1. Chemical & Drug Injuries

2. Chemical & drug injuries
***All chemicals & drugs are capable of causing injury or
death.***
accidental exposure
self-administration
accidental overdose
non-medical use of street drugs
unanticipated result of self-administered or prescribed use
of standard medicines.
exaggeration of an intended pharmacologic effect or an
accompanying side effect

3. Adverse drug reactions (ADRs)
 any response to a drug that is noxious & unintended,
occurring at doses used in humans for prophylaxis,
diagnosis, or therapy, excluding failure to accomplish the
intended purpose; [mechanisms: direct toxicity to cells;
immunologic/idiosyncratic reactions; or due to
↓immunologic / hormonal host defenses]
Predictable ADRs: known side-effects; dose-related, severity
depends on route of administration
Unpredictable ADRs: unanticipated, usually immunologic,
idiosyncratic; dose & route of administration do not affect the
severity

4. Therapeutic agents
ANALGESICS
 Aspirin
 Aspirin + Phenacetin
 NSAIDS (non-steroidal anti-inflammatory drugs):
Ibuprofen, Diclofenac,
 Acetaminophen/Paracetamol
ANTIMICROBIALS
ANTI-NEOPLASTIC AGENTS
 Anti-metabolites
 Immunosuppressives

5. Therapeutic agents: aspirin
Therapeutic dose: 0.5-1.0 gm./day
Lethal dose: 2-4 gm./day in children
10-30 gm./day in adults
Acute toxicity: initial alkalosis--- fluid & electrolyte
imbalance--- metabolic acidosis--- death
Chronic toxicity: (3 gm/day): dizziness, nausea, vomiting,
diarrhea, drowsiness, hallucinations, convulsions, coma
Known effects: analgesic; anti-platelet aggregation; gastric
irritant--- acute erosive gastritis
Unpredictable ADRs: hypersensitivity: rashes, urticaria,
exfoliative dermatoses

6. Therapeutic agents: analgesics
Aspirin + Phenacetin
 Toxicity: nephropathy : renal papillary necrosis
NSAIDS:
 known side effect: gastric irritation;
 UADR: hypersensitivity
Acetaminophen:
 therapeutic dose: 0.5 gm q 4 hrs.(up to 3gm/day)
 toxic dose: 15-25 gm;
 toxicity: nausea, vomiting, diarrhea; shock; hepatic
injury
 pathology: hepatic necrosis; renal/myocardial
damage

7. Therapeutic agents: anti-neoplastics
Anti-metabolites
 Bone marrow suppression
 GI mucosal injury
 Hair follicle injury
 Immunosuppression
 Nonlethal mutations
 Initiation of some form of Cancer
Immunosuppressives
 ↑ susceptibility to infections, esp. opportunistic
 ↑ risk of malignant lymphoma

8. Therapeutic agents:
antimicrobials/antibiotics
Hypersensitivity
 rashes, urticaria, exfoliative dermatoses
 anaphylaxis
Emergence of microbial resistance
 “super-infections”
Eradication of normal flora
 vitamin K deficiency--- bleeding diathesis

9. Adverse drug reactions
 BLOOD (DYSCRACIAS)
 Granulocytopenia
 Aplastic anemia
 Pancytopenia
 Hemolytic anemia
 thrombocytopenia
 CNS
 Tinnitus, dizziness
 Acute dystonic reactions
 Parkinson’s syndrome
 CUTANEOUS
 Urticaria
 Petechia
 Exfoliative dermatitis
 BLOOD DYSCRACIAS
 Anti-neoplastics
 Immunosuppressants
 Chloramphenicol
 Quinidine
 Methyldopa
 CNS
 Salicylates
 Phenothiazine
antipsychotics
 Sedatives
 CUTANEOUS
 Sulfonamides
 Hydantoin
 Anti-neoplastics

10. Adverse drug reactions
 CARDIAC
 Arrhythmias
 Cardiomyopathy
 HEPATIC
 Fatty change
 Cholestasis
 Hepatocellular
damage
 PULMONARY
 Acute Pneumonitis
 Interstitial fibrosis
 Asthma
 CARDIAC
 Theophylline
 Hydantoin
 Doxorubicin, Daunorubicin
 HEPATIC
 Tetracycline
 Chlorpromazine, Estrogens
 Halothane,
Acetaminophen, INH
 PULMONARY
 Salicylates
 Nitrofurantoin
 Busulfan, Bleomycin

11. Adverse drug reactions
RENAL
 Glomerulonephritis
 Tubulointerstitial
nephritis
 Acute tubular nephritis
SYSTEMIC
 Anaphylaxis
 Lupus erythematosus
syndrome
RENAL
 Penicillamine
 Phenacetin
 Salicylates
 Aminoglycosides,
Cyclosporine,
Amphotericin B
SYSTEMIC
 Penicillin, Aspirin
 Hydralazine,
Procainamide

12. Fatal drug reactions
Tricyclic anti-depressants
 Alprazolam
 Ipramine, Desipramine
 Nortriptyline
Acetaminophen
Halothane
Aspirin
CNS depression
Hepatic necrosis
Hepatic necrosis
Metabolic acidosis; Fluid &
Electrolyte imbalance

13. Thank you !