which scenario would toxicity be considered a dose-related effect?

Overdose or prolonged use leading to side effects. Signup and view all the answers

What factor is NOT typically considered a patient-related factor affecting adverse drug reactions?

Inherent toxicity of the drug Signup and view all the answers

Which of the following scenarios best illustrates a common cause of adverse drug reactions?

Combining prescribed medications with an over-the-counter pain reliever without checking for interactions. Signup and view all the answers

Which of these conditions is NOT a risk associated with the use of medications during pregnancy?

Increased metabolic rate in the mother due to drug use Signup and view all the answers

Which of the following factors does NOT influence the likelihood of developing adverse drug reactions in the elderly?

Current economic status and healthcare access Signup and view all the answers

Which type of adverse drug reaction is characterized by being less common, unrelated to pharmacological action, and having high mortality risk?

Type B (Bizarre) Signup and view all the answers

What is the appropriate management for a Type C adverse drug reaction?

Reduce the dose or use alternate day therapy Signup and view all the answers

Which of the following is an example of a Type D adverse drug reaction?

Tardive dyskinesia Signup and view all the answers

What features characterize Type E adverse drug reactions?

Occurs soon after withdrawal of the medicine Signup and view all the answers

Which classification of adverse drug reactions is likely to result in permanent damage to the patient?

Severe ADRs Signup and view all the answers

What is the common cause for a Type F adverse drug reaction?

Unexpected failure of therapy due to drug interactions Signup and view all the answers

What management approach is advised for immunological reactions classified under Type B?

Withhold the drug and avoid in the future Signup and view all the answers

Which of the following examples illustrates a potential outcome of Type D adverse drug reactions?

Carcinogenesis after long-term medication use Signup and view all the answers

Which statement accurately describes Type C adverse drug reactions?

They are uncommon but related to cumulative drug dosage. Signup and view all the answers

Which of the following management strategies is crucial for addressing withdrawal syndrome associated with Type E reactions?

Reintroduce the drug and withdraw slowly Signup and view all the answers

Which of the following types of adverse drug reactions (ADRs) is characterized by predictable reactions at therapeutic doses and typically low mortality?

Type A (Augmented) Signup and view all the answers

Which of the following examples correctly matches a serious adverse drug reaction to its drug type?

Angioedema - Captopril Signup and view all the answers

Which class of ADRs is referred to as 'Bizarre' and usually occurs independently of the drug dose?

Type B (Bizarre) Signup and view all the answers

What type of drug is most likely to cause respiratory depression as a Type A adverse drug reaction?

Opioids Signup and view all the answers

Which drug combination is known to potentially result in Stevens-Johnson Syndrome or Toxic epidermal necrolysis?

Metronidazole and Mebendazole Signup and view all the answers

Which medication is associated with dry mouth as a Type A adverse drug reaction?

Tricyclic Antidepressants Signup and view all the answers

Which type of drug-related event requires a decrease in dosage or indicates caution for future use?

Adverse drug reaction (ADR) Signup and view all the answers

Which of the following drugs is unlikely to be associated with bone fractures as an adverse reaction?

Chloroquine Signup and view all the answers

What is a distinguishing feature of Type C adverse drug reactions?

They are cumulative and related to long-term therapy Signup and view all the answers

Which of the following medications is known to cause confusion and drowsiness as a serious adverse reaction?

Diphenhydramine Signup and view all the answers

Study Notes

Drug Abuse

Using a drug outside of approved medical or social patterns
Deviates from generally accepted use within a specific culture

Drug Addiction

Compulsive drug use pattern
Involves an overwhelming preoccupation with the drug
Obtaining and using the drug takes priority over other activities

Drug Habituation (Psychological Dependence)

Less intensive involvement with a drug
Withdrawal causes only mild discomfort
Examples: tea, coffee, tobacco, social drinking

Drug Withdrawal Reactions

Adverse consequences from suddenly stopping therapy with certain drugs
Worsens the clinical condition the drug was treating

Teratogenicity

A drug's ability to cause fetal abnormalities when administered to a pregnant woman
Three stages of fetal development can be affected by drugs:
- Fertilization and Implantation (0-17 days): May lead to pregnancy failure (often unnoticed)
- Organogenesis (18 - 55 days): Most vulnerable period, leads to deformities
- Growth and Development (56 days onward): Leads to developmental or functional abnormalities

Mutagenicity and Carcinogenicity

Mutagenicity: A drug's ability to cause genetic defects
Carcinogenicity: A drug's ability to cause cancer
Reactive intermediates affect genes and can cause chromosomal changes
Chemicals can promote malignant changes in genetically damaged cells (even without direct interaction with DNA)
Carcinogenesis typically takes 10 - 40 years to develop

Drug Induced Diseases (Iatrogenic Diseases)

Caused by medical treatment (physician induced)
Management: reduce drug dosage or withhold the drug, consider interactions of concomitant therapy

Type B (Bizarre) Adverse Drug Reactions

Less common
Not related to the drug's pharmacological action
Unpredictable
High mortality
Examples
- Immunological reactions: Anaphylaxis with penicillin
- Idiosyncratic reactions: Malignant hyperthermia with general anesthetics
- Skin rashes with antibiotics
Management: Withhold the drug and avoid it in the future

