Medical complications of
drug taking
Learning objectives
Defining medical complications
Understanding of different forms of medical
complications
How these complications can be avoided
Socio-economic aspects of medical complications
Role of pharmacist in preventing medical
complications
Medical Complications
Medical complications can be defined as:
an unfavorable elevation in the disease or altered
health condition during the treatment of other
disease condition. The disease may become worse in
its severity and show higher number of signs and
symptoms
Medical Complications also involve the new
pathological changes due to drug taking or
surgical problems and cause new issues of
concerns for the healthcare team in addition to
previously existing drug therapy.
Some of Important Medical Complications
1. Medical complications due to irrational IV therapy.
2. Medical complications due to due ADRs and other
side-effects.
3. Medical complications due to drug abuse.
4. Medical complications due to contraindicated drugs
5. Medical complications due to antibiotic resistance.
6. Medical complications due to irrational prescribing
7. Medical complications due to use of medicine in
pregnancy
Medical complications due to irrational
parentral / I/V therapy
There may be many Medical complications due IV
therapy.
Local
Systemic
Local Medical Complications due to Irrational
IV Therapy
Hypersensitivity
infiltration
Extravasation
Inflammation
infection
Phelibitis
Systemic Medical complications due to
Irrational IV Therapy
Systemic Hypersensitivity
Tissue damage
Cell damage
HYPERSENSITIVITY
refers to undesirable reactions produced by the
normal immune system, including allergies and
autoimmunity.
It is a one of the most common type of complication
occurring due to IV therapy.
It is the duty of medical staff to check whether a
patient is allergic to any drug or not.
How Allergic Reaction are Accessed?
Allergic history/profile to any drug allergy is checked
Family allergy history
If patient is aged <3 month then allergies to his/her
mother are taken into the account (as at this age
antibodies of mother are present in the infant.
How to make a pt safe from allergic reaction?
There are two types of allergic reactions depending
on the time of onset.
Those that occur during first 5- 10 min.
Those that occur after first 10-15 min.
After the administration stay near the patient for 5-10
min,
Symptoms of allergic reactions
During mild reaction
Rashes
Redness
Joint swelling
Fever
Itching at site of administration
In case of anaphylactic shock
Bronchiospasm
Decreased heart rate
What to do when an allergic reaction occurs?
Keep checking the patient at regular intervals after a
TPN is administered and check for any allergic
reaction.
If any reaction occurs then
Discontinue the I/V line
Inform the prescriber.
Give antidote to the patient for this
Look for vital signs(ABC)
Pulse rate Monitor the patient Give him the treatment
of that reaction
INFILTRATION
It is defined as Leakage of material in the
surrounding of the site of venipuncture
INFILTRATION
Causes:
Improper placement or dislodgment of catheter
Risk of infiltration increases in older patients because their
veins are thin
Tip of catheter positioned in wrong direction
Type of drugs depending on the ability to form the
vesicles
There are 2 types of materials depending on the ability to
cause the formation of the vesicles or blisters
Vesicant
Non vesicant
INFILTRATION
Vesicant
Those agents that cause the blistering or vesicle formation
on the skin
Normally due to the vesicant materials infiltration causes:
Blistering on the skin
Swelling
Discomfort at the site of infiltration
Bumping sensation
Tightness of the skin
Blanching on the skin(vesicle formation)
INFILTRATION
Non Vesicant
These are drugs those causes low grade discomfort
and mild reaction and there is no formation of
blisters.
If infiltration occurs then what should be done?
Discontinue the IV line
Inform the doctor
Estimate the vesicle formation ability of the drug
Administer antidote to the patient
Check for ABC
Don't use the same site for the next IV administration
EXTRAVASATION
It is the worst form of infiltration. In this there is leakage of fluids
(vasicant) that cause serious effects as compared to infiltration.
Due to the leakage of the vesicant material many changes occur in the
surroundings of the site of venipuncture
These may be
Delayed healing of the site of
venipuncture
Tissue necrosis
Damage to cells, tissue or to the
organ of the patient
Loss of function of the organ
And even amputation(surgically removal of organ) can be
needed
EXTRAVASATION
Symptoms of Extravasation
Blanching
Cool skin
Burning sensation at IV site
Discomfort
Swelling at the site of administration
What to do when an Extravasation occurs?
