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CSON IM1 > Pharm Quiz 3 > Flashcards

Pharm Quiz 3 Flashcards

1
Q

adverse drug reaction (ADR)

A

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

defined by WHO, med error

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2
Q

mild ADR effects

A
  • drowsiness
  • itching
  • nausea
  • rash
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3
Q

severe ADR effects

A
  • respiratory depression (bradypnea, distress)
  • organ injury
  • anaphylaxis (extreme allergice reaction)
  • death
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4
Q

what increases risks for ADR?

A
  • comorbidities (especially liver/kidney problems)
  • young/old age
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5
Q

who is impacted by an ADR?

A
  • pt
  • family
  • staff
  • other pts (more time is required for the pt with the ADR)
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6
Q

how can harm be minimized considering ADRs?

A
  • EMR
  • allergy band
  • pt ID & verification
  • monitor pts when administering a new med
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7
Q

side effect

A

nearly unavoidable secondary drug effect produced at therapeutic doses

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8
Q

toxicity

A

severe ADR, regardless of the dose that caused it

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9
Q

allergic reaction

A

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

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10
Q

allergic reaction

A

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

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11
Q

idiosyncractic effect

A

uncommon drug response resulting from a genetic predisposition

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12
Q

paradoxical effect

A

the opposite of the intended drug response

kids tend to have a paradoxical. effect to sedatives

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13
Q

paradoxical effect

A

the opposite of the intended drug response

kids tend to have a paradoxical. effect to sedatives

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14
Q

iatrogenic disease

A

occurs as the result of medical care/tx, including disease produced by drugs

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15
Q

physical dependence

A

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

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16
Q

carcinogenic effect

A

ability of certain medications & chemicals to cause cancers

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17
Q

teratogenic effect

A

drug-induced birth defect

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18
Q

hepatotoxic drugs

A
  • 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
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19
Q

statin & cholesterol drugs

A
  • extremely hepatotoxic
  • many Americans need them
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20
Q

QT drugs

A
  • 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
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21
Q

QT interval

A

some meds are not appropriate for pts with prolonged QT interval

22
Q

possible kidney damage

A
  • kidneys filter metabolites out of body
  • cumulative exposure can cause damage
23
Q

ototoxic drugs

A
  • cause permanent damage to inner ears
  • very important to dx early

ex: lasix, must be slow IV push or could cause hearing loss

24
Q

ototoxic drugs

A
  • cause permanent damage to inner ears
  • very important to dx early

ex: lasix, must be slow IV push or could cause hearing loss

25
Q

pneumotoxic

A
  • damage to lungs
  • over 600 drugs
26
Q

identifying/preventing ADRs

A
  • underlying illness
  • polypharmacy (pt takes multiple meds, EMR helps to keep everything straight, ensures staff knows pts meds)
  • unknown- idiosyncratic (uncommon drug response)
27
Q

questions to ask when ADR occurs

5

A
  • 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?
28
Q

ways to minimize ADRs

A
  • 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)
29
Q

black box warning

A
  • 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

30
Q

questions to ask yourself with a black box warning

5

A
  • 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?
31
Q

medication error

definition

A

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

32
Q

how many major types of med errors are there?

A

13

direct & indirect harm

33
Q

causes of med errors

A
  • human factors
  • communication mistakes (90% of fatal errors)
  • name confusion (drugs or pts)
  • packaging, formulations, & delivery services
34
Q

how does body composition affect ADR?

A

drug concentration will be higher in a smaller/lighter pt than in a heavier pt

35
Q

how does age affect ADR?

A
  • infants- immature organ systems
  • elderly- decline in organ function

not metabolizing/excreting as quickly

35
Q

how does age affect ADR?

A
  • infants- immature organ systems
  • elderly- decline in organ function

not metabolizing/excreting as quickly

36
Q

how does kidney disease effect ADR?

A

reduces rate of drug excretion (drugs may accumulate to toxic levels)

37
Q

how does liver disease affect ADR?

A

reduces rate of drug metabolism (drugs may accumulate to toxic levels)

38
Q

a decline in liver or kidney function

A

leads to an increase of drug levels in the body

can be toxic

39
Q

how does tolerance affect ADR?

A

decreased responsiveness to a drug as a result of repeated drug admin

40
Q

how do comorbidities/drug interactions affect ADR?

A

drugs for one condition may complicate management of another condition

41
Q

how does diet affect ADR?

A
  • good died can elicit therapeutic responses & reduce harm from ADR
  • some foods can interact w drugs & cause ADR
42
Q

how does pt compliance affect ADR?

A

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
43
Q

when can med errors happen? who is the last line of defense?

A
  • any step in the process
  • RN is last line of defense
44
Q

geriatric concerns for ADR

A
  • decreased organ fuction
  • comorbidities (cause decreased organ function, likely to be fatal/chronic)
  • polypharmacy
  • noncompliance
45
Q

drug absorption in geriatric pts

A
  • slower rate
  • gastric acidity declines (may not be able to physically handle drugs as well as before)
46
Q

drug distribution in geriatric pts

A
  • increased body fat % (stores meds longer, higher drug levels in body)
  • decreased % lean body mass, total body water, & serum concentration (less drug levels)
47
Q

drug excretion in geriatric pts

A

declines progressively
most important cause of ADRs in older adults

48
Q

how much more likely is an ADR for a geriatric pt than a young adult?

A

7x

49
Q

elderly drug reations account for what % of hospital ADRs? % of medication-related deaths?

A
  • 16 % hospital admissions
  • 50% medication-related deaths
50
Q

ADRs in elderly pts

A
  • mostly dose related
  • symptoms are non-specific
  • pts are less likely to share alcohol/drug use
  • mostly avoidable
51
Q

process of drug administration

A
  • 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

CSON IM1 (15 decks)

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