ISSN 1658-8788

INSIDE: Adverse Drug

Reactions Part II
An adverse drug reaction (abbreviated ADR) is a term to describe the unwanted, negative consequences sometimes associated with the use of different medications. ADR is a particular type of adverse effect.

March - April 2007

Guidelines for the Development of an Ecotourism Park

Ms. Joy Era The focus of this paper is to recommend guidelines on the Development of Ecotourism facilities. The take off point is one of La Consolacion College Manilas (LCCM) outreach sites, Pantabangan, Nueva Ecija.

Greening Pantabangan La Consolacion College Manila, through its Community Relations and Extension Services Office, has embarked on a great mission of helping the community of Pantabangan, Nueva Ecija through the development of an Ecological Park. Guided by the Augustinian values of bettering the lives of others, this is a project of the college department with a livelihood (integrated farming) component for the local beneficiaries. A 25-year MOA was entered into between LCCM and the Municipality of Pantabangan, Nueva Ecija on September 1, 2004. This paved the way for the start of the implementation of a greening (reforestation) process to protect the watershed of Pantabangan Dam and portion of the 240 hectares municipal park and transform the area into a nature's

haven as a legacy of LCCM to the people of Pantabangan and the Filipino nation (LCCM Website). At present, the greening of Pantabangan has begun to be realized, as well as the goat-raising and other livelihood projects. The challenge of transforming Pantabangan into an Ecological Park is a formidable task because this will need the concerted efforts not only of the public and private sectors, but most importantly, the local communities who are the direct beneficiaries of this project. As pointed by Andersen (:117), To continue the growth of ecotourism as an industry, it is important for government and private enterprise to pool technical, cultural and financial resources to carry out a meaningful environmental agenda. IMPORTANT CONSIDERATIONS Environmental Ethics Aside from the financial resources that should be considered in the building of an

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ecotourism project, the most important factor to consider is the projects adherence to sound ethical standards that are environmentally sensitive and aligned to the principles of sustainable development. The following is from the Department of Tourisms Primer on Ecotourism: 1. Assess the current and future state of a potential tourism spot and its impact to the environment when planning for any tourism development. Ensure that an Environmental Impact Assessment is made before proceeding with the development. 2. Consider the cultural values of the local people before introducing tourism to prevent cultural shock and degradation.

Organizational Issues As one looks toward a particular region for the development of ecotourism facilities, there are a number of broadly conceptual issues to address: 1. Is the area so unique that it requires government protection? 2. Is the infrastructure sufficient to support ecotourism? 3. Has an analysis been done of the areas ecologic sensitivity? 4. Is the facility development for current market demand or does it anticipate future market demand? Is phased development possible? 5. How can the facility express the unique characteristics of an area and its people? Upon securing a potential building site, the developer should anticipate the following: 1. Obtaining a boundary survey and posting the perimeter. 2. Obtaining a topographic survey with the appropriate contour intervals identified for detailed study. 3. Locating significant site features, trees, marshes, streams, existing structures (if any), archeologically significant areas, etc. 4. Obtaining aerial photographs of the site to confirm survey information. 5. Identifying seasonal high-water marks. 6. Investigating approval requirements by local and national agencies. 7. Identifying seismic zone classification.

3. Conduct consultations with the local population who will be affected by the tourism development. 4. Utilize the local population for employment in the tourism-related establishments and activities.

5. Minimize the use of scarce resources like water and fuel. 6. Help in stopping deforestation and marine resources decimation.

7. Stop or minimize the use of environmentally damaging materials. Instead, practice and encourage the use of local and environment-friendly materials. 8. Do not patronize firms or individuals engaged in environmentally destructive practices. David Andersens A Window to the Natural World: The Design of Ecotourism Facilities can also serve as a guide in the development and design of the Pantabangan Eco-Park. Some of the important concerns that need to be addressed follow:

8. Investigation of social conditions bearing capacities for building.

and

9. Observing prevailing winds and weather patterns as they affect the site during all seasons. 10. Reviewing the local watershed layout relative to the site, noting activities on adjacent property which may impact drainage and water quality.

