Adverse drug reactions risk reduction

To enable reduction of the dose of one component and hence reduce the risks of adverse drug reactions, e.g. flucytosine plus amphotericin B for Cryptococcus neoformans meningitis. 

Second, consider all the myriad forms of harm that can come from healthcare complications of surgery, infection from unsafe injections, infection from over crowded hospitals, adverse drug reactions, overdoses from badly designed infusion pumps and so on. Should we assume that all these are necessarily due to error If we equate patient safety with error reduction, we run the risk of not addressing any form of harm which is either not due to error, or only partly due to error. 

Management of adverse drug reactions Preferential use of male donor plasma for FFP transfusions has led to a substantial reduction in the incidence of TRALI [6, 12 ]. Serious Hazards of Transfusion (SHOT) data suggest a 50% reduction in the risk of TRALI when 99% of FFP is from male donors only [33 ]. In another study, 12 of 21 allo-immune TRALI cases implicated plasma from female donors, suggesting that theoretically 57% of all allo-immune TRALI cases could be prevented by using male plasma only [14 ]. In another study there was no statistically significant difference in pulmonary morbidity between patients who received units from female or male donors, but these results were limited by the small number of morbid outcomes [11 ]. 

Meperidine is thought to inhibit both the 5-HT2A receptors and norepinephrine (NE) reuptake mechanism which may precipitate a serotonin syndrome, a toxic state secondary to excessive serotonin ago-nism of the CNS [3,4]. This adverse drug reaction occurs most commonly in patients who are using single or multiple medications that increase postsy-naptic serotonin levels. Inherited deficiencies in the metabolism of serotonin may contribute to the development of the syndrome. Hypertension, atherosclerosis, and hyperlipidemia are all associated with a reduction in endothelial MAO activity and thus a reduced capacity to metabolize serotonin may increase the risk of a serotonin crisis. The diagnosis... 

Noncardiac Diarrhea is the most common adverse effect during quinidine therapy, occurring in 30-50% of patients, usually within the first several days of quinidine therapy but sometimes later. Diarrhea-induced hypokalemia may potentiate the risk of torsades de pointes due to quinidine. A number of immunological reactions can occur during quinidine therapy. The most common is thrombocytopenia, which can be severe but resolves rapidly with drug discontinuation. Hepatitis, bone marrow depression, and lupus syndrome occur rarely. None of these effects is related to elevated plasma quinidine concentrations. Quinidine also can produce cinchonism, a syndrome that includes headache and tinnitus. In contrast to other adverse responses to quinidine therapy cinchonism usually is related to elevated plasma quinidine concentrations and can be managed by dose reduction. 

The rate of drug-induced adverse reactions in HIV-infected patients is over five times higher than the rate for HIV-negative subjects, and although the reason for this is not known, some observations related to reduction of the reactive nitroso-sulfamethoxazole metabolite may be pertinent. Deficiencies of ascorbate and thiols (for example glutathione), two agents that effect reduction of the metabolite in vivo, have been reported in HIV-infected subjects and it has been speculated that this may result in increased metabolite-mediated lymphocyte toxicity and a significantly increased risk of hypersensitivity reactions. 

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