pharm 3

Question 1

adverse drug reaction (ADR)

Answer 1

-any noxious, unintended, undesired effect that occurs at normal drug doses
-pretty unpredictable

Question 2

mild ADR effects (4)

Answer 2

-drowsiness
-rash
-itching
-nausea

Question 3

severe ADR effects (4)

Answer 3

-respiratory depression
-organ injury
-anaphylaxis
-death

Question 4

ADR considerations (questions - 3)

Answer 4

-what increases the risk?
-what is the impact - for whom?
-how can harm be minimized?

Question 5

side effect

Answer 5

a nearly unavoidable secondary drug effect produced at therapeutic doses

Question 6

toxicity

Answer 6

any severe ADR, regardless of the dose that caused it

Question 7

allergic reaction

Answer 7

immune response, the intensity of which is determined by immune system, not dosage

Question 8

idiosyncratic effect

Answer 8

uncommon drug response resulting from a genetic predisposition
-effect we were not expecting

Question 9

paradoxical effect

Answer 9

the opposite of the intended drug response

Question 10

iatrogenic disease

Answer 10

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

Question 11

physical dependence

Answer 11

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

Question 12

carcinogenic effect

Answer 12

the ability of certain medications and chemicals to cause cancers

Question 13

teratogenic effect

Answer 13

drug-induced birth defect

Question 14

organs that can be effected by drugs

Answer 14

-liver
-kidneys
-heart
-lungs
-inner ears

Question 15

organs that can be effected by drugs

Answer 15

-liver
-kidneys
-heart
-lungs
-inner ears

Question 16

liver is the primary site of _______

Answer 16

metabolism

Question 17

_________ are leading cause of liver failure

Answer 17

drugs

Question 18

over 50 commonly given drugs are __________

Answer 18

hepatotoxic

Question 19

some drug metabolites are __________

Answer 19

hepatotoxic

Question 20

giving 1+ hepatotoxic drugs ___________ risk of liver injury

Answer 20

increases

Question 20

giving 1+ hepatotoxic drugs ___________ risk of liver injury

Answer 20

increases

Question 21

DILI

Answer 21

drug induced liver injury

Question 22

prolonged QT

Answer 22

some drugs cause space from Q to T to spread out

Question 23

QT drugs can cause life-threatening ______________

Answer 23

dysrhythmias

Question 24

QT drugs are found in ________ drug classes

Answer 24

several

Question 25

___________ are at higher risk

Answer 25

females

Question 26

multiple QT drugs should/should not be given concurrently

Answer 26

should NOT

Question 27

kidney function

Answer 27

filtration

Question 28

(kidneys) cumulative exposure can cause _______

Answer 28

damage

Question 29

__________ reactions cause permanent damage

Answer 29

ototoxic

Question 30

(ears) very important to catch it _______

Answer 30

early !!!!!

Question 31

medication that is ototoxic to inner ears

Answer 31

furosemide (lasix)

Question 32

pneuomotoxic how many drugs are pneumotoxic?

Answer 32

drugs toxic to lungs 600+

Question 33

poly pharmacy

Answer 33

pt taking lots of drugs

Question 34

questions to ask? (5)

Answer 34

-did symptoms appears shortly after the drug was first used? -did symptoms abate when drug was discontinued? -did symptoms reappear when drug was reinstituted? -is the illness itself sufficient enough to explain the event? -are the other drugs in the regimen sufficient enough to explain the event?

Question 35

minimizing ADRs (5)

Answer 35

-early identification -know major ADRs a drug can produce -monitoring organ function if toxic drugs being given -individualizing therapy -pt teaching

Question 36

black box warnings are described as __________ (3)

Answer 36

-the strongest safety warning a drug can carry and still remain on the market -concise summary of the adverse effects of concern -the most serious medication warning required by FDA

Question 37

considerations when faced with a BBW (5)

Answer 37

-does the potential benefit of treatment outweigh the risk? -are there safer (and equally effective) alternatives? -would a safer but less effective alternative be appropriate? -is the boxed warning applicable to this specific pt? -can action be taken to ameliorate the potential for an adverse reaction?

Question 38

medication errors

Answer 38

any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer

Question 39

______ major types of medication errors

Answer 39

13

Question 40

causes of medication errors (3)

Answer 40

-human factors -communication mistakes -name confusion

Question 41

communication mistakes are ____ % of fatal errors

Answer 41

90

Question 42

name confusion factors (4)

Answer 42

-packaging -formulations -delivery services -labeling and reference materials

Question 43

factors affecting individual response body composition

Answer 43

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

Question 44

factors affecting individual response age (why?)

Answer 44

-infants - immature organ systems -older adults - decline in organ function

Question 45

factors affecting individual response pathophysiology kidney disease

Answer 45

reduced rate of drugs EXCRETION - drugs may accumulate to toxic levels (increase, drugs stay in body longer)

Question 46

factors affecting individual response pathophysiology liver disease

Answer 46

reduces rate of drug METABOLISM - drugs may accumulate to toxic levels (increase, drugs stay in body longer)

Question 47

factors affecting individual response tolerance

Answer 47

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

Question 48

factors affecting individual response comorbidities and drug interactions

Answer 48

drugs taken to manage on condition may complicate management of another conditions -pt has many issues

Question 49

factors affecting individual response diet

Answer 49

-good diet can elicit therapeutic responses and reduce harm from ADRs -some foods can interact with drugs and cause ADRs

Question 50

factors affecting individual response failure to take as prescribed patient compliance (4)

Answer 50

-manual dexterity -intellectual capacity and physiologic state -attitude and belief towards drugs -ability to pay

Question 51

factors affecting individual response failure to take as prescribed medication errors

Answer 51

-can happen at any step in process -nurses are last line of defense

Question 52

geriatric concerns (4)

Answer 52

-organ function -comorbidities -polypharmacy -noncompliance

Question 53

pharmacokinetic changes : ADME (elderly) absorption

Answer 53

-slows -gastic acidity decreases

Question 54

pharmacokinetic changes : ADME (elderly) distribution (4)

Answer 54

-increased body fat % > plasma drug levels reduced -decreased % lean body mass > plasma drug levels increased -decreased total body water > plasma drug levels increased -decreased serum albumin concentration > plasma drug levels increased

Question 55

pharmacokinetic changes : ADME (elderly) metabolism

Answer 55

-declines with age -highly variable

Question 56

pharmacokinetic changes : ADME (elderly) excretion

Answer 56

-decline progressively in early adulthood -MOST IMPORTANT cause of older adults

Question 57

ADR is ___x more common in older adults

Answer 57

7

Question 58

goal of treatment

Answer 58

reduce symptoms, improve quality of life