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)

CCC Pharmacology Series

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the  Clinician Educator Incubator programme, and a CICM First Part Examiner.

He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.

His one great achievement is being the father of three amazing children.

On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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