CLASSIFICATION OF ADVERSE DRUG REACTIONS

Type of reaction Features Examples Management

Type A: Common Toxic effects: digoxin Reduce dose or withhold;
Dose- Related Related to pharmacological action toxicity, serotonin Consider effects of
(Augmented) of the drug syndrome with SSRIs concomitant therapy
Predictable Low mortality Side effects:
Anticholinergic effects of
TCAs
Type B: • Uncommon Immunological reactions: Withhold and avoid in
Non- Dose Related • Not Related to penicillin hypersensitivity future
(Bizarre) pharmacological action Idiosyncratic reactions:
of the drug Acute porphyria
• Unpredictable Malignant hyperthermia
• High mortality Pseudo allergy (eg.,
  ampicillin rash)
Type C: • Uncommon Hypothalamic-pituitary- Reduce dose or withhold;
Dose- related and • Related to cumulative adrenal axis suppression Withdrawal may have to
Time-related (Chronic) dose by corticosteroids be prolonged
Type D: • Uncommon Teratogenesis Often intractable
Time-related (Delayed) • Usually dose-related Carcinogenesis
• Occurs or becomes Tardive dyskinesia
apparent some time after
the use of the drug
Type E: • Uncommon Opiate withdrawal Reintroduce and withdraw
Withdrawal • Occurs soon after syndrome slowly
(End of use) withdrawal of drug Myocardial ischemia (β-  
blocker withdrawal)
Type F: • Common Inadequate dosage of an Increase dosage
Unexpected failure of • Dose-related oral contraceptive Consider effects of
therapy • Often caused by drug- particularly when used concomitant therapy
(Failure) interaction with specific enzyme
inducers
 CLASSIFICATION OF MEDICATION ERRORS
1- Type of error
 Prescribing error: Errors in this category are fairly broad, but generally focus on inappropriate drug
selection, dose, dosage form, or route of administration.
 Wrong time error: In general, this type of error occurs when a dose is not administered in accordance
with a predetermined administration interval.
 Omission error: An omission error occurs when a patient does not receive a scheduled dose of
medication. This is considered to be the second most common error in the medication use process, behind
wrong time errors..
 Unauthorized drug error: This type of error occurs when patients receive a drug that was not
authorized by an appropriate prescriber. This might include giving the wrong patient a medication
 Improper dose error: This error occurs when the dose administered is different than what was
prescribed, assuming that the prescribed dose was appropriate
 Wrong dosage form error: This error occurs when a patient receives a dosage form different from that
prescribed, assuming the appropriate dosage form was originally ordered.
 Wrong drug preparation error: When medications require some type of preparation, such as
reconstitution, this type of error may occur. These kinds of errors may also occur in the compounding of
various intravenous admixtures and other products
 Wrong administration technique: These errors occur when a drug is given to a patient inappropriately.
Example: when an agent meant for intramuscular administration is given intravenously
 Deteriorated drug error: This error occurs when drugs are administered that have expired or have
deteriorated prematurely due to improper storage conditions.
 Monitoring error: These errors occur when patients are not monitored appropriately either after they
have received a drug or before they received a drug.

 Compliance error: This type of error occurs when patients use medications inappropriately. Proper
patient education and follow-up may play a significant role in minimizing this type of error.
 CLASSIFICATION OF MEDICATION ERRORS
2- severity or outcome
1. NO ERROR:
 Category A: Circumstances or events that have the capacity to cause error
2. ERROR, NO HARM
 Category B: An error occurred, but the medication did not reach the patient.
 Category C: An error occurred that reached the patient, but did not cause the patient harm.
 Category D: An error occurred that resulted in the need for increased patient monitoring, but caused no
patient harm
3. ERROR, HARM
 Category E: An error occurred that resulted in the need for treatment or intervention and caused
temporary patient harm.
 Category F: An error occurred that resulted in initial or prolonged hospitalization and caused temporary
patient harm.
 Category G: An error occurred that resulted in permanent patient harm.
 Category H: An error occurred that resulted in a near-death event (e.g., anaphylaxis and cardiac arrest).
4. ERROR, DEATH
 Category I: An error occurred resulting in patient death.