Cases Of Adverse Drug Reactions Research Articles

Cutaneous adverse drug reactions to psychotropic drugs and their risk factors – a case-control study

Cutaneous adverse drug reactions (CADRs) in patients with psychotropic drugs are common. Large studies on the relevant drugs and other risk factors are still scarce.594 cases of severe CADRs (“cases”) were compared with 8085 cases of other adverse drug reactions (“non-cases”) documented in a pharmacovigilance program in psychiatry (AMSP) from 1993 to 2014. Logistic regression was carried out to determine risk factors and between-drug differences.CADRs were relatively more prevalent in patients treated with clomipramine, maprotiline, carbamazepine, lamotrigine, acamprosate, clomethiazole and disulfiram as well as with antidepressants and anticonvulsants as drug classes (p < 0.01). For these drugs, significantly more women were found in patients using maprotiline, lamotrigine (not carbamazepine) and in the groups of antidepressants, tricyclics and anticonvulsants (p < 0.01). Women were more vulnerable to CADRs (67% in cases and 56% in non-cases, p < 0.01). The significantly higher rate of CADRs in women was mainly observed under age of 50 years, i.e. during female reproductive years. In a multivariate logistic regression, female sex, the diagnostic group ICD F1 (substance abuse), maprotiline, carbamazepine, lamotrigine and clomethiazole were identified as risk factors of CADRs.The case/non-case approach allowed to identify risk factors based on empirical data rather than experts’ evaluations. The new findings of substance abuse and clomethiazole as risk factors for CADRs have to be confirmed in further studies. Since CADRs can be life-threatening, it is important to be aware of risk factors, especially women during their reproductive period and with lamotrigine treatment.

Prescribing pattern of antimicrobials and adverse drug reactions in children suffering from lower respiratory tract infection in tertiary care hospital

Background: Acute respiratory tract infections are leading cause of mortality in children in India. Further, indiscriminate use of antimicrobials has led to increased drug resistance and large number of adverse drug reactions (ADR). Therefore, aim of study was to study antimicrobial prescribing pattern and record incidence and causality assessment of ADRs in pediatric in-patients having lower respiratory tract infection (LRTI).Methods: In this prospective and observational study total of 300 children aged 2 months to 12 years suffering from LRTI and hospitalized for minimum 48 hrs duration were included. A descriptive analysis was carried out to determine frequency and combinations of antibiotics prescribed and causality and number of ADRs.Results: Out of 300 subjects, 70.3% of patients were males and 54.6% of cases with LRTI belonged to 2-6 months age group. The most frequently prescribed antibiotic was ceftriaxone alone in 67 (22.3%) patients while ceftriaxone and amikacin was the most common 2 drug combination in 60 (20%) patients. Ceftriaxone, ampicillin and gentamicin was most common 3 drug combination in 7 (2.3%) patients. There were 49 cases (16.3%) of ADRs and maximum were in 2-6 months age group and ceftriaxone with amikacin was associated with maximum number 10 (20.4%) of cases. Diarrhoea was most frequent adverse effect associated with antibiotics in 36 (76.6%) cases.Conclusions: The use of cephalosporins (single or combination) are most commonly used drug and associated with maximum number of ADRs in 2-6 months male children with LRTI so clinicians should use them judiciously and rationally.

