Chapter 7: Adverse Drug Reactions and Medication Errors Flashcards
Adverse Drug Reactions (ADR)
An ADR, as defined by the World Health Organization, is any noxious, unintended, and undesired effect that occurs at normal drug doses.
Side Effect:
A side effect is formally defined as a nearly unavoidable secondary drug effect produced at therapeutic doses.
Side Effect intensity is dependent on what
Side effects are generally predictable, and their intensity is dose dependent.
Toxicity: formal definition
The formal definition of toxicity is the degree of detrimental physiologic effects caused by excessive drug dosing.
Toxicity everyday definition
in everyday language the term toxicity has come to mean any severe ADR, regardless of the dose that caused it.
Allergic Reaction:
An allergic reaction is an immune response
Intensity of allergic reaction and dosage size:
the intensity of allergic reactions is largely independent of dosage.
Idiosyncratic Effect:
An idiosyncratic effect is defined as an uncommon drug response resulting from a genetic predisposition.
Paradoxical Effect:
A paradoxical effect is when an effect is the opposite of the intended drug response.
Example of Paradoxal effect:
A common example is the insomnia and excitement that may occur when some children and older adults are given benzodiazepines for sedation.
Iatrogenic Disease:
An iatrogenic disease is a disease that occurs as the result of medical care or treatment.
Physical Dependence:
Physical dependence is a state in which the body has adapted to drug exposure in such a way that an abstinence syndrome will result if drug use is discontinued.
Carcinogenic Effect:
The term carcinogenic effect refers to the ability of certain medications and environmental chemicals to cause cancers.
Teratogenic Effect:
A teratogenic effect is a drug-induced birth defect.
Teratogens
Medicines and other chemicals capable of causing birth defects are called teratogens.
Important sites of drug toxicity:
- Liver
- Kidney
- Bone Marrow
For drugs that are toxic to the liver, the patient should be monitored
the patient should be monitored for signs and symptoms of liver damage (jaundice, dark urine, light-colored stools, nausea, vomiting, malaise, abdominal discomfort, loss of appetite),
For drugs that are toxic to the kidneys, what is needed for the patient?
For drugs that are toxic to the kidneys, the patient should undergo routine urinalysis and measurement of serum creatinine or creatinine clearance levels.
For drugs that are toxic to bone marrow, what is needed for patient?
For drugs that are toxic to bone marrow, periodic complete blood cell counts are required.
Among fatal medication errors involving drug administration, the most common types are:
Among fatal medication errors involving drug administration, the most common types are giving an overdose (36.4%), giving the wrong drug (16.2%), and using the wrong route (9.5%).
Among fatal medication errors, the Institute of Medicine (IOM) identifies three categories that account for 90% of all errors.
- human factors,
- communication mistakes, and
- name confusion
