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By: Lourade U. A!o"#o$ MAN$RN
Early drug plants, animals & minerals
2700 BB earliest recorded drug use found in Middle East & China
1550 BC Egyptians created Eers Medical !apyrus
Castor oil la"ati#e
$pium pain
Moldy read %ounds & ruises
&alen '1(1)201 *+, -oman physician. initiated common use of prescriptions
12/0 *+ introduction of apothecary system '*ra doctors,
set of drug standards & measurements 'grains, drams, minims,, currently
eing phased out
century apothecary shops o%ned y arer, surgeons, physicians, independent
century small po" #accine 'y 1enner,
+igitalis from fo"glo#e plant for strengthening & slo%ing of hearteat
2itamin C from fruits
century morphine & codeine e"tract from opium
4ntroduction of atropine & iodine
*myl nitrite used to relie#e anginal pain
+isco#ery of anesthetics 'ether, nitrous o"ide,
Early 20
century aspirin from salicylic acid
4ntroduction of !henoarital, insulin, sulforamides
Mid 20
13/0 +isco#ery antiiotics 'penicilline, tetracycline, streptomycin,,
antihistamines, cortisone
1350 disco#ery antipsychotic drug, antihypertensi#es, oral contracepti#es,
polio #accine
Dru) chemical introduced into the ody to cause some changes
56$ def7 any product8sus used to modify8e"plore physiologic system8pathologic states
for the enefit of the patient
P*ar+a,oo)y study of the manner in %hich the function of li#ing system is affected y
chemical agents8drugs
9cience concerned %ith history, sources, physical & chemical properties of drugs & the
%ay in %hich drug affects li#ing system
Su-d./.#.o"# o! 0*ar+a,oo)y:
1: 0*ar+a,ody"a+.,# study of the iochemical & physiological effects of drugs & mechanisms
of action
%hat the drug does to the ody
2: 0*ar+a,o1."e2.,# deals %ith the asorption, distriution, iotransformation & e"cretion of
%hat the ody does to the drug
(: 0*ar+a,o2*era0eu2.,# study of drugs used in the diagnosis, pre#ention, suppression, &
treatment of diseases
deals %ith eneficial effects of the drugs 'medicines,
/: 0*ar+a,o)"o#y study of drugs in their original unaltered state. origin of drugs
source of drugs
e"7 penicillin from penicillium 'fungi,
5: To3.,oo)y study of iologic to"ins7 study of poison & its effects deals %ith deleterious effects
of physical & chemical agents 'including drugs, in human
!harmacoeconomics study of relationship of drugs & economics
!harmaco#igilance science of collecting,researching, analy;ing, & e#aluating set of information aout
ad#erse drug effects:
-eceptor a component of the cell that interacts %ith drug, initiating a chain of iochemical e#ents leading
to drugs< oser#ed effects
6uman ody %or=s through complicated series of chemical reactions & processes
4mportant aspects of nursing7 understanding ho% drug ant on ody to cause changes & apply that
=no%ledge in clinical setting
!atients ta=e complicated drug regimen & recei#e potentially to"ic drug
9ome manage their o%n care at home
>ursing responsiilities regarding drug therapy7
*dministering drugs
*ssessing drug effects
4nter#ening to ma=e drug regimen more tolerale
!ro#ide patient teachings aout drugs & drug regimen
?no%ing ho% drug %or=s ))) easier to handle ))) enhances drug therapy
1: C6EM4C*@ >*ME atomic8molecular structure of drug
2: &E>E-4C >*ME8>$>)!-$!E-AB >*ME original designation gi#en to the drug %hen the
drug company applies for appro#al patents
) uni#ersally accepted & not capitali;ed. efore drug ecomes official, used in all countries
) protected y la%. not capitali;ed
(: A-*+E8B-*>+8!-$!-4EAB >*ME name gi#en y the drug company that de#eloped it
) follo%ed y the symol - or AM, 1
letter is capitali;ed
chemical name acetylsalicylic acid
generic name aspirin
trade name aspilet
1: *nimal sources from organs, organ secretion or organ cells
Csed to replace human chemical not produces ecause of disease or genetic prolems
Ahyroid drugs & gro%th hormones preparations from animal thyroid & hypothalamus
tissue 'many of these preparations are no% created synthetically safer & purer,
4nsulin from pancreas of animals 'hog, cattle, sheep,7 thru genetic engineering cld