The cancer registry as an ally in monitoring treatment effectiveness

ObjectiveTo evaluate if the cancer registry database can be used to monitor treatment effectiveness using nivolumab treatment of non-small cell lung cancer (NSCLC) as an example. MethodAn observational inception cohort was used, where all registered cases of NSCLC with authorisation to initiate treatment with nivolumab were monitored retrospectively to evaluate disease characteristics and response to prior treatments. Current exposure to nivolumab was prospectively characterised and treatment outcomes classified based on the clinical information registered in the patient medical record. The main outcome measure used to assess treatment effectiveness was overall survival (OS). Secondary outcomes considered were progression free survival (PFS) as a measure of effectiveness and occurrence of Adverse Drug Reaction (ADRs) as a measure of safety. Data were analysed using SPSS, version 24. ResultsA total of 115 patients received treatment with nivolumab for NSCLC, between November 1st 2015 and July 31st 2016, and were registered in the database. The majority were non-squamous type (n=107). The median OS was 11.4 months {CI95%: 11.1–11.7}, with a 1-year survival of 44%, in line with clinical trial data. Median PFS was 5.4 months {CI95%: 2.8–7.9}. Treatment was discontinued in 82 cases, most frequently due to disease progression. There were 38 cases of ADRs documented in the patient medical chart, 21 of which led to treatment discontinuation. ConclusionThe analysed data suggest that the cancer registry is a powerful tool to monitor treatment effectiveness, although considerable investment is needed to improve the medical culture of recording treatment exposure, particularly documentation of ADRs.

Timeline representation of clinical data: usability and added value for pharmacovigilance

BackgroundPharmacovigilance consists in monitoring and preventing the occurrence of adverse drug reactions (ADR). This activity requires the collection and analysis of data from the patient record or any other sources to find clues of a causality link between the drug and the ADR. This can be time-consuming because often patient data are heterogeneous and scattered in several files. To facilitate this task, we developed a timeline prototype to gather and classify patient data according to their chronology. Here, we evaluated its usability and quantified its contribution to routine pharmacovigilance using real ADR cases.MethodsThe timeline prototype was assessed using the biomedical data warehouse eHOP (from entrepôt de données biomédicales de l’HOPital) of the Rennes University Hospital Centre. First, the prototype usability was tested by six experts of the Regional Pharmacovigilance Centre of Rennes. Their experience was assessed with the MORAE software and a System and Usability Scale (SUS) questionnaire. Then, to quantify the timeline contribution to pharmacovigilance routine practice, three of them were asked to investigate possible ADR cases with the “Usual method” (analysis of electronic health record data with the DxCare software) or the “Timeline method”. The time to complete the task and the data quality in their reports (using the vigiGrade Completeness score) were recorded and compared between methods.ResultsAll participants completed their tasks. The usability could be considered almost excellent with an average SUS score of 82.5/100. The time to complete the assessment was comparable between methods (P = 0.38) as well as the average vigiGrade Completeness of the data collected with the two methods (P = 0.49).ConclusionsThe results showed a good general level of usability for the timeline prototype. Conversely, no difference in terms of the time spent on each ADR case and data quality was found compared with the usual method. However, this absence of difference between the timeline and the usual tools that have been in use for several years suggests a potential use in pharmacovigilance especially because the testers asked to continue using the timeline after the evaluation.

Hospitalisation and morbidity due to adverse drug reactions in elderly patients: a single‐centre study

Adverse drug reaction (ADR) is a leading but under-recognised cause of illness, particularly in frail subjects with multiple comorbidities. To investigate the frequency, patterns and outcomes of ADR as a cause of hospitalisation in elderly patients admitted to an internal medicine ward. We performed a retrospective observational study including every patient aged over 65 years who was admitted to our department during a 12-month period. Patients admitted to short-stay (<24 h) observation unit were excluded. ADR accounted for 106 of total 1750 recorded admissions, which constituted a proportion of 6.1% (95% confidence interval 5.0-7.3%). The median age of patients was 83.5 (78.0-87.0) years and 56.6% were on polypharmacy. A total of 170 ADR was recorded with 45.3% of subjects experiencing concomitantly more than one ADR from a single molecule. Diuretics were the most commonly imputed molecules (30 events, 17.6%), followed by antithrombotics (25 events, 14.7%) and central nervous system-active drugs (16 events, 9.4%). Interactions were judged responsible for 39 cases of ADR (36.8%). An unfavourable outcome was observed in about one-third of patients (37.7%). Among those subjects, 11 (10.4%) died and 29 (27.4%) had residual disability. ADR are a common cause of hospital admission in elderly patients and are often associated with adverse outcomes. Our data underline the need of appropriate strategies aimed at identifying high-risk patients and avoiding potentially preventable drug toxicities.

