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Unerwünschte Arzneimittelwirkungen als Ursache unspezifischer Symptome bei Patienten in der zentralen Notaufnahme

Adverse drug reactions as cause of nonspecific symptoms in patients in the emergency department

  • Notfallmedizin
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Zusammenfassung

Hintergrund

Bei einem großen Anteil der Patienten, die zentralen Notfallaufnahme (ZNA) zugeführt werden, ist das initiale Leitsymptom unspezifisch. Eine mögliche Ursache hierfür können gerade bei älteren Patienten unerwünschte Arzneimittelwirkungen (UAW) der häufig vorhandenen Polypharmazie sein.

Ziel der Arbeit

Veranschaulichung von UAW-Inzidenzen, der betroffenen Patientenklientel, inklusive Risikofaktoren, sowie von Arzneimittelklassen, deren UAW zu unspezifischen Symptomen führen können. Empfehlungen für die Praxis zum Management von UAW in der ZNA.

Material und Methode

Darstellung der pharmakologischen Grundlagen zu UAW, Statistiken der Pharmakovigilanzzentren sowie Originalliteratur unter Einbezug von Erfahrungen aus der klinischen Praxis und eigenen Projekten.

Ergebnisse

Bei 10 % der Patienten mit unspezifischen Symptomen ist eine UAW für die ZNA-Vorstellung verantwortlich. In 60 % der Fälle werden diese nicht korrekt erkannt. Eine geringe Anzahl an Arzneimittelklassen ist für die meisten dieser Zuweisungen verantwortlich. Zur Verbesserung der UAW-Identifikation und des UAW-Managements stehen Datenbanken, Risikostratifizierungen, klinische Pharmazeuten oder „clinical decision support systems“ zur Verfügung. Eine flächendeckende Anwendung dieser Möglichkeiten findet in deutschen Notaufnahmen bisher nicht statt.

Schlussfolgerungen

Eine korrekte Identifikation von UAW bei Patienten mit unspezifischen Symptomen in der ZNA ist notwendig, um die adäquate Therapie einleiten zu können. Häufig werden die UAW übersehen, da Prozesse und Tools zur Identifizierung und zum Management von UAW in der ZNA nicht angewendet werden. Bei Risikopatienten in der ZNA sollte der Fokus auf die Arzneimittelanamnese gelegt werden, idealerweise unter Berücksichtigung patientenindividueller Risikofaktoren und bestimmter Arzneimittelklassen.

Abstract

Background

In a large proportion of patients admitted to the emergency department (ED), the initial main symptom is nonspecific. One possible reason for this, especially in older patients, may be adverse drug reactions (ADR) due to their frequent polypharmacy.

Aim

To illustrate the incidence of ADRs, the affected patient population including risk factors, and drug classes with ADRs leading to nonspecific symptoms. To provide practice recommendations for the management of ADRs in the ED.

Material and methods

Presentation of the pharmacological principles on ADRs, statistics of pharmacovigilance centers as well as original literature including experiences from clinical practice and own projects.

Results

In 10% of patients with nonspecific symptoms an ADR is responsible for presentation in the ED. In 60% of cases these ADRs are not correctly identified in the ED setting. A small number of drug classes are responsible for most of these referrals. Databases, risk stratification, clinical pharmacists, or clinical decision support systems are available to improve ADR identification and management. As these options are partly associated with considerable costs or the validation for German EDs is missing, a widespread application does not take place.

Conclusion

Correct identification of ADRs in patients with nonspecific symptoms in the ED is necessary to initiate adequate treatment. These ADRs are often overlooked because processes and tools for identification and management are not applied in the ED, leading to a lack of awareness. For high-risk patients in the ED, the focus should be on drug history, ideally considering patient-specific risk factors and specific drug classes.

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Author information

Authors and Affiliations

  1. Klinikapotheke, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland

    Benjamin J. Hellinger & Yvonne Remane

  2. Abteilung für Klinische Pharmazie, Medizinische Fakultät, Universität Leipzig, Leipzig, Deutschland

    Benjamin J. Hellinger & Thilo Bertsche

  3. Zentrale Notaufnahme/Beobachtungsstation, Universitätsklinikum Leipzig AöR, Liebigstr. 20, 04103, Leipzig, Deutschland

    Benjamin J. Hellinger & André Gries

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  1. Benjamin J. Hellinger
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  2. Yvonne Remane
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  4. André Gries
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Correspondence to Benjamin J. Hellinger.

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Interessenkonflikt

B.J. Hellinger, Y. Remane, T. Bertsche und A. Gries geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Hellinger, B.J., Remane, Y., Bertsche, T. et al. Unerwünschte Arzneimittelwirkungen als Ursache unspezifischer Symptome bei Patienten in der zentralen Notaufnahme. Anaesthesiologie 72, 887–893 (2023). https://doi.org/10.1007/s00101-023-01355-4

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