Tiêu đề 4. ADVERSE DRUG REACTION MANAGEMENT.pdf ✅

PHARMD GURU Page 1 ROLE OF PHARMACIST IN THE MANAGEMENT OF ADRs:  Monitoring the patients who are at greater risk of developing ADRs.  Monitoring the patients who are prescribed with drugs highly susceptible to cause ADRs  Assessing and documenting the patient’s previous allergic status  Assessing the patient’s drug therapy for its appropriateness  Assessing possible drug interactions in case of multiple therapies  Assessing health care professionals in detection and assessment of ADRs  Encouraging/ stimulating healthcare professionals in reporting on ADR  Documentation of suspected reported reactions for future reference  Follow up of patients to assess the outcome of the reaction and management  Obtaining feedback about the reported reaction  Educating healthcare professionals about the importance of an ADR  Educating patients. CAUSES FOR ADR:  Predisposing factors.  Poly-pharmacy.  Multiple and intercurrent diseases (renal (or) hepatic problems).  Age (Geriatrics, Paediatrics).  Drug characteristics (Highly toxic, narrow therapeutic index).  Gender (women are more susceptible).  Race and genetics (Genetic defects). MECHANISM OF ADVERSE DRUG REACTIONS: 1) TYPE A ADVERSE DRUG REACTIONS: a) PHARMACEUTICAL CAUSES:  Drug quantity present in a particular product.  Changes in the drug release properties.  Salt forms of the drug used. ADVERSE DRUG REACTION MANAGEMENT
PHARMD GURU Page 2 b)PHARMACOKINETIC CAUSES:  Alterations in absorption, distribution, metabolism and elimination. c) PHARMACODYNAMIC CAUSES:  Increased sensitivity of target tissue or organs may predispose a person to adverse drug reactions.  Drug receptors.  Homeostatic mechanism.  Disease conditions unmask adverse drug reactions. 2)TYPE B ADVERSE DRUG REACTIONS: Caused due to:  Decomposition of the active ingredient.  Excipients (Additives, Preservatives, Coloring and Solubilizing agents).  Synthetic byproducts of active ingredients. PREVENTION OF ADVERSE DRUG REACTION:  Cannot be totally avoided.  It can only be minimized. STEPS TAKEN INCLUDE:  Avoid inappropriate drugs in the context of clinical condition.  Use appropriate dose, route, frequency based around the patient variables (age, gender, other drugs, other disease conditions etc.).  Elicit medication history, considered untoward incidents, rule out drug interactions.  Elicit history of allergies.  Carry out appropriate monitoring. MANAGEMENT OF ADVERSE DRUG REACTIONS: The ADRs are can be managed by following methods: 1) ASSESS THE NATURE AND SEVERITY OF THE REACTION: Whether an urgent action is required or can be managed by primary care.
PHARMD GURU Page 3 E.g.: whether an anaphylactic shock or something minor. 2) REVIEW ON THE PRESENTING SYMPTOMS:  Timing: Time of start of the reaction after giving the drug; Time taken to abate after the stopping of drug or reducing the dose.  Relationship to dose: Whether reaction minimized with reducing the dose; symptoms resolve when the medicine withdrawn and recur when reintroduced.  Other possible causes: Possibility of underlying illness or other disease; other medications (including OTC and Herbals); drug interactions (including diet). 3) TAKE COMPLETE DRUG HISTORY - REVIEW ANY HISTORY OF ALLERGY OR PREVIOUS ADR:  When the drug was started, dose, other drugs, OTC and herbal. Past ADRs long duration of action or long term use effect can be expected for some drugs.  Review the adverse effect profile of the drugs, and check how common it is. 4) FURTHER EXAMINATION AND INVESTIGATIONS IF REQUIRED: Specific investigations and laboratory tests required. E.g.: Liver and Renal Function Tests.  Assess the reaction: Emergency care/admission, if adverse drug reaction is a serious or life threatening, primary care, or seek specialist advice.  Review the treatment: Either withdraw the suspected drug or reduce the dose.  Manage the symptoms of adverse drug reaction and provide supportive therapy.  Record the adverse drug reaction in the individual's health record.  Consider the submission of adverse drug reaction report (yellow card), if appropriate.  Documentation for the further purpose.