Drug Effects and Toxicities Quiz
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Questions and Answers

What are some common symptoms of Stevens-Johnson syndrome (SJS)?

  • Nausea and vomiting
  • Severe headache and dizziness
  • Chest pain and shortness of breath
  • Fever and flu-like symptoms (correct)

Which medication is commonly associated with triggering Stevens-Johnson syndrome?

  • Lisinopril
  • Carbamazepine (correct)
  • Metformin
  • Levothyroxine

What is the primary focus of treatment for Stevens-Johnson syndrome?

  • Reinforcing the immune system
  • Providing long-term medication
  • Managing symptoms and preventing complications (correct)
  • Curing the underlying infection

Which of the following is NOT a trigger for Stevens-Johnson syndrome?

<p>Vaccinations (C)</p> Signup and view all the answers

Which of the following anticonvulsants is associated with an increased risk of developing Stevens-Johnson syndrome?

<p>Lamotrigine (C)</p> Signup and view all the answers

What is a characteristic of a side effect from medication?

<p>Occurs at therapeutic dose (D)</p> Signup and view all the answers

Which of the following describes an adverse effect of drugs?

<p>Harmful and usually requires intervention (C)</p> Signup and view all the answers

What does a black box warning indicate?

<p>Potential for severe adverse effects (B)</p> Signup and view all the answers

Which drug is known to cause nephrotoxicity?

<p>Aminoglycosides (A)</p> Signup and view all the answers

What is a common symptom of anaphylaxis?

<p>Chest tightness (B)</p> Signup and view all the answers

Which condition is known for potentially causing painful shedding of skin and mucous membranes?

<p>Stevens-Johnson syndrome (C)</p> Signup and view all the answers

Which drug interaction involves the consumption of green leafy vegetables?

<p>Warfarin (A)</p> Signup and view all the answers

What type of toxicity is characterized by the damage to the heart, potentially leading to prolonged QT intervals?

<p>Cardiotoxicity (D)</p> Signup and view all the answers

What is a recommended strategy for preventing medication errors?

<p>Use barcode technology to scan and confirm (A)</p> Signup and view all the answers

Which physiological change in the elderly increases the risk of renal injury related to medication use?

<p>Decreased kidney function (D)</p> Signup and view all the answers

What constitutes polypharmacy?

<p>Taking 5 or more medications (A)</p> Signup and view all the answers

Which medication class is associated with sedation and confusion in elderly patients?

<p>Benzodiazepines (C)</p> Signup and view all the answers

What is one of the proposed strategies to enhance medication adherence in elderly clients?

<p>Utilize large font on pill bottles (C)</p> Signup and view all the answers

Which synergistic effect occurs when two drugs combined have a total effect equal to the sum of their individual effects?

<p>Synergism (C)</p> Signup and view all the answers

How does the liver function change with age, affecting medication metabolism?

<p>Decreased ability to metabolize medications (D)</p> Signup and view all the answers

Which herbal supplement is indicated for post-menopausal symptoms but has potential hepatotoxic effects?

<p>Black Cohosh (A)</p> Signup and view all the answers

What adverse effect is commonly associated with the use of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) in elderly patients?

<p>GI bleeding (B)</p> Signup and view all the answers

Which of the following medications is contraindicated in patients with existing renal disorders?

<p>Aloe (D)</p> Signup and view all the answers

What effect do opioids have on elderly patients that increases their risk of serious side effects?

<p>Can lead to sedation and reduced breathing (A)</p> Signup and view all the answers

Which dietary supplement is exempt from FDA regulation under the DSHEA?

<p>Herbal products (D)</p> Signup and view all the answers

What is a common complication of polypharmacy in elderly patients?

<p>Reduced adherence to prescriptions (A)</p> Signup and view all the answers

Flashcards

Side effect

A predictable and expected effect of a medication that occurs at therapeutic dose.

Adverse effect

A harmful or undesirable effect of a medication that may occur at or above therapeutic dose.

Black Box Warning

A label warning from the FDA about the potential for serious adverse effects of a medication.

Allergic reaction

An immune-mediated response that occurs relatively rapidly after administration of a medication. It can range from mild itching to life-threatening anaphylaxis.

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Teratogenicity

Damage to the developing fetus that can cause birth defects.

