Chapter 3:

Toxic Effects of Drugs

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 Adverse Drug Reaction

• 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 being given.
– The drug’s action on the body causes other responses
that are undesired or unpleasant.
– The patient is taking too much or too little of the
drug.

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 Types of Adverse Reactions

• Primary Actions
– Overdose; extension of the desired effect
• Secondary Actions
– Undesired effects produced in addition to the
pharmacologic effect
• Hypersensitivity Reactions
– Excessive response to primary or secondary effect of
drug

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 Types of Drug Allergies

• Anaphylactic Reaction
• Cytotoxic Reaction
• Serum Sickness Reaction
• Delayed Allergic Reaction

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Drug-Induced Tissue and Organ Damage

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 Dermatological Reactions
• Rash/Hives
– Assessment
• Abnormalities in the skin, red area, blisters
– Interventions
• May need to discontinue the medication in severe cases
• Stomatitis
– Assessment
• Inflammation of the mucous membranes
– Interventions
• Frequent mouth care

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Drug-Induced Tissue and Organ Damage

• Superinfections — Destruction of the body’s normal flora

– Assessment
• Fever, diarrhea, vaginal discharge
– Interventions
• Supportive care (mouth and skin care), administer antifungal
medications as needed, may also need to stop drug responsible
for the superinfection
• Blood Dyscrasia — Bone marrow suppression
– Assessment
• Fever, chills, weakness
– Interventions
• Monitor blood counts, protective isolation

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 Toxicity
Affecting the body in a very noxious or toxic way
•Liver- Assessment
• Fever, nausea, jaundice, change in color of urine or stool,
elevated liver enzymes
– Interventions
• Discontinue medication
•Kidney- Assessment
• Change in urinary pattern, elevated BUN and creatinine
– Intervention
• Notify physician, may need to stop medication or decrease the
dosage

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 Poisoning

• Poisoning occurs when an overdose of a drug damages

multiple body systems.
• Damage to multiple systems can lead to a fatal reaction.
• Treatment varies accordingly with drug

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 Altered Glucose Metabolism

• Hypoglycemia
– Assessment Finding: Low serum blood glucose level
– Intervention: Restore glucose to the body
• Hyperglycemia
– Assessment Finding: High serum glucose level
– Intervention: Administer medications to decrease
glucose level

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 Electrolyte Imbalance

• Hypokalemia
– Assessment Finding: Decrease in serum potassium levels
– Interventions: Replace serum potassium (IV or oral
supplement) and monitor serum levels of potassium
• Hyperkalemia
– Assessment Finding: Increase in serum potassium level
– Interventions: Decrease the serum potassium
concentration (Sodium Polystyrene Sulfonate), monitor
serum levels of potassium, and monitor cardiac rhythm

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 Sensory Effects

• Ocular Toxicity
– Assessment Findings: Visual changes
– Interventions: Monitor for any visual changes when giving
any medication that is known to cause ocular damage;
discontinue medication as appropriate.
• Auditory Damage
– Assessment Findings: Dizziness, ringing in the ears
(tinnitus), loss of balance, and loss of hearing
– Interventions: Monitor for hearing loss; discontinue
medication as appropriate if a decrease in hearing is noted
on assessment.

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 Neurological Effects
• General Central Nervous System (CNS) Effects
– Assessment Findings: Altered level of consciousness
– Interventions: Prevent injury
• Atropine-like (Anticholinergic) Effects
– Assessment Findings: Dry mouth, urinary retention,
blurred vision
– Interventions: Sugarless lozenges to keep mouth moist;
have the patient void before administration of the
medication

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 Neurological Effects (cont.)

• Parkinson-like Syndrome
– Assessment Findings: Muscle tremors and changes in
gait
– Interventions: Discontinue medication as appropriate
• Neuroleptic Malignant Syndrome
– Assessment Findings: Extrapyramidal symptoms
– Interventions: Discontinue medication as appropriate

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 Teratogenicity

• Teratogenicity: Any drug that causes harm to the developing

fetus or embryo
• Teaching to prevent teratogenicity
– Advise the pregnant woman that any medication may
have possible effects on the baby.
– Weigh the actual benefits against the potential risks.
– Discuss with pregnant women that they should not take
medications without checking with their health care
provider first.

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 Question
Is the statement below true or false, explain?
Poisoning occurs when too much of a drug causes damage
to multiple systems of the body.

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 Answer
True

Rationale: Poisoning occurs when an overdose of a drug

damages multiple body systems. Damage to multiple
systems can lead to a fatal reaction.

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