Be prepared for prescription drug reactions
Be prepared for prescription drug reactions
The next time a patient comes to your ED with symptoms such as headache, confusion, or nausea, suspect reactions to prescription drugs. New pharmaceuticals such as antidepressants, antianxiety, antismoking, and migraine drugs can cause unexpected symptoms.
"Always consider relating the abnormal and things you would never expect to these agents," advises Robert Knies Jr., RN, MSN, CEN, clinical nurse specialist for emergency services at HealthSystem Minnesota in St. Louis Park.
Classic signs and symptoms of side effects
The classic signs and symptoms of side effects include flulike symptoms, but with missing parts, such as tremors, dermatologic conditions, generalized body aches without the fever, or malaise without nausea, vomiting, and diarrhea, notes Knies.
Consider these points about prescription drug reactions:
• Know cross reactions.
Patients may become allergic to substances due to new prescription drugs. "People may have cross reactions to antibiotics. For example, cephalsporins can cause reactions to people who are allergic to penicillin," says Knies.
Drugs may contain additives that aren’t listed, such as colors or substances to make them dissolve at different times, notes Knies. "Anything that someone ingests can affect a person," he says. Examples are sustained release medications such as Cardizem sustained release (diltiazem HCI, manufactured by Hoechst Marion Roussel in Kansas City, MO), and others with rapid-dissolving substances such as Nitro, or yellow dye No. 4 and other colors, he says.
• Realize that patients may not know the correct names of the medications they are taking.
A significant number of drugs sound similar, such as Cerebyx (Parke-Davis, Morris Plains, NJ) and Celebrex (G.D. Searle & Co., Chicago). "I wouldn’t expect a consumer to know how to spell the names," notes Knies.
To reduce the chance of mistaking one drug for another, ask patients what conditions they are taking the drug for, he recommends.
• Understand that migraine drugs may cause reactions in patients also taking selective serotonin reuptake inhibitors (SSRIs).
Patients with migraines often also have psychiatric problems, so they will be taking antidepressants at the same time, which can cause reactions. "Because of this, many pharmacists, especially those who work for chain pharmacies, are starting to cross check medications of patients before they dispense medications," says Knies.
Drug interactions occur frequently and can be life-threatening, says Clyde Miyagawa, PharmD, clinical pharmacy specialist in critical care at the University Hospital in Cincinnati.
"It is imperative that patients have their prescriptions filled at a single pharmacy so that screening for these interactions can occur," he says. "Drug interactions can result in increased or decreased metabolism of one of the offending drugs, resulting in toxic manifestations or decreased efficacy, respectively."
However, patients may see a neurologist for their migraine drugs and a family doctor for psychotropic and blood pressure medication, notes Knies. "Physicians may unknowingly prescribe something that doesn’t work well with the patient’s other medications," he says. "Patients may have all three drugs going at once, which requires really careful management." (See story on the trend of patients demanding prescriptions for heavily marketed drugs, p. 153.)
Ask why they’re taking meds
• Ask whether patients are allergic to drugs and food products.
Miyagawa says, "Many health care providers fail to address food allergies."
List all current medications the patient is taking or has taken within the past month, he suggests. Also ask patients why they are taking these medications.
"Many times, there is no good reason that patients are on a particular medication," says Miyagawa. The patient may be allergic to the new prescription or entities within the prescription, such as metabisulfite preservatives, he adds.
The severity of drug reaction also must be considered. "Some patients can develop life-threatening anaphylactic reactions to penicillin, while others will manifest this type of allergic reaction as a mild rash," Miyagawa says. In some instances, the drug still should be dispensed and taken by the patient, despite the reaction if no other agent will suffice and the reaction is well-tolerated, he notes.
• Ask whether patients are taking herbal medicines.
Many patients don’t consider herbs as drugs and won’t volunteer this information unless asked, notes Miyagawa. "Indeed, herbs are drugs and can manifest in many ways," he says. "With the growing use of herbal remedies by consumers for a wide range of ailments, you must become familiar with these agents and their potential adverse side effects." (For more information, see story on reactions to herbal medicines in ED Nursing, May 1999, p. 89.)
• Encourage patients to report side effects.
With many drugs, toxicity profiles are well-known and, in some cases, expected, says Miyagawa. "Patient education and monitoring for these well-known side effects becomes essential."
Many patients develop nausea and/or vomiting that they may attribute to their underlying illness and not their medications. "This may delay their reporting of these problems to pharmacists/physicians, which may result in the onset of more severe adverse effects," says Miyagawa. "Patients should not hesitate to report any new concerning physical findings to health care providers once they have started a new medication."
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