Drug-induced diseases have become an increasing problem
Pharmacists create a resource, suggest process for determining AEs
Much has been written about drugs and their adverse effects (AEs). But two pharmacists saw the need for a central source of information for an important subset of adverse effects: drug-induced diseases.
The resulting reference book, Drug-Induced Diseases: Prevention, Detection, and Management, was published this summer by the American Society of Health-System Pharmacists (ASHP). "The impetus for this book was an increasing awareness of drug-induced diseases as a significant cause of morbidity and mortality. Drug-induced diseases are associated with significant human costs and have a substantial financial impact on the health care system," says James E. Tisdale, PharmD, BCPS, FCCP, professor of pharmacy practice at Purdue University in West Lafayette, IN. Tisdale co-edited the book with Douglas A. Miller, PharmD, a professor in the department of pharmacy practice at Wayne State University in Detroit.
Tisdale and Miller define a drug-induced disease as an adverse drug reaction that may cause death, require hospitalization, or result in symptoms severe enough to prompt a patient to seek medical attention. "We wanted to create a comprehensive source that clinicians — pharmacists, physicians, nurses, and others — could use to review information regarding drug-induced diseases," Tisdale says. "The overall objective was to make it easier for practitioners to determine whether a patient’s symptoms are being caused by a drug that the patient is taking."
The book includes more than 50 chapters that cover a plethora of drug-induced diseases. "Drugs can cause diseases in just about every system in the body," Tisdale says. "[For example], drugs can cause a number of dermatologic conditions that are serious enough to require patients to seek medical attention. Some may even require hospitalization or result in death. [In addition], almost any cardiac arrhythmia can be caused by drugs, and drug-induced diseases can resemble many neurologic and psychiatric disorders. The list just goes on and on.
"Some drugs [induce diseases] at higher-than-recommended doses, while others can cause problems even at their usual and customary doses," he continues. Drug-induced diseases are becoming more prevalent, most likely because a greater number of drug products are available and more drugs are prescribed today than ever before. And, drug use is expected to continue to increase in the future as the population ages.
Determining drug-induced diseases
Many health professionals, including pharmacists, could be better informed about drug-induced diseases, Tisdale says. "In the past, many pharmacy schools had stand-alone courses in drug-induced diseases. Today, much of the information regarding drug-induced diseases is interspersed with other material concerning pharmacology and therapeutics. This can make it more challenging for those who have to learn how to differentiate a drug-induced disease from diseases that are normally occurring."
For this reason, the book has been designed to try to make it easier for clinicians to apply a logical thought process in their efforts to determine whether a drug is the likely cause of a given symptom and how to treat those drug-induced diseases that do occur. The book has been organized around the approach Tisdale teaches his students to use in evaluating their patients.
"I teach my students that any time a patient develops new symptoms or experiences an exacerbation of an existing disease, drugs must be ruled out as a potential cause or contributor," he says. To help, Tisdale and Miller have included in the book tables of drugs known to cause specific diseases.
Tisdale teaches his students to use a systematic approach in making a determination as to whether a suspect drug is the likely actual cause of a patient’s disease. The system involves answering questions that include, "What is the likelihood that the disease could be caused by a drug to which this patient has been exposed? Is this drug-induced disease relatively common or is it rarely reported? Is there a temporal relationship between the exposure to the drug and the onset of symptoms? Is that relationship consistent with a drug-induced disease in this patient?"
"The symptoms the patient experiences with a drug-induced disease are not always the same as those experienced by patients who have the naturally occurring disease," Tisdale says. "I teach students to sort through patients’ signs and symptoms, to determine whether the clinical presentation is consistent with drug-induced disease."
An offending drug often needs to be discontinued in patients who experience a drug-induced disease. In some situations, however, other treatments can be employed to help alleviate symptoms.
"There is a risk/benefit equation to consider," Tisdale says, "It’s not always possible to discontinue drug therapy and sometimes you have to look for other ways to manage a patient’s drug-induced disease." When applicable, authors have discussed those management approaches in the book.
Tisdale will discuss drug-induced diseases further at ASHP’s Midyear Clinical Meeting and Exhibition in Las Vegas this month. "I want to give people an overall perspective of drug-induced diseases — how prevalent might they be, and at what cost to health care and society," he says. The session at the meeting will focus on two specific drug-induced diseases. One session discusses drug-induced dermatologic conditions. The other addresses drug-induced liver disease. For more information about the program or the book, see www.ashp.org.
Much has been written about drugs and their adverse effects (AEs). But two pharmacists saw the need for a central source of information for an important subset of adverse effects: drug-induced diseases.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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