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KMID : 0869620120290030271
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Journal of Korean Society of Hospital Pharmacists
2012 Volume.29 No. 3 p.271 ~ p.280
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Medications causing emergency department visits due to adverse drug reactions in Korean geriatric patients
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Chun Yung-Seon
Suh Ye-Won
Lee Eun-Sook
Lee Byung-Koo
Kim Kwang-Il
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Abstract
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Geriatric patients are likely to have a high probability of adverse drug reactions.
Physiological functions (e.g., blood flow) that are known to be altered by the age, lead to changes in pharmacokinetic and pharmacodynamic characteristics. While the dependency of age with respect to the incidence of adverse drug reaction has been well established in developed countries, similar studies have not been reported for Koreans in the literature. The objective of this study was to analyze major causes for emergency department visits by adverse drug reactions in Korean geriatric patients. A retrospective study was conducted from January 2010 to June 2010 at Seoul National University Bundang Hospital (SNUBH) to review major medications that led to emergency department visits by adverse drug reactions in Korean patients aged 65 years or older.
During the study period of 6-months, over 6000 geriatric patients visited the emergency department of SNUBH. Of these patients, 126 (2.0%) geriatric patients visited the emergency department as a result of an adverse drug reaction; 135 drugs were involved in the incidence of the adverse drug reaction. Most common drug classes of the adverse reaction included platelet inhibitors [19 cases (14.1%)], oral hypoglycemic agents [16 cases (11.9%)], diuretics [12 cases (8.9%)], and systemic antimicrobial agents [9 cases (6.7%)]. In addition, 14 cases (10.4%) were caused by aspirin, while other drugs [e.g., glimepiride, 13 cases (9.6%) and hydrochlorothiazide, 9 cases (6.7%)] also caused adverse drug reactions. Amongst the medications that caused the adverse reactions, the number of medications unsuitable for geriatric patients based on Beers’ criteria was 11 (8.1%). Common adverse reaction in these patients included hypoglycemia [21 patients (16.7%)], melena [14 patients (11.1%)], and hyponatremia [11 patients (8.7%)]; Atypical conditions, such as dizziness and general weakness, were among the chief complaints of adverse
reactions. Interestingly, there was a slight difference from the current study to literature findings in the rank of the medication causing adverse drug reactions. In the literature, warfarin, insulin, and digoxin were reported as the most common causes of adverse drug reactions in geriatric patients in developed countries. Based on the findings of the current study, guidelines specific for Korean hospitals may be necessary for adequate pharmacotherapy in Korean geriatric patients (e.g., handling platelet inhibitors and/or oral hypoglycemic agents). Furthermore, considering the fact that some drugs causing adverse reactions in Korean geriatric patients were associated with significant variability in pharmacokinetics, pharmacists, specialized in geriatric medicine, may be necessary for optimal pharmacotherapy in this age group.
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KEYWORD
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Adverse drug reactions, emergency department, older adults, Beers criteria
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