Toxic Toll: Adverse Drug Reactions Requiring Critical Care
-
Upload
changezkn -
Category
Health & Medicine
-
view
533 -
download
4
description
Transcript of Toxic Toll: Adverse Drug Reactions Requiring Critical Care
![Page 1: Toxic Toll: Adverse Drug Reactions Requiring Critical Care](https://reader034.fdocuments.in/reader034/viewer/2022052617/547db010b479598e508b49c5/html5/thumbnails/1.jpg)
![Page 2: Toxic Toll: Adverse Drug Reactions Requiring Critical Care](https://reader034.fdocuments.in/reader034/viewer/2022052617/547db010b479598e508b49c5/html5/thumbnails/2.jpg)
Toxic Toll: Adverse Toxic Toll: Adverse Drug Reactions Drug Reactions Requiring Critical Requiring Critical CareCare
Angela Collins DSN,RN,CCNS,APRN BCAngela Collins DSN,RN,CCNS,APRN BC
The University of Alabama The University of Alabama
Region 6 Region 6
Greater Birmingham Chapter of ACCNGreater Birmingham Chapter of ACCN
![Page 3: Toxic Toll: Adverse Drug Reactions Requiring Critical Care](https://reader034.fdocuments.in/reader034/viewer/2022052617/547db010b479598e508b49c5/html5/thumbnails/3.jpg)
Disclosures / None
![Page 4: Toxic Toll: Adverse Drug Reactions Requiring Critical Care](https://reader034.fdocuments.in/reader034/viewer/2022052617/547db010b479598e508b49c5/html5/thumbnails/4.jpg)
Check the Sound of the Umbicals
![Page 5: Toxic Toll: Adverse Drug Reactions Requiring Critical Care](https://reader034.fdocuments.in/reader034/viewer/2022052617/547db010b479598e508b49c5/html5/thumbnails/5.jpg)
ObjectivesObjectives
Discuss variables that influence or increase the Discuss variables that influence or increase the likelihood of an Adverse Drug Reaction (ADR) likelihood of an Adverse Drug Reaction (ADR) occurrence.occurrence.
Delineate case reports of seven drug classifications Delineate case reports of seven drug classifications associated with adverse drug reactions.associated with adverse drug reactions.
Consider how skilled communication can improve Consider how skilled communication can improve data collection to build an evidence base about data collection to build an evidence base about adverse drug reactions.adverse drug reactions.
![Page 6: Toxic Toll: Adverse Drug Reactions Requiring Critical Care](https://reader034.fdocuments.in/reader034/viewer/2022052617/547db010b479598e508b49c5/html5/thumbnails/6.jpg)
Risks,Benefits,AlternativeRisks,Benefits,Alternativess
Variables that Variables that influence ADR’sinfluence ADR’s
Number of ADR’sNumber of ADR’s
Complex ProcessesComplex Processes
![Page 7: Toxic Toll: Adverse Drug Reactions Requiring Critical Care](https://reader034.fdocuments.in/reader034/viewer/2022052617/547db010b479598e508b49c5/html5/thumbnails/7.jpg)
Whose responsibility?Whose responsibility?
FDAFDA
PatientPatient
Licensed Independent PractionerLicensed Independent Practioner
AdministratorAdministrator
![Page 8: Toxic Toll: Adverse Drug Reactions Requiring Critical Care](https://reader034.fdocuments.in/reader034/viewer/2022052617/547db010b479598e508b49c5/html5/thumbnails/8.jpg)
DRUG + UNIQUE DRUG + UNIQUE PHYSIOLOGY = ADRPHYSIOLOGY = ADR
Unique genetic Unique genetic blendsblends
Designer profilesDesigner profiles
CostCost
![Page 9: Toxic Toll: Adverse Drug Reactions Requiring Critical Care](https://reader034.fdocuments.in/reader034/viewer/2022052617/547db010b479598e508b49c5/html5/thumbnails/9.jpg)
![Page 10: Toxic Toll: Adverse Drug Reactions Requiring Critical Care](https://reader034.fdocuments.in/reader034/viewer/2022052617/547db010b479598e508b49c5/html5/thumbnails/10.jpg)
Steven’s Johnson Part of Steven’s Johnson Part of TEN (Toxic Epidermal TEN (Toxic Epidermal Necrolysis)Necrolysis)
![Page 11: Toxic Toll: Adverse Drug Reactions Requiring Critical Care](https://reader034.fdocuments.in/reader034/viewer/2022052617/547db010b479598e508b49c5/html5/thumbnails/11.jpg)
Rashes that lead to Rashes that lead to disability and deathdisability and death
http://www.emedicinehealth.com/life-threatening_skin_rashes/article_em.htm
http://www.sjsupport.org/
![Page 12: Toxic Toll: Adverse Drug Reactions Requiring Critical Care](https://reader034.fdocuments.in/reader034/viewer/2022052617/547db010b479598e508b49c5/html5/thumbnails/12.jpg)
Offending MedicationsOffending Medications
Anti-seizureAnti-seizure
Antibiotics Antibiotics particularly sulfaparticularly sulfa
CocaineCocaine
Herpes SimplexHerpes Simplex
![Page 13: Toxic Toll: Adverse Drug Reactions Requiring Critical Care](https://reader034.fdocuments.in/reader034/viewer/2022052617/547db010b479598e508b49c5/html5/thumbnails/13.jpg)
Why Critical Care?Why Critical Care?
