Adverse drug interactions landing elderly in ERs.htm

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Adverse drug interactions landing elderly in ERs

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* Health and Healing *

Wednesday, April 10, 2002 10:17 PM

Adverse drug interactions landing elderly in

ERs.htm

 

 

- http://www.medicalpost.com/mdlink/english/members/medpost/data/3804/08A.HTM

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Adverse drug interactions landing elderly in ERs

 

Study shows the most common drugs are often implicated

By Susannah Benady

 

MONTREAL – A study here of randomly selected elderly emergency patients

underscores the importance of checking for adverse drug interactions, especially

in patients on nonsteroidal anti-inflammatories, antibiotics or anticoagulants.

The study, done at Montreal's Jewish General Hospital and published in

the Annals of Emergency Medicine, showed the more medications the patient was

taking, the more likely it was that an adverse drug interaction was the cause of

the visit.

On further review of patients' drug regimens, it turned out almost

one-third of all the patients were at risk for at least one adverse drug

interaction in the future, even if the complaint that had brought them to the ER

in the first place was not related to medication side-effects.

This figure rose to 50% for those who presented because of a

drug-related adverse event.

" Emergency physicians must be vigilant in monitoring elderly patients

for medication-related problems, " said Dr. Corinne Michèle Hohl of McGill

University, a resident at the Jewish General and one of the study authors.

The findings underline the need for physicians to take a very careful

medication history, added Dr. Hohl in an interview.

" This includes trying to establish what the compliance is, what

over-the-counter medication the patient might also be taking and what comorbid

conditions the patient has, as well as what the presenting problem is. "

The findings showed that overall, drug-related adverse events were

responsible for 10.6% of emergency department visits by the elderly.

The study was a retrospective analysis led by Dr. Marc Afilalo,

director of the emergency department at the Jewish General and Dr. Jerrald

Dankoff, assistant professor of emergency medicine at McGill.

The team looked at 283 emergency consultations by randomly selected

patients ages 65 to 100 years during a one-year period, from January to December

1998.

Of the total number of visits reviewed, 257 involved patients taking

one or more over-the-counter or prescribed medications daily. On average,

patients were taking 4.2 drugs, although more than 13% took at least eight

drugs.

In patients taking two to five medications, the proportion of

drug-related adverse events being the cause of an emergency visit was 11.5%.

The corresponding figure for those taking six or more drugs was 16.9%.

No adverse events were seen in patients taking just one medication.

The most frequently implicated classes of medications were nonsteroidal

anti-inflammatory drugs, antibiotics, anticoagulants, diuretics, hypoglycemics,

calcium-channel blockers and chemotherapeutic agents.

" Drugs that are most commonly prescribed are the ones most commonly

implicated, " said Dr. Hohl.

The symptoms patients presented with included duodenal ulcers (about

10%), allergic reactions to antibiotics, withdrawal reactions and even renal

failure, she said.

" These were cases identified by the attending physician as being due to

an adverse drug interaction.

" In all the events, the treating physician had to recognize there was a

medication implicated and had to withdraw the medication, and only if the

patient got better could we conclude that it was an (adverse drug interaction). "

However, she stressed it is possible that some of the emergency visits

were due to adverse drug interactions but were not recorded as such.

" Because it was retrospective, the study could only consider the cases

that the attending physician had identified as an adverse drug interaction. But

drug-related adverse events are not always obvious and it is possible some were

missed. "

The authors are now trying to start a prospective study. Dr. Hohl added

that one of the aims would be to design better tools for ER physicians.

" Treatments for adverse drug interactions include withdrawing

medication and carefully weighing the cost/benefit to the patient of taking the

medication.

" A physician might consider a different class of medication. And

sometimes it is just a matter of balancing the dose.

" But more specific advice on what ER physicians can do in these cases

is one of the goals of the prospective study. "

 

 

 

 

 

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