chapter 3

Question 1

blood dyscrasia

Answer 1

bone marrow depression caused by drug effects on the rapidly multiplying cells of the bone marrow; lower-than-normal levels of blood components can be seen (pt can’t fight infection so important to use PPE and put pt in isolation, monitor w/ CBC)

Question 2

dermatological reactions

Answer 2

skin reactions commonly seen as adverse effects of drugs; can range from simple rash to potentially fatal exfoliative dermatitis

Question 3

drug allergy

Answer 3

formation of antibodies to a drug or drug protein; causes an immune response when the person is reexposed to that drug

Question 4

hypersensitivity

Answer 4

excessive responsiveness to either the primary or the secondary effects of a drug; may be caused by a pathological condition or, in the absence of one, by a particular patient’s individual response (a pt who has kidney problems may accumulate the drug and cause toxic effects)

Question 5

poisoning

Answer 5

overdose of a drug that causes damage to multiple body systems and has the potential for fatal reactions

Question 6

stomatitis

Answer 6

inflammation of the mucous membranes related to drug effects; can lead to alterations in nutrition and dental problems

Question 7

superinfections

Answer 7

infections caused by the destruction of normal flora bacteria by certain drugs, which allow other bacteria to enter the body and cause infection; may occur during the course of antibiotic therapy

Question 8

Adverse effects

Answer 8

undesirable: unpleasant or dangerous (occurs due to sensitivity, taking too much or too little, the drug’s action on the body may cause other responses

Question 9

What is the most critical factor in helping the patient comply w/ drug therapy?

Answer 9

For the nurse to look for drug reactions, and teach the patient and their families what to look for. Knowing that these effects may occur and what can be done to prevent or cope with them will encourage compliance.

Question 10

Primary Actions

Answer 10

adverse effects from simple overdose. The patient suffers from effects that are an extension of the desired effect; dose may need to be adjusted to fit the patient’s needs. (the effects can be caused by individual response to the drug due to weight, age, underlying pathology

Question 11

Secondary Actions

Answer 11

The drug is effective in treating the disease, but causes other effects not related to the therapeutic effects. (ex. antihistamines help w/ breathing, but can cause drowsiness)

Question 12

What are the 4 classifications of drug allergies? What do they all involve?

Answer 12

anaphylactic, cytotoxic, serum sickness, and delayed allergic. All involve antibodies!

Question 13

What is an anaphylactic reaction?

Answer 13

This allergy causes an IMMEDIATE reaction that can lease to respiratory distress and/or arrest. An antibody reacts w/ specific sites to cause the release of chemicals to cause mucous membrane swelling and constricting of bronchi. ADMINISTER epinephrine! Patient could get hives, rash, trouble breathing, increased BP/HR, dilated pupils, sweating

Question 14

What is a cytotoxic reaction?

Answer 14

This allergy involves antibodies that circulate in the blood and attack antigens (the drug) on cell sites, causing cell to die. Reactions is over a FEW DAYS. Discontinue the drug and support patient til response ends. CBC will show decrease in hematocrit, WBC,and platelets, other tests show elevated liver enzymes, and decrease in renal function

Question 15

What is a serum sickness reaction?

Answer 15

This allergy involves antibodies that circulate in the blood and cause damage to various tissues by depositing in blood vessels. This reaction may occur up to 1 WEEK or more after exposure to the drug. Discontinue the drug and support patient til response ends w/ cooling. Could show itchy rash, high fever, swollen lymph nodes and joints, edema of face and limbs.

Question 16

What is a delayed allergic reaction?

Answer 16

Involves antibodies that are bound to specific WBC and reaction occurs SEVERAL HOURS after exposure. Discontinue the drug and support patient til response ends. Similar to poison ivy and may use antihistamines. Can show rash, hives, swollen joints.

Question 17

What are some dermatological reactions to drugs?

Answer 17

Rashes, hives and stomatitis. Antihistamines may be administered for rashes and hives, but discontinuing the drug may be necessary. Stomatitis require proper mouth care.

Question 18

Which two organs can lead to injury from toxicity?

Answer 18

LIVER and KIDNEYS. Oral drugs are absorbed and passed directly to liver, so the liver cells get the full impact of the drug before being broken down for circulation; can affect liver integrity. (fever, N&V, jaundice, urine/stool changes) The kidneys excrete the drugs, but some get plugged in the capillary network and build up. (elevated blood urea N, F&E imbalance, fatigue, edema…)

Question 19

What are the cells of the CNS dependent on to function properly?

Answer 19

constant glucose levels.

Question 20

Why do many drugs impact the glucose levels?

Answer 20

The liver is a place for glucose storage and release, and drug effects on the liver and endocrine system affect the hormones and enzymes that control the process.

Question 21

Hypoglycemia

Answer 21

low serum blood glucose concentration

some drugs affect the metabolism and use of glucose. drugs may lower the blood glucose levels too far.

Tx: Must restore glucose orally.

Question 22

Hyperglycemia

Answer 22

high serum blood glucose concentration

some drugs stimulate the breakdown of glycogen or alter metabolism.

Tx: administer insulin therapy

Question 23

Hypokalemia

Answer 23

low potassium <3.5 mEq/L

drugs affecting kidney can alter the renal exchange system; and K+ is essential for the normal functioning of nerves and muscles.

Question 24

Hyperkalemia

Answer 24

high potassium >5 mEq/L

Monitor for cardiac irregularities because potassium is an important electrolyte in the action potential, which is needed for cell membrane stability.

Question 25

How can drugs affect the sensory?

Answer 25

Ocular damage: some drugs get deposited in the blood vessels of the retina which end, and causes inflammation. Lease to blurry vision, color vision changes, corneal dmg.

Auditory damage: tiny vessels and nerves in the 8th cranial nerve are easily irritated and damaged by certain drugs.

Question 26

How can drugs have neurologic effects?

Answer 26

Medications can cross the blood brain barrier and alter a person’s level of consciousness (CNS); lead to being drowsy or dizzy. Prevent injury by having bed rails up.

Can have atropine-like (anticholinergic) effects and cause dry mouth, urinary retention and blurred vision. Patient should void before taking the medication and suck on sugarless lozenges to keep mouth moist

Parkinson-Like Syndrome (from antipsychotics)
Neuroleptic Malignant Syndrome (from anesthetics)

Question 27

Teratogenicity

Answer 27

Many drugs that reach the developing fetus or embryo can cause death or congenital defects, which can include skeletal and limb abnormalities, CNS alterations, heart defects, and the like. Before a drug is administered to a pregnant patient, the actual benefits should be weighed against the potential risks. All pregnant women should be advised not to self-medicate during the pregnancy.