tailieunhanh - Chapter 005. Principles of Clinical Pharmacology (Part 14)

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". | Chapter 005. Principles of Clinical Pharmacology Part 14 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 for a novel association and any drug should be suspected of causing an adverse effect if the clinical setting is appropriate. Illness related to a drug s intended pharmacologic action is often more easily recognized than illness attributable to immune or other mechanisms. For example side effects such as cardiac arrhythmias in patients receiving digitalis hypoglycemia in patients given insulin and bleeding in patients receiving anticoagulants 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. Electronic sources of adverse drug reactions can be useful. However exhaustive compilations often provide little sense of perspective in terms of frequency and seriousness which can vary considerably among patients. Eliciting a drug history from patients is important for diagnosis. Attention must be directed to OTC drugs and herbal preparations as well as to prescription drugs. Each type can be responsible for adverse drug effects and adverse interactions may occur between OTC drugs and prescribed drugs. Loss of efficacy of oral contraceptives or cyclosporine by concurrent use of St. John s wort are examples. In addition it is common for patients to be cared for by several physicians and .