Ch 5 Adverse Effects, Interactions, and Contraindications

Question 1

Where are adverse effects reported?

Answer 1

the FDA (using MedWatch)

Question 2

Adverse effects: Central Nervous System and nursing actions

Answer 2

• From CNS stimulation or depression
• If stimulation expected: risk for seizures
• If depression expected: advise to not operate heavy machinery or drive.

Question 3

Adverse effects: Anticholinergic and nursing actions

Answer 3

• effects are result of muscarinic receptor blockade
• most seen in eyes, smooth muscle, exocrine glands, and heart
• avoid activities that cause overheating (decreased ability to sweat)
• Manage dry mouth, photophobia, and urinary retention

Question 4

Adverse effects: Cardiovascular and nursing actions

Answer 4

• Monitor for orthostatic hypotension

Question 5

Adverse effects: GI and nursing actions

Answer 5

• Local irritation of GI tract and stimulation of vomiting center
• Take NSAIDS with food
• Opioid analgesics slow peristalsis and cause nausea and sedation. Avoid constipation and GI irritation

Question 6

Adverse effects: Hematologic and nursing actions

Answer 6

• Pretty common and life-threatening with some types of meds
• Bone marrow depression with anticancer meds
• hemorrhagic disorders with anticoagulants and thrombolytics
• monitor for bleeding (bruising, gums, blood in stool/urine, petechiae)

Question 7

Hepatotoxicity

Answer 7

• drug-induced injury to the liver
• damage to liver cells then impair metabolism of medications, which causes accumulation and adverse effects
• 2+ hepatotoxic meds are combined = risk for liver damage increases
• routine liver function tests when on hepatotoxic med
• monitor for nausea, vom, jaundice, dark urine, anorexia, abdominal discomfort

Question 8

Nephrotoxicity

Answer 8

• primarily due to NSAIDs and antimicrobial agents
• Monitor blood BUN and creatinine

Question 9

Rapid/immediate hypersensitivity

Answer 9

• overproduce immunoglobin-E antibodies: histamine, basophils, mast cells, eosinophils
• ANAPHYLAXIS, angioedema and mild allergies

Question 10

Angioedema

Answer 10

• severe allergic reaction that affects deep tissues
• usually involves face, lips, neck, oropharyngeal cavity
• often caused by NSAIDs and ACE inhibitors
• Interventions: apply oxygen, alleviate anxiety, maintain airway
• treatment: corticosteroids and ephinephrine

Question 11

Anaphylaxis nursing interventions

Answer 11

1. Notify rapid response team
2. esetablish an airway and administer bronchodilators if needed
3. treat with epi IM or IV (promotes bronchodilation and constricts blood vessels)
4. administer diphenhydramine to decrease urticaria
5. administer oxygen

Question 12

Extrapyramidal symptoms

Answer 12

• abnormal body movements
• usually associated with antipsychotics
• treated with anticholinergic meds

Question 13

Drug interactions

Increased therapeutic effects

Answer 13

Some meds given together to potentiate their action

example: albuterol prior to a glucocorticoid inhaler

Question 14

Drug interactions

Increased adverse effects

Answer 14

Taking 2 meds that have the same adverse effect

Question 15

Drug interactions

decreased therapeutic effects

Answer 15

One med given to counteract the side effects of another med

Question 16

Drug interactions

Decreased therapeutic effects

Answer 16

• one med can increase the metabolism or block the effects of a second med, which decreases blood levels and effect of the second med.

Question 17

Drug interactions

Increased blood levels leading to toxicity

Answer 17

One med decreases metabolism of second med, which increases blood level of second med leading to toxicity

Question 18

What does Vitamin K interact with?

Answer 18

Warfarin

Decreases therapeutic effect of warfarin and can cause blood clots because vitamin k is used to produce clotting factors

Question 19

Category A Pregnancy risk

Answer 19

No evidence of risk to fetus due to adequate and well controlled studies

Question 20

Category B Pregnancy risk

Answer 20

No evidence of risk to animal fetuses, but no adequate studies in pregnant people

Question 21

Category C Pregnancy risk

Answer 21

Adverse effects demonstrated in animal fetuses. No adequate studies in pregnant people, but use of med can be warranted based on risk benefit analysis

Question 22

Category D Pregnancy risk

Answer 22

Adverse effects on human fetuses based on data from investigational experience, but use of med can be warranted