Upload
druprathnakarmddihpgdhm
View
221
Download
0
Embed Size (px)
Citation preview
8/14/2019 Adverse Drug Effects BDS
1/30
Dr.U.P.RathnakarDr.U.P.RathnakarMD.DIH.PGDHMMD.DIH.PGDHM
8/14/2019 Adverse Drug Effects BDS
2/30
Adverse Drug EffectsAny undesirable or unintended consequence
of drug administration
Any response to a drug that is noxious andunintended and that occurs at doses usedin man for the prophylaxis, diagnosis, or
therapy of disease or for modification ofphysiological function WHO
Adverse event: Any untoward event thatoccurs during treatment not necessarilywith causal relation ship to treatment
8/14/2019 Adverse Drug Effects BDS
3/30
ADE: Predictable and Unpredictable
Predictable: Type A : Augmented
Augmented pharmacological properties
Side effects, toxic effects, Drug withdrawaleffects
Common, dose related, Reversible
Unpredictable: Type B: Bizarre Reactions
Not known action of drug
Idiosyncracy, AllergyLess common, Non dose related
8/14/2019 Adverse Drug Effects BDS
4/30
ADE: SeverityMinor:No tt requiredModerate: Requires change in tt, change of drug
Severe:Potentially life threatening,permanent damage
Lethal: Directly or indirectly contributes to
death
8/14/2019 Adverse Drug Effects BDS
5/30
ADE1. Side effects:
Unwanted ,unavoidable pharmacodynamic effectsat therapeutic doses
Eg. Antihistaminics cause sedation2. Secondary effects:
Indirect consequence of primary action of a drug
Eg. Tetracyclines cause superinfection3. Toxic effects:
Due to overdose or prolonged use
Eg. Respiratory failure by morphineComa by barbiturates
8/14/2019 Adverse Drug Effects BDS
6/30
ADE4. Intolerance:
Low threshold to the action of drug
Eg. EPS with single dose of Metoclopromide
5. Idiosyncrasy:
A genetically determined reaction
An unusual individual reaction to food or a drugEg. Barbiturates cause excitement and mentalconfusion
Chloramphenicol causes aplastic anemia
8/14/2019 Adverse Drug Effects BDS
7/30
6. ADE:Drug allergy (drug hypersensitivity)
Immunologically mediated reaction
Types of drug allergy
1.Anaphylactic- -Type I
2.Cytolytic -Type II
3.Immune complex mediated[Arthus]:-Type III
4.Delayed hypersensitivity-Type IV
8/14/2019 Adverse Drug Effects BDS
8/30
8/14/2019 Adverse Drug Effects BDS
9/30
Type 1
8/14/2019 Adverse Drug Effects BDS
10/30
Drug allergy-Type I [Anaphylaxis]
Exposure todrug
Eg.Penicillin
IgE ABFixed tomast cells
Reexposure AG+AB
Release ofmediators:
Histamine, 5-HT,PGs, LTs, PAF
Anaphylactic shock:Hypotension,
Bronchospasm,
Urticaria Etc.
