pharm 3 Flashcards
adverse drug reaction (ADR)
-any noxious, unintended, undesired effect that occurs at normal drug doses
-pretty unpredictable
mild ADR effects (4)
-drowsiness
-rash
-itching
-nausea
severe ADR effects (4)
-respiratory depression
-organ injury
-anaphylaxis
-death
ADR considerations (questions - 3)
-what increases the risk?
-what is the impact - for whom?
-how can harm be minimized?
side effect
a nearly unavoidable secondary drug effect produced at therapeutic doses
toxicity
any severe ADR, regardless of the dose that caused it
allergic reaction
immune response, the intensity of which is determined by immune system, not dosage
idiosyncratic effect
uncommon drug response resulting from a genetic predisposition
-effect we were not expecting
paradoxical effect
the opposite of the intended drug response
iatrogenic disease
occurs as the result of medical care of treatment, including disease produced by drugs
physical dependence
body has adapted to drug exposure in such a way that abstinence syndrome will develop if discontinued
carcinogenic effect
the ability of certain medications and chemicals to cause cancers
teratogenic effect
drug-induced birth defect
organs that can be effected by drugs
-liver
-kidneys
-heart
-lungs
-inner ears
organs that can be effected by drugs
-liver
-kidneys
-heart
-lungs
-inner ears
liver is the primary site of _______
metabolism
_________ are leading cause of liver failure
drugs
over 50 commonly given drugs are __________
hepatotoxic
some drug metabolites are __________
hepatotoxic
giving 1+ hepatotoxic drugs ___________ risk of liver injury
increases
giving 1+ hepatotoxic drugs ___________ risk of liver injury
increases
DILI
drug induced liver injury
prolonged QT
some drugs cause space from Q to T to spread out
QT drugs can cause life-threatening ______________
dysrhythmias
QT drugs are found in ________ drug classes
several
___________ are at higher risk
females
multiple QT drugs should/should not be given concurrently
should NOT
kidney function
filtration
(kidneys) cumulative exposure can cause _______
damage
__________ reactions cause permanent damage
ototoxic
(ears) very important to catch it _______
early !!!!!
medication that is ototoxic to inner ears
furosemide (lasix)
pneuomotoxic
how many drugs are pneumotoxic?
drugs toxic to lungs
600+
poly pharmacy
pt taking lots of drugs
questions to ask? (5)
-did symptoms appears shortly after the drug was first used?
-did symptoms abate when drug was discontinued?
-did symptoms reappear when drug was reinstituted?
-is the illness itself sufficient enough to explain the event?
-are the other drugs in the regimen sufficient enough to explain the event?
minimizing ADRs (5)
-early identification
-know major ADRs a drug can produce
-monitoring organ function if toxic drugs being given
-individualizing therapy
-pt teaching
black box warnings are described as __________ (3)
-the strongest safety warning a drug can carry and still remain on the market
-concise summary of the adverse effects of concern
-the most serious medication warning required by FDA
considerations when faced with a BBW (5)
-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 pt?
-can action be taken to ameliorate the potential for an adverse reaction?
medication errors
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
______ major types of medication errors
13
causes of medication errors (3)
-human factors
-communication mistakes
-name confusion
communication mistakes are ____ % of fatal errors
90
name confusion factors (4)
-packaging
-formulations
-delivery services
-labeling and reference materials
factors affecting individual response
body composition
if the same dose of a drug is given to a big person and a small person, the drug concentration will be higher in the smaller person
factors affecting individual response
age (why?)
-infants - immature organ systems
-older adults - decline in organ function
factors affecting individual response
pathophysiology
kidney disease
reduced rate of drugs EXCRETION - drugs may accumulate to toxic levels (increase, drugs stay in body longer)
factors affecting individual response
pathophysiology
liver disease
reduces rate of drug METABOLISM - drugs may accumulate to toxic levels (increase, drugs stay in body longer)
factors affecting individual response
tolerance
decreased responsiveness to a drug as a result of repeated drug administration
factors affecting individual response
comorbidities and drug interactions
drugs taken to manage on condition may complicate management of another conditions
-pt has many issues
factors affecting individual response
diet
-good diet can elicit therapeutic responses and reduce harm from ADRs
-some foods can interact with drugs and cause ADRs
factors affecting individual response
failure to take as prescribed
patient compliance (4)
-manual dexterity
-intellectual capacity and physiologic state
-attitude and belief towards drugs
-ability to pay
factors affecting individual response
failure to take as prescribed
medication errors
-can happen at any step in process
-nurses are last line of defense
geriatric concerns (4)
-organ function
-comorbidities
-polypharmacy
-noncompliance
pharmacokinetic changes : ADME (elderly)
absorption
-slows
-gastic acidity decreases
pharmacokinetic changes : ADME (elderly)
distribution (4)
-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
pharmacokinetic changes : ADME (elderly)
metabolism
-declines with age
-highly variable
pharmacokinetic changes : ADME (elderly)
excretion
-decline progressively in early adulthood
-MOST IMPORTANT cause of older adults
ADR is ___x more common in older adults
7
goal of treatment
reduce symptoms, improve quality of life
