Ioatrogenic disease

Disease induced by/ due to the activity of a physician or therapy. For example, an iatrogenic illness is an illness that is caused by a medication or physician.
What are iatrogenic effects?
Medical error and negligence. Iatrogenic conditions do not necessarily result from medical errors, such as mistakes made in surgery, or the prescription or dispensing of the wrong therapy, such as a drug. In fact, intrinsic and sometimes adverse effects of a medical treatment are iatrogenic.

What is social Iatrogenesis?
Medicalisation is associated with a social process that Illich termed 'iatrogenesis'. This concept refers to the detrimental consequences of medical interventions (clinical iatrogenesis), such as adverse drug reactions and hospital acquired infections.

1. Ioatrogenic Disease
Presented by
Dr. Debasish Pradhan
Sr. Faculty Pharmacology
University Department of Pharmaceutical Sciences
Utkal University, VaniVihar, Bhubaneswar, Odisha
NAAC A+

2. What is iatrogenic?
Iatrogenic:
Diseaseinducedby/duetotheactivityofaphysicianortherapy.Forexample,
aniatrogenicillnessisanillnessthatiscausedbyamedicationorphysician.
Whatareiatrogeniceffects?
Medicalerrorandnegligence.Iatrogenicconditionsdonotnecessarilyresultfrom medical
errors,suchasmistakesmadeinsurgery,ortheprescriptionordispensingofthe wrongtherapy,
suchasadrug.Infact,intrinsicandsometimesadverseeffectsofa medical treatment
areiatrogenic.
WhatissocialIatrogenesis?
MedicalisationisassociatedwithasocialprocessthatIllichtermed'iatrogenesis'.This
conceptreferstothedetrimentalconsequences ofmedicalinterventions
(clinicaliatrogenesis),suchasadversedrugreactionsandhospitalacquiredinfections.

3. Causes of Iatrogenesis
Causes of iatrogenesis may include:
complications arising from a medical procedure or treatment
side effectsof possibledrug interactions
medical errors
negligence
use ofcontaminatedinstruments
anxietyor annoyance in the patient, physician or treatment provider in relation to
medical procedures or treatments
unnecessary medical treatmentresulting from a physician's decision

4. Medical Error & Negligence
Iatrogenicconditionsdonotnecessarilyresultfrommedicalerrors,suchasmistakes
madeinsurgery,ortheprescriptionordispensingofthewrongtherapy,suchas
adrug.Infact,intrinsicandsometimesadverseeffectsofamedicaltreatmentare
iatrogenic.Forexample,radiationtherapyandchemotherapy—necessarily
aggressivefortherapeuticeffect–frequentlyproducesuchiatrogeniceffectsashair
loss,hemolyticanemia,diabetesinsipidus,vomiting,nausea,brain
damage,lymphedema,infertility,etc.
Theincidenceofiatrogenesismaybemisleadinginsomecases.Forexample,
rupturedaorticaneurysmisfatalinmostcases;thesurvivalrateforarupturedaortic
aneurysmisunder25%.Patientswhodieduringorafteranoperationwillstillbe
considerediatrogenicdeaths,buttheprocedureitselfremainsabetterbetthanthe
100%probabilityofdeathifleftuntreated.
Othersituationsmayinvolveactualnegligenceorfaultyprocedures,suchas
whenpharmacotherapistsproducehandwrittenprescriptionsfordrugs.

5. Adverse Effects
Averycommoniatrogeniceffectiscausedbydruginteraction,i.e.,whenpharmacotherapistsfailto
checkforallmedicationsapatientistakingandprescribenewonesthatinteractagonisticallyor
antagonistically(therebypotentiatingorattenuatingtheintendedtherapeuticeffect).Suchsituations
cancausesignificantmorbidityandmortality.Adversereactions,suchasallergicreactionstodrugs,
evenwhenunexpectedbypharmacotherapists,arealsoclassifiedasiatrogenic.
Theevolutionofantibioticresistanceinbacteriaisiatrogenicaswell.Bacterialstrainsresistantto
antibioticshaveevolvedinresponsetotheoverprescriptionofantibioticdrugs.
Certaindrugsaretoxicintheirownrightintherapeuticdosesbecauseoftheirmechanismof
action.Alkylatingantineoplasticagents,forexample,causeDNAdamage,whichismoreharmfulto
cancercellsthanregularcells.However,alkylationcausessevereside-effectsandis
actuallycarcinogenicinitsownright,withpotentialtoleadtothedevelopmentofsecondarytumors.In
asimilarmanner,arsenic-basedmedicationslikemelarsoprol,usedtotreattrypanosomiasis,can
causearsenicpoisoning.
Adverseeffectscanappearmechanically.Thedesignofsomesurgicalinstrumentsmaybedecades
old,hencecertainadverseeffects(suchastissuetrauma)mayneverhavebeenproperlycauterized.
[