Treat like a burn Treat like a burn patientpatient
Percentage of BSA Percentage of BSA involvedinvolved
Locate the offending Locate the offending medicationmedication
![Page 14: Toxic Toll: Adverse Drug Reactions Requiring Critical Care](https://reader034.fdocuments.in/reader034/viewer/2022052617/547db010b479598e508b49c5/html5/thumbnails/14.jpg)
Serotonin SyndromeSerotonin Syndrome
Number of persons Number of persons taking taking antidepressantsantidepressants
Number of persons Number of persons experiencing experiencing syndromesyndrome
![Page 15: Toxic Toll: Adverse Drug Reactions Requiring Critical Care](https://reader034.fdocuments.in/reader034/viewer/2022052617/547db010b479598e508b49c5/html5/thumbnails/15.jpg)
Signs and SymptomsSigns and Symptoms
Action potentialsAction potentials
without purposewithout purpose
Cardiac and neural Cardiac and neural tissues in imbalancetissues in imbalance
![Page 16: Toxic Toll: Adverse Drug Reactions Requiring Critical Care](https://reader034.fdocuments.in/reader034/viewer/2022052617/547db010b479598e508b49c5/html5/thumbnails/16.jpg)
Antibiotics in the Action Potential
![Page 17: Toxic Toll: Adverse Drug Reactions Requiring Critical Care](https://reader034.fdocuments.in/reader034/viewer/2022052617/547db010b479598e508b49c5/html5/thumbnails/17.jpg)
Linezoid ( )
![Page 18: Toxic Toll: Adverse Drug Reactions Requiring Critical Care](https://reader034.fdocuments.in/reader034/viewer/2022052617/547db010b479598e508b49c5/html5/thumbnails/18.jpg)
BEWARE OF THE BLACK BEWARE OF THE BLACK BOXBOX
![Page 19: Toxic Toll: Adverse Drug Reactions Requiring Critical Care](https://reader034.fdocuments.in/reader034/viewer/2022052617/547db010b479598e508b49c5/html5/thumbnails/19.jpg)
Vitamin K
Anaphylactic shock associated with IV use
IV has no advantage over subcutaneous
No change in rate of metabolism
![Page 20: Toxic Toll: Adverse Drug Reactions Requiring Critical Care](https://reader034.fdocuments.in/reader034/viewer/2022052617/547db010b479598e508b49c5/html5/thumbnails/20.jpg)
Dilantin
PHENYTOIN
![Page 21: Toxic Toll: Adverse Drug Reactions Requiring Critical Care](https://reader034.fdocuments.in/reader034/viewer/2022052617/547db010b479598e508b49c5/html5/thumbnails/21.jpg)
BE on the Q-T
Medications that
Change the Q-T interval
Categories that offend
Additive effect or genetic story
![Page 22: Toxic Toll: Adverse Drug Reactions Requiring Critical Care](https://reader034.fdocuments.in/reader034/viewer/2022052617/547db010b479598e508b49c5/html5/thumbnails/22.jpg)
Serotonin’s RoleSerotonin’s Role
ManicManic
Pursuit of HappinessPursuit of Happiness
ReversalReversal
From an antibioticFrom an antibiotic
![Page 23: Toxic Toll: Adverse Drug Reactions Requiring Critical Care](https://reader034.fdocuments.in/reader034/viewer/2022052617/547db010b479598e508b49c5/html5/thumbnails/23.jpg)
Suicide / Triggered by Medications
Interferon
Accutane
Pediatric patients
![Page 24: Toxic Toll: Adverse Drug Reactions Requiring Critical Care](https://reader034.fdocuments.in/reader034/viewer/2022052617/547db010b479598e508b49c5/html5/thumbnails/24.jpg)
Rates of Suicide Attempt by Age Group
SSRI ANTIDEPRESSANT USAGE
Risk StatisticsSSRI None
AGE GROUP
Suicide Attempts
Number of
Subjects
Rate per 1,000
Suicide Attempts
Number of Subjects
Rate per 1,000
RR Lower 95% CL
Upper 95%CL
19-24 40 9,214 4.34 122 27,317 4.46 0.97 0.68 1.39
25-64 75 67,853 1.11 364 252,178 1.44 0.77 0.59 0.98
65+ 2 2,810 0.71 10 12,214 0.82 0.87 0.19 3.96
Overall 117 79,877 1.47 496 291,709 1.70 0.86 0.70 1.05
Source: FDA Website
![Page 25: Toxic Toll: Adverse Drug Reactions Requiring Critical Care](https://reader034.fdocuments.in/reader034/viewer/2022052617/547db010b479598e508b49c5/html5/thumbnails/25.jpg)
Main Findings: Pediatric Population Rate of MDD Diagnosing in Population decreased
