Pharmacology Chapters 7 And 8

Front 1

What is an adverse drug reaction as defined by WHO?

Back 1

any noxious, unintended, and undesired effect that occurs at normal drug doses

Front 2

Name some of the adverse drug reaction symptoms

Back 2

mild-drowsiness, nausea, itching, rash

severe-neutropenia, hepatocellular injury, cardiac dysrhythmias, anaphylaxis, hemorrhage

Front 3

In whom do adverse drug reactions most commonly occur?

Back 3

elderly and very young, patients over 60 account for 50%

Patients with severe illness and on multiple drugs

Front 4

Define side effect

Back 4

a nearly unavoidable secondary drug effect produced at therapeutic doses. they are predictable and dose dependent. some develop when drug started others take weeks or months

Front 5

Define toxicity

Back 5

adverse drug reaction caused by excessive dosing

Front 6

define allergic reaction and list symptoms

Back 6

It is an immune response. Must be prior sensitization with re-exposure triggering an allergic reaction

Symptoms include mild itching to severe rash

Front 7

explain anaphylactic response

Back 7

life-threatening response characterized by bronchospasm, laryngeal edema, and drop in blood pressure. response is independent of dosage

Front 8

list medications known to cause a allergic reaction

Back 8

penicillins, nonsteroidal anti-inflammatory drugs, sulfonamide group of compounds (diuretics,"", antibiotics, and oral hypoglycemic agents

Front 9

define idiosyncratic effects

Back 9

uncommon drug response resulting from a genetic predisposition

Front 10

Define iatrogenic disease

Back 10

disease produced by physician

patients taking certain anipsychotic drugs may develop a syndrome whose symptoms resemble parkinson's disease

Front 11

Identify physical dependence

Back 11

body has adapted to drug exposure that an abstinence syndrome will occur if stopped.

often associated with narcotics and centrally acting drugs

Front 12

define carcinogenic effect

Back 12

ability of medication and environmental chemicals to cause cancer

Front 13

define teratogenic effects

Back 13

drug-induced birth defect

Front 14

List organ specific toxicity

Back 14

kidneys, heart, lungs, inner ear, liver, altered cardiac function causing prolonged QT interval

Front 15

Discuss the process of liver damage

Back 15

LIver is primary site of drug metabolism. as some drugs are metabolized they are converted to toxic products. combining a hepatotoxic drug with other drugs increases risk of liver damage

Front 16

What precautionary blood test should be done on patients taking hepatotoxic drugs? and how often

Back 16

aspartate aminotransferase (AST) and alanine aminotransferase (ALT)

should be performed every 3 months

Front 17

list signs of liver injury

Back 17

jaundice, dark urine, light colored stools, nausea, vomiting, malaise, abdominal discomfort, loss of appetite

Front 18

Define QT interval

Back 18

QT is a measure of the time required for the ventricles to depolarize after each contraction. When QT interval is long results in dysrhythmia called torsades de pointes causing fatal ventricular fibrillation

>470msec males
>480 msec females

all drugs must be tested for QT interval

Front 19

List patients at risk for increased QT interval

Back 19

elderly, patients with bradycardia, heart failure, congenital QT malformation, women (have longer QT interval than men)

Front 20

Questions to ask when identifying an ADR

Back 20

did symptoms appear after drug first used?
did symptoms abate after DC?
did symptoms reappear when drug restarted?
does illness explain event?
did any other drugs explain event?y

Front 21

Many new drugs do not have ADR present until after release. What should you fill out if you suspect an ADR with a newly released drug?

Back 21

MedWatch, FDA medical products reporting form and postmarketing drug safety evaluation

Front 22

List sights of drug toxicity

Back 22

Liver, bone marrow, kidneys

LIver-monitor LFT
bone marrow-monitor CBC
kidney-monitor creatinine and urinalysis

Front 23

What is the purpose of the medication guide?

