Adverse Drug Effects
Definition & DDx
Common culprit drugs
- Anticonvulsants
- Antibiotics
- Anti-inflammatories
- Allopurinol
Anatomy & Risks
Drug induced exanthem (morbilliform drug eruption)
- Delayed type Iv immune reaction
- E.g., amoxicillin given during EBV
Fixed drug eruption
- Inflammatory, red, circular patch
Type 1 hypersensitivity
- Morbilliform rash with angioedema and urticaria
- If severe, can lead to anaphylaxis
- Antihistamines normally treat
Lichenoid drug eruption
- Presents similarly to lichen planus
Phototoxic reactions
- Medication sensitises skin to UV
- E.g., hydroxychloroquine, tetracycline, antibiotics, retinoids, psoralens
Symptoms & Complications
Complications
- SCAR derm emergencies (severe cutaneous adverse reactions)
o DRESS – drug rash with eosinophilia and systemic symptoms
o AGEP – acute generalised exanthematous pustulosis
o SJS-TENS – Steven-Johnson syndrome / toxic epidermal necrolysis
Allergies
Anatomy & Risks Type III – Immune complex
Hypersensitivity Types (ACID) - SLE
Type I - Anaphylactic - Post-strep GN
- Anaphylaxis Type IV - Delayed hypersensitivity
- Atopy e.g., asthma, eczema and - TB
Hayfever - Graft v Host disease
Type II – Cell bound - Allergic contact dermatitis
- Autoimmune haemolytic anaemia / - Scabies
ITP / pernicious anaemia / acute - MS / GBS
haemolytic transfusion reactions Type V
- Goodpasture’s syndrome - Grave’s disease
- Rheumatic fever - Myasthenia gravis
- Bullous pemphigoid
, Post-surgical care and complications
Definition & DDx
Pre-operative phase = 1hr before anaesthesia induction
Intraoperative temperature measured with oesophageal probes
Anatomy & Risks
Post-op pyrexia - Wound infection
Early causes (0-5 days) - Anastomotic leak
- Blood transfusion
- Cellulitis Perioperative hypothermia
- UTI - ≥ASA2
- Physiological response - Major surgery
- Atelectasis - Low BMI
Late causes (>5 days) - Large volumes unwarmed IV
- VTE infusions/transfusions
- Pneumonia
Symptoms & Complications
Complications
Post-tonsillectomy haemorrhage
- All for ENT assessment
- If 6-8hrs post-op = return to theatre
- If >5 days = re-admit and abx
Peri-operative hypothermia
- Can cause coagulopathy, reduced wound healing, infection, prolonged recovery
- At risk groups: high ASA; emergency surgery; low BMI; combined regional and general
surgery
Investigations
5Ws of post-op pyrexia - Wound
- Wind o Infection
o Pneumonia - Wonder drugs
o Atelectasis o Anaesthetic reactions
- Water - Walking
o UTI o DVT
Post-operative nausea and vomiting
- Infection/hypovolaemia/pain/paralytic ileus/drugs
- Ondansetron first line (risk of QT prolongation and constipation)
- Cyclizine – avoid in severe heart failure
- Prochlorperazine – risk of EPS
Treatment/Management & Side effects
- Bair Hugger used for any operation >30mins
o Documentation of temperature every 15mins until transfer out of recovery
Definition & DDx
Common culprit drugs
- Anticonvulsants
- Antibiotics
- Anti-inflammatories
- Allopurinol
Anatomy & Risks
Drug induced exanthem (morbilliform drug eruption)
- Delayed type Iv immune reaction
- E.g., amoxicillin given during EBV
Fixed drug eruption
- Inflammatory, red, circular patch
Type 1 hypersensitivity
- Morbilliform rash with angioedema and urticaria
- If severe, can lead to anaphylaxis
- Antihistamines normally treat
Lichenoid drug eruption
- Presents similarly to lichen planus
Phototoxic reactions
- Medication sensitises skin to UV
- E.g., hydroxychloroquine, tetracycline, antibiotics, retinoids, psoralens
Symptoms & Complications
Complications
- SCAR derm emergencies (severe cutaneous adverse reactions)
o DRESS – drug rash with eosinophilia and systemic symptoms
o AGEP – acute generalised exanthematous pustulosis
o SJS-TENS – Steven-Johnson syndrome / toxic epidermal necrolysis
Allergies
Anatomy & Risks Type III – Immune complex
Hypersensitivity Types (ACID) - SLE
Type I - Anaphylactic - Post-strep GN
- Anaphylaxis Type IV - Delayed hypersensitivity
- Atopy e.g., asthma, eczema and - TB
Hayfever - Graft v Host disease
Type II – Cell bound - Allergic contact dermatitis
- Autoimmune haemolytic anaemia / - Scabies
ITP / pernicious anaemia / acute - MS / GBS
haemolytic transfusion reactions Type V
- Goodpasture’s syndrome - Grave’s disease
- Rheumatic fever - Myasthenia gravis
- Bullous pemphigoid
, Post-surgical care and complications
Definition & DDx
Pre-operative phase = 1hr before anaesthesia induction
Intraoperative temperature measured with oesophageal probes
Anatomy & Risks
Post-op pyrexia - Wound infection
Early causes (0-5 days) - Anastomotic leak
- Blood transfusion
- Cellulitis Perioperative hypothermia
- UTI - ≥ASA2
- Physiological response - Major surgery
- Atelectasis - Low BMI
Late causes (>5 days) - Large volumes unwarmed IV
- VTE infusions/transfusions
- Pneumonia
Symptoms & Complications
Complications
Post-tonsillectomy haemorrhage
- All for ENT assessment
- If 6-8hrs post-op = return to theatre
- If >5 days = re-admit and abx
Peri-operative hypothermia
- Can cause coagulopathy, reduced wound healing, infection, prolonged recovery
- At risk groups: high ASA; emergency surgery; low BMI; combined regional and general
surgery
Investigations
5Ws of post-op pyrexia - Wound
- Wind o Infection
o Pneumonia - Wonder drugs
o Atelectasis o Anaesthetic reactions
- Water - Walking
o UTI o DVT
Post-operative nausea and vomiting
- Infection/hypovolaemia/pain/paralytic ileus/drugs
- Ondansetron first line (risk of QT prolongation and constipation)
- Cyclizine – avoid in severe heart failure
- Prochlorperazine – risk of EPS
Treatment/Management & Side effects
- Bair Hugger used for any operation >30mins
o Documentation of temperature every 15mins until transfer out of recovery
