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REACTIONS (ADR)
Adverse Drug reactions MODERATOR
Dr. SIDDALINGAPPA
ASSO.PROFFESSOR.
PHARMACOLOGY & THERAPEAUTICS
SUNANDA.BPV.
M.SC
DEF:
Any noxious change which is suspected to be due to a
drug, occurs at doses normally used in man, requires
treatment or decrease in dose or indicates caution in the
future use of the same drug.
Secondary
Toxic effects
effects
1. Side effects:
Unwanted but often unavoidable Pharmacodynamic
effects that occur at therapeutic dose.
Reduce the dose generally ameliorates the symptoms.
Ex: Insulin – hypo glycemia.
Atropine – dry mouth.
Acetazolamide – acidosis.
Side effects may also based on different facet of action
Ex: Estrogens- nausea.
Promethazine- sedation.
An effect may be therapeutic in one context but side effect
in another context.
Coma – Barbiturates.
Vestibular damage-streptomycin.
Over dose of the drugs also leads to the toxicity;
Ex: Morphine – Respiratory failure.
Imipramine – Cardiac arrhythmias.
Clinical Features.
Specific Therapies.
General principles of Management
Resuscitation.
Termination of exposure.
Prevention of absorption.
Hastening elimination.
Resuscitation
A - Airway.
B- Breathing.
C- Circulation.
D- Disability.
E- Exposure.
Don’t Ever Forget Glucose.
Termination of exposure
Activated charcoal
Adsorbs toxic substances or irritants, thus inhibiting GI
absorption.
Addition of sorbitol →laxative effect.
Hastening elimination.
Forced alkaline diuresis-Diuretics – Furosemide.
Hemodialysis or haemoperfusion
Universal Antidote
Hypersensitivity / Allergy.
Anaphylactic Shock.
Ex :
Ex : Acetylator status.
Ex : - G6PD Deficiency.
Idiosyncratic responses
An idiosyncratic reaction is a qualitatively abnormal drug
effects that occurs in small population of individuals.
Acute : Demeclocycline .
Chronic: Nalidixic acid, Fluroquinolone , Thiazides .
b) Photoallergic
UVA)
Chloroquine.
Intolerance :
Appearance of characteristic toxic effects of a drug in an
individual at therapeutic doses.
abdominal pain.
Drug dependence
A state in which use of drugs for personal satisfaction is
accorded a higher priority than other basic needs, often in the
face of known risks to health.
Psychological dependence:
Neuroadaptation
Ex: Opioids, barbiturates, alcohol, BZDs
Cocaine, Amphetamine Little or no
physical dependence.
Drug abuse:
Use of drugs by self medication in a manner & amount that
deviates from the approved medical and social patterns in a
given culture at a given time.
Drug addiction:
It is a pattern of compulsive drug use characterized by
overwhelming involvement with the use of a drug.
Ex:
i) Severe hypertension, restlessness & sympathetic over
activity – clonidine.
ii)Worsening of Angina, Precipitation of MI- β - blockers.
iii) Frequencies of seizures – Antiepileptic.
Teratogenicity
Parkinsonism - Phenothiazines
Hepatitis - INH
Common Causes of ADRs
Antibiotics
Antineoplastics
Anticoagulants
Cardiovascular drugs
Hypoglycemic
Antihypertensive
NSAID/Analgesics
Diagnostic agents
CNS drugs
ADR Risk Factors
Subjective report
patient complaint
Objective report:
direct observation of event
abnormal findings
physical exam
laboratory test
diagnostic procedure
Preliminary Assessment