SlideShare ist ein Scribd-Unternehmen logo
1 von 49
Downloaden Sie, um offline zu lesen
A 
• ADVERSE 
D • DRUG 
R • REACTIONS
ADVERSE DRUG REACTIONS 
WHO DEFINITION 
Any noxious, unintended & undesired effect of a drug 
which occurs at a dose used in humans 
for prophylactic, diagnostic or therapeutic 
purposes 
FDA Definition 
 an adverse event occurring in the course of the use 
of drug in professional practice 
 an adverse event from drug overdose whether 
accidental or intentional 
 an adverse event occurring from drug abuse 
 an adverse event from drug withdrawal 
 any significant failure of expected pharmacological 
action.
Classification 
• Type A (predictable) 
 extension of pharmacologic effect 
 often predictable and dose dependent 
 responsible for at least two-thirds of ADRs 
 e.g. anticholinergics and dry mouth 
• Type B (unpredictable) 
 idiosyncratic or immunologic reactions 
 rare and unpredictable 
 e.g., chloramphenicol and aplastic anemia 
 Penicillin induced anaphylactic shock
Predictable 
Pharmacologic side effect Dry mouth from antihistaminics 
Secondary pharmacologic side effect Thrush while taking antibiotics 
Drug toxicity Hepatotoxicity from diclofenac 
Drug-drug interactions Seizure from theophylline while taking 
erythromycin (increased thephylline 
level) 
Drug overdose Seizure from excessive lidocaine 
(Xylocaine)
Unpredictable 
Pseudoallergic Anaphylactoid reaction after ASPIRIN 
Idiosyncratic Hemolytic anemia in a patient with 
G6PD deficiency after ciprofloxacin 
therapy 
Intolerance Tinnitus after a single, small dose of 
aspirin
• Type C 
 associated with long-term use 
 involves dose accumulation 
 e.g., NSAID induced nephropathy 
• Type D 
 delayed effects (dose independent) 
 Carcinogenicity 
 Teratogenicity
 Type E: End-of-use 
◦ Withdrawal 
◦ Related to discontinuation which is too abrupt 
◦ Examples: 
 Addisonian crisis after steroid withdrawal 
 Angina pectoris after stopping -blockers
CLASSIFICATION OF ADRs 
~According to SEVERITY~ 
 Mild 
Does not affect patient’s day-to-day activity 
 Moderate 
Affects patient’s day-to-day activity to some 
extent 
 Severe 
Adversely affects patient’s health may 
lead to death
ADVERSE DRUG EFFECTS 
1. Side Effects 
 Unwanted but unavoidable 
pharmacodynamic effects 
occuring at therapeutic doses. 
 Side effect may be based on same 
action as therapeutic effect. 
 Eg. Atropine and dry mouth 
 Codeine and constipation
2. SECONDARY EFFECTS 
 Indirect consequences of a primary action 
of the drug. 
a.Super infection due to tetracyclines. 
b.Latent tuberculosis activated by 
corticosteroids.
3. Idiosyncratic reactions 
 Gentically determined abnormal reactivity to a 
chemical. 
 Chloramphenicol – aplastic anemia 
4. INTOLERANCE 
 Failure to tolerate even a single dose of the drug 
 Appearance of characteristic toxic effects of a drug 
in an individual at therapeutic doses. 
 Aspirin - gastric bleeding
5ee1 adverse drug reaction
Poisons and Poisoning 
 chemical 
substance that 
endangers life by 
affecting one or 
more vital functions 
of the body.
Accidental? 
Suicidal Homicidal
Deliberate?
hypersenstivity:
Immunological 
Type I reaction (IgE-mediated) 
Anaphylaxis from 
β-lactam antibiotic 
Type II reaction (cytotoxic) Hemolytic anemia from 
penicillin 
Type III reaction (immune complex) SLE, RHEUMATOID 
ARTHRITIS 
Type IV reaction (delayed, cell-mediated) Contact dermatitis from 
topical antihistamine
Immune reaction Mechanism Clinical 
manifestation 
Timing of 
reactions 
Type I (IgE-mediated) Drug-IgE complex 
binding to mast cells 
with release of 
histamine, 
inflammatory 
mediators 
Urticaria, angioedema, 
bronchospasm, 
pruritus, vomiting, 
diarrhea, anaphylaxis 
Minutes to hours after 
drug exposure 
Type II (cytotoxic) Specific IgG or IgM 
antibodies directed at 
drug-hapten coated 
cells 
Hemolytic anemia, 
neutropenia, 
thrombocytopenia 
Variable 
Type III (immune 
complex) 
Tissue deposition of 
drug-antibody 
complexes with 
complement activation 
and inflammation 
Serum sickness, 
fever, rash, 
arthralgias, 
lymphadenopathy, 
urticaria, 
glomerulonephritis, 
vasculitis 
1 to 3 weeks after 
drug exposure 
Type IV (delayed, 
cell-mediated) 
MHC presentation of 
drug molecules to T 
cells with cytokine and 
inflammatory mediator 
release 
Allergic contact 
dermatitis, 
2 to 7 days after 
cutaneous drug 
exposure
Drug abuse 
 It is the use of a drug for a 
nontherapeutic effect. 
 Some of the most commonly abused drugs 
are alcohol; nicotine; marijuana; 
amphetamines; barbiturates; 
cocaine;opium alkaloids; synthetic opioids; 
benzodiazepines, phencyclidine; ketamine; 
and anabolic steroids. 
 Drug abuse may lead to organ damage, 
addiction, and disturbed patterns of 
behavior. 
 Use of these drugs often incurs criminal 
penalty in addition to the potential for 
physical, social, and psychologic harm
Drug dependence 
 Drug dependence is the body's 
physical need, or addiction, to a 
specific agent. 
 It is a state in which use of 
drugs for personal satisfaction 
often in the face of known risk 
to health. 
Types: 
 Psychological dependence 
 Physical dependence.
Psychological dependence 
develops when the individuals 
believe that optimal state of 
well being is achieved through 
the action of the drug. 
 It results in compulsive drug 
use in some individuals. 
 Intensity of dependence vary 
from desire to craving.
Physical dependence 
 it is manifested by a withdrawal 
(abstinence) syndrome, in which 
untoward physical effects occur when the 
drug is stopped or when its effect is 
counteracted by a specific antagonist. 
 Drugs that cause strong physical 
dependence include heroin, alcohol, 
benzodiazepines, and cocaine. 
Reinforcement : 
Ability of the drug to produce effects that make the 
user wish to take it again. 
Ex., opiods,cocaine,LSD,benzodiazepines.
Drug addiction Drug habituation 
 Drug addiction is a state of periodic 
or chronic intoxication produced by 
the repeated consumption of a drug 
(natural or synthetic). 
Its characteristics include: 
1) An overpowering desire or need 
(compulsion) to continue taking the 
drug and to obtain it by any means; 
2) A tendency to increase the dose; 
3) A psychic (psychological) and 
generally a physical dependence 
on the effects of the drug; 
 Drug habituation (habit) is a 
condition resulting from the 
repeated consumption of a 
drug. 
Its characteristics include: 
1) A desire (but not a 
compulsion)to continue taking 
the drug for the sense 
of improved wellbeing which it 
engenders: 
2) Little or no tendency to increase 
the dose; 
3) Some degree of psychic 
dependence on the effect of the 
drug,but absence of physical 
dependence and hence of an 
abstinence syndrome;
Addiction habituation
Teratogenicity 
 Definition : 
 Ability of a drug to 
cause fetal 
abnormalities when 
administered to a 
pregnant women.
PHOTOSENSITIVITY 
 Cutaneous reaction resulting from drug induced 
sensitisation of the skin to UV radiation 
 Phototoxic 
◦ Photochemical 
◦ Erythema, edema, hyperpigmentation, desquamation 
◦ Fluroquinolones, sulfonamides, tetracyclines, 
ibuprofen, naproxen 
 Photoallergic 
◦ Cell mediated immune reaction 
◦ Papule or contact dermatitis 
◦ Sulfonamides, ketoprofen, and celecoxib, grasofulvin
Sun burn
Hyperpigmentation Desquamation
Contact Dermatitis
 Any adverse condition in a 
patient occurring as the result 
of treatment by a physician, 
surgeon, or other health 
