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

Disclosures / None

Check the Sound of the Umbicals

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.

Risks,Benefits,AlternativeRisks,Benefits,Alternativess

Variables that Variables that influence ADR’sinfluence ADR’s

Number of ADR’sNumber of ADR’s

Complex ProcessesComplex Processes

Whose responsibility?Whose responsibility?

FDAFDA

PatientPatient

Licensed Independent PractionerLicensed Independent Practioner

AdministratorAdministrator

DRUG + UNIQUE DRUG + UNIQUE PHYSIOLOGY = ADRPHYSIOLOGY = ADR

Unique genetic Unique genetic blendsblends

Designer profilesDesigner profiles

CostCost

Steven’s Johnson Part of Steven’s Johnson Part of TEN (Toxic Epidermal TEN (Toxic Epidermal Necrolysis)Necrolysis)

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/

Offending MedicationsOffending Medications

Anti-seizureAnti-seizure

Antibiotics Antibiotics particularly sulfaparticularly sulfa

CocaineCocaine

Herpes SimplexHerpes Simplex

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

Serotonin SyndromeSerotonin Syndrome

Number of persons Number of persons taking taking antidepressantsantidepressants

Number of persons Number of persons experiencing experiencing syndromesyndrome

Signs and SymptomsSigns and Symptoms

Action potentialsAction potentials

without purposewithout purpose

Cardiac and neural Cardiac and neural tissues in imbalancetissues in imbalance

Antibiotics in the Action Potential

Linezoid ( )

BEWARE OF THE BLACK BEWARE OF THE BLACK BOXBOX

Vitamin K

Anaphylactic shock associated with IV use

IV has no advantage over subcutaneous

No change in rate of metabolism

Dilantin

PHENYTOIN

BE on the Q-T

Medications that

Change the Q-T interval

Categories that offend

Additive effect or genetic story

Serotonin’s RoleSerotonin’s Role

ManicManic

Pursuit of HappinessPursuit of Happiness

ReversalReversal

From an antibioticFrom an antibiotic

Suicide / Triggered by Medications

Interferon

Accutane

Pediatric patients

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

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

Photodynamic Photodynamic LasersLasers

Pharmacology + LightPharmacology + Light

Photoferrin Photoferrin

Cancer therapyCancer therapy

NSCLS NSCLS

Stage IStage I

Stage IVStage IV

Photodynamic LasersPhotodynamic Lasers

Pharmacology + LightPharmacology + Light

Photoferrin Photoferrin

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

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?

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?

Head Trauma/ / Propofol Syndrome

Farewell to Harms

Farewell to Harms

Farewell to Harms