Question

Briefly describe five common examples of drug-induced tissue or organ damage. Include two nursing interventions for each reaction that can be implemented to man Conduct an Internet search to determine the most frequent causes of adverse drug reactions. Discuss nursing interventions that can be implemented to decrease the likelihood of the identified adverse drug reactions.age the reaction or promote patient comfort.

Answer 1

According to World Health Organisation Adverse drug reaction refers "Any response to a drug which is noxious & unintended & which occurs at doses in man for prophylaxis, diagnosis or treatmant". A number of drugs have been noted to cause tissue and organ damage. Tissue and organ damage includes injury to the muscles, bones, tendons, ligaments, cartilage,skin,heart,kidney and liver.

Some of the common examples of drug-induced tissue or organ damages as follows,

1.Drug induced kidney injury or Nephro toxicity: This means any renal injury caused directly or indirectly by medications, with acute renal failure, tubulopathies, and glomerulopathies including acute reduction of glomerular filtration rate. This drugs consists of anti-inflammatories, antibiotics, such as vancomycin and aminoglycosides, and chemotherapeutic agents, such as cisplatin and methotrexate. Tubulopathy are very common with amphotericin B, polymyxins, and tenofovir, and glomerulopathies are common with VEGF inhibitors, bisphosphonates, and immunotherapy, and it is also common to have multiple clinical presentation related to a single agent.

Nursing interventions:

• Assessment and identification of high risk individuals or risk factors of individuals who have prone to develope kidney diseases.
• Cautious administation of medications and maintenence of normal fluid and electrolyte level: intake out put chart,electrolyte monitoring.

2.Muscle damage: These issue commonly associated with statin group of drugs for example HMG-CoA reductase inhibitors:Lovastatin,Atorvastatin,Compactin (mevastatin),Crestor (rosuvastatin),Lescol (fluvastatin) etc. This drugs known to cause damage to a patient’s muscles. In its extreme form, this muscle damage leads to rhabdomyolysis, and it involves a massive release of myoglobin into the bloodstream because of the breakdown of skeletal muscle. Major symptoms of rhabdomyolysis include extreme weakness, muscle pain, vomiting, confusion, and dark brown urine (due to the presence of excess myoglobin). This statin-induced tissue damage can lead to arrhythmia, kidney failure, heart failure, and death too.

Nursing interventions:

• Keen observation and early identification of muscle injury.
• Physical therapy to improve muscle strength.

3.Drug induced Liver injury: Drug-induced liver injury is one the major drug induced tissue injuries. Almost all classes of medications can cause liver disease.Most of the cases pre exsisting liver diseases or genetic conditions leads to the liver damage.Accetaminophen is the most common drug which causing liver damage.However, variety of drugs induce liver damage, including anesthetics eg; Halothane, anticancer drugs, antibiotics eg;Pencillin,cephalosporins, sulfonylureas, antituberculosis agents eg; Isoniazid, Analgesics eg;Diclofenac, antiretrovirals, and cardiac medications,some of the  traditional medical therapies and herbal remedies may also be hepatotoxic. Early identification and withdrawal of the offendin agent is the major management,but in severe cases liver transplantation is required.

Nursing interventions:

• Monitor the early signs of liver injury such as edema and changes in weight gain.
• strict intake out put chart maintenance.

4.Bone damages:Several drugs and medical devices used to treat patients with bone-related medical problems have been noted to cause additional harm to the patients. This includes Biphosphonate group of drugs,which is used to treat osteoporosis, metastatic bone disease, Paget’s disease, and other conditions. Biphosphonates gradualy leads to osteopenia and weakening of internal bone structures

Nursing interventions

• Encourage the patient to participate some active and passive excercises.
• Give heallth education regarding healthy diets which includes calcium and minerals and encourage to take the diet according to dietitian's order.

5.Skin Damage;The major skin injuries that a patient can suffer due to drug reaction is Stevens Johnson Syndrome (SJS) or Toxic Epidermal Necrolysis (TEN).This is often start with a mild rash soon after a new medication has been ingested. Within hours rash progresses and causes sloughing of the skin in most affected patients.For example some of the antiarthritic medications Bextra found that an effect on skin.

Nursing interventions

• Watch for early signs of hypersensitivity reactions especially initial dose of new drug.
• Check History of allergy towards any medicatios,food or any ther products.

NURSING INTERVENTIONS FOR ADVERSE DRUG REACTIONS

Successful management of adverse drug reactions requires early identification and prompt treatment of anaphylaxis, whether due to immunoglobulin (Ig) E- or non-IgE-mediated mechanisms of mast cell mediator release.

a. Emergency management icludes Maintenance of oxygenation and normotension

b. Immediately stope the offending drug.followed by,

1. Identification of Adverse Events.
2. Assessment of Adverse Event , which includes seriousness, causality, expectedness, and severity
3. Reporting of Adverse reactions ; Patient details Initials Gender Age and date of birth Weight Height Suspected drugs Generic name of the drug , Indication(s) for which suspect drug was prescribed or tested,dosage form and strength.
4. Reporting of daily dose and regimen of the drug (specify units - e.g., mg, ml, mg/kg) .Route of administration. Starting date and time of day. Stopping date and time, or duration of treatment.
5. While reporting drug reaction full description of reaction(s) including body site and severity, as well as the criteria for regarding the report as serious,whenever possible, describe a specific diagnosis for the reaction.
6. Adverse drug reaction should be reported to the licensing authority.