MEDICATION-INDUCED BLOOD DYSCRASIAS Etiology And Disease Types Jassin M. Jouria, MD Dr. Jassin M. Jouria is a medical doctor, professor of academic medicine, and medical author. He graduated from Ross University School of Medicine and has completed his clinical clerkship training in various teaching hospitals throughout New York, including King’s County Hospital Center and Brookdale Medical Center, among others. Dr. Jouria has passed all USMLE medical board exams, and has served as a test prep tutor and instructor for Kaplan. He has developed several medical courses and curricula for a variety of educational institutions. Dr. Jouria has also served on multiple levels in the academic field including faculty member and Department Chair. Dr. Jouria continues to serves as a Subject Matter Expert for several continuing education organizations covering multiple basic medical sciences. He has also developed several continuing medical education courses covering various topics in clinical medicine. Recently, Dr. Jouria has been contracted by the University of Miami/Jackson Memorial Hospital’s Department of Surgery to develop an e-module training series for trauma patient management. Dr. Jouria is currently authoring an academic textbook on Human Anatomy & Physiology. Abstract Although drug-induced hematologic disorders are less common than other types of adverse reactions, they are associated with significant morbidity and mortality. Some agents, such as hemolytics, cause predictable hematologic disease, but others induce idiosyncratic reactions not directly related to the drug’s pharmacology. The most important part of managing hematologic disorders is the prompt recognition that a problem exists. The main mechanisms to manage hematologic disorders include vigilance to observe signs and symptoms indicating a blood disorder and patient education of the warning symptoms to alert them of the need to report a condition to their primary care provider or an emergency health team. nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com 1 Continuing Nursing Education Course Director & Planners William A. Cook, PhD, Director, Douglas Lawrence, MA, Webmaster, Susan DePasquale, MSN, FPMHNP-BC, Lead Nurse Planner Policy Statement This activity has been planned and implemented in accordance with the policies of NurseCe4Less.com and the continuing nursing education requirements of the American Nurses Credentialing Center's Commission on Accreditation for registered nurses. It is the policy of NurseCe4Less.com to ensure objectivity, transparency, and best practice in clinical education for all continuing nursing education (CNE) activities. Continuing Education Credit Designation This educational activity is credited for 4 hours. Nurses may only claim credit commensurate with the credit awarded for completion of this course activity. Pharmacology content is 0.5 hours (30 minutes). Statement of Learning Need Clinicians need to know how to manage the risk of hematologic disorders induced by medication. Understanding the risk, recognizing the signs and symptoms that may indicate a blood disorder, and being skilled in how to educate the patient are essential knowledge needs of clinicians to ensure patients, caregivers and health teams are able to recognize the warning symptoms of hematologic disorders. nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com 2 Course Purpose To provide nurses and health team associates with knowledge about medication-induced dyscrasias to better recognize, treat, and educate patients, caregivers and all health team members on acute and long-term management. Target Audience Advanced Practice Registered Nurses and Registered Nurses (Interdisciplinary Health Team Members, including Vocational Nurses and Medical Assistants may obtain a Certificate of Completion) Course Author & Director Disclosures Jassin M. Jouria, MD, William S. Cook, PhD, Douglas Lawrence, MA Susan DePasquale, MSN, FPMHNP-BC – all have no disclosures Acknowledgement of Commercial Support There is no commercial support for this course. Activity Review Information Reviewed by Susan DePasquale, MSN, FPMHNP-BC Release Date: 5/19/2016 Termination Date: 5/19/2019 Please take time to complete a self-assessment of knowledge, on page 4, sample questions before reading the article. Opportunity to complete a self-assessment of knowledge learned will be provided at the end of the course. nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com 3 1. __________ is a lowered threshold to the normal pharmacological action of a drug. a. Dyscrasia b. Intolerance c. Hypersensitivity d. Idiosyncrasy 2. True or False: Idiosyncrasy differs from intolerance in that it is not an exaggeration of the normal response; it is an abnormal response per se. a. True b. False 3. The development of corneal opacities and retinal damage in patients treated with chloroquine as an antimalarial or for arthritis and amebiasis is an example of a drug a. side effect. b. intolerance. c. hypersensitivity. d. overdosage. 4. The principal ions necessary for normal cell function include calcium, sodium, potassium, __________, magnesium, and hydrogen. a. albumin b. bilirubin c. chloride d. heme 5. The main protein constituent of plasma is ________, which is the most important component in maintaining osmotic pressure. a. intrinsic factor (IF) b. bilirubin c. heme d. albumin nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com 4 Introduction Hematologic disorders have long been a potential risk of modern pharmacotherapy. Although drug-induced hematologic disorders are less common than other types of adverse reactions, they are associated with significant morbidity and mortality. Some agents, such as hemolytics, cause predictable hematologic disease, but others induce idiosyncratic reactions not directly related to the drug’s pharmacology. The most important part of management of a hematologic disorder is the prompt recognition when a problem exists. This is done by two mechanisms: firstly, vigilance for signs and symptoms that may indicate a blood disorder; and, secondly, patient education about the warning symptoms that should alert them to the need to urgently contact their medical provider or emergency services if a prompt medical appointment is not possible. This two-part course series discusses the link between modern pharmacotherapy and hematologic disorders and the identification and management of this risk. Medication-Induced Hematologic Disease: An Overview Some agents cause predictable hematologic diseases, such as antineoplastic medication, but others induce idiosyncratic reactions not directly related to the drug’s pharmacology. The most common drug-induced hematologic disorders include aplastic anemia, agranulocytosis, megaloblastic anemia, hemolytic anemia, and thrombocytopenia. The incidence of idiosyncratic drug-induced hematologic disorders varies depending on the condition and the associated drug. Few epidemiologic studies have evaluated the actual incidence of these adverse reactions, but these reactions appear to be rare. Women are generally more susceptible than men to the hematologic effects of drugs. The incidence varies based on nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com 5 geography, which suggests that genetic differences may be important determinants of susceptibility. Drug-induced thrombocytopenia is the most common drug-induced hematologic disorder. Some reports of heparin-induced thrombocytopenia suggest as many as 5% of patients who receive heparin develop thrombocytopenia. The Berlin Case-Control Surveillance Study was conducted from 2000 to 2009 to assess the incidence and risks of drug- induced hematologic disorders. This evaluation found that almost 30% of all cases of blood dyscrasias were possibly attributable to drug therapy. Although drug-induced hematologic disorders are less common than other types of adverse reactions, they are associated with significant morbidity and mortality. An epidemiologic study conducted in the United States estimated that 4,490 deaths were attributable to blood dyscrasias from all causes. Aplastic anemia was the leading cause of death followed by thrombocytopenia, agranulocytosis, and hemolytic anemia. Similar to most other adverse drug reactions, drug-induced hematologic disorders are more common in elderly adults than in the young; and, the risk of death also appears to be greater with increasing age. Because of the seriousness of drug-induced hematologic disorders, it is necessary to track the development of these disorders to predict their occurrence and to estimate their incidence. Reporting during postmarketing surveillance of a drug is the most common method of establishing the incidence of adverse drug reactions. The MedWatch program supported by the Food and Drug Administration (FDA) is one such program. Many facilities have similar drug-reporting programs to follow adverse drug reaction trends and to determine whether an association between a drug and an adverse nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com 6 drug reaction is causal or coincidental. In the case of drug-induced hematologic disorders, these programs can enable practitioners to confirm that an adverse event is indeed the result of drug therapy rather than one of many other potential causes; general guidelines are readily available.1 Adverse Drug Effect1,2 Blood