produce human insulin y altering E: coli acteria ma=ing it a etter product %ithout
impurities that come %ith animal products
2: #egetale8plant sources roots, ar=, sap, lea#es, flo%ers, seeds of medicinal plants
digitalis from %ildflo%er, purple fo"glo#e, dried lea#es of plant
acti#e principles of plants
al=aloids al=aline in reaction, itter in taste, po%erful in physiologic
o atropine & scopolamine
o morphine sulfate, cocaine, Duinine, nicotine, caffeine
o procaine
glycosides digitalis
resin solule in alcohol. e"ample colonic irritant found in la"ati#e cascara
gums used in ul=)type la"ati#es7 some used in certain s=in preparations for their
soothing relief
oils castor oil, oil of %intergreen
(: Mineral sources from free elements, oth metallic & non)metallic usually in form of acids ases,
salts found in food
+ilute 6C4 control8pre#ent indigestion
Calcium, aluminum, fluoride, iron, gold, potassium
/: synthetic sources many drugs de#eloped synthetically after chemical in plants, animals, or
en#ironment ha#e een screened for signs of therapeutic acti#ity
more potent, more stale, less to"ic
steroids arthritis & other diseases
sulfonamides8chemotherapeutic agents =ill microorganism slo% their gro%th
meperidine 6C4 '+emerol,
*: y action
*nti infecti#es antiseptics, disinfectants, sterilants
*ntimicroials, metaolic, diagnostic materials, #itamins & minerals
2accine & serums, antifungals, antihistamines, antineoplastics, antacids
B: By ody system
C>9 'E,8'), actions of neural path%ays & centers7 !henoarital
*>9 go#erns se#eral odily functions so that drugs that affect *>9 %ill at the same
time affect other systems functions
&4A acts on mascular & glandular tissues7 loperamide
-E9!4-*A$-B 9B9AEM act on resp: tract, tissues, cough center, suppress, rela",
liDuefy & stimulate depth & rate of respiration
Crinary system act on =idney & urinary tract
Circulatory system act on heart, lood #essels, lood. metoprolol
!rescription8legend drug can e dispensed if %ith prescription order. %ith specific name
of drug & dosage regimen to e used y patient
non)prescription drug can e dispensed o#er the)counter8%ithout prescription order
) for self treatment of #ariety of complaints
) #itamin supplements, cold8cough remedies, analgesics, antacids, heral products
) cautions in use of $AC drugs7
1: delay in professional diagnosis & treatment of serious8potentially
serious condition may occur
2: symptoms may e mas=ed ma=ing the diagnosis more complicated
(: clients< health care pro#ider8pharmacist should e consulted efore
$AC preparations are ta=en
/: laels8instructions should e follo%ed carefully
5: ingredients in $AC drug may interact %ith prescried drug
F: inacti#e ingredients may result in ad#erse reactions
7: potential for o#erdose
0: multiple medication users are at ris= as more medications are added to
therapy regimen
3: interactions of medications are potentially dangerous
4n#estigational drug ne% drugs undergoing clinical trails
4llicit8street drug used8distriuted illegally for non)medical purposes to alter mood of feeling
GG%hen drug is ta=en y mouth, it undergoes ( phases7
1: pharmaceutic8dissolution
2: pharmaco=inetics
(: pharmacodynamics
) +rug goes into solution so that it can cross the iologic memrane
) >ot found in drug administered parenterally
) 1
phase of drug action of agents ta=en y mouth
) *dditi#e enhances asoraility of drugs
) EHC4!4E>A97 filters & inert sustances
*llo%s drugs to ta=e on particular si;e & shape
Enhance drug dissolution potassium '?, ))) losartan ? 'co;aar,. sodium '>a, )))clo"acillin >a
2 phases7
) +isintegration rea=do%n into smaller parts
) +issolution futher rea=do%n into smaller parts in &4A asorption. dissol#ed
into liDuid
) rate limiting7 time it ta=es drug to disintegrate & dissol#e to ecome a#ailale for ody to asor it
) factors affecting dissolution
form of drug '@4IC4+ 29: 9$@4+, liDuid more asored than solid, already in solution,
rapidly a#ailale for &4 asorption
&astric ph 'acid #s al=aline, acidic media 'phJ1:2, faster disintegration & asorption
