Management of Adverse Drug Reactions (ADRs).pptx

Adverse drug reactions

1. Management of Adverse Drug Reactions (ADRs) 1

2. CONTENTS INTRODUCTION DEFINATION OF ADRS Prevention of ADRs Diagnosis of ADRs Management Strategies for ADRs Antidotes or Reversal Agents Patient Education on ADRs 2

3. INTRODUCTION Effective management of Adverse Drug Reactions (ADRs) is essential to ensure patient safety, minimize harm, and provide appropriate care. The management process involves prevention , diagnosis , treatment strategies , and patient education . The management of an adverse drug reaction requires reversal of the acute manifestations of anaphylaxis as well as identification and elimination of the offending anergen and development of a program of‘ long-term prophylaxis. 3

4. DEFINITION -ADRs 4 An ADR is defined by the WHO as a “response to a drug which is noxious and unintended, and which occurs at doses normally used in humans for the prophylaxis, diagnosis, or therapy of disease, or for the modification of physiological function” Adverse drug events (ADEs), which have many similarities with ADRs, are defined as harm arising from a patient’s exposure to a particular drug but not necessarily arising from a direct adverse effect of that drug. 

5. Of primary importance in the management of adverse drug reactions is the early recognition and prompt treatment of anaphylaxis. This life-threatening reaction is often explosive in onset and is the most emergent allergic catastrophe. Symptoms may vary from mild itching to irreversible hypotension andjor fatal puhnonary insufficiency resulting from laryngeal edema. 5

6. Prevention of ADRs Prevention is the first and most crucial step in managing ADRs. Preventing adverse effects is better than treating them once they occur. Thorough Patient History: A detailed history of the patient’s allergies , previous drug reactions, and underlying conditions helps identify potential risks before prescribing drugs. For example, if a patient has a known penicillin allergy , alternative antibiotics should be chosen to avoid allergic reactions. This also includes checking for any drug-drug interactions that could lead to ADRs. 6

7. Cont … Application : Always screen for allergies to common dental medications (e.g., local anesthetics like lidocaine or penicillin used for infections). Inquire about drug reactions such as anaphylaxis to antibiotics, or sedation reactions in patients who have had issues with sedatives in the past (e.g., benzodiazepines). If a patient has a known allergy to penicillin, prescribe an alternative antibiotic like clindamycin or azithromycin Ask about any pre-existing medical conditions , such as cardiovascular disease , that could increase the risk of ADRs to vasoconstrictors (e.g., epinephrine in local anesthetics). 7

8. Cont.. Careful Monitoring During Drug Therapy: Monitoring the patient’s response to the drug allows early detection of any adverse effects. Application : Monitor for immediate local reactions after administering local anesthetics (e.g., swelling , burning , erythema ). Monitor vital signs (e.g., blood pressure and pulse) during procedures involving sedation or general anesthesia, to detect cardiovascular effects from sedatives or opioid analgesics . If using nitrous oxide for sedation, monitor the patient closely for signs of hypoxia (low oxygen levels). 8

9. Diagnosis of ADRs Identifying and diagnosing ADRs is essential for providing appropriate management and reducing complications. Identifying ADRs through Clinical Observations: Observing clinical symptoms is one of the first steps in diagnosing ADRs. Many ADRs present with specific signs and symptoms. Application : Pay attention to early clinical signs like rash after the administration of antibiotics (e.g., amoxicillin ), or signs of overdose with local anesthetics (e.g., numbness, convulsions , or arrhythmias ). Be aware of anaphylactic reactions that can occur after certain medications like penicillin or NSAIDs . A patient who suddenly develops difficulty breathing and swelling of the lips after receiving an antibiotic may be experiencing an allergic reaction or anaphylaxis . 9

10. Laboratory Tests to Assess Organ Function: Application : If a patient is on long-term antibiotics , periodic liver function tests might be indicated to detect hepatotoxicity before performing dental procedures. Renal function tests (e.g., serum creatinine) help detect nephrotoxicity . Complete blood count (CBC) can reveal blood dyscrasias like agranulocytosis or anemia caused by drugs. 10

11. Management Strategies for ADRs When an ADR occurs, timely and effective management is essential to ensure patient safety. Discontinue the Offending Drug: if a patient experiences a local anesthetic reaction (e.g., severe swelling or allergic reaction ), stop the procedure and manage symptoms promptly. If a sedative leads to excessive sedation or respiratory depression , reverse the sedative use or manage the effects immediately. If a patient is given a local anesthetic and shows signs of toxicity (e.g., dizziness, blurred vision, or seizures ), immediately halt the procedure and provide supportive care . 11

