Management of Adverse Reactions to Medications

Drug Side Effects 

 

Severe reactions to cephalosporins are much less common than with penicillins. However, there is a small chance that someone with a true penicillin allergy could also react to cephalosporins, since the drugs are related. An allergist may be able to help determine if these antibiotics are safe for you.

3. Sulfonamides (including antibiotics, oral diabetes medications and some water pill diuretics). It is unclear whether these reactions are truly allergic or due to another immunologic process. There is no reliable test available to determine is a person is allergic to this class of medications.

4. Non-Steroidal Anti-Inflammatory Drugs (NSAID), including aspirin, ibuprofen and naproxen. This class of medications can cause allergic and non-allergic flares of hives/swelling, worsen asthma, and result in anaphylaxis. There is no reliable test available for most people with reactions to these medications.

5. IV Contrast/Dye. This reaction is non-allergic but can result in anaphylaxis because the high concentration of the dye causes mast cells to release their contents, which mimics an allergic reaction. While there is no test available for reactions to IV contrast, most patients can take the dye safely by taking oral steroids and anti-histamines hours before the contrast is given. The contrast is usually given in a less concentrated form to these patients. Let your doctor know if you've had a past reaction to IV contrast before receiving it again.

6. Local Anesthetics. True allergic reactions to local anesthetics (novocaine, lidocaine) are extremely rare, and usually due to other ingredients in the medication, such as preservatives or epinephrine (present in the local anesthetic to make the medication last longer once it's injected). An allergist can perform testing to various local anesthetics and find one that works for almost everybody.

7. General Anesthesia. Some medications used during surgery are very common causes of true allergic reactions and anaphylaxis. If you think you experienced an allergic reaction during or shortly after surgery, an allergist may be able to help determine the cause.

8. Anti-Seizure Medications. Many medications used for treatment of epilepsy can cause non-allergic reactions as a result of certain enzyme deficiencies in the person taking the medication. Symptoms can include a rash, fever, body aches and hepatitis. There is no test available for this type of reaction.
 

Management of Adverse Reactions to Medications

1. Avoidance/Removal of the suspect medication. Most often, if a medication is causing a person to have an unpleasant reaction, the medication is stopped. Usually this is all that is needed to resolve the problem.

2. Treatment of any allergic or non-allergic symptoms. If the reaction is severe, such as anaphylaxis, or in Stevens-Johnson Syndrome/toxic epidermal necrolysis, emergency treatment may be required.

3. Consideration of testing by an allergist. An allergist may be able to help determine what medication caused the reaction and if there is testing that can be accomplished.

4. Determination of a need for current or replacement medication. If the person still has an infection, for example, another antibiotic may be required.

A physician can determine a safe alternative medication in this instance.
5. Consideration of desensitization. In some unique cases, a very specific medication is needed. In most forms of true medication allergy, a person can be desensitized to the medication by giving very small amounts initially (orally or intravenously) with increasing doses over many hours. This is usually done in a hospital given the chance of life-threatening anaphylaxis, and should only be done under the supervision of an allergist.

2 months

Two Months

By Daniel Politi

The Washington Post leads with the growing divide between Republican lawmakers, as some continue to clamor for a change in Iraq, while others are standing behind the White House. The Wall Street Journal tops its worldwide newsbox with President Bush promising to veto any legislation that sets a date for withdrawal. Bush implored lawmakers to wait until the September progress report before passing any Iraq-related legislation. But there's an earlier report coming down the pipeline this week, and the Los Angeles Times leads with its own assessment of the overall Iraq strategy. Although the administration can point to some successes, it's unclear whether they're very meaningful or if they can even be sustained. Meanwhile, Iraq continues to be plagued by many of the same problems, and the chances that things could improve by September are slim at best.

The New York Times leads with Dr. Richard Carmona, the surgeon general from 2002 until 2006, telling Congress that the Bush administration frequently tried to shape his public statements so that they would fit its political goals and prevented him from speaking out about several issues. Carmona has thus become the latest in a string (the WP has a good rundown) of officials who have said that political considerations take precedence over scientific facts at the Bush White House. USA Today leads with a look at how more states are providing discounts in college tuition for veterans, partly as a way to make up for severe deficiencies in the federal GI Bill. Some of it has to do with the increased number of National Guard troops that are being sent into battle, but also because often the money provided by the federal government is simply not enough. But as more state lawmakers are dealing with budgetary woes, some are considering cutting back.

GOP leaders are counting on the fact that Democrats need 60 votes in order to get any legislation passed in the Senate, and the administration went into an all-hands-on-deck mode to try to prevent any more defectors. There are several amendments being discussed in the Senate, but the ones that have the greater chance of getting Republican support do not include a precise withdrawal date and give Bush greater flexibility. Meanwhile, lawmakers aren't the only ones defecting, as the LAT fronts a look at how the three Republican front-runners have been " quietly backing away" from supporting a continuation of the "surge.

As more troops have moved into Baghdad neighborhoods, they continue to face a barrage of attacks and "have been unable to establish security, even for themselves," says the LAT. Iraqis who live in mixed neighborhoods continue to leave their homes in a massive scale. So, while the administration is likely to point to a decrease in sectarian violence in Baghdad, some suspect it is merely a sign that most neighborhoods have become segregated. And although Iraqis are moderately optimistic that U.S. troops could have some success against al-Qaida in Iraq, it's less clear whether they can be effective in creating political unity and economic opportunities, two factors that everyone says are crucial to bring about security.

