 A response to a drug that is noxious

and unintended, that occurs at doses

normally used in humans for the
prophylaxis, diagnosis or therapy of
disease.

 ADR is due to the intrinsic property of

the drug and cannot be prevented.
 An injury resulting from medical
intervention related to a drug.

 Includes
 ADR
 Errors related to the giving of the
medication (including human error)
 Type A – AUGMENTED
 Type B – BIZAARE
 Type C – CONTINUOUS
 Type D – DELAYED
 Type E – END OF USE
 Type F – FAILURE OF EFFICACY
 Intrinsic to the drug effect
 Predictable
 Usually dose-related
 Extension effect related or unrelated to
the therapeutic pharmacologic activity
 DRUG ADR
Sulfonylureas Hypoglycemia
Adrenergic beta antagonist Bradycardia
Broad spectrum antibiotics Pseudomembranous
colitis
Anti-coagulants Bleeding
CNS depressants Respiratory
depression
 DRUG ADR
Opiates Constipation
Nitroglycerin Headache
ACE inhibitor Cough
Minoxidil Hypertrichosis
Anti-histamine Sedation
 Uncommon
 Unpredictable
 Not dose-related
 Includes:
 GENETICALLY DETERMINED REACTIONS
 HYPERSENSITIVITY REACTIONS
 Malignant hyperthermia
 Neuroleptic malignant syndrome
 Hemolytic anemia in G6PD deficiency
 Steven-Johnson syndrome
 Hypersensitivity reactions
 HYPERSENSITIVITY REACTIONS
TYPE I Immediate hypersensitivity
Anaphylactic type hypersensitivity
IgE mediated hypersensitivity
TYPE II Cytotoxic reactions
TYPE III Immune complex deposition
TYPE IV Delayed hypersensitivity
Cell-mediated hypersensitivity
Tuberculoid type hypersensitivity
 Uncommon
 Dose and time related
 Cumulative effect
 Includes
 ADDICTION
 DEPENDENCE
▪ Physical dependence
▪ Psychological dependence
 TOLERANCE
 Chronic toxicity
 Includes
 CARCINOGENICITY
 TERATOGENICITY
 Anti-neoplastic agents
 Heterocyclic amines
 Aromatic hydrocarbons
 Nitrosamine
 Aflatoxin
 Carbamazepine and valproic acid
 Ethanol
 Diethylstilbestrol
 Phenytoin
 Aminoglycosides
 Tetracyclines
 Thalidomide
 Isotretinoin
 Uncommon
 Withdrawal symptoms
 Generally occur after abrupt
discontinuation
 Examples:
 Opiate withdrawal
 Rebound insomnia (benzodiazepines)
 Rebound hypertension (clonidine)
 Rebound nasal congestion (decongestants)
 Adrenal crisis (glucocorticoids)
 Unexpected failure of efficacy
 PENICILLINS
 NSAIDs
 CONTRAST MEDIA
 Phenothiazines
 Tetracyclines
 Amiodarone
 Aminoglycosides
 Loop diuretics
 Furosemide
 Ethacrynic acid
 Salicylates
 Quinine
 Cisplatin
 AGENTS THAT VESTIBULOTOXIC
IMPAIR HEARING AGENTS
Neomycin Streptomycin
Kanamycin Gentamicin
Amikacin
 Phenothiazines
 Digitalis
 Chloroquine
 Ethambutol
 NSAIDs
 Aminoglycosides
 Neomycin, Tobramycin, Gentamicin
 Penicillins, Cephalosporins
 Amphotericin B
 Cisplatin, Cyclosporine, B
ASPIRIN Impairment of platelet
aggregation
CHLORAMPHENICOL Aplastic anemia
PHENYLBUTAZONE
SULFONAMIDE
GOLD
HEPARIN Thrombocytopenia
CLOZAPINE Agranulocytosis
CO-TRIMOXAZOLE
PENICILLIN
PHENYLBUTAZONE
 Doxorubicin
 Thioridazine
 Tricyclic antidepressants
 Lithium
 Fluoroquinolones
 Digoxin
 Anti-arrhythmics
 Amiodarone
 Bleomycin
 Mitomycin
 Arises during the compounding or
dispensing of a prescription
 Interaction between 2 or more
substances
 FORMS:
 Therapeutic incompatibilities
 Physical incompatibilities
 Chemical incompatibilities
 Undesirable pharmacological
interaction between two or more
ingredients
 DRUG-DRUG
 DRUG-FOOD
 DRUG-LABORATORY TEST
 Pharmacokinetic
 Pharmacodynamic
 ALTERATION OF pH
 COMPLEX FORMATION
 DECREASED GASTRIC EMPTYING
 INCREASED GASTRIC EMPTYING
 INCREASED GI MOTILITY
 ADSORPTION
 INTERRUPTION OF THE ENTEROHEPATIC
CIRCULATION
 DISPLACEMENT FROM PLASMA PROTEIN
 Phenylbutazone (Warfarin/ Glibenclamide)
 Salicylates (Bilirubin/ oral hypoglycemics)
 ENZYME INDUCTION
 ENZYME INHIBITION
ENZYME INDUCERS ENZYME INHIBITORS
CARBAMAZEPINE AMIODARONE
PHENYTOIN CIMETIDINE
PHENOBARBITAL CIPROFLOXACIN
DEXAMETHASONE ERYTHROMYCIN
GRISEOFULVIN AZOLES (antifungals)
ISONIAZID FLUVOXAMINE, FLUOXETINE
PRIMIDONE GRAPEFRUIT
RIFAMPICIN ISONIAZID
TOBACCO SMOKE ORAL CONTRACEPTIVES
CHARBROILED FOOD VALPROATE
ALCOHOL (chronic) VERAPAMIL
ALCOHOL (acute)
 ALTERATION OF URINARY pH
 Ion trapping
▪ Bicarbonate
▪ Acetazolamide
▪ Ammonium chloride
 INHIBITION OF ACTIVE TRANSPORT
 Probenicid
 NSAIDs
 Quinidine and Amiodarone on Digoxin elimination
 ADDITION 1+1=2
 SYNERGISM 1+1=3
 POTENTIATION 1 + 0 = 2
 ANTAGONISM 1+1=0
 DRUG + FOOD EFFECT
CNS Depressants + Coffee ANTAGONISM

Warfarin + Green leafy vegetables ANTAGONISM

Tetracyclines + Dairy products CHELATION leading to decreased

tetracycline absorption
MAOI + tyramine rich food (cheese, beer, HYPERTENSIVE CRISIS
wine, chicken liver)
INH + histamine rich food FLUSHING OF SKIN; HYPERSENSITIVITY

Bisacodyl + Milk PREMATURE LIBERATION OF

BISACODYL
Aspirin + Coffee INCREASED ABSORPTION OF ASPIRIN