Drug reactions, other than the intended and anticipated effects, are normally divided into those reactions known as side effects and known as allergic reactions. Due to a drug's structure, class, and mechanism of action, certain other effects in addition to the intended effects tend to occur. For example, most drugs used for the treatment of nausea ( anti-emetics) also tend to cause drowsiness. Side effects can involve virtually any organ system of the body. For example, neurologic effects can include headache, dizziness, or blurry vision; gastrointestinal symptoms can include nausea, vomiting, or diarrhea, to name a few; dermatologic symptoms can include itching, hives, or rash, and so on. Side effects tend to affect patients differently and not necessarily in proportion to the size of the dose given. Many times other drugs can be taken for the same primary problem which don't have the same side effects or which have them to a lesser degree in a particular patient. Sometimes though alternative choices are limited and the side effects must either be tolerated to the extent possible or treated with yet another drug. This can lead to what is know as “ polypharmacy ”, a situation where the patient is taking multiple drugs for multiple different problems thereby creating a fairly complex situation of various drug interactions which can present a challenging situation for both patient and physician alike.
The other major category of drug reactions are allergic reactions. These may include nausea, itching ( prutitus ), hives, swelling of the tongue or throat, shortness of breath and difficulty breathing, chest pain and abdominal pain. These symptoms may progress rapidly and unpredictably, and anyone experiencing them is well advised to either proceed directly to an Emergency Room or contact their local EMS for transport to the Emergency Room. The advantage of contacting EMS is that monitoring and interventions can begin immediately upon EMS' arrival at the site. You may have taken the medicine before ( a true allergic reaction) or you may not have (an anaphylactoid reaction). Anaphylactoid reaction can be just as severe as an allergic reaction. Allergic reactions occur as a result of prior exposure to the drug or nanti9gen (allergic stimulus). You may have taken a drug a hundred times before and never have had a reaction, and then develop an allergy on your one hundred and first exposure. Anaphylactic reactions are severe systemic hypersensitivity reactions characterized by multisystem involvement which can include airway compromise and hypotension.
Mild allergic reactions are usually treated with diphenhydamine (Benadryl) and ranitidine (Zantac) or cimetidine ( Tagamet ). Diphenhydramine is an H-1 blocker, and ranitidine and cimetidine are H-2 blockers. When used together they tend to have synergistic effects greater than either one when used alone. They may both be given orally or
parenterally (by injection). Airway compromise ( bronchospasm ) is usually treated bronchodialators like albuterol and ipratropium bromide. Epinephrine is usually reserved for the more severe allergic reactions where multiple organ systems are involved. It is given exclusively parenterally and usually in a closely monitored environment including an ambulance.
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