Kesan ubat yang tidak diingini (Adverse Drug Reaction)



Kesan ubat yang tidak diingini (ENG: Adverse Drug Reaction), merupakan sebarang gejala atau kesan yang membahayakan kesihatan @ nyawa akibat daripada pengambilan ubat yang diambil pada dos/sukatan yang normal. Contohnya,

Ali menghidap penyakit kencing manis, dan dia memakan tablet Metformin sebanyak 1 gram (2 biji tablet), dua kali sehari. Tiba-tiba pada suatu hari lepas makan 2 biji tablet Metformin tu, secara beransur-ansur dia mengalami keletihan, berlaku peningkatan dalam kadar pernafasan, pening2 dan muntah2 sehingga terpaksa dikejarkan ke hospital. Selepas diperiksa, Ali mengalami lactic acidosis (peningkatan acid lactic dalam darah sehingga menyebabkan darah menjadi berasid), kesan daripada pengambilan Metformin.

Berbanding dengan kesan sampingan (ENG: side effects), kesan ubat yang tak diingini ataupun ADR ni memang effect negatif daripada pengambilan ubat.

Contoh ADR                 : gastritis & pendarahan pada usus disebabkan pengambilan ubat aspirin

Kesan sampingan pulak kadang2 kita tak nak tapi kadang2 berguna juga 

Contoh kesan sampingan: ubat-ubat yang tergolong opiod agonist macam morphine, diphenoxylate boleh menyebabkan sembelit, tapi side effect ubat tu iaitu menyebabkan sembelit tu boleh digunakan untuk merawat cirit birit. Begitu juga ubat selsema, Chlorpheniramine, kesan sampingannya menyebabkan mengantuk. Tapi untuk rawatan masalah susah nak tidur, chlorpheniramine boleh juga diberi untuk membantu pesakit tidur (gunakan side effect ubat untuk merawat masalah penyakit).

Berikut merupakan sedikit info tentang klasifikasi kesan ubat yang tidak diingini. Dialih bahasa daripada sumber berikut: Marc A.R. et. al (2003) Adverse Drug Reaction: Types and Treatment Options, American Family Physician, 68(9), 1781-1791

Reaksi Ubat (Immunologik dan Bukan Immunologik)*


Jenis    Contoh

Immunologik

Reaksi jenis 1 (melibatkan IgE)

  Alahan kepada β-lactam antibiotic
Reaksi jenis 2 (sitotoksik)
  Hemolytic anemia akibat penicillin
Reaksi jenis 3 (kompleks     imun)
  Alahan kepada anti-thymocyte globulin
Reaksi jenis 4 (tertangguh, melibatkan sel)
  Bengkak/ruam kulit akibat ubat sapu antihistamine
Pengaktifan sel T spesifik
  Ruam cacar akibat sulfonamides
Fas/Fas ligand-induced      apoptosis
  Stevens-Johnson syndrome



Lain-lain
  Sindrom lupus akibat pengambilan ubat


  Sindrom alahan kepada ubat epilepsi

Bukan Immunologik

Boleh dijangka


Kesan sampingan ubat primer

Mulut kering akibat antihistamines

Kesan sampingan ubat sekunder
Jangkitan fungi/yis semasa mengambil antibiotics

Kesan toksik ubat
Kesan toksik pada hati akibat pengambilan methotrexate

Interaksi antara ubat-ubatan
Sawan akibat mengambil theophylline selepas memakan erythromycin

Dos berlebihan
Sawan akibat pengambilan berlebihan lidocaine (Xylocaine)

Tidak boleh dijangka




Pseudoallergic

Alahan teruk selepas terdedah kepada media radio-kontras

Idiosyncratic
Hemolytic anemia di kalangan pesakit yang  kekurangan enzim G6PD selepas mengambil primaquine (ubat anti malaria)

Kegagalan untuk toleransi kepada ubat 
Telinga berdengung setelah memakan satu dos kecil aspirin


Macam mana nak tau lepas makan sesuatu ubat tu, kita mengalami kesan yang diingini atau pun tak diingini? Memang sukar jugak la nak tau dengan sendiri. Jadi nak bagi senang cerita macam ni, bila anda semua memperoleh sesuatu jenis ubat daripada kaunter farmasi, pastikan anda diberitahu serba sedikit maklumat menenai ubat tu - apa kegunaan ubat tu, apa kesan yang dijangkakan daripada ubat tu sama ada kesan baik atau kesan buruk. Sebagai contoh, baca la perbualan kat bawah ni:



Pegawai Farmasi: Pakcik, ni ada dua jenis ubat, pakcik kena makan ubat ni untuk penyakit pakcik.


Pakcik Karl       : Ok, amendanya ubat tu. Cuba cerita sikit.




Pegawai Farmasi: Ini yang warna kuning ni, perindopril. Ubat ni untuk darah tinggi pakcik. Kena makan waktu pagi sebelum makan sarapan. Makan 1 biji sekali sehari. Yang ubat satu lagi ni ubat tahan sakit, tramadol. Ubat ni makan bila rasa sakit je, sekali makan boleh makan sebiji, paling banyak bol




Pakcik Karl      : Kalau makan ubat kuning hijau macam bendera kedah ni (tunjuk jari kat tramadol), lepas makan patutnya rasa sakit kurang la sikit kan. Tapi yang ubat bijik kuning ni, amenda ke tadi, perindopril, kalau pakcik makan..macam mana nak tau ubat ni dah bagi kesan ke tak?





Pegawai Farmasi: Ubat perindopril ni, bila pakcik dah makan dalam tempoh seseminggu dua ni, sepatutnya pening kepala pak cik makin kurang la. Lepas tu, nanti kalau makan ubat ni nanti selalunya ada batuk2 la sikit. Kalau teruk sangat batuknya, pakcik datang balik la hospital, jumpa doktor bagitau pasal batuk tu.


Pakcik Karl       : Ooo. Makan ubat-ubat ni takde kesan lain ke, sembelit ke, muntah darah ke, payah nak kencing ke?





Pegawai Farmasi: Takdela extreme sampai camtu pakcik..Aa, satu lagi kalau makan ubat tramadol tu ada kemungkinan sembelit, pening2 sikit, jadi kena minum banyak air la pakcik ye




Pakcik Karl        : Ooo. Ok2. Selain tu, takde kesan2 adverse effect lain ke?





Pegawai Farmasi: Er, setakat yang saya cerita tadi tu jela biasanya, lain2 takde sangat. Ala ubat pakcik ni sikit je, bukan sampai 7-8 ubat pun, rilek la pakcik, takyah takut. Pakcik add saya kat facebook, ape2 hal kalau ade benda2 lain jadi kat pakcik yg pakcik rasa sebab ubat yang pakcik makan tu, pakcik tulis je kat wall saya, ok?





Pakcik Karl       : Okeh, set. Assalamualaikum

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What if kesan tu jd mula2 mkn ubat sbb badan belum boleh adapt? Ade ke kesan camtu? Ke ubat tu mmg tak sesuai dgn kita n should stop immediately?

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