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ADVERSE DRUG REACTION

By
Wiwik Kusumawati
INTRODUCTION

Up to 5 % of adverse drug reactions in general


practice (admission to hospital)
Up to 20 % of px experience an adverse drug
reaction (0.5 % - 1 % of hospital in px death)
Adverse drug reaction
DOSE RELATED
NON- DOSE RELATED
DOSE RELATED

Type A
Predictable
Low therapeutic index
Drug interactions are involved in 10 – 20 % of
adverse drug reaction (Elderly)
Anticoagulants, Digoxin, Anti-Arrythmics, Insulin,
Immunosuppressive drugs, Aminoglycosides,
Xanthines, Morfin
DOSE RELATED
Caused by
Incorrect dose
Altered pharmacokinetics
Adverse drug reaction (Altered pharmacokinetics) can
influences by
Individually
Genetics factor
Renal disease
Etc.
DRUG INTERACTIONS

Pharmacodynamics
Similar actions
Benzodiazepine & alcohol
ACE-inhibitor & Diuretics
Opposing actions
β-blocker & β-agonists
Theophyllin & CTM
Pharmacokinetics
– Absorption
– Distribution
– Metabolism
– Excretion
NON- DOSE RELATED

Type B
Elatively rare
A considerable mortality
Unpredictable
Drug allergy-hypersensitivity reactions (types I-
IV)
ANAPHYLAXIS
NON- DOSE RELATED
Hypersensitivity reactions to drug (drug allergy)
involve immunological reactions
Drug allergy is more likely to occur in px with a
history of atopic disease (hay fever, asthma,
aczema)
Type I reactions (Anaphylaxis)
Type II reactions (Cytotoxics/blood dyscrasias)
Type III reactions (Serum sickness)
Type IV reactions (T-cell mediated)
DRUG ALLERGY

Type I reactions (Anaphylaxis)


Penicilline
Cephalosporine
Sulphonamides
Contrast media
DRUG ALLERGY

Type II reactions (Cytotoxics/blood dyscrasias)


Hemolytic anaemia : Penicilline, Quinidine,
methyldopa
Agranulocytosis : Carbimazole, clozapine
Thrombocytipenia : Quinidine, Heparin
DRUG ALLERGY

Type III reactions (Serum sickness)


Penicilline
Sulphonamides
Thiazides
DRUG ALLERGY

Type IV reactions (T-cell mediated)


Penicilline
Cephalosporine
Local Anaesthetics
phenytoin
TERATOGENESIS

Fetal developmental abnormalities caused by


drugs taken during the first trisemester
pregnancy
Alcohol, anticancer drugs, warfarin, valproate,
carbamazepine, anticonvulsants, tetracyclines
CARCINOGENESIS

Very rare
The mechanism are usually unknown
Immunosuppression (Azathioprine with
prednisolone) is associated with a greately
increased risk of lymphomas
Cyclophosphamide may cause non lymphocytic
leukaemias