1.

Adverse event AE  Minoxidil- hypertrichosis

Any event caused by medical tx not

necessarily due to drug error
2. Type B bizarre
2. Adverse drug event o Unrelated to pcol action
o Patient susceptibility is
Any AE associated with use of drug in humans
influenced by genetic and
3. adverse drug rxn environmental factors
o Idiosyncratic rxns
Any response to a drug thag is noxious &  Sulfonamides - SJS
unintended w/c occurs at normal doses (stevens johnson synd)
 Vancomycin red man
4. side effect
syndrome
Unintended effect occurring at normal dose ev  Halothane hepatic
is related to pharmacological properties of the necrosis (kids)
drug  Anesthetic drugs-
malignant hyperthermia
tx:halothane
Type of adr Hypersensitive rxn
1. Type A augmented o Type 1 name anaphylactic allergy
Rationalizable from drug pcol action Antibodies ige
Dose delendent predictable Example penicillin cepha

Iron dextran
À) toxicity - exaggerated effects Xray contrast media
 Oha hypoglycemic o Type 2 cytotoxic
 Antihpn hypotension
 Bblockers-bradycardia low hr Igg igm
 Sedatives- daytime somnolence
Methyldopa-hemolytic anemia (coombs
test)

Chloramphenicol- aplastic anemia

B) side effect- undesired effect but related to idiopathic thrombocytopenic Purpura
moa
o Type 3
 Narcotics and opiods- constipation
 Loop diuretics hypokalemia Immune complex rxn
 Antineoplastics- alopecia Igg
 Antidepressants- loss of libido
 Nsaid -gastric irritation Drug induced SLE (HIPS) hydralazoone isoniazid
 Acei- dry cough inhibit bradykinin procainamide sulfonamide [n acetyl transferase
 Statins- rhabdomyolysis muscle wasting it metabolizes hips] nat2
Fast Asian List of teratogens

Slow Caucasian,africans, americans o Isotretinoin- heart and brain

abnormalities (vitamin a)
DewIgm infant developed
o Phenytoin - fetal hydantion SYNDROMe
Igg Placental transfer o (Cryptorvhidism, cleft palate,
polydactyl)
Iga Secretion o Valproic acid- neural tube effectsSPINA
Igd Mature b cells BIFIDA
o Ace I and ARBS- renal dysgenesjs
Igg most abundant underdeveloped kidneys
o Oligohydramnios absence of.amniotic
Igm first infection
fluid
Ige parasitic infection o Lithium- ebstein anomaly tricuspid valve
o Methimazole- aplasia cutis antithyroid
IG (MADGE)
(lesions on the scalp)
o Type 4 delayed o Warfarin- fetal warfarin syndrome
o T cells (hemorrhage, cns)
o Contact dermatitis uroshiol o Antineoplastics- embryocidal
poison ivy o Alcohol-microcephaly, most teratogenic
commonly used substance in man, fetal
alcohol syndrome
o Thalidomide- phocomelia
3. Type C long term effect of cumulative dose
( underdeveloped limbs) antileprosy
Ethambutol- optic neuritis (red green blindness) once used as a antimorning sickness
children lower than 6yrs old drug
Steroids - cushings (moon face, buffalo humps) 5. Type E (remedy is taper the dose)
Anthracyclines -cardiotoxicity (doxurubicin) -result from termination or sudden drug
irreversible heart failure discontinuation
Phenothiazine- tardive dyskinesia Ex: narcotics and opioids- withdrawal s/sx
Narcotics, nicotine, caffeine- dependent Clonidine,bblocker- rebound hpn*********
addiction
Steroids - adrenal insufficiency (Addison's
disease)
4. Type D - Delayed onset

A. Carcinogenic 6. Type F
°diethylstilbestrol- vaginal o Antimicrobial use
adenocarcinomas o Inappropriate use
o Inappropriate route of admin
B. Teratogenic - birth defect
o Underdosing
 o Drug interxns °eutexia: lower melting point when contact
o Counterfeit with other compartment (liquefy @rt)
o Manuf-errors/ toxic excipient
o Patient compliance Ex: phenol, menthol, thymol, asa
o Expired drugs Lidocaine + prilocaine

o Hygroscopic: absorbs mositure doesn't

Incompatibilities dissolve
o Deliquescent: absorbs moisture dissolve
°Physicochemical incompatabilities or o Efflorescence:releases water of
pharmaceutical incompatabilities- crystallization copper sulfate
physical,chemical

