Toxic Effects of Drugs

A. Adverse Effects

- undesired effects that may be unpleasant or even dangerous

1. Primary Actions

- simple overdose: most common occurrences in drug therapy where patient suffers from
effects that are merely an extension of the desired effect

2. Secondary Actions

- sometimes it is impossible for a drug dose to achieve the desired effect without producing
adverse effects

3. Hypersensitivity

- patients are excessively responsive to either primary or the secondary effects of drugs which
may result from underlying condition

B. Drug Allergy

- the body forms antibodies to a particular drug causing an immune response when person is re-
exposed to the drug
C. Drug Induced Tissue and Organ Damage

Type Assessment Intervention

Dermatologic Reactions: adverse reactions on the skin
1. Rashes, Hive Exfoliative dermatitis: rash and MILD
- Meprobamate scaling, fever, enlarged lymph nodes - skin care
(treat anxiety): enlarged liver - instruct patient to avoid rubbing,
Stevens-Johnson Syndrome: fatal wearging tight clothes or use
erythema multiforme exudativum harsh soaps or perfumed lotions
characterized by dark papules appearing - administer antihistamines as
on the extremities often in ring-shaped appropriate
patches SEVERE
- Discontinue and notify
prescriber
- topical corticosteroids, and
emollients
2. Stomatitis - swollen gums - frequent mouth care, monitoring
- inflammation of - gingivitis: inflamed gums solution
the mucuos - glossitis: swollen and red tongue - nutrition evaluation (frequent
memberane because - difficulty breathing small meals)
of a direct toxic - bad breath - dental consultation
reaction to the drug - pain in the mouth and throat - antifungal and/or local
or because drug anesthetics are sometimes used
deposits in the end
capillaries
- Antineoplastic
Drugs: commonly
cause stomatitis
because they are
toxic to rapidly
turning over cells
Superinfections
- destroyed normal - fever, diarrhoea, black or hairy tongue, - frequent mouth care, skin care,
flora or infections inflamed and swllon tongue, muscuos access to bathroom facilities,
caused by organisms membrane lesions and vaginal discharge small and frequent meals
that are usually - administer antifungal therapy
controlled by - discontinue if severe
normal flora
Blood Dyscracia
- bone marrow - fever, chills, sore throat, weakness, - Monitor blood counts. Provide
suppression back pain, dark urine, decreased supportive measures (rest,
- drugs that can - hematocrit (anemia), low platelet protection from exposure to
cause cell death count (thrombocytopenia), low white infections, protection from injury,
(antineoplastic, blood cell count (leukopenia), and a avoidance of activities that might
antibiotic) are used reduction of all cellular elements of the result in injury or bleeding).
complete blood count (pancytopenia) - In severe cases, discontinue the
drug
Toxicity
1. Liver Injury - fever, malaise, nausea, vomiting, Discontinue the drug and notify
- Most drugs are jaundice, change in color of urine or the prescriber and/or primary
metabolized in the stools, abdominal pain or colic caregiver. Offer supportive
liver, so any - elevated liver enzymes (e.g., aspartate measures such as small, frequent
metabolites that are aminotransferase, alanine meals, skin care, a cool
irritating or toxic aminotransferase), alterations in environment, and rest periods.
will also affect liver bilirubin levels, and –
integrity. - changes in clotting factors (e.g., partial
thromboplastin time)
2. Renal Injury Elevated blood urea nitrogen, elevated - Notify the prescriber and/or
- Some drug creatinine concentration, decreased primary caregiver and discontinue
molecules are just hematocrit, electrolyte imbalances, the drug as needed.
the right size to get fatigue, malaise, edema, irritability, and - Offer supportive measures—for
plugged into the skin rash may be seen. example, positioning, diet and
capillary network, fluid restrictions, skin care,
causing acute electrolyte therapy, rest periods,
inflammation and and a controlled environment.
severe renal - In severe cases, be aware that
problems dialysis may be required for
- Some drugs are survival.
excreted from the
kidney unchanged;
they have the
potential to directly
irritate the renal
tubule and alter
normal absorption
and secretion
processes.
- Gentamicin:
potent antibiotic
frequently
associated with
renal toxcitiy
Poisoning
- overdose of a drug
damages multiple
body systems,
leading to the
potential for fatal
reactions
Alterations in Glucose Metabolism
1. Hypoglycemia fatigue; drowsiness; hunger; anxiety; - Restore glucose—orally, if
- low serum blood headache; cold, clammy skin; shaking possible, or intravenously
glucose and lack of coordination - Provide supportive measures
concentration (tremulousness); increased heart rate; (e.g., skin care, environmental
- Glipizide increased blood pressure; numbness and control of light and temperature,
(Glucotrol) and tingling of the mouth, tongue, and/or rest).
glyburide lips; confusion; and rapid and shallow - Institute safety measures to
(DiaBeta) are respirations. In severe cases, seizures prevent injury or falls. Monitor
antidiabetic agents and/or coma may occur.` blood glucose level
that lower blood
glucose too far
2. Hyperglycemia Fatigue, increased urination (polyuria), - Administer insulin therapy to
- breakdown of increased thirst (polydipsia), deep decrease blood glucose as
glycogen or alter respirations (Kussmaul respirations), appropriate, while carefully
metabolism in such restlessness, increased hunger monitoring glucose levels
