Adverse drug reactions

Adverse drug reactions

By Elsa Mohamed

Most ADRs are detected during development: Animal studies & clinical trials. ​

Multiple Choice

Which of these combination of drug and its adverse effects indicate idiosyncratic drug reaction?

• Anticoagulant: Bleeding

• Antihypertensive: Hypotension

• Antituberculous: hepatotoxicity

• Insulin: Hypoglycaemia

Multiple Choice

These are known adverse effect of anticholinergic drugs EXCEPT:

answer choices

• Blurred vision

• Dry mouth

• Gynaecomastia

• Urinary retention

Multiple Choice

Which of these drugs requires close clinical monitoring to prevent ADR?

answer choices

• Atenolol

• Paracetamol

• Penicillin

• Warfarin

Multiple Choice

A patient is started with drug A, an anticoagulant, to prevent blood clot. Drug A is metabolised by CYP450. These situations can increase the risk of adverse effects of Drug A (bleeding) EXCEPT?

• Combination of Drug A with another anticoagulant

• Combination of Drug A with CYP450 inducer

• Combination of Drug A with CYP450 inhibitor

• Double dose of Drug A

Multiple Choice

What should you do when you suspect an adverse drug reactions?

answer choices

• Take a careful drug history, including over the counter drug

• Stop the most probable causative drug taken by the patient

• Treat the symptoms

• Notify the regulatory agency

• All of the above

Multiple Choice

Which of these is/are valid option to treat adverse drug reaction due to overdose of a drug?

• Give ’antidote’ if available

• Observe and monitor the condition of patient

• Perform gastric lavage

• Perform haemodialysis

• All of the above

Multiple Choice

Which of these drugs is known to have a narrow therapeutic index, and can lead to increased risk of ADR?

answer choices.

• Antacid

• Digoxin

• Paracetamol

• Penicillin

Multiple Choice

Which of these adverse effects are considered as an emergency?

answer choices

• Abnormal liver function test

• Anaphylactic shock

• Erythematous rash

• Gastrointestinal disturbance

Multiple Choice

These are considered cutaneous adverse drug reactions that could happen due to allergy to antibiotics EXCEPT

answer choices

• Haematoma

• Maculopapular rash

• Skin blister

• Urticaria (hives)

​Cutaneous Drug Reactions

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Open Ended

A 42-year-old man presents with jaundice and right hypochondrial pain 2 weeks following anti-TB drug treatment. Investigations show raised ALT & AST. Causality assessment confirmed that it was anti-TB-drug-induced liver injury (AT-DILI). Investigations also showed that he has a genotype of NAT2 that made him a slow acetylator.

How does being a slow acetylator cause this ADR in this patient?

Slow acetylators

INH is mainly inactivated by n- acetyltransferase-2 (NAT2)-mediated acetylation, resulting in acetyl-INH, which is hydrolyzed to acetylhydrazine and isonicotinic acid.

Slow acetylation of INH results in increased plasma levels of the drug and its toxic intermediate metabolites. Several studies have shown that the slow-acetylator NAT2 phenotype is strongly associated with a higher risk of AT-DILI consistently across different ethnic groups

Open Ended

Puan Soo has been on warfarin for her valvular heart disease for many years. She reveals that she has recently been treated with ketoconazole for 2 weeks for a fungal infection. Monitoring of her INR today shows the level prolonged beyond the target level.

•What could have caused the INR to prolong?

Why was her INR prolonged?

Ketoconazole inhibits warfarin metabolism (CYP3A4), causing an increase in Warfarin levels. Because of this, you get an enhanced warfarin effects, which is prolonged INR

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