Drug effects, Adverse Reactions, Principles of Drug Administration and Medication Incidents Chapter 8, 9, and 10 Flashcards
- Differentiate between adverse effects and side effects.
- Adverse drug effect: an undesirable and potentially harmful action caused by the administration of medication.
- Side effect: Types of drug effects that are less serious than adverse effects, are predictable, and may occur even at therapeutic doses.
- Create a plan to minimize or prevent adverse drug events in clients.
- Obtain a thorough medical history
- Thoroughly assess the client and all diagnostic data
- Prevent Medication errors
- Monitor pharamacotherapy carefully
- Know the drug
- Be prepared for the unusual
- Question unusal orders
- Teach clients about adverse effects
- Explain why certain drugs with carcinogenic or teratogenic potential are used in pharmacotherapy
If a client has a condition that is likely to cause premature death if left untreated, the benefits of taking a drug with carcinogenic potential may outweigh the long-term risks. This assumes, of course, that effective, safer alternatives are not available.
- Teratogenic: drug or other agent that causes developmental birth defects
What they do: Can cause birth defects if taken during pregnancy.
Why they’re used: Treat severe conditions (e.g., severe acne or autoimmune diseases) when safer options aren’t available. Pregnancy is avoided or carefully managed.
- Carcinogenic Drugs:
What they do: Can cause cancer with long-term use.
Why they’re used: Treat life-threatening conditions (e.g., chemotherapy for cancer) where the benefit of saving lives outweighs the risk of future cancer.
Carcinogenic Drugs
Only used when benefits outweigh risks
Damage DNA, leading to mutations that affect gene expression
Effects may not be seen for years
Responses to carcinogens vary from individual to individual
Drugs known for producing cancer risk
- Antineoplastics
- Immunosuppressants
- Hormone and hormone antagonists
Teratogenic Drugs
Drugs that promote birth defects during pregnancy
Concern with use of teratogens is limited to pregnancy but drugs may have benefits for other populations
- Only used during pregnancy when benefit clearly outweighs the
risk to the fetus
- Report the characteristic signs, symptoms, and treatment for each of the following organ-specific adverse events: nephrotoxicity, neurotoxicity, hepatotoxicity, dermatologic toxicity, bone marrow toxicity, cardiotoxicity, and skeletal muscle toxicity.
Nephrotoxicity
- Sign & Symptoms: Majority of drugs excreted in kidneys
Occurs when renal tubules exposed to high drug concentrations
Can occur over short-term and over long-term use by client
Recognize and manage signs of risk in client - Treatment: providing proper hydra-tion, monitoring urinary laboratory values, and adjusting doses appropriately for clients with renal impairment.
neurotoxicity
- Sign & Symptoms: CNS Effects:
Depression, mania, or sedation.
Behavioral changes, suicidal thoughts, hallucinations, or seizures.
Sensory Effects:
Visual changes, hearing loss (ototoxicity), or loss of balance.
- Treatment:
Client Education:
Warn clients not to drive or perform hazardous tasks until they know how the drug affects them.
Teach caregivers to watch for behavioral changes.
Monitoring:
Report serious symptoms (e.g., seizures, delirium, suicidal thoughts, hearing/vision loss) to the prescriber immediately.
Caution:
Neurotoxic drugs can worsen preexisting mental health conditions.
hepatotoxicity
- Sign & Symptoms: Signs and Symptoms:
Early Signs:
Mild, nonspecific symptoms: Right upper quadrant pain, loss of appetite, bloating, fatigue, nausea, or vomiting.
Chronic Signs:
Jaundice (yellow skin/eyes), itching, and easy bruising.
Severe Cases:
Liver failure: Inability to metabolize drugs, leading to high drug levels in the blood.
- Treatment:
Treatment and Management:
Monitoring:
Regularly check liver enzyme tests (e.g., ALT, AST) to detect early toxicity.
Client Care:
Watch for symptoms like jaundice, fatigue, or nausea and report them promptly.
Caution:
Use extreme care when giving hepatotoxic drugs to clients with preexisting liver disease.
dermatologic toxicity
- Sign & Symptoms: Common Reactions:
Rash: Often appears within 1-2 weeks of starting the drug, may itch (pruritus).
Urticaria (hives): Raised, itchy welts; may indicate an allergic reaction.
Serious Reactions:
Angioedema: Swelling around the eyes, mouth, or throat; can impair breathing and be life-threatening.
Phototoxicity: Skin becomes overly sensitive to sunlight, causing sunburn-like symptoms.
- Treatment:
Mild Reactions:
Rash or itching: May resolve on its own; antihistamines or corticosteroids can help.
Serious Reactions:
Stop the drug: Discontinue immediately if angioedema or severe rash occurs.
Monitor breathing: Angioedema can be life-threatening; seek emergency care if swelling affects breathing.
