Advers İlaç Reaksiyonları Yönetimi
Özet
Advers ilaç reaksiyonları (AİR), DSÖ tarafından ilaçların normal dozlarında görülen istenmeyen ve zararlı yanıtlar olarak tanımlanmakta olup dünya genelinde morbidite ve mortalitenin önemli bir kaynağıdır. Bu reaksiyonlar dozla ilişkili olan (Tip A) ve doz dışı alerjik (Tip B) gibi altı farklı grupta sınıflandırılmakta; yaş, cinsiyet, çoklu ilaç kullanımı (polifarmasi), genetik faktörler ve mevcut ek hastalıklar gelişim riskini doğrudan artırmaktadır. Yoğun bakım ünitelerinde polifarmasi ve değişen organ fonksiyonları nedeniyle hastaların %7,5’inde AİR görülmekte; amfoterisin B ve diltiazem gibi ilaçlar dermatolojik, kardiyovasküler (QT uzaması, hipotansiyon), hematolojik (trombositopeni), gastrointestinal, renal ve nörolojik (deliryum) sistemler üzerinde ciddi toksisiteler oluşturabilmektedir. Bu reaksiyonların önlenmesinde Naranjo olasılık skoru gibi standardize edilmiş ölçeklerin kullanılması ve klinik eczacıların multidisipliner tedavi süreçlerine dahil edilmesi kritik öneme sahiptir. Sonuç olarak, karmaşık tedavilerin artmasıyla birlikte sağlık sistemine büyük yük getiren AİR’lerin başarılı yönetimi için tüm sağlık profesyonellerinin yetkinlik kazanması, reaksiyonların ulusal veri tabanlarına bildirilmesi ve yakın takibin yapılması gerekmektedir.
Adverse drug reactions (ADRs) are defined by the WHO as unintended and harmful responses occurring at normal drug doses, representing a major source of global morbidity and mortality. These reactions are classified into six types, such as dose-related (Type A) and non-dose-related allergic (Type B), with risk factors including age, female gender, polypharmacy, genetic variations, and comorbidities significantly increasing susceptibility. In intensive care units, due to polypharmacy and fluctuating organ functions, ADRs affect approximately 7.5% of patients; high-risk drugs like amphotericin B and diltiazem induce severe toxicities across dermatological, cardiovascular (QT prolongation, hypotension), hematological (thrombocytopenia), gastrointestinal, renal, and neurological (delirium) systems. Preventing ADRs requires standardized scoring systems like the Naranjo scale for risk assessment alongside the active involvement of clinical pharmacists within multidisciplinary teams. Ultimately, as complex treatments rise and burden healthcare systems, effective ADR management demands enhanced clinical awareness among healthcare professionals, systematic national reporting, and diligent patient monitoring to mitigate associated mortality.
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