Patterns of adverse drug reaction signals in NAFDAC pharmacovigilance activities from January to June 2015: safety of drug use in Nigeria.

Adverse drug reactions (ADRs) are expected to be associated with an economic drain on the healthcare systems. The study was carried out to determine the occurrence of ADRs reported to NAFDAC Pharmacovigilance from January to June 2015, to illustrate the pattern of organ system affected by ADRs, to assess the completeness of ADR report, to determine the relationship between the occurrence of ADRs with suspect drugs and the use of concomitant drugs as well as to generate possible signals from the reported ADRs. A total number of 921 ADR cases reported from January to June 2015 were analyzed using SPSS version 22. A higher percentage of ADR reports were seen in females (65.5%). The highest percentages of reports (45.6%) were from the age range of 21‐40 years, most of the suspected drugs reported had both NAFDAC (50.2%) and batch number identification (65.6%). HIV (56.9%) was the most prevalent indication reported for using the suspected drug; Zidovudine/Lamivudine/Nevirapine combination (16.9%) was reported as the suspected drug with the highest occurrences of ADRs and generalized body itching (6.9%) as the most prevalent ADR. “General disorders” (47.3%) was the most predominant organ system affected by ADRs and Pharmacists were revealed as the highest reporters of ADRs (80.2%). Overall, patients on ARVs should be vigilantly followed up as they are mostly prone to ADRs. Adverse drug reaction reporting systems need to be robust and complete in order to be able to detect new drug alerts, possible signals and improve pharmacovigilance

Analysis of adverse drug reactions induced by compound Kushen injection in Qingdao central hospital

Objective The adverse drug reaction (ADR) reports of compound Kushen injection in Qingdao Central Hospital were analyzed to improve the level of safe and rational use of drugs. Methods We investigated 35 cases of severe ADR reports induced by compound Kushen injection in Qingdao Central Hospital from 2016.09 to 2018.03 retrospectively. Then the type of report, relevance evaluation and prognosis, ADR occurrence and recovered time, involved system/organs and main clinical manifestations were analyzed. Results The new moderate and new severe ADR incident were 51.4% of 35 ADR reports. Twenty-nine cases of the ADR were occurred 30 minutes after injection. Twenty-three cases of ADR clinical symptoms can be recovered after 30 minutes. The main ADR was the digestive system reaction, followed by the neural system, respiratory system and cardiovascular system. Conclusions It is important to pay attention to the occurrence of compound Kushen injection ADR and strengthen its monitoring. Key words: Traditional Chinese drug adverse reaction; Compound Kushen injection; Adverse drug reaction reporting systems; Drug monitoring; Rational use of drugs

Analysis of drug related electrolyte disturbances in emergency medicine department

Background: Electrolytes play an important role in various physiological functions of the body. Electrolyte disturbances are one of the most common problems encountered in critically ill patients. Drugs are also known to cause adverse electrolyte consequences. These drugs could be anti-hypertensive agents, hormones, antipsychotics or steroids. There is paucity of published literature on electrolyte disturbances caused by drugs. The purpose of our study was to evaluate the electrolyte disturbances caused by various drugs in critically ill patients.Methods: Following approval of the Institutional Ethics Committee, data collection was started. Adverse Drug Reactions (ADRs) presenting as an electrolyte disturbance in emergency medicine department or occurring in hospitalized patients in the Intensive care unit (ICU) of our hospital was be collected. ADRs resulting into electrolyte disturbances were identified and analysed in detail for demographic details, types of electrolyte disturbances, seriousness, severity, causality and preventability of ADRs. Fisher's exact test was done to find out the statistical difference between the electrolyte disturbances and different drugs.Results: Total 58 ADRs were reported as an electrolyte disturbance. Mean age of the patients affected was 52.48 years. Highest number of ADRs were observed in the age group of 61 to 70 years. Hypokalemia constituted 32 cases (55.2%) followed by hyponatremia (25.9%), hyperkalemia (6.9%), hypernatremia (6.9%), hypocalcemia (1.7%), hypomagnesemia (1.7%) and hypophosphatemia (1.7%). Insulin was associated with maximum cases of ADRs (27.6%).Conclusions: Electrolyte disturbances constitutes a major chunk of ADRs especially in critically ill patients. The physicians must be well-versed with the dynamics of fluid-electrolyte balance.