Rate of diagnosed MDD per 1,000 enrollees dropped significantly Fraction of diagnosed episodes classified as “New” decreased
(increasing fraction of recurrent episodes) Pediatricians, PCP’s diagnosing MDD less, Psychiatrists more
Decrease in antidepressant prescribing Pediatricians, PCP’s, Psychiatrists all prescribing less, Other (known)
specialists prescribing more (emergency medicine=highest) SSRIs being prescribed less, in favor of no antidepressant therapy
No Major Substitution Patterns are Apparent No significant shifts towards increased use of psychotherapy,
atypical antipsychotic or anxiolytic drugs in lieu of antidepressants
![Page 26: Toxic Toll: Adverse Drug Reactions Requiring Critical Care](https://reader034.fdocuments.in/reader034/viewer/2022052617/547db010b479598e508b49c5/html5/thumbnails/26.jpg)
Photodynamic Photodynamic LasersLasers
Pharmacology + LightPharmacology + Light
Photoferrin Photoferrin
![Page 27: Toxic Toll: Adverse Drug Reactions Requiring Critical Care](https://reader034.fdocuments.in/reader034/viewer/2022052617/547db010b479598e508b49c5/html5/thumbnails/27.jpg)
Cancer therapyCancer therapy
NSCLS NSCLS
Stage IStage I
Stage IVStage IV
![Page 28: Toxic Toll: Adverse Drug Reactions Requiring Critical Care](https://reader034.fdocuments.in/reader034/viewer/2022052617/547db010b479598e508b49c5/html5/thumbnails/28.jpg)
Photodynamic LasersPhotodynamic Lasers
Pharmacology + LightPharmacology + Light
Photoferrin Photoferrin
![Page 29: Toxic Toll: Adverse Drug Reactions Requiring Critical Care](https://reader034.fdocuments.in/reader034/viewer/2022052617/547db010b479598e508b49c5/html5/thumbnails/29.jpg)
Propofol: Milk of Propofol: Milk of Sedation?Sedation?
Favorite medication in critical careFavorite medication in critical care
Handle with careHandle with care
Watch out in the Neuro ICUWatch out in the Neuro ICU
Monitor for febrile reactions, Refractory Monitor for febrile reactions, Refractory Acidosis, Not for pediatricsAcidosis, Not for pediatrics
![Page 30: Toxic Toll: Adverse Drug Reactions Requiring Critical Care](https://reader034.fdocuments.in/reader034/viewer/2022052617/547db010b479598e508b49c5/html5/thumbnails/30.jpg)
Labeled/// High Risk High Labeled/// High Risk High Alert?Alert?
Calculate it is all about the amount of Calculate it is all about the amount of adipose tissueadipose tissue
Right environment? Right credential?Right environment? Right credential?
![Page 31: Toxic Toll: Adverse Drug Reactions Requiring Critical Care](https://reader034.fdocuments.in/reader034/viewer/2022052617/547db010b479598e508b49c5/html5/thumbnails/31.jpg)
Labeled High Risk - High Alert?Labeled High Risk - High Alert?
Calculate !Calculate ! It is all about It is all about
the amount of the amount of adipose tissueadipose tissue
Right environment? Right credential?Right environment? Right credential?
![Page 32: Toxic Toll: Adverse Drug Reactions Requiring Critical Care](https://reader034.fdocuments.in/reader034/viewer/2022052617/547db010b479598e508b49c5/html5/thumbnails/32.jpg)
Head Trauma/ / Propofol Syndrome
![Page 33: Toxic Toll: Adverse Drug Reactions Requiring Critical Care](https://reader034.fdocuments.in/reader034/viewer/2022052617/547db010b479598e508b49c5/html5/thumbnails/33.jpg)
Farewell to Harms
![Page 34: Toxic Toll: Adverse Drug Reactions Requiring Critical Care](https://reader034.fdocuments.in/reader034/viewer/2022052617/547db010b479598e508b49c5/html5/thumbnails/34.jpg)
Farewell to Harms
![Page 35: Toxic Toll: Adverse Drug Reactions Requiring Critical Care](https://reader034.fdocuments.in/reader034/viewer/2022052617/547db010b479598e508b49c5/html5/thumbnails/35.jpg)
Farewell to Harms
![Page 36: Toxic Toll: Adverse Drug Reactions Requiring Critical Care](https://reader034.fdocuments.in/reader034/viewer/2022052617/547db010b479598e508b49c5/html5/thumbnails/36.jpg)