US Pharm. 2020;45(8)(Specialty&Oncology suppl):2.
One of my current clinical obsessions is exploring and expanding the horizon of the role of the pharmacist in detecting, investigating, and preventing adverse drug reactions (ADRs). This journey has been revealing, to say the least, and my efforts are further challenged by the inherent significant diversity of ADRs. Often, the very definition of ADRs comes into question. In fact, some prescribers believe that “side effects” are absolutely not ADRs and, further, that reporting these events could expose them to liability for exercising poor prescribing practices.
Recently, I learned about a family member struggling with a seemingly random change in her hematologic panel—a significant increase in platelets. This individual had been managed on a combination of medications for years after vascular surgery, and when picking up her monthly prescription, she voiced concern over the recent laboratory results to her pharmacist. Although drug-induced thrombocytosis is considered a relatively rare ADR, the pharmacist reviewed the medication list and asked if she could follow up after her investigation. The next day, the pharmacist reported that she found evidence that one of the medications could alter platelet counts and, in some cases, increase these numbers.
As it turns out, the patient had a genetic mutation that was responsible for her platelet elevation; however, it sparked further inquiry as to whether the clinical manifestation of the genetic mutation could have been activated in some way by the routine medication she had been taking. To date, no one has been able to answer this question, but I applaud the pharmacist’s vigilance in considering a new condition to be a potential ADR rather than simply diagnosing this hematologic condition as a new, standalone condition.
Hematologic ADRs are more common than most might realize. Pharmacists, now more than ever before, are engaged in evaluating laboratory findings associated with medication management, and they are in a prime position to initially rule out drug-induced effects when the rest of the healthcare team fails to consider the ADR as an alternative diagnosis. Pharmacists can also play a critical role in encouraging ADR reporting, both by their patients and by allied healthcare providers. (Nurses, according to recent studies, are among the most common reporters.)
Further, I strongly believe that our role includes assisting prescribers in establishing a more balanced perspective on the definition and reason for reporting ADRs as a means to improve patient safety. Also, pharmacists can contribute to the evolving understanding of the postmarketing surveillance that can lead to official FDA labeling updates and, perhaps, future medication-use recommendations.
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