Pharm Quiz 3 Flashcards
adverse drug reaction (ADR)
any noxious, unintended, undesired effect occurs at normal drug doses
defined by WHO, med error
mild ADR effects
- drowsiness
- itching
- nausea
- rash
severe ADR effects
- respiratory depression (bradypnea, distress)
- organ injury
- anaphylaxis (extreme allergice reaction)
- death
what increases risks for ADR?
- comorbidities (especially liver/kidney problems)
- young/old age
who is impacted by an ADR?
- pt
- family
- staff
- other pts (more time is required for the pt with the ADR)
how can harm be minimized considering ADRs?
- EMR
- allergy band
- pt ID & verification
- monitor pts when administering a new med
side effect
nearly unavoidable secondary drug effect produced at therapeutic doses
toxicity
severe ADR, regardless of the dose that caused it
allergic reaction
immune response, the intensity of which is determined by immune system, not dosage
pt was exposed to drug, body made antibodies>next exposure?bad reaction
allergic reaction
immune response, the intensity of which is determined by immune system, not dosage
pt was exposed to drug, body made antibodies>next exposure> bad reaction
idiosyncractic effect
uncommon drug response resulting from a genetic predisposition
paradoxical effect
the opposite of the intended drug response
kids tend to have a paradoxical. effect to sedatives
paradoxical effect
the opposite of the intended drug response
kids tend to have a paradoxical. effect to sedatives
iatrogenic disease
occurs as the result of medical care/tx, 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
ability of certain medications & chemicals to cause cancers
teratogenic effect
drug-induced birth defect
hepatotoxic drugs
- liver is primary metabolism site
- drugs are leading cause of liver failure
- over 50 commonly given drugs are hepatotoxic
- some drug metabolites are hepatotoxic
- combining hepatotoxic drugs increases risk of liver injury
statin & cholesterol drugs
- extremely hepatotoxic
- many Americans need them
QT drugs
- prolonged QT interval
- can cause life-threatening dysrhythmias
- found in several drug classes
- females at higher risk (usually dx in late teens/20s)
- multiple QT drugs should not be given concurrently
QT interval
some meds are not appropriate for pts with prolonged QT interval
possible kidney damage
- kidneys filter metabolites out of body
- cumulative exposure can cause damage
ototoxic drugs
- cause permanent damage to inner ears
- very important to dx early
ex: lasix, must be slow IV push or could cause hearing loss
ototoxic drugs
- cause permanent damage to inner ears
- very important to dx early
ex: lasix, must be slow IV push or could cause hearing loss
pneumotoxic
- damage to lungs
- over 600 drugs
identifying/preventing ADRs
- underlying illness
- polypharmacy (pt takes multiple meds, EMR helps to keep everything straight, ensures staff knows pts meds)
- unknown- idiosyncratic (uncommon drug response)
questions to ask when ADR occurs
5
- did symptoms appear shortly after first admin ?
- did symptoms abate (go away) when the drug was dc?
- did symptoms reappear when the drug was reinstituted?
- is the illness itself sufficient to explain the event? (was it the med or the illness that caused the symptoms?)
- are other drugs in the regimen sufficient to explain the event?
ways to minimize ADRs
- early identification is key (vitals & assess immediately upon noticing ADR)
- know major ADRs of each drug
- monitor organ function if drugs are toxic
- individualizing therapy
- pt ed (side effects, cautions)
black box warning
- strongest safety warning a drug can carry & still remain **on the market **
- concise summary of the adverse effects of concern (warnings & precautions)
- most serious medication warning req by FDA
alerts perscriber & pt
questions to ask yourself with a black box warning
5
- does the potential benefit/tx outweigh the risk? (cancer tx outweighs liver failure)
- are there safer (effective) alternatives?
- would a safer but less effective alternatibve be appropriate?
- is the warning applicable to this specific pt?
- can action be taken to ameliorate (relieve) the potential for ADR?
medication error
definition
any preventable event that may cause or lead to inappropriate medicaiton use/ pt harm while the med is in the control of the healthcare professional, pt, or consumer
wrong med, pt, dose, route, etc
how many major types of med errors are there?
13
direct & indirect harm
causes of med errors
- human factors
- communication mistakes (90% of fatal errors)
- name confusion (drugs or pts)
- packaging, formulations, & delivery services
how does body composition affect ADR?
drug concentration will be higher in a smaller/lighter pt than in a heavier pt
how does age affect ADR?
- infants- immature organ systems
- elderly- decline in organ function
not metabolizing/excreting as quickly
how does age affect ADR?
- infants- immature organ systems
- elderly- decline in organ function
not metabolizing/excreting as quickly
how does kidney disease effect ADR?
reduces rate of drug excretion (drugs may accumulate to toxic levels)
how does liver disease affect ADR?
reduces rate of drug metabolism (drugs may accumulate to toxic levels)
a decline in liver or kidney function
leads to an increase of drug levels in the body
can be toxic
how does tolerance affect ADR?
decreased responsiveness to a drug as a result of repeated drug admin
how do comorbidities/drug interactions affect ADR?
drugs for one condition may complicate management of another condition
how does diet affect ADR?
- good died can elicit therapeutic responses & reduce harm from ADR
- some foods can interact w drugs & cause ADR
how does pt compliance affect ADR?
can be intentional non-compliance or unavoidable due to mental status, physical disabilities, finances, home situation, etc. (not always “won’t”, sometimes it’s “can’t”)
- manual dexterity & visual acuity
- intellectual capacity & psychologic state
- attitude & belief toward drugs
- ability to pay
when can med errors happen? who is the last line of defense?
- any step in the process
- RN is last line of defense
geriatric concerns for ADR
- decreased organ fuction
- comorbidities (cause decreased organ function, likely to be fatal/chronic)
- polypharmacy
- noncompliance
drug absorption in geriatric pts
- slower rate
- gastric acidity declines (may not be able to physically handle drugs as well as before)
drug distribution in geriatric pts
- increased body fat % (stores meds longer, higher drug levels in body)
- decreased % lean body mass, total body water, & serum concentration (less drug levels)
drug excretion in geriatric pts
declines progressively
most important cause of ADRs in older adults
how much more likely is an ADR for a geriatric pt than a young adult?
7x
elderly drug reations account for what % of hospital ADRs? % of medication-related deaths?
- 16 % hospital admissions
- 50% medication-related deaths
ADRs in elderly pts
- mostly dose related
- symptoms are non-specific
- pts are less likely to share alcohol/drug use
- mostly avoidable
process of drug administration
- assessment: drug hx, compliance
- monitoring: clinical responses, plasma drug levels (especially for strong drugs, new admins)
- teaching: administration, compliance
- advocating: simplist regimen possible, easy to open containers, large print, cost
