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Module 5 • Medication Safety
Pharmacoeconomics & Safe Medication Use
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Pharmacoeconomics & Safe Medication Use
Adrian Wong ~2 min read Module 5 of 20
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Pharmacoeconomics and Safe Medication Use

Appendix 1. Adverse Drug Event Reporting Form (continued)

KJMC ADVERSE DRUG EVENT REPORTING FORM

Modified Naranjo Criteria for Causality (also called ADR Probability Scale)

ASSESSMENT

YES

NO

DON’T KNOW

(not conducted,

not reported)

SCORING

SYSTEM

1.  Are there previous reports (in the literature)

of this reaction? (If no, please provide docu-

mentation of search strategy)

+1

Based on the total

score, circle the

term that best

defines this ADR:

β‰₯ 9 Definite

5–8 Probable

1–4 Possible

≀ 0 Doubtful

2.  Did the ADR appear after the suspected drug

was administered, confirming a temporal

relationship? (If no, please explain)

+2

-1

3.  Did the ADR improve when the drug

was discontinued or a specific antagonist

was administered? (If no, please explain)

+1

4.  Did the ADR reappear when the drug was

readministered?

+2

-1

5.  Are there alternative causes (other than the

drug) that could have caused the ADR? (If

yes, please explain)

-1

+2

6.  Did the ADR reappear when a placebo was

given?

-1

+1

7.  Was the drug detected in the blood or other

fluids in toxic concentrations?

+1

8.  Evaluate the dose-response relationship;

was the ADR more severe when the dose

was increased or less severe when the dose

was decreased?

+1

9.  Did the patients have a similar reaction to the

same or similar drugs (i.e., same drug class)

in a previous exposure?

+1

10.  Consider signs, symptoms, and laboratory

values other than drug concentrations. Was

the ADR confirmed by objective evidence?

+1

TOTAL SCORE

Source: Naranjo CA, Busto U, Sellers EM, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981;30:239-45.

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