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Drug Toxicity

Nursing Knowledge

Drug Toxicity

Drug toxicity is the harmful impact of a drug in the body, leading to severe adverse events or organ damage. Monitoring clients for signs of drug toxicity through regular assessments and laboratory tests is a vital part of nurses’ roles. Educating patients on the risks and signs of toxicity can help early detection. Immediate intervention is essential if toxicity is suspected.
Last updated: December 4, 2023

Table of contents

What is drug toxicity? 

Drug toxicity refers to the harmful effects of a drug when administered at a normal or high dose. It can result in adverse reactions that can be life-threatening, causing damage to organs like the liver or kidneys, or leading to other significant health issues.

Adverse effects also can occur even at therapeutic doses and are generally less severe, although they can still be harmful. While mild adverse effects are usually anticipated and listed by the manufacturer, drug toxicity often results from medication errors, interactions, or individual sensitivities and is generally more severe and urgent. Nurses should monitor for both but treat drug toxicity as a medical emergency requiring immediate intervention.

What is ototoxicity?

Ototoxicity definition 

Ototoxicity refers to the harmful effects of certain medications or substances on the inner ear, specifically affecting structures responsible for hearing and balance. 

Ototoxic drugs

Antibiotics: 

  • Gentamicin and tobramycin
  • Macrolides (reversible when stopped)

Loop diuretics: 

  • Furosemide

Chemotherapy: 

  • Cisplatin
  • Carboplatin

Ototoxicity symptoms 

Ototoxicity can lead to symptoms like vertigo, tinnitus, and hearing loss. 

What is nephrotoxicity?

Nephrotoxicity definition 

Nephrotoxicity refers to the toxic effect of medication, chemicals, or toxins on the kidneys. It can lead to reduced kidney function and, in severe cases, renal failure.

Nephrotoxic drugs

Antibiotics: 

  • Gentamicin
  • Amphotericin B

ACE inhibitors

NSAIDs

Radiocontrast media (especially with metformin)

Lithium salts:

  • Rifampin 
  • INH

Chemotherapy:

  • Cisplatin

Nephrotoxicity symptoms 

To detect nephrotoxicity, watch for: 

  • Elevated BUN (normal 7–20 mg/gL (2.5–7.1 mmol/L)
  • Elevated serum creatinine (normal for females: 0.6–1.1 mg/dL [53–97.2 µmol/L] for males 0.7–1.3 mg/dL [61.9–114.9 µmol/L) 
Nephrotoxicity

Download: Nephrotoxicity Cheat Sheet

Overview of nephrotoxic medications: definition, medications with increased risk, lab values to monitor, and prevention

What is hepatotoxicity? 

Hepatotoxicity definition 

Hepatotoxicity refers to the damaging effects of substances, including medications, on the liver. 

Hepatotoxic drugs

Antihypertensives:

  • ACE inhibitors

Anti-infectives:

  • Erythromycin
  • Fluconazole
  • Itraconazole

Alcohol

Pain medications:

  • Acetaminophen
  • NSAIDs

Tuberculosis drugs:

  • Rifampin
  • INH

Phenothiazines

Hepatotoxicity symptoms 

Hepatotoxicity can present with: 

  • Unusual fatigue/weakness
  • Loss of appetite
  • Pain in upper abdomen
  • Dark-colored urine
  • Yellowing of skin or eyes
Hepatotoxicity

Download: Hepatotoxicity Cheat Sheet

Overview of hepatotoxic medications: definition, medications with increased risk, lab values to monitor, and symptoms

Practice question: Which statement best describes the term “drug toxicity?”

  1. Drug toxicity refers to the beneficial effects of a drug when taken in therapeutic doses.
  2. Drug toxicity refers to the harmful effects of a drug when taken at normal or high doses, leading to adverse reactions or organ damage.
  3. Drug toxicity is the same as experiencing the adverse effects of a drug and is generally expected.
  4. Drug toxicity only occurs when two or more drugs interact with each other to produce an undesirable effect.

The correct answer is option 2: “Drug toxicity refers to the harmful effects of a drug when taken at normal or high doses, leading to adverse reactions or organ damage.” 

This statement encapsulates the essence of what drug toxicity is—a harmful impact that can cause severe health issues or damage to organs. It specifies that these effects can happen at both normal and high doses, differentiating it from known adverse effects, which can occur even at therapeutic doses.

FREE CHEAT SHEET

Drug Toxicity

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Nursing Cheat Sheet

Quickly review the medications that can be harshest on the liver, kidney, and ears so that you can be on the lookout for possible signs of toxicity.

Master the topic with a unique study combination of a concise summary paired with video lectures. 

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