Evaluating Twitter as a complementary data source for pharmacovigilance

ABSTRACTBackground: Social media are currently considered as a potential complementary source of knowledge for drug safety surveillance. Our primary objective was to estimate the frequency of adverse drug reactions (ADRs) experienced by Twitter users. Our secondary objective was to determine whether tweets constitute a valuable and informative source of data for pharmacovigilance purposes, despite limitations on character number per tweet.Research design and methods: We selected a list of 33 drugs subject to careful monitoring due to safety concern in France and Europe, and extracted tweets using the streaming API from 30 September 2014 to 5 April 2015. Two pharmacovigilance centers classified these tweets manually as potential ADR case reports.Results: Among 10,534 tweets, 848 (8.05%) implied or mentioned an ADR without meeting the four FDA criteria required for reporting an ADR, and 289 (2.74%) tweets were classified as ‘case reports.’ Among them 20 (7.27%) tweets mentioned an unexpected ADR and 33 (11.42%) tweets mentioned a serious ADR.Conclusions: With the use of dedicated tools, Twitter could become a complementary source of information for pharmacovigilance, despite a major limitation regarding causality assessment of ADRs in individual tweets, which may improve with the new limitation to 280 characters per tweet.

Suicidal Ideation and Suicidal Behavior as Rare Adverse Events of Antidepressant Medication: Current Report from the AMSP Multicenter Drug Safety Surveillance Project.

BackgroundSuicidal ideations, suicide attempts, and fatal suicides are rare adverse drug reactions to antidepressant drugs, but they essentially are clinically relevant. Drawing on a larger dataset of the European drug surveillance program, the present naturalistic study updates a previous contribution (Stübner et al., 2010).MethodsFirst an analysis of the comprehensive data collected in 81 psychiatric hospitals from 1993 to 2014 by the European drug surveillance program Arzneimittelsicherheit in der Psychiatrie was made. All documented single cases of suicidal ideations or behavior judged as adverse drug reactions to antidepressant drugs were carefully assessed as to their clinical features and drug prescriptions.ResultsAmong 219,635 adult hospitalized patients taking antidepressant drugs under surveillance, 83 cases of suicidal adverse drug reactions occurred (0.04%): 44 cases of suicidal ideation, 34 attempted suicides, and 5 committed suicides were documented. Restlessness was present in 42 patients, ego-dystonic intrusive suicidal thoughts or urges in 39 patients, impulsiveness in 22 patients, and psychosis in 7 patients. Almost all adverse drug reactions occurred shortly after beginning antidepressant drug medication or increasing the dosage. Selective serotonin reuptake inhibitors caused a higher incidence of suicidal ideation and suicidal behavior as adverse drug reactions than noradrenergic and specific serotonergic antidepressants or tricyclic antidepressants, as did monotherapy consisting of one antidepressant drug, compared to combination treatments.ConclusionsThe study supports the view that antidepressant drug-triggered suicidal ideation and suicidal behavior (primarily with selective serotonin reuptake inhibitors) are rare. Special clinical features (restlessness, ego-dystonic thoughts or urges, impulsiveness) may be considered as possible warning signs. A combination therapy might be preferable to antidepressant drug monotherapy when beginning treatment.

