Wardround 8xii6

This week’s theme for two minute talks was Adverse Drug Reactions. ADRs are not uncommon and are sometimes fatal. Drug induced agranulocytosis mortality is shown in the figure. Even when an ADR is recognised, its presence may not be flagged up in the final diagnosis and the opportunity to prevent a repeat episode can be lost. When did you last write “Adverse Drug Reaction” in the diagnostic list?

In the talks we heard about:
Non-drug reactions (SS): the importance of asking patients if they are using non-prescribed remedies, the effects of food on drug activity such as pectins/digoxin and broccoli/warfarin.
Prevention (TJ): be aware of interactions with drugs you commonly use and check for interactions when the drug is unusual or has a narrow therapeutic window.
Diagnosis (HG)**: always consider ADR in your differential diagnoses. Be clear about information gathered and consider risk factors.
Warfarin and Antibiotics (RT): always check for interactions and monitor INR daily if interaction is expected. And of course, the second rule of ID, always ask yourself if the antibiotic is really needed.
Penicillins (AM): identify true allergy. Give some thought to the common situation of a patient reporting allergy to an antibiotic but not recalling which one. When you last prescribed an antibiotic did you tell the patient which one it was...or did you say “we’re giving you an antibiotic/a different antibiotic”
Amiodarone (MR): a bit of an aside here...MR, fight your corner, argue for your patient and don’t give in.

**=best talk

I was at a conference recently where one of the speakers had a paroxysm of acronymophilia while talking about ADRs. You will tell from the example that the example was an immunosuppressive agent.

S...Stratify: is the patient at higher risk of an ADR: comorbidities, drugs, age.
A...Assess: Hepatitis status, TB risk, vaccinations up to date?
F...Fend-off: vaccinate, optimise health (stop smoking etc).
E...Evaluate: check what ADRs might be expected, look for them.
T...Treat: nip it in the bud (UTI is easier to treat than septic multi-organ failure).
Y...Yearly: re-evaluate all of the above regularly. The frequency depends on the drug.

I have been contacted by EM from pharmacy, who has asked me to remind everyone about the risk of using ciprofloxacin in patients with epilepsy. And I will take the opportunity to mention the risk of ciprofloxacin in patients with tendonopathy (especially if on steroids). From a more general point of view we discussed the possibility of having a red dot system, similar to that used by radiographers, for the drug kardex. What do you think?

Next week’s two minute talks are on the OMG emergencies. We want to know the practical immediate management of:

Anaphylaxis (HG)
Hyperkalaemia (RT)
Sudden loss of consciousness (MR)
Hypoglycaemia (MR)
Sudden hypotension (TJ)
Sudden hypoxia (DK)

Two minutes please. Keep it concise yet precise and quote your sources. Can we make the handouts a visual aid? We don’t really need the talk written out.

The cardinal paper will be carried over once more...discussion on Tuesday as suggested by HG.

Interesting topics
Mitral regurgitation

ADR Agranulocytosis

Benign intracranial hypertension or alternatively

MJM