Pharmacology Quiz 3 Flashcards
ADR effects that are mild (4)
- drowsiness
- itching
- nausea
- rash
ADR effects - severe (4)
Respiratory depression
Organ injury
Anaphylaxis
Death
What increased the risk - ADR
- very ill patients
- increase for a adverse drug reaction
- very young
- very old
- immunocompromised
- human error
Side effect
A nearly unavoidable secondary drug effect produced at therapeutic doses
Toxicity
Any severe ADR regardless of the dose that caused it
Allergic reaction
Immune response, the intensity of which is determined by immune system, not dosage
Idiosyncratic effect
Uncommon drug response resulting from a genetic predisposition
Paradoxical effect
The opposite of the intended drug response
Iatrogenic disease
Occurs as the result of medical care of treatment, including disease produced by drugs
Body has adapted to drug exposure in such a way that abstinence will develop if discontinued
Physical dependence
The ability of certain medications and chemicals to cause cancers
Carcinogenic effect
Drug induced birth defect
Teratogenic effect
Liver is primary site of
Metabolism
Drugs are leading cause of
Liver failure
Over 50 commonly given drugs are
Hepatotoxic
Some drugs metabolites are
Hepatotoxic
Combining hepatotoxic drugs increase risk of
Liver injury
QT drugs
Prolong QT interval
QT drugs can cause
Life threatening dysthymias
Kidneys
Filter metabolites out of body
Cumulative exposure can cause damage
Ears
Ototoxic reactions cause permanent damage
Very important to catch early
Lungs
Over 600 drugs are pneumotoxic
What 5 ways to minimize ADRs
- early Identification
- know major ADRs that a drug can produce
- monitoring of organ function of toxic drugs are being given
- individualizing therapy
- patient teaching
Black box warnings
Strongest safety warning a drug can carry and still remain on the market
Risperdal (black box warning)
Older people- risk for death
Calm and induce sleep
Celebrex (black box warning)
An increase risk of serious cardiovascular thrombotic events
- arthritis
- heart attacks
- strokes
- GI bleed
13 major types of medications errors
What 2 ?
Direct harm
Indirect harm
Cause of medication errors
Human factors
Communication mistakes (90% of fatal errors)
Name confusion
If the same dose of a drug is given to a big person and a small person the drug concentration will be higher in the smaller person
Body composition
Larger people will need a high dose of medication
Factors affecting individual response
- age
- infants
- older adults
- immature organ systems
- decline in organ function
Reduces rate of drug excretion , drugs may accumulate to toxic levels
Kidney disease
Reduces rate of drugs metabolism, drugs may accumulate to toxic levels
Liver disease
—— drug levels in our system, ——- in liver or kidney function
Increased; decline
Decreased responsiveness to a drug as a result of repeated drug administration
Tolerance
Drugs taken to manage one condition may complicate management of another condition
Comorbidities and drug interactions
Good diet can elicit therapeutic responses and reduce harm from ADRs
- some foods can interact with drugs and cause ADRs
DIET
Failure to take as prescribed
Patient compliance
Medication errors
Elderly pharmacokinetic changes
Absorption & distribution
Elderly - Absorption
Rate of absorption slows
Gastric acidity declines (drugs don’t get broken down)
Elderly - distribution
Increase body fat
Decrease % lean body mass
Decreased total body water
Decreased serum albumin concentration
Increase body fat (what happens to the plasma)
Plasma drug levels reduce
Decreased % lean body mass - plasma
Plasma drugs increase
Decreased total body water - plasma
Plasma drug levels increase
Decreased serum albumin concentration- plasma
Plasma drug levels increase
Metabolism tends to ___ with ___ , highly variable
Decline with age
Excretion begins to —- progressively in —- —-
The most important cause of ADRs in older adults
Decline
ADRS are 7x more common in
Older adults
ADRs in the elderly account for
16% of hospital admissions of older adults
50% of all medication related deaths
ADRs mostly —- related
Dose
In elderly ADRs symptoms tend to be
Nonspecific
Older adults less likely to share
Alcohol or drug use
ADRs are mostly
Avoidable
Risk factors of ADRs in elderly
- reduce renal function (drug accumulation)
- poly pharmacy
- greater severity of illness
- low therapeutic index drugs
- increased individual variation
- inadequate supervision of long term memory
- poor adherence
Goal of treatment
Improve quality of life
Reduce symptoms
Assessment
Drug history
Compliance
Monitoring
Clinical responses
Plasma drug levels
Teaching
How to take medications
Strategies for compliance