Drug-Induced Disorders

Drug-Induced Disorders is a topic covered in the Pocket ICU Management.

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Anesthesia Central is an all-in-one web and mobile solution for treating patients before, during, and after surgery. This collection of drugs, procedures, and test information is derived from Davis’s Drug, MGH Clinical Anesthesia Procedures, Pocket Guide to Diagnostic Tests, and PRIME Journals. Explore these free sample topics:

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First Things First (assess & treat for the following)

  • There are as many side effects from drugs we use as there are drugs.
  • Hematologic effects of drugs can be mediated by one or many factors.
  • The diagnosis can be difficult & may require discontinuation of an offending drug to confirm.
  • Hemolysis is usually not severe, but can be in up to 2%.
  • Diagnostic tests are not always specific; usually make diagnosis based on history & physical & removal of suspected drug.
  • Suspect drug-induced hemolytic anemia if:
    • Anemia, fevers, rash, renal failure develop when drug started
      • Some drug-induced disorders may occur weeks to years after use.
    • Hemolytic indices are seen:
      • Anemia
      • Reticulocytosis
      • Increased LDH
      • Decreased haptoglobin
      • Increased indirect bilirubin
  • Discontinue any new drug that may be responsible for a recent change in pt’s condition.
  • Check
    • Coombs’ test (usually positive in autoantibody & innocent bystander types)
    • Peripheral smear for schistocytes
    • Plasma & urine for Hb
    • Blood bank screen for anti-Rh antibodies
    • For temp-induced agglutination
    • Check penicillin antibodies
    • Some drugs, like procainamide, can produce positive RF & ANAs (lupus-like). Drugs that induce lupus-like disorders do not typically have low complement or + Ds-DNA antibodies.
    • Inform blood lab about possibilities of drug-induced disease.

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First Things First (assess & treat for the following)

  • There are as many side effects from drugs we use as there are drugs.
  • Hematologic effects of drugs can be mediated by one or many factors.
  • The diagnosis can be difficult & may require discontinuation of an offending drug to confirm.
  • Hemolysis is usually not severe, but can be in up to 2%.
  • Diagnostic tests are not always specific; usually make diagnosis based on history & physical & removal of suspected drug.
  • Suspect drug-induced hemolytic anemia if:
    • Anemia, fevers, rash, renal failure develop when drug started
      • Some drug-induced disorders may occur weeks to years after use.
    • Hemolytic indices are seen:
      • Anemia
      • Reticulocytosis
      • Increased LDH
      • Decreased haptoglobin
      • Increased indirect bilirubin
  • Discontinue any new drug that may be responsible for a recent change in pt’s condition.
  • Check
    • Coombs’ test (usually positive in autoantibody & innocent bystander types)
    • Peripheral smear for schistocytes
    • Plasma & urine for Hb
    • Blood bank screen for anti-Rh antibodies
    • For temp-induced agglutination
    • Check penicillin antibodies
    • Some drugs, like procainamide, can produce positive RF & ANAs (lupus-like). Drugs that induce lupus-like disorders do not typically have low complement or + Ds-DNA antibodies.
    • Inform blood lab about possibilities of drug-induced disease.

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Last updated: May 20, 2010