*ge young #s elderly inc ph: +ec asoption
Enteric coated drugs resist disintegration in gastric acid
+isintegration occurs only in al=aline en#ironment 'intestine,
9hould not e crushed
!resence of food interfere %ith dissolution & asorption, enhance asorption of
other drugs, may e protectants of gastric mucosa
4: PHARMACO9INETICS action of ody to the drug7 %hat the ody does to the drug
9tudy of asoption 'ta=en into the ody,, distriution 'mo#ed into #arious tissues,,
metaolism8iotransformation 'changed into a form that can e e"creted, & e"cretion
'remo#ed from the ody, of drugs
5hat happens to the drug %hen it enters the ody
K=ineticsL mo#ement7 deals %ith drugs actions as it mo#ed through the ody
*lso concerned %ith a drug<s onset of action, pea= concentration le#el, & duration of action
5 0ro,e##e# ."/o/ed7
4: A-#or02.o" route of drug ta=es from the time it enters the ody until it is asored in circulating
Mo#ement of drug molecules from site of administration to circulatory system
Mo#ement of drug particles from &4A to ody fluids in#ol#e ( processes
!assi#e asorption 'diffusion, mo#ement from higher concentration
o >o energy reDuired7 occurs %hen smaller molecules diffuse across
o 9tops %hen drug concentration on oth sides of the memrane is
o MaMor process through %hich drugs are asored into the ody
*cti#e asorption needs carrier 'en;ymes or protein, to mo#e against a
concentration gradient
o Energy is reDuired7 from lo%er concentration to higher
o Csed to asor electrolytes 'i:e: sodium, potassium, & some drugs
!inocytosis engulfs the drug to carry it across the memrane
o Aransport fat)solule #itamins '#it:*,+,E,?,
Nactors affecting asorption7
+rug soluility lipid solule drugs pass readily through &4 memrane,
5ater solule drugs need an en;yme or protein
@ocal condition at site of asorption %ea= acids less ioni;ed in stomach
) ) ) readily pass through the 94
!ain 8 stress 8 solid foods 8 fatty or hot foods slo%s do%n
gastric emptying time
+rug concentration drugs can ta=e se#eral hours8days to reach pea=
concentration le#els 'slo% rate7 rectal administration or sustained release
Circulation at site of asorption poor circulation hampers asorption 'i:e:
Ahe more lood #essels, the faster the asorption
E"ercise decrease lood flo% to &4 slo%s asorption
*pplication of heat8massage increases lood flo%s at site
Muscles area selected for 4M administration7
Blood flo%s faster through deltoid muscle 'upper
arm, #s gluteal muscle 'uttoc=s,
&luteal muscle can accommodate larger #olume
of drug than deltoid muscle
(. Me2a-o.#+ iotransformation7 essential for termination of a drug<s iologic acti#ity so can e easily
9ites of metaolism
o @i#er main organ for drug metaolism
Ahrough the drug metaoli;ing en;ymes 'microsomal en;ymes, non)
microsomal en;ymes,
pass effect hepatic 1
pass some drugs do not directly go into
circulation ut pass thru intestinal lumen to li#er #ia portal #ein ) ) drug
metaoli;ed in li#er into inacti#e form ) ) decrease amount of acti#e drugs )
) ) increase recommended dose for oral drugs
@idocaine e"tensi#e 1
pass not gi#en orally
o !lasma
o ?idneys
o Memranes of intestine
!rocess y %hich ody changes a drug from its dosage form to a more %ater)solule form that
can then e e"creted
Can e metaoli;ed in se#eral %ays7
o Most drugs metaoli;ed into inacti#e metaolites 'products of metaolism,, %hich
are then e"creted
o $ther drugs con#erted to acti#e metaolites capale of e"erting their o%n
pharmacologic action
May undergo further metaolism or may e e"creted from ody unchanged
!rodrugs some drugs administered as inacti#e drugs %hich don<t ecome
acti#e until they<re metaoli;ed
o !ermits the ody to inacti#e a potent drug efore it accumulates & produces to"ic
Nactors affecting iotransformation7
o &enetic some people metaoli;e drugs rapidly, other more slo%ly
o !hysiologic
@i#er diseases 'cirrhosis,, heart failure dec circulation in li#er
4nfants immature li#ers dec rate of metaolism
o *rea of asoring surface to %hich a drug is e"posed 'E, chemical agents may
destroy the drug
