Chapter 7 Pharm

adverse drug reaction
any harmful, unintended, and undesired effect that occurs at normal drug doses
more than 700,000 ER visits for

in the eldery and the very young
mild reactions = drowsiness, nausea, itching, and rash
sever reactions= respiratory depression, neutropenia, hepatocellular injury, anaphylaxis, and hemorrhage

a nearly unavoidable secondary drug effect produced at therapeutic doses
may deveop soon afer drug is initiated or not until drug has been taken for weeks or months

adverse drug reaction caused by excessive dosing
may occur even with normal dosing -> neutropenia (risk for infection) and anticancer medications

immune response
determined by the degree of sensitization of the immune system rather than by drug dose
pt sensitivity to a drug can change over time
very few drugs can cause severe allergic reactions

penicillins

an uncommon drug response resulting from a genetic predisposition
ex: succinylcholine-induced paralysis -> hard to wake them up

the opposite of the intended drug response
using sleeping pill but stay awake all night

"a disease produced BY drugs"
ex: antipsychotic drugs can cause Parkinson's-like symptoms
aka drug-induced disease

develops during long-term use of certain drugs (opoids, alcohol, barbiturates, and amphetamines)
body had adapted to drug exposure in such a way that an abstinence syndrome will result if drug use is discontinued

a few therapeutic agents are carcinogenic
serveral drugs used to treat cancer are among those with the greates carcinogenic potential
may tkae decades for evidence of carcinogenesis to appear after exposure

drug-induced birth defect

many drugs are toxic to specific organs
kidneys: amphotericin B
heart: doxorubicin
lungs: amiodarone
inner ear: aminoglycoside

leading cause of liver failure in the US, >50 drugs are known to be hepatotoxic
some drugs are metabolized and converted to toxic products that can injure liver cells
combining hepatotoxic drugs may increase the risk for liver damage

monitor liver enzymes - Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT) for liver injury?

watch for signs of liver injury; educate patients about jaundice, dark urine, light-colored stools, nausea, vomiting, malaise, abdominal discomfort, loss of appetite

measure of the time required for the ventricles to repolarize after each contractions
QT drugs: drugs that prolong the QT interval on electrocardiography (ECG)

warning to alert prescribers to: potentially severe side effects (for example, life-threatening dysrhthmias, suicidality, major fetal harm)
ways to prevent or reduce harm (for example, avoid a teratogenic drug during pregnancy)
strong warning that drug can have severe side effects

(FDA, 2016) Injure 1.3 million people per year
(John Hopkins) 400,000 deaths per year

the risk for error in hospitals is high because each medication order is processed by several people
the nurse is the last person in this sequence
the nurse is the last line of defense against mistakes which places a heavy burden on the nurse to ensure patient safety

overdose 36.4%
wrong drug 16.2%
wrong route 9.5%

performance deficits are the most common followed by knowledge deficits and the miscalculation of dosages