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https://jamanetwork.com/journals/jama/articlepdf/645225/jbk0126_413_414.pdf

Cummings Otolaryngology: Head and Neck Surgery

Background Adverse drug reactions (ADRs) present a challenging and expensive public health problem. Polypharmacy is defined according to the WHO criteria as the, “concurrent use of five or more different prescription medication”. Elderly are more prone to adverse reactions due to comorbid conditions, longer lists of medications and sensitivity to drug effects. The aim of the study is to estimate the incidence and strength of association of ADRs due to polypharmacy among the geriatric cohort attending outpatient clinics at a tertiary care center. Methods A hospital based prospective cohort study was conducted at ambulatory care clinics of Aga Khan University Hospital April 2012 to March 2013. One thousand geriatrics patients (age ≥65 years) visiting ambulatory clinics were identified. They were divided on the basis of exposure (polypharmacy vs. no polypharmacy). We followed them from the time of their enrollment (day zero) to six weeks, checking up on them once a week. Incidence was calculated and Cox Proportional Hazard Model estimates were used. Results The final analysis was performed on 1000 elderly patients. The occurrence of polypharmacy was 70% and the incidence of ADRs was 10.5% among the study cohort. The majority (30%) of patients were unable to read or write. The use of herbal medicine was reported by 3.2% of the patients and homeopathic by 3%. Our Cox adjusted model shows that polypharmacy was 2.3 times more associated with ADRs, con-current complementary and alternative medicine (CAM) was 7.4 times and those who cannot read and write were 1.5 times more associated with ADRs. Conclusion The incidence of ADRs due to poly pharmacy is alarmingly high. The factors associated with ADRs are modifiable. Policies are needed to design and strengthen the prescription pattern.

Effects of Polypharmacy on Adverse Drug Reactions among Geriatric outpatients at a Tertiary Care Hospital in Karachi, A prospective cohort study

http://manuscript.elsevier.com/S0002939422000733/pdf/S0002939422000733.pdf

Hearing Dysfunction After Treatment with Teprotumumab for Thyroid Eye Disease.

Therapeutic Area: This comprehensive textbook covers a number of drug-induced disease states. In addition, it provides a general overview of the epidemiology and impact of drug-induced diseases. Format: The text is divided into 12 sections. The first introduces the general concept of drug-induced disease, while the remaining sections focus on a specific group of diseases or disorders. Audience: This resource is intended for students, clinical pharmacists, or other general practitioners. It could serve as a reference for pharmacy students in adverse drug reactions courses or as a resource in general therapeutics courses. Purpose: To provide in-depth information to aid in the identification, prevention, and management of drug-induced diseases. Content: The authors define a drug-induced disease as “an unintended effect of a drug that may result in mortality or morbidity with symptoms sufficient to prompt a patient to seek medical attention and/or require hospitalization.” Therefore, drug-induced diseases may be considered a subset of adverse reactions. Examples of drug-induced disease states described in the book include drug-induced gastrointestinal, cardiovascular, and allergic/immunologic diseases. Each section is divided into multiple chapters, with the text organized in a consistent structure that includes causative agents, epidemiology, mechanism, clinical presentation and diagnosis, risk factors, morbidity and mortality, prevention, management, and patient information. Usability: This well referenced text contains current references. The book also contains an index; however, the index is somewhat limited in that many of the drug names mentioned in the book are not necessarily listed in the index. The reader should consult the appendix of the book for a summary of the druginduced diseases found in the text. Highlights: A helpful feature is the many summary tables, which are useful for quick reference. Limitations: Although a number of drug-induced disease states are included in the text, the lack of a chapter or section on drug-induced dermatologic diseases is disappointing. Some of this material is covered in the drug-induced allergic/immunologic diseases section; however, more comprehensive coverage of this topic would be an excellent addition. Comparison with Other Related Books: This book can be differentiated from the standard adverse reaction textbooks, Meyler’s Side Effects of Drugs and Davies’s Textbook of Adverse Drug Reactions, because those texts are focused on providing a comprehensive list of adverse reactions, whereas Drug-Induced Diseases: Prevention, Detection, and Management focuses more on the specifics of the disease state and does not intend to provide a comprehensive list of adverse reactions for individual drugs. Summary: As a moderately priced reference, this book is a valuable resource for libraries, drug information centers, and students. Those who are searching for a text to summarize adverse reactions of individual drugs should not purchase this text; however, if the reader is interested in a more comprehensive examination of drug-induced diseases, this is a worthwhile investment. Reviewer: Courtney Krueger PharmD, Clinical Assistant Professor, Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, Illinois

