Handler et al reported several signals that can help to detect an adverse drug reaction in a nursing home resident. One signal involves review of laboratory values in patients taking certain medications. The authors are from Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh.
Patient selection: nursing home resident
Laboratory Value
Drug
hypoglycemia
cause or worsen hypoglycemia
elevated INR
warfarin
Clostridium difficile toxin in stool
drug capable of causing pseudomembranous colitis
hyperkalemia
cause or worsen hyperkalemia
hypokalemia
cause or worsen hypokalemia
thrombocytopenia
cause or worsen thrombocytopenia
elevated aPTT
heparin
low TSH/high T4
cause or worsen hyperthryoidism
high TSH/low T4
cause or worsen hypothyroidism
hyponatremia
cause or worsen hyponatremia
leukopenia
cause or worsen leukopenia
elevated serum ALT or AST
cause or worsen hepatocellular toxicity
elevated serum BUN or creatinine
cause or worsen renal injury
neutropenia
cause or worsen neutropenia
elevated CK
cause or worsen muscle injury
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