Queixas técnicas e reações adversas a medicamentos notificadas em um hospital regional (Brasil): um estudo transversal

Introdução: Reações adversas e os incidentes associados com medicamentos ocasionam a morte e ameaçam a segurança do paciente. No Brasil, persiste-se uma escassez de dados epidemiológicos e uma abordagem ainda insuficiente. Objetivo: Descrever a frequência e as características das notificações de queixas técnicas e reações adversas a medicamentos (RAM) em um hospital regional. Métodos: Estudo transversal, realizado em um hospital de ensino referência para o noroeste do Estado de São Paulo. Por meio do sistema Notivisa da Anvisa, foram contabilizadas as notificações de RAM e queixas técnicas do período de junho de 2012 a julho de 2014. Excluíram-se as não finalizadas e com dados incompletos. Os casos de RAM foram classificados de acordo com o critério de gravidade, sistema de órgãos afetado e caracterização da classe do fármaco suspeito. Ademais, as características do sexo e da idade dos pacientes envolvidos também foram investigadas. Os dados foram descritos como frequência simples e proporções. Resultados: No total, contabilizaram-se 151 (84,8%) notificações de potenciais RAM e 27 (15,2%) de queixas técnicas. Mulheres (62,9%) com idades entre 26-59 anos (42,4%) foram predominantes entre os pacientes notificados com RAM. A maioria das reações foram distúrbios da pele (33,1%), de gravidade moderada (70,2%), provindas de medicamentos que atuam no sistema nervoso (35,8%). Sobre as queixas técnicas, o extravasamento de líquido do material de acondicionamento foi a ocorrência mais descrita (40,7%). Conclusão: As notificações associadas com medicamentos são recorrentes no âmbito hospitalar e as características relatadas embasam conhecimentos sobre o perfil clínico dos episódios adversos apresentados.

A retrospective study to evaluate the pattern of spontaneously reported antiretroviral induced adverse drug reactions in a tertiary care hospital

Background: To evaluate the adverse effect profile of spontaneously reported cases of adverse drug reactions due to antiretroviral (ART) drugs in a tertiary care teaching hospital.Methods: A descriptive retrospective study of pattern of ART induced adverse drug reactions (ADRs) spontaneously reported to the Pharmacology department at a tertiary care hospital from January 2011 to December 2016. The details of suspected ADRs including drugs involved, treatment given for ADRs, and the outcome were also documented. These ADRs were analyzed for causality (WHO scale), severity (Hartwig et al. scale), seriousness (ICH E 2A guidelines), preventability (Schumock and Thornton scale) and type based on Edwards and Aronson classification system.Results: Of the 75 cases of ART induced ADRs, reactions were slightly more common in males (52%) and had median age and duration of ART as 36 years and 109 days respectively. Drug induced anemia was the most common presentation followed by cutaneous ADR and zidovudine being the commonest offender. Severity was moderate in 85.3% and causality was probable in 16% and possible in 84% cases. The type reaction was augmented type in 41.3% and not preventable in 76%.Conclusions: Zidovudine is the commonest drug implicated in causing anemia amongst the antiretrovirals. Spontaneous reporting method for antiretroviral pharmacovigilance is insufficient. Targeted spontaneous reporting or cohort event monitoring need to be studied for antiretroviral pharmacovigilance.

A study on the usage of antimicrobial agents and adverse drug reaction of antimicrobial used in a tertiary care hospital in North East India

Background: Irrational use of antimicrobial agents (AMAs) has led to large scale development of drug resistance and adverse drug reactions (ADRs) which has become a growing world -wide concern. The study was conducted to analyze the prescribing pattern of AMAs and to evaluate the reported ADR of the AMAs prescribed.Methods: A prospective study was conducted by analyzing 900 case sheets receiving AMAs in a tertiary care hospital. The study plan included analysis of average number of AMA prescribed, morbidity profile of patients, types of AMAs used, drug prescribed by generic/brand name, injectable AMA preparations and appropriateness of indication of AMA used. Thirty reported cases of ADR were evaluated for their casualty by Narnajo’s scale and severity by Hartwigs scale.Results: Average number of drugs per prescription was 1.54. Most common morbidity was fever due to various causes. 86.2% of AMA used was antibiotics. About 72.0% of AMAs were prescribed by generic name. Percentage of injectable preparation was 85.0%. 65.0% of drugs were prescribed from Essential drug list (EDL). Most offending drug for ADR was fixed drug combination (FDC) 30.0%. Common organ system involved was skin (63.3%). Most of the ADR were possible (80.0%) and mild (76.6%) in nature.Conclusions: Average number of AMAs per prescription was1.54. Percentage of drug prescribed by generic name is encouraging. However use of injectable preparation was very high. Majority of AMAs prescribed were antibiotics which is also very high. Periodic prescription audit will provide feedback to the prescribers and help in reducing the prescribing error and ADR cases.

