![Page 1: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/1.jpg)
![Page 2: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/2.jpg)
Adverse Drug Reactions
After approval of a drug, the FDA assigns the drug to one of the
following categories: prescription, nonprescription, or controlled
substance.
1- Prescription drugs :
are drugs that the federal government has designated to be potentially
harmful unless their use is supervised by a licensed health care provider,
such as a nurse practitioner, physician, or dentist.
Although these drugs have been tested for safety and therapeutic effect,
prescription drugs may cause different reactions in some individuals.
![Page 3: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/3.jpg)
2- Nonprescription Drugs :
Nonprescription drugs are drugs that are designated by the FDA to be
safe (if taken as directed) and obtained without a prescription.
These drugs are also referred to as over-the-counter (OTC) drugs and
may be purchased in a variety of settings, such as a pharmacy, drugstore,
or in the local supermarket.
OTC drugs include those given for symptoms of the common cold,
headaches, constipation, diarrhea, and upset stomach.
3- Controlled Substances :
Controlled substances are the most carefully monitored of all drugs.
![Page 4: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/4.jpg)
Drug use and pregnancy
The use of any medication prescription or nonprescription carries a risk
of causing birth defects in the developing fetus.
Drugs administered to pregnant women, particularly during the first
trimester (3 months), may cause teratogenic effects.
A teratogen is any substance that causes abnormal development of the
fetus leading to a severely deformed fetus. Drugs are one type of
teratogen.
In an effort to prevent teratogenic effects, the FDA has established five
categories suggesting the potential of a drug for causing birth defects .
In general, most drugs are contraindicated during pregnancy or lactation
unless the potential benefits of taking the drug outweigh the risks to the
fetus or the infant.
![Page 5: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/5.jpg)
During pregnancy, no woman should consider taking any drug, legal or
illegal, prescription or nonprescription, unless the drug is prescribed or
recommended by the primary health care provider.
Smoking or drinking any type of alcoholic beverage also carries risks,
such as low birth weight, premature birth, and fetal alcohol syndrome.
Children born of mothers using addictive drugs, such as cocaine or
heroin, often are born with an addiction to the drug abused by the
mother.
![Page 6: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/6.jpg)
![Page 7: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/7.jpg)
![Page 8: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/8.jpg)
![Page 9: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/9.jpg)
![Page 10: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/10.jpg)
![Page 11: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/11.jpg)
FDA categorization of drugs in pregnancy Category
Description Examples
Controlled human studies show no risk
Exemples :
Vitamins : B,C,D,E, Folic acid,
Tyroxine, Inj.mag.sulfate
A
No evidence of risk in humans
Exemples :
Metronidazole,Paracetamol,Piperazine,penicillin,erythr
omycine
B
Risk cannot be ruled out Most drugs C
Positive evidence of risk Antiepileptics D
Contraindicated in pregnancy Teratogenic drugs X
![Page 12: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/12.jpg)
Drugs prescribing during pregnancy, Diseases/Condition drugs to be
used
Cyclizine, Meclizine, Metoclopromide(safe in 3 rd trimester of
pregnancy)
Nausea and
vomiting
Methyldopa Hypertension
Diphenhydramine, Codiene, Dextromethorphan Cough
Paracetamol, Codiene, Benzodiazepines Aspirin and other
NSAID s(1 st and 2 nd trimesters)
Headache
Heparin Anti coagulants
Milk of Magnesia, DocusateSodium, Glycerin, Mineral oil,
Bisacodyl
Constipation
Sucralfate, H2 blockers, Bismuth Salicylate, Non Systemic
Antacids
Peptic ulcer
Isoniazid & Ethambutol, Rifampin Tuberculosis
Metronidazole Anti-amoebic
drugs
![Page 13: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/13.jpg)
![Page 14: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/14.jpg)
![Page 15: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/15.jpg)
Teratogenesis
Terato "monster" Genesis producing A teratogen is any infectious agent
drug, chemical or radiation that alters fetal morphology or fetal function
if the fetus is exposed during a critical stage of development.
