Di / 17B16: Classify and describe adverse drug reactions with examples of each

17B16: Exam Report

Classify and describe adverse drug reactions with examples of each

44% of candidates passed this question.

Candidates should have provided a definition of adverse drug reactions and then a classification. There are at least two widely accepted systems for classification, either was acceptable; though candidates often switched between both which led to a less structured answer. The WHO classification is comprehensive and logical, though both Rang and Dale and Goodman and Gilman also have sections on this topic.

Common errors were the citing of examples with the incorrect mechanism, describing only drug interactions rather than all adverse reactions and focussing the answer on the 4 hypersensitivity reactions which could only score a low mark. Some candidates confused drug errors with adverse reactions.

Di / 17B16: Classify and describe adverse drug reactions with examples of each

ADR = any response to a drug which is noxious, unintended and occurs at doses used in man for prophylaxis, diagnosis or therapy (WHO)

Classification

A – Augmented

Example

Dose dependant & predictable

Augmentation of known pharmacological effects of drug

Eg orthostatic hypoT w AHTNs

Classification

B – Bizzare

Example

Uncommon & unpredictable

Independent of dose

Affect small % popn

Eg Anaphylaxis to SUX

Classification

C – Chronic

Example

Uncommon

Related to cumulative dose

Eg Hypothalmic-Pit-Adrenal axis suppression by corticosteroids

Classification

D – Delayed

Example

Uncommon

Usually dose related

Only becomes apparent sometime after use of drug

Eg Tardive dyskenisia w Metaclopramide

Classification

E – End of use

Example

Uncommon

Occurs after drug withdrawal

Eg Withdrawal syndrome with opiates/BZD

Classification

F – Failure of Tx

Example

Common

Dose related

Often due to drug interactions

Eg inadequate dose of OCP when used with enzyme inducer.  a/b resistance