In this lecture I discuss the Management of adverse drug reactions.
Multiple choice question on adverse drug reaction also discuss.
Rapid action is sometimes important because of the
serious nature of a suspected adverse drug reaction, for
example anaphylactic shock.
Emergency treatment and withdrawal of all medicines is occasionally essential, in which case cautious reintroduction of essential medicines
should be considered. Otherwise, using clinical benefit-risk
judgment, together with help from investigations, one
decides which medicine or medicines should be withdrawn
as a trial.
A problem immediately arises if one or more of
the medicines is essential to the patient. If the culprit is
fairly clear, a benefit-risk decision needs to be taken about
the need for the drug (are there equally effective
substitutes that are unlikely to produce the same adverse
drug reaction?), the severity of the reaction, and its
potential for treatment.
If several medicines could be causative, the non-essential medicines should be
withdrawn first, preferably one at a time, depending on the
severity of the reaction. If the reaction is likely to be dose related, dose reduction should be considered.
Many prescribers unnecessarily withhold a drug when interactions are suspected, rather than adjusting the dose.
The patient should be observed during withdrawal. The
waiting period will vary, depending on the rate of
elimination of the drug from the body and the type of
pathology. For example, urticaria usually disappears
quickly when the drug is eliminated, whereas fixed
psoriatic skin reactions can take weeks to resolve.
If the patient is clearly getting better, in keeping with the prediction, alternative medicines for the basic disease can
be introduced if necessary.
If the patient is not doing well
after withdrawal of the first drug, the next most likely
culprit should be considered, and the process repeated. On
the other hand, the patient may be suffering through being
deprived of the medicine withheld. In that case, either
another suitable drug should be substituted (remembering
the possibility of cross-sensitivity), or the same drug should
be tried at a lower dosage (for a dose-related reaction).
The latter approach should be tried if more than one drug
was withheld, for instance if an interaction was suspected
or if the seriousness of the reaction made it wise to
withhold several possible drugs. Reintroduce apparently
essential medicines one at a time, starting with the one
least likely to be the culprit.
If the patient cannot manage without a medicine that
has caused an adverse reaction, provide symptomatic relief
while continuing the essential treatment. For example,
severe nausea and vomiting are routinely treated
symptomatically in patients receiving anti-cancer drugs.
However, when treating an adverse drug reaction, it is
important not to introduce more medicines than are
essential. Always have a clear therapeutic objective in
mind, do not treat for longer than is necessary, and review
the patient regularly and look for ways to simplify
management.
Various playlist of our Channel
Anitmicrobial agent Pharmacology
https://www.youtube.com/watch?v=OjOEO_LpObc&list=PLwijlZe7Cz3WUq5cCltemz1tcpggQFGJf
Human Anatomy & Physiology Lectures Playlist
https://www.youtube.com/watch?v=83d8lyCSgxU&list=PLwijlZe7Cz3Uzqt3s42pvEmXeDJ1E4B1U
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