NUR 3035-002: Adverse Drug Reactions and Lifespan Considerations

Drug Therapy: During Pregnancy and Breast Feeding: Categorization

Do not take is: pregnant, lactating, and or of reproductive health (male and female)

Physiologic Changes in Pregnancy:

Changes in renal, liver, and gastrointestinal function, as well as placental drug transfer can alter pharmacokinetics of drugs

Drug Therapy During Pregnancy and Breast Feeding: Adverse Effects

Up to 60 days after implantation: Organogenesis;

-- Results in gross malformations

Drug Therapy in Pediatrics:

Dosage based on weight in kg or square meters

Drug Therapy in Pediatrics: Absorption

Enteral, Parenteral, Topical

Drug Therapy in Pediatrics: Distributions

Higher water concentration, lower fat

Immature blood brain barrier

Limited protien Binding Capacity

Drug Therapy in Pediatrics: Metabolism

Liver and Respiratory Rate

Drug Therapy in Pediatrics: Adverse Effects

Age Related

Drug Therapy: Neonates and Infants

Neonates (1-4 weeks) and Infants (5-52 Weeks) at risk of for the most intense adverse effects

Pharmacokinetic action is more similar to adults after 1 year

Drug Therapy in Geriatrics: Challenges

Pharamacokinetic changes

Multiple and severe illnesses

Multidrug therapy

Poor Adherence

Drug Therapy in Geriatrics: Distribution Changes

Increased body fat

Decreased lean body mass

Decreased total body water

Reduced concentration of Serum Albumine

Drug Therapy in Geriatrics: Excretion Changes

Creatine clearence rather than serum creatinine is a better indicator in older adults of renal function

Drug therapy in Geriatrics: Nursing Interventions

Monitoring and preventing adverse drug reactions

Promote Adherence

Drug Therapy in Geriatric Patients: Assessment of the Home

Patient's ability for self care

Family Support

Risk Factors

Financial, Transportation Issues

Drug Therapy in Geriatric Patients: Drug Storage

Stability

Proper Disposal

Adverse Effects of Drug Therapy

An effect other than the desired therapeutic effect that may occur during therapy

Side Effects of Drug Therapy:

Usually refers to a minor, nearly unavoidable secondary drug effect produced at therapeutic dosing eg: nausea

Allergic Reactions

An immune response

Must have had prior sensitization

Note: not determined by size of dose but the degree of sensitization

Anaphylaxis

Most serious of allergic reactions. It is a medical emergency

Anaphylaxis System:

Systemic reaction

-- Contraction of smooth muscles..

-- Airway closes

-- Increased Vascular permeability swelling

S/S of Anaphylaxis

Dyspnea, bronchospams, laryngeal edema, cardiac dysrythmias, occasionally seizures

Drug Toxicity:

Resuls when the dosage of drugs exceeds the amount the body can eliminate through metabolism and excretion

Boxed Warning/Black Box Warning

Strongest safety warning a drug can carry and still remain on the market

Idiosyncratic Drug Response

- Unusual, abnormal or peculiar response to a drug

- thought to occur because of genetic enzymatic deficiencies that alter the drug's metabolism

Paradoxical Response

Opposite of an intended drug response

Latrogenic Disease

A disease that occurs as a result of medical care or treatment

- Can be the result of drugs

Physical Dependence

A state in which the body has adapted to prolonged drug exposure insuch a way that abstinence syndrome will result if drug is discontinued

Abstinence Syndrome

Varies depending on drug

Pateint teaching related to abrupt discontinuation

Carcinogenic Effect

Ability of certain medication and enviornmental chemicals to cause cancer

Teratogenic Effect

Drug induced birth defects

Neurotoxicity:

Brain is sensitive to small amounts of toxic substances

-- Occurafter exoisure to drugs and other chemicals and gases

S/S of Neurotixicity

- Change in level of consciousness (drowsiness, restlessness)

- Auditory and Visual disturbances, nystagmus

- Tonic Clonic (grand mal) seizures

Hepatotoxicity:

Liver is highly susceptible to toxicants due to direct exposure to ingested drugs anf other toxicants

Manifestations of Hepatotoxicity:

- Hepatitis

- Jaundice

- Elevated liver enzymes

- Fatty infiltration of liver

Neprhotoxicity:

Chemically induced Kidney damage is typically manifested as acute tubular necrosis

Assess labs: blood urea nitrogen (BUN), Creatinine, and Creatinine Clearance

Immunotoxicity:

A wide variety of drugs can affect the immune system

- Immunosuppresion

- Direct Destruction of Immune System Component i.e. leukocytes

Ototoxicity:

Toxicity to the ears, often drug induced and manifesting as varying degrees of hearing loss that is likely to be permanent.

Affected structures: cochlea, vestible, and semicircular canals