Benefits and Risks of Pharmacological Drugs
Benefits of drugs are obvious.
Risks:
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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