Adverse drug reactions Flashcards
What are the two defintions of an ADR?
WHO: a response to a drug which is noxious and unintended, and which occurs at doses normally used in man for the prophylaxis, diagnosis or therapy of disease or for the modification of physiological function.
ASoHP is more practical and long winded.
How do medication eroors relate to ADR’s?
There is not much overlap. ME’s are very common. 1-10% lead to harm.
An adverse drug event encompasses ADR’s, as well as overdoses, and harm from discontinuing/ dose reduction of drug
Allergy vs side effect
Allergy: adverse drug reaction mediated by immune response
Side effect: an expected known effect of a drug that is not the intended therapeutic outcome. (ADR)
MILD;MODERATE;SEVERE ADR’s
Mild: no change to treatment
Moderate: requires change in treatment or additional
Severe: life threatening and needs hospital admission
Classifications of ADR’s? (Alphabet)
A: augmented effect, predictable and dose dependent
B: bizarre, may be allergic, can not predict. Dose independent
C: chronic, over a long time
D: delayed, post chemo
E: end of
F: failure
Classifications of ADR’s? (DoTS)
Dose: Supra, standard or sub therapeutic
Timing: Independent and dependent (rapid reaction, first dose, early,intermediate, late, delayed)
Susceptibility: reasons for hypersensitivity include genetics, age, sex, physiology
What patients are at a higher risk of an ADR?
Younger children (diff metabolism etc) and older people; co morbidities; polypharmacy; women; race
How can you tell if it is an ADR?
Consider the possibility; investigate whether the drug is known to; rule out alterntives; establish a temporal link; can use probability assessment tool
Strategies to avoid ADRs?
Only give unless absolutely indicated; prescribe as few as possible, whenever possible use familiar drug; history v important, ie taking herbal meds; ask about previous reactions
