@article{Woods_2019, title={The role of hospital pharmacists in the prevention of adverse drug reactions: O PAPEL DOS FARMACÊUTICOS HOSPITALARES NA PREVENÇÃO DE REAÇÕES ADVERSAS A MEDICAMENTOS}, volume={8}, url={https://rbfhss.org.br/sbrafh/article/view/287}, abstractNote={<p>A significant proportion of these events are estimated to be preventable1<br>so the question arises<br>as to whether health professionals, including pharmacists, are doing enough to prevent ADRs at the time<br>of prescribing or to identify their onset before the reaction becomes potentially serious.<br>An obvious opportunity to make a risk assessment for potential adverse reactions is to review<br>newly prescribed medicines. A lot of emphasis is placed on checking for drug-drug interactions but less so<br>with evaluating the potential for the drug to “interact” with a patients individual risk factors or comorbidities.<br>This is partly due to lack of information and guidance, both in standard texts and in drug data sheets provided<br>by manufactures. A prescriber or pharmacist is provided with a long list of cautions and adverse drug reactions<br>which is often overwhelming and provides little information on risks that may be applicable to an individual<br>patient. The intensity of risk assessment strategies is offset by the fact that many serious ADRs are rare and<br>so the risks to patients on a population incidence perspective are relatively low. However, a large exposed<br>population experiencing a rare event can result in a significant number of patients who experience harm.<br>The serotonin reuptake inhibitors are widely prescribed and are associated with an increased risk of<br>bleeding disorder and haemorrhage2<br>. The risk of harm is significantly increased with concurrent use of<br>NSAIDs, anticoagulants and in patients with a history of previous bleeding events3<br>. If this risk is recognised<br>the time of prescribing, the drug combination can be modified or the patient closely monitored as<br>appropriate. Preventable bleeding events, particularly gastrointestinal haemorrhage, are a major cause of<br>hospital admissions and drug related morbidity and mortality. SSRIs may contribute to this problem but<br>the risks may not always be recognised at the time of prescribing.<br>Serious events, including death, still occur in patients who are re-administered a drug or<br>drug-class that has previously caused anaphylaxis or a drug hypersensitivity reaction. Such events can be<br>prevented by accurate and detailed documentation of the original event and appropriate alerting systems<br>such as personalised bracelets and electronic allergy checkers in clinical decision support. The prevention of<br>repeat events is often compromised as patients’ drug allergy history is not always available to all prescribers<br>at the point of care and there is a lack of standard information and guidance on the potential for cross<br>reactivity. Two other factors may paradoxically lead to patient harm in this context. Firstly, computerised<br>alerts for drug allergy are often overridden4<br>as they are irrelevant or incorrect – so called alert fatigue. Alert<br>overrides may dilute the importance and recognition of clinically significant and potentially serious events.<br>Secondly, it is well recognised that many patients are incorrectly labelled as being allergic to a medicine;<br>some studies have reported rates of false labelling in up to 90 per cent of patients with antibiotic allergy5<br>. As a consequence, falsely labelled patients may actually be harmed if they are denied an effective medicine<br>or prescribed an alternative medicine which is associated with a greater risk of adverse effects.<br>Many adverse effects are delayed and may occur after weeks to months of treatment.<br>Appropriate monitoring may detect the early onset of a reaction and mitigate against potentially serious<br>consequences. Effective and appropriate monitoring for an adverse reaction requires an understanding<br>of the time-course, pathophysiology and characteristics of its presentation along with consideration<br>of individual risk factors. Nitrofurantoin can cause serious inflammatory lung disease, especially after<br>chronic treatment of six months or more. Early onset can be detected by advising the patient to report<br>new respiratory symptoms such as cough or shortness of breath6<br>. These symptoms may be more difficult<br>to identify in patients with congestive heart disease or asthma which may indicate that nitrofurantoin<br>poses a higher risk or may be inappropriate in such patients. The Proton Pump Inhibitors (PPIs)<br>such as omeprazole are widely prescribed and available over the counter in many countries. Rare, but<br>potentially serious ADRs include acute interstitial nephritis7<br>(AIN) and hypomagnesaemia8<br>. Whilst<br>AIN is rare, it can lead to long-term kidney injury so it is important to identify non-specific symptoms<br>such as raised plasma creatinine, rash, arthralgia, malaise, fever, nausea, lethargy and weight loss to<br>differentiate these from other possible causes. Hypomagnesaemia can develop after chronic use of a<br>PPI and monitoring would be especially appropriate if the patient has risk factors for arrhythmias or is<br>taking digoxin.</p>}, number={2}, journal={Revista Brasileira de Farmácia Hospitalar e Serviços de Saúde}, author={Woods, David J}, year={2019}, month={Jun.} }