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Nursing Pharmacology > Module 10 > Flashcards

Module 10 Flashcards

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1
Q

Unintended and undesired responses from drugs

A

Adverse drug reactions - ADRs

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2
Q

Canadian research suggests that ___% of hospital admissions in Canada are attributed to ADRs

A

7.5%

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3
Q

ADRs include these 7 types.

A 
Side effects
Drug toxicity
Allergic reactions
Idiosyncratic reactions
Carcinogenic effects
Mutagenic effects
Teratogenic effects
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4
Q

Secondary to the main therapeutic effect of the drug, and are expected.

A

Side effects

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5
Q

Side effects of a drug are often due to this.

A

Poor specificity or selectivity of a drug

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6
Q

What are side effects of antihistamines? How do they come about?

A

Sides include drowsiness, dry mouth and urinary retention - sides occur when histamines bind to receptors in the brain

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7
Q

Considered any severe adverse drug event

A

Drug toxicity

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8
Q

Drug toxicity is often mediated by this.

A

Overdose

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9
Q

Drug toxicity reactions are often extensions of the _________ effect.

A

therapeutic

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10
Q

Allergy requires prior ___________.

A

Sensitization - patient exposed to the allergen

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11
Q

What cells release histamine in allergies?

A

Mast cells

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12
Q

Allergic reactions can vary from ______ and ______, to life threatening ________.

A

itching, rash

anaphylaxis

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13
Q

What are the symptoms of anaphylaxis?

A

hypotension, bronchospasm, edema

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14
Q

the intensity of allergic reactions are __________ of dosage size.

A

independent - therefore small doses can produce severe allergy

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15
Q

What percentage of ADRs are due to allergy?

A

10%

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16
Q 
What is the most common drug class to cause drug allergy?
What are some others?
A

Penicillins

Sulfonamides and NSAIDs also cause allergy

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17
Q

Reactions that occur rarely and unpredictably in the population

A

idiosyncratic reactions

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18
Q

What accounts for the majority of idiosyncratic reactions?

A

Genetic polymorphisms

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19
Q

Warfarin is metabolized by what enzyme?

A

CYP2C9

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20
Q

6-mercaptopurine is metabolized by what enzyme?

A

TMPT - thiopurine methyltransferase

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21
Q

Describe the CYP2C9 genetic polymorphism

A

Approx 15% of caucasians have a polymorphism that decreases metabolism (of warfarin).

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22
Q

Describe the CYP2D6 genetic polymorphism.

A

10% of Caucasians and African Americans are poor metabolizers - these patients do not experience pain relief when they take codeine (converted to morphine)

23
Q

Describe the genetic polymorphism of thiourine methyltransferase.

A

Approximately 10% of patients have decreased activity, and 0.3% have none. - treatment with thiopurine drugs in these patients may result in life threatening bone marrow suppression

24
Q

Describe the genetic polymorphism in OATP1B1.

A

OATP1B1 is an uptrake transporter in the liver
15% of Caucasian and Asian patients have a polymorphism decreasing function
has been implicated in myopathy in patients taking statin drugs

25
Q

Describe the effect of G6PDH deficiency.

A

Important in RBC metabolism - may have RBChemolysis following analgesic or anti-malarial treatment in certain people of African or Middle-Eastern descent

26
Q

Why is it difficult to determine whether a drug is carcinogenic or not?

A

Takes years after the initial dose to appear

27
Q

Describe a drug that was pulled of the shelves for being carcinogenic.

A

Diethylstibestrol (DES) - used to be prescribed to prevent spontaneous abortions in high-risk pregnancies - female offspring often developed vaginal or uterine cancer

28
Q

Often drugs that are mutagenic are also carcinogenic or teratogenic. When would they be approved?

A

If there is sufficient evidence of safety from preclinical studies

29
Q

How are drugs tested for mutagenic potential?