professional, especially 
infections acquired by the patient 
during the course of treatment. 
 drug induced / physician 
induced disease. 
 Ex.,hepatitis by isoniazid 
 Peptic ulcer by salicylates and 
corticosteroid. 
Iatrogenic disease
 "The term carcinogen denotes a chemical 
substance or a mixture of chemical substances 
which induce cancer or increase its incidence“ 
 Mutagen is An agent, such as a chemical, 
ultraviolet light, or a radioactive element, that can 
induce or increase the frequency of mutation in 
an organism. 
Carcinogenicity & 
mutagenicity.
Effects of Medication on Oral 
Tissues 
 Most but not all drugs have effect on the 
health of oral . 
 One of the most common and the earliest 
known adverse/side effect involved the use of 
tetracycline. 
 The administration of tetracycline to pregnant 
women resulted in tooth staining/discoloration 
in their children. It resulted in yellow brown 
stains on the teeth of these children. 
 Most common oral effects of medications 
include dry mouth, a common condition that 
may lead to decay of teeth, opportunistic 
infections like candidiasis and/or difficulty in 
speaking and swallowing. .
 Contact stomatitis 
 It is a localized reaction of the oral 
mucosa usually after repeated contact 
with the causative agent. 
 It may result in erythema or ulcerative 
lesions with or without burning sensation. 
 The reaction may occur as early as one 
day after the drug usage 
 Antibiotics, iodine, mouthwashes, 
toothpastes, certain cosmetics, etc 
have the potential to cause contact 
somatitis.
5ee1 adverse drug reaction
aphthous ulcers 
 aphthous ulcers or more commonly 
known as the canker sores. These are 
tiny, painful lesions which occur either 
singly or in groups on the labial or buccal 
mucosa. 
 These usually heal without scar 
formation within 14 days. 
 Various drugs including NSAIDs, 
captopril, losarton and penicillamine 
can cause aphthous ulcers.
 Dry mouth 
 Certain drugs such as sedatives, 
anticholinergics, omeprazole, anti 
cancer drugs, antidepressants etc 
cause dry mouth as these affect the 
function of the saliva glands reducing the 
saliva. 
 Some of the common problems 
associated with it are burning sensation, 
constant sore throat, speech problems, 
difficulty in swallowing and hoarseness. 
 Drugs that cause xerostomia most 
commonly are benzodiazepines, 
morphine, calcium channel blockers, 
etc
Teeth discoloration 
 Tooth discoloration may be intrinsic or 
extrinsic. 
 Intrinsic stains are usually caused by 
drugs which are taken during and affect 
the tooth development, more so during 
the stages of enamel and dentin 
formation. Such drugs, for example, 
tetracycline gets accumulated in the 
dentin and enamel of the developing 
tooth and appears as yellow or brown 
stains on the tooth. 
 Extrinsic stains are the ones which are 
taken up by the tooth after development. 
These include tea and coffee stains and 
stains caused by some drugs such as 
chlorhexidine, tobacco
Oral pigmentation 
 Pigmentation may occur either due to 
systemic absorption or local use of drugs 
in the oral cavity. 
 Pigmentation has been reported in cases 
taking mercury, arsenic, gold, cupper, 
zinc etc, especially around the gingival 
margins around the teeth. 
 These are more prominent in the 
presence of plaque and inflammation. 
 These may be temporary or permanent 
but usually most of the pigmentation 
disappears with the discontinuation of 
the drug.
 Burning mouth syndrome 
This syndrome may occur due to hormonal 
withdrawal, iron or vitamin deficiencies, 
psychogenic factors or hypersensitivity 
reactions to various dental materials or 
drugs. 
 Glossitis 
Glossitis or inflammation of the tongue is 
characterized by intense pain and swelling 
that may be referred to the ear. It usually 
results in difficulty in speaking, swallowing 
along with systemic signs such fever and 
enlarged lymph nodes. Glossitis though not a 
common side effect is usually associated with 
penicillin, bleomycin, lansoprazole, etc.
5ee1 adverse drug reaction
 Oral Ulceration 
 More commonly referred to as burns of 
the oral mucosa. Aspirin, cocaine, 
hydrogen peroxide, phenytoin, 
penicillin, etc can cause either local 
irritation or ulceration in the oral cavity. 
 Ptyalism 
 Some drugs alter the function of salivary 
glands by increasing the rate of 
formation of saliva, commonly known as 
ptyalism. The saliva is thin and watery 
without its usual buffering properties 
leading to decay of hard and soft tissues 
of the oral cavity. Example: pilocarpine
 Drug induced Gingival hyperplasia 
 It is the painless overgrowth of the gingival 
tissues, usually the interdentally papilla is 
more affected, later extending to other areas 
of the gingival. 
 The common drugs causing the drug induced 
gingival enlargement are cyclosporine, 
phenytoin, calcium channel blockers like 
nidefine and oral contraceptives. 
 Reducing the dose of the offending drug 
along with the maintenance of good oral 
hygiene usually suffices the treatment for 
gingival hyperplasia. In severe cases 
complete stoppage and/or changing to an 
alternative drug is required to treat the case.
5ee1 adverse drug reaction
 Taste disturbance 
 this may include alteration in taste by reducing 
the sensitivity in taste perception, or a total loss 
of taste or a disturbance in correct identification 
of taste. 
 Drugs that are capable of affecting/altering the 
taste sensation are aspirin, cetrizine, various 
antibiotics like penicillamine, ofloxacin, 
metronidazole, etc. 
 Halitosis 
 Halitosis or bad breadth can result from poor oral 
hygiene, ingestion of certain drugs, use of 
tobacco products, oral or dental infections, and 
some systemic disorders. Sublingual nitrate 
and disulfiram have the potential to cause 
halitosis.
 Oral candidiasis 
 At times the systemic drug therapy alters the 
oral micro flora predisposing the mouth to 
various bacterial and fungal infections. Also 
the drugs that reduce/suppress the immunity 
of the individual make the individual 
susceptible to opportunistic infections such 
as candidiasis. Such drugs include 
corticosteroids, antimicrobials, 
immunosuppressive agents, anticancer 
drugs, 
 Abnormal bleeding 
 Abnormal bleeding is caused by drugs such 
as aspirin, NSAIDs, anticoagulants and 
steroids which thin the blood, used in 
conditions of stroke, myocardial infarctions 
and arrhythmias
5ee1 adverse drug reaction
 Alveolar osteitis or, a dry socket, is a 
complication of wound healing following extraction 
of a tooth. It is known as "dry socket" as after the 
clot is lost, the socket has dry appearance 
because of exposed bone. The blood clot helps in 
stopping the bleeding and lays framework for new 
tissues to develop there but in case of dry socket, 
the clot is dislodged and the bone is exposed. This 
bare bone is exposed to bacteria in the saliva and 
the food which the patient consumes and the bone 
becomes infected and painful. The uses of oral 
contraceptives have also been associated with 
significant increase in the frequency 
of dry socket.
Aphthous ulcer treatment 
 Treatment is symptomatic and 
includes oral pain relievers, mouth 
rinses, topical creams with or without 
steroids, diphenhydramine, and 
tetracycline suspension mixed with 
nystatin and diphenhydramine. 
 Aphthasol is a new topical drug which 
decreases the duration of healing and 
ulcer pain.
5ee1 adverse drug reaction

