Focus on Nursing Pharmacology Chapter 3

Adverse Drug Reaction
Undesired effects of drugs that may are unpleasant but may also be dangerous

Reasons Adverse Drug Reactions Occur
The drug may have other effects on the body besides the therapeutic effect.
The patient is sensitive to the drug being given.
The drug’s action on the body causes other responses.
The patient is taking too much or too little of the drug.

Types of Adverse Reactions p. 34
Primary Actions
Secondary Actions
Hypersensitivity Reactions

Primary Actions
Overdose; extension of the desired effect

Secondary Actions
Undesired effects produced in addition to the pharmacologic effect

Hypersensitivity Reactions
Excessive response to primary or secondary effect of drug

Types of Drug Allergies
P 35 Table 3.1
Anaphylactic Reaction
Cytotoxic Reaction
Serum Sickness Reaction
Delayed Allergic Reaction

Drug-Induced Tissue and Organ Damage
p. 36 figure 3-1
Renal damage, ocular damage, CNS effects, liver damage, bone marrow depression, teratogenicity, dermatological reactions, allergic reactions, auditory damage, stomatitis

Dermatological Reactions
May need to discontinue the medication

Inflammation of the mucous membranes
Frequent mouth care

Destruction of the body’s normal flora
Fever, diarrhea, vaginal discharge
Supportive care (mouth and skin care), administer antifungal medications, may need to stop drug responsible for the infection

Blood Dyscrasia
Bone marrow suppression
Fever, chills, weakness
Monitor blood counts, protective isolation

Drug effects the body in a noxious way

Fever, nausea, jaundice, change in color of urine or stool, elevated liver enzymes
Discontinue medication

Toxicity Kidney
Change in urinary pattern, elevated BUN and creatinine
Notify physician, may need to stop medication or decrease the dosage

Occurs when an overdose of a drug damages multiple body systems.
Damage to multiple systems can lead to a fatal reaction.

Altered Glucose Metabolism
Hypoglycemia-Assessment Finding: Low serum blood glucose level
Intervention: Restore glucose to the body (D50)
Assessment Finding: High serum glucose level
Intervention: Administer medications to decrease glucose level (insulin)

Electrolyte Imbalance
Hypokalemia Hyperkalemia

Assessment Finding: Increase in serum potassium level
Interventions: Decrease the serum potassium concentration (Sodium Polystyrene Sulfonate), monitor serum levels of potassium, and monitor cardiac rhythm

Assessment Finding: Decrease in serum potassium levels
Interventions: Replace serum potassium (IV or oral supplement) and monitor serum levels of potassium

Sensory Effects
Ocular Toxicity
Assessment Findings: Visual changes
Interventions: Monitor for any visual changes when giving any medication that is known to cause ocular damage; discontinue medication after notifying physician.

Auditory Damage
Assessment Findings: Damage to the eighth cranial nerve
Interventions: Monitor for hearing loss; discontinue medication after notifying physician if a decrease in hearing is noted on assessment.

Neurological Effects
General Central Nervous System (CNS) Effects
Assessment Findings: Altered level of consciousness
Interventions: Prevent injury

Atropine-like (Anticholinergic) Effects
Assessment Findings: Dry mouth, urinary retention, blurred vision
Interventions: Sugarless lozenges to keep mouth moist; have the patient void before administration of the medication

Neurological Effects (cont.)
Parkinson-like Syndrome
Assessment Findings: Muscle tremors and changes in gait
Interventions: Discontinue medication
Neuroleptic Malignant Syndrome
Assessment Findings: Extrapyramidal symptoms
Interventions: Discontinue medication

Teratogenicity: Any drug that causes harm to the developing fetus or embryo

Teaching to prevent teratogenicity
Advise the pregnant woman that any medication may have possible effects on the baby.
Weigh the actual benefits against the potential risks.
Discuss with pregnant women that they should not take medications without checking with their health care provider first.

■ No drug does only what is desired of it. All drugs have adverse effects associated with them.
■ Adverse drug effects can range from allergic reactions to tissue and cellular damage. The nurse, as the health care provider most associated with drug adminis-tration, needs to assess each situation for potential adverse effects and intervene appropriately to mini-mize those effects.
■ Adverse effects can be extensions of the primary action of a drug or secondary effects that are not necessarily desirable but are unavoidable.
■ Allergic reactions can occur when a person’s body makes antibodies to a drug or drug protein. If the person is exposed to that drug at another time, an immune response may occur. Allergic reactions can be of various types. The exact response should be noted to avoid future confusion in patient care.
■ Tissue damage can include skin problems, mucous membrane inflammation, blood dyscrasias, super-infections, liver or renal toxicity, poisoning, hypo-glycemia or hyperglycemia, electrolyte disturbances, various CNS problems (ocular damage, audi-tory damage, atropine-like effects, Parkinson-like syndrome, NMS), and teratogenicity.

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