Chapter 3 - Toxic Effects of Drugs

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Adverse Effects

undesired effects that my be unpleasant or even dangerous

Reasons for adverse drug reactions to occur

1) the drug may have other effect on the body besides the therapeutic effect
2) the patient is sensitive to the drug being given
3) the drug's action on the body causes other responses
4) the patient is taking too much or too little of the drug

Types of Adverse Reactions

1) primary actions - Overdose; extension of the desired effect
2) secondary actions - undesired effects produced in addition to the pharmacologic effect
3) hypersensitivity reactions - excessive response to primary or secondary effect of drug

Types of Drug Allergies

1) anaphylactic reaction
2) cytotoxic reaction
3) serum sickness reaction
4) delayed allergic reaction

anaphylactic reaction

rash, hives, SOB, respiratory arrest

cytotoxic reaction

cell killer, decreased hematocrit, decreased RBC or platelets, decreased WBC

serum sickness reaction

swollen painful joints, swelling in face and extremities

delayed allergic reactions

poison ivy
(the body may react to a medication even if it has been taken many times)

Dermatological Reactions

*Rash/Hives
-assessment - abnormalities in the skin, red area, blisters
-interventions - may need to discontinue the medication
*Stomatitis - assessment - inflammation of the mucous membranes
-interventions - frequent mouth care

Drug-Induced Tissue and Organ Damage

SUPERINFECTIONS - destruction of the body's normal flora
*Assessment - fever, diarrhea, vaginal discharge
*Interventions - supportive care (mouth and skin care), administer antifungal medications, may need to stop drug responsible for the infection
BLOOD DYSCRASIA - bone marrow suppression (worst reaction you can have, you can die)(no white cells)
*Assessment - fever, chills, weakness
*Interventions - monitor blood counts, protective isolation

Toxicity

*Liver
Assessment - fever, nausea, jaundice, change in color of urine or stool, elevated liver enzymes
Interventions - discontinue medication
*Kindney
Assessment - change in urinary pattern, elevated BUN and creatinine
Intervention - notify physician, may need to stop medication or decrease the dosage

Poisoning

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
hyperglycemia:
*Assessment Finding - high serum glucose level
*Intervention - administer medications to decrease glucose level (insulin)

Electrolyte Imbalance

hypokalemia:
*Assessment Finding - decrease in serum potassium levels
*Interventions - replace serum potassium (IV or supplement) and monitor serum levels of potassium
hyperkalemia:
*Assessment Finding - increase in serum potassium level
*Interventions - decrease the serum potassium concentration, monitor serum levels of potassium, and monitor cardiac rhythm

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 8th 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 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
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

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