Adverse drug reactions can be classified in several ways including onset, severity, type of reaction, and cause or mechanism. Some key points about classification include:
- Reactions are classified as type A, B, C, or D based on predictability and dose-dependence. Type A reactions are predictable and dose-dependent while type B reactions are unpredictable.
- Skin reactions to drugs can include urticaria, fixed drug eruptions, Stevens-Johnson syndrome, and toxic epidermal necrolysis. Organ-specific reactions can affect the renal, hepatic, or hematologic systems.
- Multi-organ reactions include serum sickness, an immune-complex reaction, and drug-induced lupus
Therapeutic drug monitoring (TDM) of drugs used in seizure disordersAbel C. Mathew
Therapeutic drug monitoring (TDM) of drugs used in seizure disorders- Phenytoin, Valproic acid, Carbamazepine are major drugs used in epilepsy disorders. These drug need TDM to ensure their proper usage.
Therapeutic drug monitoring (TDM) of drugs used in seizure disordersAbel C. Mathew
Therapeutic drug monitoring (TDM) of drugs used in seizure disorders- Phenytoin, Valproic acid, Carbamazepine are major drugs used in epilepsy disorders. These drug need TDM to ensure their proper usage.
Therapeutic drug monitoring for immunosuppressive agents ( organ transplants)pavithra vinayak
Therapeutic drug monitoring for immunosuppressive agents ( organ transplants)
1)CALCINEURIN INHIBITORS
i. CYCLOSPORIN/ CYCLOSPORINE
ii. SIROLIMUS
iii. TACROLIMUS
iv. EVAROLIMUS
2) ANTIPROLIFERATIVE/ANTIMETABOLIC AGENTS,
i. MYCOPHENOLATE
ii. AZATHIOPRINE
3) BIOLOGICS (ANTIBODIES)
i. MUROMONAB-CD3 (OKT3)
ii. BASILIXIMAB
iii. DACLIZUMAB
iv. ALEMTUZUMAB
v. ANTITHYMOCYTE GLOBULIN
4)GLUCOCORTICOIDS,
clinical pharmacokinetics and therapeutic drug monitoring ----- fifth pharm D notes
Immunosuppressant are drugs or medicines that lower the body's ability to reject a transplanted organ. Another term for these drugs is anti-rejection drugs. There are 2 types of immunosuppressants: Induction drugs: Powerful antirejection medicine used at the time of transplant.
Basic principles of chemotherapy/ AMAs covers definition, history of AMAs development, principles of AMAs, problems associated with AMAs, failure of therapy with examples.
Essential drug concept and rational use of medicinesPravin Prasad
Many medical students are unheard of the Essential Medicine List. This has been mentioned in very small sections in various textbooks that are in use in Nepal. The discussion on this topic is a must among medical and nursing students, as well as anyone related to field of Medicine
Therapeutic drug monitoring for immunosuppressive agents ( organ transplants)pavithra vinayak
Therapeutic drug monitoring for immunosuppressive agents ( organ transplants)
1)CALCINEURIN INHIBITORS
i. CYCLOSPORIN/ CYCLOSPORINE
ii. SIROLIMUS
iii. TACROLIMUS
iv. EVAROLIMUS
2) ANTIPROLIFERATIVE/ANTIMETABOLIC AGENTS,
i. MYCOPHENOLATE
ii. AZATHIOPRINE
3) BIOLOGICS (ANTIBODIES)
i. MUROMONAB-CD3 (OKT3)
ii. BASILIXIMAB
iii. DACLIZUMAB
iv. ALEMTUZUMAB
v. ANTITHYMOCYTE GLOBULIN
4)GLUCOCORTICOIDS,
clinical pharmacokinetics and therapeutic drug monitoring ----- fifth pharm D notes
Immunosuppressant are drugs or medicines that lower the body's ability to reject a transplanted organ. Another term for these drugs is anti-rejection drugs. There are 2 types of immunosuppressants: Induction drugs: Powerful antirejection medicine used at the time of transplant.
Basic principles of chemotherapy/ AMAs covers definition, history of AMAs development, principles of AMAs, problems associated with AMAs, failure of therapy with examples.
Essential drug concept and rational use of medicinesPravin Prasad
Many medical students are unheard of the Essential Medicine List. This has been mentioned in very small sections in various textbooks that are in use in Nepal. The discussion on this topic is a must among medical and nursing students, as well as anyone related to field of Medicine
ADE
INCIDENCE OF ADR
GREADING OF SEVERITY OF ADR
CLASSIFICATIONS
PHARMACOVIGILANCE
CATAGORIES
CAUSES OF ADR
DRUG INDUCED HEPATIC DYSFUNCTION
DRUG INDUCED ENDOCRINE DYSFUNCTION
DRUG INDUCED PHERIPHERAL NEUROPATHY
MANAGEMENT OF ADR
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
3. • Adverse reaction: WHO, (1972)
• A response to a drug which is noxious and unintended, and
which occurs at doses normally used in man for the
prophylaxis, diagnosis, or therapy of disease, or for the
modifications of physiological function'
Poisonous
effects
4. • Classification of ADRs: Depending on….
