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Adverse Drug Reaction
(ADR's) |
* Adverse Drug Reaction - Undesired effects of drugs that may be unpleasant or dangerous. Most often affects the very young and the very old.
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Reasons ADR's Occur
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- Drug may have other effects on the body besides the theraputic effect. (Impotence w/beta blockers)
- Patient is sensitive to the drug being given. - The drug's action on the body causes other responses. - Patient is taking too much or too little of the drug. |
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Types of Adverse Reactions
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- Primary Actions
* Over dose: extension of the desired effect (blood pressure too low) - Secondary Actions * Undesired effects produced in addition to the pharmacologic effect (elevated blood glucose with steroids) - Hypersensitivity Reactions * Excessive response to primary or secondary effect of drug (often due to a co-morbidity such as BPH) |
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Drug Allergies
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- In all true allergic reactions, the body forms antibodies; must have primary exposure or expsure to a drug that is closely related (cross allergy)
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Types of Drug Allergies
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Anaphylactic
Cytoxic Serum Sickness Delayed Allergic Reaction |
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Anaphylactic Reaction
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- Hives
- Shortness of breath - Elevated heart rate and B/P - Throat swelling - respiratory arrest - EMERGENCY SITUATION - Treat with epinephrine |
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Cytoxic Reaction
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- Antibodies attack cells carrying the drug and kill them.
- Takes a few days - Blood counts decreased - Can affect renal and liver functions (elevated LFT and creatinine) |
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Serum Sickness Reaction
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- Antibodies deposit themselves in tissues and cause damage.
- Rash - Fever - Swollen Joints - Facial edema |
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Delayed Allergic Reaction
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- Occurs several hours after exposure
- Rash - Hives - Swollen Joints |
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DRUG INDUCED TISSUE
AND ORGAN DAMAGE |
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Dermatological Reactions
* RASH /HIVES* |
- Assessment:
* Abnormalities in the skin, red area blisters - Interventions * Frequently need to discontinue medication - Stomatitis - often seen with chemotherapy * Inflammation of the mucous membranes - Interventions * Frequent mouth care |
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Superinfections
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- Destruction of the body's normal flora
- Assessment: * Fever, diarrhea, vaginal discharge. Vaginal bacterial or yeast infections are very common w/AIDS - Intervention: * Supportive care (mouth and skin care), administer anti-fungal medications, may need to stop drug responsible for the infection |
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Blood Dyscrasias
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- Bone marrow supression. New blood cells are not created to replace the one's that are dying.
* Assessment: Watch that bloodwork for trending * Blood Counts are LOW * RBC, WBC, PLATELETS - Fever, chills, weakness - Interventions: * monitor blood counts * protective isolation ( RBC = red blood cells, WBC = white blood cells, Platelets) |
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Toxicity
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- Liver
* Assessment: - Fever - Nausea - Jaundice - Change in color of urine (dark) or stool (pale) - elevated liver enzymes * Interventions - discontinue medication FAST - Kidney * Assessment: - Change in urinary pattern - Elevated BUN and creatinine * Interventions - Notify physician, may need to stop medication or decrease the dosage. If very bad, dialysis may be needed. |
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Poisoning
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- Poisoning occurs when an overdose of a drug damages mulptiple body systems
- Damage to multiple systems can lead to a fatal reaction |
