week 3: Ch. 5-6 [adverse effects/errors] Flashcards
What is an adverse drug effect?
Any undesirable effects; could be harmful
Any type of drug/supplement can have an adverse effect
What are side effects?
Predictable
Can occur at a therapeutic drug dose
Less serious than adverse effects
Tolerable
Name ways to prevent adverse drug effects
– Obtain thorough medical history
– Assess patient & diagnostic data
– Prevent medication errors
– Monitor pharmacotherapy carefully
– Know all drugs taken by patient
– Be prepared for unusual drug effects
– Question unusual orders
– Teach clients about adverse effects
FDA’s Adverse Event Reporting System (FAERS)
Voluntary program that encourages providers & consumers to report adverse effects directly to ______________________________
If safety concern, FDA may:
– Conduct additional _______
– Require __________ to labeling information
– Require __________ warning
– Restrict use of drug in specific _____________
– Communicate safety information to providers,
consumers
– __________ product w/ quality/performance
concerns/ Remove from market
Voluntary program that encourages providers & consumers to report adverse effects directly to FDA or manufacturer
- If safety concern, FDA may:
– Conduct additional studies
– Require changes to labeling information
– Require black box warning
– Restrict use of drug in specific populations
– Communicate safety information to providers,
consumers
– Recall product w/ quality/performance
concerns/ Remove from market
All drug allergies are caused by:
hyper response in the immune system
Name the drug classes most likely to cause allergic reactions
– Penicillin and related antibiotics
– Radiologic contrast media with iodine
– Insulin
– NSAIDs
– Sulfonamides
– Cancer chemotherapy agents
– Preservatives
– Certain antiseizure drugs
Idiosyncratic reactions
– Unusual or unexpected responses
– Unrelated to pharmacological action of drug
– Rare
– Unpredictable
– Vary in individual clients
Risk-benefit ratio: a drug has benefits that outweigh:
long-term risk
Carcinogenic drugs
& examples
– Damage______, leading to mutation
– Effects may not be seen for ______
▪Anti______________
▪Immuno__________
▪__________ and hormone antagonists
– Damage DNA, leading to mutation
– Effects may not be seen for years
▪Antineoplastics
▪Immunosuppressants
▪Hormone and hormone antagonists
Teratogens
– Drugs with potential to cause birth defects
– Only used in pregnancy when benefit clearly outweighs risk
– Drugs not tested in pregnant women
– Drug should be identified as safe for use in pregnancy.
Bone marrow toxicity
Serious/ ____________________
Bone marrow important for ______________________________; pancytopenia/aplastic anemia can occur with B.M.T
If recognized, can be reversed
Commonly associated with ________________ drugs
Serious/ life-threatening
Bone marrow important for WBC, RBC, platelets; pancytopenia/aplastic anemia can occur with B.M.T
If recognized, can be reversed
Commonly associated with antineoplastic drugs
Cardiotoxicity
– Common class is _________________________
▪____________________medications
– Prolongation of ___________________________ on ECG
▪Torsade de pointes
>Rare type of ventricular tachycardia that can cause sudden cardiac death
– Common class is anthracyclines
▪Antineoplastic medications
– Prolongation of QT interval on ECG
▪Torsade de pointes
>Rare type of ventricular tachycardia that can cause sudden cardiac death
Dermatologic toxicity
– ________ reactions are common adverse effects.
– Rash with ________________ (itching) common
– Urticaria (hives) may lead to _______________________
– Angioedema & SJS may be fatal.
– _____________________ [skin absorbs extra UV light]
– Skin reactions are common adverse effects.
– Rash with pruritis (itching) common
– Urticaria (hives) may lead to anaphylaxis.
– Angioedema & SJS may be fatal.
– Phototoxicity [skin absorbs extra UV light]
Hepatotoxicity
– _________ detoxifies majority of drugs.
– Hepatotoxicity common adverse effect
– Monitor liver ____________ w/ hepatotoxic drugs
– Signs of liver impairment can be vague.
