An iatrogenic illness is, literally, a disorder induced by, or resulting from, the activities of the attending physician. Iatrogenesis is the cause of illness, complications, or other adverse effects resulting from any medical activity, including diagnosis, intervention, error, or negligence. Iatrogenesis can include mental suffering through medical belief or declaration of the person who does it. Some iatrogenic events are obvious, such as the wrong amputation, while others, such as drug interactions, may escape recognition. According to a 2013 estimate, about 20 million adverse drug reactions have occurred worldwide. In 2013, about 142,000 people died from adverse effects of the treatment, compared to about 94,000 in 1990.
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What are the risks associated with radiation?
1. Radioactive lesions are progressive and chronic
2. Pneumonitis
3. Glomerulosclerosis and chronic interstitial nephropathy
4. Enteritis and cystitis
5. Veno-occlusive disease of the liver
6. Malignancy
7. Bone marrow
What are the risks in the hospital?
The incidence of nosocomial infections is about 10%. Infectious diseases are often caused by infectious diseases.
There is a high risk of infection associated with diagnostic and treatment procedures and antibiotic-resistant bacteria.
How do doctors get infected?
A physician's potential injury is not limited to careless use of drugs or procedures, but can include unwarranted statements and misinterpretation of experimental data.
The doctor must know the characteristics of the drugs he prescribes and their risks. Ignorance of the possibility of reaction is a clear sign of negligence.
The doctor should warn the patient about possible side effects.
What are drug and food interactions?
Medicines can reduce food intake, increase urinary excretion, directly compete or oppose protein-carrying nutrients, and inhibit the synthesis of enzymes or coenzymes necessary for the metabolism of food.
What is drug fever?
Drug fever represents one percent of all fevers of unknown origin. Any drug can cause fever (antihistamines, barbiturates, iodides, penicillins, phenytoin, propylthiouracil, β-lactum antibiotics, etc.). A history of allergy, rash, or eosinophilia is rare in drug fever.
Medication errors and negligence
Iatrogenic conditions do not result from medical errors, such as mistakes made during surgery, or from prescribing or administering the wrong treatment, such as medication. In fact, the internal and sometimes negative effects of medical treatment are iatrogenic. For example, radiotherapy and chemotherapy, which are aggressive for therapeutic effects, often produce iatrogenic effects such as hair loss, hemolytic anemia, diabetes insipidus, vomiting, nausea, brain damage, lymphedema, infertility, etc.
Loss of function resulting from the removal of a diseased part of the body is iatrogenic, as in the case of diabetes following the removal of the pancreas or all parts.
The effects of iatrogenesis can be misleading in some cases. For example, a ruptured aortic aneurysm is fatal in most cases.
The survival rate for treating a ruptured aortic aneurysm is less than 25%.
Patients who die during or after surgery will be considered as iatrogenic deaths, but the procedure itself is still better than the chance of dying if it is not treated.
Other situations may involve actual negligence or incorrect procedures, such as when pharmacists produce handwritten prescriptions.
Another situation may include neglect where patients are sidelined and do not receive appropriate care because providers are biased because of factors such as sex, race, religion, immigration status, etc. This can lead to a lack of trust between patients and providers, leading patients to not seek treatment, resulting in more deaths.
Risks associated with medical assistance
- Negligence
- Side effects from prescription or over-the-counter medications
- Interactions with prescription drugs
- Nosocomial infections
- Incorrect prescriptions, possibly due to poor handwriting or computer typos
- Improper processes, procedures, information, methods or equipment
- Overuse of drugs (causing, for example, bacterial resistance to antibiotics)
- Medication errors
Drug Interactions
The most common iatrogenic side effects are caused by drug interactions, that is, when pharmacists do not check all the drugs the patient is taking and prescribe new ones that interact in an agonistic way or opposition (potential). ). Such conditions can cause severe morbidity and mortality.
Adverse reactions, such as allergic reactions to drugs, even if the pharmacists did not expect them, are also classified as iatrogenic.
Changes in the immune system against bacteria are also iatrogenic. Antibiotic-resistant strains of bacteria have developed in response to prescription antibiotics.
Some drugs and vaccines themselves are clinically toxic due to their mechanism of action. For example, antineoplastic alkylating agents cause DNA damage, which harms cancer cells more than normal cells. However, alkylation causes serious side effects and is carcinogenic in itself, which can lead to the development of secondary tumors. Similarly, arsenic-based drugs such as melarsoprol, which is used to treat trypanosomiasis, can cause arsenic poisoning.
