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P&T Intro to Pharmaceutical Care > Exam #02a > Flashcards

Exam #02a Flashcards

1
Q

Name the 5 criteria the ASHP use to define an adverse drug reaction (ADR)?

A
  1. causes hospital admission
  2. prolongs hospitalization
  3. leads to drug discontinuation/dose modification
  4. complicates a disease state
  5. patient needs supportive therapy (ex. patient must be moved to ICU)
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2
Q

What % of hospitalized patients incur a serious ADR?

A

7%

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3
Q

What % of hospital admissions are due to an ADR? Which population of patients may be hospitalized due to an ADR more than any other population? What %?

A

3 - 6%
elderly
up to 20%

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4
Q

What % of ADR are considered preventable?

A

50%

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5
Q

True or False - ADR is a category of an adverse drug event (ADE)?

A

True

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6
Q

This term is defined as an injury resulting from administration of a drug?

A

ADE

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7
Q

Name the 5 types of ADE?

A
  1. ADRs
  2. Medication errors
  3. Adverse drug withdrawal events (taking patient off benzodiazepine too quickly)
  4. Therapeutic failures & non-compliance (taking Levoquin with iron - iron decreases Levoquin absorption by up to 90%
  5. Intentional/accidental poisonings
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8
Q

Are preventable ADRs medication errors?

A

YES!!

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9
Q

List 7 actions by a pharmacist that, if done, would be considered a preventable ADR?

A
  1. Giving an inappropriate drug for a patient’s condition or contraindicated drug
  2. giving a patient an inappropriate dose
  3. giving a patient a drug with known drug interactions to patient’s other meds
  4. incomplete monitoring
  5. patient has history of allergy or previous ADR and patient still receives the drug
  6. a toxic blood level/abnormal lab documented
  7. Poor patient compliance
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10
Q

What are the two types of ADRs?

A

Type A

Type B

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11
Q

Which ADR is related to the pharmacologic activity of the drug?

A

Type A ADR

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12
Q

Which ADR is predictable, usually preventable, and represents 70-80% of ADRs?

A

Type A ADR

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13
Q

Which ADR is related to allergic, immunologic reactions?

A

Type B ADR

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14
Q

Which ADR is unpredictable, often not preventable, and represents 20% of ADRs?

A

Type B ADR

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15
Q

True or False - both Type A and Type B ADRs can be life threatening?

A

True

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16
Q

True or False - drug allergies have no correlation with pharmacologic properties of the drug?

A

True

17
Q

True or False - drug allergies are dose related?

A

False - they are not!

18
Q

Name 6 signs/symptoms of a drug allergy?

A
  1. rash
  2. hives
  3. angioedema
  4. fever
  5. serum sickness
  6. anaphylactic shock
19
Q

According to the Gell and Coombs classification of allergic reactions, what are Types I - IV?

A

I - anaphylactic (IgE)
II - Cytotoxic (Ab dependent prim. IgG, then IgM - ex blood binds to cell membrane causing immune response at that cell)
III - Immune complex (Prim. IgM, then IgG b/c IgM has multiple binding sites)
IV - Cell mediated (antigen binds to sensitized T lymphocyte, contact dermatitis)

20
Q

For each mediator describe its effect during anaphylactic reaction:

  1. leukotrienes
  2. histamine
  3. prostaglandin
  4. bradykinin
  5. platelet activating factor
A
  1. leukotrienes - bronchoconstriction
  2. histamine - itching
  3. prostaglandin - vasodilator
  4. bradykinin - vasodilator
  5. platelet activating factor - vasodilator and bronchoconstriction
21
Q

True or False - a Type I allergic reaction requires an initial sensitization?

A

True

22
Q

True or False - pseudoallergy can occur with 1st exposure to drug?

A

True - does not need sensitization

23
Q

Why is it called a pseudoallergy?

A

It looks like an allergic reaction, but the immune system is not involved

24
Q

What does the degree of pseudoallergy seen depend on (2 things)

A
  1. dose dependent

2. ROA dependent

25
Q

True or False - a pseudo allergy is sometimes related to incipient and not the drug itself?

A

True

Ex. emulsifiers used to deliver lipid soluble drugs

26
Q

Name 3 properties of drugs that can cause a pseudoallegy?

A
  1. large molecular structure (most drugs are small and can’t elicit an allergy themselves)
  2. protein based drug
  3. hyperosmolar drug
27
Q

What type of allergy would angioedema from an ACE inhibitor be considered?

A

pseudoallergy - the immune system is not involved

28
Q

What protein in latex are some people allergic to? What does this have some cross sensitivity with?

A

HEVb protein

fruits (bananas, mango, papaya, guava)

29
Q

What races are prone to hemolytic anemia due to G6PD deficiency?

A
  1. Mediterranean
  2. African
  3. Asian
30
Q

Which race is a fast acetylator? Which is a slow acetylator?

A

fast - East Asian

slow - Mediterranean

31
Q

FDA announced that manufacturers of which drug has to be labeled that before patient starts therapy on this drug, patients with Asian ancestry get a genetic blood test to identify a significantly increased risk of developing Stevens Johnson syndrome?

A

Carbamazepine (anticonvulsant used in epilepsy and bipolar disorder)

32
Q

What population are most prone to ADRs?

A

elderly

33
Q

Which pregnancy category represents a drug that is absolutely contraindicated and known to cause birth defects?

A

Category X

34
Q

Which pregnancy category represents a drug that is proven to be teratogenic in humans, but the benefit of therapy might outweigh the risk to the child developing birth defects?

A

Category D

35
Q

Would Valproic acid for epilepsy be considered Category X or D?

A

category D b/c the seizures may be more damaging to the child than the drug

P&T Intro to Pharmaceutical Care (3 decks)

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