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Nephrotoxicity

Damage to the kidneys.

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Hepatotoxicity

Damage to the liver.

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Cardiotoxicity

Damage to the heart, potentially leading to dangerous heart rhythm abnormalities.

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Stevens-Johnson Syndrome (SJS)

A serious skin reaction that causes painful blisters and sores, often triggered by medications, infections, or other factors.

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Antibiotics

A common trigger for SJS, including antibiotics like Sulfonamides, Penicillins, and some Cephalosporins.

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Anticonvulsants

Another class of medications that can cause SJS, such as Carbamazepine, Lamotrigine, Phenytoin, and Valproate.

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Non-steroidal anti-inflammatory drugs (NSAIDs)

A type of medicine that could trigger SJS, including Ibuprofen and Diclofenac.

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Allopurinol

A medication used for Gout that might lead to SJS.

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Weaker Hearts in the Elderly

Reduced cardiac output in the elderly leads to less efficient medication circulation.

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Blood Pressure Changes in the Elderly

Decreased vascular control in the elderly increases the risk of orthostatic hypotension, bradycardia, tachycardia, and subsequent falls, fractures, and immobility.

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Reduced Kidney Function in the Elderly

Reduced kidney function in the elderly results in a decreased ability to eliminate medications, increasing the risk of renal injury.

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Reduced Liver Function in the Elderly

Decreased liver function in the elderly leads to a reduced ability to break down medications, resulting in increased drug accumulation.

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Decreased Muscle Mass in the Elderly

Reduced muscle mass in the elderly decreases the volume of distribution for medications, leading to increased drug accumulation.

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Thinner Skin in the Elderly

Thinner skin in the elderly makes topical medications more effective.

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Polypharmacy

The use of five or more medications, increasing the risk of drug interactions and adverse effects. Complicated drug regimens can also lead to reduced adherence.

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Beers Criteria

A list of medications that should be used with caution in elderly clients due to an increased risk of adverse effects.

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Synergism

A condition where the combined effect of two drugs is equal to the sum of their individual effects.

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Agonism

A condition where the combined effect of two drugs is greater than the sum of their individual effects.

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Antagonism

A condition where the combined effect of two drugs is less than the sum of their individual effects.

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GABA (gamma-amino butyric acid)

An amino acid neurotransmitter in the central nervous system (CNS) that inhibits nerve transmission and reduces neuronal excitation.

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Dietary Supplement Health and Education Act (DSHEA)

Dietary supplements are exempt from FDA standards, treating them like food.

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Herbal Medications

Nutritional supplements sold without a prescription and lacking FDA approval.

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Alternative Medicine

Therapies that fall outside of conventional medicine, such as naturopathy, yoga, hypnosis, and acupuncture.

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Study Notes

Drug Effects

  • Side Effect: A predictable and expected effect occurring at a therapeutic dose
  • Adverse Effect: A harmful and undesirable effect that can occur at or above a therapeutic dose.
  • Black Box Warning: FDA warning label indicating potential severe adverse effects.
  • Allergic Reaction: An immune-mediated response, often rapid, after medication administration.
    • Mild: Pruritis (itching), rash
    • Anaphylaxis: Severe reaction involving multiple body systems, treated with epinephrine.
      • Respiratory: Chest tightness, airway swelling, hoarseness, wheezing, trouble breathing
      • Cardiovascular: Chest pain, hypotension (low blood pressure), rapid heart rate
      • Skin: Hives (urticaria), flushing, itching (pruritis), swelling of face/throat/tongue (angioedema)
      • CNS: Anxiety, headache, confusion, drowsiness
      • GI: Nausea/vomiting, diarrhea, cramping

