pharm adverse drug reactions

allergic reaction

• immune response

• determined by degree of sensitization of immune system, not drug dosage

• pt’s sensitivity to drug can change over time

idiosyncratic effect

uncommon drug response resulting from genetic predisposition

iatrogenic disease

disease produced by physician, or disease produced by drugs (ex. drugs for antipsychotic disorders can cause parkinson’s symptoms)

physical dependence

body has adapted to drug exposure in such a way that abstinence syndrome will result if drug is discontinued

carcinogenic effect

drugs used to treat cancer have the most potential for this

teratogenic effect

drug-induced birth defect

organ-specific toxicity - kidney

amphotericin b - antifungal

organ-specific toxicity - heart

doxorubicin - anticancer

organ-specific toxicity - lungs

amiodarone - antidysrhythmic

organ-specific toxicity - inner ear

aminoglycoside - antibiotic

hepatotoxic drug

some drugs converted to toxic products that can injure liver cells when they undergo metabolism

individual variation in drug responses caused by:

1. body weight and composition

2. body surface are vs weight

3. age

4. significant variability with age (esp children and old people)

individual variation in drug responses

• pathophysiology

• kidney disease - reduced excretion and increased toxicity

• liver disease - reduced metabolism and increased toxicity

• acid-base imbalance - ph changes that alter adme

three categories of drug tolerance

1. pharmacodynamic tolerance

2. metabolic tolerance

3. tachyphylaxis

pharmacodynamic tolerance

long-term administration of drugs like morphine or heroin

metabolic tolerance

accelerated drug metabolism

tachyphylaxis

reduction in drug responsiveness brought on by repeated dosing over a short time

bioavailability

ability of drug to reach systemic circulation from its site of administration, normally with oral stuff

pharmacogenomics

study of how genes affect individual drug responses (like altered drug metabolism - faster or slower)

genetic variations

• altered drug targets - genetic variations alter structure of drug receptors

• some responses based on factors other than changes in drug metabolism or targets

• gender

  • alcohol metabolized more slowly by women than men

  • certain opiods more effective in women

  • quinidine casues greater qt interval stuff in women

• other genetic variations

• diet

• starvation - reduced protein binding