Adverse Drug Reaction

By,
krutika
Clinical Pharmacist ,
HCG MS
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 Definition by WHO

– Any response to a drug which is noxious and

unintended and which occurs at doses used in man
for prophylaxis, diagnosis or therapy.

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 • ADR may result from:
– Effects of the drug
– Illness
– Interaction with other drugs or food

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 • Not always the active ingredient causing the
problem but may also be due to:
– Solvent
– Excipients
– Formulation
– Contaminants produced in the manufacturing
process.!

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 Some drugs
All Drugs are have a low
Dangerous therapeutic
ratio

Some The most

adverse dangerous
Some adverse
effects occur drugs have the
effects can be
after a delay greatest
predicted if you
or after potential for
know the
stopping benefit
pharmacology
(Type A); some
are not (Type B)

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 Steven Johnson’s Syndrome

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 Bullous dermatitis medicamentous caused by sulfathiazole

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 Corticosteroids immunity oral candidiasis

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 Warfarin, Insulin
and Digoxin are
the most
Dangerous
drugs in the
elderly.
Do we believe
that?

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 6 Classifications of ADR

• Type A (Augmented)
• Type B (Bizzare)
• Type C (Continuous)
• Type D (Delayed)
• Type E (Ending Use)
• Type F (Failure of Efficacy)

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 Type A or Augmented

– Refers to actions related to the pharmacological activity of a drug

– Extension effects – predictable, dose related responses arising from an
extension therapeutic effect.
• Example:
– Benzodiazepine (anxiety neurosis)– sedation and falls trauma
– Furosemide (diuresis) – water and electrolyte imbalance

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 Type B reactions or Bizzare

– Refers to totally abnormal effects, unrelated from the

drug’s known pharmacological actions
– Idiosyncrasy is an example of bizzare reaction:
– Genetically abnormal response
– Dose-dependent

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 Examples
Genetic Idiosyncratic
Drugs
Abnormality Response

Abnormal Phenacitin Methemoglobinemia

hemoglobin Sulfanilamides Hemolytic anemia

Aspirin
Erythrocyte G6PD-
Sulfonamides Hemolytic anemia
deficiency
Vitamin C
Low plasma ChE Local anesthetic
Procaine
activity toxicity

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 Type C Reactions or Continuous

– Long term effects are usually related to the

dose and duration of treatment.
• Example:
–Ethambutol – optical neuropathy

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 Type D reactions or delayed

– Carcinogenesis
• Hormonal
• Gene toxicity
• Suppression of immune response
• Adverse Effects associated with
reproduction
– teratogens

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 Type E Reactions or Ending of Use
(Withdrawal Syndrome)

• Alcohol – Delirium Tremens

• Barbiturates – Restlessness, Mental ,
Confusion, Convulsion
• Clonidine – Rebound Hypertension
• Opioids – Narcotic Withdrawal

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 Type E

• Unstable angina after B adrenoceptor antagonist

are suddenly stopped,
• Adrenocortical insufficiency after
glucocorticosteroids such as prednisolone are
stopped
• Seizures after stopping anticonvulsants like
phenytoin or phenobarbital

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 Prevention of Adverse Drug
Reactions
• Never use any drug unless there is good
indication. If the patient is pregnant do
not use the drug unless the need is
imperative.
• Allergy and idiosyncrasy are important
causes of ADRs. Ask if the patient had
previous reactions.
• Ask if the patient is already taking other
drugs including self medication
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 Thank you

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