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Chapter 7 - Adverse Drug Reaction and Medication Errors

Chapter 7 - Adverse Drug Reaction and Medication Errors

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Published by dlneisha61

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Published by: dlneisha61 on Mar 18, 2009
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03/07/2014

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C
HAPTER
7A
DVERSE
D
RUG
R
EACTIONS
& M
EDICATION
E
RRORS
I. Adverse Drug Reactions (ADR)
- any noxious, unintended, and undesired effect that occurs at normal drugdoses, excludes undesiredeffects that occur when dosage is excessive (defined by the WorldHealth Organization)- can range in intensity from annoying to life threatening- when drugs are used properly, many ADR can be avoided or at least keptto a minimum
A. S
COPE
 
OF
 
THE
P
ROBLEM
 
- drugs can adversely affect all body systems in varying degrees of intensity- mild reactions include drowsiness, nausea, itching, and rash- severe reactions include respiratory depression, neutropenia (profoundloss of neutrophilic white bloodcells, hepatocellular injury, anaphylaxis, and hemorrhage – all of which can result in death- adverse effects are
most common in the elderly and very young
- severe illness also increases the risk of an ADR- adverse events are more common in patients receiving multiple drugs
B. D
EFINITIONS
 1. Side Effect
– a nearly unavoidable secondary drug effect produced attherapeutic doses- intensity is dose dependent and generally predictable- response can develop soon after the onset of the drug use or aslong as weeks or monthslater- ex. Antihistamines causing drowsiness
2. Toxicity
– an adverse drug reaction caused by excessive dosing- today the term has come to mean any severe ADR, regardless of the dose that caused it- anticancer drugs cause neutropenia putting patients at high risks of infection even though thedosage is therapeutic- ex. Overdose of morphine causing a coma or severe hypoglycemiafrom an overdose of insulin
3. Allergic Reaction
– an immune response- once the immune system has been sensitized to a drug, re-exposure to that drug can triggeran allergic response-
intensity is largely independent of dosage
 
- very few medications cause severe allergic reactions; in fact, themost serious reactions arecaused by just one drug family --
 penicillins
- reactions can range from mild itching to sever rash to anaphylaxis- reactions are determined primarily by the degree of sensitization of the immune system – notby drug dosage
anaphylaxis
– a life-threatening response characterized bybronchospasm, laryngealedema, and a precipitous drop in blood pressure
4. Idiosyncratic Effect
– an uncommon drug response resulting from agenetic predisposition
5. Iatrogenic Disease
– a disease produced by a physician- derived from the Greek word iatros = physician and –genic = toproduce- also used to denote a disease produced by drugs- nearly identical to idiopathic (naturally occurring) diseases- ex. Patients taking certain antipsychotic drugs may develop asyndrome whose symptomsclosely resemble those of Parkinson’s disease
6. Physical Dependence
– a state in which the body has adapted toprolonged drug exposure in such away that an abstinence syndrome will result if drug use isdiscontinued- develops during long term use- precise nature of the abstinence syndrome is determined by thedrug involved- usually associated with “narcotics” (heroin, morphine, and otheropioids); however, these arenot the only dependence-inducing drugs- patients should be warned against abrupt discontinuation of anymedication without firstconsulting a knowledgeable health professional- people heal better when not in pain –
DO NOT WITHHOLDMEDICATIONS DUE TOPHYSICAL DEPENDENCY 7. Carcinogenic Effect
– ability of certain medications and environmentalchemicals to cause cancers- several drugs used to treat cancer are among the drugs with thegreatest carcinogenicpotential- unlikely that carcinogenic potential will be detected duringpreclinical and clinical drug trials
 
- ex. Diethylstilbestrol (DES) – synthetic hormone with actions similarto estrogen was at onetime used to prevent spontaneous abortion during high-riskpregnancies. It wasn’t untilyears later when vaginal and uterine cancers developed infemales who had beenexposed to this drug in utero.
8. Teratogenic Effect
– a drug-induced birth defect- capable of causing birth defects- ex. Accutane for acne
C. O
RGAN
S
PECIFIC
T
OXICITY 
 
- many drugs are toxic to specific organs- examples include: injury to the
kidneys
caused by amphotericin B(antifungal drug)injury to the
heart
caused by amiodarone(antidysrhythmic drug)injury to the inner ear caused by aminoglycosideantibiotics (e.g., gentamicin)
1. Hepatotoxic Drugs
- drugs are the leading cause of acute liver (primary site of drugmetabolism) failure,
a rare
 
condition
that can rapidly prove fatal (most cases end with aliver transplant or indeath)- as some drugs undergo metabolism, they are converted to toxicproducts that can injure livercells (most common reason for withdrawing drugs from themarket)- signs of liver injury include jaundice (yellow skin and eyes), darkurine, light-colored stools,nausea, vomiting, malaise, abdominal discomfort, loss of appetite- patients taking hepatotoxic drugs should undergo liver functiontests (LFTs) at baseline andperiodically thereafter- ex. Combination of acetaminophen (Tylenol, others) with alcohol
2. QT Interval Drugs
– ability of some medications to prolong the QTinterval on the electrocardiogram,thereby creating a risk of serious disrhythmias- QT interval is a measure of the time required for the ventricles torepolarize after eachcontraction; when the interval is prolonged, patients candevelop dysrhythmia called
torsades de pointes
which can lead to potentially fatalventricular fibrillation

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