Slide 8 Medication Related Problems

CHAPTER
Medication
Related
Problem
CHAPTER
8
 Definition of Medication Related
Problems
 Classification of medication related
problems
 Ways to minimize medication related
problems
Medication Related Problems CHAPTER
8
Medication Related Problems
Definition
An undesirable event experienced by a

patient that is involved or suspected to be
involved in a drug therapy that could
actually or potentially interferes with the
desired patient outcome.
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Reasons Why It isn’t Addressed
• Patient has been taking this medication

for many years without a problem
• One provider did not prescribe all of the
medications the patient is taking
• Patients and prescribers are concerned
that the risk of discontinuing the
medication is greater than the benefit
• Patients resists changes on their drug
therapy
• The problems the patient is experiencing
is not often usually seen with this
medication
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Types
• Medical condition requires new or

additional drug therapy that has not
been prescribed
• Patient taking unnecessary drug given
with the present condition
• Wrong drug for Patient’s medical
condition or age
• Correct drug, wrong dose
• Patients not taking the correct
medication
• Adverse drug reaction
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Adverse Drug Reactions (FDA)
Any AE associated with the use of drugs in

humans, whether or not considered drug
related, including the following
• AE in course of drug in professional
practice
• AE in drug overdose- accidental/
intentional
• AE from drug abuse
• AE from drug withdrawal
• Any significant failure of expected
pharmacological action
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Adverse Drug Reactions (WHO)
Any response to a drug that is noxious and

unintended which occurs at doses normally
used in man for prophylaxis, dx, or the
therapy of disease or modification of
physiological functions
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Adverse Drug Reactions: Risk Factors
• Age
• Concurrent medicines
• Duration of therapy
• Gender
• Co-morbidities
• Narrow therapeutic index
• Ethnicity and genetics
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Adverse Drug Reactions: Types
1. Type A (Augmented)
• Extension effects (excessive
stimulation of receptors)
• Side effects (stimulation of untargeted
receptors)
-Dose dependent, predictable, common
-Examples:
Diazepam(sedation)
Opioids (constipation)
NSAIDs (gastric irritation)
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2. Type B (Bizarre)
• Idiosyncratic reaction- unrelated to drug’s
pharmacological action
-Not dose dependent
-Often serious and fatal
-Patient’s susceptibility and genetics
• Immunologic reaction
A. TYPE I (IgE Mediated Anaphylactic Reaction)
-Allergies; immediate
-Ex: penicillin
B. TYPE II (IgG or IgM Cytotoxic Reaction)
-Cytolysis or blood dyscrasias
-Ex: methyldopa (hemolysis)
Chloramphenicol ((aplastic anemia)
Aspirin (thrombocytopenia)
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C. TYPE III (IgG Mediated immune complex

reaction)
-Serum sickness
-Drug induced SLE
D. TYPE IV (T-cell Mediated Delayed Reaction)

-Occurs After Days Or Weeks
-Example: Tissue/Organ Rejection
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3. Type C (Continuous)
- Long term effect related to the drug’s
dose and duration of treatment
-Due to cumulative doses of the drugs
-Examples:
Ethambutol (optic neuritis)
Narcotics (addiction)
*Drug tolerance –increasing the dose of the
drug to achieve the same response
*Tachyphylaxis –repeated administration 
decreases effectiveness  desensitization
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4. Type D (delayed)
Manifested after a long exposure
Delayed on set; usually dose related
A. Carcinogenic
B. Teratogenic
*Pregnancy ratings
• Controlled studies (no risk)
• No evidence of risk in humans
• Risk cannot be ruled; but benefit
justifies the risk
• Positive evidence, benefit outweighs the
risk
• C/I for pregnancy
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List of some teratogens:

• Vitamin a derivatives- heart and brain
abnormalities
• Phenytoin-fetal hydantoin syndrome
• Valproic acid- neural tube defect (prevented by
folic acid) aka spina bifida
• ACEi’s- Renal dysgenesis
• Lithium- ebstein anomaly (problem in tricuspid
valve)
• Methimazole- aplasia cutis
• Warfarin – (1st trimester) fetal warfarin
syndrome
• Antineoplatics- embryocidal
• Alcohol- craniofacial problems “precious
moments dolls”
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5. Type E (End Of Use)

-Results from sudden termination or
discontinuation
-Ex: Opioids (withdrawal)
Clonidine (hypertension)
Steroids (adrenal insufficiency)
-Solution: dose tapering
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6. Type F (Failure)
-Antimicrobial Resistance
-Inappropriate Use
-Counterfeits
-Patient Tolerance And Poor Compliance
-Expired Drugs
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Preventing MRPs
1. Communicate with healthcare providers

about medications
2. Keep a list of the patient’s medications
and identify the possible drug-drug and
drug-food adverse drug reactions
3. Perform drug monitoring and counseling

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CHAPTER

An undesirable event experienced by a

• Patient has been taking this medication

• Medical condition requires new or

Any AE associated with the use of drugs in

Any response to a drug that is noxious and

C. TYPE III (IgG Mediated immune complex

D. TYPE IV (T-cell Mediated Delayed Reaction)

List of some teratogens:

5. Type E (End Of Use)

1. Communicate with healthcare providers

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