Professional Documents
Culture Documents
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
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