Beruflich Dokumente
Kultur Dokumente
School of Medicine
Universitas Sumatera Utara
2010
Paracelsus (1493-1541)
Terfenadine (1998)
Mibefradil (1998)
Astemizole (1999)
Grepafloxacin (1999)
Cisapride (2000)
Cerivastatin (2001)
Troglitazone (Rezulin) (2000)
Rofecoxib (Vioxx) (2004)
Only heart disease, cancer, and stroke kill more Americans than
ADRs
The number of deaths from ADRs is three times the number of
deaths from people killed by automobile accidents
What is an
Adverse Drug Reaction (ADR)?
Ref. MCA/CSM Suspected adverse drug reaction (ADR) reporting and the Yellow Card Scheme, Guidance notes
Examples of ADRs
Common ADRs
Constipation with opioids
Sedation with antihistamines
Nausea when starting fluoxetine
Gastrointestinal upset with non steroidal antiinflammatory drugs
Uncommon but well recognised ADRs
Achilles tendonitis caused by quinolone antibiotics
Visual field defects with vigabatrin
Classification
ADR
PREDICTABLE
UNPREDICTABLE
Perpanjangan respons
farmakologik
Penyebab
imunologik
(alergi dan
hipersensitifitas)
Tipe I
Tipe II
Cytotoksisitas
Tipe III
Defek genetik
Tipe IV
Predictable
Drug toxicity
Drug-drug interactions
Drug overdose
UnPredictable
Pseudoallergic
Idiosyncratic
Intolerance
Obat
Obat antitiroid
Benzodiazepin
Barbiturat
Ketregantungan Obat
AINS
Tetrasiklin
Warfarin
Tetrasiklin
Karbimazol
Hipotiroidisme
Benzodiazepin
Letargia
Aspirin
Barbiturat
Mengantuk
PREDICTABLE
UNPREDICTABLE
Synonyms
Mechanism
Predictable, understood
Site
Incidence
High (70%)
Low(30%)
Morbidity
Mild
Severe
Mortality
Low
High
Phseutic
Phkinetic
Liberation of an abnormal
metabolite
Phdynamic
1. Genetic
2. Immunologic
3. Neoplastic
4. Teratologic
Reproducibility
Reproducible
Not reproducible
Treatment
Stop treatment
Causes
Age
- Very young
Very old
Pregnancy
Risk to fetal development (first trimester, phenytoin)
Prevention of ADRs
Avoid inappropriate in the context of clinical condition
Use right dose, route, frequency, based on patient variables
Elicit medication history; consider untoward incidents
Elicit history of allergies ( in patients with allergic disease)
PENCEGAHAN ROTD
PASIEN
Pemantauan pasien
Pengurangan dosis
DOKTER
APOTEKER
PERAWAT
No
Other etiology likely
Is there a suspicion of
drug-induced hypersensitivity/
immunologic reaction?
Nonimmune mechanism
Pharmacologic side effect
Drug toxicity
Drug-drug interactions
Drug overdose
Pseudoallergic
Idiosyncratic
Intolerance
Immune mechanism
IgE-mediated
Cytotoxic
Immune complex
Delayed, cell-mediated
Other immune mechanism
Evaluate with appropriate
confirmatory tests.
Are tests supportive of
immune drug reaction?
Yes
Diagnosis of drug
hypersensitivity/
immunologic
reaction confirmed
No
No
Management
Consider desensitization (IgE) or
graded challenge (non-IgE) before
administration, as appropriate.*
Anaphylactic reactions require prompt
emergency treatment.
Avoid drug if possible.
Consider prophylactic regimen before
administration (if shown to be effective).
Prudent use of drugs in future
Patient education
Remember!
All health-care professionals have a
responsibility to inform colleagues
about clinically important adverse
drug reactions that they detect, even
if a well-recognised or causal link is
uncertain.
Edwards IR and Aronson JK. Adverse drug reactions: definitions, diagnosis, and
management. Lancet 2000; 356: 1255-59