°Therapeutic incompatibilities or drug

3. Polymorphism
interaction
Exists as several crystalline
°drug herbal
structures(polymorphs)
°drug lab
o cubic polymorph nacl
°drug food o Monoclinic sucrose
o Tetragonal - urea
°drug drug : pharmacodynamics and
o Hexagonal - iodoform
pharmacokinetics o Rhombic- iodine
o Triclinic -boric acid

A. Physical incompatibilities

- same drug is present but physical state is 4. Sorption (drug->tubing)

altered
a) adsorption -adhere to surface
1. Insolubility - manifestation thru precipitation
B) absorption- penetrate into capillary spaces
A. Dehydration/ salting out
BDZ- NITRATE,INSULIN+PVC TUBING
°acacia mucilage (mucilage is gum dispersed
5. VOLATILIZATION/ VAPORIZATION
in water) + ethanol/nacl = ppt of acacia
HIGH VP ->gas formation
B. Temp change - endothermic (high temp) KI,
BORIC ACID. DECREASED SOLUBILITY Ex: volatile oils, ntg

Exothermic- exothermic (low temp)

INCREASED SOLUBILITY. CALCIUM

HYDROXIDE SOLUTION (LIME WATER)
6. Water loss

A. Ointments-crumbling
2. Liquefaction/ melting
B. Emulsion- cracking, phase inversion

C. Gels- syneresis (imbibition-opposite)

B. Chemical incompatibilities 3. Antihtn+ licorice (raises bp)--> cancel out

1. Redox 4. Sedative + valerian --> additive sedation

o °fats- rancid 5. Ma huang or ephedra (ephedrine alkaloid)

o °volatile oil- resins + caffeine/maoi] +-> increases bp
o °sh cmpds -Sulfide oxidized disulfide
o °ephinephrine pinkish solution when B. Drug-laboratory
oxidizned 1. rif+ urinalysis
o °vitamin c- yellow.to brown
2. Vit c (reducing oxide) + glucose test
2. Hydrolysis (fehlings and Benedicts test) copper sulfate
o Ester (local anethetic) reduced to oxide = false positive result
o Amide (b lactams) 3 allopurinol + blood cholesterol test
o Glycoside =false.positive result
3. Photo chemical degradation C. Drug-food
A.photooxidation 1. Quinolones/ tetracycline + ca² rich diet/
B. Photolysis antacid

Ex. Nifedipine, na nitroprusside, riboflavin 2. Warfain + green leafy veggies --> cancel out

°riboflavin 3. Metronidazole+ alcohol -> disulfiram like

effects inhibits aldehyde dehydrogenase
Precaution
4. MaoI + tyramine rich food --> hypertensive
4.optical isomerism crisis
o Thalidomide r isomer and s isomer (s is 5. Spirinolactone + k rich food --> hyperkalemia
teratogenic)
o Ibuprofen active form of s isomer 6. Griseofulvin/ itraconazole (take with faty
o Naproxen food) 1 hr before meal

5.gelatinization acacia + salts 7. Bisphosphanates + food/beverages -->

decrease drug ba
6. Cementation: acacia + bismuth salts
8. Digoxin+ oatmeal/fiber lowers absorbtion

C. Therapeutic incompatabilities

9. Erythromycin
A. drug-herbal
A. Ethylsuccinate - anytime
1.warfarin + garlic/ginger
B. Stearate - before meals
-> additive anticogulant
D. Drug-drug
2. Oha + ginseng(saponin glycoside) ->
hypoglycemia 1.Pharmacodynaimc- change in drug effect
 A. Addition 1+1=2 1. Alteration of gastric ph

