The management of adverse drug reactionsI Ralph Edwards.ppt

The management of adverse drug reactionsI Ralph Edwards Diagnosis Procedures Management Therapy Often no clear separation... The management of adverse drug reactions Is the patient taking drugs? OTC OC Herbal/traditional Abused drugs Long term prescription Check with medical history A patient An 81 year old man with an old valve replacement and recent heart failure. Digoxin 0.25 mg daily Warfarin 4mg daily Frusemide 80 mg daily Potassium supplements The patient Develops a deep bleeding ulcer Eventually looks like this: The management of adverse drug reactions Could the symptoms and signs be due to drugs? Yes! When there is polypharmacy, this becomes difficult WHICH DRUG?! The management of adverse drug reactions How serious is the patients clinical state? If very serious: Stop all drugs which may POSSIBLY cause condition Treat, as necessary Consider step-wise re-introduction, later If not serious: Proceed logically Patient Diagnosis Possible bleeding tendency: over-anticoagulated Patient Action Stop warfarin Check prothrombin ratio The management of adverse drug reactions Time relationships Do they make sense? Drug before disease? Timing of drug and reaction? Kinetics-steady state Withdrawal reaction? Allergy type Previous exposure? Pregnancy stages Neoplasia kinetics The management of adverse drug reactions YES,BUT WHICH DRUG? Known pharmacology Of single drug Of class Known idosyncracy Of single drug Of class Patient Prothrombin ratio normal and patient has been stabilised for a long time New diagnosis Possible coumarin necrosis During chronic treatment? The management of adverse drug reactions Are there any special tests which may help? Blood levels of medicines (therapeutic monitoring) Other clinical tests to help establish The disease entity eg. allergy testing, skin biopsy Baseline state eg. liver and kidney function Follow up of response following discontinuation of medicine or reduction of dose Patient Cons