Pharmacy

1. •Drug “cure’d yesterday of
my disease but I died last
night”
 Drugs prescribed for diseases are themselves the cause of
serious amount of diseases.
 Any drug irrespective of its therapeutic action, has the potential
to do harm.
“All substances are poisons; there is
none which is not a poison. The
right dose differentiates a poison
and a remedy.”

2. Toxicity depends on the dose
– High oxygen level cause “oxygen intoxication”
– Too much water (several gallons) can cause osmotic
imbalance and brain damage
– 1 beer vs. a six pack of beer
– 1 sleeping pill vs. a bottle of sleeping pills
– 1 aspirin vs. a bottle of aspirins

3. DEFINITION
Adverse drug reaction
( W.H.O Definition)
“ Adverse drug reaction is defined as any
response to a drug that is noxious and
unintended and that occurs at dose used in man
for prophylaxis, diagnosis or therapy of disease
or for modification of physiological function”.

5. To avoid her mental
disease the mother
of this child taken
lithium
Effect
of
Amino
pterin
taken
during
child
bearing

6. Devil child born to a mother taken a
drug Coumarin

7. A child born to
Gentamycin
consumed mother
Valproate effect -
ugly face

8. Story of Diethylstilbestrol children –
SEEDLESS children
 During 1940 – 1970, five million
pregnant ladies received Diethyl
stilboestrol to prevent abortion. DES is a
highly potent (200-400 times more active
than oestradiol), orally active non
steroidal estrogen.
The males born to DES mothers showed
less sperm count, sperm motility, sperm
volume.

9. Nimesulide,
cause liver
damage –
banned in
many
countries
except India

10. CLASSIFICATION
Type “A” Adverse Drug Reactions.(predictable)
 Conseqences of drug’s pharmacological action
 common, Usually dose related & preventable
Attenuated/Quantitative
 E.g Hyper responses to main action and excessive effect of
the drug (Insulin hypoglycemia)
– Cardic arrythmias with glycosides
Chloroqine Retinopathy
(Account for 75-80% of adverse drug reactions)
 E.g side effects, toxic effects & consequences of drug
withdrawal

11. Type “B” Adverse Drug Reactions (bizzare)(Un predictable)
 Usually unrelated to the drug’s pharmacologic actions
 Based on peculiarities of patient (Often related to
patient’s immunologic responsiveness)
 Generally less common, dose independent , Can be
prevented if genetic basis is known & Serious and
require withdrawal of drugs.
 E.g Drug allergy & idiosyncrasy

12. Comparision between Type A and Type B
(Rawlins and Thompson 1997,1998)
Type “A” Type “B”
Pharmacological
predictability
Yes No
Dose-dependent Yes No
incidence High Low
morbidity High Low
mortality Low High
management Appropriate dose
adjustment
Stop

13. GRADING OF A.D.R
 MINOR:- No therapy, antidote or prolongation of
hospitalization is required
 MODERATE:- Requires change in drug therapy,
specific treatment or prolong hospital stay.
 SEVERE:- Life threatening, causes permanent
damage or requires intensive med. Treatment.
 LETHAL:- Directly or indirectly contributes to death.

14. Side effects
 Side effects are infact pharmacological effects produced
with therapeutic dose of the drug. They can be predicted
from pharmacological profile of the drug.
e.g. Based on same action
Atropine used in preanaesthetic medication for its
antisecretory action produces dryness of mouth as side effects.
Based on different facet of action.
Promethazine produces sedation unrelated to its
antiallergic action

15. Untoward effect
 They develop with therapeutic dose of drug, but are
undesirable and, if severe, may necessitate the cessation of
treatment.
E.g: Potassium loss due to diuretic drugs.
Toxic effect
 When drug is administered rapidly and/or in large dose.
 Is predictable and dose related.
e.g. Morphine causes resp. failure in overdose.

16. Intolerance.
 Lower threshold to normal
pharmacological response
e.g. Chloroquin- abdominal pain
Idiosyncracy
 A qualitatively abnormal, unexpected
response, differing from it’s
pharmacologic action
E.g: Chloroquin- Hemolysis

17. HYPERSENSITIVITY REACTIONS
 When an individual have been sensitized to an
antigen can cause tissue damaging reactions called
hypersensitivity or allergic reactions.
Coomb and gel clasification(1968)
Type I (Immediate)-IgE mediated
Type II (Cytotoxic)
Type III (Immune complex)
Type IV (Delayed)- cell mediated
/Drug allergy

18. Type-I Hypersensitivity (Anaphylaxis/
immediate type)
• Allergen Interaction with IgE on the Surface of Mast Cells
triggers the Release of Inflammatory Mediators
Ca+
Ca+
degranulation
Mediators
Eg Histamine
Bronchospasm, BP &
even death

19. Type-II Hypersensitivity (cytotoxic type)
Antibodies bind to antigens on specific body cells,
stimulating phagocytosis and complement-mediated lysis of
the cellular antigens
Example: Agranulocytosis, aplastic anaemia by Clozapine
Ag contaning cells
Phagocytosis

20.  widely distributed Ag + soluble circulating Ab
Insoluble antigen-antibody complexes release
histamine, activates kinin system, aggregation of platelets -
Intense inflammation, local cell lysis, and death may result
 Example: Sulfonamides induces nephritis
Type-III Hypersensitivity (immune complex
Mediated type)

21. Onset is slow (1–3 days)
Mediated by mechanisms involving delayed
hypersensitivity T cells and cytotoxic T cells
Cytokines from activated TC are the mediators of the
inflammatory response
 E.g Sulphonamides- erythema
Type-IV Hypersensitivity (cell-Mediated
type/delayed type)

22. Teratogenicity
•Capacity of a drug to induce foetal abnormal when
administered to pregnant mother
•Placnta is not a complete barrier so any drug can enter
in fetal circln
E.g: Thalidomide, Methotrexate

23. Carcinogenicity & mutagenicity
• Capacity of drug to cause cancer & genetic deflects respectively
E.g: Radiations, tobacco, Anticancer drugs, radioisotopes.
Photosensitivity
a) Phototoxic
• Drug/its metabolites accumulates in skin absorbs light &
undergoes a photochemical reaction followed by photobiological
reaction local tissue damage, sunburn like rean i.e erythema, edema
E.g: Fqs, phenothiazines, thiazide
b) Photo allergic
• Drug/its metabolites induces a cell mediated immune response
On exposure to light papular or eczematous contact dermatitis like
picture
E.g Sulfonamide, Griseofulvin, chloroquin.

24. Prevention of A.D.R
 Avoid all inappropriate use of drugs
 Appropriate dose, route, frequency of drug adm.
 Consider previous history of drug reaction.
 Rule out possibility of drug interaction
 Adopt Correct administration technique
 Appropriate laboratory monitoring