Onset of event
Severity
Type of reaction:
Cause or mechanism
ONSET OF EVENT:
SUB-ACUTE
(1-24 HRS)
LATENT
(>2 DAYS)
5. Classification of ADRs
Severity: Minor, Moderate, Severe, Lethal ADRs
Minor ADRs: No therapy, antidote or prolongation of
hospitalization is required.
Moderate ADRs: Requires change in drug therapy, specific
treatment or prolongs hospital stay by atleast 1 day.
Severe ADRs: Potentially life threatening, causes
permanent damage or requires intensive medical
treatment.
Lethal: Directly or indirectly contributes to death of the
patient.
7. Classification of ADRs
Type of reaction…………………..wills and brown
AUGMENTED
DELAYED
END
OF
TREATMENT
FAMILIAL
GENOTOXICITY
HYPERSENSITIVITY
UNCLASSIFIED
8. Type A (Augmented) reactions
Anticoagulants
↓ Intra Vascular
Coagulation
Antihypertensives
Vasodilators
Hypotension
Head ache
Antidiabetics
Antiarrhythmics
β blockers
Hypoglycemia
Normalize
Blood Glucose
Bleeding
therapeutic effect
Normalize
heart rate
Normalize
Blood pressure
Bradycardia
augmented
effect
9. Type A (Augmented) reactions
– Reactions which can be predicted from the known
pharmacology of the drug
– Dose dependent
– Can be alleviated by a dose reduction
10. Type B (Bizarre) reactions
Cannot be predicted from the pharmacology of the drug
Not dose dependent
Host dependent factors important in predisposition
Penicillin → Anaphylaxis
Anticonvulsant → Hypersensitivity
Type C (Chemical) reactions
can be predicted from the chemical structure of the
drug/metabolite
Paracetamol → Hepatotoxicity
11. Type D (Delayed) reactions
– Occur after many days of treatment
– Can be due to accumulation.
Chemotherapy → Secondary tumours
Phenytoin during pregnancy → Teratogenic effects
Antipsychotics → Tardive dyskinesia
Analgesics → Nephropathy
12. Type E (End of treatment) reactions
– Occur on withdrawal especially when drug is stopped
abruptly
Phenytoin withdrawal → Seizures
Steroid withdrawal → Adrenocortical insufficiency
13. Predictable Unpredictable
Expected- Undesirable Unexpected- Undesirable
Based- Pharmacological
properties of drug
Based- Peculiarities of patient
More common Less common
Dose related Non dose related
Mostly preventable and
reversible
More serious, requires drug
withdrawl
Includes- Side effects , Secondary
effects , Toxic effects,
Consequences of drug
withdrawal
Includes-Hypersensitivity/allergy ,
Idiosyncrasy
14.
15. Side effects
Unwanted but often unavoidable, pharmacodynamic
effects that occur at therapeutic doses
Predicted from the pharmacological profile of a drug
Known to occur in a given percentage of drug recipients
Range
of
Pharmacodynamic
Effects
Effect 1
Effect 2
Effect 3
Desirable
Undesirable
19. Secondary effects
Indirect consequences of a primary action of the drug
Broad Spectrum
Antibiotics
Activation of latent TB
Weakens host defense
Immunosupressant
Corticosteroids
Super infections
↓Microbial flora
Antibacterial 1⁰ action
20. Toxic effects
Result of excessive pharmacological action of the drug due
to over dosage or prolonged use
Over dosage may be
1. Absolute (Accidental, homicidal, suicidal)
2. Relative (Gentamycin in Renal failure)
Result from
Extension of therapeutic effect: augmented effects
Functional alteration:
Atropine → Delirium
Drug induced tissue damage:
Paracetamol → Hepatic necrosis
21. Intolerance
Appearance of characteristic toxic effects of a drug in an
individual at therapeutic doses
Converse of tolerance
Indicates a low threshold of the individual
Triflupromazine (single dose) → Muscular
dystonias in some individuals
Carbamazepine (few doses) → Ataxia in some
individuals
Chloroquine (single tablet) → Vomiting and
abdominal pain in some individuals
23. Idiosyncrasy
Drug interacts with some unique feature of the
individual, not found in majority subjects, and produces
the uncharacteristic reaction.
