LEHNE’S PHARMACOTHERAPEUTICS FOR ADVANCED PRACTICE NURSES AND PHYSICIAN ASSISTANTS FINAL EXAM QUESTIONS AND THEIR COMPLETE CORRECT SOLUTIONS

Define adverse drug reaction Any noxious, unintended, and undesired effect that occurs at normal drug doses Define allergic reaction An immune response triggered by re-exposure of a previous immune system sensitizing drug. Define carcinogenic effect The ability of certain medications and environmental chemicals to cause cancers. Define hepatotoxic drugs Drugs that, after metabolism in the liver, are converted to toxic products that can injure liver cells. Define iatrogenic disease. A disease that occurs as the result of medical care or treatment. A disease produced by drugs. Define idiosyncratic effect An uncommon drug response resulting from a genetic predisposition. *Ex:) when people with glucose-6-phosphate dehydrogenase (G6PD) deficiency take drugs such as sulfonamides or aspirin, they develop varying degrees of red blood cell hemolysis, which may become life threatening. Define medication error Any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer. Define organ-specific toxicity Many drugs are toxic to specific organs. Special attention to drugs that cause liver injury (hepatotoxic) and altered cardiac function, as evidenced by prolonged QT interval on the ECG (QT interval drugs) Define physical dependence A state in which the body had adapted to drug exposure in such a way that an abstinence syndrome will result if drug use is discontinued. Develops during long-term use of certain drugs, such as opioids, alcohol, barbiturates, and amphetamines. Patients should be warned against abrupt discontinuation of any medication without first consulting a health professional. Define QT interval drugs The ability of some medications to prolong the QT interval on the ECG, thereby creating a risk of serious dysrhythmias. QT interval is a measure of the time required for the ventricles to repolarize after each contraction. When the QT interval is prolonged, patients can develop a dysrhythmia known as torsades de pointes, which can progress to potentially fatal ventricular fibrillation Define side effect A nearly unavoidable secondary drug effect produced at therapeutic doses. Side effects are generally predictable, and their intensity is dose dependent. Ex:) drowsiness caused by traditional antihistamines Ex:) gastric irritation caused by aspirin Define teratogenic effect A drug-induced birth defect. Medicines and other chemicals capable of causing birth defects are called teratogens. Define toxicity The degree of detrimental physiologic effects caused by excessive drug dosing. Ex:) respiratory depression from an overdose of morphine Ex:) hypoglycemia from an overdose of insulin Define paradoxical effect The opposite of the intended drug response. Ex:) insomnia and excitement that may occur when some children and older adults are given benzodiazepines for sedation. Which patients are at an increased risk of adverse drug events? - the very young - older adults (65+) - those taking multiple drugs What is the intensity of an allergic drug reaction based on? What is it not based on? - the degree of immune system sensitization - it is not based on drug dosage. What is the most common cause of acute liver failure? - drugs (hepatotoxic) What is the most common reason for removing drugs from the market? Hepatotoxicity What is the risk of drugs that prolong the QT interval? Torsades de pointes, a dysrhythmia that can progress to fatal ventricular fibrillation. When is a drug able to cause adverse effects that are as yet unreported? At the time a new drug is released. When a new drug is released for general marketing, the drug's carcinogenic potential is usually unknown. Which measures should be used to minimize adverse drug events in patients? - avoiding drugs that are likely to harm a particular patient - monitoring the pt for s/s of likely adverse effects - educating the pt about possible adverse effects - monitoring organs that are vulnerable to a particular drug What might the FDA require of manufacturers to reduce the risk of serious reactions to certain drugs? - creation of a MedGuide for patients (boxed warning to alert prescribers) - and/or a Risk Evaluation and Mitigation Strategy, which may involve patients, prescribers, and pharmacists What is a major cause of morbidity and mortality? Medication errors Who is capable of making a medication error? - pharmaceutical workers - pharmacists - prescribers - transcriptionists - nurses - patients - patient's families How many people process a medication order in the hospital? Of these people, each are in a position to do what? Medication orders are processed by several people in a hospital. Each is in a position to introduce errors and to catch errors made by others. Who is the patient's last line of defense against medication errors?