o Aypes of transport diffusion, acti#e, pinocytosis
o -outes of administration s=in asorption slo%er than 4M
*sorption %ith in seconds8minutes7 sulingual, 42, y inhalation route
9lo%er rate asorption7 oral, 4M 9C routes
o Bioa#ailaility consideration of highest importance in drug effecti#eness & safety
9ucategory of asorption
O of administered drug does that reaches systemic circulation
$ral route P100O'usually 20)/0O,. 42 route J 100O
Nactors that alter ioa#ailaility7
+rug form 'talet, capsule,
-oute of administration
&4 mucosa & motility
Nood & other drugs 'E, food ) ) ) pord of gastric acid inc drug
asorption 'i:e: Ka;oleL,
Changes in li#er metaolism, li#er disorder dec li#er function
inc ioa#ailaility
44: d.#2r.-u2.o" process y %hich drug ecomes a#ailale to ody fluids & tissues
the %ays a drug is transported from the site of administration to the site of action
factors affecting distriution7
o si;e of the organ
o lood flo%s drug is Duic=ly distriuted to organs %ith large supply of lood 'heart,
li#er, =idneys,
distriution to other internal organs, s=in, fat, muscle is slo%er
o soluility lipid solule drugs can also cross the lood)rain arrier & enter the
o Binding as drug tra#els trough the ody, it comes in contract %ith proteins
'alumin,: Ahe drug can remain free or ind to protein:
!ortion of drug ound to protein is inacti#e, no therapeutic affect
Nree8unound portion acti#e ) ) ) ) 'E, pharmacologic response
6ighly protein ound drug ) Q 03O of drug is ound to protein
+ia;epam, piro"icam, #alproic acid
Moderately highly protein ound drugs 'F1)03O ound protein,
Erythromycin, phenytoin
Moderately protein ound drugs (0)F0O
*spirin, lidocaine, pindolol, theophyliine
@o% protein)ound drugs ) P (0O ound to protein 'ami=acin, amo"icillin,
Elderlies dec li#er si;e, lood flo%, en;yme production ) ) ) slo%s
En#ironment cigarette smo=e may affect rate of some drugs
o 9tressful en#ironment prolonged illness, surgery, inMury
444: E3,re2.o"4e.+."a2.o" remo#al of drug from the ody7 drug is changed into
inacti#e form & e"creted y the ody
o ?idney main organ for drug elimination7 lea#es the ody through
Nree8unound8%ater solule drugs filtered in =idney
!rotein ound drug cannot e filtered in =idney
o @ungs, e"ocrine 's%eat, sali#ary, mammary, glands, s=in, intestinal
Nactors affecting drug e"cretion
o Crine ph normal7 /)5:0
*cid urine promotes elimination of %ea= ase drugs
i:e: cranerry Muice dec urine ph ) ) ) '), elimination of
al=aline urine 'E, elimination of %ea= acid drug
o#erdose aspirin ) ) ) gi#e >aicaronate inc urine ph
) ) ) 'E, e"cretion of drug
o glomerular filtration rate '&N-, dec &N- ) ) ) drug e"cretion
can result to drug accumulation
e"tent of filtration directly proportional to &N- & to fraction of
unound drug to plasma
o creatinine clearance most accurate test to determine renal function
creatinine e"creted in =idney
dec renal &N- inc serum creatinine le#el & dec urine
creatinine clearance
2/ hrs urine collection & lood sample
>ormal 05)1(5 ml8min. elderly F0ml8min
6alf)life8elimination half)life 't R, time it ta=es for one half of drug
concentration to e eliminated
o 9hort t R J /)0 hrs7 gi#en se#eral times a day 'i:e: penicillin &,
o @ong t R J Q 12 hrs7 gi#en 2" or 1" 8 day 'digo"in,
44: PHARMACODYNAMICS refers to action of drug to the ody
5hat happens to the ody in response to the drug
Effects of drugs on the cell<s iological & physiological functions &
mechanisms of action
4nteractions et%een chemical components of li#ing systems & foreign
chemicals including drugs that enter these system
Mechanism of action7 means y %hich a drug produces alteration in function
of their action
+rug actions7
a: Ao replace8act as sustitute for missing chemicals
: Ao inc or stimulate certain cellular acti#ities
c: Ao depress8slo% cellular acti#ities
d: Ao interfere %ith functioning of foreign cells 'i:e: in#ading
microorganisms8neoplasms, chemotherapeutic *gents
Aheories of +rug *ctions
a: +rug)receptors interaction certain portion of drug molecule 'acti#e
