Clinical Pharmacy 4th Pharm D

1. PREVENTION OF ADRS
PHARM-D 4TH YEAR
CLINICAL PHARMACY
Dr. Pradeepthi.k
Assistant Professor
Department of Pharmacy Practice

2. (I) PREVENTING ADRS OR MINIMIZING
 Anticipation by Patient monitoring
 It is preferable to prevent or minimize the
consequences of an adverse drug reaction. This
can be done by assessing the patient and
anticipating the possible.
 ADRs that may occur in that patient. For example,
certain drugs cause hemolytic anemia in patients
with glucose-6-phosphate dehydrogenase (G-6-PD)
deficiency.
 Patients at high risk for this condition could be
screened for G-6-PD activity prior to administering
a potentially offending agent

3.  Anticipation of dosage reduction Dosage reduction prior to
initiating therapy should be anticipated for certain patients.
 For example, patients with impaired renal function, whether due
to disease or to advanced age, should receive a reduced dose
of any drugs excreted unchanged in the urine.
 Monitoring of serum levels Many ADRs are associated with high
drug serum levels.
 Examples of these drugs are theophylline, anticonvulsants,
antiarrhythmics, aspirin, and amino glycosides
 Appropriate monitoring of serum levels, using basic
pharmacokinetic principles, will prevent many ADRs which result
from levels outside the therapeutic range.

4. MONITORING OF PHARMACOLOGIC ACTIVITY
 The ADRs associated with many drugs are an
extension of their pharmacologic properties.
 For example, diuretics are given to promote salt
and water loss but may cause electrolyte depletion
and dehydration.
 Warfarin is given as an anticoagulant but may
cause bleeding.
 Prevention of such toxic effects involves setting
therapeutic endpoints and selecting appropriate
monitoring techniques and frequency to ensure that
the endpoint is not exceeded.

5.  The key to the prevention and minimization of common or
predictable ADRs is anticipation. As described below,
many ADRs can be prevented if the individual patient is
evaluated prior to the initiation of therapy for the potential
of developing an ADR during therapy.
 Based on patient-specific information and a thorough
knowledge of drug, appropriate endpoints and monitoring
techniques can be selected before the patient actually
receives the drug.
 For this reason, many ADRs can be prevented or
detected and quickly corrected.

6. (II) MINIMIZING NON-PREVENTABLE ADRS
 Adverse drug reactions that are idiosyncratic or
hypersensitive reactions are not as preventable;
 however, anticipation can minimize the
consequences of these types of reactions.
 A thorough knowledge of the drug and an
observation of the patient can help minimize ADRs.
 If reported idiosyncratic reactions occur or unusual
patient symptoms are correlated with drug
administration, the dose of the drug may be
reduced or discontinued before the complications
are severe. The reaction may

7.  be minimized also by anticipating a response and providing
more frequent monitoring of the patient.
 If particularly severe reactions are anticipated, monitoring
the consequences could be minimized by having antidotes
or to reverse the effects on hand prior to the initiation of
therapy.
 For example, if it is decided that the patient with a life-
threatening infection such as meningitis should be treated
with penicillin, although the patient has a history of
penicillin, allergy, diphenhydramine epinephrine and
corticosteroids should be available .The patient is carefully
monitored, the allergic reaction if it occurs may be quickly
recognized, treated, and minimized.

8. THANK YOU