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A Grass Roots Approach Local involvement is important in the development of the area because of the following reasons: 1. Local, cultural and ecologic knowledge can contribute to the design. 2. To ensure long-term support for ecotourism in the area; 3. It can reduce negative cultural impact. A Checklist for Development of Ecotourism Facilities The following generalized criteria are suggested as a guideline for more detailed standards related to specific local issues and the ecological characteristics of a given site: Site Planning Issues Building Design Issues 1. Site buildings and structures should avoid cutting significant trees and to minimize disruption of other natural features. 2. Trail systems should respect patterns and habitats of wildlife. travel 1. Design of buildings should utilize local construction techniques, materials, cultural images wherever that approach is environmentally sound. 2. Provide building forms and images in harmony with the natural environment. Design buildings based on long-term environmental standards and not necessarily on short-term material standards. 3. Maintenance of ecosystem should take priority over view or dramatic design statements. 4. Provide an architecture consistent with environmental philosophies and/or scientific purposes. Avoid contradictions. 5. Use low tech design solutions wherever possible. 6. Prominently post an environmental code of conduct for visitors and staff. 7. Building practices should respect local cultural standards and morals. Involvement of local inhabitants should be encouraged to provide input for the designer as well as a sense of ownership and acceptance by local residents. 8. Plan for future growth of the facility to minimize future demolition and waste. 9. Utilize low impact site development techniques, such as boardwalks, instead of paved or unpaved trails wherever possible. 10. Review any potential sources of sound or smell associated with the development that may be disruptive to the environment or offensive to the visitor. 11. Design should reflect seasonal variations such as rainy seasons and solar angles. 12. Site lighting should be limited and controlled to avoid disruption of wildlife diurnal cycles.

3. Erosion control should be considered in all building /trail placements. 4. Divert water off trails and roads before it gains sufficient flow and velocity to create significant erosion problem. 5. Buildings should be spaced to allow for wildlife travel patterns and forest growth. 6. Use of automobiles and other vehicles should be strictly limited. 7. Provide trailhead signs to enhance appreciation of natural environment and to clearly establish rules of conduct. Post additional rules in guest units. 8. Discretely label plant/tree types around the immediate lodging facilities to acquaint visitors with species they may encounter in the surrounding preserved/ protected area.

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Energy Resource and Utility Infrastructure Issues 1. Landscape elements should be placed to enhance natural ventilation of facilities and avoid unnecessary consumption of energy. 2. Consider use of passive or active solar or wind energy sources wherever practical. 3. Water lines should be so located as to minimize disruption of areas adjacent to trails wherever possible. 4. Hydroelectric power generation techniques should be utilized with minimal disruption to the environment. it open its doors to the public, particularly the tourists? Physical and cultural boundaries should also be fluidly defined and redefined to accommodate these transformations and changes.

Definition of Terms 1. Ecotourism a tool for sustainable development through the proper management, protection and conservation of the countrys natural and cultural resources while at the same time generating jobs and businesses for the local people. (Agenda 21, 1992) 2. Sustainable development - meeting the needs of the present without compromising the ability of future generations to meet their own needs. (Rio de Janeiro, Earth Summit Agenda 21, 1992)

Waste Management Issues 1. Provide ecologically sound restroom and trash disposal facilities at trail heads for guests and non-guest use. 2. Provide for environmentally methods of trash removal. sound

3. Provide trash storage secure from animals and insects. 4. Provide facilities for recycling. 5. Utilize appropriate technologies for the treatment of organic wastes, such as composting, septic tanks, or biogas tanks. 6. Look at methods to recycle wastewater for non-potable uses and to treat tainted waters before their return to the natural environment.

3. Ecology - study of the structure and function of nature. The totality or pattern of relations between organisms and their environment (wikipedia).

References: Cruz, R. (2000). Principles of Tourism. Q.C.. DOT. Primer on Ecotourism

Mrs. Joy B. Era Full time Faculty School of HRM and Tourism Research Interests: Tourism Management

Final Considerations After all the above-mentioned issues have been addressed, evaluation tools should be formulated to monitor and maintain sound environmental practices. Pertinent questions should also be answered such as the length and extent of LCCMs involvement in the development of the Pantabangan Ecotourism Park. For instance, once the park becomes operational, will

Contact Number 736-02-356 loc.141

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Adverse Drug Effects (Part II)

Dr. Raul Salvador

The selective effects of drugs are known for all over-the-counter (OTC) and prescription medications. Individual variations in body composition, age, metabolism, and systemic conditions may affect drug actions, and these effects are not always known or predictable. All drugs have the potential to cause adverse or harmful effects that can either be related or unrelated to the principal action of the drug. Harmful effects that are directly related to drug action are predictable, and occur as a consequence of that action. For example, using aspirin causes increased bleeding due to its anticoagulant effect. These predictable effects are reversible when the drug is discontinued. However, reversal can be difficult for drugs associated with addiction, such as narcotics and alcohol, and at times, these effects can be fatal, as with hypoglycemic coma induced by insulin. Harmful effects that are unrelated to the principal action of the drug are rare. Unusual and unpredictable responses to medications, such as anaphylaxis, are referred to as idiosyncratic reactions. However, there are situations when these effects are likely to occur, such as excessive dosing of a medication. For example, using high doses of aspirin can cause tinnitus, an unwanted effect. In this situation, the effect is predictable, because the dose taken has exceeded that which is considered safe. Teratogenic effects are also examples of these predictable, unwanted effects.

Ocular Toxicity Chloroquine (Aralen), a drug used to treat some rheumatoid diseases, can cause retinal damage and even blindness Assessment Blurring of vision, color vision changes, corneal damage, and blindness may be observed. Interventions Monitor the patient's vision carefully when the patient is receiving known oculotoxic drugs. Consult with the prescriber. Discontinue the drug as appropriate. Provide supportive measures, especially if vision loss is not reversible. Monitor lighting and exposure to sunlight Auditory Damage Tiny vessels and nerves in the eighth cranial nerve are easily irritated and damaged by certain drugs. The macrolide antibiotics can cause severe auditory nerve damage. Aspirin, one of the most commonly used drugs, is often linked to auditory ringing and eighth cranial nerve effects.

All drugs have the potential to cause adverse or harmful effects.

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Assessment Dizziness, ringing in the ears (tinnitus), loss of balance, and loss of hearing may be observed. Interventions Monitor the patient's perceptual losses or changes. Provide protective measures to prevent falling or injury. Consult with the doctor to decrease dose or discontinue the drug. Provide supportive measures to cope with drug effects General Central Nervous System Effects Assessment Symptoms may include confusion, delirium, insomnia, drowsiness, hyperreflexia or hyporeflexia, bizarre dreams, and hallucinations Interventions

Interventions 1. Provide sugariess lozenges and mouth care to help mouth dryness. 2. Arrange for bowel program as appropriate. Have the patient void before taking the drug, to aid voiding. 3. Provide safety measures if vision changes occur. 4. Arrange for medication for headache and nasal congestion as appropriate. 5. Advise the patient to avoid hot environments and to take protective measures to prevent falling and to prevent dehydration, which may be caused by exposure to heat owing to decreased sweating. Parkinson-like Syndrome

Provide safety measures to prevent injury. Caution the patient to avoid dangerous situations such as driving a car or operating dangerous machinery. Orient the patient and provide support. Consult with the prescriber to decrease drug dose or discontinue the drug. Atropine-like (Cholinergic) Effects Some drugs mimic the effects of the parasympathetic nervous system by directly or indirectly stimulating cholinergic receptors. Donepezil (Aricept), a drug used to treat Alzheimer's disease, causes many cholinergic effects. Many cold remedies and antihistamines also cause cholinergic effects Assessment Dry mouth, altered taste perception, dysphagia, heartburn, constipation, bloating, paralytic ileus, urinary hesitancy and retention, impotence, blurred vision, cycloplegia, photophobia, headache, mental confusion, nasal congestion, palpitations, decreased sweating, and dry skin may be seen.

Drugs that directly or indirectly affect dopamine levels in the brain can cause a syndrome that resembles Parkinson's disease. Many of the antipsychotic and neuroleptic drugs can cause this effect. Assessment Lack of activity, akinesia, muscular tremors, drooling, changes in gait, rigidity, extreme restlessness or "jitters" (akathisia), spasms (dyskinesia) may be observed. Neuroleptic Malignant Syndrome General anesthetics and other drugs that have direct central nervous system effects can cause neuroleptic malignant syndrome, a generalized syndrome that includes high fever.

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Assessment Extra-pyramidal symptoms, hyper-thermia, autonomic disturbances, and fever may be observed. Interventions Discontinue the drug, if necessary. Know that treatment with anticholinergics or antiparkinson drugs may be required. Provide supportive care to lower the body temperature. Institute safety precautions as needed. Teratogeneticity This is the ability of a drug to cause abnormalities in a developing fetus when taken by the mother. US Federal Drug Administration (FDA) Pregnancy Risk Categories classify drugs as follows, according to the risk they impose on the developing fetus. Category X drugs should not be given to pregnant women or women who may become pregnant. CATEGORY A. No risk to fetus. Studies have not shown evidence of fetal harm CATEGORY B. No risk in animal studies and well controlled studies in pregnant women are not available. It is assumed there is little to no risk in pregnant women. CATEGORY C. Animal studies showed a risk to the fetus. Controlled studies on pregnant women are not available. Risk versus benefit of the drug must be determined. CATEGORY D. A risk to the human fetus has been proved. Risk versus benefit of the drug must be determined. It could be used in life threatening conditions. CATEGORY X. Studies in animals and humans showed fetal abnormalities or adverse reaction. Reports of evidence of fetal risks.

Dental hygienists must understand the differences between drug toxicity, drug allergies and drug side effects. Drug toxicity is toxininduced cellular damage and cell death. Usually, the reactive metabolites formed during metabolic breakdown of the drug in either the liver or the kidney are responsible for causing cell damage, as opposed to the actual drug itself: These reactive metabolites cause permanent changes in cell structure and function, resulting in altered cellular metabolism, cellular mutation and cell death. Drug hypersensitivity, or an allergic reaction, occurs when either the drug or its metabolites trigger the immune system and is not predictable. Hypersensitivity is produced with repeated exposure to the same drug. Signs of a true allergy include skin rash, itching, hives, respiratory distress and rhinitis. Other hematologic signs of allergy include hemolytic anemia, agranulocytosis and thrombocytopenia. An individual may take a drug nine times, and have an allergic reaction the tenth time. Serious, life-threatening reactions are rare, and include anaphylaxis, hemolysis, and bone marrow suppression. The penicillins are the most common cause of drug-induced anaphylaxis, affecting one in every 50,000 individuals exposed. All drugs produce side effects, which occur for one of two reasons: First, a drug may produce an exaggerated effect on its target tissue when given at its correct dose. In this situation, the side effect is an extension of the therapeutic effect of the drug. For example, dangerously low blood sugar may result from taking an oral hypoglycemic agent. Second, a drug may produce an effect on non-target tissues, so that the effects produced differ from those that are desired. For example, taking NSAIDS for pain control may result in Gl ulceration and bleeding. The Food and Drug Authority requires reporting of all known side effects, which can be found in pharmacology reference texts. Adverse drug effects can also be caused by drug interactions. Drug interactions can be avoided by knowing

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proper drug relationships. These adverse effects range in severity from minor alterations in drug action to severe, life-threatening situations. The dental hygienist must be able to recognize the early warning signs of drug interactions to maintain the health and safety of the client. As with side effects, the BFAD requires the reporting of all known drug interactions, which are updated frequently and routinely published in a variety of professional sources. Side effects can also occur if the client is not managing medications correctly. Managing medications is difficult for both practitioners and clients, as clients are treated by multiple providers in multiple care settings, all of whom may be prescribing for specific client needs. Further, clients may be self-medicating, under/over-medicating, or may fail to comply because they misunderstood instructions, are unable to read labels, or choose to stop taking their medications due to boredom or intolerance of side effects. Helping clients manage their medications is an important role for the dental hygienist. Management of the oral side effects caused by medication use is an ongoing challenge for dental hygienists. Oral side effects cause client discomfort, and may interfere with the client's ability to adequately chew, swallow and digest food. Some oral side effects place the client at risk for oral trauma, while others contribute to infection, pain and possible tooth loss. Dental hygienists need to accurately diagnose these oral conditions in order to recommend appropriate treatment interventions. Timely recognition and professional interventions are necessary to improve client comfort and function.

References Karch, M. (2003). Focus on Nursing Pharmacology. Lippincott, Williams & Wilkins. Wynn R.L, Meiller T.F and Crossley HL. (199899). Drug Information Handbook in Dentistry. 4th ed. Hudson: Lexi-Comp, Inc.

Dr. Raul S. Salvador Full time Faculty School of Nursing Research Interests: Pharmacology, Psychiatric Nursing, Mental Health Contact Number 736-02-356 loc. 72

LCCM Research Digest is published by the Research and Publication Center to serve as a sounding board of up to date ideas and actions related to research, classroom management and material delivery of the faculty in the different schools of the College. It encourages and welcomes condensed versions or a short summary of research or review essays, conference papers, lecture notes, teaching guides and other classroom materials for its bimonthly publication.
Editorial Board: Sr. Imelda A. Mora, OSA, LCCM President, Mr. Geronimo C. Suliguin Jr. Director, Research and Publications Center, Dr. Divina Edralin, Consultant. Managing Editor: Carmela R. Claud. For comments, suggestions and contributions, call (632) 736-02-35 loc. 173 or 313-05-09 or e-mail us at res@lccm.edu.ph. Also visit http://researchdigest.blogspot.com.

Conclusion In principle, medical professionals are required to report all adverse effects related to a specific form of therapy. In practice, it is at the discretion of the professional to determine whether a medical event is at all related to the therapy.

The Research Digest is now accepting contributions for the May-June 2007 Issue. Feel free to visit us for inquiries.

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