Top Three Drugs that Lead to a Visit to the ER
December 5th, 2007 | by Timothy Kintzel, M.D. |
A large study recently published looked at Emergency Department vists for older adults caused by reactions or toxicity to certain medications. Between 2004 and 2005, a total of 177,504 visits to the ER were caused by adverse reactions to drugs in patients over 65. The top three offenders were Warfarin (Coumadin), Insulin, and Digoxin (Lanoxin). All of these medications are very commonly used in elderly patients - warfarin is to thin the blood, insulin is for diabetes, and digoxin is for heart rhythm problems like atril fibrillation and for heart failure. Unfortunately, all of them are difficult to dose - and frequent monitoring of levels needs to be done. They all require the patient and doctor to communicate frequently to obtain a safe and effective level. To complicate matters, other medications often interact with them and can dramatically change circulating blood levels. This can lead to toxicity like bleeding, arrhythmias, gastrointestinal problems, and low or high blood sugar (hypo and hyper glycaemia). Antibiotics are a frequent culprit. Of further interest, is that medications that are generally ill-advised in the elderly (a large list) account for a very small percent of visits (3%) for adverse advents. The investigators go on to conclude in stating “a reminder that doctors and patients need to work on doing the best job we can managing these medicines.”
Reference: Annals of Internal Medicine, Dec 4, 2007
3 Responses to “Top Three Drugs that Lead to a Visit to the ER”
By stefanos pantagis, MD on Dec 6, 2007 | Reply
enjoy the web page: I find that monitoring for adverse drug events a challenging clinical task: I often have felt that a quality indicator for discharge from the hospital is placing understanding ones odds of having an adverse event as part of informed consent: Pasteur stated “chance favors the prepared mind;” as a very modern and applicable adage.
By stefanos pantagis, MD on Dec 6, 2007 | Reply
Test hyperlink of powerpoint lecture on patient safety>
By Timothy Kintzel, M.D. on Dec 6, 2007 | Reply
That is a good idea. Many people just think they can just take their meds and forget about it!