Chapter 5 (Adverse Effects) Flashcards
Central Nervous System
Can result from CNS stimulation (excitement) or CNS depression.
Nursing Actions:
if stimulation is expected, clients can be at risk for seizures.
If depression is expected, advise clients not to drive, operate heavy machinery, or participate in activities that can be dangerous.
Anticholinergic
Effects that are a result of muscarinic receptor blockade. Most often seen in eyes, smooth muscle, exocrine glands, and the heart.
Client education:
- manage these effects to minimize discomfort (for example; dry mouth can be relieved by sipping on liquids.)
- avoid activities that could lead to overheating, because there is a decreased ability to produce sweat to cool the body.
Cardiovascular
Can involve blood vessels and the heart, and antihypertensives can cause orthostatic hypotension.
Client Education: monitor for indications of postural hypotension. If these occur, sit up or lie down. Postural hypotension can be minimized by getting up and changing positions slowly.
Gastrointestinal
Can result from local irritation of the GI tract, and stimulation of the vomiting center also results in adverse effects.
Client education: NSAIDS can cause GI upset. Take these medications with food.
Opioid analgesics slow peristalsis and can cause nausea and sedation. Perform methods to avoid constipation and GI irritation, and promote safety.
Hematologic
Relatively common and potentially life threatening with some groups of meds
Nursing Actions: bone marrow depression/suppression is generally associated with anticancer meds and hemorrhagic disorders with anticoagulants and thrombolytics.
Client Education: monitor for bleeding (bruising, discolored urine/stool, petechiae, bleeding gums). Notify provider if these effects occur.
Toxicity
An adverse medication effect that is considered to be severe and can be life threatening. It can be caused by an excessive dose, but it also can occur at therapeutic dose levels as well.
Nursing Actions: liver damage will occur with acetaminophen overdose. There is a greater risk of liver damage with chronic alcohol use. The antidote, acetylcysteine, can be used to minimize liver damage.
Hepatotoxicity
Can occur with many medications.
- because most medications are metabolized in the liver the liver is particularly vulnerable to drug-induced injury.
- damage to liver cells can impair metabolism of many medications, causing medication accumulation in the body causing many adverse effects.
- many medications can alter normal values of liver function tests with no obvious clinical indications of liver dysfunction.
Nursing actions:
when two or more medications that are hepatotoxic are combined, the risk for liver damage is increased.
Liver function tests are indicated when clients start a medication known to be hepatotoxic and periodically thereafter.
Monitor clients for manifestations of hepatotoxicity (nausea, vomiting, jaundice, dark urine, abdominal discomfort, and anorexia.) Advise clients to monitor for these manifestations at home as well.
Nephrotoxicity
Can occur with a number of medications, but it is primarily the result of certain antimicrobial agents and NSAIDS. Damage to the kidneys can interfere with medication excretion, leading to medication accumulation and adverse effects.
Nursing actions: aminoglycosides can injure cells in the renal tubules of the kidneys. Monitor blood creatinine and BUN as well as peak and trough medication levels for clients taking medication that is nephrotoxic. (Examples can be NSAIDS, cyclosporine, etc)
Hypersensitivity/Allergy
Occurs when an individual develops an immune response to a medication, the individual has been previously exposed to the medication and has developed antibodies.
Can result in mild reaction (itching, watery eyes, sneezing) or can result in a severe reaction resulting in anaphylaxis.
Rapid or immediate hypersensitivity
Called atopic allergy causes an overproduction of immune-globulin E antibodies, resulting in acute inflammation, histamine release, and vasoactive amines release (basophils, eosinophils, and mast cells)
Can result in hay fever, or rhino-sinusitis. Can mild but can also become severe.
Angioedema
A severe allergic reaction that affects deep tissues (blood vessels, skin, subcutaneous tissue, mucous membranes.)
Generally, angioedema involes the lips, face, oropharyngeal cavity, and neck,
NSAIDS and angiotensin-converting enzyme inhibitors (ACE inhibitors) are the most common meds to cause angioedema and can occur within 24hrs or anytime thereafter.
