Adverse Drug Reactions Flashcards
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Read the first 7 Adverse Drug Reactions flashcards as text
Which pharmacokinetic change in elderly patients most significantly increases ADR risk from renally cleared drugs?
Answer: Progressive decline in glomerular filtration rate
GFR declines approximately 1 mL/min/year after age 40, so standard doses of renally cleared drugs accumulate to toxic levels in elderly patients despite apparently normal serum creatinine.
A patient with CKD stage 4 (eGFR 22) requires opioid analgesia. Which opioid is relatively preferable with appropriate dose reduction?
Answer: Oxycodone
Oxycodone's active metabolites accumulate less problematically than those of morphine (M6G) or codeine in severe renal impairment, making it relatively preferable with careful monitoring.
In a patient with severe hepatic impairment (Child-Pugh C), which effect on drug handling is most expected?
Answer: Reduced hepatic enzyme activity causing drug accumulation
Severe hepatic impairment reduces CYP enzyme activity and hepatic blood flow while impairing albumin synthesis, causing drug accumulation and an increased free fraction of protein-bound drugs.
Under the UK Pregnancy Prevention Programme, what is the minimum mandatory precaution before prescribing sodium valproate to a woman of childbearing potential?
Answer: Effective contraception and annual specialist review
The MHRA PPP mandates that valproate is only prescribed to women of childbearing potential if they use effective contraception and undergo annual specialist review acknowledging the risks.
A patient with G6PD deficiency requires treatment for Plasmodium vivax malaria. Which drug must be avoided due to risk of haemolytic anaemia?
Answer: Primaquine
Primaquine is an oxidant drug that generates reactive oxygen species, causing severe haemolytic anaemia in G6PD-deficient patients who cannot regenerate reduced glutathione.
A patient on warfarin starts rifampicin for tuberculosis. What adjustment to warfarin dosing would most likely be required?
Answer: Significant dose increase due to enzyme induction
Rifampicin is a potent inducer of CYP2C9 and other hepatic enzymes, dramatically accelerating warfarin metabolism and requiring substantial dose increases to maintain therapeutic INR.
Which definition best describes polypharmacy in the context of ADR risk?
Answer: Regular use of five or more medications concurrently
Polypharmacy is commonly defined as the regular use of five or more medications, which increases ADR risk and the probability of clinically significant drug-drug interactions exponentially.