IM1- Pharm 3 quiz Flashcards
What is an adverse drug reaction (ADR)
“Any noxious, unintended, undesired effect that occurs at normal drug doses”
What are some mild ADR effects?
- Drowsiness
- Itching
- Nausea
- Rash
What are some severe ADR effects?
- Respiratory depression
- Organ injury
- Anaphylaxis
- Death
What are some ADR Considerations?
- What increases the risk?
-Multiple illnesses
-age - What is the impact- for whom?
- How can harm be minimized
- Checking the mar
-Verify arm band - ask allergies
- Checking the mar
Define side effect
A nearly unavoidable secondary drug effect produced at therapeutic doses
Define toxicity
Any severe ADR, regardless of the dose that caused it
Define allergic reactions
Immune response, the intensity of which is determined by immune system, not dosage
Define idiosyncratic effect
Uncommon drug response resulting from genetic predisposition
Define Paradoxical effect
The opposite of the intended drug response
Define iatrogenic disease
Occurs as the result of medical care or treatment including disease produced by drugs.
Define physical dependence
Body has adapted to drug exposure in such a way that abstinence syndrome will develop if discontinued
Define carcinogenic effect
The ability of certain medications and chemicals to cause cancers
Define teratogenic effect
Drug-induced birth defect
What are some characteristics of hepatotoxic drugs. list 5
- Liver is the primary site of metabolism
- Drugs are leading cause of liver failure
- Over 50 commonly given drugs are hepatoxic
- Some drug metabolites are hepatoxic
- Combining hepatoxic drugs increases risk of liver injury.
What are characteristics of QT drugs?
- QT drugs - prolong QT interval
- Can cause life-threatening dysrhythmias
- QT drugs found in several drug classes
- Females at higher risk
- Multiple QT drugs should not be given concurrently
True or false: Some medications are not appropriate for patients with prolonged QT interval
True
How are kidneys affected by ADR
- Because kidneys filter metabolites out of body cumulative exposure can cause damage
How are the ears affected by ADR?
- Ototoxic reactions can cause permeant damage
How are the lungs affected by ADR?
- Can be pneumotoxic
over 600 drugs are pneumotoxic
What are some questions you should ask when trying to determine if your patient is having an ADR?
- Did symptoms appear shortly after the drug was first used?
- Did symptoms abate when the drug was discontinued
- Did the symptoms reappear when the drug was reinstituted
- Is the illness itself sufficient to explain to explain the event
- Are other drugs in the regimen sufficient to explain the event.
What are some ways to minimize ADRs?
- Early identification is key
- Know major ADR’s that a drug can produce
- Monitoring of organ function if toxic drugs are being given
- Individualizing therapy
- Patient teaching
What are black box warnings?
- Strongest safety warning a drug can carry and still remain on the market
What does the black box warning contain?
Concise summary of the adverse effects of concern
True or false: The most serious medication warning required by the FDA is the black box warning?
True
What are some considerations when faced with a BBW? (black box warning)
- Does the potential benefit of treatment outweigh the risk?
- Are there safer (and equally effective) alternatives?
- Would a safer but less effective alternative be appropriate?
- Is the boxed warning applicable to this specific patient?
- Can action be taken to ameliorate the potential for an adverse reaction?
Define a medication error?
Any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer
True or false: A medication error can cause both direct and indirect harm?
True
What are causes of medication errors?
- Human factors
- Communication mistakes = 90% of fatal errors
- Name confusion
4 Packaging, formulations and delivery services - Labeling and reference materials
True or false: If the same dose of a drug is given to a big person and a small person, the drug concentration will be lower in the small person?
False- the drug concentration would be higher
What are some factors affecting individual response to a drug?
- Body composition
- Age
-Infants– immature organ system- Older adults – decline in organ function
- Pathophysiology
- Tolerance
- Comorbidities and drug interactions
- Diet
- Patient compliance
- Medication Errors
How does kidney disease affect an individual response to a medication?
Reduces the rate of drug excretion- drugs may accumulate to toxic levels
How does liver disease affect an individual response to a medication?
Reduces rate of drug metabolism- drug may accumulate to toxic levels
How does tolerance affect an individual’s response to a drug?
it decreases responsiveness to a drug as a result of repeated drug administration
How does comorbidities and drug interactions play a factor in an individual’s response to a drug?
- Drugs taken to manage one condition may complicate management of another
How does a diet play a factor in an individual response to a drug?
Good diet can elicit therapeutic responses and reduce harm from ADR’s
Some foods can interact with drugs and cause ADR’s
How does patient compliance play a factor in an individual’s response to a drug?
- Failure to take
What are some reason a patient may not be able to comply with taking medication?
- Manual dexterity and visual acuity
- Intellectual capacity & Psychologic state
- Attitude and belief toward drugs
- Ability to pay
What are some geriatric concerns with drug therapy?
- Organ function
- Comorbidities
- Polypharmacy
- Noncompliance
In the elderly the ability to to absorb drugs……?
- Rate of absorption slows
- Gastric acidity declines
In elderly the ability of distribution is affected by many factors including…..
- Increased body fat % —> plasma drug levels reduced
- Decreased % lean body mass—> plasma drug levels increased
- Decreased total body water—> plasma drug levels increased
- Decreased serum albumin concentration —> plasma drug levels increased
In Elderly metabolism tends to _____ with age
decline (highly variable)
In elderly excretion begins to decline progressively in _____ adulthood (wait… what?? not sure what I was asking here sorry)
Early
What is the most important cause of ADR’s in older adults?
Excretion
True or false: ADR’s are 7 times more common in older adults?
True
ADR”s in the elderly population account for what percentage of hospital admissions?
16 %
ADR’s in the elderly population account for what percentage of all medication-related deaths?
50%
True or false: ADR’s are mostly dose related in elderly?
True
True or false: ADR’s in the elderly are unavoidable?
False– Mostly avoidable
True or false: older adults are less likely to share alcohol or recreation drug use?
True
True or false: Symptoms of ADR’s in the elderly tend to be nonspecific?
True
What are important risk factors for ADR’s in the elderly?
- Reduced renal function- drug accumulation
- Polypharmacy
- Greater severity of illness
- Low therapeutic index drugs
- Increased individual variation
- Inadequate supervision of long-term therapy
- Poor adherence
What is the goal of drug thearpy?
Reduce symptoms and improve quality of life
What should the nurse plan look like for drug therapy/preventing ADR’s?
- Assessment– drug history, compliance
- Monitoring– clinical responses & Plasma drug levels
- Teaching– How to take meds, strategies for compliance
- Advocating– simplest regimen possible, easy to open containers, large print, cost
