week 3: Ch. 5-6 [adverse effects/errors]

Question 1

What is an adverse drug effect?

Answer 1

Any undesirable effects; could be harmful

Any type of drug/supplement can have an adverse effect

Question 2

What are side effects?

Answer 2

Predictable
Can occur at a therapeutic drug dose
Less serious than adverse effects
Tolerable

Question 3

Name ways to prevent adverse drug effects

Answer 3

– 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

Question 4

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

Answer 4

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

Question 5

All drug allergies are caused by:

Answer 5

hyper response in the immune system

Question 6

Name the drug classes most likely to cause allergic reactions

Answer 6

– Penicillin and related antibiotics
– Radiologic contrast media with iodine
– Insulin
– NSAIDs
– Sulfonamides
– Cancer chemotherapy agents
– Preservatives
– Certain antiseizure drugs

Question 7

Idiosyncratic reactions

Answer 7

– Unusual or unexpected responses
– Unrelated to pharmacological action of drug
– Rare
– Unpredictable
– Vary in individual clients

Question 8

Risk-benefit ratio: a drug has benefits that outweigh:

Answer 8

long-term risk

Question 9

Carcinogenic drugs
& examples

– Damage______, leading to mutation
– Effects may not be seen for ______

▪Anti______________
▪Immuno__________
▪__________ and hormone antagonists

Answer 9

– Damage DNA, leading to mutation
– Effects may not be seen for years

▪Antineoplastics
▪Immunosuppressants
▪Hormone and hormone antagonists

Question 10

Teratogens

Answer 10

– 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.

Question 11

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

Answer 11

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

Question 12

Cardiotoxicity

– Common class is _________________________
▪____________________medications

– Prolongation of ___________________________ on ECG
▪Torsade de pointes
>Rare type of ventricular tachycardia that can cause sudden cardiac death

Answer 12

– 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

Question 13

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]

Answer 13

– 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]

Question 14

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.

Answer 14

– 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.

Question 15

Nephrotoxicity

– Majority of drugs _________ in kidneys.
– _____________________ exposed to high drug concentrat.

– Recognize signs of risk in client
▪De___________
▪______________ lab values
▪History of renal ____________

Answer 15

– 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

Question 16

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

Answer 16

– 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

Question 17

Skeletal muscle and tendon toxicity

Answer 17

– Drug-induced skeletal myopathy uncommon

▪Most severe myopathy is rhabdomyolysis
▪Monitor CK levels

Question 18

3 basic drug mechanisms

Answer 18

inhibition
enhancement
change drug response

Question 19

Many drugs travel through the blood bound to:

Answer 19

Plasma proteins

Question 20

Prodrugs are activated by:

Answer 20

metabolism

Question 21

Most drugs eliminated through :

Answer 21

renal excretion

Question 22

• 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

Answer 22

▪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.

Question 23

_____ of all US deaths are associated with medical error

Answer 23

10% [3d most common]

250k deaths annually

Question 24

A majority of medical errors come from:

Answer 24

human factors

frequently-
– Errors in patient assessment
– Inaccurate prescribing
– Errors in administration

Question 25

Most errors involve one branch of the cardinal “five rights” of medication administration:

Answer 25

– Right patient – Right drug – Right dosage – Right route – Right time

Question 26

Institute for Safe Medication Practices (ISMP) – Founded in 1994 to help standardize medication__________________________________________ – List of error-prone _____________________________________________ designations

Answer 26

– Founded in 1994 to help standardize medication error reporting systems – List of error-prone abbreviations, symbols, and dose designations

Question 27

Strategies for Reducing Medication Errors

Answer 27

* 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

Question 28

Medication reconciliation

Answer 28

– 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

Question 29

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.

Answer 29

– 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.