Pharm Quiz 3 Content Flashcards by Osvaldo Colmenero

Mild ADR

Drowsiness
Itching
Nausesa
Rash (Mild or Severe)

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Severe ADR

Resp. Depression
Organ Injury
Anaphylaxis
Death
Rash(mild or severe)

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3 ADR considerations

What increases the risks?
What/who is the impact?
How to minimize? (7 rights)

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Side effect

Nearly Unavoidable secondary effect at therapeutic doses

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Toxicity

Any severe ADR regardless of dose, or the ability to cause harm no matter the dose

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Allergic Reaction

Immune Response determine by the imm. system not the dosage
- Can only happen if you have been exposed to the drug before

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Idiosyncratic Effect

Uncommon drug response due to genetics

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Paradoxical Effect

Opposite of the intended Drug Response

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What 2 groups of people tend to have paradoxical drug effects?

Young and Old pt’s

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Latrogenic Effect

Disease caused by the drug or treatment

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Physical Dependance

addiction

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Carcinogenic Effect

Ability to cause cancers

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Teratogenic Effect

Drug induced Birth defect

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What are the 2 most affected organs by drugs?

Liver and Kidneys

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Hepatotoxic Drugs
- Primary metabolism site?
- Leading cause of?
- DILI = ?
- What kind tend to be toxic to liver?

Liver
- Liver
- Liver failure
- Drug Induced Liver Injury
- Statins

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QT Drugs
- QT Drugs Delay?
- Can cause?
- Whos at higher risk?
- Should not be given?

Heart/Qt complex
- QT interval
- Life threatening dysrhythmia
- Women
- Multiple drugs shouldn’t be given concurrently

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Kidneys filter what where?

Metabolites out of the body

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What part of the ear can get damaged?

Inner ear

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Polypharmacy
Common for who?

Too many drugs
Elderly pt’s

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5 ways to minimize ADR’s

Early identification
Know Major potential ADR
Monitor organ function
Individual Therapy
Pt teaching

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Strongest safety warning yet still able to be sold?

Black Box warning

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What’s a common black box warning on Fluoroquinolones?

Achiles tendon rupture

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3 considerations when seeing Black Box Warned drugs?

Does the benefit outweigh the risk?
Safer and equally effective alternatives?
Is the BBW applicable to your pt?

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med Error

Any preventable event that led to innapropiate drug use and/or pt harm

What type of mistakes causes 90% of fatal errors?

communication

What does kidney disease cause?

Slower excretion which leads to drug buildup?

What does liver disease cause?

Slower metabolism which leads to drug buildup

More levels of drugs in us = ?

Lower kidney or liver function

Tolerance

Decreased responiveness due to repeated drug admission

Comorbitites and drug interactions

Drugs taken to mage one condition may complicate management of another condition

What can a good diet reduce?

Harm from ADR's

Some foods can___?

Interact with drugs and cause ADR's

Empty stomach = ?

1hr before or 2hr after a meal

What does grapefruit juice do?

Slows drug metabolism by 3x

Factors of Patient Compliance?

Dexterity and acuity Intelectual Capacity Psych state Attitude and belief of drug ability to pay

Geriatric Concerns for drugs

Organ Function Comorbidities Polypharmacy Noncompliance

Absorption changes in elderly pt's?

Slower rate Gastric acidity declines

Distribution changes in older pt's?

^ Body fat = v plasma drug lvls v lean body mass v total body water v serem albumin conc. (Last 3 all ^ plasma drug lvls)

What is the most important cause of ADR's in older adults?

Declining excretion

How much more likely are ADR's in older pt's? Most are _____ related?

7x dose

7 important risk factors for elderly pt's

v renal function polypharmacy ^ illness severity v therapeutic index ^ pt variation v poor long term supervision of therapy poor adherence

Goal of treatment

^ quality of life v symptoms

Most common Synthetic Thyroxine? Indications? Normal daily dose? What's needed to admin. these? Forms? Common Side effects

Levothyroxine (Synthroid, Levoxyl) Indications: Slow - Obese - Cardiovascular - COPD Usually 1.6 mcg/kg/day or 50-200 mcg/day Empty Stomach PO IV IM Side Effects: - Tachycardia - Palpations - Dyspnea on exertion - Gioter/ Thyroid gland swelling

In Levothyroxines, low doses =? High doses ?

Low: Slow Constipation Fatigue High: Fly/fast Diarrhea Temors Insomnia

Proton Pump inhibitors (PPI) examples

Pantoprazole (common) Omperazole ^ both over the counter v Lansoprazole

Indicators for PPI's

GERD PUD Stress ulcer prophylaxis

PPI's usually given in hospitals to prevent?

stress ulcers

PPI PO dosage

40 mg daily on empty stomach

PPI IV push dosage?

40 mg daily over 2 minutes

PPI IV piggyback dosage

80 mg bolus and 8 mg/hr for GI bleed

6 Side effects of PPI's

Cutaneous lupus C Diff Gastroenteritis Diarrhea Bone fracture Hypomagnesemia

PPI's inhibit

Formation of gastric acid

What blood work to look for with PPI

H Pylori. the antibiotics and conduct with PPI

Hydrocodone indications

pain and cough

what 2 common drugs are given in Combo with hydrocodone

Hydro./Acetaminophen = Norco, Vicodin or Lortab for pain Hydro./ Chlorpheniramine = Tussoinex for cough

With Hydro./Aceto. what must you be careful for? Limit? Risk?

Overdose the limit is 4g a day in adults Risk of liver damage

Common BBW of Hydrocodone?

Addiction abuse and misuse

Hydrocodone ADR's

Constipation Itching Vomiting Hypotension CNS Depression Withdrawl