Chapter 4.3: Side Effects vs Adverse Effects - Recognizing Severe Rxns

what is the difference between a side effect and severe adverse events?

• a pt can have nausea after taking levofloxacin but a tendon rupture is a severe adverse effect

• kidney failure caused by gentamicin is an ADE

why is anaphylaxis a medical emergency?

• immune system releases a chemical that constricts the airways and lowers BP → shock

• symptoms: swelling of lips, tongue, or face (angioedema), wheezing or difficulty breathing, and sudden rash/hives

• most common culprits: penicillin, sulfa drugs, and specific formulas containing peanuts or soy in propofol

• immediate treatment is epipen; temp bridge to survival → call 911 immediately after use

why is Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) a medical emergency?

• begins with flu-like symptoms → painful purple/red rash that blisters → top layer of skin dies and sheds → body burn that leaves patients vulnerable to massive infection

• commonly assoc with: lamotrigine (Lamictal), allopurinol (Zyloprim), and sulfonamides

  • pts starting Lamictal must slowly increase in dosage

why is Rhabdomyolysis a medical emergency?

• muscle tissue breaks down rapidly → myoglobin enter blood stream

  • kidneys are unable to filter myoglobin → blockage → acute kidney failure

• symptoms: severe, unexplained muscle pain, weakness, and dark (tea-colored) urine

• significant risk of statin class of cholesterol medicine (ex: simvastatin, atorvastatin); risk increases if dose is high or patient combines statin with gemfibrozil or grapefruit juice (inhibit body’s ability to clear drug)

why is angioedema a medical emergency?

• rapid swelling of deep layers of skin, most dangerously around eyes, lips, and throat → block airways

• reaction is associated with ACE inhibitors, BP medicine ending in “-pril”4

• unpredictable timing; angioedema can occur after 1st dose or after pt has been taking it for years

  • be aware of any lip/tongue swelling in pt

what is ototoxicity?

• ear damage

• physiology of ear is linked to physiology of kidney

• drug-induced damage to inner ear → temporary/permanent hearing loss and balance issues

  • hallmark warning is Tinnitus

• loop diuretics (specifically furosemide) causes this, particularly if administration is too fast via injection

• vancomycin (antibiotic) and aminoglycoside class carries significant risks of hearing damage if blood levels become too high

what is gingival hyperplasia (gum overgrowth)?

• rare but distinct side effect where gums can completely grow over teeth

• side effect of anticonvulsant phenytoin (dilantin), immunosuppresant cyclosporine, and certain calcium channel blockers (nifedipine)

what drugs have a photosensitivity/sunburn risk?

• tetracyclines (esp doxycycline)

• sulfa antibiotics

• fluoroquinolones (levaquin)

• accutane (isotretinoin)

what are