Acute adverse reactions to psychoactive drugs, drug usage, and psychopathology.

Used a field survey method to examine the relationship between psychopathology and acute adverse reactions to psychoactive drugs. A paper-and-pencil measure of acute adverse reactions was developed and administered to 530 college students with drug-use experience. Acute adverse reactions were hypothesized to covary positively with regression, schizophrenia, and drug usage, and to covary negatively with adjustment and paranoia. These hypotheses were supported. The hypotheses that usage of LSD and mescaline would covary positively with regression and covary negatively with adjustment were also supported. A hypothesis that schizophrenia would positively covary with LSD and mescaline usage was not confirmed. Regression was also found to be related to marihuana usage. A recursive linear model was developed in an attempt to integrate and explain these results. (25 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Bupropion and anticonvulsant drug interactions

The haemolytic uraemic syndrome, first described in 1955 by Gasser, is the number one cause of acute renal failure in infants. There are three types of the haemolytic uraemic syndrome: the seasonal epidemic form with prodromic diarrhoea and generally favourable outcome which usually occurs in infants, a less typical form without signs of digestive tract involvement and no seasonal prevalence which occurs more readily in older children and sometimes in families has a less favourable prognosis, and finally drug- or disease-related forms. Currently, overall mortality due to haemolytic uraemic syndrome has been reduced to about 4%, usually as a result of damage to the central nervous system. Several microorganism, including Shigella dysenteriae, Salmonella typhi, Campylobacter jejuni, Streptococcus pneumoniae, Rickittsiae and certain viruses (Coksackiae, Influenzae, Epstein-Barr) have been identified as causative agents. In 1983, digestive tract infection due to an Escherichia coli strain producing verotoxin was identified as capable of producing haemolytic uraemic syndrome and more rarely thrombopenic thrombotic purpura. The germ produces two exotoxins (whose effect is accentuated by the E. coli lipopolysaccharide endotoxin) which lead to the glomerular microangiopathy causing haemolytic uraemic syndrome. Diagnosis is based on identification (monoclonal antibodies, ELISA, PCR) of the verotoxins themselves or the two encoding genes in stool samples. Symptomatic treatment is essential but the effectiveness of antibiotics is still debated. Theoretically, antibiotics could worsen the syndrome by increasing endotoxin release from lysed bacteria, but inversely they could also prevent the syndrome if given early enough. Further research is required to acquire precise epidemiological data and identify animal reservoirs of verotoxin producing E. coli.     

Gender differences in adverse drug reactions

The objective of this study is to identify gender-related differences in the types of symptoms and drugs reported to cause an adverse drug reaction. Patient data from the Sunnybrook Health Science Centre ADR Clinic for the period from April 1986 to May 1996 were reviewed. Of the 2,367 patients assessed, 74.1% were female. The mean age of the patients was 43 +/- 17 years. Drug classes most frequently reported to elicit an adverse event were general antiinfectives (60.4%), nervous system agents (21.5%), and musculoskeletal agents (3.7%). Skin-related reactions accounted for 49.0% of all reported adverse drug reactions. More than one agent was reported to be responsible for the adverse drug reaction(s) in 50% of the female patients, versus 33.1% of all male patients. Of the female patients, 47.6% were referred for skin or oral challenge testing, versus 41.6% of the male patients. Of the female patients, 6.2% tested positive to the agent compared with 6.1% of all male patients. These results support previous findings that female gender is a risk factor for the development of adverse drug reactions. Further work is required to elucidate the mechanisms explaining the differences observed between male and female patients.     

Mechanisms of unpredictable adverse drug reactions

Adverse drug reactions are common problems associated with therapy, and are major sources of morbidity and mortality. There are numerous types of drug reactions, including predictable drug reactions such as side effects, toxicity, drug interactions and secondary effects that can be anticipated when planning therapy. There are also a number of unpredicted adverse effects, which are unexpected consequences of therapy. The least severe unpredicted adverse drug reaction is intolerance, which appears to be an exaggeration of pharmacological or toxic effects of the drug among vulnerable subsets of patients. Some of the most severe and life-threatening adverse drug reactions are allergic. These adverse effects can be mediated by a number of mechanisms, including the development of drug-specific IgE, serum-sickness-like reactions in response to drug-antibody complexes, direct release of inflammatory mediators, or involvement of the immune system by mechanisms that are poorly understood. Idiosyncratic adverse drug reactions are a heterogeneous group of adverse effects that are not predictable from the pharmacological actions of the drug. Many of these reactions occur as a consequence of pharmacogenetic variations in drug bioactivation and drug or metabolite detoxification or clearance. The physician must be vigilant for the possibility of unpredictable adverse drug reactions during or after therapy. Research currently underway may afford the opportunity to predict, and hopefully prevent, some of these adverse reactions in the future.     

Reporting of adverse drug reactions: practice in the UK

As the range of available drugs becomes increasingly wide, it is ever more important for adverse drug reactions and interactions to be reported. With the extended role of the nurse moving closer towards nurse prescribing, this article seeks to demystify the adverse drug reactions reporting system in the UK, and explain the role of nurses.     

The adverse reactions of anti-tuberculosis drugs and its management

This paper reviews adverse reactions to anti-tuberculous drugs. Hepatotoxicity occur with isoniazid, rifampicin, pyrazinamide and ethionamide. Risk factors include high age, malnutrition and high alcohol consumption. Liver function should be followed every two weeks to prevent serious hepatotoxicity. If this occurs drugs should be stopped until improvement of liver functions. Fulminant hepatitis has poorer prognosis in regimen with pyrazinamide than without. The Combination of pyrazinamide and ethionamide is frequently hepatotoxic and should be avoided. Gastric reactions occur frequently. Elderly persons are highly intolerant to rifampicin. Peripheral neuritis is reported with isoniazid, ethambutol and ethionamide, but effectively prevented with pyridoxine. Allergic reaction including fever or rash occur with many anti-tuberculosis drugs. If necessary desensitization to re-introduce the drugs. Ocular toxicity due to ethambutol occur infrequently with a dose of 15 mg/kg. Drug interactions are frequent in tuberculosis treatment. Rifampicin reduce serum the concentration of such drugs as Methadone, Corticosteroid, and Theophylline.     

IVIG adverse reactions: potential role of cytokines and vasoactive substances

Tolcapone is a potent, selective, reversible inhibitor of COMT. Coadministration of tolcapone with levodopa and a decarboxylase inhibitor prolongs the elimination half-life of levodopa and reduces the formation of 3-0-metildopa in a dose-dependent form. The improvement in the pharmacokinetics of levodopa prolongs the motor effects of levodopa. Clinical studies have shown that the concomitant administration of levodopa and tolcapone is effective on the management of the wearing-off phenomenon. Tolcapone can significantly reduce the off time and increases the total on time while simultaneously reducing levodopa dosage and frequency. Most adverse events are dopaminergic in nature and related to the increase in levodopa bioavailability. Dyskinesias may increase in frequency and severity in patients already having dyskinesias and these may appear for the first time after adding tolcapone in patients at risk. Diarrhoea is the main nondopaminergic adverse event leading to the stop of the drug in less than 10% of cases. Taking into account that tolcapone significantly enhance the action of levodopa, it would be wise to reduce the total daily dose of levodopa at the same time that tolcapone is introduced. No tolerance effect was observed in 12-month studies. Tolcapone can be used with standard or sustained release levodopa, and, when appropriate, in conjunction with dopamine agonists or selegiline.     

Differences in perceived and presented adverse drug reactions in general practice

BACKGROUND: Postmarketing surveillance (PMS) studies are frequently based on data from general practitioners (GPs). Patients, however, do not always report to their GP suspected adverse drug reactions. SETTING: A postmarketing cohort study on adverse reactions to sumatriptan, performed with assistance of drug dispensing GPs in The Netherlands. METHODS: Questionnaires were sent to all drug-dispensing GPs in The Netherlands, as well as to their patients on sumatriptan. To avoid bias, no specific adverse reactions were mentioned in the questionnaires. RESULTS: Of the GPs, 589 (86%) responded; of the patients, 1202 (70%) responded. The most frequently reported suspected adverse reactions to sumatriptan reported by the GPs were dizziness (1.7%), nausea or vomiting (1.5%), drowsiness or sedation (1.4%), and chest pain (1.3%). The most frequently reported suspected adverse reactions by the patients were paraesthesia (11.7%), dizziness (8.1%), feeling of heaviness (8.0%), and chest pain (7.9%). Neither the GPs nor the patients reported serious adverse reactions. CONCLUSIONS: First, patients experience significantly more suspected adverse reactions than are registered by their GP. In view of this higher frequency of reporting of suspected adverse reactions, postmarketing studies with data from GPs only, may underestimate the cumulative incidence of adverse reactions. Second, we conclude that it is possible to obtain useful additional information about adverse drug reactions from patients by sending them questionnaires via their GP.     

Correlation between steady-state plasma concentration of antituberculous drugs and age, inclusion of rifampicin in the treatment regimen, adverse drug reactions and other clinical parameters

A regional hospital in Hong Kong examined the correlation between plasma concentrations of rifampicin, pyrazinamide, isoniazid and its metabolite hydrazine and age, inclusion of rifampicin in the treatment regimen, adverse drug reactions and other clinical parameters. One hundred eighty subjects with tuberculosis were admitted consecutively to the medical wards of the Prince of Wales Hospital over a one and a half year period. Elderly patients > 65 years were randomized into one of two treatments with and without rifampicin in addition to isoniazid, pyrazinamide and ethambutol; younger patients received all four drugs. Plasma antituberculous drug concentrations were determined using high performance liquid chromatography. Elderly patients taking rifampicin had a higher mean steady-state concentration of isoniazid, together with a higher incidence of adverse effects compared with those not taking rifampicin. No age related differences were observed for the other drugs. For the whole group, higher mean concentrations of hydrazine, rifampicin and pyrazinamide were associated with a higher incidence of adverse effects and the presence of coexisting diseases. It is concluded that in sick elderly patients with coexisting diseases, use of rifampicin in the antituberculous regimen should be accompanied by close monitoring for side effects, and that there may be an indication for use of lower dosages of antituberculous drugs in such patients.     

Mortality due to acute adverse drug reactions: opiates and cocaine in Barcelona, 1989-93

Drug-related deaths have become a major source of premature mortality. This paper presents an analysis of deaths due to acute adverse drug reactions caused by opiates or cocaine in the city of Barcelona over a 5-year period during which figures were stable. Annual mortality rates due to adverse drug reactions of city residents for the 1989-93 period were estimated to be 15.3 per 100,000 people in the 15-49-year age group. Mortality rates for men (25.0) are consistently higher than mortality rates for women (5.8). Mortality rates by age group show different patterns by gender. Males in the 25-29-year group have the highest mortality rate (62.8), almost doubling the rates for the 20-24 (36.1) and 30-34 (33.3)-year groups. The highest differential in age-specific mortality by gender is seen in the 35-39-year age group, where mortality rates for men (21.5) are eight times higher than for women (2.6 per 100,000). The distribution by place of residence, stratifying data across city neighbourhoods and municipal districts displays wide differences between districts in the mean annual rates, ranking between 77.3 and 8.3 per 100,000, a nine-fold magnitude. Differences are even steeper when we break down data by neighbourhood. Although all areas with high adverse drug reactions mortality are areas of low socio-economic level, a more complex association between deprivation and drug use must exist, as other areas with similarly low socio-economic indicators do not suffer from such high mortality. A cross-tabulation of place of residence and district of death shows that for most adverse drug reaction deaths, death takes place in the district of residence but patterns related to districts who attract drug-related deaths and districts who export them may be observed. These results provide new insights into the epidemiology of substance abuse in Barcelona, where it follows patterns that may be similar to those of other major urban areas in Spain, but also in other Southern European countries.     

我院95例药品不良反应报告分析

目的 了解该院药品不良反应(ADR)的发生状况,有助于人们对药物的认识,为合理用药提供参考.结果 对我院2009年收集到95例ADR报告进行统计分析.结果在95例ADR报告中涉及的药品有67种,其中以抗感染药物居首,其次为中药注射剂.用药途径以静脉给药为主.主要的ADR类型为皮肤及胃肠道系统反应.结论 由于静脉给药途径的ADR发生率较高,临床应给予高度重视并进行药品不良反应的监测,做到合理、有效、安全用药,减少药品不良反应的发生.     

Prevention of iatrogenic illness: adverse drug reactions and nosocomial infections in hospitalized older adults

It is argued that memory for traumatic events is similar to that for other distinctive, personally significant events regardless of whether they are affectively positive or negative. Examined in this light, the focus now shifts to the role of individual differences in neurobiological, social, cognitive, and constitutional factors that conspire to determine long-term retention of significant autobiographical experiences. What is known about these factors in determining memorability is reviewed, issues of measurement inadequacies discussed, and recommendations for further research outlined.     

Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies

OBJECTIVE: To estimate the incidence of serious and fatal adverse drug reactions (ADR) in hospital patients. DATA SOURCES: Four electronic databases were searched from 1966 to 1996. STUDY SELECTION: Of 153, we selected 39 prospective studies from US hospitals. DATA EXTRACTION: Data extracted independently by 2 investigators were analyzed by a random-effects model. To obtain the overall incidence of ADRs in hospitalized patients, we combined the incidence of ADRs occurring while in the hospital plus the incidence of ADRs causing admission to hospital. We excluded errors in drug administration, noncompliance, overdose, drug abuse, therapeutic failures, and possible ADRs. Serious ADRs were defined as those that required hospitalization, were permanently disabling, or resulted in death. DATA SYNTHESIS: The overall incidence of serious ADRs was 6.7% (95% confidence interval [CI], 5.2%-8.2%) and of fatal ADRs was 0.32% (95% CI, 0.23%-0.41%) of hospitalized patients. We estimated that in 1994 overall 2216000 (1721000-2711000) hospitalized patients had serious ADRs and 106000 (76000-137000) had fatal ADRs, making these reactions between the fourth and sixth leading cause of death. CONCLUSIONS: The incidence of serious and fatal ADRs in US hospitals was found to be extremely high. While our results must be viewed with circumspection because of heterogeneity among studies and small biases in the samples, these data nevertheless suggest that ADRs represent an important clinical issue.