a way as to cause (polyphagia), nausea, hot or flushed - Provide support to help the
high serum glucose skin, and fruity odor to breath may be patient deal with signs and
levels observed symptoms
- Ephedrine - provide mouth care— the
(generic) can break patient will experience dry mouth
down stored and bad breath with the ensuing
glycogen and cause acidosis
an elevation of
blood glucose by its
effects on the
sympathetic nervous
system
Electrolye Imbalances
1. Hypokalema - serum potassium concentration lower - Replace serum potassium and
- low serum than 3.5 mEq/L carefully monitor serum levels
potassium levels - weakness, numbness and tingling in and patient response;
the extremities, muscle cramps, nausea, - Provide supportive therapy
vomiting, diarrhea, decreased bowel - Cardiac monitoring may be
sounds, irregular pulse, weak pulse, needed to evaluate the effect of
orthostatic hypotension, and the fluctuating potassium levels
disorientation. on heart rhythm.
- In severe cases, paralytic ileus (absent
bowel sounds, abdominal distention, and
acute abdomen) may occur.
2. Hyperkalemia - a serum potassium level higher than - Monitor for cardiac
- potassium 5.0 mEq/L, irregularities because potassium
retention and a - weakness, muscle cramps, diarrhea, is an important electrolyte in the
resultant increase in numbness and tingling, slow heart rate, action potential, which is needed
serum potassium low blood pressure, decreased urine for cell membrane stability.
levels output, and difficulty breathing. - potassium levels are too high
the cells of the heart become very
irritable and rhythm disturbances
can occu
Sensory Effects
1. Occular Damage Blurring of vision, color vision changes, - Monitor the patient’s vision
- blood vessels in corneal damage, and blindness may be carefully when
the retina noted. the patient is receiving known
are very tiny and are oculotoxic drugs.
called “end - Monitor lighting and exposure
arteries,” that is, to sunlight
they stop and do not
interconnect with
other arteries
feeding the same
cells. Some drugs
are deposited into
these tiny arteries,
causing
inflammation and
tissue damage
2. Auditory Damage - Dizziness, ringing in the ears Monitor the patient’s perceptual
Tiny vessels and (tinnitus), loss of balance, and loss of losses or changes. Provide
nerves in the eighth hearing may be assessed protective measures to prevent
cranial nerve are falling or injury. Consult with the
easily irritated and prescriber to decrease dose or
damaged by certain discontinue the drug. Provide
drugs. - macrolide supportive measures to cope with
antibiotics, drug effects.
streptomycin in
particular, can cause
severe auditory
nerve damage.
- Aspirin, one of the
most commonly
used drugs, is often
linked to auditory
ringing and eighth
cranial nerve effect
Neurologic Effects
1. General Central - confusion, delirium, insomnia, - Provide safety measures to
Nervous - some drowsiness, hyperreflexia or prevent injury. Caution the
drugs do affect hyporeflexia, bizarre dreams, patient to avoid dangerous
neurological hallucinations, numbness, tingling, and situations such as driving a car or
functioning, either paresthesias operating dangerous machinery.
directly or by
altering electrolyte
or glucose levels.
- Beta-blockers,
which are used to
treat hypertension,
angina, and many
other conditions, can
cause feelings of
anxiety, insomnia,
and nightmares.
2. Atropine-Like - Dry mouth, altered taste perception, Provide sugarless lozenges and
(Anticholinergic) dysphagia, heartburn, constipation, mouth care to help mouth
Effects bloating, paralytic ileus, urinary dryness.
block the effects of hesitancy and retention, impotence, Arrange for bowel program as
the parasympathetic blurred vision, cycloplegia, appropriate.
nervous system by photophobia, headache, mental Have the patient void before
directly or indirectly confusion, nasal congestion, taking the drug, to aid voiding.
blocking cholinergic palpitations, tachycardia, decreased Provide safety measures if vision
receptors sweating, and dry skin may be noted. changes occur.
- Atropine, cold Arrange for medication for
remedies and headache and nasal congestion as
antihistamines: appropriate.
cause Advise the patient to avoid hot
anticholinergic environments and to take
effects. protective measures to prevent
falling and to prevent
dehydration, which may be
caused by exposure to heat owing
to decreased sweating.

3. Parkinson-like Lack of activity, akinesia, muscular - Discontinue the drug, if

Syndrome Drugs tremors, drooling, changes in gait, necessary. Know that treatment
that directly or rigidity, extreme restlessness or “jitters” with anticholinergics or
indirectly affect (akathisia), or spasms (dyskinesia) antiparkinson drugs may be
dopamine levels in may be observed. recommended
the brain
4. Neuroleptic Neurological symptoms, including Discontinue the drug, if
Malignant slowed reflexes, rigidity, involuntary necessary. Know that treatment
Syndrome movements; hyperthermia; and with anticholinergics or
- General autonomic disturbances, such as antiparkinson drugs may be
anesthetics and hypertension, fast heart rate, and fever, required. Provide supportive care
other drugs that may be noted. to lower the body temperature.
have direct CNS Institute safety precautions as
effects can cause needed.
neuroleptic
malignant syndrome
(NMS), a
generalized
syndrome that
includes high fever
Teratogenicity
drugs that reach the
developing fetus or
embryo can cause
death or congenital
defects, which can
include skeletal and
limb abnormalities,
CNS alterations,
heart defects, and
the lik