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Ioatrogenic disease
- 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