Toxicities

  • Teratogenicity: Causing harm to a developing fetus, leading to birth defects
  • Nephrotoxicity: Kidney damage.
    • Monitor blood urea nitrogen (BUN) and creatinine levels.
    • Drug causes: Diuretics, ACE inhibitors/Angiotensin receptor blockers, aminoglycosides, metformin, NSAIDs
  • Hepatotoxicity: Liver damage.
    • Monitor liver function tests (LFTs).
    • Signs/Symptoms: Jaundice
  • Neurotoxicity: Brain or nerve damage.
    • Signs/Symptoms: Headaches, neuropathy, confusion
  • Dermatologic toxicity: Skin damage.
    • Rash, itching (pruritis), swelling (angioedema), photosensitivity, Stevens-Johnson Syndrome (SJS)
    • Drug causes: Antiepileptic drugs, sulfa drugs
  • Ototoxicity: Ear damage.
    • Tinnitus, hearing loss
    • Drug causes: Aminoglycosides (e.g., gentamicin)
  • Musculoskeletal toxicity: Muscle or tendon damage.
    • Statin drugs can cause rhabdomyolysis.
    • Fluoroquinolone antibiotics (e.g., levofloxacin, ciprofloxacin) can cause tendonitis/rupture
  • Bone marrow suppression: Damage to bone marrow, affecting red blood cells (RBCs), white blood cells (WBCs), and platelets.
    • Low RBCs → anemia, fatigue, paleness, weakness, falls
    • Low WBCs → fever, infection, cough
    • Low platelets → bleeding, bruising, petechiae
    • Drug causes: Antineoplastic agents
  • Cardiotoxicity: Heart damage.
    • Prolonged QT interval can lead to Torsades de Pointes (potentially fatal abnormal heart rhythm).
    • Drug causes: Doxorubicin

Drug Interaction

  • A change in how a drug acts when combined with another drug, food, or substance.
    • Warfarin: Interfered with by green leafy vegetables (high vitamin K)
    • Statins: Interfered with by grapefruit juice
    • Acetaminophen (Tylenol): Interfered with by alcohol
    • MAOI antidepressants: Interfered with by cheese, cured meats, ripe fruit

Stevens-Johnson Syndrome (SJS)

  • A severe, potentially life-threatening skin condition.
  • Characterized by painful skin shedding and mucous membrane involvement.
  • Often triggered by medications, infections, or other factors.
  • Symptoms include fever, flu-like symptoms, blisters, and sores.
  • Requires immediate medical attention.
  • Triggering Medications (examples): Antibiotics, Anticonvulsants, NSAIDs, Allopurinol, HIV drugs, psychiatric medications, some chemotherapy agents

Medication Error Reduction Strategies

  • Stay updated on knowledge
  • Stick to known procedures
  • Scan & confirm (e.g., with barcode technology)
  • Consult with interdisciplinary teams
  • Write everything down
  • Store look-alikes and sound-alikes separately
  • Double-check "high-alert" medications
  • Double-check neonatal prescriptions

Geriatric Care

  • Physiological Changes:
    • Reduced cardiac output
    • Weakened vascular control (orthostatic hypotension, bradycardia, tachycardia)
    • Reduced kidney function / drug elimination
    • Reduced liver function / drug metabolism
    • Decreased muscle mass/distribution
    • Thinner skin
  • Polypharmacy: ≥5 medications. Increased risk of drug interactions and adverse effects. Complicated regimens may reduce adherence
  • Beers Criteria: List of medications to use cautiously in elderly clients due to higher adverse effects. (Certain antibiotics, antipsychotics, benzodiazepines, digoxin, muscle relaxants, NSAIDs, opioid analgesics, blood thinners)

Strategies for Improving Medication Adherence

  • Non-safety caps for pill bottles
  • Use large font on bottles/instructions
  • Provide detailed instructions to patients/caregivers
  • Pill reminders
  • Simplify the drug regimen

Complementary and Alternative Medicines

  • DSHEA (Dietary Supplement Health and Education Act): Exempts supplements from FDA standards, treating them like food.
  • Herbal Medications: Nutritional supplements sold without prescription, lacking FDA approval.
  • Alternative Medicine: Therapies outside conventional medicine (e.g., naturopathic medicine, yoga, hypnosis, acupuncture).
  • Synergism: Combined effect = sum of individual effects
  • Agonism: Combined effect > sum of individual effects
  • Antagonism: Combined effect < sum of individual effects
  • GABA: Neurotransmitter inhibiting nerve transmission in the CNS

Herbal Supplements

  • (Extensive list of herbal supplements) with their uses, mechanisms, effects, and contraindications. (Note: This is a summarization, full information about each is provided).

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Description

Test your knowledge on drug effects, including side effects, adverse reactions, and allergic responses. This quiz covers essential concepts like black box warnings and teratogenicity. Prepare to challenge your understanding of medication impacts on the human body.

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