Bdz+ antihista = sedation °ketaconazole + antacid --> low ba

Bblockers + non dhpccbs = heart block ° bisacodyl + antacid --> low ba (premature
dissolve)
Antidepressants + azithromycin = prolonged qt
interval 2. Complexation And absorption

Prazosi +bblcoker = Orthostatic htn °cholestyramine+/colestipol + any drugs-->

adsorption
B.synergism 1+1=3
° penicillamine + food/bev
Tmp - smz = static static = cidal
3. Alteration of motility
Tmp : trimethirprimdihydrofolate reductase
Laxative-- high motility
Smz : sulfamethoxazole dihydropteroate
synthase -> folate SYNTHESIS Low ba of drugs

Fansidar: pyrimethamine + sulfadoxime Anticholinergic low gi motility

C. Antagonism 1+1=0 High ba or.contsct.time

Naloxone + opiate Digoxin + metocolpramide = low digoxon

absoption
Estrogen + Tamoxifen (serm)
4. alteration of gi flora
Levodopa + antipsychotics
Anticoagulant + antibiotic --> enchance
Heparin + protamine so4
coagulation
( Acidic) (Basic)
Digoxin and antibiotic enhance
D. Potentiation 1+0=2

°co amoxiclav
B. Distribution- plasma protein
° unasyn amp plus sulbactam
o Basic drug - AAG ALPHA 1 ACID
°piptaz GLYCOPROTEINS-
o ACIDIC DRUG ALBUMIN
E. Electrolyte concentration o VA DISPLACES PHENYTOIN
o Digoxin + diuretic --> low K o ASA DISPLACES WARFSRIN
o Acei + k sparinf diuretics --> high k o PHENYLBUTAZONE DISPLACES
o Li+ diuretic --> lithium toxicity WARFARIN-
o o SULFONAMIDE DISPLACES
TOLBUTAMIDE
2. Pharmacokinetics- change in drug
concentration

Àdme C .Metabolism

A. Absorption o Enzyme inducer

Phenobarbital, phenytoin, primidone Nsaid+ mtx= high mtx

Rifampin, Rifampicin

Cbz , chronic oh, char broiled food Medication errors-

St John's wort, smoking any preventive event that may lead to

inappropriate med use or cause harm to the px
Omeprazole
Type of administration error
Griseofulvin
o Wrong time
o Enzyme inhibitor
o Wrong df
Metronidazole o Admin of discontinued med
o Improper dose error
Erythromycin (macrolides except azithromycin) o Overdose
o underdose
Disulfiram ,diltiazem, diphenhydramine

Valproic, verapamil
o Caterogory A
Inh, indinavir

Chloramphenicol cimetidine ciprofloxacin L

Ketoconazole A

Grapefruit juice L

Acute alcoholism A

D. Excretion N

Low ph. High ph G

Weak acid. Absorbed. Excreted o Category b

butinalang
o Category c
chos nakarating sa px pero walang
Weak base . Excreted. Absorbed
harm

o Category d
1. Alteration in urinary ph needs monitoring
o Category e
°asa toxicity nacho3 eto na. Temporary px harm
o Category f
°amphetamine toxicity - nh4cl or.vit ç
frolonged hospitalization
o Catgegory g
grabi na permanent px harm
2. Alteration of active transport o Category h
Penicillin+ probenecid = high pen hinalo near death
 o Category i o Dependence- type c
ililibing

Asop

Automatic stop order policy

5. Omission error- skipped dose

Exclusions

A. Patients refusal

B.recognized cis

C. Patient is for procedure surgery (asop)

6. Unauthorized drug error

°wrong drug

°dose given to the wrong.patient

°unordered drugs

°doses given outside STG

7. WRONG DRUG PREPARATION ERROR

INCORRECT DILUTION OR RECNSTITUTION

° MIXING DRUGS that are physically or

chemically incompatable

8. Wrong admin technique error

o Wrong route
o Wrong site
o Wrong rate
9. Deteriorated Drug error
-expired or unstable drugs

o Constipation with morphine type a side

effect
o Diarrhea with bisacodyl- type a toxicity
o Urticaria with nsaid- type b
o Teratogenic- type d
o Caffeine withdrawal- type e