Adverse Drug Reactions (ADR) and Emergencies.

Adverse drug reactions (ADR) are a common reason for emergency room visits and for hospitalization. An ADR is said to have occurred when the patient's symptoms and signs are considered to be possibly, probably, or definitely related to the intake of a drug. In four large hospital emergency departments, one in each of four German cities ( Ulm, Fürth, Bonn, and Stuttgart), the percentage of suspected ADR cases among all patients presenting to the emergency room was determined during a 30-day period of observation. ADRs were ascertained by screening the digital records of all patients seen in the emergency room; causality was assessed as specified by the WHO-UMC (Uppsala Monitoring Center). ADR were sought in a total of 10 174 emergency department visits. 665 cases of suspected ADR were found, yielding a prevalence of 6.5%. The prevalence of ADR among patients with documented drug intake was 11.6%. Among the patients with documented suspected ADRs, 89% were hospitalized (in contrast to the 43.7% hospitalization rate in the entire group of 10 174 emergency department visits). A possible causal relationship between the patient's symptoms and signs and the intake of a drug was found in 74-84% of cases. Patients with ADR were found to be taking a median of 7 different drugs simultaneously. Adverse drug reactions are a relevant cause of emergency department visits, accounting for 6.5% of the total visits in this study, and often lead to hospital admission. The ADRED (Adverse Drug Reactions in Emergency Departments) study, which is now being conducted, is intended to shed further light on their causes, patient risk factors, and potential avoidability.

Preventable statin adverse reactions and therapy discontinuation. What can we learn from the spontaneous reporting system?

ABSTRACTBackground: Statin treatment is often associated with poor adherence, which may be due to the onset of adverse drug reactions (ADRs). We investigated on potential risk factors related to preventable cases of statin-induced ADRs and to the discontinuation of statin therapy.Methods: We performed a study using the database of Italian spontaneous reporting. The target population for the preventability assessment was all patients with suspected statin-induced ADRs deriving from Campania Region (a territory of Southern Italy) between 2012 and 2017. Additionally, a local sentinel surveillance site involving General Practitioners was selected to countercheck in routine clinical practice the role of ADRs for statin discontinuation.Results: In total, 34 of 655 (5.19%) regional cases were preventable and among detected risk factors 90.0% was related to healthcare professionals’ practices and 10.0% to patient behaviour. In 81.4% (533/655) of cases, statin therapy was discontinued due to ADRs, mainly classified as not serious and associated with a positive prognosis. These results were also confirmed in the active sentinel site.Conclusions: Our findings suggest an inappropriate use of statins among the identified preventable cases and a potential inappropriate statin discontinuation due to ADRs. These factors may be useful for targeting interventions to improve statin adherence.

Evaluation of completeness of adverse drug reaction case reports published in biomedical Journals: A preliminary analysis

Evaluation of completeness of adverse drug reaction case reports published in biomedical Journals: A preliminary analysis

Relief System for Adverse Drug Reactions in Korea

The relief system for adverse drug reactions is a reimbursement system for non‐fault injury from drugs that started with the intent of relieving victims of adverse drug reactions despite normal use of the medicines. In Korea, the relief system for adverse drug reactions started on December 19, 2014. To date, the deliberation process for 100 cases of adverse drug reactions has ended, of which 78 cases received relief reimbursement. As this is the early phase of system implementation, efforts to stabilize the system are needed. It is very important for clinicians to participate actively in mediating between the victims of adverse drug reactions and the Korea Institute of Drug Safety & Risk Management, to establish an effective relief system. It is also important to implement the most favorable relief system considering the socioeconomic and medical environment in Korea. Keywords: Relief work; Drug‐related side effects and adverse reactions; Korea 중심 단어: í”¼í•´êµ¬ì œ ì œë„; 의약품 부작용; 한국

Critical evaluation of causality assessment of herb-drug interactions in patients.