-Examples :
cleft lip/palate, clubfoot, neural tubal defects, missing or malformed
limbs/fingers.
Also- behavorial and/ or biochemical abnormalities.
- Teratogenesis maybe :
Direct- i.e ,-malformations of structures
Or indirect-such as interfering with oxygen or nutrients.
![Page 16: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/16.jpg)
![Page 17: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/17.jpg)
![Page 18: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/18.jpg)
![Page 19: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/19.jpg)
![Page 20: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/20.jpg)
![Page 21: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/21.jpg)
![Page 22: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/22.jpg)
![Page 23: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/23.jpg)
![Page 24: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/24.jpg)
![Page 25: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/25.jpg)
![Page 26: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/26.jpg)
The effectes of some drugs in use during pregnancy
Risks of NSAID used from 30 weeks of pregnancy onwards
premature closure of the ductus arteriosus Oligohydramnios
Deficiency of amniotic fluid
NSAIDS
Fetal hydantion syndrome Craniofacial abnormalities Hypoplasia of
distal phalanges Growth deficiency Mental deficiency Cleft palate
Phenytoin
↓ absorption of folic acid Neural tube defects Valproic acid
Craniofacial defects Spina bifida. Hypoplasia of distal phalanges Carbamazepine
(Tegretol)
Increased risks of clear cell Adenocarcinoma of the vagina and cervix
and of breast cancer have been found for daughters of women who
took DES during pregnancy.
Fertility problems are also more common among these daughters.
Women who took DES during pregnancy have an increased risk of
breast cancer.
DES
(diethylstilboes
trol
![Page 27: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/27.jpg)
![Page 28: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/28.jpg)
The effectes of some drugs in use during pregnancy
It is a rare heart defect in which parts of the tricuspid valve are abnormal. Lithium salts
fetal defects Vitamin A
Hyperbilirubinemia Jaundice Kernicterus Primaquine G6PD deficiency Sulphonamides
Fetal warfarin syndrome Nasal hypoplasia Hypoplasia of the extremities
Developmental retardation Other: Central nervous system defects
Spontaneous abortion Stillbirth Prematurity Hemorrhage Ocular defects.
Warfarin
Cigarette smoking A reduction in birth weight Birth defects of heart,
brain & face Risk of sudden infant death syndrome(SIDS) Mis-located
placenta Preterm labor Miscarriages Uterine infections spontaneous
abortions.
Social Drugs
Foetal alcohol syndrome:
Risk of miscarriage
Inadequate growth before or after birth Facial defects
A small head Mental retardation Nail dystrophy
Alcohol
↓ blood flow across placenta
↓ the absorption of iron
↑ risk of anemia
↑ risk of fetal death Advice
limit coffee to 3cups/day .
Caffeine
![Page 29: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/29.jpg)
Drug Passage into Breast Milk Diffusion
The movement of the drug from a high concentration area (blood) to a low concentration area (breast milk).
Active transport : the movement of the drug from blood with a low concentration to breast milk with a high concentration.
This mechanism concentrates the drug in the breast milk.
After diffusion or active transport, drugs pass through spaces between alveolar cells into the milk .
Drug transfer into breast milk Ionization of the drug
Drugs that are not protein bound and nonionized are more likely to be transferred into breast milk.
Lower molecular weight drugs are more likely to be transferred to the breast milk than higher molecular weight drugs.
Lipid soluble drugs pass more freely into breast milk than water soluble drugs.
Weakly alkaline drugs have higher breast milk levels than weak acids.
