Good shorts notes of pharmacology, Cheat Sheet of Pharmacology

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ADVERSE DRUG REACTIONS

Nehal V. Trambadiya Asst. professor Department of Pharmacology Smt. N. M. Padalia Pharmacy College

ADVERSE DRUG REACTION

Any noxious change which is  (^) Suspected to be due to a drug 

At doses normally used in man

 May requires treatment or decrease in dose or  Caution in the future use of the same drug

 (^) Incidence of ADR more  (^) Polypharmacy  (^) Elderly  (^) Children  (^) Patient with multiple diseases  (^) Pregnancy  (^) Malnourished  (^) Immunosuppression  (^) Drug Abusers and addicts  Develop  (^) Immediately or

• (^) Prolonged medication or
• (^) After stopping.

GRADING OF SEVERITY OF ADVERSE DRUG REACTIONS :  Minor : No therapy, antidote or prolongation of hospitalization is required.  Moderate : Requires change in drug therapy, specific treatment or prolongs hospital stay.  (^) Severe : Potentially life-threatening, causes permanent damage or requires intensive medical treatment.  (^) Lethal : Directly or indirectly contributes to death of the patient.

TYPE A- AUGMENTED

 These are based on the pharmacological properties of the drug so can be predicted.  (^) They are common and account for 75% of ADRs  Dose related and preventable mostly reversible. Examples:-  (^) Anticoagulants (e.g., warfarin, heparin) – bleeding  (^) Anti-hypertensives (e.g.. α1-antagonists) – hypotension  (^) Anti-diabetics (e.g. insulin) - hypoglycemia Predictable

TYPE B- BIZZARE OR UNPREDICTABLE

 (^) Have no direct relationship to the dose of the drug or the pharmacological mechanism of drug action.  (^) Develop on the basis of: 

Immunological reaction on a drug ( Allergy )



Genetic predisposition ( Idiosyncratic reactions )

 (^) More serious clinical outcomes with higher mortality and morbidity.  (^) Mostly require immediate withdrawal of the drug. Un-predictable

TYPE D – DELAYED  They manifest themselves with significant delay  (^) Teratogenesis - Thalidomide – Phocomelia (flipper-like fore limbs)  (^) Mutagenesis/Cancerogenesis Predictable

TYPE E – END OF USE 

Drug withdrawal syndromes and rebound

phenomenons

Example – sudden withdrawal of long term therapy with  -

blockers can induce rebound tachycardia and

hypertension

Predictable

Various activities involved in pharmacovigilance are :  (^) Postmarketing surveillance and other methods of ADR monitoring such as voluntary reporting by doctors prescription event monitoring.  (^) Dissemination of ADR data through 'drug alerts', 'medical letters,' advisories sent to doctors by pharmaceuticals and regulatory agencies.  (^) Changes in the labelling of medicines indicating restrictions in use or statuary warnings, precautions, or even withdrawal of the drug.

 The Uppsala Monitoring Centre (Sweden) is the international collaborating centre.  (^) In India,  (^) National centre is located at Ghaziabad  (^) Peripheral Centres at Medical college levels and tertiary and above hospitals  (^) Reports generated by doctors, paramedical staff--to peripheral centre...National centre...Uppsala Monitoring Centre...Compilation of data..analysis of data..causal association is confirmed..guidelines issued regarding the safe use of medicine or (restricted use or withdrawal from the market)

Categorized into :  (^) Side effects-  (^) Secondary effects  Toxic effects  Intolerance  (^) Idiosyncrasy  (^) Drug allergy  Photosensitivity  Drug dependence  Drug withdrawal reactions  (^) Teratogenicity  (^) Mutagenicity and Carcinogenicity  Drug induced diseases (Iatrogenic disorders or Iatrogenicity) Beware of – Iatrogenic, Idiosyncrasy, Idiopathic, Intolerance

SIDE EFFECTS

 Unwanted often unavoidable Pharmaco-dynamic effects.  Occur at therapeutic doses.  Predictable Examples. Benzodiazepines- Motor in coordination H1 Anti-histaminics- Sedation An effect may be therapeutic in one context but side effect in another context  (^) Depression of A-V conduction is the desired effect of digoxin in atrial fibrillation, but the same may be undesirable when it is used for CHF. Constipation by codeine is side effect but can be used as therapeutic effect in patient with loose motions

TOXIC EFFECTS (Poisonous effect) It is the dose and duration which makes a poison....  Over dose or prolonged use.  The effects are predictable and dose related.  (^) The CNS, CVS, kidney, liver, lung, skin and bone marrow are most commonly involved in drug toxicity.

 (^) Toxicity may result from extension of the therapeutic effect itself, e.g. complete A-V block by digoxin, bleeding due to heparin.  Poisoning : Poison is a substance which endangers life by severely affecting one or more vital functions.