Negative effects can occur mechanically. The development of some surgical instruments can be decades old, so some side effects (such as physical trauma) may never be fully understood.
Trogen syndrome is the result of the examination and treatment process performed on the patient. With many drugs given to the same patient, side effects are inevitable. Doctors must take appropriate measures to diagnose and manage them.
One of the principles of medicine set by Hippocrates is "First, do no harm." Stories of medicinal treatments causing more harm than good have been recorded since ancient times.
Iatrogenic disease occurs when the adverse effects of treatment or diagnosis cause pathology that is not dependent on the condition in which the treatment is approved.
It is impossible to get the benefits of modern medicine if the rational process of research and treatment is suspended because of possible risks.
Diagnostic procedures (mechanical and radiological), treatment procedures (drugs, surgery, other invasive procedures), hospitals and the doctor himself can cause iatrogenic diseases.
Drug-induced hematological disorders
Megaloblastic anemia (MA)
Oral contraceptives, phenytoin, phenobarbital and primidone cause AM from folic acid deficiency, colchicines, neomycin, paraamino salicylic acid (PAS) from vitamin B12 deficiency and 6-mercaptopurine, 5-fluro -uracil, hydroxyurea, acyclovir and DNA of interferdoring in metabolism.
Hemolytic anemia
Drugs that cause hemolysis by direct action are phenacetin, PAS, sulfonamides: from the immune system, aminopyrine, chlorpromazine, quinine and tetracycline; and G-6 PD patients who cannot, antimalarials (primaquine) and antibiotics (nitrofurantoin).
Aplastic anemia
Drugs that frequently cause bone marrow depression: busulphan, cyclophosphamide, chlorambucil, vinblastine and 6 mercaptopurine.
Drugs rarely cause bone marrow depression: chloramphenicol, penicillamine, sulfonamides, isoniazid, NSAIDs, analgin, thiouracil, anticonvulsants, antidiabetics, cimetidine, tranquilizers, etc.
Drugs that cause Thrombocytopenia
Alfa-methyldopa, carbimazole, chloramphenicol, cyclosporins, phenylbutazone, quinine, quinidine, rifampicin, sulfonamides, etc.
Risks of blood transfusion
Complications occur in 2 percent of blood transfusions.
A. Immune reactions: allergic-anaphylaxis, fever, hemolysis, non-cardiopulmonary edema.
b. Non-immune diseases: blood circulation, thrombophlebitis and embolism, bacterial infection, transmission of diseases such as malaria, hepatitis, syphilis and AIDS and siderosis related to blood transfusion in multiple transfusions.
Drug-induced intestinal infections
Mouth ulcers
1. Types of lichen planus lesions: methyldopa, chloroquine and propranolol.
2. Lupus erythematosus type lesions: hydralazine, gold. Gastroduodenal acid disease: acetylsalicylic acid, NSAIDs, corticosteroids, etc. Pancreatitis: azathioprine, glucocorticoids and oral contraceptives.
Malabsorption: various antibiotics, cholestyramine and neomycin.
Liver damage
Drug-induced liver damage is something that can affect almost all drugs because the liver metabolizes almost all drugs.
Acute (acetaminophen, halothane) and chronic (nitrofurantoin, methyldopa) hepatocellular injury, veno-occlusive disease (cyclophosphamide), and hepatocellular carcinoma (sex and anabolic hormones) can occur.
There are many new drugs such as glyburide, ketoconazole, lisinopril, lovastatin, ticlopidine, etc. which is associated with hepatotoxic reactions. Among the causes of liver failure, certain drugs such as halothane, acetaminophen, phenytoin and alpha methyldopa cause 20 to 50% of cases.
Drugs that produce neutropenia
Analgesics and NSAIDs: Indomethcin, Phenacetin, Acetaminophen, Phenyl-Butazone, and Aminopyrine.
