Caso Clínico: Bradicardia desencadenada por propafenona

Existen varias alternativas para el manejo de las taquicardias supraventriculares, algunas de ellas farmacológicas y otras no farmacológicas. Dentro de las farmacológicas, los antiarrítmicos bloqueantes de los canales del sodio, clase IC como la propafenona, han demostrado ser de alto riesgo en pacientes ancianos, por la posibilidad de precipitar el fallo cardiaco. Este caso ilustra un error de medicación consistente en un problema relacionado con la selección del medicamento antiarrítmico, en el cual el haber ignorado la alerta generada por el servicio farmacéutico, provocó una reacción adversa seria (fallo cardiaco), lo cual corresponde a un problema de seguridad completamente prevenible

Caso Clínico: Bradicardia desencadenada por propafenona

Existen varias alternativas para el manejo de las taquicardias supraventriculares, algunas de ellas farmacológicas y otras no farmacológicas. Dentro de las farmacológicas, los antiarrítmicos bloqueantes de los canales del sodio, clase IC como la propafenona, han demostrado ser de alto riesgo en pacientes ancianos, por la posibilidad de precipitar el fallo cardiaco. Este caso ilustra un error de medicación consistente en un problema relacionado con la selección del medicamento antiarrítmico, en el cual el haber ignorado la alerta generada por el servicio farmacéutico, provocó una reacción adversa seria (fallo cardiaco), lo cual corresponde a un problema de seguridad completamente prevenible

Adverse Drug Reactions in Children—A Systematic Review

Adverse drug reactions in children are an important public health problem. We have undertaken a systematic review of observational studies in children in three settings: causing admission to hospital, occurring during hospital stay and occurring in the community. We were particularly interested in understanding how ADRs might be better detected, assessed and avoided

Adverse Drug Reaction-Related Hospitalizations in Elderly Australians: A Prospective Cross-Sectional Study in Two Tasmanian Hospitals

© 2017, Springer International Publishing Switzerland. Introduction: Adverse drug reactions (ADRs) have been commonly cited as a major cause of hospital admissions in older individuals. However, despite the apparent magnitude of this problem, there are limited prospective data on ADRs as a cause of hospitalization in elderly medical patients. Objectives: The objective of this study was to evaluate the proportion, clinical characteristics, causality, severity, preventability, and outcome of ADR-related admissions in older patients admitted to two Tasmanian hospitals. Methods: We conducted a prospective cross-sectional study at the Royal Hobart and Launceston General Hospitals in Tasm ania, Australia. A convenience sample of patients, aged 65 years and older, undergoing unplanned overnight medical admissions was screened. ADR-related admissions were determined through expert consensus from detailed review of medical records and patient interviews. The causality, preventability and severity of each ADR-related admission were assessed. Results: Of 1008 admissions, the proportion of potential ADR-related medical admissions was 18.9%. Most (88.5%) ADR-related admissions were considered preventable. Cardiovascular complaints (29.3%) represented the most common ADRs, followed by neuropsychiatric (20.0%) and renal and genitourinary disorders (15.2%). The most frequently implicated drug classes were diuretics (23.9%), agents acting on the renin angiotensin system (16.4%), ß-blocking agents (7.1%), antidepressants (6.9%), and antithrombotic agents (6.9%). Application of the Naranjo algorithm found 5.8% definite, 70.1% probable, and 24.1% possible ADRs. ADR severity was rated moderate and severe in 97.9% and 2.1% of admissions, respectively. For most (93.2%) ADR-related admissions the ADR resolved and the patient recovered. Conclusion: Hospitalization due to an ADR is a common occurrence in this older population. There is need for future studies to implement and evaluate interventions to reduce the risk of ADR-related admissions in elderly populations

Prediction of hospitalization due to adverse drug reactions in elderly community-dwelling patients (The PADR-EC score)

© 2016 Parameswaran Nair et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Background Adverse drug reactions (ADRs) are the major cause of medication-related hospital admissions in older patients living in the community. This study aimed to develop and validate a score to predict ADR-related hospitalization in people aged =65 years. Methods ADR-related hospitalization and its risk factors were determined using a prospective, cross-sectional study in patients aged =65 years admitted to two hospitals. A predictive model was developed in the derivation cohort (n = 768) and the model was applied in the validation cohort (n = 240). ADR-related hospital admission was determined through expert consensus from comprehensive reviews of medical records and patient interviews. The causality and preventability of the ADR were assessed based on the Naranjo algorithm and modified Schumock and Thornton criteria, respectively. Results In the derivation sample (mean [±SD] age, 80.1±7.7 years), 115 (15%) patients were admitted due to a definite or probable ADR; 92.2% of these admissions were deemed preventable. The number of antihypertensives was the strongest predictor of an ADR followed by presence of dementia, renal failure, drug changes in the preceding 3 months and use of anticholinergic medications; these variables were used to derive the ADR prediction score. The predictive ability of the score, assessed from calculation of the area under the receiver operator characteristic (ROC) curve, was 0.70 (95% confidence interval (CI) 0.65-0.75). In the validation sample (mean [±SD] age, 79.6±7.6 years), 30 (12.5%) patients' admissions were related to definite or probable ADRs; 80% of these admissions were deemed preventable. The area under the ROC curve in this sample was 0.67 (95% CI 0.56-0.78). Conclusions This study proposes a practical and simple tool to identify elderly patients who are at an increased risk of preventable ADR-related hospital admission. Further refinement and testing of this tool is necessary to implement the score in clinical practice