Chapter 3 - Toxic Effects of Drugs

Adverse Effects
undesired effects that my be unpleasant or even dangerous
Reasons for adverse drug reactions to occur
1) the drug may have other effect on the body besides the therapeutic effect
2) the patient is sensitive to the drug being given
3) the drug's action on the body causes other responses
4) the patient is taking too much or too little of the drug
Types of Adverse Reactions
1) primary actions - Overdose; extension of the desired effect
2) secondary actions - undesired effects produced in addition to the pharmacologic effect
3) hypersensitivity reactions - excessive response to primary or secondary effect of drug
Types of Drug Allergies
1) anaphylactic reaction
2) cytotoxic reaction
3) serum sickness reaction
4) delayed allergic reaction
anaphylactic reaction
rash, hives, SOB, respiratory arrest
cytotoxic reaction
cell killer, decreased hematocrit, decreased RBC or platelets, decreased WBC
serum sickness reaction
swollen painful joints, swelling in face and extremities
delayed allergic reactions
poison ivy
(the body may react to a medication even if it has been taken many times)
Dermatological Reactions
-assessment - abnormalities in the skin, red area, blisters
-interventions - may need to discontinue the medication
*Stomatitis - assessment - inflammation of the mucous membranes
-interventions - frequent mouth care
Drug-Induced Tissue and Organ Damage
SUPERINFECTIONS - destruction of the body's normal flora
*Assessment - fever, diarrhea, vaginal discharge
*Interventions - supportive care (mouth and skin care), administer antifungal medications, may need to stop drug responsible for the infection
BLOOD DYSCRASIA - bone marrow suppression (worst reaction you can have, you can die)(no white cells)
*Assessment - fever, chills, weakness
*Interventions - monitor blood counts, protective isolation
Assessment - fever, nausea, jaundice, change in color of urine or stool, elevated liver enzymes
Interventions - discontinue medication
Assessment - change in urinary pattern, elevated BUN and creatinine
Intervention - notify physician, may need to stop medication or decrease the dosage
occurs when an overdose of a drug damages multiple body systems, damage to multiple systems can lead to a fatal reaction
Altered Glucose Metabolism
*Assessment Finding - low serum blood glucose level
*Intervention - restore glucose to the body
*Assessment Finding - high serum glucose level
*Intervention - administer medications to decrease glucose level (insulin)
Electrolyte Imbalance
*Assessment Finding - decrease in serum potassium levels
*Interventions - replace serum potassium (IV or supplement) and monitor serum levels of potassium
*Assessment Finding - increase in serum potassium level
*Interventions - decrease the serum potassium concentration, monitor serum levels of potassium, and monitor cardiac rhythm
Sensory Effects
Ocular Toxicity:
*Assessment Findings - visual changes
*Interventions - monitor for any visual changes when giving any medication that is known to cause ocular damage; discontinue medication after notifying physician
Auditory Damage:
*Assessment Findings - damage to the 8th cranial nerve
*Interventions - monitor for hearing loss; discontinue medication after notifying physician if a decrease in hearing is noted on assessment.
Neurological Effects
General Central Nervous System Effects
*Assessment Findings - altered level of consciousness
*Interventions - prevent injury
Atropine-like (Anticholinergic) Effects
*Assessment Findings - dry mouth, urinary retention, blurred vision
*Interventions - sugarless lozenges to keep mouth moist; have the patient void before administration of the medication
*Assessment Findings - muscle tremors and changes in gait
*Interventions - discontinue medication
*Assessment Findings - extrapyramidal symptoms
*Interventions - discontinue medication
any drug that causes harm to the developing fetus or embryo