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Pharm 313 > Medication Error and Drug Reactions > Flashcards

Medication Error and Drug Reactions Flashcards

1
Q

Additive drug drug interaction

A

1+1 = 2, two drugs taken and get same response as if taken by themselves

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2
Q

Potentiate drug drug interaction

A

a+b=B, increase the effect of 1 of the drugs (alcohol + cns drug= incapacitated)

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3
Q

Synergism drug drug interaction

A

1+1=5, response is greater then the normal of effect of the 2 drugs when taken together (tylenol +codeine)

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4
Q

Antagonism drug drug interaction

A

1+1 = 0, blocks the action of other drugs (morphine + naloxone)

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5
Q

Idiosyncratic drug drug interaction

A

1+1 = 437 or -5 or 65, uncommon response from genetic predisposition
-response is anything but what we expected

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6
Q

Inhibitory drug drug interaction

A

1+1= 0.5, 2 drugs taken together, action of 1 drug is decreased (phenylbarbitol + oral contraceptive)

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7
Q

Pharmacokinetic Interactions affecting absorption

A
  • pH (acidic drugs absorb better in acidic enviro)
  • increase or decrease peristalsis (laxative ^, opioid v)
  • absorbent drugs- (cholestramine, metamucil)
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8
Q

Pharmacokinetic Interactions affecting distribution

A

-protein binding (warfarin, thyroxine, heparin)

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9
Q

Pharmacokinetic Interactions affecting metabolism

A

-CYP450

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10
Q

Pharmacokinetic Interactions affecting excretion

A
  • alter the filtration, reabsorption or active secretion of drugs (cardiovascular system impact on excretion due to volume)
  • p-glycoprotein (pumps drugs out of cells)
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11
Q

What route of medication gives most interactions?

A

IV

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12
Q

Where do interations between drugs occur

A
  • same site

- different sites

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13
Q

What do we call the original drug of concern?

A

Substrate

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14
Q

What do we call the other drug/substance that inhibits metabolism of substrate? How does it work?

A

Inhibitor

- v metabolism > ^ drug available > toxicity

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15
Q

What do we call the other drug/substance that increases the metabolism of substrate How does it work?

A

Inducer

- ^ metabolism > v drug available > sub therapeutic response

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16
Q

Top 3 drugs causing ER visit for drug/drug interaction

A

digoxin, coumadin, insulin

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17
Q

3 general drug/food interaction scenarios

A
  1. v rate of absorption
  2. ^ rate of absorption
  3. GI Distress
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18
Q

What happens if food decreases the rate of absorption?

A

delay onset of drug

delay extent of absorption –> v intensity of peak effect

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19
Q

Mao Inhibitors can’t be taken with what kind of food? examples of these foods?

A

Tyramine rich

-chocolate, avo, beer, aged cheese, pepperoni, salmi, hot dog, fava bean

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20
Q

What happens if you take MAO inhibitors with Tyramine rich food?

A

Hypertensive crisis

21
Q

Grapefruit/juice effects what metabolic pathway?

A

CYP450

22
Q

What kinds of drugs can’t be taken with grapefruit juice?

A
  • calcium channel blocker (HTN)
  • statin drugs (cholesterol)
  • transplant drugs
  • SSRI
  • versed (anesthesia)
23
Q

What defines an empty stomach?

A

1 hr before meal or 2 hr after meal

24
Q

What do you do if patient is continuous tube feed and needs med on empty stomach?

A

stop tube feed, give med after 2 hours, restart

25
Q

Any noxious, unintended, undesired effect that occurs at normal drug doses

A

ADR- adverse drug reaction

26
Q

Nealy unavoidable secondary drug effect produced at therapeutic doses

A

side effect

27
Q

Who is at highest risk for ADR?

A

older adults- polypharmacy

28
Q

What is definition of toxicity?

A

excessive dosing

29
Q

What population is more sensitive to CNS drugs?

A

Asian

30
Q

What is leading cause of acute liver failure?

A

drugs , >50 can cause it

31
Q

What tests monitor liver fxn? Sxs?

A

AST, ALT

-monitor s/s of hepatitis (jaundice, anorexia, RUQ, pain, fatigue, N/V, light colored stool)

32
Q

What tests monitor kidney fxn?

A

BUN, Creatinine, GFR, creatinine clearance (24 hr urine sample +blood)

33
Q

What do you use to monitor bone marrow fxn?

A

CBC (complete blood count)

34
Q

What toxic drug interaction can occur with heart?

A
  • drugs that increase QT interval increase risk of dysrhythmia
  • can lead to Torsades de Point
  • > 100 drugs can cause
35
Q

What percent of ADR are allergic reactions?

A

<10%

36
Q

When do you have an allergic reaction (which exposure)?

A

on 2nd exposure

37
Q

Intensity of drug reaction is _____ of dose causing it

A

independent

*trigger is independent of dose

38
Q

3 Key drugs that cause allergic reaction

A
  • penicillin
  • NSAIDS
  • sulfa (sulfanamides, sulfanylureas)
39
Q

Difference between a mild and a severe allergic reaction

A

mild: itching, rash
severe: bronchospasm, decrease BP, laryngeal edema, life threatening

40
Q

What is the paradoxical effect?

A

response is opposite of intended response

ex: benedryl making kids hyperactive instead of sleepy

41
Q

What isIatrogenic Disease ? What do you do to treat it?

A

a drug that gives patients sxs of a disease they don’t have

-stop drug and sxs go away

42
Q

Physical vs psychological dependence

A

physical: sxs or withdrawal that go away when you ween off
psychological: do whatever is in your power to get substance

43
Q

Teratogenic effect

A

-drugs causing fetal malformation/defects

44
Q

Nurses role in ADR management/prevention

A
  1. anticipate ADR
  2. patient teaching
  3. medication guides
  4. increase awareness for pt with choric disorders
  5. black box warnings
  6. med watch
45
Q

____ drugs cause _____% of medication errors

A

20, 80%

46
Q

1999 IOM report shows 3 main causes for medication error

A
  1. human error
  2. communication mistakes
  3. name confusion
47
Q

1 cause of human error is

A

performance deficit (30%)

48
Q

Window for drug administration

A

30 min before - 30 min after due

49
Q

Other factors to help prevent med error

A
  • TALLman lettering
  • SALAD drugs
  • medication zone/sash
  • computer order entry
  • bar code administration
  • read back verbal orders
  • do not crush list
  • medication reconcilliation

Pharm 313 (26 decks)

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