Weitere ähnliche Inhalte

Was ist angesagt?

Factors affecting bioavailability.
Factors affecting bioavailability.Factors affecting bioavailability.
Factors affecting bioavailability.Dr. Salman H. Rizvi
 
Adverse drug reaction monitoring and reporting
Adverse drug reaction monitoring and reportingAdverse drug reaction monitoring and reporting
Adverse drug reaction monitoring and reportingTHUSHARA MOHAN
 
pharmacokinetic drug interactions
 pharmacokinetic drug interactions pharmacokinetic drug interactions
pharmacokinetic drug interactionsSyed Imran
 
Adverse Drug Reaction
Adverse Drug ReactionAdverse Drug Reaction
Adverse Drug Reactionsunayanamali
 
Factors affecting drug absorption
Factors affecting drug absorptionFactors affecting drug absorption
Factors affecting drug absorptionSURYAKANTVERMA2
 
Adverse drug reactions
Adverse drug reactionsAdverse drug reactions
Adverse drug reactionsAravinda Kumar
 
Bioavailability and Factors Affecting Bioavailability of drug
Bioavailability and Factors Affecting Bioavailability of drug Bioavailability and Factors Affecting Bioavailability of drug
Bioavailability and Factors Affecting Bioavailability of drug Ashutosh Gupta
 
Community Pharmacy
Community PharmacyCommunity Pharmacy
Community PharmacyKiran Sharma
 
Drugs Interactions.ppt
Drugs Interactions.pptDrugs Interactions.ppt
Drugs Interactions.pptFarazaJaved
 
Adverse drug reactions and drug interactions
Adverse drug reactions and drug interactionsAdverse drug reactions and drug interactions
Adverse drug reactions and drug interactionsPARUL UNIVERSITY
 
Adr reporting ppt
Adr reporting pptAdr reporting ppt
Adr reporting pptRimaSingh14
 
Drug idiosyncrasy and pharmacogenetics
Drug idiosyncrasy and pharmacogeneticsDrug idiosyncrasy and pharmacogenetics
Drug idiosyncrasy and pharmacogeneticsNusaibaTohfa
 

Was ist angesagt? (20)

Drug distribution
Drug distributionDrug distribution
Drug distribution
 
Drug interactions
Drug interactionsDrug interactions
Drug interactions
 
Adverse Drug Reactions
Adverse Drug ReactionsAdverse Drug Reactions
Adverse Drug Reactions
 
Factors affecting bioavailability.
Factors affecting bioavailability.Factors affecting bioavailability.
Factors affecting bioavailability.
 
