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dispensing, incompatibilities and ADR's pacop violet

Clinical Pharmacy and Pharmacotherapeutics 2 (Our Lady of Fatima University)

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ADVERSE DRUG
REACTIONS

PAD 426

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ADE vs. ADR

ADE ADR
an injury resulting from a response to a
medical intervention drug that is noxious
related to a drug and
includes ADRs
and unintended,
also includes the result of the
preventable intrinsic properties
reactions, including of the drug and
those caused by cannot be
human error prevented

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TYPES OF ADR

TYPES:

A-AUGMENTED D-DELAYED

B-BIZARRE E-END OF USE

C-CONTINUOUS F-FAILURE OF EFFICACY

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AUGMENTED

- common
- predictable
- dose-related

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AUGMENTED

Subtypes:
1. Extension Effects - related to
pharmacological activity of the drug
hypoglycemia (oral sulfonylureas)
tachycardia (albuterol)
sedation (CNS depressants)
bleeding (anticoagulants)

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AUGMENTED

2. Side Effects - unrelated to

pharmacological activity of the
drug
constipation (opiates)
headache (nitroglycerin)
cough (ACE inhibitor)
hypertrichosis (Minoxidil)
antihistamines (sedation)

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BIZARRE

- uncommon
- unpredictable
- not dose-related
- have no relation to the
pharmacological action of the
drug

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BIZARRE

Subtypes:
1. Idiosyncracy - genetically-determined
reactions
malignant hyperthermia (Antipsychotic
agents)
hemolytic anemia (G6PD + Antimalarials
or Sulfonamides)
Stevens-Johnson Syndrome
(Carbamazepine, Phenytoin,
Sulfonamides)
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BIZARRE

2. Hypersensitivity Reactions -
immune responses to
environmental antigens
resulting in symptomatic
reactions upon secondary
exposure to the same antigen,
more commonly referred to as
allergen

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HYPERSENSITIVITY
REACTION

Type I (Immediate or Anaphylactic

Immune Response)
- most common category of allergic
reaction
- occurs after antigen (e.g. pollen)
binds onto IgE found on the
surfaces of mast cells

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HYPERSENSITIVITY
REACTION

- re-exposure to the same allergen → cross-

linking of the cell-bound IgE →
degranulation (release of histamines,
leukotrienes & prostaglandins)
- examples:
1) anaphylaxis (Pencillins)
2) hay fever
3) asthma
4) urticaria (hives)

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HYPERSENSITIVITY
REACTION

Type II (Cytotoxic Reactions)

initiated by antibody (IgG or IgM)
directed against antigens found on
the cell membrane of a given
target cell (e.g. leukocytes,
erythrocytes) → complement-
mediated lysis

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HYPERSENSITIVITY
REACTION

examples:
hemolytic anemia (Methyldopa)
aplastic anemia (Chloramphenicol)
blood transfusion reactions

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HYPERSENSITIVITY
REACTION

Type III (Immune Complex Hypersensitivity)

- tissue deposition of antigen-antibody
complexes w/ complement activation
and tissue damage
examples:
1) blood dyscrasias or serum sickness
2) Arthus reaction
3) SLE (Hydralazine, INH, Procainamide,
Phenytoin)

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HYPERSENSITIVITY
REACTION

Type IV (Cell-Mediated or Delayed Type)

- T-lymphocytes sensitized by an antigen
release lymphokines after subsequent
contact with the same antigen
- lymphokines induce inflammation and
activate macrophages
- examples:
1) tuberculin skin test
2) contact dermatitis (Poison ivy)

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CONTINUOUS

- uncommon
- dose- & time-related
- associated with the cumulative
dose of the drug

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CONTINUOUS

Subtypes:
1. Addiction
- condition where a person takes a drug
compulsively, despite the potential harm.
- examples:
Marijuana
Opiates

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CONTINUOUS

2. Dependence
- compulsion to take the drug repeatedly &
experiences unpleasant symptoms if discontinued
- examples:
Benzodiazepines
Caffeine
Cocaine

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CONTINUOUS

Physical dependence
occurs when a drug has been used habitually &
the body has become accustomed to its effects.
The person must then continue to use the drug in
order to feel normal, or its absence will trigger the
symptoms of withdrawal.

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CONTINUOUS

Psychological dependence
occurs when a drug has been used
habitually & the mind has become
emotionally reliant on its effects,
either to elicit pleasure or relieve
pain, and does not feel capable of
functioning without it.

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CONTINUOUS

3. Tolerance
- reduced effect w/ repeated use of
drug; need for higher doses to
produce the same effect
- example: Nicotine

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DELAYED

Subtypes:
1. Carcinogenicity
- ability of any substance to cause or induce cancer
- examples:
antineoplastic agents
heterocyclic amines
aromatic hydrocarbons
nitrosamines
aflatoxin

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DELAYED

2. Teratogenicity
- ability of any substance to cause congenital
malformations or birth defects
- examples:
Carbamazepine & Valproic acid (neural tube
defects)
Diethylstilbestrol (increased risk of developing
vaginal adenocarcinoma after puberty)

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DELAYED

Phenytoin (fetal hydantoin syndrome)

Streptomycin (8th nerve damage)
Tetracyclines (discoloration & defects of teeth &
altered bone growth)
Thalidomide (phocomelia)
Isotretinoin (powerful teratogen)

BREX Pharmacy Review Center Phils. Co.

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END OF USE

- uncommon
- withdrawal symptoms
- generally occur shortly
after stopping the drug

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 END OF USE

examples:
1) opiate withdrawal
2) rebound insomnia & excitation (Benzodiazepine)
3) rebound hypertension (Clonidine)
4) Rhinitis medicamentosa (nasal decongestant)
5) adrenal crisis (Addison’s disease)(steroids)

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FAILURE OF EFFICACY

- unexpected failure of efficacy

- common
- dose-related

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FAILURE OF EFFICACY

may result from:

1) drug-drug interactions
2) use of counterfeit drugs
3) drug instability
4) patient’s non-compliance
5) wrong route of administration
6) drug resistance

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END OF DISCUSSION
ADVERSE DRUG REACTION

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