8) Adverse drug effects

Definition
Adverse effect is any undesirable or unintended consequence of drug administration.
Types of adverse reactions.
Predictable (type A) reactions:
These are based on pharmacological properties of the drug, viz.augmented but
qualitatively normal response to the drug; include side effects, toxic effects and
consequences of drug withdrawal. They are more common, dose related and mostly
preventable.
Predictable (type B) reactions:
These are based on peculiarities of the patient and not on drugs known actions; include
allergy and idiosyncrasy. They are less common, often non-dose related, generally more
serious and require withdrawal of the drug.
Prevention of adverse effects to drugs
1.) avoid all inappropriate use of drugs in the context of patientss clinical condition.
2.) Use appropriate dose, route and frequency of drug administration based on
patients specific variables.
3.) Elicit and take into consideration previous history of drug reactions.
4.) Elicit history of allergic diseases and exercise caution (drug allergy is more
common in patients with allergic diseases).
5.) Rule out possibility of drugs interactions when more than one drug is prescribed .
6.) Adopt correct drug administration technique (e.g. intravenous inection of
aminophylline must be slow).
7.) Carry out appropriate laboratory monitoring (e.g. prothrombin time with warfarin,
serum drug levels with lithium).
Poisoning
Poisoning may result from large doses of drugs because it is the dose which distinguishes
a drug from poison. Poison is a substance which endangers life by severely affecting one
or more vital functions.
Termination of exposure by removing the patient to fresh air (for inhaled poisoning),
washing the skin and eyes (for poisons entering form the surface ), induction of emesis
with syrup ipecac or gastric lavage (for ingested poisons).
To prevent absorption of ingested poisons a suspension of 20-40g of activated charcoal
in 200ml water may be administered. Universal antidote consisting of burned toast,
strong tea and milk of magnesia in a ratio 2:1:1 has been used, but tannic acid (from tea)
may itself get absorbed on charcoal and reduced its binding capacity.
Maintenance of patent airway and adequate ventilation by artificial respiration, if
needed.
Maintenance of blood pressure and heart beat by fluid infusion, pressor agents, cardiac
stimulants etc. as the need may be.
Hastening elimination of poison by inducing diuresis (furosemide, mannitol) altering
urinary pH (alkalinization for acidic drugs, e.g. barbiturates, acidification for basic drugs,
e.g. amphetamine).

Idiosyncrasy
It is genetically determined abnormal reactivity to a chemical. Certain adverse effects of
some drugs are largely restricted to individuals with a particular genotype. In addition,
certain uncharacteristic or bizarre drug effects due to peculiarities of an individual (for
which no definite genotype has been described ) are included among idiosyncrasy
reactions, e.g.

barbiturates cause excitement and mental confusion in some individuals.

Quinine / quinidine cause cramps, diarrhea, purpura, asthma and vascular collapse
in some patients.