Adverse drug reaction monitoring and reporting
Adverse drug reaction monitoring and reportingAdverse drug reaction monitoring and reporting
Adverse drug reaction monitoring and reporting
 
Bioavailability ppt
Bioavailability pptBioavailability ppt
Bioavailability ppt
 
pharmacokinetic drug interactions
 pharmacokinetic drug interactions pharmacokinetic drug interactions
pharmacokinetic drug interactions
 
Pharmacokinetics
PharmacokineticsPharmacokinetics
Pharmacokinetics
 
Adverse Drug Reaction
Adverse Drug ReactionAdverse Drug Reaction
Adverse Drug Reaction
 
Factors affecting drug absorption
Factors affecting drug absorptionFactors affecting drug absorption
Factors affecting drug absorption
 
ADR AND ITS MONITORING
ADR  AND  ITS MONITORING ADR  AND  ITS MONITORING
ADR AND ITS MONITORING
 
Adverse drug reactions
Adverse drug reactionsAdverse drug reactions
Adverse drug reactions
 
Adverse drug reactions
Adverse drug reactionsAdverse drug reactions
Adverse drug reactions
 
Bioavailability and Factors Affecting Bioavailability of drug
Bioavailability and Factors Affecting Bioavailability of drug Bioavailability and Factors Affecting Bioavailability of drug
Bioavailability and Factors Affecting Bioavailability of drug
 
Community Pharmacy
Community PharmacyCommunity Pharmacy
Community Pharmacy
 
Drugs Interactions.ppt
Drugs Interactions.pptDrugs Interactions.ppt
Drugs Interactions.ppt
 
Bioavailability
BioavailabilityBioavailability
Bioavailability
 
Adverse drug reactions and drug interactions
Adverse drug reactions and drug interactionsAdverse drug reactions and drug interactions
Adverse drug reactions and drug interactions
 
Adr reporting ppt
Adr reporting pptAdr reporting ppt
Adr reporting ppt
 
Drug idiosyncrasy and pharmacogenetics
Drug idiosyncrasy and pharmacogeneticsDrug idiosyncrasy and pharmacogenetics
Drug idiosyncrasy and pharmacogenetics
 

Andere mochten auch

Drugs complications
Drugs complicationsDrugs complications
Drugs complicationsIAU Dent
 
Drug detoxication, Tolerance, Intolerance, Combined effects, Dosage, Classifi...
Drug detoxication, Tolerance, Intolerance, Combined effects, Dosage, Classifi...Drug detoxication, Tolerance, Intolerance, Combined effects, Dosage, Classifi...
Drug detoxication, Tolerance, Intolerance, Combined effects, Dosage, Classifi...Deepthi P Ramachandran
 
Drug Utilization review
Drug Utilization review Drug Utilization review
Drug Utilization review Pooja Panjwani
 
Adverse drug reactions
Adverse drug  reactionsAdverse drug  reactions
Adverse drug reactionssuniu
 

Andere mochten auch (6)

Drugs complications
Drugs complicationsDrugs complications
Drugs complications
 
Drug detoxication, Tolerance, Intolerance, Combined effects, Dosage, Classifi...
Drug detoxication, Tolerance, Intolerance, Combined effects, Dosage, Classifi...Drug detoxication, Tolerance, Intolerance, Combined effects, Dosage, Classifi...
Drug detoxication, Tolerance, Intolerance, Combined effects, Dosage, Classifi...
 
Adverse drug reactions
Adverse drug reactionsAdverse drug reactions
Adverse drug reactions
 
Drug Utilization review
Drug Utilization review Drug Utilization review
Drug Utilization review
 
Adverse drug reactions
Adverse drug  reactionsAdverse drug  reactions
Adverse drug reactions
 
Adverse drug reactions ppt
Adverse drug reactions pptAdverse drug reactions ppt
Adverse drug reactions ppt
 

Ähnlich wie 5ee1 adverse drug reaction

Adverse Reactions.ppt
Adverse Reactions.pptAdverse Reactions.ppt
Adverse Reactions.pptKeyaArere
 
Adverse Drug Reactions
Adverse Drug ReactionsAdverse Drug Reactions
Adverse Drug ReactionsNAKUL DHORE
 
Adverse effect of drug
Adverse effect of drugAdverse effect of drug
Adverse effect of drugIram Anwar
 
adr ppt (2).ppt
adr ppt (2).pptadr ppt (2).ppt
adr ppt (2).pptsumiaru
 
Adverse drug reactions
Adverse drug reactions Adverse drug reactions
Adverse drug reactions Faiza Waseem
 
Carcinogenesis
Carcinogenesis Carcinogenesis
Carcinogenesis WHO
 
adverse drug reaction.ppt
adverse drug reaction.pptadverse drug reaction.ppt
adverse drug reaction.pptmadan sigdel
 
Adverse Drug Reaction - Pharmacology
Adverse Drug Reaction - PharmacologyAdverse Drug Reaction - Pharmacology
Adverse Drug Reaction - PharmacologyAdarshPatel73
 
Adverse Drug Reactions (ADR)- Ravinandan A P
Adverse Drug Reactions (ADR)- Ravinandan  A PAdverse Drug Reactions (ADR)- Ravinandan  A P
Adverse Drug Reactions (ADR)- Ravinandan A PRavinandan A P
 
Adverse drug reaction ,pharmacy practice
Adverse drug reaction ,pharmacy practiceAdverse drug reaction ,pharmacy practice
Adverse drug reaction ,pharmacy practiceDeepali69
 
ADR.ppt pharmacilogy ppt of adverse drug reaction
ADR.ppt pharmacilogy ppt of adverse drug reactionADR.ppt pharmacilogy ppt of adverse drug reaction
ADR.ppt pharmacilogy ppt of adverse drug reactionSuma Lakavath
 

