Sunday, 2 May 2010

Adverse Drug Reactions

Drugs with low therapeutic ratio:
Anticoagulants
Antidiabetic drugs
Anticonvulsants
Digoxin
Cancer drugs


Patient Fx:
Elderly
Polypharmacy
Co-existing liver/kidney disease

Young women with child-bearing potential
IV drugs

Drug Reaction Classifications:
Type A - common, dose related, low mortality
Type B - uncommon, not dose related, high mortality
Type C - uncommon, dose and time related eg cumulative dose

Statins
AE
Myositis
Measure CK & LFTs before and 1-3 months after
If CK >x10 normal = stop drug (risk of rhabdomyolysis)
If Transaminases rise >x3 normal = stop drug

Erythema Nodosum
...from...
- oestrogens
- sulphonamides
- phenytoin
- penicillins

Stevens-Johnson Syndrome (toxic epidermal necrolysis)
Immune response to drug in skin and mucous membranes
- sulphonamides (including sulphasalazine)
- co-trimoxazole
- penicillins
- lamotrigine & phenytoin
- barbiturates

Yellow Card scheme
- intensive event monitoring
- doctors, pharmacists and pharm industry
- report suspected AE in newly licensed drugs as well as in older medicines
- cards in back of BNF
- new drugs highlighted in BNF, MIMS and ABPI by black triangle

NB More difficult to identify common adverse events

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