Chapter 3:

Toxic Effects of Drugs

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Adverse Drug Reaction
 Undesired effects that may be unpleasant or even dangerous
 Reasons Adverse Drug Reactions Occur
o The drug may have other effects on the body besides the
therapeutic effect.
o The patient is sensitive to the drug being given.
o The drug’s action on the body causes other responses that are
undesired or unpleasant.
o The patient is taking too much or too little of the drug.

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Types of Adverse Reactions
 Primary Actions
o Overdose; extension of the desired effect
 Secondary Actions
o Undesired effects produced in addition to the pharmacologic
effect
 Hypersensitivity Reactions
o Excessive response to primary or secondary effect of drug

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Types of Drug Allergies #1
 Anaphylactic Reaction
 Cytotoxic Reaction
 Serum Sickness Reaction
 Delayed Allergic Reaction

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Types of Drug Allergies #2

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Drug-Induced Tissue and Organ Damage
#1

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Dermatological Reactions
 Rash/Hives
o Assessment
 Abnormalities in the skin, red area, blisters
o Interventions
 May need to discontinue the medication in severe cases
 Stomatitis
o Assessment
 Inflammation of the mucous membranes
o Interventions
 Frequent mouth care

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Drug-Induced Tissue and Organ Damage
#2

Superinfections — Destruction of the body’s normal

flora
– Assessment
Fever, diarrhea, vaginal discharge
– Interventions
Supportive care (mouth and skin care), administer
antifungal medications as needed, may also need
to stop drug responsible for the superinfection
Blood Dyscrasia — Bone marrow suppression
– Assessment
Fever, chills, weakness
– InterventionsCopyright © 2017 Wolters Kluwer • All Rights Reserved
Toxicity
Affecting the body in a very noxious or toxic way
 Liver- Assessment
 Fever, nausea, jaundice, change in color of urine or stool,
elevated liver enzymes
o Interventions
 Discontinue medication
 Kidney- Assessment
 Change in urinary pattern, elevated BUN and creatinine
o Intervention
 Notify physician, may need to stop medication or decrease the
dosage

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Poisoning
 Poisoning occurs when an overdose of a drug damages multiple body
systems.
 Damage to multiple systems can lead to a fatal reaction.
 Treatment varies accordingly with drug

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Altered Glucose Metabolism
 Hypoglycemia
o Assessment Finding: Low serum blood glucose level
o Intervention: Restore glucose to the body
 Hyperglycemia
o Assessment Finding: High serum glucose level
o Intervention: Administer medications to decrease glucose level

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Electrolyte Imbalance
 Hypokalemia
o Assessment Finding: Decrease in serum potassium levels
o Interventions: Replace serum potassium (IV or oral supplement)
and monitor serum levels of potassium
 Hyperkalemia
o Assessment Finding: Increase in serum potassium level
o Interventions: Decrease the serum potassium concentration
(Sodium Polystyrene Sulfonate), monitor serum levels of
potassium, and monitor cardiac rhythm

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Sensory Effects
 Ocular Toxicity
o Assessment Findings: Visual changes
o Interventions: Monitor for any visual changes when giving any
medication that is known to cause ocular damage; discontinue
medication as appropriate.
 Auditory Damage
o Assessment Findings: Dizziness, ringing in the ears (tinnitus),
loss of balance, and loss of hearing
o Interventions: Monitor for hearing loss; discontinue medication
as appropriate if a decrease in hearing is noted on assessment.

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Neurological Effects #1
 General Central Nervous System (CNS) Effects
o Assessment Findings: Altered level of consciousness
o Interventions: Prevent injury
 Atropine-like (Anticholinergic) Effects
o Assessment Findings: Dry mouth, urinary retention, blurred
vision
o Interventions: Sugarless lozenges to keep mouth moist; have
the patient void before administration of the medication

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Neurological Effects #2
 Parkinson-like Syndrome
o Assessment Findings: Muscle tremors and changes in gait
o Interventions: Discontinue medication as appropriate
 Neuroleptic Malignant Syndrome
o Assessment Findings: Extrapyramidal symptoms
o Interventions: Discontinue medication as appropriate

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Teratogenicity
 Teratogenicity: Any drug that causes harm to the developing fetus or
embryo
 Teaching to prevent teratogenicity
o Advise the pregnant woman that any medication may have
possible effects on the baby.
o Weigh the actual benefits against the potential risks.
o Discuss with pregnant women that they should not take
medications without checking with their health care provider
first.

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Question #1
Is the statement below true or false, explain?
Poisoning occurs when too much of a drug causes damage to multiple
systems of the body.

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Answer to Question #1
True

Rationale: Poisoning occurs when an overdose of a drug damages

multiple body systems. Damage to multiple systems can lead to a
fatal reaction.

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