NUR 335 Exam 3 Review Questions and
Correct Answers
Adverse drug reaction (ADR) ✅any noxious, unintended, and undesired effect that
occurs at normal drug doses
Types of ADR ✅Mild: drowsiness, nausea, itching, rash, etc.
Severe: respiratory depression, neutropenia, hepatocellular injury, anaphlyaxis,
hemmorrhage
-ADR are most common in the elderly; 65+ account for 50% of ADR cases
-risk increases with severe illness presents
Side effect ✅-a nearly unavoidable secondary drug effect produced at therapeutic
doses
-generally predictable
-intensity is dose dependent
-i.e drowsiness caused by antihistamines
Toxicity ✅-the degree of detrimental physiologic effects caused by excessive drug
dosing
-any severe ADR regardless of the dose that caused it
Allergic reaction ✅-Immune response; must be a prior sensitization of the immune
system
-Determined primarily by the degree of sensitization of the immune system rather than
by drug dosage
-Intensity of allergic reactions is largely independent of dosage
-Patient's sensitivity to a drug can change over time
-Very few drugs cause severe allergic reactions
-Penicillins are the most common
-Allergies may also be induced by sulfonamides (diuretics, antibiotics, and oral
hypoglycemic agents)
Idiosyncratic effect ✅-An uncommon drug response resulting from a genetic
predisposition
Paradoxical effect ✅-The opposite of the intended drug response
-For example, when using benzodiazepines for sedation to treat insomnia, excitement
may occur instead (especially in children and older adults)
,Iatrogenic Disease ✅-disease that occurs as the result of medical care or treatment
-a disease produced by a physician; also used to refer to a disease produced by drugs
-for example, drugs for antipsychotic disorders can cause Parkinson's-like symptoms
-Sometimes also called drug-induced disease
-Essentially identical to naturally occurring pathology
Physical dependence ✅-a state of which the body has adapted to drug exposure in
such a way that an abstinence syndrome will result if drug use is discontinued
-important to warn patients against abrupt discontinuation of any medication without first
consulting a knowledgeable health professional
Carcinogenic effect ✅-the ability of certain medications and environmental chemicals
to cause cancers
-several drugs used to treat cancer are among these
carcinogenic properties are usually unknown at the time of drug release to the market
Teratogenic effect ✅-drug induced birth defect
Hepatotoxic drugs ✅-as some drugs undergo metabolism by the liver, they are
converted to toxic products that can injure liver cells
-Combining hepatotoxic drugs may increase the risk for liver damage (e.g.,
acetaminophen and alcohol)
-Liver function tests (LFT); monitor aspartate aminotransferase (AST) and alanine
aminotransferase (ALT) enzymes for liver injury
-Watch for signs of liver injury because it can develop quickly between blood tests;
educate patients about jaundice, dark urine, light-colored stools, nausea, vomiting,
malaise, abdominal discomfort, and loss of appetite
QT interval drugs ✅-the ability of some medications to prolong the QT interval on the
electrocardiogram, thereby creating a risk of serious dysrhythmias
-QT interval is the time for the ventricle to repolarize; prolonged is >470msec
-torsades develops
-Most patients are at higher risk, including women, older adults, and patients with
bradycardia, congestive heart failure (CHF), congenital QT prolongation, low potassium,
and low magnesium
-Do not use two QT drugs concurrently
Identifying Adverse Drug Reactions ✅-Can be very difficult to determine whether a
specific drug is responsible for an observed adverse event
-Other factors to consider:
>Underlying illness
>Other drugs
-50% of new drugs have serious ADR that are not revealed during phase 2 and 3 trials
,Questions to ask to help determine whether a particular drug is responsible for an ADR
✅-Did symptoms appear shortly after the drug was first used?
-Did symptoms abate when the drug was discontinued?
-Did symptoms reappear when the drug was reinstituted?
-Is the illness itself sufficient to explain the event?
-Are other drugs in the regimen sufficient to explain the event?
MEDWATCH ✅-This is the FDA reporting service for adverse effects that occur from
use of approved drugs.
Ways to Minimize Adverse Drug Reactions ✅-Responsibility for reducing ADRs lies
with everyone associated with drug production and usage.
-Pharmaceutical industry: Strive to produce the safest medications possible
-Prescriber: select the least harmful drug. Balance potential risks versus probable
benefit.
-Nurse: evaluate patient for ADRs and educate patients and families on h:ow to
minimize harm.
-Patients and families: watch for signs an ADR may be developing and notify health
care provider
-The anticipation of ADRs can help to minimize them; target the evaluation of the
function of any at-risk organs
(liver, kidney, bone marrow)
Important sites of drug toxicity ✅-Liver: Signs of jaundice; monitor liver function tests
-Kidney: Routine urinalysis and serum creatinine level (periodic creatinine clearance
testing)
-Bone marrow: Periodic blood cell counts
-Patients with chronic disorders are especially vulnerable to ADRs.
Medication guides ✅-FDA-approved documents created to educate patients about how
to minimize harm from potentially dangerous drugs
-Required when the FDA has determined that (1) patient adherence to directions for
drug use is essential for efficacy and (2) patients need to know about potentially serious
effects when deciding whether to use a drug
-MedGuide provided any time an RX is filled, even with drug samples
-prescriber can have pharmacy withhold medguide if he believes it will deter the patient
from taking a potentially lifesaving guide; pharmascist must give the info to the patient if
they end up requesting it
Standard format of MedGuides ✅-What is the most important infor I should know about
(drug name)?
- what is (drug name)? Including: a description of the drug and its indications
-who should not take (drug name)?
, How should i take (drug name)? Including: importance of adherence of doing
instructions, special instructions about administration, what to do in case of overdose,
and what to do if a dose is missed
-What should I avoid while taking (drug name)? Including: activities, other drugs, foods,
pregnancy, breastfeeding
-what are the possible or reasonably likely side effects of (drug name)?
-general information about the safe and effective use of prescription drugs
(Black) Boxed warnings ✅-the strongest safety warning a drug can carry and still
remain on the market
-text is presented inside a box with heavy black border
-provides a concise summary of concern, not a detailed explanation
-must appear prominently on package insert, product label, and any advertisements
-must also include MedGuide
Purpose of this warning is to alert prescribers to:
-Potentially severe side effects (for example, life-threatening dysrhythmias, suicidality,
major fetal harm)
-Ways to prevent or reduce harm (for example, avoiding a teratogenic drug during
pregnancy)
Risk Evaluation and Mitigation Strategies (REMS) ✅-A plan to minimize drug-induced
harm
For example, the REMS for isotretinoin is called iPLEDGE
-Isotretinoin can cause serious birth defects
-iPLEDGE was designed to ensure that those who are pregnant or who may become
pregnant will not have access to the drug
Medication Errors ✅-any preventable event that may cause or lead to inappropriate
medication use or patient harm while medication is in the control of the healthcare
professional, patient or consumer
-such events may be related to proffesional practice, healthcare products, procedures,
systems
-major cause of morbidity and mortality.
-injure at least 1.5 million Americans and kill an estimated 7000 people.
Types of medication errors ✅Can be direct or indirect
Wrong:
-patient
-drug
-route
-time
-dose
-dosage form
