Table 8.5 lists common pathologic findings in ADRs and the drugs most frequently involved. As can be seen, many of the drugs involved in ADRs, such as the anti-neoplastic agents, are highly potent, and the ADR is a calculated risk for the dosage assumed to achieve the maximum therapeutic effect. Commonly used drugs such as long-acting tetracyclines, which are used to treat diverse conditions, including acne, may produce localized or systemic reactions (
Fig. 8.11 ). Because they are widely used, estrogens and oral contraceptives (OCs) are discussed next in more detail. In addition, acetaminophen and aspirin, which are nonprescription drugs but are important
Fig. 8.11 Adversereactiontominocycline,along-actingtetracyclinederiva-tive.(A)Diffuseblue-graypigmentationoftheforearm,secondarytomino-cyclineadministration.(B)Depositionofdrugmetabolite/iron/melaninpigmentparticlesinthedermis.(A and B, Courtesy of Dr. Zsolt Argenyi, Depart-ment of Pathology,University of Washington,Seattle,Washington.) http://ebooksmedicine.net
Table 8.5 Some Common Adverse Drug Reactions and Their Agents
Granulocytopenia,aplasticanemia,pancytopeniaAnti-neoplasticagents,immunosuppressives,andchloramphenicol
Hemolyticanemia,thrombocytopeniaPenicillin,methyldopa,quinidine
Urticaria,macules,papules,vesicles,petechiae,exfoliativedermatitis,fixedAnti-neoplasticagents,sulfonamides,hydantoins,someantibiotics,anddrugeruptions,abnormalpigmentationmanyotheragents
ArrhythmiasTheophylline,hydantoins
CardiomyopathyDoxorubicin,daunorubicin
AcutetubularnecrosisAminoglycosideantibiotics,cyclosporine,amphotericinB
TubulointerstitialdiseasewithpapillarynecrosisPhenacetin,salicylates
InterstitialfibrosisBusulfan,nitrofurantoin,bleomycin
DiffusehepatocellulardamageHalothane,isoniazid,acetaminophen
CholestasisChlorpromazine,estrogens,contraceptiveagents
Lupuserythematosussyndrome(drug-inducedlupus)Hydralazine,procainamide *Featureinalmosthalfofalldrug-relateddeaths.
causes of accidental or intentional overdose, merit special comment.