12. Supportive Care: Many ADRs can be managed with supportive care , which includes treating symptoms and stabilizing the patient while allowing the body to recover. Application : Provide oxygen if a patient exhibits signs of respiratory distress after sedation or anaphylaxis . If the patient has gastrointestinal side effects from antibiotics or pain medication, provide antiemetics or fluids to support recovery. For a patient with opioid-induced constipation after wisdom tooth extraction, administer laxatives or encourage hydration . 12

13. Antidotes or Reversal Agents: For certain ADRs, specific antidotes or reversal agents are available to neutralize or reverse the effects of a drug overdose or toxicity. Application : Activated charcoal may be given in the case of some drug overdoses (e.g., acetaminophen or aspirin), to absorb the drug and prevent further absorption into the bloodstream. In some cases, specific enzyme inhibitors can be used for drugs causing toxicity by enzyme induction or inhibition For opioid overdoses caused by postoperative pain medications, administer naloxone to reverse the effects of opioids . If a local anesthetic overdose occurs (e.g., bupivacaine toxicity), manage symptoms such as seizures with appropriate medical interventions like benzodiazepines . Example: If using benzodiazepines for sedation and the patient becomes excessively sedated, flumazenil can be used to reverse the effects. 13

14. Patient Education on ADRs Patient education is a vital aspect of ADR management because it helps prevent future adverse effects and ensures that patients are aware of how to recognize potential reactions. Inform Patients About the Risks of ADRs: Educating patients about the potential risks associated with their prescribed medications, allows them to recognize early signs of ADRs and seek medical attention if needed. Encourage Reporting of Any Unusual Symptoms or Side Effects: If a patient develops symptoms like swelling , difficulty breathing , or skin rash , for early intervention and prevents complications. In cases of severe allergic reactions like anaphylaxis , rapid intervention is critical

15. ANAPHYLAXSIS How can I tell if someone is having an anaphylactic reaction? Look for these signs, usually involving their nose, mouth, skin or digestive system: Hives or swelling of their eyes, lips or tongue. Difficulty breathing. Signs of low blood pressure, such as a weak pulse, confusion or loss of consciousness. Stomach symptoms, such as vomiting, diarrhea and cramping. 15

16. Diagnosis Your provider might ask you questions about previous allergic reactions, including whether you've reacted to: Particular foods Medications Latex Insect stings To help confirm the diagnosis: You might be given a blood test to measure the amount of a certain enzyme (tryptase) that can be elevated up to three hours after anaphylaxis You might be tested for allergies with skin tests or blood tests to help determine your trigger 16

17. How is anaphylaxis treated? After injecting yourself, immediately get medical help . If symptoms don’t improve after five to 15 minutes, give yourself a second injection if you have one available. Although very effective, the effect of epinephrine is short-lived. Therefore, it’s important that you immediately seek medical care after having an anaphylactic reaction, even if the injection helps your symptoms. 17

18. MANAGEMENT OF LOCAL REACTIONS OF ANAPHYLAXSIS well-defined local reaction occurring at the site of parenterally administered drugs requires specific therapy for the prevention of discomfort and systemic manifestations. Mild wheezing, pruritus, and transient urticaria can usually be managed as I. A tourniquet applied proximal to the site of the reaction if an extremity is involved, with relaxation of the occlusion for 1 minute every 3 minutes 2. Epinephrine hydrochloride, 1:1000, 0.2 ml administered subcutaneously into the reaction site 3. Diphenhydramine hydrochloride, 50 mg by mouth or intramuscularly, depending on the severity of the local reaction 4. Theophylline, or B2-agonist. Observation of the patient until the reaction begins to subside (usually 30 to 60 minutes) 18

19. MANAGEMENT OF SYSTAMIC REACTIONS OF ANAPHYLAXSIS 19

20. What to do in an emergency? If you're with someone who's having an allergic reaction and shows signs of shock, act fast. Look for pale, cool and clammy skin; a weak, rapid pulse; trouble breathing; confusion; and loss of consciousness. Do the following immediately: E mergency medical help. Use an epinephrine autoinjector, if available, by pressing it into the person's thigh. Make sure the person is lying down and elevate the legs. Check the person's pulse and breathing and, if necessary, administer cardiopulmonary resuscitation (CPR) or other first-aid measures. 20

21. CONCLUSION By focusing on prevention , early diagnosis , appropriate management , and patient education , healthcare professionals can significantly reduce the impact of ADRs. This systematic approach enhances patient safety and ensures optimal therapeutic outcomes. 21

22. Thank you