Chapter 005. Principles of Clinical Pharmacology (Part 14)

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Diagnosis and Treatment of Adverse Drug Reactions The manifestations of drug-induced diseases frequently resemble those of other diseases, and a given set of manifestations may be produced by different and dissimilar drugs. Recognition of the role of a drug or drugs in an illness depends on appreciation of the possible adverse reactions to drugs in any disease, on identification of the temporal relationship between drug administration and development of the illness, and on familiarity with the common manifestations of the drugs. Many associations between particular drugs and specific reactions have been described, but there is always a "first time"...

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Chapter 005. of Clinical (Part 14) and Treatment of Adverse Drug Reactions The of diseases resemble those of other diseases, and a given set of may be produced by different and drugs. of the role of a drug or drugs in an illness depends on of the possible adverse reactions to drugs in any disease, on of the temporal between drug and of the illness, and on with the common of the drugs. Many between drugs and specific reactions have been but there is always a "first time" for a novel and any drug should be suspected of causing an adverse effect if the clinical setting is related to a drug's intended action is often more easily than illness to immune or other For side effects such as cardiac in patients receiving in patients given insulin, and bleeding in patients receiving are more readily related to a specific drug than are symptoms such as fever or rash, which may be caused by many drugs or by other factors. sources of adverse drug reactions can be useful. However, often provide little sense of in terms of and which can vary among patients. a drug history from patients is important for Attention must be directed to OTC drugs and herbal as well as to drugs. Each type can be for adverse drug effects, and adverse may occur between OTC drugs and drugs. Loss of efficacy of oral or by use of St. John's wort are In addition, it is common for patients to be cared for by several and additive, or drug may therefore be if the are not aware of the drug Every physician should determine what drugs a patient has been taking, for the previous month or two ideally, before any stopped for or adverse effects should be to avoid pointless and dangerous A source of drug exposure is topical therapy; for example, a patient of may not mention that an beta blocker is being used unless asked. A history of previous adverse drug effects in patients is common. Since these patients have shown a to such a history should dictate added caution in drugs. studies may include of serum antibody in some persons with drug allergies involving cellular blood elements, as in hemolytic anemia, and For example, both quinine and quinidine can produce platelet in vitro in the presence of and the serum from a patient who has developed use of this drug. such as G6PD serum level, or may also be useful in often after an adverse effect has occurred in the patient or a family member. Once an adverse reaction is of the suspected drug followed by of the reaction is evidence of a illness. evidence may be sought by the drug and seeing if the reaction However, that should be done only if would be useful in the future of the patient and if the attempt would not entail undue risk. With adverse lowering the dosage may cause the reaction to and raising it may cause the reaction to reappear. When the reaction is thought to be allergic, of the drug may be since may is unwise under these unless no drugs are available and treatment is If the patient is receiving many drugs when an adverse reaction is the drugs likeliest to be can usually be this should include both potential culprit agents as well as drugs that alter their All drugs may be at once or, if this is not one at a time, starting with the ones most suspect, and the patient for signs of The time needed for a adverse effect to disappear depends on the time required for the to fall below the range with the adverse effect; that, in turn, depends on the initial blood level and on the rate of or of the drug. Adverse effects of drugs with long or those not related to serum may take a time to Summary Modern clinical aims to replace in the use of drugs with therapy based on in-depth of factors that determine an response to drug Molecular genetics, clinical trials, and the educated all to this process. No drug response should ever be termed all responses have a mechanism whose will help guide further therapy with that drug or This rapidly expanding of in drug actions makes the process of drugs for the However, should guide this  The benefits of drug therapy, however defined, should always the risk.  The smallest dosage necessary to produce the desired effect should be used.  The number of and doses per day should be  Although the is rapidly accessing it is easier; tools such as computers and hand-held devices to search of and unbiased opinion will become  Genetics play a role in in drug and may become a part of clinical practice.  should be wary when adding or specific drugs that are liable to provoke and adverse should use only a limited number of drugs, with which they are familiar.