A

Through the Ames test (ability of compound to induce mutations in bacteria)

30
Q

Drugs causing birth defects or impair fertility

A

Teratogens

31
Q

When do gross malformations occur when exposed to teratogens?
When is function disrupted primarily?

A

1st trimester - gross malformations

2nd and third trimester - affect function more than gross anatomy

32
Q

Transfer of drugs across the placenta is greatest in the ______ trimester. Why?

A

third
b/c as the placenta develops, the surface area for transfer between maternal and fetal circulation increases and the barrier becomes thinner

33
Q

Describe how the pregnancy category of a drug works.

A

A - no evidence
B - issues in animal studies; none in women
C - benefits outweight harm - harm in animals studies but no well controlled studies for preggo women
D - Clear evidence of risk to fetus but benefits outweight possible risks
X - clear risk, should never be used in pregnant women - risks outweigh benefits

34
Q

The most common and important organ specific toxicity is observed in the ____ and the _____.

A

liver, heart

35
Q

Most common reason for an approved drug to be removed from the market.

A

Hepatotoxicity

36
Q

What are signs of hepatotoxicity?

A

jaundice, dark urine, light-coloured stool, nausea and vomitting

37
Q

Describe a blood test that can determine if liver function is impaired.

A

Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are liver enzymes that are usually low in the blood, unless the liver is damaged. In that case, they are higher

38
Q

Hepatotoxic drugs are often contraindicated for these patients.

A

Alcoholics
Pts with liver disease
Patients already taking hepatotoxic drugs

39
Q

Name each of the following ECG waves.
Normal atrial depolarization
rapid depolarization of the left and right ventricles
Repolarization of the ventricles
Wave that is not always seen
Time required for the ventricles to repolarize

A 
P-wave
QRS complex
T-wave
U-wave
QT interval
40
Q

A prolongation of the QT interval is a major risk factor for the development of this.

A

Torsades de pointes

41
Q

Life-threatening form of ventricular arythmia

A

Torsades de pointes

42
Q

Which gender is at higher risk for torsades de pointes?

A

Females since their QT interval is longer

43
Q

Drugs that prolong the QT interval should be used with caution in these patients.

A

Elderly

pts with bradychardia, heart failure, low potassium or congenital QT prolongation

44
Q

Most common cause of ADRs.

A

medication errors

45
Q

Medication error caused by a HCP.

A

iatrogenic error

46
Q

What are the 5 main types of medication errors.

A 
Prescribing
Dispensing
Administration
Patient education
Patient
47
Q

HCP prescribes the wrong drug, wrong dose or wrong route

A

Prescribing medication error

48
Q

The prescription is correct but the pharmacist dispenses the wrong drug.

A

Dispensing medication error

49
Q

The HCP administers the incorrect dose and/or drug.

A

administration medication error (can also be made by a patient)

50
Q

Illiteracy or language barriers may cuase the patient to not comprehend the instruction and have a medication error.

A

Patient education medication error

51
Q

The patient understands the instructions but doesn’t follow them

A

Patient medication error

52
Q

Confusion over drug names represents __ of all medication errors.
What types of factors can increase drug naming errors?

A

15%

poor handwriting, illiteracy, strong accents

53
Q 
Name what each of the following may be mistaken as.
Plendil
Nicoderm
Flomax
Dioval
A

Pletal
Nitroderm
Volmax
Diovan

54
Q

The institute for Safe Medication Practices has put together a list of error prone abbreviations.
Describe how each of the following may be mistaken and what the preferred way to write it is.

IU
q.d.
q.o.d.
1.0mg
.5mg
MgSO4
MS, MSO4
A

IU - misread as IV or 10 - write units
q.d. - misread as qid - write every day
q.o.d. - misread as q.d. or q.i.d. - write every other day
1.0mg - misread as 10mg - do not use trailing zeros
.5mg - misread as 5mg - use a leading zero
MgSO4 - misread as morphine sulfate - write magnesium sulfate
MS, MS04 - misread as magnesium sulfate - write morphine sulfate

Nursing Pharmacology (30 decks)

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