Week 12 Short answer questions

Compare the features of type A to type B adverse/unwanted reactions.

Type A
• predictable/augmented reactions
• can be predictable by pharmacology
• generally dose dependent
• common (80%)
• less severe compared to type B
• reproducible in animals

Type B
• bizarre, idiosyncratic reactions
• non-predictable by pharmacology
• not dose-dependent
• less common (~20%)
• not reproducible in animals
• can cause severe morbidity or death

Compare and contrast the pharmacokinetic and pharmacodynamic drug interactions. Give
an example of each.
Pharmacokinetic interaction
• Drug A interacts with Drug B, affecting the concentration of the drug B that reaches its site of
action
• Mechanisms include during drug absorption, distribution, metabolism and excretion
• they either increase or decrease the amount of drug to make an effect
• become clinically important, when the drug has a small therapeutic range such as digoxin and
warfarin
• e.g. Rifampicin increases the amount of enzymes that metabolise Warfarin, so that Warfarin is
activated faster and therefore has smaller effect, and so larger dose is required

Pharmacodynamic interaction
• Drug A interacts with Drug B, altering its pharmacological effect, but its concentration remains the
same
• Alterations in the way a drug affects a tissue or organ system
• affects drug in qualitative way- either through enhancing or antagonising effects
• more difficult to predict and prevent than pharmacokinetic interaction
• direct pharmacodynamic interactions- additive effects at a common target due to actions at
different sites in an organ e.g. beta-AR- antagonists diminish the effectiveness of beta-AR-
agonist
• indirect pharmacodynamic interactions- through different effects e.g. some diuretic can decrease
serum potassium and will increase toxicity of cardiac glycosides

Describe the three types of data that are used to determine the toxic effects of the drug and
the three types of animal toxicity testings.
• epidemiological data
• controlled clinical exposure studies
• animal toxicity studies
- acute: the drug is given in a single dose for a short time of administration, or multiple doses
within 24 hrs. Shows whether a single dose can kill
- subacute: the drug is given for a long period of time on a daily basis (at least 6 months).
Shows the adverse effects for a significant fraction of the lifespan
- chronic: the drug is given for a minimum of one year and more often > 2 years and
demonstrates that long term exposure causes no toxic effects

What are the key modalities of complementary and alternative medicines?

• complimentary and alternative medicine are treatment modalities not usually practiced in
mainstream western medicine
- Alternative medical system: homeopathic medicine, traditional chinese medicine
- mind-body interventions: prayer, meditation
- biological based therapies: dietary supplements, herbal and botanical products
- manipulative and body-based methods: massage, chiropractor, osteopathic
- energy therapies: biofuels therapies, bioelectromagnetic-based therapies

What are the differences between the ‘Listed’ and ‘Registered’ medicines?

Registered
• assessed to be of higher risk on the medicines risk continuum
• can be non-prescription (low risk) or prescription (high risk)
• they are assessed by TGA for safety, quality and efficacy
• identified by AUST R, followed by a number

Listed
• most complimentary medicine
• may only contain ingredients of low risk
• general sales medicine- access not restricted
• assessed by TGA for quality, and safety but not efficacy —> not evaluated individually or
requested their evaluation to see if they work
• identifies by AUST L followed by a number