Type A
Augmented pharmacological effects
-dose dependent and predictable
Type B
Bizarre effects - dose independent and unpredictable
Type C
Chronic effects
Type D
Delayed effects
Type E
End of treatment effects
Type F
Failure of therapy
Type A diuretic effect
Pre-renal failure, hypotension, hypovolemia
Type A ACEi/ARB effect?
Pre-renal failure, hypotension, hypovolemia
Type A gentamicin effect
Renal - ATN
Type A sulphonamide effect
Renal - ATN
Type A aspirin effect
Renal - ATN
Type A side effect of methysergide and chemotherapy
Post renal - retroperitoneal fibrosis, crystaluria, urinary calculi
What is methysergide used to treat?
Cluster headaches
Examples of type B drug effects?
1) Drug rashes
2) Bone marrow aplasia –Chloramphenicol antibiotic
3) Hepatic necrosis - halothane
Side effect of chloramphenicol (type B)
Bone marrow aplasia
Side effect of halothane
Hepatic necrosis
Type B reactions and mortality
High mortality
Type C effect of steroid therapy
Cushings
Type C effect of beta blockers
Diabetes
Type C effect of NSAIDs
Hypertension
Type C reactions emphasise the need for what?
Drug monitoring
-these effects can be anticipated but the patient MUST be warned before starting therapy!
Examples of Type D reactions
Secondary malignancies post chemotherapy
Craniofacial abnormalities in children of women taking isotretinoin
Delayed side effect of isotretinoin?
Craniofacial abnormalities in children of mothers taking isotretinoin
Type E Beta blocker effect
Angina following rapid withdrawal
- abrupt withdrawal
- rebound effects
Type E Steroid effect
Steroid withdrawal and Addisonian crisis
-loss of physiological “coping”
Type E effect of Anticonvulsant withdrawal
Changes in epilepsy frequency
-mechanism dependent biological activity
Theophylline reacts with…
Macrolide abx
Statins react with…
Statins and macrolides
Statins and fibrates
TCAs react with
Type 1 anti-arrythmics
ACEi and sulfonylureas
ACEis increase hypoglycemic effect of sulfonylureas
Clopidogrel reacts with…
PPIs
Grapfruite juice inhibits which enzyme
Cyp P450
Ginko biloba (used to treat dementia) reacts with which type of drug?
Anti-coagulant
Saw palmetto is used for BPH, it may react with which type of drug?
Anticoagulant
Glucosamine is used for OA, it may react with which type of drug
Anticoagulant
?hyperglycemia
St John’s wort is used for depression, which drug may it interact with?
The pill
Patients with which disease have an increased risk of drug induced confusion?
Parkinsons
Which drugs can exacerbate CHF?
NSAIDs/COX-2/TZDs
Urinary retention in BPH patients can be caused by which type of drug?
Anti-cholinergics
Constipation is worsened by which drugs?
Calcium, anti-cholinergics, CCBs
Which drugs lower seizure thresholds?
Neuroleptics, tramadol and quinolones
Bananas,oranges, green leafy vegetables (K+-rich) interact with
ACEis, ARBs, K-sparing diuretics
Apples, chickpeas, spinach, nuts, spinach, kiwi, broccoli
Vitamin E & K
Warfarin
Chicken, turkey, milk, soy,cheese, yogurt (alter PH) – Interacts with:
Antibiotics, thyroid meds
Digoxin, diuretics
Grapefruit, Apple, Orange, & Cranberry (Cytochrome P450) interact with
Statins, anti-histamines
Yellow card scheme?
Yellow card with suspected drug reactions etc
Drug-drug interactions, which part of the BNF would you use to check?
Appendix 1