Adverse reactions and other drug-related problems in an emergency service department

BACKGROUND: Adverse Drug Reactions (ADR) and Drug-Related Problems (DRP's) are a frequency cause of hospital emergency room visits and require better assessment. METHOD: An analysis was made of 1097 consecutive admission to the emergency room at the Nuestra Senora de los Volcanes, Hospital (currently the General Hospital of Lanzarote) in Arrecife de Lanzarote (Canary Islands) over a three-month period in order to detect any possible DAR or any other drug-related problems. RESULTS: Nineteen (19) of the 1097 admissions were due to Adverse Drug Reactions (ADR) (1.73%; 95% IC:0.96%-2.5%). Some of the most outstanding of the other "Drug-Related Problems" (DRP's) were medication overdose, which was diagnosed in 5 (0.45%) of the patients; the worsening of the symptoms due to ceasing to take the medication was involved in 8 (0.72%), and incorrect treatments which involved medical care at the emergency room totaled 11 (1.0%). The number of drug-related problems (DRP's) in the sample totaled 43 (3.9%). The drug-related problems (DRP's) led to hospitalization in 1.9% of the cases seen in the emergency room and led to hospitalization in 9.6% of all of hospital admission through the emergency room for the period of time under study. The ADR led to 4.1% of the hospital admissions. CONCLUSIONS: Drug-related problems are a frequent, major problem which has not been well-analyzed in the emergency rooms. Additionally, emergency rooms can function as the first point of detection of a ADR among an outpatient population.     

Adverse drug reactions

There are many methods of surveillance of new drugs for adverse reactions once they have been fully marketed. The yellow card system run by the Committee on Safety of Medicines is not well used by doctors: perhaps there is some other way of reporting adverse reactions?     

Adverse drug reactions in the elderly

There is limited evidence to suggest that the incidence of adverse drug reactions increases with patient age. Factors which may predispose the elderly to adverse drug reactions include multiple drug therapy and changes in pharmacokinetics and pharmacodynamics associated with ageing. Digoxin, diuretics and psychotropic drugs may be particularly hazardous in this age group.     

莫西沙星的不良反应分析

目的探讨莫西沙星不良反应发生的一般规律,为临床合理安全用药提供参考。方法以莫西沙星为关键词,检索维普数据资源系统、万方数据资源(2001年1月-2010年1月)系统,收集莫西沙星不良反应的文献和病例,对患者的一般情况、用药情况、不良反应类型和发生时间、临床表现和转归等资料进行回顾性分析。结果 94例患者中,年龄≥50岁的患者有62例,占65.96%,明显高于其他年龄段,且老年伴基础疾病患者更易发生;静脉滴注66例,占70.21%,口服28例,占29.79%;发生不良反应110例次,其中神经系统损害达38例次,占34.55%,其次主要累及皮肤及附件和四肢肌肉表现各占15.45%,过敏样反应占9.09%。结论临床应重视莫西沙星不良反应的危害性,注意用药患者的人群特点。     

Adverse drug reactions in children reported by means of the yellow card in Spain

OBJECTIVE: To analyze the case reports concerning children (14 years or younger) in the Spanish Pharmacovigilance System over a 10-year period (1982-1991). FINDINGS: The study of 1419 reports of adverse drug reaction (9.8% of all those received) showed the most commonly involved organs and systems to be the skin, digestive tract, and nervous system (62.8%). The most commonly involved pharmacological groups were antibiotics, respiratory medications, and vaccines (69%). The absolute number of reports is higher in children between 1 and 4 years of age (37.9%). There were more reports among males than in females. Less than 5% of the reports notified directly life-threatening or fatal reactions. CONCLUSIONS: Adverse drug reaction are not common in pediatric patients, and most are mild. However, due to limitations of clinical trials in children, pharmacoepidemiological studies may be the only source of information on the benefit-risk profile of drugs received by these patients, and as such require special attention.     

Adverse drug reactions and reactive oxygen species

Adverse drug reactions represent a major source of morbidity in hospitalized- and outpatients. Adverse drug reactions may affect the function of any organ or system. Due to their clinical nonspecificity adverse drug reactions are often difficult to be recognized. The clinical manifestation, the type and severity of adverse drug reactions vary a great deal depending on patient- and drug-related factors. In recent years growing evidence has emerged implicating involvement of free radicals and reactive oxygen species in chronic degenerative diseases and in acute conditions, such as stroke and infection. The review focuses on the role of reactive oxygen species in the pathogenesis of drug-induced disease with special reference to hepatotoxicity, nephrotoxicity and allergic disease. The participation of reactive oxygen species in the development of adverse drug reactions induced by special drug classes (non-steroidal anti-inflammatory drugs, anti-infective agents, cytostatics) is described. Results from studies on animals and humans reveal the putative implication of oxidative stress in drug-induced disease states.     

Adverse drug reactions in a disadvantaged population

Adverse drug reactions represent an area of concern in the delivery of medical care; most recognized negative indices of health can result from the untoward effects of drug therapy. Current data indicating the nature and extent of the problem are considered to be inadequate for making policy decisions. This study contributes new information about drug reactions in a disadvantaged population, by (1) identifying the nature and the extent of the adverse effects of drugs and (2) estimating the costs for the treatment of these adverse effects.The findings showed that oral contraceptives accounted for almost 26% of the medical care contacts and almost 33% of the estimated costs for treating adverse effects. An incidence rate of approximately 2.3 and a prevalence rate of approximately 2.2 suggest that relatively few persons were treated for the adverse effects of drugs. Costs directly attributable to their treatment, including hospitalization but excluding outpatient drug costs, were estimated to be 44 cents per person per year.Although the adverse effects of drugs did not appear to be a major problem in terms of their occurrence and potential severity for a disadvantaged population and in terms of their economic impact upon a medical care system, more information is needed if strategies for dealing with them are to be efficient and effective.Dr. Campbell is Associate Professor and Chairman, Department of Pharmacy Practice, School of Pharmacy BG-20, University of Washington, Seattle, Washington 98195. The other authors are with the Health Services Research Center, Kaiser Foundation Hospitals, 4610 S.E. Belmont Street, Portland, Oregon 97215, where Dr. Johnson is Senior Investigator, Dr. Senft is Research Consultant, and Mr. Azevedo is Projects Administrator, for Drug Systems Research. This work was supported in part by Public Health Service grant 1 R 18 HS-01561-01. The authors wish to acknowledge the contribution of Marilyn W. Drichas, Health Services Research Center, in the preparation of the data.