The LAT points out inside that Bush once again talked about the fight in Iraq as a battle against "the same people that attacked us on September the 11th." As any faithful TP reader should know by now, there's little evidence of a connection between al-Qaida in Iraq and Osama Bin Laden's terrorist network. In other Iraq news, everyone mentions what the NYT calls the "most intense mortar attack to date on the Green Zone" that killed three people , including an American service member, and wounded 18.

Carmona said he was prevented from speaking out on several issues, including stem cells, sexual education, and prisoners' health care. On the issue of sexual education, Carmona said he wanted to discuss contraceptives, but he was blocked due to the focus on abstinence-only policies. Carmona was one of three former surgeon generals who testified yesterday, and although the three discussed some sort of political interference with their jobs, they all said it seems to have gotten worse under Bush.

The NYT and WP front the big changes in Sen. John McCain's presidential campaign team as two of his top aides resigned. Despite McCain's insistence that he's still in the race, everyone says this brings further doubt to whether the man who was once considered a shoo-in for his party's nomination will be able to continue his campaign for much longer. The resignations came after several contentious meetings where McCain expressed bewilderment over the news that his campaign was in such poor financial shape. The NYT says McCain only realized the extent of the problem late last month .

USAT fronts a blunt look at the massive problems that Bush will leave for whoever ends up taking his place. "I can't think of a single modern president about to bequeath to his successor such a difficult agenda and such a damaged presidency," says Paul Light of New York University.

The WP goes inside with two Justice Department officials saying that Attorney General Alberto Gonzales didn't lie to Congress when he affirmed there hadn't been "one verified case of civil liberties abuse." Even though he knew of the reports that detailed how FBI officials had frequently overstepped their bounds, it turns out they weren't abuses because they weren't intentional.

The LAT fronts news that the Chinese government executed the former head of its food and drug safety agency for taking bribes to approve medicines. Messages supporting the execution were quick to appear online in a show of what the LAT says is the average citizen's frustration with the lack of safety in national products.

USAT reports that Springfield, Vt. (population: 9,300), was the winner of the competition to host the premiere of the Simpsons Movie that pitted 13 Springfields from across the country against each other. They each created a video to make the case for their town, and people voted online for their favorite.

Stress Management

Preventive Stress Management

We all know what it feels like to be overwhelmed by stress, and this site has many techniques that can effectively reduce high levels of stress to more manageable levels so you don't suffer negative health consequences. However, the best way to manage severe stress is to prevent it, or catch it while it's still low-grade stress and prevent it from becoming severe and chronic. This article contains some important suggestions that have also been recommended by the Mayo Clinic on how to manage stress day-by-day to prevent it from becoming overwhelming.

• Relaxing –It's important to keep your mind and body relaxed. Meditation, prayer, having a creative outlet, listening to music and laughter all help.
  For other relaxation techniques, visit the Tension Tamers section.
• Watch Your Body – Before you experience ulcers, heart disease and other major health problems from stress , your body will experience milder forms of discomfort, such as headaches, stomach upset and poor sleep. When you feel these early warning signs, start practicing your tension taming techniques and put a stop to low-grade chronic stress before it becomes a bigger problem.
• Psysical Activity –Practicing martial arts, jogging, lifting weights, or even a short walk can improve mood and reduce feelings of stress by increasing endorphins, lowering cortisol levels, and providing many other benefits. Here are some of the best ways to reduce stress with exercise.
• Eat Well --A healthy diet gives you the energy to handle daily stress, and keeps your blood sugar levels stable so you don't experience mood swings due to low blood sugar levels. Skipping meals and making poor food choices can contribute to fatigue, greater susceptibility to illness, greater feelings of stress, and a general feeling of poor health.
• Setting Boundaries – Being overscheduled and rushed can be a significant cause of stress. By prioritizing your commitments and saying no to some tasks can help you be more successful with what you find to be really important, and you'll have extra time for additional stress management activities.
• Maintain Social Support—Having a supportive network of friends can help you stay healthy and reduce stress in many ways. Friends can provide resources that you may need when you're in a bind, or a supportive ear that helps you feel accepted and understood. Studies show that having a sense of belonging can reduce your risk of depression. And having a friend who makes you laugh can also make you healthier and less stressed.
• Find Fun Distractions –Playing games, reading, watching movies and t.v. can all help you get your mind off of what's stressing you and onto something more pleasant. Sometimes this is just the break you need to stop a pattern of obsessing over your problems, and enable your body and mind to enter a relaxed state. When you come back to your stressors, they may not have the same powerful grip on you.
• Keep a Positive Perspective --Throughout the day, stop and evaluate the endless stream of thoughts that run through your mind. If they're negative, try to reframe those thoughts in a positive way. (This isn't the same as pretending everything's great when it isn't, a form of denial that doesn't always help.) Using less negative language in your self-talk, looking for the hidden benefits as well as the obvious drawbacks of stressful situations, and reminding yourself that this, too, shall pass are all effective strategies in positive thinking that have helped many people.
• Get Help If You Need It --If stress is affecting your ability to work or find pleasure in life, seek help from your doctor, mental health provider or other professional. There's no need to let stress overwhelm your life, and there are many effective forms of help available. Finding it could give you the life you want and deserve.

Working toward implementing these practices into your daily routines can go a long way toward reducing stress in your life and leaving you healthier and happier. Take baby steps at first, and reward yourself for the progress you make, and in no time, these new practices will be old habits.