Benefits and Risks of Pharmacological Drugs

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Benefits and Risks of Pharmacological Drugs

Benefits of drugs are obvious.

Two dimensions to risk of drugs: 1) the probability of an adverse event
2) the severity of an adverse event

Often the risk is so small  not considered
Sometimes risk is substantial  need to weigh up likelihood of a benefit versus the likelihood of risk – BUT often have insufficient data to do this rationally.

3 grades of risk:
• unacceptable
• acceptable
• negligible

A risk free drug would be one for which :
• the physician knew exactly what action was required and used the drug correctly
• the drug did that and nothing else, either by true biological selectivity or by selected targeted delivery
• exactly the right amount of action, not too little and not too much, was easily achieved

Why criteria for a risk free drug are not met :
1. Drugs are insufficiently selective  as concentration of drug rises  affects other target sites
2. Drugs are selective – but mechanism has widespread function
3. Prolonged modification of cellular mechanisms  permanent change in structure and function
4. Insufficient knowledge of disease process  harmful interventions
5. Patients generally heterogenous  unpredictable individual response
6. Dosage adjustment according to need is imprecise
7. Ignorant and casual prescribing

Reducing drug risk:
• better knowledge of disease
• site specific delivery/drug targeting
• site specific effect
• informed, careful and responsible prescribing

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