Quizzam 2 (Shoen)

Indication

The reason that a patient is taking a medical treatment

Contraindication

a condition that is a reason NOT to use a medication because it could cause harm to the patient

Subtherapeutic

Too low of a dose or a contradiction to treat a condition effectively

Supratherapeutic

Amount of drug is greater than the recommended concentration of maximum dose

Renal

Kidneys; renal function is how well the kidneys are eliminating medications. Some drugs are more affected by kidney function than others

Hepatic

Liver; Hepatic function is how well the liver is metabolizing medications. Some drugs are more affected by liver function than others

What is the role of a pharmacist in patient care?

-Identify, resolve, and prevent drug therapy problems

-bring focus and expertise on meds

-Does NOT diagnose

-Assess drug therapy in all patient care settings

What are the 4 types of DRPs?

Indication, effectiveness, safety, adherence

What should you consider when determining if the patient understands their medication?

Health literacy and language barriers

Can a patient have more than one DRP?

Yes

Adverse Drug Reaction (ADR)

unexpected, unintended, undesired, or excessive response to a medicine

Attributes of ADRs

-Directly attributed to a drug and its physiological properties

-Typically referring to an effect that occurs despite appropriate prescribing/dosing

-"Side-effect"

Adverse Drug event (ADE)

injury from a medicine due to appropriate or inappropriate uses

Serious adverse event

Death, life-threatening, caused or prolonged hospitalization, persistent disability, congenital abnormality, or required intervention to prevent one ADRs and ADEs

True/False: ADRs and ADEs are often not (but still can be), related to medication errors

True

Dechallenge

discontinue and monitor

Rechallenge

see if response returns after retrying drug

What are the two types of ADRs when classified by mechanism?

Type A and Type B

Type A Reactions attributes

-85-90% of all ADRs

-Predictable

-Usually related to dose

-Known Pharmacologic properties of the drugs

Type B reactions attributes

-Subset of patients affected

-10-15% od ADRs

-Unpredictable

-Hypersensitivity

Hypersensitivity

Reaction not explained by the pharmacologic effects of the drug, caused by altered reactivity of the patient

Idiosyncratic

Uncharacteristic response of a patient to a drug, usually not occurring on administration

Intolerance or Exaggerated sensitivity

Characteristic pharmacologic effect but produced by an unusually small dose, so that a usual dose tends to induce a massive overaction

Allergy

immune or inflammatory cell stimulations by the medication

Immune mediated allergies are distinguished based on ________________.

their time to onset

Immediate onset

Usually within one hour (Type I)

Attributes of immediate onset

-IgE mediated

-Typical symptoms on presentation (i.e. rash, itching, wheezing, GI symptoms, hypotension, anaphylaxis)

Delayed onset

hours to week later (type II, III, and IV)

Attributes of delayed onset

-NOT IgE mediated

-Type II and III: IgE mediated

-Type IV: T-Cell mediated

-Less common than I and IVNon

Delayed onset can cause _______.

-Cell destruction

and

-Antigen-Antibody complexes leading to platelet aggregation, release of toxic substances from neutrophils

Non-immune Drug Hypersensitivity reactions

ADEs that look like a drug allergy but immune response unproven

Impact of dose for Type A

Risk increase with dose

Impact of dose for type B

Usually NOT affected by dose

Who is affected in Type A?

ALL patients if dose increased enough

Who is affected in Type B?

Subset of patients (i.e. genetics, altered metabolism)

Which type is this: "Increasing doses of a BP med causes low BP- this could happen in all patients and is expected impact of this drug related to it's pharmacological effect"

Type A

Which type is this: "Hives with amoxicillin. Allergic response at "normal" dose and in a subset of patients. Cannot reasonably predict who will have allergy until administered"

Type B

Mild ADR severity

No antidote, therapy, or prolongation of hospitalization is required

Moderate ADR severity

Management requires change in drug therapy, specific treatment, or an increase in hospitzalization of 1+ day

Severe ADR Severity

Potentially life threatening, causing permanent damage or requiring intensive medical care

Lethal ADR severity

Directly or indirectly contributes to the death of patient

Drug-Drug Interaction (DDI)

When one drug modifies the actions of another drug in the body

Two major types of drug interactions

Pharmacodynamic and Pharmacokinetic

Pharmacodynamic

When the drug is additive, synergistic, or antagonistic to another drug

A hint that it is likely pharmacodynamic:

One drug has a type of effect that adds, subtracts, or multiple the same type of effect of another drug

Pharmacokinetic

When the drug changes the absorption, distribution, metabolism or elimination of another drug

What are some compounds that can affect CYP enzymes (drug interactions but not from other "drugs")?

Smoking, alcohol, grapefruit juice, herbals, vitamins, supplements, and even diseases

Are DDIs ever beneficial?

Yes

Pharmacodynamic interaction

A change in the pharmacodynamics of 1 drug caused by the interacting drug

Pharmacokinetic interaction

A change in the pharmacokinetics of 1 drug caused by the interacting drug

Antagonism

The effect of 2 drugs given together is less than the sum of the responses to the same doses given separately

Additive effects

The effect of 2 drugs given together is equal to the sum of the responses to the same doses given separately

Synergism

The effect of 2 drugs given together is greater than the sum of the responses to the same doses given separately

Risk Rating C

Monitor therapy

Risk rating D

Consider Therapy Modification

Narrow Therapeutic Index (NTI)

Drugs where small differences in dose or blood concentration may lead to serious therapeutic failures and/or ADRs that are life-threatening or result in persistent or significantly disability or incapacity

Medication error

Any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in control of the healthcare professional, patient, or consumer

Commission

doing something wrong

Omission

failing to do the right thing

Near miss

In simple terms: Error happened but patient harm was avoided

-any event that could have had adverse consequences but did not and was indistinguishable from fully fledged adverse events in all but outcome

Mistakes are addressed by...

remedial education and/or added layer of supervision to that individual

Slips are much more common and are addressed by...

reviewing protocols, devices, and work environments, preventing work arounds

Example of an error at the prescribing step

Wrong patient, drug, dose, route, time, frequency, interactions, or contraindications

Example of an error at the transcribing step

Writing or retyping incorrectly

Error at the dispensing step

Incorrect preparation, incorrect information on drug label, expired drug, labeling errors

Error at administering step

Wrong patient, drug, dose route, frequency, time, duration, non-compliance

Error at monitoring step

Failing to alter therapy when required, erroneous alteration

Just culture is _______.

A system of shared accountability

What is Med Rec?

The process of creating the best possible medication list of all of the medications the patient should be taking

How are Med Recs accomplished?

by comparing the patient's active medication orders or prescriptions to all of the medications that the patient has been taking

What is the goal of Med Reconciliation?

Avoid medication errors that may lead to an unwanted adverse drug event

Med Recs often focus on ________.

transitions of care and high risk patient groups

Reconcile

Compare what patient was taking prior to the encounter versus...

-newly ordered meds

-changes to health status

-updates to patient's treatment plans

MAR is defined as ______.

What the patient has been receiving

When assessing a list of meds., a one to one match is _______.

med is the same on both lists

Unintended Discrepancy refers to

Different Dose, route, or frequency

Intended discrepancy refers to

a drug being intentionally changed, but there should be documentation explaining this