By O. L. Wade and Linda Beeley (Auth.)
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Additional info for Adverse Reactions to Drugs
An excessive therapeutic response may occur if this is done with insufficient care, or if the patient's dose requirements fluctuate. A diabetic patient stabilised on insulin in hospital may develop hypoglycaemia when he leaves hospital and becomes more active, and a patient whose blood pressure is well-controlled while at rest in hospital may be incapacitated by postural hypotension when he has to get up in the morning on going home. In the case of drugs with a low therapeutic ratio unacceptable side effects may appear at doses little above those required for treatment.
Thus the protein binding of phenytoin in reduced in uraemia. Patients require 30 ADVERSE REACTIONS TO DRUGS smaller doses to achieve adequate therapeutic concentrations of free drug, and side effects are more likely to occur. Some drug effects are particularly hazardous in renal failure. Drugs which cause vomiting, such as morphine, pethidine and some oral antibiotics, may produce dehydration with exacerbation of the uraemia. 6 DISEASES WHICH ALTER TISSUE SENSITIVITY Disease Adverse Effect Drugs likely to cause Adverse Reaction Respiratory Coma precipitated by any All hypnotics, sedatives and failure respiratory depressant narcotic analgesics Myasthenia Increased sensitivity to Tubocurare, pancuronium, gravis drugs which block gallamine.
4) Even if an important amount of a drug is displaced the duration of the clinical potentiation will depend on the rate of drug elimination. The potentiation is likely to be important if the usual rate of elimination is slow or if the drug is eliminated by renal tubular secretion which is unaifected by changes in concentration of free drug. DRUG INTERACTIONS 47 In summary, displacement of drugs from protein-binding occurs commonly but important clinical consequences are much less common. 4 lists the interactions due to displacement which appear to have clinical importance.
Adverse Reactions to Drugs by O. L. Wade and Linda Beeley (Auth.)