Ähnlich wie 5ee1 adverse drug reaction (20)

Adverse Reactions.ppt
Adverse Reactions.pptAdverse Reactions.ppt
Adverse Reactions.ppt
 
Adverse Drug Reactions
Adverse Drug ReactionsAdverse Drug Reactions
Adverse Drug Reactions
 
ADR
ADR ADR
ADR
 
Adverse effect of drug
Adverse effect of drugAdverse effect of drug
Adverse effect of drug
 
Adverse Reactions.ppt
Adverse Reactions.pptAdverse Reactions.ppt
Adverse Reactions.ppt
 
adr ppt (2).ppt
adr ppt (2).pptadr ppt (2).ppt
adr ppt (2).ppt
 
1.c.1 adverse drug reaction
1.c.1 adverse drug reaction1.c.1 adverse drug reaction
1.c.1 adverse drug reaction
 
Adverse drug reactions
Adverse drug reactions Adverse drug reactions
Adverse drug reactions
 
Carcinogenesis
Carcinogenesis Carcinogenesis
Carcinogenesis
 
5.ppt
5.ppt5.ppt
5.ppt
 
ADRs.ppt
ADRs.pptADRs.ppt
ADRs.ppt
 
adverse drug reaction.ppt
adverse drug reaction.pptadverse drug reaction.ppt
adverse drug reaction.ppt
 
Adverse Drug Reaction - Pharmacology
Adverse Drug Reaction - PharmacologyAdverse Drug Reaction - Pharmacology
Adverse Drug Reaction - Pharmacology
 
Adverse Drug Reactions (ADR)- Ravinandan A P
Adverse Drug Reactions (ADR)- Ravinandan  A PAdverse Drug Reactions (ADR)- Ravinandan  A P
Adverse Drug Reactions (ADR)- Ravinandan A P
 
Adverse drug reaction ,pharmacy practice
Adverse drug reaction ,pharmacy practiceAdverse drug reaction ,pharmacy practice
Adverse drug reaction ,pharmacy practice
 
Adverse Drug Reaction
Adverse Drug ReactionAdverse Drug Reaction
Adverse Drug Reaction
 
HAROON ADR.ppt
HAROON ADR.pptHAROON ADR.ppt
HAROON ADR.ppt
 
Adverse drug reaction ppt
Adverse drug reaction pptAdverse drug reaction ppt
Adverse drug reaction ppt
 
ADR.ppt pharmacilogy ppt of adverse drug reaction
ADR.ppt pharmacilogy ppt of adverse drug reactionADR.ppt pharmacilogy ppt of adverse drug reaction
ADR.ppt pharmacilogy ppt of adverse drug reaction
 
Pharmacovigilance
Pharmacovigilance Pharmacovigilance
Pharmacovigilance
 

Mehr von Amira Badr

Industrial Ototoxicity
Industrial OtotoxicityIndustrial Ototoxicity
Industrial OtotoxicityAmira Badr
 
Chlorine Toxicity
Chlorine Toxicity Chlorine Toxicity
Chlorine Toxicity Amira Badr
 
Autonomic nervous system dental
Autonomic nervous system dentalAutonomic nervous system dental
Autonomic nervous system dentalAmira Badr
 
Warfarin toxicity
Warfarin toxicity Warfarin toxicity
Warfarin toxicity Amira Badr
 
Chlorine Toxicity
Chlorine Toxicity Chlorine Toxicity
Chlorine Toxicity Amira Badr
 
Adrenergic Antagonists
Adrenergic AntagonistsAdrenergic Antagonists
Adrenergic AntagonistsAmira Badr
 
Toxicity of aluminum signs
Toxicity of aluminum signsToxicity of aluminum signs
Toxicity of aluminum signsAmira Badr
 
Drug therapy during_pregnancy (1)
Drug therapy during_pregnancy (1)Drug therapy during_pregnancy (1)
Drug therapy during_pregnancy (1)Amira Badr
 
Antidepressant drugs
Antidepressant drugsAntidepressant drugs
Antidepressant drugsAmira Badr
 
Lithium intoxication – s
Lithium intoxication – sLithium intoxication – s
Lithium intoxication – sAmira Badr
 
Antifungal drugs
Antifungal drugsAntifungal drugs
Antifungal drugsAmira Badr
 
Organophosphorous compounds toxicity
Organophosphorous compounds toxicityOrganophosphorous compounds toxicity
Organophosphorous compounds toxicityAmira Badr
 
Drug therapy during_pregnancy (1)
Drug therapy during_pregnancy (1)Drug therapy during_pregnancy (1)
Drug therapy during_pregnancy (1)Amira Badr
 

Mehr von Amira Badr (20)

Arrhythmia
ArrhythmiaArrhythmia
Arrhythmia
 
Heart failure
Heart failureHeart failure
Heart failure
 
Angina
Angina Angina
Angina
 
Industrial Ototoxicity
Industrial OtotoxicityIndustrial Ototoxicity
Industrial Ototoxicity
 
Chlorine Toxicity
Chlorine Toxicity Chlorine Toxicity
Chlorine Toxicity
 
Autonomic nervous system dental
Autonomic nervous system dentalAutonomic nervous system dental
Autonomic nervous system dental
 
Warfarin toxicity
Warfarin toxicity Warfarin toxicity
Warfarin toxicity
 
Analgesics
Analgesics Analgesics
Analgesics
 
Chlorine Toxicity
Chlorine Toxicity Chlorine Toxicity
Chlorine Toxicity
 
Adrenergic Antagonists
Adrenergic AntagonistsAdrenergic Antagonists
Adrenergic Antagonists
 
Toxicity of aluminum signs
Toxicity of aluminum signsToxicity of aluminum signs
Toxicity of aluminum signs
 
Drug therapy during_pregnancy (1)
Drug therapy during_pregnancy (1)Drug therapy during_pregnancy (1)
Drug therapy during_pregnancy (1)
 
Antidepressant drugs
Antidepressant drugsAntidepressant drugs
Antidepressant drugs
 