site, selecti#e comines %ith some molecular structure 'reacti#e site,
on the cell to produce a iologic effect
-eceptor site drugs act at specific areas on cell mem:. react
%ith certain chemicals to cause an effect %ith in cell
Kloc= & =ey theoryL specific chemical 'key, approaches a cell
memrane & finds a perfect fit 'the lock) at receptor site
affects en;ymes system %ithin a cell produce certain effects
9pecificity selecti#ity theory
+rug action may e7
*gonists drugs that produce a response
o insulin reacts %ith specific insulin receptor site
to change cell memrane permeaility ) ) ) 'E,
mo#ement of glucose into cell
competiti#e antagonist act %ith receptor sites to loc=
normal stimulation producing no effect
o curare use on spear in *ma;on to paraly;e
prey & cause death7 occupies receptor sites for
*cetylcholine 'needed in muscle contraction &
mo#ement, ) ) ) pre#ents ner#e stimulation
causing paralusis
o noncompetiti#e antagonist ) pre#ent reaction of
another chemical %ith different receptor site on
that cell
: drug)en;ymes interaction interferes %ith en;yme systems that act as
catalyst from #arious chemical reations
en;yme systems cascade effect. one en;yme acti#ating
another ) ) ) causing cellular reaction
if single step in one of en;yme system is loc=ed normal cell
function is disrupted
e"7 aceta;olamide 'diamo", diuretic that loc= caronic
anhydrase alters 6E & 62$ e"change systems in =idneys &
c: nonspecific drug interaction act y iophysical means that do not
affect cellular en;ymatic reactions
d: selecti#e to"icity all chemotherapeutic agent %ould act only on 1
en;yme system needed for life of a pathogen or neoplastic cell & %ill
nor affect healthy cells
e"7 penicillin
unfortunately most of it cause destruction of normal human
+rug response may e7
1: primary al%ays desirale 8 physiologic effects
2: secondary desirale or undesirale
e"7 diphenhydramine 'enadryl, 1
effect7 antihistamine, treat symptoms of
allergy. 27 C>9 depression ) ) ) dro%siness
desirale7 %hen gi#en at edtime7 undesirale7 %hen client is dri#ing
Ca##.!.,a2.o" o! dru) a,2.o"7
1: rapid fe% seconds to minutes '42, 9@, inhalation,
2: intermediate 1)2 hrs after administration '4M, 9C,
(: +elayed8slo% se#eral hrs after administration 'rectal, oral,
Para+e2er# o! Dru) A,2.o":
1: onset of action latent period7 inter#al et%een time drug is administered & 1
of its effect
time it ta=es to reach the minimum effecti#e concentration 'MEC, after a drug
is administered
time from drug administration to 1
oser#ale effect SA0 A1,
2: duration of action period from onset until drug effect is no longer seen
length of time the drug e"erts pharmacologic effect 'A1 A(,
(: peak action drug reaches its highest lood 8 plasma concentration 'A0 A2,
Termination of action point from onset at %hich drug effect is no longer seen
Minimal effective concentration lo%est plasma concentration that produces the desire
Peak plasma level highest plasma concentration attained from a dose
Toxic level plasma concentration at %hich a drug produces ad#erse effects
Therapeutic range range of plasma concentration that produces the desire effect
%ithout to"icity 'range et%een minimal effecti#e concentration & to"ic le#el,
Loading dose olus of drug gi#en initially to attain rapidly a therapeutic plasma
large initial dose. %hen immediate drug response is desired
gi#en to achie#e a rapid MEC in the plasma
i:e: digo"in ) ) ) reDuires @+
Maintenance dose amount of drug necessary to maintain a steady therapeutic plasma
Dose response relationship et%een minimal #s: ma"imal amount of drug dosed needed
to produce desired drug response
i:e: some clients respond to lo%er drug dose %hile others need a high
Maximal efficacy (maximum drug effect) all drugs gi#e a ma"imum drug effect
'ma"imal efficacy,
i:e: sim#astatin /0mg #s rou#astatin 10mg
Dru);re#0o"#e rea2.o"#*.0:
Biologic half-life (t!", J time reDuired to reduce to R amount of unchanged drug that is
in the ody
short t182 drugs need to e administered more often than one %ith a
longer t182
Lethal dose '@+50, dose lethal to 50O of animals tested