– Severe liver impairment can cause __________ drug levels.
– Liver detoxifies majority of drugs.
– Hepatotoxicity common adverse effect
– Monitor liver enzymes w/ hepatotoxic drugs
– Signs of liver impairment can be vague.
– Severe liver impairment can cause toxic drug levels.
Nephrotoxicity
– Majority of drugs _________ in kidneys.
– _____________________ exposed to high drug concentrat.
– Recognize signs of risk in client
▪De___________
▪______________ lab values
▪History of renal ____________
– Majority of drugs excreted in kidneys.
– Renal tubules exposed to high drug concentrat.
– Recognize signs of risk in client
▪Dehydration
▪Abnormal lab values
▪History of renal impairment
Neurotoxicity
– Blood-brain barrier controls access of drugs - brain.
– Brain very sensitive to toxic substances
– Recognize signs/symptoms of CNS toxicity
– Safety hazards associated with CNS depressants
– Note changes in _________________________________________________
__________________
▪Hearing impairment that can result from drug-induced damage to 8th cranial nerve
– Blood-brain barrier controls access of drugs - brain.
– Brain very sensitive to toxic substances
– Recognize signs/symptoms of CNS toxicity
– Safety hazards associated with CNS depressants
– Note changes in behavior, seizures, delirium
Ototoxicity
▪Hearing impairment that can result from drug-induced damage to 8th cranial nerve
Skeletal muscle and tendon toxicity
– Drug-induced skeletal myopathy uncommon
▪Most severe myopathy is rhabdomyolysis
▪Monitor CK levels
3 basic drug mechanisms
inhibition
enhancement
change drug response
Many drugs travel through the blood bound to:
Plasma proteins
Prodrugs are activated by:
metabolism
Most drugs eliminated through :
renal excretion
- Pharmacodynamic drug interactions
3 types
▪_________ effect of similar class drugs
–Combined _____________ response
▪ ______________ effect [2 drugs not from same class]
–_____________ response from combined drugs
▪_________ effect
–______________response occurs
▪Additive effect of similar class drugs
–Combined summation response
▪Synergistic effect [2 drugs not from same class]
–Enhanced response from combined drugs
▪Antagonistic effect
–Diminished response occurs.
_____ of all US deaths are associated with medical error
10% [3d most common]
250k deaths annually
A majority of medical errors come from:
human factors
frequently-
– Errors in patient assessment
– Inaccurate prescribing
– Errors in administration
Most errors involve one branch of the cardinal “five rights” of medication administration:
– Right patient
– Right drug
– Right dosage
– Right route
– Right time
Institute for Safe Medication Practices (ISMP)
– Founded in 1994 to help standardize medication__________________________________________
– List of error-prone _____________________________________________ designations
– Founded in 1994 to help standardize medication error reporting systems
– List of error-prone abbreviations, symbols, and dose designations
Strategies for Reducing Medication Errors
- Assessment
– Assess all factors that might interfere with same drug administration - Planning
– Minimize factors that contribute to medication errors - Implementation
– Be aware of stressful situations and distractions - Implementation
– verify patient identity
– Correct procedures and techniques for all routes of administration
– Calculate dose correctly
– Open medications immediately prior to administration
– Record on MAR immediately after administration
– Confirm oral medications have been swallowed.
– Be alert to long-acting dosage forms. - Evaluation
– Assess patient for expected outcomes and adverse reactions to the drug
Medication reconciliation
– Process of keeping track of patient’s medication
– Lists all medications the patient is taking
– Should occur anytime there is a change in the site of the patient’s care
Polypharmacy
– Patients may receive multiple prescriptions for the __________________
– Patients may receive medications that have __________ pharmacological actions.
– Although it may happen to any age group, most often seen in __________ age group.
– Patients may receive multiple prescriptions for the same condition.
– Patients may receive medications that have conflicting pharmacological actions.
– Although it may happen to any age group, most often seen in older age group.
