Chapter 7: Adverse Drug Reactions and Medication Errors Flashcards
Adverse Drug Reactions (ADR)
Any noxious, unintended, and undesired effect that occurs at normal drug doses. Adverse reactions can range in intensity.
Patients at increased risk of adverse drug events include the very young, older adults, the very ill, and those taking multiple drugs.
Mild reactions
Drowsiness, nausea, itching, and rash.
Severe reactions
Potential fatal conditions such as neutropenia, hepatocellular injury, cardiac dysrhythmias, anaphylaxis, and hemorrhage.
Side Effect
A nearly unavoidable secondary drug effect produced at therapeutic doses.
Toxicity
The degree of detrimental physiologic effects caused by excessive drug dosing.
Allergic Reaction
Triggered immune response
Idiosyncratic Effect
An uncommon drug response resulting from a genetic predisposition.
Paradoxical Effect
Is the opposite of the intended drug response.
Iatrogenic Disease
A disease produced by drugs.
Physical Dependence
State in which the body has become used to the effect of the drug and will experience withdrawal symptoms without the drug.
Carcinogenic Effect
Drug-induced cancers.
Teratogenic Effect
Drug-induced birth defect.
Organ-Specific Toxicity
Common injury include:
Kidney - by amphotericin B (an antifungal drug)
Heart - by doxorubicin (an anticancer drug
Lungs - by amiodarone (an antidysrhythmic drug)
Inner ear - by aminoglycoside antibiotics (eg, gentamicin)
Hepatotoxic Drugs
Drugs metabolized by the liver can be converted to toxic products and injure liver cells.
Drugs are the most common cause of acute liver failure, and hepatotoxicity is the most common reason for removing drugs from the market.
QT Interval Drugs
Drugs that prolong the QT interval pose a risk of torsades de pointes, a dysrhythmia that can progress to fatal ventricular fibrillation. The QT interval is a measure of the time required for the ventricles to repolarize after each contraction.
Medication Guides (MedGuides)
FDA-approved documents created to educate patients about how to minimize harm from potentially dangerous drugs
Boxed Warnings (black box warning)
The black box warning indicates the serious adverse effects of the drug that have been reported.
Risk Evaluation and Mitigation Strategies (REMS)
A plan to minimize drug-induced harm.
Medication Error
Any preventable event that may cause or lead to inappropriate use or harm.
Ways to Reduce Medication Errors
- Replacing handwritten medication orders with a computerized order entry.
- Using bar-code systems.
- Incorporating medication reconciliation.
- Banned abbreviations, symbols, and dose designations.
5.
Medication Reconciliation
Medication reconciliation is the process of comparing a list of all medications that a patient is currently taking with a list of new medications that are about to be provided 3 Steps are: Verification Clarification Reconciliation
3 most common types of fatal medication errors
giving an overdose, giving the wrong drug, and using the wrong route.
3 most common causes of fatal medication errors
human factors
miscommunication
similarities in drug names.
atorvastatin [Lipitor]
A lipid-lowering drug, is a commonly prescribed example of a hepatotoxic drug.