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drug toxicity
Therapeutic index
Ratio of = Median lethal dose (LD50) Median effective dose (ED50)
Adverse drug reaction (ADR)
Unwanted effect due to drug administration
Classification of ADR:
I. Predictable (Dose related effects):
Side effects, toxic effects
II. Unpredictable (Non-dose related):
Idiosyncrasy, hypersensitivity
III. Others: Iatrogenic effect, photosensitivity,
Teratogenicity, dependence
Side effects:
Unwanted effects of a drug seen with therapeutic doses,
unavoidable.
e.g. Codeine for cough – constipation
Toxic effects :
Unwanted effects either due to over dosage or chronic
use of a drug.
e.g. Streptomycin – Renal damage
Idiosyncrasy :
Genetically determined abnormal reactivity to a drug.
Reaction is restricted to individual with particular
genotype.
e.g. Chloramphenicol causes aplastic anemia,
Succinylcholine apnoea
Hypersensitivity reactions (drug allergy)
An abnormal response to a drug due to Ag:Ab reaction
resulting in the release of various mediators (chemicals)
within the body.
Causes skin allergy, bronchospasm – (anaphylaxis)
Eg: Penicillin, sulphonamides
Teratogenicity :
Capacity of a drug to cause fetal abnormalities when
administered to the pregnant mother
Eg: Tetracycline – discolored and deformed teeth
o Thalidomide:
phocomelia ( seal-like limbs)
o Phenytoin :
cleft lip/ palate
Iatrogenic disease :
Physician induced disease due to drug therapy.
e.g. Aspirin causes peptic ulcer
Photosensitivity reactions :
Drug induced skin reaction after exposure to UV
radiation
e.g. sulfonamides, tetracycline
Drug dependence : A state in which use of drug leads to a
compulsion to take the drug for personal satisfaction
• Psychological dependence
• Physical dependence: presence of drug is necessary to
maintain normal function
• Abrupt stoppage of drug – withdrawal syndrome
• eg: Morphine, alcohol