Pharm- Adverse Drug Reactions and Med Errors

Question 1

Adverse Drug Reaction (ADR)

Answer 1

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

Question 2

What are some ADR mild side effects?

Answer 2

drowsiness
itching
nausea
rash

Question 3

What are some ADR severe side effects?

Answer 3

respiratory depression
organ injury
anaphylaxis
death

Question 4

What must we consider for ADRs?

Answer 4

what increases the risk?
what is the impact- for whom?
how can harm be minimized?

Question 5

Side effect

Answer 5

a nearly unavoidable secondary drug effect produced at therapeutic doses

Question 6

Toxicity

Answer 6

any severe ADR, regardless of the dose that caused it

Question 7

Allergic reaction

Answer 7

immune response, the intensity of which is determined by immune system, not dosage

Question 8

Idiosyncratic effect

Answer 8

uncommon drug response resulting from a genetic predisposition

Question 9

Paradoxical effect

Answer 9

the opposite of the intended drug response

Question 10

Iatrogenic disease

Answer 10

occurs as the result of medical care or treatment, including disease produced by drugs (nosocomial)

Question 11

Physical dependence

Answer 11

body has adapted to drug exposure in such a way that abstinence syndrome will develop if discontinued

Question 12

Carcinogenic effect

Answer 12

the ability of certain medications and chemicals cause cancers

Question 13

Teratogenic effect

Answer 13

drug induced birth defect

Question 14

Organs that are specifically affected by drugs include:

Answer 14

liver
kidneys
heart
lungs
inner ears

Question 15

Hepatotoxic drugs affects

Answer 15

liver is primarily site of metabolism
drugs are leading cause of liver failure
over 50 common drugs are hepatotoxic
some drug metabolites are hepatotoxic
combining hepatotoxic dogs increases risk of liver injury

Question 16

Can drugs be toxic to the heart?

Answer 16

yes, with QT drugs

Question 17

QT drugs

Answer 17

prolong QT interval
can cause life threatening dysrhythmia
QT drugs found in several drug classes
females higher at risk
multiple QT drugs should not be given concurrently

Question 18

Kidneys

Answer 18

filter metabolites out of body
cumulative exposure can cause damage

Question 19

Ears

Answer 19

ototoxic reactions cause permanent damage
very important to catch it early

Question 20

Lungs

Answer 20

over 600 drugs are pneumotoxic

Question 21

Questions to ask:

Answer 21

did symptoms appear shortly after the drug was first used?
did symptoms abate when drug was discontinued?
did symptoms reappear when the drug was reinstitution?
is the illness itself sufficient to explain the event?
are other drugs in the regimen sufficient to explain the event?

Question 22

Ways to identify ADR:

Answer 22

underlying illness
poly pharmacy (know all perceptions patient is on)
unknown

Question 23

Ways to minimize ADRs:

Answer 23

early identification is key
know major ADRs that a drug can produce
monitoring of organ function if toxic drugs are being given
individual therapy
patient teaching

Question 24

Black box warnings

Answer 24

strongest safety warning a drug can carry and still remain on the market
concise summary of adverse effects of concern
the most serious medication warning required by the FDA

Question 25

What are considerations when faced with a BBW?

Answer 25

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?

Question 26

Medication error

Answer 26

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

Question 27

Causes of medication errors:

Answer 27

human factors
communication mistakes
name confusion
packaging, formulations, and delivery services
labeling and reference materials

Question 28

Factors that affect individual responses:

Answer 28

body composition- weight
age- infants and older adults
pathophysiology- kidney and liver diseases
tolerance
comorbidity and drug interactions
diet
patient compliance
medication errors- nurses are the last line of defense

Question 29

Geriatric concerns:

Answer 29

organ function
comorbidity
poly pharmacy
noncompliance

Question 30

Pharmacokinetic changes: ADME (elderly) with absorption

Answer 30

slower rate of absorption
gastric acidity declines

Question 31

Pharmacokinetic changes: ADME (elderly) with distribution

Answer 31

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

Question 32

Pharmacokinetic changes: ADME (elderly) with metabolism and excretion

Answer 32

metabolism declines with age- highly variable
excretion begins to decline progressively in early adulthood- most important cause of ADRs in older adults

Question 33

Adverse drug reactions (elderly)

Answer 33

7 times more common in older adults
account for 16% of hospital admissions of older adults and 50% of all medication-related deaths
ADRs mostly dose related
symptoms tend to be nonspecific
older adults less likely to share alcohol or recreational drug use
ADRs mostly avoidable

Question 34

Goal of treatment

Answer 34

reduce symptoms and improve quality of life