![Page 30: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/30.jpg)
![Page 31: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/31.jpg)
![Page 32: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/32.jpg)
![Page 33: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/33.jpg)
![Page 34: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/34.jpg)
![Page 35: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/35.jpg)
![Page 36: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/36.jpg)
![Page 37: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/37.jpg)
![Page 38: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/38.jpg)
![Page 39: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/39.jpg)
Drugs to be avoided in during lactation
Neonatal hypothyroidism Amiodarone
Drowsiness Barbiturates
Lethargy Benzodiazepines
Hypothyroidism Carbimazole
Diminish milk supply, ↓ nitrogen and protein content Contraceptives
Reye’s syndrome Aspirin
Irritability Ephedrine
Tooth discoloration Tetracyclines
Gray baby syndrome Chloramphenicol
![Page 40: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/40.jpg)
Drugs which suppress /inhibit lactation
Large doses of Alcohol and Caffeine
Estradiol Oral contraceptives
Theophylline
Bromocriptine
Levodopa
![Page 41: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/41.jpg)
Drugs absolutely contraindicated in nursing mothers
Sulphonamides Phenylbutazone Anti cancer drugs
Mercurials Chloramphenicol Radiopharmaceuticals
Atropine Ergot and its derivatives
(methysergide)
Thiouracil Iodide Lithium
![Page 42: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/42.jpg)
![Page 43: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/43.jpg)
![Page 44: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/44.jpg)
Conclusion
Completely avoid alcoholic beverages in pregnancy & lactation.
Cut down or eliminate food and drinks which contain caffeine such
as coffee, tea, colas and other soft drinks, cocoa and chocolate.
Stop smoking or cut down your smoking when pregnant.
Avoid smokers and smoking areas whenever possible.
Check with your physician for his/her recommendations before
using drugs.
The responsibility of all clinicians including pharmacists to counsel
the patients with complete and current information on the risks
& benefits of using drugs during pregnancy and lactation.
![Page 45: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/45.jpg)
![Page 46: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/46.jpg)
Adverse Drug Reactions Patients may experience one or more adverse reactions (side effects)
when they are given a drug. Adverse reactions are undesirable drug effects. Adverse reactions may be common or may occur infrequently. They may be mild, severe, or life threatening. They may occur after the first dose, after several doses, or even after
many doses. An adverse reaction often is unpredictable, although some drugs are
known to cause certain adverse reactions in many patients.
For example,
drugs used in the treatment of cancer are very toxic and are known to
produce adverse reactions in many patients receiving them.
Other drugs produce adverse reactions in fewer patients.
Some adverse reaction is predictable, but many adverse drug reactions
occur without warning.
![Page 47: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/47.jpg)
Some texts use both terms side effect and adverse reactions.
These texts distinguish between the two terms by using side effects to
explain mild, common, and nontoxic reactions; adverse reaction is
used to describe more severe and life-threatening reactions.
For the purposes of this text only the term adverse reaction is used, with
the understanding that these reactions may be mild, severe, or life
threatening.
![Page 48: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/48.jpg)
![Page 49: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/49.jpg)
![Page 50: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/50.jpg)
Classification of adverse durg reactions
• Type A
• extension of pharmacologic effect
• often predictable and dose dependent
• responsible for at least two-thirds of ADRs
• e.g., propranolol and heart block, anticholinergics and dry mouth
• Type B
• idiosyncratic or immunologic reactions
• rare and unpredictable
• e.g., chloramphenicol and aplastic anemia
• Rash caused by beta lactam antibiotics
![Page 51: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/51.jpg)
Comparison between type A and type B in the Adverse drug
reactions
Type B Type A
Rare Yes Often predictable and dose
dependent
Non Yes Dose dependence
low high Incidence
low high Morbidity
high low Mortality
Stop using the
drug
Dose adjusment Therapy
![Page 52: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/52.jpg)
![Page 53: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/53.jpg)
![Page 54: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/54.jpg)
![Page 55: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/55.jpg)
Allergic Drug Reactions
An allergic reaction also is called a hypersensitivity reaction.
Allergy to a drug usually begins to occur after more than one dose of the
drug is given.
A drug allergy occurs because the individual’s immune system views the
drug as a foreign substance or antigen.
Even a mild allergic reaction produces serious effects if it goes
unnoticed and the drug is given again.
Some allergic reactions occur within minutes (even seconds) after the
drug is given; others may be delayed for hours or days.
