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BrigittaLisPanther
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Which drugs have the potential for adverse effects?
- ALL including:
- –Prescription
- –OTC
- –Herbal
- –Supplements
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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.
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What is released during an allergic reaction?
- histamine
- serotonin
- leukotriene
- prostaglandins
- complement
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What are some common meds that cause allergic reactions?
PCN and those related, contrast containing iodine, insulin, NSAIDs, sulfa, chemo, antiseizure med
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What is an idiosyncratic response?
A rare, unpredictable response to a drug, not related to pharmacological properties of the drug
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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
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Nephrotoxicity
Commonly affected by medications.
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Prevention: hydration, monitor labs, adjust doses
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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
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Note changes in behavior, seizures, senses, delirium
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Muscle Toxicity
Drug induced skeletal myopathy is uncommon
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Cardiac muscle toxicity can occur
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Assess for unexplained muscle pain
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Hepatotoxicity
Liver detoxifies majority of drugs
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Hepatotoxicity is a common adverse effect
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Monitor liver function tests with hepatotoxic drugs
Signs of liver impairment can be vague – RUQ pain, N/V, anorexia
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Severe liver impairment can cause toxic drug levels
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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
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Bone Toxicity
- Bone: Often are serious or life-threatening
- Pancytopenia
- Aplastic anemia
- Agranulocytosis and neutropenia – WBCs
- Frequently associated with antineoplastics
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What do pharmacodynamic drug interactionws include?
Pharmacodynamic drug interactions include additive, synergistic, or antagonistic effects.
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Additive effect
Combined summation response
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Synergistic effect
Enhanced response from combined drugs
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Antogonistic effect
Diminished response occurs
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What is an example of drugs with synergistic effects?
Phenergen potentiates the effect of morphine, requiring lower dose of morphine for same effect!
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What are two types of drug interactions and what do they do?
–Inhibition: decreases therapeutic action
–Enhancement: provides greater therapeutic action
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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
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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
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How can drug interactions effect metabolism?
- Hepatic enzyme activity
- Drug inducers
- Drug inhibitors
- Prodrugs
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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
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What are four different ways drug-drug interactions can occur?
- •Increased therapeutic effects
- •Increased adverse effects
- •Decreased adverse effects
- •Decreased therapeutic effects
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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
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What's affected with drug/food interactions and what's a sepcific example of one?
- •Absorption and bioavailability affected
- •Grapefruit juice and CYP3A4 enzyme
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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.
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Vitamin K can decrease effects of...
warfarin (coumadin)
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What do MOAI's interact with?
MOAIs can lead to hypertensive crisis if taken with foods with tyramine (wine and cheese)
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How do we prevent med errors?
Assess, plan, impliment
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What medication class most frequently results in death?
opiates
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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
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