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
-blocker & -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