Systemic Toxic Drugs – What Nurses needs to know?

systemic toxic drugsDifferent systemic drugs, their therapeutic level, symptoms on their toxicity and antidotes are one of the favorite area of Multiple Choice Question makers for staff nurse exams. It is indeed a vast area and if go for studying it in depth, we will not have time left for other topics. So  we are trying  to explain the major systemic drug toxicities and related questions in simplest manner possible.

Systemic Toxic Drugs – Exam point of view for Nurses preparing for staff nurse exams

What are systemic drugs?

Systemic drugs are those which affects the body as a whole or that acts specifically on systems that involve entire body such as Cardiovascular drugs, respiratory drugs, gastrointestinal drugs, drugs given for nervous system orders and even psychiatric drugs.

So systemic toxic drugs can be defined as toxic side effects that happens due to the administration of these systemic drugs.

We can see that this will be a broad topic as number of systemic drugs are countless and same is the case with the side effects arising from their administration.

So we will focus on major known drugs which causes drug toxicity and from which questions are frequently asked for staff nurse/ NCLEX RN exams. Let’s start with

Drugs that are known to cause Teratogenicity

Isotretinoin, Warfarin, Alcohol, Sodium Valproate, ACE Inhibitors, Cocaine, Diethylstilbestrol, Androgens and danzol, Tetracyclines, Antineoplastic Agents and Phenytoin

These drugs should be avoided in pregnancy.

Drugs that are known to cause Ototoxicity (Toxic to Ear)

Aminoglycoside Antibiotics, Biochemicals, Antimalarials, Analgesics, Cytotoxic Drugs and Diuretics.

Drugs that will cause Nephrotoxicity (Toxic to Kidney)

NSAIDS, Aminoglycosides, Amphotericin B, Cisplatin, Carboplatin, Cyclosporine, ACE Inhibitors and Radiographic Contrast agents.

Drugs causing Hepatotoxicity (Toxic to Liver)

Retroviral Drugs, Antiseizure drugs, Acetaminophen, TB Drugs, Halothane, Amiodarone, Statins and other lipid lowering agents, Diclofenac, Immunosuppressants, Oral Hypoglycemics and Antifungal drugs

Drugs causing Neurotoxicity (Toxic to nervous system)

Amphetamine, Nicotine, Methamphetamine, Antipsychotics, Alcohol, Levodopa and Ketamine.

Drugs causing Cardiotoxicity (Toxic to Cardiovascular System)

Beta blockers, Calcium Channel Blockers, Digoxin, Antimalaria drugs, Antiarrythmic drugs, Psychiatric drugs like Tricyclic Antidepressants and Antipsychotics, Anticonvulsants and Antihistamines

We know its difficult to remember all these, but only one way we can solve this issue. By answering multiple choice questions and by studying relatively. But before we proceed we need to study little more, ie about major toxicities, their symptoms and treatment methodology.

1. Digoxin

Therapeutic range – 0.8 – 2ng/ml

Important symptoms Yellow or green halo’s around objects.

Antidote – Digibind

Note – If Apical Pulse Rate < 60 – you have to withold Digoxin.

2. Magnesium Sulphate

Therapeutic range – 1.5 – 2.6 mg/dl

Important symptoms – Respiratory failure, Deep tendon reflex reduction, Facial Paresthesia.

Antidote – Calcium Gluconate (10%)

3. Lithium

Therapeutic Range – 0.6 – 1.2 MEG/L

Important Symptoms – Head ache, lethargy, GI Symptoms and Muscle weakness

What about making a chart of different drugs and their therapeutic levels?

drug therapeutic levels

common drugs and antidotes 1

common drugs and antidotes 2

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