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  Each drug
used for therapy involves a risk for the patient. This risk is partly due
to the drug's characteristics, the dose and the type of administration
and partly due to the patient's susceptibility. On the contrary less
attention has been paid to the health risks arising from occupational
exposure to drugs in the personnel assigned to their preparation.
Drug exposure in the health personnel can give rise to two kinds of
effects:
(i) allergic syndromes
(ii) iatrogenic effects, similar to those that may affect the patients.
Allergic manifestations are linked to the individual's constitution (e.g.
atopy) and therefore not linked to the working environment. This
symptomatology is usually due to some antibiotics (such as penicillin and
strptomycin), some antiphlogistic and antipyretic drugs (such as aspirin
and some phenothiazine derivatives), some classes of drugs that contain
the para-aminic group (such as antibiotics and sulfonylureas). A
cross-reaction may occur between such drugs, other drugs and, in general,
other commonly used products (such as detergents and cosmetics). Clinical
manifestations include dermatitis (the most frequent manifestation),
bronchial asthma, rhinitis and conjunctivitis.
On the contrary iatrogenic effects are due to conditions that can arise
in the working environment. They concern workers involved in drugs'
preparation and manipulation (nurses, doctors, chemists). In particular,
as far as hormone and cortisone preparations are concerned, iatrogenic
effects (such as cushingoid syndromes and gynaecomastia) have been
reported in the personnel involved in their production. In the hospital
personnel (that works in an environment where such risk is extremely
reduced) no such manifestation is present. Great importance, on the
contrary, is held by antineoplastic drugs. Some of them have irritant and
allergic effects.
Furthermore they can yield aspecific symptoms (nausea, headache) and
liver damage. Finally some antineoplastic drugs of certain carcinogenic
effect (such as cyclophosphamide and chlorambucil) and others of likely
carcinogenic effect (procarbazine,cisplatinum,
bis-chloro-ethyl-nitrosourea, chloro-ethyl-cycloesil-nitrosourea) are
held responsible for the increase in chromosomic alterations in
lymphocytes, for the mutagen effect that can be proved by Ames' Test in
urine, for the increase in spontaneous abortions and malformations in the
first three months of pregnancy in the personnel involved in their
manipulation.
Finally it is necessary to stress that, in general, the toxicological
characteristics of drugs are linked to the drug's chemical composition as
well as to the administerd dose and to the biotranformations that the
drug undergoes in the body. Therefore, because the most important organ
for such processes is the liver, the liver is the organ most frequently
involved in the toxic effects produced by the drug and/or its
metabolites. Another organ frequently involved is the kidney, because of
its role in the elimination of substances. Therefore it is always
necessary to consider the functionality of these two organs when
administering a drug to a patient. No effects have been reported on the
contrary with regards to this problem in the personnel involved in the
administration of the drugs.
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