Chapter 3

Toxic Effects of Drugs

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 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

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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 the primary or
secondary effect of the drug

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Types of Drug Allergies

• Anaphylactic reaction

• Cytotoxic reaction

• Serum sickness reaction

• Delayed allergic reaction

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Variety of Adverse Effects Associated With
Drug Use

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Drug-Induced Tissue & Organ Damage

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 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
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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
• Blood dyscrasia: bone marrow suppression
– Assessment
 Fever, chills, and weakness
– Interventions
 Monitor blood counts and protective isolation
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 Toxicity
• Liver
– Assessment
 Fever, nausea, jaundice, change in color of urine or
stool, 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
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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

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 Altered Glucose Metabolism

• Hypoglycemia
– Assessment finding: low serum blood glucose
level
– Intervention: restore glucose to the body (D50)
• Hyperglycemia
– Assessment finding: high serum glucose level
– Intervention: administer medications to
decrease glucose level (insulin)

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 Electrolyte Imbalances
• Hypokalemia
– Assessment finding: decrease in serum potassium level
– Interventions: replace serum potassium (IV or oral
supplement) and monitor serum level of potassium
• Hyperkalemia
– Assessment finding: increase in serum potassium level
– Interventions: decrease the serum potassium
concentration (using sodium polystyrene sulfonate),
monitor serum level of potassium, and monitor cardiac
rhythm

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 Sensory Effects
• Ocular toxicity
– Assessment finding: visual changes
– Interventions: monitor for visual changes when
giving medication known to cause ocular damage;
discontinue medication after notifying physician
• Auditory damage
– Assessment finding: damage to the eighth cranial
nerve
– Interventions: monitor for hearing loss; discontinue
medication after notifying physician
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 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

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 Neurologic Effects (cont.)
• Parkinson-like syndrome

– Assessment: muscle tremors and changes in

gait

– Intervention: discontinue medication

• Neuroleptic malignant syndrome

– Assessment: extrapyramidal symptoms

– Intervention: discontinue medication

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 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

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