Ch 5 Adverse Effects, Interactions, and Contraindications Flashcards
Where are adverse effects reported?
the FDA (using MedWatch)
Adverse effects: Central Nervous System and nursing actions
- From CNS stimulation or depression
- If stimulation expected: risk for seizures
- If depression expected: advise to not operate heavy machinery or drive.
Adverse effects: Anticholinergic and nursing actions
- 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
Adverse effects: Cardiovascular and nursing actions
- Monitor for orthostatic hypotension
Adverse effects: GI and nursing actions
- 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
Adverse effects: Hematologic and nursing actions
- 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)
Hepatotoxicity
- 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
Nephrotoxicity
- primarily due to NSAIDs and antimicrobial agents
- Monitor blood BUN and creatinine
Rapid/immediate hypersensitivity
- overproduce immunoglobin-E antibodies: histamine, basophils, mast cells, eosinophils
- ANAPHYLAXIS, angioedema and mild allergies
Angioedema
- 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
Anaphylaxis nursing interventions
- Notify rapid response team
- esetablish an airway and administer bronchodilators if needed
- treat with epi IM or IV (promotes bronchodilation and constricts blood vessels)
- administer diphenhydramine to decrease urticaria
- administer oxygen
Extrapyramidal symptoms
- abnormal body movements
- usually associated with antipsychotics
- treated with anticholinergic meds
Drug interactions
Increased therapeutic effects
Some meds given together to potentiate their action
example: albuterol prior to a glucocorticoid inhaler
Drug interactions
Increased adverse effects
Taking 2 meds that have the same adverse effect
Drug interactions
decreased therapeutic effects
One med given to counteract the side effects of another med
Drug interactions
Decreased therapeutic effects
- one med can increase the metabolism or block the effects of a second med, which decreases blood levels and effect of the second med.
Drug interactions
Increased blood levels leading to toxicity
One med decreases metabolism of second med, which increases blood level of second med leading to toxicity
What does Vitamin K interact with?
Warfarin
Decreases therapeutic effect of warfarin and can cause blood clots because vitamin k is used to produce clotting factors
Category A Pregnancy risk
No evidence of risk to fetus due to adequate and well controlled studies
Category B Pregnancy risk
No evidence of risk to animal fetuses, but no adequate studies in pregnant people
Category C Pregnancy risk
Adverse effects demonstrated in animal fetuses. No adequate studies in pregnant people, but use of med can be warranted based on risk benefit analysis
Category D Pregnancy risk
Adverse effects on human fetuses based on data from investigational experience, but use of med can be warranted
