Pharmacology Week 2: Interactions And Adverse Reactions

Adverse Drug Reactions (ADR) ARE the nontherapeutic, unintended effects of a drug that occur at a therapeutic dose. They may be predictable, well known, or unpredictable and not well known. They can also range from annoying yet tolerable to life threatening.

Environment is not a part of the Right of medication administration

Epinephrine

(Causes vasoconstriction to reduce third spacing and bronchodilation to open airways)

Corticosteroids (to prevent delayed reaction)

An additive drug effect happens when 1 Drug + 1 Drug = 2 Drug effects in 1

Synergism and poteniation is when 1 Drug + 1 Drug = 3 Drug effects in 1 (Oxycodone and Tylenol are often given together because they both make the other work better 1 + 1 = 3)

An anaphylactic reaction is considered Hypersensitivity Type I

The Joint Commission requires Two patient identifiers when giving a medication (Typically name and date of birth are used)

The given answer states that the drug to drug interactions increase by 20% for 2 drugs and approximately 90% for 5 drugs. This means that when two drugs are taken together, there is a 20% increase in the likelihood of interactions occurring. Similarly, when five drugs are taken together, the likelihood of interactions increases by approximately 90%. This suggests that the more drugs are taken simultaneously, the higher the risk of potential interactions between them.

Poly-pharmacy describes the concurrent use of multiple medications that are often medically unnecessary. Current data indicates that upwards of 40% of elderly patients living in their own homes and 21% of adults with intellectual disability are experiencing poly-pharmacy.

Abnormal plasma or serum electrolyte concentration affecting certain drug therapies would be an example of a drug-lab interaction.

Medication orders typically include the client's name, date/time of the order, medication name, medication dosage, administration route, timing and frequency, parameters/indications, and the signature of the provider ordering the medication. These elements are necessary for ensuring accurate and safe medication administration. The client's name is needed to ensure that the medication is intended for the correct individual. The date/time of the order is important for tracking when the medication was prescribed. The medication name, dosage, administration route, timing and frequency, and parameters/indications provide specific instructions for the medication administration. The signature of the provider ordering the medication is necessary for accountability and legal purposes.

Medication errors are PREVENTABLE

Antihistamines (diphenhydramine (aka Benadryl) is usually the drug of choice)

During a Hypersensitivity Type I reaction, the body produces antibodies, typically IgE, in response to an allergen. This leads to the activation of mast cells, which release histamine. This histamine release causes vasodilation, smooth muscle spasm/contraction, and increased membrane permeability, resulting in a systemic or localized reaction in specific tissues or organs. Excessive mucous production and forceful coughing due to dermatitis are not associated with a Hypersensitivity Type I reaction.

Provider concerns related to OTC medications include unclear ingredients, self-diagnosis and treatment, overdose risk, and risk of drug-drug interactions. Providers may be concerned about the lack of transparency regarding the ingredients in OTC medications, as this can affect their ability to effectively treat their patients. They may also be concerned about patients self-diagnosing and treating their conditions without proper medical guidance, which can lead to incorrect treatment and potential harm. Providers are also mindful of the risk of overdose with OTC medications, as patients may not always follow dosage instructions correctly. Additionally, providers are concerned about the potential for drug-drug interactions when patients take multiple OTC medications simultaneously, which can have adverse effects.

Steven-Johnson Syndrome is a rare and serious reaction to medications or infections (especially antibiotics) which requires immediate and advanced intervention. Often times the symptoms can be confused with Hand, Foot, and Mouth disease.

A photoallergic reaction occurs when ultraviolet exposure alters the chemical structure of a drug, causing the body's immune system to recognize it as a foreign substance. This recognition triggers an allergic response, leading to inflammation of the skin in areas exposed to the sun. The terms "photoallergic" and "photoallergy" are used to describe this specific type of allergic reaction caused by sunlight.

Remove offending agent first to stop the progression of allergic reaction. Reverse effects of biochemical mediators to relieve symptoms, promote adequate tissue perfusion to restore blood pressure and reestablish homeostasis.

I tend to think that preserving and supporting a patient's ABC's should come first, but Smith seemed fairly adamant that he wants the offending agent removed first (and this is definitely very, very important.) Probably something we should clarify with him as to how he had the information structured on his slide. (Hopefully, he won't have any questions that are that nuanced or tricky on the test.)

An adverse reaction is never intended whereas a side effect can sometimes be desired.
E.g. If diphenhydramine were used to treat an allergic reaction, and a person experienced dyspnea (difficulty breathing) and lethargy (drowsiness), the adverse event would be respiratory distress whereas a side effect would be drowsiness.