Treatment:Medical emergencyInj.Adrenaline[1:1000] .3 to .5 ml
i.m.Inj.Hydrocortisone 100 mgi.v.Inj.Diphenhydramine 25mg i.v.Oxygeni.v. fluids
8/14/2019 Adverse Drug Effects BDS
11/30
Type 2
8/14/2019 Adverse Drug Effects BDS
12/30
Drug allergy-Type II [Cytolytic]
Exposure todrug
Eg.Quinine
Drug+Tissue=AG
IgG, IgM- AB
Reexposure
Tissue+AB
Complement
Celldestruction
Eg. Hemolysis byQuinine, Quinidine
8/14/2019 Adverse Drug Effects BDS
13/30
Type 3
8/14/2019 Adverse Drug Effects BDS
14/30
Drug allergy-Type III[Immune mediated]AG+ABIgG
Complementfixation
Destructive inflammatoryresponse
Eg. Serum sicknes[Fever, urticaria,
joint pain,lymphadenopathy]Penicillin, SulfaNSAIDs
Deposited onvascular
endothelium
8/14/2019 Adverse Drug Effects BDS
15/30
Type 4
8/14/2019 Adverse Drug Effects BDS
16/30
Drug allergy-Type IV[Delayed]
Inflammatory responeDelayed by 2-3 daysContact dermatitis with LA creamsNot AB relatedCell mediated
8/14/2019 Adverse Drug Effects BDS
17/30
7. Photosensitivity
Sensitization of the skin by drugs UV radiation Cutaneous reaction-Photosensitivity
8. Carcinogenicity & mutagenicity: Ability of the drug to cause cancer and genetic
defects respectively
Eg. Tobacco, anticancer drugs9. Iatrogenic diseases:iatros= physician
(physician induced diseases):
Parkinsonism PhenothiazinesPeptic ulcer Aspirin,corticosteroidsHepatitis - Isoniazid
8/14/2019 Adverse Drug Effects BDS
18/30
Drugs frequently cause allergic reactions
Penicillins
Cephalosporins
Sulfonamides
Tetracyclines
Quinolones
Antitubercular
drugsSalicylates
Carbamazapine
ACE inhibitors
Localanesthetics
8/14/2019 Adverse Drug Effects BDS
19/30
10. Teratogenicity: terataos= monster
Capacity of the drug to cause fetal abnormalitieswhen administered to pregnant mother
I. Preimplantation:conception to 17 days-Abortionii.Organogenesis:18-55 days-Deformitiesiii.Growth and development:56 days onwards
Thalidomide PhocomeliaCorticosteroids Cleft lipTC-Discolouration of teeth, retarded bone growth
8/14/2019 Adverse Drug Effects BDS
20/30
17 D 17-55 D >56D
ImplantationOrganogen Growth&Dev
DeathFetus Malform
Growthretard
8/14/2019 Adverse Drug Effects BDS
21/30
Cleft Palate HydrocephalusAnticancer drugs
PhocomeliaThalidomide
Neural tubeDefects
Valproate
Hand defects
Warfarin
Fetal alcoholsyndrome
AlcoholHydantoin syndrome
Phenytoin
Human teratogenic drugs
8/14/2019 Adverse Drug Effects BDS
22/30
Tetracycline
Staining
After Tt
8/14/2019 Adverse Drug Effects BDS
23/30
11.Organ toxicity Hepatotoxicity: INH, Rifampicin
Nephrotoxicity: Aminoglycosides Ototoxicity: Aminoglycosides,
Frusemide Ocular toxicity: Ethambutol,
Chloroquine
8/14/2019 Adverse Drug Effects BDS
24/30
12. Drug dependence A state
Psychological or physical
Due to interaction - living organism+Drug
Characterised by behavioral and other responses
Always includes a compulsion to take the drugcontinuously or periodically
Psychological: Intense desire to take drug andimmense satisfaction later
Physical: Physiological equilibrium is maintained bydrug
8/14/2019 Adverse Drug Effects BDS
25/30
Poisoning
Poisons in small doses are the best medicines; anduseful medicines in too large doses are poisonous
William Withering 1789
8/14/2019 Adverse Drug Effects BDS
26/30
Poisoning Large enough dose of a drug Sub.which endagers life
Accidental or suicidal
TreatmentHospitalization
Gastric lavage
Airway-Suction, Endotracheal tube
Breathing-Mechanical ventilation
Circulation-i.v.Fluids
Diuretics or Dialysis
Antidote-OP poisoning-Atropine
8/14/2019 Adverse Drug Effects BDS
27/30
Poisoning
1. Resuscitation and maintainance of vital functions
Airway, BP, Body temp., Blood sugar
2. Termination of exposure
Fresh air, remove wet clothes, wash,
3. Prevention of absorption
Gastric lavage, Activated charcoal,4. Hastening elimination
Diuresis, Altering urine pH, Hemodialysis
8/14/2019 Adverse Drug Effects BDS
28/30
Prevention of adverse effectsRight dose, route, frequency
Previous history drug allergy andallergic diseases
Rule out drug interactions
Correct technique ofadministration
TDM if appropriate
8/14/2019 Adverse Drug Effects BDS
29/30
Pharmacovigilance
Actively look for adverse drug effects Activities relating to detection, assessment,
understanding and prevention of adverse effects or
any other drug related problem Information collected by
Regional centers to
Zonal centers toNational centers to
Uppsala monitoring center(Sweden)
Uses
Educating doctors about ADE
Assessing safety of drugs
8/14/2019 Adverse Drug Effects BDS
30/30