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pharm 5018 ETSU

Ch 5 Adverse Drug Reactions

Incidence of ADRs The World Health Organization Drug Monitoring Program •Pharmacovigilance centers worldwide evaluate data and allow for rapid dissemination of information/Under-reporting is still common/Prevalence/Populations at higher risk /Children/Elderly /Patients with renal impairment
Adverse Drug Reactions Every drug has the potential to cause harm. ADRs are unintended/may be unpredictable/may be predictable
Predicting ADRs Age: extremes of age – young and old Body mass /Adult dosing is based on average weight of 150 lbs./Lean and obese patients/Children dosed in mg/kg
Predicting ADRs Morbidly obese patients need dosing adjustment of some medications due to distribution/Gender/Women tend to be smaller/Different fat distribution/Pregnancy changes
Predicting ADRs Environment/Drugs affecting mood and behavior/Physical /environment: low O2, temperature/Time of administration/Timing with food/Biorhythms may affect drug absorption and excretion.
Predicting ADRs Pathological state/Pain intensifies need for opioids; anxiety may produce resistance to antianxiety drugs/Renal or hepatic dysfx/Genetic factors/Psychological factors/Cultural or faith-based attitudes toward drug
Dose-Related ADRs Secondary effects: drugs have intended effect, but may also have secondary effects Hypersusceptibility: Even at usual doses some patients are more susceptible to the drug, probably due to altered pharmocokinetics. Overdose: intentional or accidental Latrogenic effects: ADRs may mimic pathological disorders.
Type A ADRs Type A reactions are predictable from a drug’s known pharmacological properties. May be exaggeration of pharmacological effect of drug/Hypoglycemia from insulin/Hypotension from antihypertensives/May be a drug’s secondary effect/Diarrhea from antibiotics/Anticholinergic effects with antidepressants
Type I Allergic Response Anaphylactic reaction/Immediate response/Previously sensitized person/Reaction mediated by the IgE antibodies on the mast cells/May be fatal if not treated immediately
Type III Allergic Response Arthus reaction or immune complex reaction/Also called “serum sickness”/Angioedema, arthralgia, fever, swollen lymph nodes, and splenomegaly /Occurs 1 to 3 weeks after drug exposure
Type IV Allergic Response Cell-mediated, delayed hypersensitivity/Common skin reaction that occurs 24 to 48 hours after drug contact with skin
Type C ADRs Cumulative effects of a drug from chronic use/Dose-related and time-related/Example: hypothalamic-pituitary-adrenal axis suppression with chronic corticosteroid use/Treatment is to reduce dose or withdraw the medication.
Type D ADRs Delayed ADRs that are not apparent for some time after the drug is taken/Teratogens/Effects may be seen at or before birth/Effects may manifest years later/Carcinogens/May be due to activation of oncogenes or inactivation of suppresser genes
Drugs During Pregnancy Teratogens/Exposure during first trimester/Some drugs are known to cause teratogenesis/Category X/Category C/Exposure later in pregnancy/Fetal effects/Abortificants
Pregnancy Labeling Change After July 1, 2015 all new drugs will have new pregnancy labeling. /Older drug relabeling will be phased in.
Carcinogenic Drugs Immunomodulators/Antineoplastic drugs/Androgens/Estrogens/Ethanol
Type B ADRs: Allergic Response Drug allergy or hypersensitivity/A drug allergy occurs when a patient’s immune system identifies a drug, a drug metabolite, or a drug contaminate as a foreign substance./The body mounts an immune response. Type I, II, III, IV allergic responses
Type II Allergic Response Cytotoxic reaction /Sometimes called an autoimmune response/ Hemolytic anemia, thrombocytopenia, lupus erythematosus/Improves with removal of drug
Created by: palmerag



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