Adverse Drug Reactions Flashcards
What is the WHO definition of an adverse drug reaction?
A response to a drug which is noxious and unintended and which occurs at doses normally used
How do medication errors relate to adverse drug reactions?
10% lead to adverse drug events but not all adverse drug events are adverse drug reactions
What is the difference between an allergy and a side effect?
Allergy is an adverse reaction mediated by an immune response
Side effect is an expected and known effect of the drug that is not the intend therapeutic outcome
What are the three levels of adverse drug reactions?
Mild: no change in treatment required
Moderate: requires change in treatment
Severe: disabling, life threatening
What is the difference between type A and type B of ADRs?
Type A: predictable extension of the pharmacological treatment
Type B: idiosyncratic drug allergy that is rare and unpredictable
What are the two types of drug allergies?
Immediate(type 1=anaphylatic)
Delayed (type2=cytotoxic type3=immune complex type4=cell mediated)
What are the DoTS classifications?
Dose, Timing and Susceptibility
What are the different ways that reactions can be classified by dose?
Supratherapeutic
Standard therapeutic
Subtherapeutic
What are the different ways that reactions can be classified by timing?
Time independent or time dependent (rapid, first dose, early, immediate, late or delayed reactions)
What are the most significant issues with adverse drug reactions?
Death/serious harm
Hospital admission
Cost
1/3 to a 1/2 are preventable
What are the most risky drugs?
Anticoagulants, opiods and insulin
Which patients are at a higher risk?
Younger children and older adults Multiple comorbidities Polypharmacy Women Race
What are some doctor based strategies to reduce ADRs?
Avoid and be vigilant of high risk drugs Discontinue unnecessary meds Consider drugs as cause of new symptoms Avoid drug drug interactions Adjust dosing based on age and creatinine
What are some system based strategies?
Computerised order entry Electronic record Bar coding Smart pumps Pharmacist interventions Medicine reconcilliation
How do you know if it is an adverse drug reaction?
Investigate whether the drug is known to cause that reaction
Establish a temporal link between onset of reaction and drug administration
You can use a probability assessment tool (Naranjo)
