Management of ADR
Management Rapid action is sometimes important because of the serious nature of a suspected adverse drug reaction, for example anaphylactic shock. Emergency treatment and withdrawal of all medicines is occasionally essential, in which case cautious reintroduction of essential medicines should be considered. Otherwise, using clinical benefit-risk judgment, together with help from investigations, one decides which medicine or medicines should be withdrawn as a trial.
A problem immediately arises if one or more of the medicines is essential to the patient. If the culprit is fairly clear, a benefit-risk decision needs to be taken about the need for the drug (are there equally effective substitutes that are unlikely to produce the same adverse drug reaction?), the severity of the reaction, and its potential for treatment.
If several medicines could be causative, the non-essential medicines should be withdrawn first, preferably one at a time, depending on the severity of the reaction. If the reaction is likely to be doserelated, dose reduction should be considered. Many prescribers unnecessarily withhold a drug when interactions are suspected, rather than adjusting the dose.
The patient should be observed during withdrawal. The waiting period will vary, depending on the rate of elimination of the drug from the body and the type of pathology. For example, urticaria usually disappears quickly when the drug is eliminated, whereas fixed psoriatic skin reactions can take weeks to resolve. If the patient is clearly getting better, in keeping with the prediction, alternative medicines for the basic disease can be introduced if necessary.
If the patient is not doing well after withdrawal of the first drug, the next most likely culprit should be considered, and the process repeated. On the other hand, the patient may be suffering through being deprived of the medicine withheld. In that case, either another suitable drug should be substituted (remembering the possibility of cross-sensitivity), or the same drug should be tried at a lower dosage (for a dose-related reaction).
The latter approach should be tried if more than one drug was withheld, for instance if an interaction was suspected or if the seriousness of the reaction made it wise to withhold several possible drugs. Reintroduce apparently essential medicines one at a time, starting with the one least likely to be the culprit.
If the patient cannot manage without a medicine that has caused an adverse reaction, provide symptomatic relief while continuing the essential treatment. For example, severe nausea and vomiting are routinely treated symptomatically in patients receiving anti-cancer drugs.
However, when treating an adverse drug reaction, it is important not to introduce more medicines than are essential. Always have a clear therapeutic objective in mind, do not treat for longer than is necessary, and review the patient regularly and look for ways to simplify management.
Full detailed article : https://sci-hub.hkvisa.net/10.1016/0091-6749(84)90110-6
MCQ on Pharmacovigilance given at the end of Lecture (see above lecture)
Pharmacovigilance Lectures Playlist
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