#ffective dose 'E+50, dose reDuired to produce therapeutic effect on 50O animals
Therapeutic index 'A4, ratio et%een @+50 and E+50. the closer the ratio is to 1, the
greater the danger in#ol#ed in gi#ing the drug to humans
estimates the margin of safety of a drug through the use of a ratio that
measures the effecti#e 'therapeutic or concentration, dose 'E+, in 50O
of persons8animals 'E+50, & lethal dose in 50O of animals '@+50,
lo% therapeutic inde"7 narro% margin of safety. might need to adMust
drug dose & plasma drug le#els need to e monitored
high therapeutic inde"7 %ide margin of safety less danger of producing
to"ic effects
5 Ca2e)or.e# o! Dru) A,2.o":
1: stimulation8depression
stimulation inc rate of cell acti#ity8secretion from the gland
depression dec cell acti#ity & function of a specific organ
2: replacement replaces essential ody compounds. i:e: insulin
(: inhiition8=illing of organism interfere %ith acterial cell gro%th . i:e: antiiotics
/: irritation i:e: la"ati#e irritate inner %all of colon ) ) ) inc peristalsis ) ) ) inc
Dru) 0o2e",y relati#e amount of drug reDuired to produce desired response
also used to compare a drug
lo% dose lo% response
dosage increased produce slight increase response, as dose further increases, drug
response increases mar=edly, at certain point ho%e#er, inc dose yield little or no
inc in response ) ) ) drug ha#e reached Ma"imum Effecti#eness
Fa,2or# A!!e,2.") Do#e Re#0o"#e 7
) nurse must e a%are that human factor has tremendous influence on
%hat actually happens %hen it enter the ody
) no 2 people react in e"actly the same %ay to any gi#en drug
1: %eight hea#ier patient larger dose to get therapeutic effect 'more tissue to
perfuse & inc receptor site in some reacti#e tissues,
) dec %eight dec dose
2: age children 'immune system for handling drugs, & older adults
) older patients7 less asorption, distriution et%een fe%er plasma
proteins & less efficient perfusion7 geriatric dosages
) nurse should monitor closely for desired effects 'may adMust dose,
(: to"icity
/: pharmacogenetics effect of a drug action that #aries from a predicted drug
response ecause of genetic factors or hereditary influence
people ha#e different genetic ma=eup do not al%ays respond identically to a
drug dosage or planned drug therapy
e"7 *frican *mericans do not respond as %ell as %hites to some classes of
antihypertensi#e medications
5: route of administration
F: emotional factors
7: pre)e"isting disease state li#er disease
0: drug history drug interaction synergistic8e"cretion
3: tolerance
10: cumulati#e effect
11: drug) drug interaction
12: BM- inc BM- inc drug metaolism & e"cretion
Dru) I"2era,2.o"
1: *dditi#e effect 2 drugs %ith similar actions are ta=en for a douled effect
'desirale8undesirale, '1 E 1 J 2,
4uprofen E paracetamol E added analgesic effect
2: 9ynergistic comined effect of 2 drugs is greater than sum of the effect or each
drug gi#en alone '1 E 1 J (,
*spirin E codeine J greater analgesic effect
(: potentiation a drug that has no effect enhances the effect of a 2
drug '0 E 1J 2,
/: *ntagonistic one drug inhiits the effect of another drug '1 E 1 J 0,
Aetracycline E antacid J dec asorption of tetracycline
!hysiologic effects not related to desired drug effects
*ll drugs ha#e side effects
+esirale7 diphenhydramine 'Benadryl, at edtime s8e7
-esult mostly from drugs that lac= specificity
Might e used interchangealy %ith ad#erse reactions
>ot a reason to discontinue drug therapy
>urse<s role7 teach clients to report any side effects
More se#ere than side effects
-ange of unto%ard effects 'unintended, occurring at normal doses, of drug
that cause mild)se#ere side effects7 anaphyla"is 'cardio#ascular collapse,
*l%ays undesirale
Must al%ays e reported & documented ecause they represent #ariances
from planned therapy:
Can e identified y monitoring the plasma 'serum, therapeutic range of the
>arro% A4 'aminoglycoside & antiiotics, therapeutic range is monitored
5hen drug le#el e"ceeds therapeutic range, to"ic effects are li=ely to occur
from o#erdosing or drug accumulation: