scholarly journals Causation of potential drug to drug interactions alerts, alert overrides, and adverse drug events

2021 ◽  
Author(s):  
Aminah Mazyin Mohamed Ariff ◽  
Sivalingam Nalliah ◽  
Hafidz Abd Hadi ◽  
Nay Thu Win ◽  
Mohamed Imran Thoulath ◽  
...  
Keyword(s):  
Drug Interactions ◽  
Critically Ill ◽  
Adverse Drug Events ◽  
Cardiac Patients ◽  
Drug Event ◽  
Potential Ddis ◽  
Preventive Actions ◽  
The Relationship ◽  
Related Harm ◽  
Cardiac Care Unit

Abstract Background: Drug-drug interactions (DDIs) leading to adverse drug event (ADEs) are of special interest because they represent preventable medication errors. Preventable ADE can result in errors involving the manifestation of adverse patient outcomes. Given the high complexity of critically ill cardiac patients, it is important to learn how CDDSS affects outcomes in this population and the number of alerts that likely be safely suppressed. Purpose: Identify adverse DDIs that is clinically detected and review the appropriateness of the doctor’s actions to the potential DDIs (PDDIs) alert. Study Design: This is a prospective observational study conducted at critical cardiac care unit (CCU) in a selected tertiary cardiac center for a duration of six months. Methods: Physicians treating critically ill cardiac patients were presented with PDDIs data which were acquired from two commercially available CDDSS. The relationship between the decision to prescribe and factors hypothesized to affect physicians' decisions were examined. Results: Evaluation of 709 patient medication profiles were conducted, resulting in 521 assessed patient profiles having had one or more PDDIs with 87% of them were influenced by polypharmacy. Ninety-one patients (17.5%) were associated with one or more adverse DDIs. Of the total 3284 potential DDIs alerts, 95.5% of the alerts were overridden. Preventable ADE as an outcome of inappropriate override have resulted 83.1 %. (236/284) of adverse DDIs. Whereas, appropriate overrides as an outcome of clinically irrelevant ADE were 16.9 % (48/284). Conclusion: Poor preventive actions taken by the doctors caused drug related harm to the patients despite having CDDSS in place. This suggests that CDDSS is an important application to minimize the harm associated with adverse DDIs by alerting physicians of potentially unsafe situations.

Monitoring of the kidneys, liver, and other vital organs

2015 ◽  
Author(s):  
K Werdan ◽  
B Patel ◽  
M Girndt ◽  
H Ebelt ◽  
J Schröder ◽  
...  
Keyword(s):  
Critical Care ◽  
Organ Failure ◽  
Critically Ill ◽  
Cardiac Disease ◽  
Critical Care Unit ◽  
Cardiac Patients ◽  
Cardiac Care ◽  
Close Monitoring ◽  
Cardiac Care Unit ◽  
Organ Complications

The prognosis of critically ill cardiac patients in the critical care unit and intensive cardiac care unit depends not only on the underlying cardiac disease, but also on the development of secondary organ complications and failures. Therefore, close monitoring of vital organs is mandatory in all critically ill cardiac patients to detect the development of non-cardiac organ failure as early as possible.

Identification and evaluation of potentially inappropriate medications (PIMs) in hospitalized geriatric patients using Beers criteria

2015 ◽  
Vol 26 (4) ◽  
Author(s):  
Pattani Danisha ◽  
Chandrasekhar Dilip ◽  
Panakkal Linu Mohan ◽  
Cholamugath Shinu ◽  
Jaffer Chalil Parambil ◽  
...  
Keyword(s):  
Drug Interactions ◽  
Geriatric Patients ◽  
Adverse Drug Events ◽  
Inappropriate Medication ◽  
Drug Event ◽  
Beers Criteria ◽  
Potentially Inappropriate Medications ◽  
Close Monitoring ◽  
Entire Study ◽  
Hospitalized Elderly

AbstractThe aim of the study was to identify and evaluate potentially inappropriate medication (PIM) in geriatric patients using Beers criteria and also to identify adverse drug events (ADEs) due to PIMs and various drug-drug interactions.The medications in the prescriptions of patients above 60 years of age, their dosage regimen respective of their diagnosis were analyzed. Each medication was then checked with Beers list tables, and any medication if mentioned in the Beers list, was noted along with its strength of recommendation and quality of evidence. Any adverse drug event (ADE) due to PIM was identified. Causality of the events was assessed by Naranjo’s Scale. The number of drug-drug interactions per prescription and the severity of each interaction were also analyzed. The collected data from 200 subjects were subjected to statistical treatments using Statistical Package for Social Sciences (SPSS) software version 16.0 for WINDOWS.Based on the Beers criteria 2012, 106 out of 200 (53%) prescriptions had at least one PIM prescribed. A sum of 1690 medications was prescribed as a whole for the entire study subjects. Among which, 134 PIMs were identified. Most commonly prescribed PIMs were benzodiazepines (39, 19.5%), followed by sliding scale use of insulin (31, 15.5%), and prazosin at a rate of 11.5% (23). A total of 10 ADEs were identified during the study. The average number of drug interactions observed among total samples was found to be 3.0±6.0 with 0±5.0 serious interactions, 2±4.0 significant interactions requiring close monitoring, and 0±6.0 minor interactions.The study shows high prevalence of prescribing PIMs in hospitalized elderly patients; PIM also caused incidence of ADEs; and serious drug-drug interactions were scarce among the patients.

Monitoring of the kidneys, liver, and other vital organs

2018 ◽  
Author(s):  
Karl Werdan ◽  
Brijesh Patel ◽  
Matthias Girndt ◽  
Henning Ebelt ◽  
Jochen Schröder ◽  
...  
Keyword(s):  
Critical Care ◽  
Organ Failure ◽  
Critically Ill ◽  
Cardiac Disease ◽  
Critical Care Unit ◽  
Cardiac Patients ◽  
Cardiac Care ◽  
Close Monitoring ◽  
Cardiac Care Unit ◽  
Organ Complications

The prognosis of critically ill cardiac patients in the critical care unit and intensive cardiac care unit depends not only on the underlying cardiac disease, but also on the development of secondary organ complications and failures. Therefore, close monitoring of vital organs is mandatory in all critically ill cardiac patients to detect the development of non-cardiac organ failure as early as possible.

scholarly journals The Influence of Pharmacogenetics on the Clinical Relevance of Pharmacokinetic Drug–Drug Interactions: Drug–Gene, Drug–Gene–Gene and Drug–Drug–Gene Interactions

2021 ◽  
Vol 14 (5) ◽  
pp. 487
Author(s):  
Martina Hahn ◽  
Sibylle C. Roll
Keyword(s):  
Drug Therapy ◽  
Drug Interactions ◽  
Clinical Relevance ◽  
Adverse Drug Events ◽  
Current Evidence ◽  
Drug Event ◽  
Gene Interactions ◽  
Genetic Profile ◽  
The Impact ◽  
Pharmacokinetic Drug

Drug interactions are a well-known cause of adverse drug events, and drug interaction databases can help the clinician to recognize and avoid such interactions and their adverse events. However, not every interaction leads to an adverse drug event. This is because the clinical relevance of drug–drug interactions also depends on the genetic profile of the patient. If inhibitors or inducers of drug metabolising enzymes (e.g., CYP and UGT) are added to the drug therapy, phenoconcversion can occur. This leads to a genetic phenotype that mismatches the observable phenotype. Drug–drug–gene and drug–gene–gene interactions influence the toxicity and/or ineffectivness of the drug therapy. To date, there have been limited published studies on the impact of genetic variations on drug–drug interactions. This review discusses the current evidence of drug–drug–gene interactions, as well as drug–gene–gene interactions. Phenoconversion is explained, the and methods to calculate the phenotypes are described. Clinical recommendations are given regarding the integratation of the PGx results in the assessment of the relevance of drug interactions in the future.

scholarly journals Drug Prescribing to the Elderly Patients

2018 ◽  
Vol 1 (2) ◽  
pp. 65
Author(s):  
Misha’l Aly A
Keyword(s):  
Elderly Patients ◽  
Drug Interactions ◽  
Adverse Drug Event ◽  
Older Patients ◽  
Adverse Drug Events ◽  
The Elderly ◽  
Health Sciences ◽  
Drug Event ◽  
Drug Prescribing ◽  
Age Related

Age-related physiologic and anatomic changes in various body systems are accompanied by significant pharmacokinetic and pharmacodynamic alterations that make it mandatory for treating physicians to adjust types and dosages of medications for their older patients. Moreover, physicians should be always alert for adverse drug events, and consider any new symptoms as drug-related until proven otherwise. Other issues addressed include prescribing cascades, polypharmacy, drug-drug interactions, and the need to review all medications used by the elderly patients, with special attention to non-prescription and herbetic drugs. This review aims at maximizing safe medicine prescribing, and minimizing adverse drug event in caring for older subjects.International Journal of Human and Health Sciences Vol. 01 No. 02 July’17. Page : 65-69

Monitoring of the kidneys, liver, and other vital organs

2021 ◽  
pp. 147-164
Author(s):  
Karl Werdan ◽  
Brijesh Patel ◽  
Matthias Girndt ◽  
Henning Ebelt ◽  
Jochen Schröder ◽  
...  
Keyword(s):  
Critical Care ◽  
Organ Failure ◽  
Critically Ill ◽  
Cardiac Disease ◽  
Critical Care Unit ◽  
Cardiac Patients ◽  
Cardiac Care ◽  
Close Monitoring ◽  
Cardiac Care Unit ◽  
Organ Complications

The prognosis of critically ill cardiac patients in the critical care unit and intensive cardiac care unit depends not only on the underlying cardiac disease, but also on the development of secondary organ complications and failures. Therefore, close monitoring of vital organs is mandatory in all critically ill cardiac patients to detect the development of non-cardiac organ failure as early as possible.

Pharmacology, polypharmacy and the older adult: a review

2021 ◽  
Vol 26 (6) ◽  
pp. 290-295
Author(s):  
Patricia Robinson
Keyword(s):  
Older People ◽  
Adverse Drug Events ◽  
Pharmacokinetics And Pharmacodynamics ◽  
Age Related ◽  
Medicines Use ◽  
District Nurses ◽  
The Impact ◽  
The Relationship ◽  
Related Harm

District nurses routinely visit and care for older patients who are prescribed multiple medicines. Older people living with multiple comorbidities and polypharmacy are commonly encountered in community nursing. It is important for nurses to recognise that regular medicines use and age-related physiological changes in older people place them at greater risk of medication-related harm. In order to understand this, an underpinning knowledge of the pharmacological principles relating to older people is required. This review will consider the effects of age-related changes and the impact of ageing on pharmacokinetics and pharmacodynamics. The relationship between polypharmacy and identifying high-risk drugs and adverse drug events will be explored. Medicines use in older adults with multimorbidity including frailty will be discussed. The role of district nurses in supporting older people with medicines optimisation will be considered, with a focus on how the community nurse can contribute to reducing avoidable harm for patients.

scholarly journals Potential Drug-drug Interactions Analysis in Children Out-patients with Bronchopneumonia Medication Prescriptions

2020 ◽  
Vol 3 (2) ◽  
pp. 79-83
Author(s):  
Ilil Maidatuz Zulfa ◽  
Fitria Dewi Yunitasari ◽  
Susanty Kartika Dewi
Keyword(s):  
Drug Interactions ◽  
Adverse Drug Events ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Potential Ddis ◽  
Pharmacodynamic Interaction ◽  
Cross Sectional ◽  
Drug Pair ◽  
Outpatient Settings ◽  
Outpatient Children

Drug-drug interactions (DDIs) is defined as the alteration of efficacy and toxicity of some drugs in the presence of other drugs. In the treatments of bronchopneumonia in outpatient settings, there is a lack of documentation of DDIs. This study was aimed to observe the potential DDIs on the prescriptions of children with bronchopneumonia. An observational and cross-sectional study was conducted on outpatient children with bronchopneumonia prescriptions during 2017. Potential for DDI was identified by online drug interaction checkers. The potential DDI then classified based on its severity (minor, moderate, and major) and mechanism (pharmacokinetic and pharmacodynamic). Among 86 prescriptions analyzed, potential DDIs observed at 48.84% of it. Of that, there were 67 potential DDIs where 72.34% of it were categorized as moderate. The majority of potential DDIs was pharmacodynamic interaction (76.12%) with the most frequently involved drug pair was Ephedrine-Salbutamol (29.85%). Children outpatients with bronchopneumonia are at risk of potential DDIs, especially to minor and moderate potential DDIs. Prescriptions screening for potential DDIs followed by monitoring of therapeutical effects and associated adverse drug events will optimize patient safety.

scholarly journals Using ActionADE to create information continuity to reduce re-exposures to harmful medications: study protocol for a randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jeffrey P. Hau ◽  
Penelope M. A. Brasher ◽  
Amber Cragg ◽  
Serena Small ◽  
Maeve Wickham ◽  
...  
Keyword(s):  
Health Information ◽  
Adverse Drug Event ◽  
Primary Outcome ◽  
Adverse Drug Events ◽  
Primary Objective ◽  
Drug Event ◽  
Controlled Trials ◽  
Drug Reactions ◽  
Main Trial ◽  
Randomized Controlled

Abstract Background Repeat exposures to culprit medications are a common cause of preventable adverse drug events. Health information technologies have the potential to reduce repeat adverse drug events by improving information continuity. However, they rarely interoperate to ensure providers can view adverse drug events documented in other systems. We designed ActionADE to enable rapid documentation of adverse drug events and communication of standardized information across health sectors by integrating with legacy systems. We will leverage ActionADE’s implementation to conduct two parallel, randomized trials: patients with adverse drug reactions in the main trial and those diagnosed with non-adherence in a secondary trial. Primary objective of the main trial is to evaluate the effects of providing information continuity about adverse drug reactions on culprit medication re-dispensations over 12 months. Primary objective of the secondary trial is to evaluate the effect of providing information continuity on adherence over 12 months. Methods We will conduct two parallel group, triple-blind randomized controlled trials in participating hospitals in British Columbia, Canada. We will enroll adults presenting to hospital with an adverse drug event to prescribed outpatient medication. Clinicians will document the adverse drug event in ActionADE. The software will use an algorithm to determine patient eligibility and allocate eligible patients to experimental or control. In the experimental arm, ActionADE will transmit information to PharmaNet, where adverse drug event information will be displayed in community pharmacies when re-dispensations are attempted. In the control arm, ActionADE will retain information in the local record. We will enroll 3600 adults with an adverse drug reaction into the main trial. The main trial’s primary outcome is re-dispensation of a culprit or same-class medication within 12 months; the secondary trial’s primary outcome will be adherence to culprit medication. Secondary outcomes include health services utilization and mortality. Discussion These studies have the potential to guide policy decisions and investments needed to drive health information technology integrations to prevent repeat adverse drug events. We present an example of how a health information technology implementation can be leveraged to conduct pragmatic randomized controlled trials. Trial registration ClinicalTrials.gov NCT04568668, NCT04574648. Registered on 1 October 2020.

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