DentalCare Logo

Adverse Drug Reactions - Part II

Course Number: 537

Preventing ADRs

Preventing ADRs is a critical part of clinical practice. Oral healthcare providers must have an awareness of and have access to information related to ADRs. To minimize such events, they must develop a rational approach to the use of pharmacotherapeutic agents in the management of oral/odontogenic problems; especially, since in the treatment of most such conditions non-pharmacological intervention such as primary dental care is a more effective and safer alternative than pharmacotherapy.

However, when pharmacotherapy is indicated practitioners must avoid “rationalized activism”. The rational activist assumes that it is better to over-treat than not to treat at all. Even if the risk is considered small, prescribing a drug with the potential to cause an ADR may not be justified. Practitioners must also avoid “reflex prescribing”. The reflex prescriber, the agent of brief encounters, is typically concerned with the patient’s symptoms or caters to the patient’s expectations.

Benefits should always outweigh the risks when a drug is prescribed. If clinicians were to observe this basic principle routinely, then the number of unnecessary or inappropriate prescriptions would be reduced. Drug therapy should be individualized by taking into consideration both drug- and patient-related variables. Errors in medications, which may lead to ADRs, are related to such factors as progressing age, multiple illnesses, living alone, and poor coping ability of ambulatory patients with their environment.

In addition to the choice and dosage of a drug consider the route of administration and other drugs the patient may be taking. Take time to explain the role of drugs in the treatment of the patient’s condition. Pay special attention to impaired intellect, poor vision, and diminished hearing. Simple and clear oral instructions on how and when to take a drug should be given and reinforced by clear labeling and written instructions. Special labels are available for blind or poorly sighted patients.

Assess the patient’s response to drug therapy frequently to confirm efficacy and compliance. When new signs and symptoms are reported, rule out ADRs. Adjust dosages and/or discontinue unnecessary medications. Complex regimens and frequent dosing lend themselves to noncompliance. A byproduct of poor compliance is hoarding of drugs, which can further contribute to noncompliance and ADRs as patients may confuse new bottles with old ones or use hoarded drugs for the wrong purpose.