Genetically determined abnormal reactivity to a
chemical
Barbiturates → Excitement and mental confusion in
some individuals
Quinine → Cramps, diarrhea, asthma, vascular
collapse in some individuals
Chloramphenicol → Aplastic anemia
in rare individuals
24. Photosensitivity
Cutaneous reaction resulting from drug induced
sensitization of the skin to UV radiation.
The reactions are of two types
Phototoxic: Drug or its metabolite accumulates in the skin,
absorbs light and undergoes a photochemical reaction
resulting in local tissue damage (sunburn-like, i.e.,
erythema, edema, blistering, hyper pigmentation)
E.g. Tetracyclines, Nalidixic acid, Fluoroquinolones etc
25. Photosensitivity
Photo allergic: Drug or its metabolite induces a cell
mediated immune response which on exposure to light
(longer wave length) produces a papular or eczematous
contact dermatitis like picture.
E.g. Sulfonamides, Sulfonylureas, Griseofulvin, Chloroquine
26. Drug dependence
Drugs capable of altering mood and feelings are liable to repetitive
use to derive euphoria, withdrawal from reality, social adjustment,
etc.
Psychological dependence: Individual believes that optimal state of
well being is achieved only through the actions of the drug
Physical dependence: Altered physiological state produced by
repeated administration of a drug which necessitates the continued
presence of the drug to maintain physiological equilibrium.
Discontinuation of the drug results in a characteristic withdrawal
(abstinence) syndrome.
27. Drug dependence
Drug abuse: Use of a drug by self medication in a manner and
amount, that deviates from the approved medical and social
patterns in a given culture at a given time. Drug abuse refers to any
use of an illicit drug.
Drug addiction: Compulsive drug use characterized by overwhelming
involvement with the use of a drug
Drug habituation: Less intensive involvement with the drug,
withdrawal produces only mild discomfort
Habituation and addiction imply different degrees of psychological
dependence.
30. Drug withdrawal reactions (end of treatment)
Sudden interruption of therapy with certain drugs result
in adverse consequences, mostly in the form of
worsening of the clinical condition for which the drug
was being used.
– Corticosteroid → Adrenal insufficiency
– β-blockers → worsening of angina, precipitation of MI
31. Drug withdrawal reactions (end of treatment)
Switch Off The
Hypothalamo Adrenal
Axis
Adrenal
insufficiency
32. Teratogenicity
Capacity of a drug to cause foetal abnormalities when
administered to the pregnant mother.
• Thalidomide → Phocomelia, multiple defects
• Anticancer drugs → Cleft palate, hydrocephalus,
multiple defects
• ACE inhibitors → Hypoplasia of organs (lungs, kidney)
33. Drug Effect
Thalidomide phocomelia and multiple defects
Anticancer drugs
cleft palate, hydrocephalus, multiple
defects and foetal death
Androgens
virilization; limb, esophageal, cardiac
defects
Progestins virilization of female foetus
Stilboestrol
vaginal carcinoma in teenage female
offspring
Tetracyclines &
Glycylcyclines
discolored and deformed teeth,
retarded bone growth
Warfarin
depressed nose; eye and hand
defects, growth retardation
34. Drug Effect
Phenytoin
hypoplastic phalanges, cleft lip/palate,
microcephaly
Phenobarbitone various malformations
Carbamazepine neural tube defects, other abnormalities
Valproate spina bifida and other neural tube defects
Alcohol
low IQ baby, growth retardation, fetal
alcohol syndrome
ACE inhibitors
hypoplasia of organs, growth retardation,
fetal loss
Lithium fetal goiter, cardiac and other abnormalities
Indomethacin/a
spirin
premature closure of ductus arteriosus
Isotretinoin craniofacial, heart and CNS defects
35. Mutagenecity and Carcinogenicity
Capacity of a drug to cause genetic defects and cancer
respectively
Chemical carcinogenesis generally takes several (10-40)
years to develop.