Back 23

required by FDA, printout on all medications when received from pharmacy. intended to educate patient on important information concerning drug (name, who should not take it, how to take, what to avoid, side effects, general info

Front 24

Define boxed warning

Back 24

black box warning si the stingiest safety warning a drug can carry and still remain on the market. It alerts prescribers to severe effects, gives ways to avoid harm, provides concise summary of adverse effects

Front 25

What is REMS and iPLEDGE

Back 25

risk mitigation strategy is a plan to minimize drug induced harm

iPledge is a program for women who are pregnant or about to become pregnant to not be prescribed these medications as they cause severe birth defects

Front 26

Define a medication error

Back 26

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

Front 27

List the types of medication errors

Back 27

wrong patient, wrong drug, wrong route, wrong time, wrong dose, overdose, underdone, extrados, omitted dose, wrong dosage form, wrong dilutent, wrong strength/concentration, wrong infusion rate, wrong technique, deteriorated drug (expired), wrong duration of treatment

Front 28

List the 3 main causes of medication error leading causing death that the IOM identified

Back 28

human factors, communication mistakes, name confusion

see page 75

Front 29

Individual responses to drugs are related to what?

Back 29

body weight and composition, age, pathophysiology,

Front 30

Why are infants sensitive to drug therapy?

Back 30

immature organs

Front 31

Why are the elderly sensitive to drug therapy?

Back 31

severity of illness, presence of multiple pathologies, treatment with multiple drugs

Front 32

Kidney disease reduces drug_________________

Back 32

excretion, causing drugs to accumulate in the body

Front 33

LIver disease causes drug levels to _____________

Back 33

increase

Front 34

Digoxin toxicity is directly related to what electrolyte

Back 34

potassium

If low, dysrhythmias occur

Front 35

Define tolerance

Back 35

decreased responsiveness to a drugs as a result of repeated drug administration

Front 36

Name three types of drug tolerance

Back 36

1. pharmacodynamic tolerance
2. metabolic tolerance
3. tachyphylaxis

Front 37

Define pharmacodynamic tolerance

Back 37

related to long-term use of drugs such as morphine and heroin. it is result of adaptive processes that occur in response to chronic receptor occupation

Front 38

Define metabolic tolerance

Back 38

tolerance resulting from accelerated drug metabolism

caused by ability of certain drugs to induce synthesis of hepatic drug metabolizing enzymes causing drug metabolism to increase. dosage must increase to maintain therapeutic drug levels

Front 39

Define tachyphylaxis

Back 39

reduction in drug responsiveness brought on by repeated dosing over a short time, it is not common

example is a transdermal nitro patch which looses effectiveness in 24 hours

Front 40

Define placebo

Back 40

preparation devoid of intrinsic pharmacologic activity. any reaction is based on psychological response. primary purpose is control preparation during clinical trial

Front 41

Discuss variations in drug absorption

Back 41

caused by variation in manufacturing, presence or absence of food, diarrhea, constipation, and difference in gastric emptying time

Front 42

Define bioavailability

Back 42

ability of a drug to reach the systemic circulation from tis site of administration. occur mainly with oral preparations

Front 43

Difference in bioavailability are greatest concern with drugs with a ______________therapeutic range and why?

Back 43

Narrow

A small decline in drug may cause therapeutic failure while and increase may cause toxicity

Front 44

Define pharmacogenomics

Back 44

study of of how genetic variations can affect individual responses to drugs

Front 45

Identify the drugs in which genetic testing is required and recommended

Back 45

maraviroc (selzentry)and trastuzumab (herceptin)

recommended for coumadin (warfain)and tegretol (carbamazepine)

Front 46

What mechanism does genetic alter

Back 46

drug metabolism

Front 47

List the variant and related drug that can be altered

Back 47

Decreases drug metabolism
CYP2D6-tamoxifen for breast cancer, inability to convert codeine to morphine
CYP2C19-Plavix
white americans-isoniazid 52% metabolize slow, 48% fast due to N-acetyltransferase forms

increases drug metabolism
CYP2C9-coumadin
TPMT acitivity reduce-thiopurine or mercaptopurine

In US !% of population does not produce dihydropyrimidine dehydrogenase and does not metabolize fluorouracil (anticancer)

Front 48

List to genetic variants that affect drug targets on normal cells

Back 48

ADRB1 and VKORC1 (pg 85 for discussion)

Front 49

Genetic variants affect the immune system and increase the risk of severe hypersensivity reactions. What is the gene

Back 49

HLA-B 1502 and HLA-B 5701

Front 50

List differences in drug metabolism between men and women

Back 50

Digoxin may increase mortality in women
Alchol is metabolized more slowly by women
Opiods are more effective in women
Quinidine causes greater QT interval in women than men

Front 51

Define drug interaction

Back 51

process in which one drug alters the effects of another

Front 52

How can diet alter drug responses?

Back 52

Poor nutrition does not enable drugs to elicit therapeutic responses. Starvation reduces protein binding of drugs , level of free drug rises, making response more intense