1What are ADRs?
adverse drug reaction
any harmful, unintended, and undesired effect that occurs at normal drug doses
more than 700,000 ER visits for
2When are ADRs most common?
in the eldery and the very young
mild reactions = drowsiness, nausea, itching, and rash
sever reactions= respiratory depression, neutropenia, hepatocellular injury, anaphylaxis, and hemorrhage
3What is a side effect? **important**
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
4What is toxicity? **important**
adverse drug reaction caused by excessive dosing
may occur even with normal dosing -> neutropenia (risk for infection) and anticancer medications
5What is an allergic reaction? **important**
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
6Which allergic reactions are the most common?
penicillins
7What is idiosyncratic effect? **important**
an uncommon drug response resulting from a genetic predisposition
ex: succinylcholine-induced paralysis -> hard to wake them up
8What is paradoxical effect? **important**
the opposite of the intended drug response
using sleeping pill but stay awake all night
9What is iatrogenic disease? **important**
"a disease produced BY drugs"
ex: antipsychotic drugs can cause Parkinson's-like symptoms
aka drug-induced disease
10What is physical dependence?
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
11What is carcinogenic effect?
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
12What is teratogenic effect?
drug-induced birth defect
13What is organ-specific toxicity?
many drugs are toxic to specific organs
kidneys: amphotericin B
heart: doxorubicin
lungs: amiodarone
inner ear: aminoglycoside
14What are hepatotoxic drugs?
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
15What should you monitor in the liver?
monitor liver enzymes - Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT) for liver injury?
16What signs do you look for in hepatotoxic drugs? **important**
watch for signs of liver injury; educate patients about jaundice, dark urine, light-colored stools, nausea, vomiting, malaise, abdominal discomfort, loss of appetite
17What is QT interval?
measure of the time required for the ventricles to repolarize after each contractions
QT drugs: drugs that prolong the QT interval on electrocardiography (ECG)
18What are black box warnings? **important**
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
19How many med errors are estimated? **important**
(FDA, 2016) Injure 1.3 million people per year
(John Hopkins) 400,000 deaths per year
20Where is the risk for error high in medication administration? **important**
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
21Types of fatal medication errors **important**
overdose 36.4%
wrong drug 16.2%
wrong route 9.5%
22What causes medication errors? **important**
performance deficits are the most common followed by knowledge deficits and the miscalculation of dosages