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Adverse drug reactions: classification, susceptibility and reporting

Kaufman, Gerri.  Nursing Standard (2014+); London Vol. 30, Iss. 50,  (Aug 10, 2016): 53. DOI:10.7748/ns.2016.e10214

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Aims and intended learning outcomes

This article discusses adverse drug reactions (ADRs), which are a significant cause of morbidity and mortality. After reading this article and completing the time out activities you should be able to:

Describe the classification of ADRs.

Differentiate between type A and type B reactions, and type C, D and E reactions.

Explain the terms 'therapeutic index' and 'drug interactions'.

Identify patient groups at risk of ADRs.

Explain why ADRs may not be detected before a drug becomes available on the market and is included in the British National Formulary (BNF).

Explain pharmacovigilance and the purpose of the Yellow Card Scheme.

Outline the ways in which nurses and other healthcare professionals can work with patients to identify and prevent ADRs.

Introduction

Nurses and other healthcare professionals may inadvertently overlook the burden of treatment, including ADRs, when helping patients to cope with illness ( Jordan 2008 ). Any drug given to a patient can cause an unintended harmful effect, which may be described as an ADR ( Cossey 2010 ). ADRs are increasingly common and estimated to occur in 10-20% of patients who are prescribed drugs ( Cossey 2010 ).

ADRs impose a burden on the NHS and account for significant morbidity, mortality and cost ( Pirmohamed et al 2004 ). A study attempting to quantify this burden found that ADRs account for one in 16 hospital admissions and 4% of hospital bed capacity ( Pirmohamed et al 2004 ). ADRs are estimated to occur in 10-20% of hospital inpatients ( Medicines and Healthcare products Regulatory Agency (MHRA) 2015a ), and more than 2% of patients admitted to hospital with an ADR died ( Pirmohamed et al 2004 ).

In the primary care setting, up to 10% of all GP consultations are related to ADRs ( Cossey...