Toxic Effects of

Drugs

AVA MARIE D.CLARO,

RN.USRN.RM.MAN
Adverse Drug Reaction
Definition
◦ Adverse effects are undesired effects that may be
unpleasant or even dangerous
Reasons adverse drug reactions occur:
◦ The drug may have other effects on the body besides
the therapeutic effect
◦ The patient is sensitive to the drug given
◦ The drug’s action on the body causes other
responses
◦ The patient is taking too much or too little of the drug
Types of Adverse Reactions

Primary actions

One of the most common occurrences in drug therapy is the development of adverse
effects from simple overdose. In such cases, the patient suffers from effects that are
merely an extension of the desired effect
◦ Overdose: extension of the desired effect (anticoagulant may act so effectively that the
patient experiences excessive/spontaneous bleeding)
Secondary actions

Drugs can produce a wide variety of effects in addition to

the desired pharmacological effect. Sometimes the drug
dose can be adjusted so that the desired effect is
achieved without producing undesired secondary
reactions.
Sometimes this is not possible, however, and the adverse
effects are almost inevitable.
◦ Undesired effects produced in addition to the
pharmacologic effect (antihistamine dries up
secretion & helps breathing but causes drowsiness,
glutathione (whitens skin)
Hypersensitivity
reactions

Hypersensitivity also can occur if a patient has an

underlying condition that makes the drug’s effects
especially unpleasant or dangerous.

Excessive response to the primary or secondary effect of

the drug ( pt. w/ enlarge prostate taking anticholinergic
may develop urinary retention or bladder paralysis when
the drug effects block the urinary sphincter )
DRUG
ALLERGY
Occurs when the body
forms antibodies to a
particular drug, causing an
immune response when
the person is re-exposed
to the drug.
Types of Drug
Allergies
Anaphylactic reaction

Cytotoxic reaction

Serum sickness reaction

Delayed allergic reaction

Variety of Adverse Effects Associated With Drug Use
Drug-Induced Tissue & Organ Damage
Dermatologic
Reactions
Rash/hives
◦ Assessment
▪ Abnormalities in
the skin, red
areas, blisters

◦ Interventions
▪ May need to
discontinue the
medication
Stomatitis
◦ Assessment
▪ Inflammation of
the mucous
membranes
◦ Interventions
▪ Frequent mouth
care
Drug-Induced
Tissue and
Organ Damage
Superinfections: destruction of
the body’s normal flora
◦ Assessment
▪ Fever, diarrhea, and
vaginal discharge
◦ Interventions
▪ Supportive care
(mouth/skin care), give
antifungal medications,
stop drug responsible for
the infection
Drug-Induced
Tissue and
Organ
Damage
Blood dyscrasia: bone
marrow suppression
◦ Assessment
▪ Fever, chills, and
weakness
◦ Interventions
▪ Monitor blood
counts and
protective isolation
Toxicity
Liver
◦ Assessment
▪ Fever, malaise, N/V, jaundice, change in color of urine or stool, abdominal pain and
elevated liver enzymes
◦ Interventions
▪ Discontinue medication
Kidney
◦ Assessment
▪ Change in urinary pattern or elevated BUN and creatinine
◦ Interventions
▪ Notify physician, stop medication, or decrease dosage
Poisoning
Poisoning occurs when an overdose of a drug damages multiple body systems

Damage to multiple systems can lead to a fatal reaction

Altered Glucose Metabolism
Hypoglycemia
◦ Assessment finding: low serum blood glucose level,
fatigue drowsiness, hunger, anxiety, headache, cold,
clammy skin, shaking & lack of coordination, inc HR, BP;
numbness & tingling of the mouth, tongue, lips, confusion,
rapid & shallow respiration
◦ Intervention: restore glucose to the body (D50)
Altered Glucose Metabolism
Hyperglycemia- some drugs stimulates breakdown of glycogen or alter
metabolism as to cause h-serum level ephedrine- bronchodilator/anti asthma, for nasal congestion, can break down glycogen

◦ Assessment finding: high serum glucose level

fatigue, polyuria, polydipsia, polyphagia, deep respirations
restlessness, hot/flushed skin & fruity odor
◦ Intervention: administer medications to decrease glucose level
(insulin)
 Electrolyte Imbalances
Hypokalemia
◦ Assessment finding: decrease in serum potassium level loop diuretics

Assessment
Symptoms include a serum potassium concentration ([K] lower than 3.5 mEq/L, weakness,
numbness and tingling in the extremities, muscle cramps, nausea, vomiting, diarrhea, decreased
bowel sounds, irregular pulse, weak pulse, orthostatic hypotension, and disorientation.
In severe cases, paralytic ileus (absent bowel sounds, abdominal distention, and
acute abdomen) may occur.
◦ Interventions: replace serum potassium (IV or oral supplement) and monitor serum level of
potassium
Electrolyte Imbalances
◦ Hyperkalemia (antineoplastic agent cause cell death or injury that causes cell to
release K)
Assessment finding: increase in serum potassium level

Assessment
Symptoms include a serum potassium level higher than 5.0 mEq/L, weakness, muscle cramps,
diarrhea, numbness and tingling, slow heart rate, low blood pressure, decreased urine output, and
difficulty breathing.

◦ Interventions: decrease the serum potassium concentration (using sodium polystyrene

sulfonate), monitor serum level of potassium, and monitor cardiac rhythm
Sensory Effects
Ocular toxicity ( chloroquine/rheumatic
disease can cause retinal damage or
blindness)
◦ Assessment finding: visual changes
◦ Interventions: monitor for visual
changes when giving medication
known to cause ocular damage;
discontinue medication after notifying
physician
Sensory
Effects
Auditory damage
(aspirin/tinnitus)
◦ Assessment finding:
damage to the eighth
cranial nerve
◦ Interventions: monitor for
hearing loss; discontinue
medication after notifying
physician
Neurologic Effects
General central nervous system (CNS) effects
◦ Assessment: altered level of consciousness
◦ Intervention: prevent injury

Atropine-like (anticholinergic) effects

◦ Assessment: dry mouth, urinary retention, and
blurred vision
◦ Interventions: sugarless lozenges to keep mouth
moist; advise the patient to void before
administration of the medication
 Neurologic Effects (cont.)

Parkinson-like syndrome (drugs that directly or indirectly affect dopamine levels in the brain)

◦ Assessment: muscle tremors and changes in gait

◦ Intervention: discontinue medication

Neuroleptic malignant syndrome

◦ Assessment: extrapyramidal symptoms

◦ Intervention: discontinue medication

 Teratogenicity
Drugs may harm the developing fetus or embryo

Prevent teratogenicity through teaching

◦ Advise pregnant women that any medication may
adversely affect the baby
◦ Weigh the actual benefits against the potential
risks
◦ Advise pregnant women that they should not take
medications without checking with their health
care provider first