The document provides an overview of iatrogenic diseases, which are conditions induced by medical interventions or therapies, highlighting causes and types of iatrogenic effects, including medical errors, drug interactions, and social repercussions. It discusses various examples of iatrogenic conditions, particularly the adverse effects of certain drugs and medical treatments, as well as the classification of drugs based on their danger levels. The conclusion emphasizes the need for careful drug use and early recognition of drug-induced injuries to prevent permanent damage.

1. Ioatrogenic Disease
Presented by
Dr. Debasish Pradhan
Sr. Faculty Pharmacology
University Department of Pharmaceutical Sciences
Utkal University, VaniVihar, Bhubaneswar, Odisha
NAAC A+

2. What is iatrogenic?
 Iatrogenic:
Disease induced by/ due to the activity of a physician or therapy. For example,
an iatrogenic illness is an illness that is caused by a medication or physician.
 What are iatrogenic effects?
Medical error and negligence. Iatrogenic conditions do not necessarily result from medical
errors, such as mistakes made in surgery, or the prescription or dispensing of the wrong therapy,
such as a drug. In fact, intrinsic and sometimes adverse effects of a medical treatment
are iatrogenic.
 What is social Iatrogenesis?
Medicalisation is associated with a social process that Illich termed 'iatrogenesis'. This
concept refers to the detrimental consequences of medical interventions
(clinical iatrogenesis), such as adverse drug reactions and hospital acquired infections.

3. Causes of Iatrogenesis
 Causes of iatrogenesis may include:
 complications arising from a medical procedure or treatment
 side effects of possible drug interactions
 medical errors
 negligence
 use of contaminated instruments
 anxiety or annoyance in the patient, physician or treatment provider in relation to
medical procedures or treatments
 unnecessary medical treatment resulting from a physician's decision

4. Medical Error & Negligence
 Iatrogenic conditions do not necessarily result from medical errors, such as mistakes
made in surgery, or the prescription or dispensing of the wrong therapy, such as
a drug. In fact, intrinsic and sometimes adverse effects of a medical treatment are
iatrogenic. For example, radiation therapy and chemotherapy — necessarily
aggressive for therapeutic effect – frequently produce such iatrogenic effects as hair
loss, hemolytic anemia, diabetes insipidus, vomiting, nausea, brain
damage, lymphedema, infertility, etc.
 The incidence of iatrogenesis may be misleading in some cases. For example,
ruptured aortic aneurysm is fatal in most cases; the survival rate for a ruptured aortic
aneurysm is under 25%. Patients who die during or after an operation will still be
considered iatrogenic deaths, but the procedure itself remains a better bet than the
100% probability of death if left untreated.
 Other situations may involve actual negligence or faulty procedures, such as
when pharmacotherapists produce handwritten prescriptions for drugs.

5. Adverse Effects
 A very common iatrogenic effect is caused by drug interaction, i.e., when pharmacotherapists fail to
check for all medications a patient is taking and prescribe new ones that interact agonistically or
antagonistically (thereby potentiating or attenuating the intended therapeutic effect). Such situations
can cause significant morbidity and mortality. Adverse reactions, such as allergic reactions to drugs,
even when unexpected by pharmacotherapists, are also classified as iatrogenic.
 The evolution of antibiotic resistance in bacteria is iatrogenic as well. Bacterial strains resistant to
antibiotics have evolved in response to the overprescription of antibiotic drugs.
 Certain drugs are toxic in their own right in therapeutic doses because of their mechanism of
action. Alkylating antineoplastic agents, for example, cause DNA damage, which is more harmful to
cancer cells than regular cells. However, alkylation causes severe side-effects and is
actually carcinogenic in its own right, with potential to lead to the development of secondary tumors. In
a similar manner, arsenic-based medications like melarsoprol, used to treat trypanosomiasis, can
cause arsenic poisoning.
 Adverse effects can appear mechanically. The design of some surgical instruments may be decades
old, hence certain adverse effects (such as tissue trauma) may never have been properly cauterized.[