Lithium intoxication – s
Lithium intoxication – sLithium intoxication – s
Lithium intoxication – s
 
Antiemetics
AntiemeticsAntiemetics
Antiemetics
 
Antifungal drugs
Antifungal drugsAntifungal drugs
Antifungal drugs
 
Laxatives (1)
Laxatives (1)Laxatives (1)
Laxatives (1)
 
Alzheimer
AlzheimerAlzheimer
Alzheimer
 
Organophosphorous compounds toxicity
Organophosphorous compounds toxicityOrganophosphorous compounds toxicity
Organophosphorous compounds toxicity
 
Drug therapy during_pregnancy (1)
Drug therapy during_pregnancy (1)Drug therapy during_pregnancy (1)
Drug therapy during_pregnancy (1)
 

Kürzlich hochgeladen

Pregnacny, Parturition, and Lactation.pdf
Pregnacny, Parturition, and Lactation.pdfPregnacny, Parturition, and Lactation.pdf
Pregnacny, Parturition, and Lactation.pdfMedicoseAcademics
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communicationskatiequigley33
 
introduction to neurology (nervous system, areas, motor and sensory systems)
introduction to neurology (nervous system, areas, motor and sensory systems)introduction to neurology (nervous system, areas, motor and sensory systems)
introduction to neurology (nervous system, areas, motor and sensory systems)Mohamed Rizk Khodair
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.kishan singh tomar
 
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxMAsifAhmad
 
World-TB-Day-2023_Presentation_English.pptx
World-TB-Day-2023_Presentation_English.pptxWorld-TB-Day-2023_Presentation_English.pptx
World-TB-Day-2023_Presentation_English.pptxsumanchaulagain3
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.whalesdesign
 
Microbiology lecture presentation-1.pptx
Microbiology lecture presentation-1.pptxMicrobiology lecture presentation-1.pptx
Microbiology lecture presentation-1.pptxkitati1
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfHongBiThi1
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)kishan singh tomar
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfHongBiThi1
 
Male Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondMale Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondSujoy Dasgupta
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisSujoy Dasgupta
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfDolisha Warbi
 
The Importance of Mental Health: Why is Mental Health Important?
The Importance of Mental Health: Why is Mental Health Important?The Importance of Mental Health: Why is Mental Health Important?
The Importance of Mental Health: Why is Mental Health Important?Ryan Addison
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project reportNARMADAPETROLEUMGAS
 
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.aarjukhadka22
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismusChandrasekar Reddy
 
General_Studies_Presentation_Health_and_Wellbeing
General_Studies_Presentation_Health_and_WellbeingGeneral_Studies_Presentation_Health_and_Wellbeing
General_Studies_Presentation_Health_and_WellbeingAnonymous
 

Kürzlich hochgeladen (20)

Cone beam CT: concepts and applications.pptx
Cone beam CT: concepts and applications.pptxCone beam CT: concepts and applications.pptx
Cone beam CT: concepts and applications.pptx
 
Pregnacny, Parturition, and Lactation.pdf
Pregnacny, Parturition, and Lactation.pdfPregnacny, Parturition, and Lactation.pdf
Pregnacny, Parturition, and Lactation.pdf
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communications
 
introduction to neurology (nervous system, areas, motor and sensory systems)
introduction to neurology (nervous system, areas, motor and sensory systems)introduction to neurology (nervous system, areas, motor and sensory systems)
introduction to neurology (nervous system, areas, motor and sensory systems)
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.
 
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
 
World-TB-Day-2023_Presentation_English.pptx
World-TB-Day-2023_Presentation_English.pptxWorld-TB-Day-2023_Presentation_English.pptx
World-TB-Day-2023_Presentation_English.pptx
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.
 
Microbiology lecture presentation-1.pptx
Microbiology lecture presentation-1.pptxMicrobiology lecture presentation-1.pptx
Microbiology lecture presentation-1.pptx
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
 
Male Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondMale Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and Beyond
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosis
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
 
The Importance of Mental Health: Why is Mental Health Important?
The Importance of Mental Health: Why is Mental Health Important?The Importance of Mental Health: Why is Mental Health Important?
The Importance of Mental Health: Why is Mental Health Important?
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project report
 
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismus
 
General_Studies_Presentation_Health_and_Wellbeing
General_Studies_Presentation_Health_and_WellbeingGeneral_Studies_Presentation_Health_and_Wellbeing
General_Studies_Presentation_Health_and_Wellbeing
 