Drug-Induced Diseases: Prevention, Detection, and Management:

(1) Background: The purpose of this article is to review pharmacological treatments for COVID-19 (currently approved by the EMA (European Medical Agency) and FDA (Food and Drug Administration)) and highlight their potential audio-vestibular side-effects as an ototoxic adverse reaction. (2) Methods: Review of the available literature in the scientific databases PubMed, ResearchGate, Scopus, and ScienceDirect, and in summaries of product data sheets. (3) Results: In accordance with EBM (evidence-based medicine) the treatment of COVID-19 by using lopinavir/ritonavir, chloroquine and hydroxychloroquine, azithromycin, favipiravir, amantadine, oseltamivir, and ivermectin is no longer recommended for patients suffering from COVID-19 due to a lack of clinical data, publications, and recommendations. There were 39 publications and 15 summaries of product characteristics (as other sources of data) which were also used in this analysis. Adverse events could be permanent or disappear over time. Following treatment for COVID-19, the most frequent adverse audio-vestibular reactions reported in clinical trials and publications in the area of audiology and otorhinolaryngology were: dizziness, blurry vision with dizziness, nasopharyngitis, dysgeusia, and tinnitus. As far as vaccines are concerned, dizziness as an ototoxic effect was uncommon and occurs only in hypersensitive people who experience anaphylactic shock. (4) Conclusions: The ototoxicity of the drugs discussed here does not have as severe symptoms as the drugs used in the treatment of COVID-19 in 2020 (e.g., hydroxychloroquine), and relates mainly to disorders of the vestibulocochlear system. However, there is still a need to monitor ototoxic side-effects because of potential interactions with other ototoxic drugs. Many of the drugs approved by EMA and FDA are new, and not every side-effect is known.

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Adverse Audio-Vestibular Effects of Drugs and Vaccines Used in the Treatment and Prevention of COVID-19: A Review

Objective In an era of increasing polypharmacy, adverse drug effects such as ototoxicity have significant public health implications. Despite the availability of evidence, many health care professionals may not know the risk of ototoxicity in common medications. Therefore, the aim of this review is to provide a comprehensive, easy to use, ototoxic profile of medications with an assessment of supporting evidence. Methods Medications of interest were identified through adverse drug reaction reports derived from Micromedex (IBM), Lexicomp (Wolters Kluwer), and the textbook, Drug Induced Diseases: Prevention, Detection, and Management. Additional evidence was identified though a query of PubMed and the Cochrane database. Evidence of causality was graded according to the following: A (randomized, controlled clinical trials), B (nonrandomized clinical trials, prospective observational studies, cohort studies, retrospective studies, case-controlled studies, and/or postmarketing surveillance studies), and C (case reports/case series). Results A total of 194 systemically administered medications associated with ototoxicity were identified, most commonly antimicrobials (53), psychotropics (21), antihypertensive/antiarrhythmics (19), nonsteroidal antiinflammatory drugs (18), and antineoplastics (16). There was evidence of cochleotoxicity in 165 medications (evidence grading A [22], B [77], C [69]), vestibulotoxicity in 100 medications (evidence grading A [23], B [47], and C [30]), and dizziness in 142 medications (evidence grading A [50], B [76], and C [16]). In addition, a review of the evidence of ototoxicity in ototopical medications is also reviewed. Conclusion The effect and severity of ototoxicity can vary immensely depending on pharmacological and individual patient risk factors. The intent of this comprehensive review was to help health care providers of all sectors obtain a deeper knowledge of drug-induced ototoxicity to make more informed management decisions for their patients.

Drug-Induced Ototoxicity: A Comprehensive Review and Reference Guide.

Multiple sclerosis is a chronic demyelinating disease of the central nervous system that requires treatment with disease modifying therapies (DMTs). Use of DMTs has been associated with potential safety concerns dictating the need for medication monitoring.

Implementation of a pharmacist-managed population health monitoring tool for disease modifying therapies in treatment of patients with multiple sclerosis in a veterans affairs medical center

Julianne L. Isaac

Papers

Drug-Induced Ototoxicity: A Comprehensive Review and Reference Guide.

Implementation of a pharmacist-managed population health monitoring tool for disease modifying therapies in treatment of patients with multiple sclerosis in a veterans affairs medical center