Then elevate the limb of patient
Remove IV line
Estimate the amount of the vesicant infused into the patient
Inject the antidote of the vesicant depending on the amount infused
Note ABC of patient
PHLEBITIS
Inflammation of veins due to the I/V therapy
lt occurs if the solution infused is highly osmolar,
acidic or basic in nature.
During insertion of needle Trauma may also occur
PHLEBITIS
Causes of Phlebitis
Phlebitis can occur due to
Infusion of catheter in small Veins
Using large size(diameter) catheter
Prolonged use of same IV site. i.e., 2-3 days or more
How this occurs & how it can be stopped?
Phlebitis occur mostly in the distilled ends of the veins
This can be prevented by
using vein which have large diameter with more circulation
By diluting the IV solution if large doses are to be infused
Using proper techniques of venipuncture
PHLEBITIS
If it occurs what can be done?
Observe the I/V site and see the signs of the
Redness
Fever
Puffy skin and veins
Check for its symptoms if any discontinue the IV line
Report to the doctor
Apply warm packs of cotton at the IV site
INFECTIONS
If the needle or catheter used for the IV line is
contaminated then the chances of the infections are
increased many folds
The infections can be of 2 types
Systemic
local
INFECTIONS
Systemic infections
These include
AIDS
Hepatitis
Allergic reaction & Other blood born infections
Local infections
These includes
Bacterial
Fungal
Viral infections
INFECTIONS
If symptoms of infection occur what should be
done?
Check for any discharge from the IV site
Stop infusing the IV mixture
Notify the health-care provider (HCP)
Remove the device
Culture the site, device& determine the organism
Administer the medication as prescribed
Monitor the ABC
2) MEDICAL COMPLICATIONS DUE TO ADR'S AND
OTHER SIDE EFFECTS
WHO defines adverse drug reaction (ADR) “a
response to a drug which is noxious, unintended and
which occurs at doses normally used in man for
prophylaxis, diagnosis or therapy of disease or for
modification of physiological function”
A side effect is defined by ASHP “an expected, well-
known reaction resulting in little or no change in
patient management (e.g., drowsiness or dry mouth
due to administration of certain antihistamines or
nausea associated with the use of antineoplastics
Classification of the adverse drug reactions
Type A reactions (Augmented)
Type A reactions are dose related and predictable, such
reactions can be corrected by withdrawing drug.
Hypoglycemia with sulfonylurea, bradycardia with
beta-blockers are type A reactions.
Type B reactions (Bugs)
Type B reactions involve interaction with
microorganism and are predictable, e.g. dental caries
with sugar coated tablets, resistance developed due to
antibiotic overuse.
These type of reactions can be improved by
withdrawing drug.
Classification of the adverse drug reactions
Type C reactions (Chemical)
Type C reactions are time and dose related, related to the
cumulative dose and are uncommon, e.g. Hypothalamic-
pituitary-adrenal axis suppression by corticosteroids,
osteonecrosis of the jaw with bisphosphonates.
These reactions can be managed by withholding drug for
longer period of time or by reducing dose.
Type D reactions (Delivery)
These type of reactions are usually due to method of
administration or nature of formulation dose related,
uncommon, e.g. infection at injection site, inflammation
around implant particles.
Reactions can be managed by withdrawing drug or by
changing delivery method.
Classification of the adverse drug reactions
Type E reactions (End of use)
These type of reactions occurs soon after drug
withdrawal and are uncommon, e.g. Withdrawal
syndrome with opiates or benzodiazepines (e.g.,
insomnia, anxiety.
These reactions can be managed by slow withdrawal
of drug.
Type F reactions (familial)
These type of reactions occur only in patients
genetically predisposed, e.g. Hemolytic anemia with
primaquin in G6PD deficient individuals.
Classification of the adverse drug reactions
Type G reactions (Genotoxicity)
These type of reactions cause genetic damage, e.g.
teratogenic agents like thalidomide.
Type H reactions (Hypersensitivity)
Type H reactions occurs due to immune system activation,
e.g. allergic reactions due to antimicrobial agents,
anaphylaxis due to penicillin.