Anticancer drugs
Radio-isotypes
Estrogens
Tobacco
36. Drug induced diseases
Also called Iatrogenic(Physician induced) diseases
Functional disturbances caused by drugs which persist
even after the offending drug has been withdrawn and
largely eliminated
• Salicylates, Corticosteroids→ Peptic ulcer
• Phenothiazines, other antipsychotics → Parkinsonism
Isoniazid → Hepatitis
37. Drug allergy (bizarre reactions)
Immunologically mediated reaction producing
stereotype symptoms, unrelated to the
pharmacodynamic profile of the drug
Generally occur even with much smaller doses
(dose independent)
Also called Drug hypersensitivity
40. Drug allergy
Hypersensitivity Reactions
Type I Type IV
Type III
Type II
Antibody Mediated Immunity
Cell Mediated
Immunity
Fast Response
Minutes
Intermediate Response Late Response
Arthralgia
Glo nephritis
Cell Mediated
Cytotoxicity
Body Cells
Directly Attacked
By Antibodies
Allergic
Reactions
Urticaria
Anaphylxia
Hemolytic
anemia
granulocytopenia
Complex
accumulation
and destruction
Contact
dermatitis
42. Drug allergy (typeS)
Immune reaction: Type I (IgE-mediated)
Mechanism: Drug-IgE complex binding to mast cells with
release of histamine, inflammatory mediators
Clinical manifestations: Anaphylaxis, urticaria,
angioedema, bronchospasm
Time of reaction: Minutes to hours after drug exposure
43. Drug allergy (typeS)
Immune reaction: Type II (Cytotoxic)
Mechanism: Specific IgG or IgM antibodies directed at
drug-hapten coated cells
Clinical manifestations: Hemolytic Anemia, leukopenia,
Thrombocytopenia
Time of reaction: Variable
44. Drug allergy (typeS)
Immune reaction: Type III (immune complex)
Mechanism: Tissue deposition of drug-antibody complexes
with complement activation and inflammation
Clinical manifestations: Serum sickness, vasculitis,
fever, rash, arthralgia
Time of reaction: 1 to 3 weeks after drug exposure
45. Drug allergy (typeS)
Immune reaction: Type IV (delayed, cell mediated)
Mechanism: MHC presentation of drug molecules to T cells
with cytokine and inflammatory mediator release; may
also be associated with activation and recruitment of
eosinophils, monocytes, and neutrophils
Clinical manifestations: Contact sensitivity, Skin rashes,
organ-tissue damage
Time of reaction: 2 to 7 days after drug exposure
46. Drug allergy
Skin reactions
Urticaria (hives) and angioedema (swelling)
Anticonvulsants, neuromuscular blocking agents,
Antibiotics, ACE inhibitors, NSAIDs, narcotics
Fixed drug eruption: Hyper-pigmented plaques that occur
at the same site upon re-exposure to the culprit drug
Sedatives, Anticonvulsants, Chemotherapeutic Agents,
Sulfonamide And Tetracycline Antibiotics NSAIDs,
47. Drug allergy----Skin reactions
Urticaria (hives) and angioedema (swelling)
Fixed drug eruption:
48. Drug allergy
Skin reactions
• Severe forms of cutaneous drug reactions are
Stevens-Johnsonsyndrome (SJS): SJS begins with a
maculopapular rash that often progresses to bullae,
mucous membrane ulcerations, conjunctivitis, fever, sore
throat and fatigue.
Toxic epidermal necrolysis (TEN): Same symptoms of SJS +
exfoliative dermatitis (detachment of skin’s outer most
layer + scalded skin appearance.
Anticonvulsants, Phenytoin, Carbamazepine, Lamotrigine,
Barbiturates, Psychotropic Agents, Sulfonamides,
Corticosteroids, NSAIDs (oxicams)
52. Drug allergy
Multi-organ reactions
Serum sickness: an immune-complex reaction that presents
with fever, lymphadenopathy (swollen/enlarged lymph
nodes), arthralgia, and cutaneous lesions.
Heterologous antibodies, infliximab, allopurinol,
thiazides, antibiotics (e.g., cefaclor)
Drug-induced lupus erythematosus (DILE): The typical
symptoms of DILE include sudden onset of fever and
malaise; myalgia, arthralgia, and arthritis may also occur
several weeks after drug initiation.
Hydralazine, procainamide, isoniazid, quinidine,
minocycline, antibiotics, and anti–TNF-alpha agent
54. Drug allergy
Multi-organ reactions
Vasculitis : a heterogeneous group of disorders that are
characterized by inflammatory destruction of blood
vessels).
Sulfonamide antibiotics and diuretics, hydralazine,
penicillamine, propylthiouracil
Anaphylaxis : a serious systemic allergic reaction that is
rapid in onset and may cause death
Antibiotics, neuromuscular blocking agents, anesthetics,
recombinant proteins (e.g., omalizumab)
57. Name of the drug Year of withdrawl country reason
aceclofenac 1979 UK Vasculitis
Cyclobarbital 1980 Norway Risk of overdose
Dexfenfluramine 1997
European Union, UK,
US
Cardiotoxic
Gatifloxacin 2006 US
Increased risk of
dysglycemia
Ketorolac 1993
France, Germany,
others
Hemorrhage, Kidney
Failure
Lysergic acid
diethylamide (LSD)
1950s–1960s
Marketed as a
psychiatric drug;
withdrawn after it
became widely used
recreationally. Now
illegal in most of the
world.
Phenformin and Bufor
min
1977 France, Germany US Severe lactic acidosis
Rofecoxib (Vioxx) 2004 Worldwide
Withdrawn by Merck
& Co. Risk
of myocardial
infarction and stroke[2]