Anticonvulsants: Phenytoin, Carbamazepine
Antithyroid drugs: thiouracil, methimazole
Phenothiazine: Chlorpromazine
Antiarrhythmic: Quinidine
Breathing problems due to medicine
Types of reactions : Examples of drugs
1. Airway obstruction (bronchospasm) : beta-blockers, adenosine, NSAIDs.
2.ACE inhibitors : Cough
3. Nasal congestion : Oral decongestants, reserpine, guanithidine
4. Pulmonary edema : Contrast agents, methadone, interleukin 2
5. Fenfluramine : high blood pressure
6. Inhalation of the lungs : Cancer agents, Acyclovir, Amiodarone
7. Pleural disease : Hydralazine, Methysergide
8. Pulmonary thromboembolism : Oral contraceptives
Drugs that cause thrombocytopenia
Alfa-methyldopa, carbimazole, chloramphenicol, cyclosporins, phenylbutazone, quinine, quinidine, rifampicin, sulfonamides, etc.
Risks of blood transfusion
Complications occur in 2 percent of blood transfusions.
i. Immune reactions: allergic-anaphylaxis, fever, hemolysis, non-cardiopulmonary edema.
ii. Non-immune diseases: blood circulation, thrombophlebitis and embolism, bacterial infection, transmission of diseases such as malaria, hepatitis, syphilis and AIDS and siderosis related to blood transfusion in multiple transfusions. Gastrointestinal disorders caused by drugs
Mouth ulcers
1. Types of lichen planus lesions: methyldopa, chloroquine and propranolol.
2. Lupus erythematosus type lesions: hydralazine, gold. Peptic acid disease: acetylsalicylic acid, NSAIDs, corticosteroids, etc.
Pancreatitis: azathioprine, glucocorticoids and oral contraceptives. Malabsorption: various antibiotics, cholestyramine and neomycin.
Liver damage
Drug-induced liver damage is something that can affect almost all drugs because the liver metabolizes almost all drugs.
Acute (acetaminophen, halothane) and chronic (nitrofurantoin, methyldopa) hepatocellular injury, veno-occlusive disease (cyclophosphamide), and hepatocellular carcinoma (sex and anabolic hormones) can occur.
There are many new drugs such as glyburide, ketoconazole, lisinopril, lovastatin, ticlopidine, etc. which is associated with hepatotoxic reactions.
Among the causes of liver failure, certain drugs such as halothane, acetaminophen, phenytoin and alpha methyldopa cause 20 to 50% of cases.
Drug-induced heart disease
Drug reactions can lead to worsening of angina (alpha-blockers), arrhythmias (digitalis, beta-adrenergic agents, tricyclic antidepressants and quinine), cardiomyopathy (daunorubicin, emetine and lithium), hypo or hypertension (glucocorticoids and sympathomimetics), . (emetine, procainamide and minoxidil) and Torsades de pointes (sparfloxacin). Kidney problems caused by drugs
The kidney is the main excretory organ of the body and therefore many drugs affect it.
1. Directly toxic to tubular cells: paracetamol, amphotericin B, cisplatin, sulfonamides, etc.
2. Acts as an antigen or hapten in the antigen-antibody reaction that damages the renal interstitium and leads to severe interstitial nephritis: penicillins, cephalosporins, NSAIDs, anticoagulants, gold salts, captopril, etc.
3. Renal failure due to decreased renal blood flow: norepinephrine and dopamine in high doses. NSAIDs affect renal blood flow by inhibiting the production of prostaglandins. Analgesic nephropathy
Large and long-term use of compound analgesic preparations, especially those containing phenacetin, can lead to chronic kidney failure.
Analgesic nephropathy is part of a broader analgesic syndrome, which includes hypertension, peptic ulcer disease, anemia, and frequent headaches. Drug-induced kidney disease
Common risk factors for adverse effects include older age, depressed voice, pre-existing renal dysfunction, and previous use of other nephrotoxins.
Side effects due to sudden discontinuation of treatment
Stopping treatment suddenly can cause:
A. Relapse: relapse with or without an increase in the underlying disease.
b. Distraction: a new clinical illness unrelated to the original illness
Antihypertensives: Sudden withdrawal of clonidine and alpha methyldopa causes pheochromocytoma-like syndrome.
Beta-blockers: Stopping the drug suddenly in heart disease can cause heart attack, worsening of angina or stomach upset.
Corticosteroids: Absence of withdrawal after long-term treatment is observed, unrelated to dose and duration of treatment and recurrence of primary disease even in severe form.
Barbiturates: Abrupt discontinuation of treatment in epileptic patients may result in status epilepticus.
When used to induce sleep, sudden discontinuation can cause severe insomnia, confusion, agitation, hallucinations, and seizures.
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