The aim of this review was to assess the severity of adverse drug reactions (ADRs) due to herb-drug interactions (HDI) in patients taking herbs and prescribed medications based on published evidence. Electronic databases of PubMed, the Cochrane Library, Medline and Scopus were searched for randomized or nonrandomized clinical studies, case-control and case reports of HDI. The data were extracted and the causal relationship of ADRs as consequences of HDI assessed using Horn's drug interaction probability scale or Roussel Uclaf Causality Assessment Method scoring systems. The mechanism of interaction was ascertained using Stockley's herbal medicine interaction companion. Forty-nine case reports and two observational studies with 15 cases of ADRs were recorded. The majority of the patients were diagnosed with cardiovascular diseases (30.60%), cancer (22.45%) and renal transplants (16.32%) receiving mostly warfarin, alkylating agents and cyclosporine, respectively. HDI occurred in patients resulting in clinical ADRs with different severity. Patients may poorly respond to therapeutic agents or develop toxicity due to severe HDI, which in either scenario may increase the cost of treatment and/or lead to or prolong patient hospitalization. It is warranted to increase patient awareness of the potential interaction between herbs and prescribed medicines and their consequences to curb HDI as a potential health problem.

Prescripción de analgésicos y reacciones adversas en pacientes hospitalizados

Justificación. El dolor tiene alta prevalencia en la población general, siendo mayor en pacientes hospitalizados, con cifras cercanas al 80%. El control del dolor no siempre es adecuado debido a varios factores, siendo uno de los más importantes, el escasoconocimiento en el manejo de los analgésicos. Como una de las primeras medidasde mejoramiento asistencial para reducir el dolor en un hospital, debe conocerse la prevalencia de este síntoma y, asimismo, debe analizarse el abordaje terapéutico realizado.Es por esto por lo que este estudio tuvo como objetivo analizar el uso de analgésicos en pacientes de un hospital de cuarto nivel en Bogotá, Colombia, identificar los analgésicos más utilizados, el rango de dosis, las posibles interacciones y reacciones adversas a medicamentos (RAM) existentes. Resultados. El 78,9% de los pacienteshospitalizados presentaban dolor. Se prescribió analgésicos en 561 pacientes hospitalizados.Entre los más utilizados se encuentran: el acetaminofén (33,3%) y eltramadol (29,7%). El rango de duración de la terapia analgésica más común fue de 1 a 5 días (81,7%). Se identificaron 37 casos de sobredosificación y tres de terapia duplicada. Se presentaron 28 casos de reacciones adversas a medicamento (RAM).Discusión. El adecuado tratamiento del dolor cobra vital importancia al evaluar la satisfacción del paciente. Se encuentran diferentes tendencias de uso de analgésicos en pacientes hospitalizados, siendo los más utilizados el acetaminofén y los antiinflamatoriosno esteroideos (AINE). Se debe seguir investigando en este tema para tener evidencias científicas más firmes que permitan dictar unos lineamientos de aplicación universal para un correcto alivio del dolor.

Stamping a case of cutaneous adverse drug reaction: Proving beyond causality assessment

Different types of skin testing with a suspected drug have been reported to be helpful in determining the cause of cutaneous adverse drug reactions (CADRs). It is of utmost importance for practicing dermatologists to have a first hand knowledge of different types of skin tests available in a case of CADR. In each suspected case, a detailed investigation with the suspected agent and correlation of the positive skin reaction with clinical variant of CADR is advocated. Drug skin tests are performed 6 weeks to 6 months after complete healing of the CADR. Drug patch tests are performed similar to the methods used in patch testing in studying contact dermatitis. The commercialized form of the drug used by the patient is tested at 30% dilution. The pure drug is tested at 10% dilution. In severe CADR, drug patch tests should be performed at lower concentrations. It is also of value to test on the most affected site of the initial CADR.