Pharmacology Lecture 3 Flashcards
Adverse drug Response
only noxious, unintended, and undesired effects that occur at normal drug doses
ADR Mild effects
drowsy, itching, nausea, rash
ADR Severe effects
respiratory depression, organ injury, anaphylaxis, death
ADR Considerations
What increases the risk? illnesses
What impact whom? nurse, pt
How to minimize harm? check and monitor
Side effects def
nearly unavoidable secondary drug effect produced at therapeutic doses
Toxicity def
any severe ADR, regardless of dose that caused it
Allergic reaction def
immune response, the intensity determined by immune system not dosage
Idiosyncratic effect def
uncommon drug response resulting from a genetic predisposition
Paradoxical effect def
opposite of intended drug response
Iatrogenic disease def
occurs as a result of medication care or treatment, including disease produced by drugs
Physical dependence def
adapted to drug exposure in such a way that abstinence syndrome will develop if d/c
Carcinogenic effect def
ability of certain meds and chemicals to cause concern
Teratogenic def
drug induced birth effects
Hepatotoxic drugs effect the
liver
The liver is the primary site of
metabolism
Drugs are the leading cause of
liver failure
What increases the risk of liver injury?
combining hepatotoxic drugs
Hepatotoxic drug example
(Hint: cholesterol)
Statine
What type of drugs are toxic to the heart?
QT drugs
QT drugs do what to the body
prolong QT intervals
cause life-threatening dysrhythmias
What genders are at higher risk when taking QT drugs?
females
Multiple QT drugs are not given _____________
concurrently
Kidneys filter
metabolites out of the body
-cumulative exposure cause damage
Ototoxic reactions cause
(reason need to catch early)
permanent damage
How many approximate drugs are pneumotoxic
600 +
How to identify ADR?
underlying diseases
polypharmacy
unknown
Polypharmacy
simultaneous use of multiple drugs to treat a single ailment or condition
What questions do you ask to know more about adverse drug reactions?
Symptoms appear shortly after 1st use?
Did they go away after d/c?
Reappear after reinstititution
Illness explain event?
Other drug regimen?
How do you minimize ADRs?
early id is key
knowing the major ADRs a drug produces
monitor organ functions if toxic
individual therapy
pt teaching
Black box warnings
strongest safety warning a drug can carry and still remain on the market
-concise summary of ADR with warnings and precautions
–most serious med warning required by FDA
Considerations with Black Box Warnings
benefits outweigh the risks
safer and equally effective alternative
safer but less effective appropriate
warning applicable to specific pt
ameriorlate the potential of ADR
Medication Error
any preventable event that may cause or lead to inappropriate meds used or pt harm
-direct harm
-indirect harm
Med Error causes
human factors
communication mistakes
name confusions
packaging, formulations, and delivery services
labeling and references materials
What medication error has a 90% fatality rate?
communication mistakes
Body composition in relation to drug responses
if the same dose is given to a small and a big person = the drug concentration will be higher in the small person
Infants has premature
organ systems
Older adults have a decline in
organ functions (decline in liver/kidney functions and increase in level of drug in system)
Individual Variation Factors in drug responses
tolerance
comorbidities
diet
Tolerance
decrease in responsiveness to a drug as a result of repeated drug administration
Comorbidities
taken to manage 1 condition may complicate management of another condition
Diet in relation to ADRs
good diets elicit therapeutic responses and reduce harm from ADRs
-some foods interact with drugs
Kidney disease pathophysiology
due to accumulation of drug toxicity
decrease rate of drug exertion
Liver disease
drug accumulation of drug toxicity causes
decrease rate of drug metabolism
Failing to take drugs as prescribed bc of
Patient compliance (manual dexterity or visual activity)
Intellectual capacity and psychologic state
attitude and belief
ability to pay
any steps of med errors
In drug med errors, Nurses are the
last line of defense
Drug therapy in older adults factors
organ function
comorbidities
polypharmacy
noncompliance
Pharmacokinetics Changes
Absorption
rate slows
gastric acidity decreases
Pharmacokinetics Changes
Distribution
Plasma drug lvl reduced
=increase in body fat
Plasma drug lvl increased
=decrease % lean body mass
=decrease in total body water
=decrease serum albumin concentration
Pharmacokinetics Changes
Metabolism
decrease with age - highly variable
Pharmacokinetics Changes
Excretion
reduce progressively in early adulthood
What is the most important cause of ADRs in elderly
decrease progressively in excretion
ADR is _____ times more common in the elderly.
7
The elderly ADRs account for ____% of hospital admissions.
16
The elderly ADRs account for ____% of all med-related deaths.
50
-mostly dose related
-mostly avoidable
-symptoms nonspecific
Important Risk Factors in Elderly
-reduce renal function - drug accumulation
-polypharmacy
-greater severity of illness
-low therapeutic index drugs
-increase individual variation
-inadequate supervision of long-term therapy
-poor adherence
Goal Treatment
reduce symptoms
improve quality of life
Assessment of Risk factors
drug history
compliance
Monitoring of Risk factors
clinical responses
plasma drug levels
Teaching pts Risk factors of
how to take meds
strategies for compliance
Nurse advocates for the best medication administration for the pt
simpliest regimen possible
easy to open containers
large print
cost
Plasma drug lvl reduced =
increase in body fat
Plasma drug lvl increased =
=decrease % lean body mass
=decrease in total body water
=decrease serum albumin concentration