5ee1 adverse drug reaction

  • 1. A • ADVERSE D • DRUG R • REACTIONS
  • 2. ADVERSE DRUG REACTIONS WHO DEFINITION Any noxious, unintended & undesired effect of a drug which occurs at a dose used in humans for prophylactic, diagnostic or therapeutic purposes FDA Definition  an adverse event occurring in the course of the use of drug in professional practice  an adverse event from drug overdose whether accidental or intentional  an adverse event occurring from drug abuse  an adverse event from drug withdrawal  any significant failure of expected pharmacological action.
  • 3. Classification • Type A (predictable)  extension of pharmacologic effect  often predictable and dose dependent  responsible for at least two-thirds of ADRs  e.g. anticholinergics and dry mouth • Type B (unpredictable)  idiosyncratic or immunologic reactions  rare and unpredictable  e.g., chloramphenicol and aplastic anemia  Penicillin induced anaphylactic shock
  • 4. Predictable Pharmacologic side effect Dry mouth from antihistaminics Secondary pharmacologic side effect Thrush while taking antibiotics Drug toxicity Hepatotoxicity from diclofenac Drug-drug interactions Seizure from theophylline while taking erythromycin (increased thephylline level) Drug overdose Seizure from excessive lidocaine (Xylocaine)
  • 5. Unpredictable Pseudoallergic Anaphylactoid reaction after ASPIRIN Idiosyncratic Hemolytic anemia in a patient with G6PD deficiency after ciprofloxacin therapy Intolerance Tinnitus after a single, small dose of aspirin
  • 6. • Type C  associated with long-term use  involves dose accumulation  e.g., NSAID induced nephropathy • Type D  delayed effects (dose independent)  Carcinogenicity  Teratogenicity
  • 7.  Type E: End-of-use ◦ Withdrawal ◦ Related to discontinuation which is too abrupt ◦ Examples:  Addisonian crisis after steroid withdrawal  Angina pectoris after stopping -blockers
  • 8. CLASSIFICATION OF ADRs ~According to SEVERITY~  Mild Does not affect patient’s day-to-day activity  Moderate Affects patient’s day-to-day activity to some extent  Severe Adversely affects patient’s health may lead to death
  • 9. ADVERSE DRUG EFFECTS 1. Side Effects  Unwanted but unavoidable pharmacodynamic effects occuring at therapeutic doses.  Side effect may be based on same action as therapeutic effect.  Eg. Atropine and dry mouth  Codeine and constipation
  • 10. 2. SECONDARY EFFECTS  Indirect consequences of a primary action of the drug. a.Super infection due to tetracyclines. b.Latent tuberculosis activated by corticosteroids.
  • 11. 3. Idiosyncratic reactions  Gentically determined abnormal reactivity to a chemical.  Chloramphenicol – aplastic anemia 4. INTOLERANCE  Failure to tolerate even a single dose of the drug  Appearance of characteristic toxic effects of a drug in an individual at therapeutic doses.  Aspirin - gastric bleeding
  • 13. Poisons and Poisoning  chemical substance that endangers life by affecting one or more vital functions of the body.
  • 17. Immunological Type I reaction (IgE-mediated) Anaphylaxis from β-lactam antibiotic Type II reaction (cytotoxic) Hemolytic anemia from penicillin Type III reaction (immune complex) SLE, RHEUMATOID ARTHRITIS Type IV reaction (delayed, cell-mediated) Contact dermatitis from topical antihistamine
  • 18. Immune reaction Mechanism Clinical manifestation Timing of reactions Type I (IgE-mediated) Drug-IgE complex binding to mast cells with release of histamine, inflammatory mediators Urticaria, angioedema, bronchospasm, pruritus, vomiting, diarrhea, anaphylaxis Minutes to hours after drug exposure Type II (cytotoxic) Specific IgG or IgM antibodies directed at drug-hapten coated cells Hemolytic anemia, neutropenia, thrombocytopenia Variable Type III (immune complex) Tissue deposition of drug-antibody complexes with complement activation and inflammation Serum sickness, fever, rash, arthralgias, lymphadenopathy, urticaria, glomerulonephritis, vasculitis 1 to 3 weeks after drug exposure Type IV (delayed, cell-mediated) MHC presentation of drug molecules to T cells with cytokine and inflammatory mediator release Allergic contact dermatitis, 2 to 7 days after cutaneous drug exposure
  • 19. Drug abuse  It is the use of a drug for a nontherapeutic effect.  Some of the most commonly abused drugs are alcohol; nicotine; marijuana; amphetamines; barbiturates; cocaine;opium alkaloids; synthetic opioids; benzodiazepines, phencyclidine; ketamine; and anabolic steroids.  Drug abuse may lead to organ damage, addiction, and disturbed patterns of behavior.  Use of these drugs often incurs criminal penalty in addition to the potential for physical, social, and psychologic harm
  • 20. Drug dependence  Drug dependence is the body's physical need, or addiction, to a specific agent.  It is a state in which use of drugs for personal satisfaction often in the face of known risk to health. Types:  Psychological dependence  Physical dependence.
  • 21. Psychological dependence develops when the individuals believe that optimal state of well being is achieved through the action of the drug.  It results in compulsive drug use in some individuals.  Intensity of dependence vary from desire to craving.
  • 22. Physical dependence  it is manifested by a withdrawal (abstinence) syndrome, in which untoward physical effects occur when the drug is stopped or when its effect is counteracted by a specific antagonist.  Drugs that cause strong physical dependence include heroin, alcohol, benzodiazepines, and cocaine. Reinforcement : Ability of the drug to produce effects that make the user wish to take it again. Ex., opiods,cocaine,LSD,benzodiazepines.
  • 23. Drug addiction Drug habituation  Drug addiction is a state of periodic or chronic intoxication produced by the repeated consumption of a drug (natural or synthetic). Its characteristics include: 1) An overpowering desire or need (compulsion) to continue taking the drug and to obtain it by any means; 2) A tendency to increase the dose; 3) A psychic (psychological) and generally a physical dependence on the effects of the drug;  Drug habituation (habit) is a condition resulting from the repeated consumption of a drug. Its characteristics include: 1) A desire (but not a compulsion)to continue taking the drug for the sense of improved wellbeing which it engenders: 2) Little or no tendency to increase the dose; 3) Some degree of psychic dependence on the effect of the drug,but absence of physical dependence and hence of an abstinence syndrome;
  • 25. Teratogenicity  Definition :  Ability of a drug to cause fetal abnormalities when administered to a pregnant women.
  • 26. PHOTOSENSITIVITY  Cutaneous reaction resulting from drug induced sensitisation of the skin to UV radiation  Phototoxic ◦ Photochemical ◦ Erythema, edema, hyperpigmentation, desquamation ◦ Fluroquinolones, sulfonamides, tetracyclines, ibuprofen, naproxen  Photoallergic ◦ Cell mediated immune reaction ◦ Papule or contact dermatitis ◦ Sulfonamides, ketoprofen, and celecoxib, grasofulvin
