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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
Relatively rare
A considerable mortality
Unpredictable
Drug allergy-hypersensitivity reactions (types IIV)
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 (Cytotoxic/blood dyscrasia)
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

A 14 years old woman who presented to ED with a high fever, vomiting,


diarrhea, and 3 days history of a skin rash. The rash is maculo papular with
blisters and has spread to involve 75% of her body surface area. She had
UTI about 11/2 weeks ago and was prescribed a 7 days course of
trimethoprime sulfa methoxazole (TMP/SMX), she adhered to the regimen;
her urinary tract symtomps is dysuria and frequency and her abdominal
discomfort resolve with in 2-3 days.
This was her first UTI. She continued to take TMP/SMX as directed. Seven
days after starting therapy, she notice red spots on her arm and leg that
began to spread over the whole body. The rash began to blister. She
became febrile, and last night she began vomiting and had two bouts of
diarrhea. This morning her mother brought her to the ED and she was
admitted to the ICU, where she was immediately intubated to protect her
airway patency.

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