IATROGENESIS

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 The side effects and risks associated with the
medical intervention are called iatrogenesis.

iatros,” - Means physicians and “genesis,”

Means origin.

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 IATROGENESIS
Iatrogenesis is the causation of disease, a harmful
complication, or ill effect by any medical
activity, including diagnosis, intervention, error,
or negligence

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• Some iatrogenic events are obvious, like amputation of
the wrong limb, where as others, like drug interactions,
can evade recognition.

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 • Negligence is a failure to exercise appropriate
and/or ethical ruled care
• Negligence involves harm caused by failing to
act as a form of carelessness

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 EXAMPLES OF IATROGENESIS

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 1.ADVERSE EFFECTS OF
DIAGNOSTIC PROCEDURES
Diagnostic radiology
Reactions to contrast media -a nephrotoxic
reaction.
Cerebral angiography may cause transient or
permanent neurological deficits.
Aspiration of fluids
Hemorrhage, secondary infection, shock and
even death.
Endoscopic procedure -perforation of hollow
viscus

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 2.Risk associated with medical
interventions
• Adverse effects of prescription drugs or vaccines

• Overuse of drugs ( for example, antibiotic

resistance in bacteria)
• Prescription drug interaction.

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 3. Medical errors
• Incorrect prescription,
• illegible handwriting or computer typos
• Faulty procedures, techniques, information,
methods, or equipment
• Negligence
• Hospital-acquired infections

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 ADVERSE EFFECTS OF
PRESCRIPTION DRUGS OR
VACCINES

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 4. Adverse effects of
prescription ofdrugs or
vaccines
• Any response for a drug which is unintended and
which occurs at doses normally used for
prophylaxis, diagnosis and therapy of disease.

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 They are classified
• Dose-related
• Time-related
• Withdrawal
• Failure of therapy

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 5.Adverse effects of
prescription -Anaphylaxis
• Penicillin ,Beta-lactum antibiotics ,Aspirin and
nonsteroidal anti-inflammatory agents (NSAIDs)
cause anaphylactoid reactions

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 Iatrogenic disorders

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 1.Drug induced cutaneous
manifestations: examples
1.Alopaecia Cytotoxic agents

Chlorpropamide,
2. Erythema multiforme
Sulphonamides

3. Exanthematous eruptions Allopurinol, Anti convulsants

4. Exfoliative dermatitis streptomycin

5. Photosensitivity Indomethacin

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 2.Drug induced haematological
disorders
Megaloblastic Anaemia (MA)
Oral contraceptives, phenytoin, phenobarbitone
Hemolytic anemia
Drugs causing haemolysis are sulphonamides
chlorpromazine, quinine and tetracycline

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]

3.Drugs producing Neutropenia

Analgesics and NSAIDs :Indomethcin, Acetaminophen,

Anticonvulsants :Phenytoin, Carbamazepine

Antithyroid drugs :Thiouracil, Methimazole

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4.Drugs that cause thrombocytopenia

• chloramphenicol, cyclosporins,quinidine,
rifampicin, sulphonamides etc.

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 5.Hazards of blood transfusion
• Allergic-anaphylaxis, fever, haemolysis, non
cardiac pulmonary oedema,transmission of
diseases like malaria, hepatitis, and AIDS

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 6.Traumatic nerve injuries

• Direct damage during surgery

• Pressure or traction because of positioning
during anesthesia
• Injection of neurotoxic substances
• Compression of a hematoma secondary to
drawing blood or through anticoagulation
• Tourniquet
• Dressings, casts or orthotic devices
• Radiation.

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 7 Hepatic damage

• Acetaminophen, nitrofurantoin, methyldopa,

ketoconazole, phenytoin

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 8.Renal failure
• Renal failure by reducing renal blood flow:
noradrenaline and dopamine in high doses.
NSAIDs indirectly affect renal blood flow by
inhibiting production of prostaglandins.

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 9.Drug induced gastro-
intestinal diseases
• Oral lesions
• Lichen planus like lesions : methyldopa,
chloroquine and propranolol.
• Acid peptic disease : acetyl salicylic acid,
NSAIDs, corticosteroids etc.
• Pancreatitis : azathioprine, glucocorticoids and
oral contraceptives.

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 Lichen planus

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 10.Ophthalmological
complications
• 1.Cataract Busulphan
• 2. Corneal opacities Chloroquine
• 3. Colour vision alteration Digitalis
• 4. Glaucoma Sympathomimetics
• 5. Optic neuritis Quinine
• 6. Retinopathy Chloroquine

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 11.Delirium
• Delirium is one of the most common
iatrogenic complications in hospitalized elders
affecting 50% or more post-operative hip
fracture and thoracic surgery patients over
age 65.

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 Risk Factors for Delirium
• Age ≥ 70 years
• Existing cognitive impairment
• Functional impairment
• Alcohol abuse
• Abnormal preoperative level of sodium,
potassium or glucose
• Preoperative psychotropic drug use
• Depression
• Increased comorbidity
• Living in a long-term care facility
• Visual or hearing impairment

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 12.Hazards of hospitalization
• Hospital-acquired infections
• Urinary tract infections and respiratory
infections are the commonest.

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 Nosocomial Infections

• Infections are usually related to a procedure

or treatment used to diagnose or treat the
patient’s initial illness or injury

• 36% of these are preventable!

UTIs
Pneumonia
Surgical wound infections
Clostridium difficile colitis

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 Urinary Catheters
• Catheter-associated urinary tract infections
(CAUTIs) represent the most common
nosocomial infection, accounting for 40% of
all hospital-acquired infections and are a
preventable cause of hospital-acquired
infections.
 13.Restrain

Restraints are associated with:

 increased rates of pressure sores

 increased incidence of nonsocomial infections
 distress
 falls

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 14.Iatrogenic wounds
• complications resulting from various
treatments and operations (e.g., surgical site
infections (SSIs)), and chronic wounds
caused by improper surgical treatment
• hospital-acquired pressure ulcers

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 Prevention
Most Iatrogenic disorders can be avoided by using
simple precautions
increased knowledge of contraindications
 restriction of self-medication
lowering the number of concomitant drugs.

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