Adverse Drug Reactions
TYPES
Expected
Pharmaceutics
- compatibility issues
- effects of associated additives and preservatives
Pharmacokinetics
- absorption
- competition for binding sites
- enzyme induction
Pharmacodynamics
- side effects
- toxic effects
- innocent bystander organs
- agonism of receptor sites other than target sites (bradycardia with suxamethonium)
Interactions with other drugs
- prolongation of effect (gentamicin and neuromuscular blockade)
- enzyme induction or inhibition
- additive effects (erythromycin, haloperidol, amiodarone and prolong QT syndrome)
Unexpected
- idiosyncratic reactions (haematological, hepatic, dermatological)
- allergy (mild -> anaphylaxis/anaphylactoid reactions)
PREVENTION
History
- good drug history, normal medications, OTC,
- alcohol intake
- previous drug reactions
- clear documentation in notes of alerts and allergies
- consideration of co-morbid conditions that make adverse effects more likely (respiratory depression and OSA)
Examination
- looking for conditions that make reactions more likely
Management
- careful prescribing
- knowledge of drugs and interactions
- vigilance in monitoring for adverse effects
- close liaison with clinical pharmacologist
- appropriate drug monitoring (drug levels, organ function)
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC