Adverse Drug Reactions

Question 1

ADR

Answer 1

any noxious, unintended, and undesired effect that occurs at normal drug doses

Question 2

Scope of the Problem

Answer 2

MILD: drowsiness, nausea, itching, minor rashes

SEVERE: neutropenia, cardiac dysthymias

Question 3

Which patients are more likely to suffer ADR

Answer 3

Older adults and very young

Patients older that 65 = 50% of ADR cases

Question 4

Side Effect

Answer 4

Nearly unavoidable secondary drug effect produced at therapeutic doses

Question 5

Toxicity

Answer 5

degree of detrimental physiologic effects cause by excessive drug dosing

Question 6

Allergic RXN

Answer 6

IMMUNE RESPONSE

• there must be a prior sensitization of immune system
  –> mild itching to anaphlaxis

Question 7

how dosage affect intensity of allergic reaction

Answer 7

it does not affect the intensity of reaction

Question 8

Physical Dependence

Answer 8

abstinence syndrome will result if drug is discontinued

Question 9

Carcinogenic Effect

Answer 9

ability of certain medication to cause cancer

Question 10

Teratogenic Effect

Answer 10

Drug induced birth defect

Question 11

Paradoxical Effect

Answer 11

when an effect is opposite of intended drug response

Question 12

Latrogenic Disease

Answer 12

a disease produced by therapeutic procedures

Question 13

What are the types of organ-specific toxicity

Answer 13

(1) Drug which injury the liver (HEPATOTOXIC)
(2) Drugs that alter cardiac function (prolonged QT interval

Question 14

Hepatotoxic Drugs

Answer 14

Drugs that metabolize by liver are converted into toxic products

drugs are leading cause of liver failure

Question 15

What should patients who take heapatotoxic drugs do

Answer 15

undergo baseline and periodically liver function testing

Question 16

QT interval

Answer 16

time from ventricle initiation of depolarization until repolarization finished

Question 17

what is it called when QT is prolonged

Answer 17

Dysthymia

• torsades de pointes

Question 18

what questions should you ask to determine if a particular drug is responsible for an adr?

Answer 18

1) symptoms occur shortly after drug was first used?

2) abate when drug discontinued?

3) reappear after reinstated?

4) is it the illness itself?

5) other drugs in regime?

Question 19

how many new drugs have serious ADRs not revealed?

Answer 19

50% are not revealed in phase II and III trials

Question 20

Medication Guides

Answer 20

are FDA approved documents

educate patients about how to minimize harm

Question 21

When is a med guide required

Answer 21

1) patient adherence to directions is essential to efficacy

2) patients need to know about serious effects when using a drug

Question 22

Boxed Warnings

Answer 22

strongest warning a drug can carry and still remain on market

required on serious life-threatening risks

MUST ALSO HAVE MED GUIDE

Question 23

Medication errors

Answer 23

any PREVENTABLE event that may cause or lead to inappropriate medication use or PATIENT HARM while medication is in CONTROL OF the healthcare professional, patient, or consumer.

Question 24

Direct harm med. error

Answer 24

giving too high a dose

Question 25

indirect harm med error

Answer 25

giving too low a dose

Question 26

most common types of med errors

Answer 26

1) Overdose - 36.4%

2) Wrong dose- 16.2%

3) Wrong route- 9.5%

Question 27

What are human factors of medication errors

Answer 27

Performance deficits - ex. administrating iv vs IM - 29.8%

Knowledge deficits- 14.2%

Miscalculation of dosage- 13 %

Question 28

What are communication mistake medication errors

Answer 28

involving oral and written orders - 15.8%

Question 29

confusion over drug names

Answer 29

ex: anaspaz/ antipas - 15%

Question 30

Specific measures to reduce med errors

Answer 30

• computerized order entry (no handwriting)- reduced by 50%
• have senior clinical pharmacist accompany physicians on ICU rounds- 66% reduction
• bar-code system that match patient arm band code to drug bar code- reduced by 85%

Question 31

what are other ideas to reduce med errors

Answer 31

• minimize verbal/telephone orders
• list indications next to each other
  -beware of abbreviations
• never assume
• NEVER USE ZEROS AFTER PERIOD
• ALWAYS PUT LEADING ZERO FOR DECIMAL DOSES