Recognizing Hospital Adverse Drug Reactions

Abstract

Adverse drug reactions (ADRs) are a frequently overlooked complication of drug therapy. The categories of drugs most commonly implicated include anticoagulants, antimicrobials, cardiac agents, CNS agents, diagnostic agents, nonsteroidal antiinflammatory agents, and hormones. In addition to knowing what drug classes most commonly produce ADRs, the clinician should also recognize what drugs are most frequently associated with specific ADRs. Anaphylaxis is one of the most serious, and potentially life-threatening, ADRs. Treatment of an anaphylactic reaction involves correcting the physiologic effects of released chemical mediators and also inhibiting the release of additional mediators. The mainstay of therapy is aqueous epinephrine. Severe reactions may require administration of aminophylline, inotropic agents, antihistamines, corticosteroids, and intravenous fluids. The best treatment for any ADR is prevention. Pharmacists can actively participate in the monitoring of risk factors, especially the number of drugs in a regimen, potential drug interactions, and drug allergies, which may predispose patients to ADR development. Pharmacists can also assist in the detection of ADRs by monitoring alerting orders. Other potential activities for pharmacists include providing timely and accurate information about ADRs ; educating patients, physicians, and other health care professionals; and influencing prescribing patterns to minimize the trend towards polypharmacy.