Nursing Actions:
- obtain a complete medical history to understand what medications the client is taking.
- intervention is to supply oxygen, alleviate anxiety with reassurance, and if needed, maintain an open airway with intubation and or tracheostomy if laryngeal edema, strider, and inability to swallow develops.
- treatment with corticosteroids, diphenhydramine, and epinephrine depending on severity of clients condition. Monitor for reoccurrence when medications wear off.
Anaphylaxis
Life threatening, immediate systemic reaction caused from an allergic response to a medication, dye, food, or insect bite or sting. Allergic asthma also has a rapid onset with similar causes.
Manifestations o anaphylaxis can start with anxiety , weakness, itching/hives that progress to erythema and angioedema of the head and neck. Crackles in the throat, hoarseness, and strider can develop into a life threatening condition that results in respiratory failure, hypoxemia, hypotension, tachycardia, and death. Allergic asthma is the production of an asthma response following exposure to an allergen.
Nursing actions:
- prevention and rapid intervention is vital a to avoid a fatal outcome. If the allergy is known the client should wear a medical alert bracelet. The client should ave available at all times injectable epinephrine.
- stop the medication immediately if that is the antigen and notify the rapid response team.
- establish an airway to maintain ventilation. Administer bronchodilators if needed.
- treat with epi IM or IV to constrict blood vessels, improve cardiac contraction, and promote broncodilation of the pulmonary system, every 5 to 5 mins as needed.
- administer diphenhydramine, to decrease manifestations of the angioedema and urticaria.
- continue oxygen
- administer corticosteroids
- monitor hemodynamics, watch for fluid overload.
Extrapyramidal symptoms (EPSs)
Abnormal body movements that can include involuntary fine motor tremors, rigidity, uncontrollable restlessness, and acute dystonia (spastic movements). Can occur within a few hours or take months to develop.
Nursing Actions:
- EPSs are more often associated with medications affecting CNS (like those to Tx mental health disorders)
- most EPSs can be treated with anticholinergic meds.
Immunosupressions
Decreased or absent immune response.
Nursing Actions:
- immunosuppressant meds (glucocorticoids) can mask the usual manifestations of infection (fever).
- monitor clients taking an immunosuppressant for delayed wound healing and subtle manifestations of infection (sore throat)
Drug-drug interactions
Increased therapeutic effect
Nursing action: some medications can be given together to potential their action and increase therapeutic effects.
Client education: if with asthma, use albuterol, 5 min prior to using a glucocorticoid inhaler to increase the absorption of triamcinolone acetone.
Increased adverse effects
Nursing actions: clients can take two meds that have same adverse effect. Taking these meds together increases the risk of potentiating these findings.
Decreased therapeutic effects
Nursing actions: one medication can increase the metabolism or block the effects of a second med and therefore decrease the blood level and effectiveness of the second medication.
Decreased side/adverse effects
Nursing actions: one medication can be given to counteract the side/adverse effects of another medication.
Ex: giving ondansetron to patients receiving chemo to help with nausea.
Increased blood levels, leading to toxicity
Nursing actions: one medication can decrease the metabolism of a second med and therefore increase the blood level of the second medication. This can lead to toxicity.
Vitamin K and Warfarin?
Vitamin K can decrease the therapeutic effects of warfarin and place clients at risk for developing blood clots. Clients taking warfarin should include a consistent amount of vitamin K in their diet.
Grapefruit and meds?
Grapefruit seems to act by inhibiting medication metabolism in the small bowel, thus increasing the amount of medication available for absorption of certain oral meds. This increases either the therapeutic effects or the adverse reactions. Instruct clients not to drink grapefruit juice if they are taking such medications.
Morphine caution?
Morphine depresses respiratory function, so it should be used with caution for clients who have asthma or impaired respiratory function.
Ex: asthma or COPD, contraindicated.
