Adverse drug events are important preventable causes of hospitalization in older adults.

4 medications linked to 67% of drug-related hospitalizations

Four medications or medication classes were implicated alone or in combination in 67% of hospitalizations:

- warfarin, 33%
- insulins, 14%
- oral antiplatelet agents, 13%
- oral hypoglycemic agents, 11%

High-risk medications were implicated in only 1.2% of hospitalizations.

50% of these hospitalizations were among adults 80 years of age or older. 65% of hospitalizations were due to unintentional overdoses.

Classification of adverse reactions to drugs: "SOAP III" mnemonic (click to enlarge the image):

Adverse drug reactions (ADRs) affect 10–20% of hospitalized patients and 25% of outpatients.

Rule of 10s in ADR

10% of patients develop ADR
10% of these are due to allergy
10% of these lead to anaphylaxis
10% of these lead to death

Insulin is one of the top 10 high risk medications

Insulin has been identified as one of the top 10 high risk medicines worldwide. Errors are common - the first national audit in England and Wales showed prescribing errors in 19.5% of cases.

Not only are mistakes common, they often lead to harm - 3% of medication errors are related to insulin, but these errors were also twice as likely to cause harm as errors for other prescribed drugs.

Over 20 different types of insulin are in use, in various strengths and forms, and with a range of delivery devices, including insulin syringes (from vials), insulin pens (prefilled or reusable), or infusion pumps.

Top 10 most prescribed medications

According to a report from the IMS Institute for Healthcare Informatics, the top 10 most-prescribed drugs in the U.S. are:

- hydrocodone (combined with acetaminophen)
- simvastatin
- lisinopril
- levothyroxine
- amlodipine
- omeprazole
- azithromycin
- amoxicillin
- metformin
- hydrochlorothiazide

References:

Emergency Hospitalizations for Adverse Drug Events in Older Americans. Daniel S. Budnitz, M.D., M.P.H., Maribeth C. Lovegrove, M.P.H., Nadine Shehab, Pharm.D., M.P.H., and Chesley L. Richards, M.D., M.P.H. N Engl J Med 2011; 365:2002-2012, November 24, 2011.
Insulin is one of the top 10 high risk medications worldwide for prescription errors
Top 10 Most Prescribed Medications
Drug Allergy: Introduction and Epidemiology
Drug Allergy
Image source: Wikipedia, public domain.

Comments from Google Plus and Twitter:

Wendy Hemken - I noticed that opioids weren't on that list. All the talk seems to be about how deadly they are. Is this not the case?

Aaron Sparshott @IVLINE: An important one for #medstudents

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