Type C (Chemical) Adverse Drug Reactions

Uncommon
Persistent effects, lasting a relatively long duration
Related to cumulative drug dosage
Examples
- Osteoporosis of jaw with bisphosphonates
- Nephrotoxicity by NSAIDs
- Hepatotoxicity by paracetamol
- Hypothalamic-pituitary-adrenal axis suppression by corticosteroids
Management: Reduce the drug dosage, consider alternate day therapy (if possible), withdrawal needs to be prolonged

Type D (Delayed) Adverse Drug Reactions

Uncommon
Usually dose-related
Occurs or becomes apparent after the drug has been taken
Examples: Carcinogenesis, Teratogenesis, Tardive dyskinesia, Leucopenia with lomustine (after 6 weeks on medication)
Management: Often intractable

Type E (Exit/End of Treatment) Adverse Drug Reactions

Uncommon
Occurs shortly after stopping medication
Examples: Withdrawal syndrome with opioids or benzodiazepines (e.g., insomnia, anxiety)
Management: Reintroduce the drug and withdraw it slowly

Type F (Failure) Adverse Drug Reactions

Common
Dose related
Often caused by drug interactions
Examples: Inadequate dosage of an oral contraceptive (when used with an enzyme inducer), resistance to antimicrobial agents
Management: Increase the dosage, consider effects of concomitant therapy

Classification of Adverse Drug Reactions (ADRs) by Severity

Minor ADRs: Don't require therapy, antidote, or hospital stay extension
Moderate ADRs: Requires drug therapy changes, specific treatment, or hospital stay extension of at least 1 day
Severe ADRs: Potentially life-threatening, can cause permanent damage or require intensive medical treatment
Lethal ADRs: Directly or indirectly contribute to the patient's death

ADR Categories

Side effects
Secondary effects
Toxic effects
Intolerance
Idiosyncrasy
Drug allergy
Photosensitivity
Drug dependence, Drug withdrawal reactions, Teratogenicity
Mutagenicity and Carcinogenicity
Drug-induced diseases (Iatrogenic disorders or Iatrogenicity)

Side Effects

Unwanted, often unavoidable pharmacodynamic (PD) effects
Occur at therapeutic doses
Predictable
Examples
- Benzodiazepines: Drowsiness, dizziness, confusion
- H1 Anti-histaminics: Sedation
An effect can be therapeutic in one context, but a side effect in another
- Example: Constipation with codeine - side effect, but can be therapeutic for diarrhea

Secondary Effects

Indirect consequences of a drug's primary action
Examples:
- Corticosteroids (weaken host defense): Activation of latent tuberculosis
- Tetracyclines (Alter bacterial flora): Superinfection

Toxic Effects

Occur due to overdose or prolonged use
Effects are predictable and dose-related
Examples:
- High dose heparin: Bleeding
- High dose paracetamol: Hepatic necrosis
- Prolonged use of gentamicin: Ototoxicity, nephrotoxicity

Intolerance

Appearance of characteristic toxic drug effects at therapeutic doses
Indicates an individual's low threshold to the drug's action
Sensitivity to low drug doses
Unpredictable
Examples:
- Carbamazepine (few doses): Ataxia in some individuals
- Chloroquine (single tablet): Vomiting & abdominal pain in some individuals

Idiosyncrasy

Genetically determined abnormal reactivity to a chemical
Drug interacts with unique individual features (not found in most people)
Produces an uncharacteristic reaction
Unpredictable
Examples:
- Chloramphenicol: Aplastic anemia (non-dose-related) in rare patients
- Barbiturates: Excitement and mental confusion in some patients

Drug Allergy

Also called drug hypersensitivity
Immunologically mediated allergic reaction, producing stereotypical symptoms unrelated to the drug's PD profile
Occurs even with very small doses
Different onset and duration than PD effects
Unpredictable
Allergic reactions affect a small proportion of the population exposed to a drug

ADRs and Side Effects

ADRs and side effects are unintended medication responses
ADRs are harmful and more unexpected than side effects
Side effects are more predictable than ADRs
Side effects can be beneficial or harmful

Common Causes of ADRs

Incorrect drug dosage, timing, or regimens
Drug overdose
Drug allergies
Alcohol consumption while taking medication
Drug interactions (with other medications or substances)
Taking someone else's prescribed medication

Age
Sex
Genetics
Concurrent diseases (e.g., renal, liver, cardiac)
Previous ADRs
Drug regimen compliance
Number of medications
Miscellaneous: Diet, smoking, environmental exposures

Dosage
Duration of treatment
Drug inherent toxicity
Pharmacodynamic (PD) properties
Pharmacokinetic (PK) properties

FDA ADR Definition

Death
Life-threatening
Hospitalization required
Disability
Congenital anomalies
Intervention needed to prevent permanent injury

Metronidazole and Mebendazole (Vermox) Adverse Reactions

Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis

Type A (Augmented) Adverse Drug Reactions

Exaggerated/amplified effects of a drug's typical pharmacological actions at a normal therapeutic dose
Dose-dependent
Predictable
Low mortality
Examples:
- Respiratory depression with opioids
- Bleeding with warfarin
- Dry mouth with tricyclic antidepressants
- Bradycardia with beta-blockers
- Headache with nitrates

Learning Objectives For ADRs

Define and classify ADRs
Assess characteristics of each ADR type
Describe examples of ADRS
Appraise stages of drug evaluation (pre- and post-marketing)

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Description

This quiz explores key concepts related to drug abuse, addiction, and the effects of drug use on health. It covers definitions, psychological dependence, withdrawal reactions, and teratogenicity aspects. Perfect for students studying drug-related topics in health sciences.