  • 30.  Any adverse condition in a patient occurring as the result of treatment by a physician, surgeon, or other health professional, especially infections acquired by the patient during the course of treatment.  drug induced / physician induced disease.  Ex.,hepatitis by isoniazid  Peptic ulcer by salicylates and corticosteroid. Iatrogenic disease
  • 31.  "The term carcinogen denotes a chemical substance or a mixture of chemical substances which induce cancer or increase its incidence“  Mutagen is An agent, such as a chemical, ultraviolet light, or a radioactive element, that can induce or increase the frequency of mutation in an organism. Carcinogenicity & mutagenicity.
  • 32. Effects of Medication on Oral Tissues  Most but not all drugs have effect on the health of oral .  One of the most common and the earliest known adverse/side effect involved the use of tetracycline.  The administration of tetracycline to pregnant women resulted in tooth staining/discoloration in their children. It resulted in yellow brown stains on the teeth of these children.  Most common oral effects of medications include dry mouth, a common condition that may lead to decay of teeth, opportunistic infections like candidiasis and/or difficulty in speaking and swallowing. .
  • 33.  Contact stomatitis  It is a localized reaction of the oral mucosa usually after repeated contact with the causative agent.  It may result in erythema or ulcerative lesions with or without burning sensation.  The reaction may occur as early as one day after the drug usage  Antibiotics, iodine, mouthwashes, toothpastes, certain cosmetics, etc have the potential to cause contact somatitis.
  • 35. aphthous ulcers  aphthous ulcers or more commonly known as the canker sores. These are tiny, painful lesions which occur either singly or in groups on the labial or buccal mucosa.  These usually heal without scar formation within 14 days.  Various drugs including NSAIDs, captopril, losarton and penicillamine can cause aphthous ulcers.
  • 36.  Dry mouth  Certain drugs such as sedatives, anticholinergics, omeprazole, anti cancer drugs, antidepressants etc cause dry mouth as these affect the function of the saliva glands reducing the saliva.  Some of the common problems associated with it are burning sensation, constant sore throat, speech problems, difficulty in swallowing and hoarseness.  Drugs that cause xerostomia most commonly are benzodiazepines, morphine, calcium channel blockers, etc
  • 37. Teeth discoloration  Tooth discoloration may be intrinsic or extrinsic.  Intrinsic stains are usually caused by drugs which are taken during and affect the tooth development, more so during the stages of enamel and dentin formation. Such drugs, for example, tetracycline gets accumulated in the dentin and enamel of the developing tooth and appears as yellow or brown stains on the tooth.  Extrinsic stains are the ones which are taken up by the tooth after development. These include tea and coffee stains and stains caused by some drugs such as chlorhexidine, tobacco
  • 38. Oral pigmentation  Pigmentation may occur either due to systemic absorption or local use of drugs in the oral cavity.  Pigmentation has been reported in cases taking mercury, arsenic, gold, cupper, zinc etc, especially around the gingival margins around the teeth.  These are more prominent in the presence of plaque and inflammation.  These may be temporary or permanent but usually most of the pigmentation disappears with the discontinuation of the drug.
  • 39.  Burning mouth syndrome This syndrome may occur due to hormonal withdrawal, iron or vitamin deficiencies, psychogenic factors or hypersensitivity reactions to various dental materials or drugs.  Glossitis Glossitis or inflammation of the tongue is characterized by intense pain and swelling that may be referred to the ear. It usually results in difficulty in speaking, swallowing along with systemic signs such fever and enlarged lymph nodes. Glossitis though not a common side effect is usually associated with penicillin, bleomycin, lansoprazole, etc.
  • 41.  Oral Ulceration  More commonly referred to as burns of the oral mucosa. Aspirin, cocaine, hydrogen peroxide, phenytoin, penicillin, etc can cause either local irritation or ulceration in the oral cavity.  Ptyalism  Some drugs alter the function of salivary glands by increasing the rate of formation of saliva, commonly known as ptyalism. The saliva is thin and watery without its usual buffering properties leading to decay of hard and soft tissues of the oral cavity. Example: pilocarpine
  • 42.  Drug induced Gingival hyperplasia  It is the painless overgrowth of the gingival tissues, usually the interdentally papilla is more affected, later extending to other areas of the gingival.  The common drugs causing the drug induced gingival enlargement are cyclosporine, phenytoin, calcium channel blockers like nidefine and oral contraceptives.  Reducing the dose of the offending drug along with the maintenance of good oral hygiene usually suffices the treatment for gingival hyperplasia. In severe cases complete stoppage and/or changing to an alternative drug is required to treat the case.
  • 44.  Taste disturbance  this may include alteration in taste by reducing the sensitivity in taste perception, or a total loss of taste or a disturbance in correct identification of taste.  Drugs that are capable of affecting/altering the taste sensation are aspirin, cetrizine, various antibiotics like penicillamine, ofloxacin, metronidazole, etc.  Halitosis  Halitosis or bad breadth can result from poor oral hygiene, ingestion of certain drugs, use of tobacco products, oral or dental infections, and some systemic disorders. Sublingual nitrate and disulfiram have the potential to cause halitosis.
  • 45.  Oral candidiasis  At times the systemic drug therapy alters the oral micro flora predisposing the mouth to various bacterial and fungal infections. Also the drugs that reduce/suppress the immunity of the individual make the individual susceptible to opportunistic infections such as candidiasis. Such drugs include corticosteroids, antimicrobials, immunosuppressive agents, anticancer drugs,  Abnormal bleeding  Abnormal bleeding is caused by drugs such as aspirin, NSAIDs, anticoagulants and steroids which thin the blood, used in conditions of stroke, myocardial infarctions and arrhythmias
  • 47.  Alveolar osteitis or, a dry socket, is a complication of wound healing following extraction of a tooth. It is known as "dry socket" as after the clot is lost, the socket has dry appearance because of exposed bone. The blood clot helps in stopping the bleeding and lays framework for new tissues to develop there but in case of dry socket, the clot is dislodged and the bone is exposed. This bare bone is exposed to bacteria in the saliva and the food which the patient consumes and the bone becomes infected and painful. The uses of oral contraceptives have also been associated with significant increase in the frequency of dry socket.
  • 48. Aphthous ulcer treatment  Treatment is symptomatic and includes oral pain relievers, mouth rinses, topical creams with or without steroids, diphenhydramine, and tetracycline suspension mixed with nystatin and diphenhydramine.  Aphthasol is a new topical drug which decreases the duration of healing and ulcer pain.