The management of ADRs depends on
;the type of reaction and severity. The questions that need to be answered when an ADR is suspected include:
Recognition of Adverse Drug Reactions and Identification of the Offending Agent
Clinical and Medication Histories
A detailed clinical history
;is necessary to
;identify an ADR and its severity. Determining
;if the patient experienced a reaction of significant concern is of particular importance. Simple open-ended questions to ask include but are not limited to:
Obtaining an accurate medication history is also important. Questions to be considered include but are not limited to:
The medication history should be taken from the most reliable source(s). Often, patients are unreliable historians or unable to provide history due to illness. Thus, members must consider the use of multiple sources. Beyond the patient, a medication history may be obtained directly from a caregiver, the patient's preferred pharmacy, documentation in the electronic medical record, or a combination of these. Beware of relying on static "medication lists" as these are often outdated and may not appraise self-medication, supplement use, or recent changes. Consider employing a pharmacist, nurse, or other medical professional with special medication history training if this does not lead to a significant delay in obtaining the medication history.
Temporal Association
Clinicians
;should
;investigate the
;temporal association(s) between the administered medication(s) and the reaction. They should also use available literature to assist in determining the likelihood of the drug causing the reaction.
Diagnostic AlgorithmsHyderabad Investment
When an ADR diagnosis is in doubt, several decision aids and algorithms can be employed. Available tools include the Naranjo algorithm, the Begaud algorithm, the Yale algorithm, the Jones algorithm, the Karch algorithm, the ADRAC, the WHO-UMC16, and the quantitative approach algorithm.
;The Naranjo algorithm uses
;a scoring system to indicate the likelihood of an ADR. A score of
;strongly indicates an ADR. A score of 5
;to 8 indicates a probable ADR, while a score of
;to 4 indicates a possible ADR. A score of 0 indicates that an ADR is in doubt.
;Though these algorithms can help with assessing the causality of ADRs, they cannot prove or disprove such an association.
Diagnostic Testing
Despite detailed evaluation and use of the algorithms, it may be challenging to identifyAhmedabad Wealth Management
;whether the reaction is related to a medicationGuoabong Stock. In such cases,
;additional diagnostic testing may help determine an ADR diagnosis.
Treatment of Adverse Drug Reactions
Modifying the dosage or discontinuing the offending agent is the most crucial step in treating an ADR. The basic treatment plan for some of the common ADRs is as follows:
Drug Overdose
Drug overdose can be accidental or intentional, and symptoms depend on the medication(s) used, the amount of drug taken, whether the toxicity is acute or chronic, and the influence of underlying medical conditions. In case of severe reactions, one must ensure that the airway and circulation are maintained. An appropriate antidote (for example, N-acetyl cysteine for acetaminophen toxicity, naloxone for opioid toxicity) needs to be administeredMumbai Wealth Management. Consulting with poison control or a toxicologist, especially in an overdose of an unknown amount or combination of medications, is critical in the management of drug overdose.
Urticaria
Urticaria is usually treated with antihistamines such as diphenhydramine, cetirizine, levocetirizine, and loratadine.
;Histamine 2 receptor antagonists such as ranitidine may also be beneficialSimla Investment. Additionally, corticosteroids such as prednisone may also be beneficial.
Exanthematous Drug Eruptions
Topical corticosteroids and oral antihistamines are effective for treating exanthematous drug eruptions. Systemic corticosteroids can be considered in case of a widespread reaction.
Acute Generalized Exanthematous Pustulosis
AGEP is a self-limiting disease with a favorable prognosis. The recommended management of AGEP includes withdrawal of the offending drug, supportive care, and symptomatic treatment of pruritus and skin inflammation with topical corticosteroids.
Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis
SJS and TEN are severe ADRs
;and should be managed in a tertiary care facility that can treat burns patients.
;These reactions are characterized by widespread detachment of skin, a high risk for fluid and electrolyte imbalances, sepsis, organ dysfunction, and death. Depending on the extent of the disease, organ involvement, the patient's age, and other comorbidities, the mortality rate is about 10% to 50%.
;In addition to stopping the offending agent, management should focus on supportive care and preventing short- and long-term complications. The patient will need wound care, fluid management, pain control, and management of other complications such as sepsis. Besides supportive care, pharmacotherapy with cyclosporin or etanercept might be beneficial in cases of severe skin involvement.
;The role of systemic corticosteroids is unclear.
Drug Reaction With Eosinophilia and Systemic Symptoms
This condition has various manifestations involving skin and other organ systems. Management of the condition is based on the extent and severity of skin and organ involvement. Mild symptoms may be managed
;in the outpatient setting, but severe symptoms require hospitalization.
;Topical corticosteroids can be used for mild skin reactions. For severe symptoms, in addition to supportive therapy, systemic corticosteroids are considered to be the first-line therapy.
;Second-line treatment options include immunosuppressive therapies like cyclosporine and intravenous immunoglobulin.
Anaphylaxis
Anaphylaxis constitutes a medical emergency. The offending agent should be immediately stopped, and IM epinephrine should be administered promptly. Simultaneous oxygen administration, fluid resuscitation, and albuterol nebulization should be provided. Adjunctive therapies include intravenous antihistamines (histamine 1 and 2 receptor antagonists) and intravenous corticosteroids. If there is evidence of impending airway obstruction or compromise, intubation is required. In the case of anaphylactic shock, the patient may
;require additional fluid and vasopressor administration.
Desensitization
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