6. Class A drugs
ClassAdrugsareconsideredtobemostdangeroustohealth.Theyinclude:
cocaine(includingcrack;nicknamedcharlie,coke,snow),dicanol,
heroin(nicknamedsmack,H,gear,scag,brown),LSD(lysergicaciddiethylamide;
nicknamedacid,trips,blotters,tabs),
mescalin,methylamphetamine(crystalmeth),
methadone,morphine,
opium;PCP(phencyclidine;nicknamedangeldust),pethadine,
poppystraw,psilocybin,
STP(amphetamine;nicknamedserenity,tranquilityandpeace),
magicmushrooms(nicknamedliberties,shrooms),and
DMA(methylenedioxymethamphetamine;nicknamedecstasy,E,pills,XTC,disco
biscuits,Mitsubishis,Rolexs,dolphins).

7. Class B drugs
ClassBdrugsarealsoconsideredtobedangerous,butlessso
thanclassAdrugs.Theyinclude:
amphetamine(aningredientofecstasy;nicknamedspeed,whizz,
dexies),
codeine(inconcentrationsabove2.5%),
DF118(dihydrocodeine),
ritalin,andbarbiturates.

8. Class C drugs
ClassCdrugsareconsideredtobetheleastharmfulto
healthbuttheyarestillillegaltopossessandgiveorsellto
otherpeople.Theyinclude:
cannabis,cannabisresinandcannabinol(marijuana,grass,
pot,weed),
methaqualone,anabolicsteroids(nicknamedroids),
ketamine(nicknamedspecialK,vitaminK,green),
GHB(gammahydroxybutrate;nicknamedGBH,liquidecstasy
andsometimesreferredtoasdate-rapedrugs),
benzodiazepinesincludingvalium,androhypnol(nicknamed
roofiesandsometimesreferredtoasdate-rapedrugs).

9. Drug induced renal disorders
NSAIDS,ACE-inhibitors,Diuretics,Interleukin-2,Amphotericin-B
ACUTETUBULARNECROSIS
Aminoglycosides,Rifampicin,NSAIDs,Cyclosporines,Cis-platin
ACUTEINTERSTITIALNEPHRITIS
Pencillins,NSAIDs,Allopurinol,Thiazides,Sulphonamides
HEMOLYTICUREMICSYNDROME
Mitomycin-c,cyclosporin,Quinine,Cocaine,Clopidogrel

10. ISOLATED PROTEINURIA WITH NEPHRITIC
SYNDROME
Gold. Heroin, Captopril, NSAIDs, IFN-alpha, D-pencillamine
CHRONIC TUBULOINTERSTITIAL DISEASE:
NSAIDs, Thiazides, Lithium, Germanium, Chinese herb nephropathy
RETROPERITONEAL FIBROSIS :
Methysergide, Hydralazine, Methyldopa
Drug-induced renal structural-functional changes Proximal convoluted
tubule (s1/s2 segment)
Amino glycoside ,Cadmium Cl, K dichromate,
NSAIDs ,ACE Inhibitor , Cyclosporin A, Interferon-α , Gold Penicillamine Cisplatin,
Mercuric Cl , Dichlorovinyl -L-cysteine 6

11. DRUG INDUCED CARDIOVASCULAR
DISEASES
DRUG INDUCED CARDIOVASCULAR DISEASES :
Exacerbationofangina-alphablockersArrhythmias-digitalis,beta-adrenergic
agents,tricyclicanti-depressantsandquinineCardiomyopathy–daunorubicin,
emetine,lithiumHypo/hypertension–glucocorticoidsandsympathomimetics
Pericardialdisease–emetine,procainamideandminoxidilTorsadedepointes-
sparfloxacin11
DRUGINDUCEDARRHYTHMIA:
ProlongationoftheQTcintervalhasbeenassociatedwithproarrhythmiaresulting
fromapotentiallyfatalformofpolymorphicventriculartachycardiacalledTorsade
depointes(TdP)12

12. Conclusion:
Judicioususeofabovementioneddrugsisrequiredtopreventmost
unwantedsideeffectsespeciallyonsuchavitalorgan.Identifyinghighrisk
patientsandquickrecognitionofdruginducedinjury-relatedsyndrome
withpromptcessationoftheoffendingdrugarethekeytomanagingsuch
acasebeforetheinjurycausespermanentdamagetothetissue.

13. Thank You