Allergic reactions are manifested by a variety of signs and symptoms
include itching, various types of skin rashes, and hives (urticaria).
Other symptoms include difficulty breathing, wheezing, cyanosis, a
sudden loss of consciousness, and swelling of the eyes, lips, or
tongue.
![Page 56: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/56.jpg)
![Page 57: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/57.jpg)
![Page 58: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/58.jpg)
![Page 59: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/59.jpg)
Anaphylactic shock
is an extremely serious allergic drug reaction that usually
occurs shortly after the administration of a drug to which
the individual is sensitive.
This type of allergic reaction requires immediate medical
attention.
All or only some of these symptoms may be present.
Anaphylactic shock can be fatal if the symptoms are not
identified and treated immediately.
![Page 60: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/60.jpg)
![Page 61: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/61.jpg)
![Page 62: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/62.jpg)
![Page 63: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/63.jpg)
- Treatment :
is to raise the blood pressure, improve breathing, restore
cardiac function, and treat other symptoms as they occur.
• Epinephrine (adrenalin) 0.1 to 0.5 mg may be given by
subcutaneous or intramuscular injection.
• Hypotension and shock may be treated with fluids and
vasopressors.
• Bronchodilators are given to relax the smooth muscles of
the bronchial tubes.
• Antihistamines may be given to block the effects of
histamine.
![Page 64: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/64.jpg)
![Page 65: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/65.jpg)
![Page 66: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/66.jpg)
Common Causes of ADRs :
- • Antibiotics
• Antineoplastics
• Anticoagulants
• Cardiovascular drugs
• Hypoglycemics
• Antihypertensives
• NSAID/Analgesics
![Page 67: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/67.jpg)
ADR Risk Factors
• Age (children and elderly)
•Multiple medications
• Inappropriate medication prescribing, use, or
monitoring
• Altered physiology
• Prior history of ADRs
• Extent (dose) and duration of exposure
• Genetic predisposition
![Page 68: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/68.jpg)
Management Options
•Sensibilization test :
•Lewise Tripple Response
![Page 69: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/69.jpg)
![Page 70: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/70.jpg)
![Page 71: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/71.jpg)
Therapeutic Drug Monitoring
• Drug response differs between individuals.
• This variability results from two main sources:
• 1. variation in absorption, distribution, metabolism or
elimination (pharmacokinetic);
• 2. variation at or beyond tissue receptors or other macro-
molecular drug targets (pharmacodynamic).
• There must be a continuous variable that is readily
measured and is closely linked to the desired clinical
outcome.
![Page 72: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/72.jpg)
Example
• Antihypertensive drugs are monitored by their effect on
blood pressure,
• Statins by their effect on serum cholesterol.
• Oral anticoagulants by their effect on the international
normalized ratio (INR).
• Measuring drug concentrations in plasma or serum
identifies only pharmacokinetic variability, but can
sometimes usefully guide dose adjustment .
For example in treating an epileptic patient with an anti-
convulsant drug.
• Measuring drug concentrations for use in this way is often
referred to as ‘therapeutic drug monitoring’.
![Page 73: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/73.jpg)
ROLE OF DRUG MONITORING IN THERAPEUTICS
Measurement of drug concentrations is sometimes a useful complement
to clinical monitoring to assist in selecting the best drug regimen for
an individual patient.
Measurements of drug concentrations in plasma are most useful when:
1. There is a direct relationship between plasma concentration and
pharmacological or toxic effect
2. Effect cannot readily be assessed quantitatively by clinical
observation.
3. Inter-individual variability in plasma drug concentrations from the
same dose is large (e.g. phenytoin).
4. There is a low therapeutic index (e.g. if the ratio of toxic
concentration/effective concentration is 2).
5. Several drugs are being given concurrently and serious interactions are
anticipated.
![Page 74: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/74.jpg)
• oral anticoagulants by their effect on the international
normalized ratio (INR).
• Measuring drug concentrations in plasma or serum
identifies only pharmacokinetic variability, but can
sometimes usefully guide dose adjustment .
