Beruflich Dokumente
Kultur Dokumente
-Rohit Shrivastava
Overview of this Presentation
• Introduction
• History
• Definition of Adverse drug reaction
• Classification of Drug interactions
• Dose related ADR’s
– Pharmaceutical, Pharmacokinetic,Pharmacodynamic
• Non-dose related ADR’s
– Immunological, Pharmacogenetic
• Long term and delayed effects causing ADR’s
– Adaptive, Carcinogenesis, Hormonal, Gene toxicity
• Surveillance methods used to detect ADR’s
– Anecdotal, CSM, Yellow card, Post marketing
Introduction
• Medicines are classified according to their therapeutic
action, but no drug induces only one specific effect.
• Type B(bizarre)
– Not related to pharmacological effect of drug
– idiosyncratic or immunologic reactions.
– E.g. Hypersensitivity
• Type C
– involves dose accumulation
– E.g. antimalarials and ocular damage
• Type D
– delayed effects (dose independent)
– E.g Teratogenicity ( thalidomides and neonatal defects)
Common Causes of ADR
• Antibiotics
• Antineoplastics*
• Anticoagulants
• Cardiovascular drugs*
• Hypoglycemics
• Antihypertensives
• Analgesics
• CNS drugs*
ADR Risk Factors
• Age
• Multiple medications
• Inappropriate medication prescribing or use
• Altered physiology
• Prior history of ADRs
• Extent (dose) and duration of exposure
• Genetic predisposition
Dose related ADR’s
• Pharmacokinetic variation
– E.g. Renal dysfunction enhanced toxicity of digitalis, aminoglycoside,
allopurinol, cephalosporins, Li and amphoterecin B.
• Pharmacodynamics variation
– Hepatic disease may influence pharmacodynamic response to
drugs. Drugs like oral anticoagulants by inhibiting clotting may cause
bleeding.
• Pharmacogenetic variation
– Variation in drug response and drug metabolism due to
genetic polymorphism.
• Immunological reactions
– Commonly known as Allergy or Hypersensitivity.
– No relation to pharmacological effect
– Always delay between first and subsequent exposure to drug
– E.g. Ampicillin causes rashes in patients with Infectious mononucleosis.
• Pharmacogenetic variations
– Include Idiosyncratic Reactions
– Heinz body hemolytic anemia – sulfones, primaquine,
phenylbutazone.
Long term and Delayed effects of
ADRs
• Long term effects causing ADR:
• 1. Due to Adaptive changes :
– physical dependence by narcotic analgesics.Tardive dyskinesia
associated with long term neuroleptic therapy for schizophrenia.