Prevent phototoxicity: Advise clients to avoid sunlight or UV exposure.
bone marrow toxicity
- Sign & Symptoms:
Signs and Symptoms:
Low Blood Cell Counts:
Red blood cells (RBCs): Anemia (fatigue, weakness, pale skin).
White blood cells (WBCs): Neutropenia or agranulocytosis (increased risk of infections).
Platelets: Thrombocytopenia (easy bruising, bleeding).
Severe Cases:
Pancytopenia or aplastic anemia: All three cell types are low, leading to severe illness.
- Treatment:
Monitoring:
Regularly check blood counts (RBCs, WBCs, platelets) to detect early signs of toxicity.
Stop the Drug:
Discontinue the drug if bone marrow toxicity is suspected.
Prevention:
Be cautious with clients who have preexisting blood disorders.
Watch for symptoms like fatigue, infections, or unusual bleeding.
Reversal:
Toxicity is often reversible if caught early and the drug is stopped.
cardiotoxicity
- Sign & Symptoms:
Heart Muscle Damage:
Fatigue, cough, shortness of breath (especially when lying down), weight gain, or swelling in the legs (peripheral edema).
Severe cases: Bradycardia, tachycardia, heart failure, or acute left ventricular failure.
QT Prolongation:
Can lead to a dangerous arrhythmia called torsade de pointes, which may cause sudden cardiac death.
- Treatment:
Monitoring:
Watch for symptoms like fatigue, shortness of breath, or swelling.
Regularly check ECGs for QT prolongation in clients on high-risk drugs.
Stop the Drug:
Discontinue the drug if signs of cardiotoxicity or QT prolongation occur.
Prevention:
Be cautious with clients at risk for heart problems.
Follow FDA guidelines for drugs that may cause QT prolongation.
skeletal muscle toxicity
- Sign & Symptoms:
Skeletal Muscle Toxicity:
Muscle pain, weakness, or soreness.
Rhabdomyolysis: Severe muscle breakdown, leading to dark urine, muscle pain, and weakness (rare but serious).
Tendon Toxicity:
Tendon pain, swelling, or rupture (especially the Achilles tendon).
Most common in older adults (over 65) and with fluoroquinolone antibiotics.
- Treatment:
Monitoring:
Watch for muscle or joint pain, weakness, or swelling.
Check creatine kinase (CK) levels to detect muscle damage.
Stop the Drug:
Discontinue the drug if muscle or tendon toxicity is suspected.
Prevention:
Avoid fluoroquinolones in children under 18 (risk of cartilage damage).
Be cautious with statins and fluoroquinolones in older adults.
Identify examples of food-drug interactions that may affect pharmacotherapeutic outcomes.
Most of the food-drug interactions discovered thus
far act by either increasing or decreasing the absorption or bioavailability of the drug. Food-drug interactions are easily avoided by timing the drug dose appropriately with the food or supplement.
- Grapefruit juice may not be safe for people who take certain medications.
Examples:
- antiplatelet and anticoagulant drugs: antiplatelet and anticoagulant drugs
- antiplatelet and anticoagulant drugs: antiplatelet and anticoagulant drugs
- antiplatelet and anticoagulant drugs: antiplatelet and anticoagulant drugs
- antiplatelet and anticoagulant drugs: antiplatelet and anticoagulant drugs
- antiplatelet and anticoagulant drugs: antiplatelet and anticoagulant drugs
- Describe the roles and responsibilities of the nurse regarding drug administration.
The nurse must have comprehensive knowledge of the actions and side effects of drugs before they are administered to limit the number and severity of adverse drug reactions.
The nurse’s responsibilities include knowledge and understanding of the following:
- What drug is ordered?
- Drug name (generic and trade) and classification
- Intended or proposed use
- Effects on the body
- Contraindications
- Special considerations (i.e., how age, gender, weight, body fat distribution, diet, genetics, and individual patho-physiological states affect pharmacokinetics, pharmaco-dynamics, and overall pharmacotherapeutic response)
- Side effects
- Why the medication has been prescribed for this par-ticular client
- How the medication is supplied by the pharmacy * How the medication is to be administered, including dosage ranges
- What nursing process considerations related to the medication apply to this client?
- Explain how the 10 rights of drug administration affect client safety.
three checks of drug administration in conjunction with the 10 rights of drug administration, these ascertain client safety and drug effectiveness
- Right drug
- Right client
- Right dose
- Right route of administration
- Right time of delivery and frequency
- Right documentation
- Right history and assessment
- Drug approach and right to refuse
- Right drug-drug interaction and evaluation
- Right education and information
- Give specific examples of how the nurse can ensure client adherence in taking medications.
Adherence is taking a medication in the manner prescribed by the practitioner or, in the case of over-the-counter drugs, following the instructions on the label. Client nonadherence ranges from not taking the medication at all to taking it at the wrong time or in the wrong manner.