• For example in treating an epileptic patient with an
anticonvulsant drug.
• Measuring drug concentrations for use in this way is often
referred to as ‘therapeutic drug monitoring’.
![Page 75: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/75.jpg)
![Page 76: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/76.jpg)
![Page 77: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/77.jpg)
![Page 78: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/78.jpg)
![Page 79: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/79.jpg)
![Page 80: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/80.jpg)
![Page 81: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/81.jpg)
![Page 82: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/82.jpg)
![Page 83: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/83.jpg)
![Page 84: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/84.jpg)
![Page 85: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/85.jpg)
Drug-induced immune haemolytic anaemias
Drugs may cause immlme haemolytic anaemias via three mechanisms :
1- Antibody directed against a drug-red cell membrane complex (e.g.
penicillin, ampicillin);
2- Deposition of complement via a drug-protein (antigen)-antibody
complex onto the red cell surface (e.g. quinidine, rifampicin); or
3- A true autoimmune haemolytic anaemia in which the role of the drug
is lmclear (e.g. methyldopa).
In each case, the haemolytic anaemia gradually disappears when the drug
is discontinued but with methyldopa the autoantibody may persist for
several months.
The penicillin-induced immune haemolytic anaemias only occur with
massive doses of the antibiotic.
![Page 86: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/86.jpg)
Three different mechanisms of drug-induced immune haemolytic anaemia.
In each case the coated (opsonized) cells are destroyed in the reticulo endothelial
system
![Page 87: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/87.jpg)
![Page 88: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/88.jpg)
![Page 89: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/89.jpg)
![Page 90: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/90.jpg)
![Page 91: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/91.jpg)
![Page 92: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/92.jpg)
Drug - Drug Interactions :
occurs when one drug interacts with or interferes with the action of
another drug.
For example, taking an antacid with oral tetracycline causes a decrease in
the effectiveness of the tetracycline.
The antacid chemically interacts with the tetracycline and impairs its
absorption into the bloodstream, thus reducing the effectiveness of the
tetracycline.
Drugs known to cause interactions include oral anticoagulants, oral
hypoglycemics, anti-infectives, antiarrhythmics, cardiac glycosides,
and alcohol.
Drug–drug interactions can produce effects that are additive, synergistic,
or antagonistic.
![Page 93: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/93.jpg)
![Page 94: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/94.jpg)
![Page 95: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/95.jpg)
![Page 96: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/96.jpg)
![Page 97: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/97.jpg)
![Page 98: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/98.jpg)
![Page 99: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/99.jpg)
![Page 100: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/100.jpg)
A- Synergism (Additive):
1- Penicillin + Gentamycin :
2- Aminophyllin + Ephedrine :
3- Ampicillin + Clavulinic Acid (Augmentin) :
B-Synergism (Enhancing):
1- Ergotamine + Caffeine (Cafergot) :
2- Fe SO4 + VitC :
3- Adrenaline + Procaine :
![Page 101: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/101.jpg)
![Page 102: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/102.jpg)
Antagonisitic drug reaction
An antagonistic drug reaction occurs when one drug interferes with the
action of another, causing neutralization or a decrease in the effect of
one drug.
For example, protamine sulfate is a heparin antagonist.
This means that the administration of protamine sulfate completely
neutralizes the effects of heparin in the body.
The nonsteroidal anti-inflammatory drugs and salicylates are examples of
drugs that are given with food to decrease epigastric distress.
Still other drugs combine with a drug forming an insoluble food–drug
mixture.
For example, when tetracycline is administered with dairy products, a
drug food mixture is formed that is unabsorbable by the body.
When a drug is unabsorbable by the body, no pharmacologic effect
occurs.
![Page 103: Adverse Drug Reactionsjude.edu.sy/assets/uploads/lectures/AA7.pdfAdverse Drug Reactions After approval of a drug, the FDA assigns the drug to one of the following categories: prescription,](https://reader036.vdocuments.site/reader036/viewer/2022062922/5f09bbbf7e708231d428422d/html5/thumbnails/103.jpg)