Lecture 3, chs 6,7,9

  1. Which drugs have the potential for adverse effects?
    • ALL including:
    • –Prescription
    • –OTC
    • –Herbal
    • –Supplements
  2. What is the difference between an adverse effect and a side effect?
    • Adverse effects are unpredictable, undesirable
    • Side effects are generally predictable, we are okay with them.
    • Some times the difference between a side effect and an adverse effect is simply the severity. For example, a mild head ache might be considerd a side effect whereas an excruciating headache would be considered an adverse effect.
  3. What is released during an allergic reaction?
    • histamine
    • serotonin
    • leukotriene
    • prostaglandins
    • complement
  4. What are some common meds that cause allergic reactions?
    PCN and those related, contrast containing iodine, insulin, NSAIDs, sulfa, chemo, antiseizure med
  5. What is an idiosyncratic response?
    A rare, unpredictable response to a drug, not related to pharmacological properties of the drug
  6. What are carcinogens? What are some examples of carcinogens?
    • They damage DNA.They may take decades to manifest as cancer. They are utilized if they can add years of life initially
    • Ex: antineoplastics, horomones, immunosuppressants
  7. Nephrotoxicity
    Commonly affected by medications.
  8. Prevention: hydration, monitor labs, adjust doses
  9. Neurotoxicity
    • The brain gets a large blood supply. Blood brain barrier controls access of drugs to brain
    • The brain is very sensitive to toxic substances
    • Recognize signs/symptoms of CNS toxicity
    • Safety hazards associated with CNS depressants
  10. Note changes in behavior, seizures, senses, delirium
  11. Muscle Toxicity
    Drug induced skeletal myopathy is uncommon
  12. Monitor CK levels
  13. Cardiac muscle toxicity can occur
  14. Monitor ECG’s
  15. Assess for unexplained muscle pain
  16. Hepatotoxicity
    Liver detoxifies majority of drugs
  17. Hepatotoxicity is a common adverse effect
  18. Monitor liver function tests with hepatotoxic drugs
    Signs of liver impairment can be vague – RUQ pain, N/V, anorexia
  19. Severe liver impairment can cause toxic drug levels
  20. Dermatologic Toxicity
    • Skin reactions are common adverse effect
    • Rash with pruritis is common
    • Urticaria may lead to anaphylaxis (hives)
    • Angioedema and Stevens-Johnson syndrome are serious reactions
    • Photosensitivity
    • – sunburn easily
  21. Bone Toxicity
    • Bone: Often are serious or life-threatening
    • Pancytopenia
    • Aplastic anemia
    • Agranulocytosis and neutropenia – WBCs
    • Frequently associated with antineoplastics
  22. What do pharmacodynamic drug interactionws include?
    Pharmacodynamic drug interactions include additive, synergistic, or antagonistic effects.
  23. Additive effect
    Combined summation response
  24. Synergistic effect
    Enhanced response from combined drugs
  25. Antogonistic effect
    Diminished response occurs
  26. What is an example of drugs with synergistic effects?
    Phenergen potentiates the effect of morphine, requiring lower dose of morphine for same effect!
  27. What are two types of drug interactions and what do they do?
    –Inhibition: decreases therapeutic action

    –Enhancement: provides greater therapeutic action
  28. How can drug interactions change the rate of absorption?
    • Rate of peristalsis
    • Coadministration with resins
    • Administration with food or on empty stomach
    • pH of stomach
  29. How can drug interactions change distribution?
    • Drugs travel bound to protein
    • Displacement from protein increases drug level
    • Increased protein binding decreases drug level
    • Plasma pH affects drug ionization and ability to cross membranes
  30. How can drug interactions effect metabolism?
    • Hepatic enzyme activity
    • Drug inducers
    • Drug inhibitors
    • Prodrugs
  31. How can drug interactions effect excretion?
    • Cardiac output and glomerular filtration rate
    • Competition for excretion in renal tubules
    • Ph changes
    • Biliary drug excretion
    • Effects of aging
  32. What are four different ways drug-drug interactions can occur?
    • •Increased therapeutic effects
    • •Increased adverse effects
    • •Decreased adverse effects
    • •Decreased therapeutic effects
  33. What are four examples of drug-drug interactions?
    1.Using inhaled bronchodilator before glucocorticoid (Azmacort)

    2.ASA and warfarin increased bleeding

    3.Antiemetics with narcotics

    4.Alcohol can increase the metabolism of phenytoin
  34. What's affected with drug/food interactions and what's a sepcific example of one?
    • •Absorption and bioavailability affected
    • •Grapefruit juice and CYP3A4 enzyme
  35. What does grapefruit juice do?
    inhibits presystemic medication metabolism in the small bowel which increases absorption of some medications which can increase their effect/adverse reactions.
  36. Vitamin K can decrease effects of...
    warfarin (coumadin)
  37. What do MOAI's interact with?
    MOAIs can lead to hypertensive crisis if taken with foods with tyramine (wine and cheese)
  38. How do we prevent med errors?
    Assess, plan, impliment
  39. What medication class most frequently results in death?
  40. Can the nursing process be used in pharmacology?
    Yes. It's a good way to discover if pt is having a drug interaction, adverse effects, etc
Card Set
Lecture 3, chs 6,7,9
adverse vs side, med errors, etc