6. Class A drugs
Class A drugs are considered to be most dangerous to health. They include:
 cocaine (including crack; nicknamed charlie, coke, snow), dicanol,
 heroin (nicknamed smack, H, gear, scag, brown), LSD (lysergic acid diethylamide;
nicknamed acid, trips, blotters, tabs),
 mescalin, methylamphetamine (crystal meth),
 methadone, morphine,
 opium; PCP (phencyclidine; nicknamed angel dust), pethadine,
 poppy straw, psilocybin,
 STP (amphetamine; nicknamed serenity, tranquility and peace),
 magic mushrooms (nicknamed liberties, shrooms), and
 DMA (methylenedioxymethamphetamine; nicknamed ecstasy, E, pills, XTC, disco
biscuits, Mitsubishis, Rolexs, dolphins).

7. Class B drugs
Class B drugs are also considered to be dangerous, but less so
than class A drugs. They include:
 amphetamine (an ingredient of ecstasy; nicknamed speed, whizz,
dexies),
 codeine (in concentrations above 2.5%),
 DF118 (dihydrocodeine),
 ritalin, and barbiturates.

8. Class C drugs
Class C drugs are considered to be the least harmful to
health but they are still illegal to possess and give or sell to
other people. They include:
 cannabis, cannabis resin and cannabinol (marijuana, grass,
pot, weed),
 methaqualone, anabolic steroids (nicknamed roids),
 ketamine (nicknamed special K, vitamin K, green),
 GHB (gammahydroxybutrate; nicknamed GBH, liquid ecstasy
and sometimes referred to as date-rape drugs),
benzodiazepines including valium, and rohypnol (nicknamed
roofies and sometimes referred to as date-rape drugs).

9. Drug induced renal disorders
 NSAIDS, ACE- inhibitors, Diuretics, Interleukin-2, Amphotericin- B
 ACUTE TUBULAR NECROSIS
 Aminoglycosides, Rifampicin, NSAIDs, Cyclosporines, Cis-platin
 ACUTE INTERSTITIAL NEPHRITIS
 Pencillins, NSAIDs, Allopurinol, Thiazides, Sulphonamides
 HEMOLYTIC UREMIC SYNDROME
 Mitomycin-c, cyclosporin, Quinine, Cocaine, Clopidogrel

10. ISOLATED PROTEINURIA WITH NEPHRITIC
SYNDROME
 Gold. Heroin, Captopril, NSAIDs, IFN-alpha, D-pencillamine
 CHRONIC TUBULOINTERSTITIAL DISEASE:
 NSAIDs, Thiazides, Lithium, Germanium, Chinese herb nephropathy
 RETROPERITONEAL FIBROSIS :
 Methysergide, Hydralazine, Methyldopa
 Drug-induced renal structural-functional changes Proximal convoluted
tubule (s1/s2 segment)
 Amino glycoside ,Cadmium Cl, K dichromate,
 NSAIDs ,ACE Inhibitor , Cyclosporin A, Interferon- α , Gold Penicillamine Cisplatin,
Mercuric Cl , Dichlorovinyl -L- cysteine 6

11. DRUG INDUCED CARDIOVASCULAR
DISEASES
 DRUG INDUCED CARDIOVASCULAR DISEASES :
 Exacerbation of angina- alpha blockers Arrhythmias - digitalis, beta-adrenergic
agents, tricyclic anti- depressants and quinine Cardiomyopathy– daunorubicin,
emetine, lithium Hypo/hypertension– glucocorticoids and sympathomimetics
Pericardial disease – emetine, procainamide and minoxidil Torsade de pointes -
sparfloxacin 11
 DRUG INDUCED ARRHYTHMIA:
 Prolongation of the QTc interval has been associated with proarrhythmia resulting
from a potentially fatal form of polymorphic ventricular tachycardia called Torsade
de pointes( TdP ) 12

12. Conclusion:
 Judicious use of above mentioned drugs is required to prevent most
unwanted side effects especially on such a vital organ .Identifying high risk
patients and quick recognition of drug induced injury-related syndrome
with prompt cessation of the offending drug are the key to managing such
a case before the injury causes permanent damage to the tissue.

13. Thank You