These reactions can be managed by drug withdrawal.
Type U reactions (unclassified)
Reactions with unknown mechanism are in this category,
e.g. taste disturbances with simvastatin, vomiting and
nausea due to gaseous anaesthetic (Wills and Brown, 1999).
Treatment
Mild ADRs: No antidote/ No hospitalization.
Moderate ADRs: A change in treatment but no
discontinuation
Severe ADRs: Life threatening, require
discontinuation of drug, specific treatment of ADRs.
MEDICAL COMPLICATIONS DUE TO DRUG ABUSE
The use of the drugs for the purpose other then the reasons
for which it is/was prescribed is called drug abuse.
The word drug is largely replaced the word "substance
abuse” because certain substances like alcohol are also under
addiction
Drug Abuse
The continuous compulsive use of the drugs, despite,
physical harms that occur in an individual and to the society
following are the causes of the drug abuse
Biological factors
Psychological factors
Biological Factors
These include
Family history
Genetics
Predisposition
Pre-existing psychotic disorder
Withdrawal effects Graving(discomfort)
Psychological Factors
Curiosity
Social rebelliousness
Poor control
Feeling high(esteem condition)
Poor stress management
Feeling as if person is relieving from fatigue
Boring sensation
Escaping from reality
Drugs causing addiction
Alcohol
Cannabis
Cocaine
Amphetamine
Nicotine
LSD (Lysergic acid diethylamide)
Benzodiazepine
Barbiturate
Morphine & codeine
Substance Disorders
Substance Withdrawal
Substance Induced Psychotic Disorder
Substance Induced Mood Disorder
Substance Induced Anxiety Disorder
Substance Intoxication
Substance Induced Sleep Disorder
Substance Induced Delirium
Substance Induced Persisting Dementia
Substance Induced Persisting Amnestic Disorder
Substance Induced Sexual Dysfunction
How to assess that a person is involved in drug
addiction or not
Change in attention towards work or performance
Alteration of personal appetence
Mood swings
Withdrawal from the family Contacts
Association with the drug taking friends
Unusual pattern of behavior
Defensive attitude concerning the drug abuse
Treatment of Drug Abuse
May include
Supportive care program
Job counseling
Educational training
Family therapy
Social servicing
MEDICAL COMPLICATIONS DUE TO
CONTRAINDICATED DRUGS
If two or more drugs are used at a time then some
medical complication can occur due to the induction
or inhibition of cytochrome P450, change in rate of
absorption of drug, interaction due to elimination.
These drugs may cause lethal interaction to cause
death.
MEDICAL COMPLICATIONS DUE TO ANTIBIOTIC
RESISTANCE
Antibiotics
A chemical substance derivable from a mold or
bacterium that kills microorganisms and cures
infection.
Antibiotic Resistance
Ability of the micro-organisms to withstand or counter
the effect of a antibiotic
Facts about Antibiotic resistance/ How it
occurs
Antibiotic has been called one of the worlds most
pressing public health problems.
More than 70% of the bacteria that cause hospital
acquired infections are resistant to at least one of the
drugs most commonly used to treat them.
Some resistant infections can cause death.
Consequences
MEDICAL COMPLICATIONS DUE TO DRUG USE IN
PREGNANCY
There are many clinically significant medical
complications that are induced by pregnancy as it
induces large number of changes in:
Function of body
Physical changes in body
Fluid composition of the body
Tissue composition of the body
Effect of drugs on pregnant women and fetus
Teratogenic drugs: A teratogen is an agent that
can disturb the development of the embryo or
fetus. Teratogens halt the pregnancy or produce a
congenital malformation (a birth defect).
Pregnancy loss
Structural deformalities
Abnormal growth
Loss f body organ
Infertility of mother
How these medical complications can be avoided
Do not take medication by your own
Good communication skill should be achieved by
healthcare provider and pharmacist.
Promote rational drug use
Counsel patient about potential side effects of the drug
Counsel patient on long term multiple drug regimen
Consider patient age, gender, hepatic and renal function
Ask patient about the allergies
Counsel patient on OTC and POM medicines
Give clear instructions to patient
Ask about any other treatments or medications