- Interpret drug orders that contain abbreviations.
ac
AM
bid
cap
gtt
h or hr
IM
IV
PO
PM
prn
qid
q2h
q4h
q6h
q8h
q12h
STAT
tab
tid
- Explain the proper methods to administer enteral, topical, and parenteral drugs.
- Enteral Route: The enteral route of drug administration involves drugs taken orally or via nasogastric/gastrostomy tubes. It is the most common, convenient, cost-effective, and safest method, as it avoids compromising the skin barrier and allows retrieval of medications in case of overdose. Oral drugs come in tablet, capsule, or liquid forms and are absorbed through the oral mucosa, stomach, or small intestine.
- Topical: Topical drugs are applied locally to the skin or the mem-branous linings of the eye, ear, nose, respiratory tract, uri-nary tract, vagina, and rectum. These applications include the following: * Dermatological preparations: Drugs are applied to the skin; this is the topical route most commonly used. Formulations include creams, lotions, gels, powders, and sprays.
- Instillations and irrigations: Drugs are applied into body cavities or orifices. These include the eyes, ears, nose, urinary bladder, rectum, and vagina.
- Inhalations: Drugs are applied to the respiratory tract by inhalers, nebulizers, or positive pressure breath-ing apparatuses. The most common indication for inhaled drugs is bronchoconstriction due to bronchi-tis or asthma; however, a number of recreational or “illicit” drugs are taken by this route because it pro-vides a very rapid onset of drug action.
- Parenteral drugs: delivers drugs via a needle into the skin layers, subcutaneous tissue, muscles, or veins. More advanced parenteral delivery includes administration into arteries, body cavities (such as intrathecal), and organs (such as intracardiac). Parenteral drug administration is much more invasive than topical or enteral administration. Because of the potential for introducing pathogenic microbes directly into the blood or body tissues, aseptic techniques must be strictly applied.
Enteral Route Advantages and disadvantages
- Enteral Route (Oral, Nasogastric, Gastrostomy)
Advantages:
Convenient and easy to administer.
Cost-effective compared to other routes.
Non-invasive (does not break the skin barrier).
Safe, as medications can often be retrieved in case of overdose or error.
Utilizes the body’s natural absorption processes (oral mucosa, stomach, small intestine).
Wide variety of formulations (tablets, capsules, liquids).
Disadvantages:
Slower onset of action compared to parenteral routes.
Absorption variability due to factors like food, gastrointestinal motility, or pH.
Not suitable for unconscious or vomiting patients.
Some drugs may be destroyed by stomach acid or liver metabolism (first-pass effect).
Patient compliance can be an issue (e.g., difficulty swallowing, taste).
Topical Route (Skin, Mucous Membranes) advantages and disadvantages
Advantages:
Localized effect, ideal for treating skin conditions or localized pain.
Minimal systemic side effects (if absorbed in small amounts).
Non-invasive and easy to apply.
Useful for patients who cannot take medications orally or parenterally.
Disadvantages:
Limited absorption for systemic effects.
May cause skin irritation or allergic reactions.
Not suitable for large or deep tissue infections.
Messy or inconvenient for some formulations (e.g., creams, ointments).
Variable absorption rates depending on skin condition and thickness.
Parenteral Route (IV, IM, Subcutaneous) advantages and disadvantages
Advantages:
Rapid onset of action, especially with intravenous (IV) administration.
Predictable and complete absorption (avoids first-pass metabolism).
Suitable for unconscious, vomiting, or critically ill patients.
Allows precise dosing and control (e.g., IV infusions).
Can administer drugs that are irritating or ineffective via other routes.
Disadvantages:
Invasive and requires trained personnel for administration.
Higher risk of infection (e.g., sepsis, abscesses).
Pain or discomfort at the injection site.
More expensive due to equipment and sterilization requirements.
Irreversible once administered (cannot retrieve medication in case of error).
Potential for complications (e.g., embolism, tissue damage).
- Explain the importance of documentation in the administration of medications.
Nurses are legally and ethically responsible for reporting medication errors—whether or not they cause harm to a client—to the physician, and for documenting them in the client’s medical record and the incident report.
Medication errors affect client morbidity, mortality, and length of hospital stay. Nurses must be vigilant to prevent errors and protect clients.
- Identify the process in reporting and managing medication incidents.
- DOCUMENTING IN THE CLIENT’S MEDICAL RECORD. Agency policies and procedures provide guidance on reporting medication incidents. Documentation of the incident should occur in a factual manner
- COMPLETING A WRITTEN INCIDENT REPORT. In addition to documenting in the client’s medical record, the nurse who made or discovered the incident should complete a written incident report.
- REPORTING AT THE NATIONAL LEVEL. Health Can-ada requests that nurses and other healthcare providers report medication incidents in order to build an up-to-date database that can be used to develop national strate-gies to improve medication safety.
