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level: Level 1 of Dug- Induced Tissue and Organ Damage

Questions and Answers List

level questions: Level 1 of Dug- Induced Tissue and Organ Damage

QuestionAnswer
Dermatological Reactions:Adverse reactions involving the skin. Drugs deposit toxic chemical reaction causing irritation to the tissue.
Dermatological Reactions: Can range from:simple rash to potential fatal exfoliative dermatitis.
Dermatological Reactions: Assessment:Hives, rashes Exfoliative dermatitis: -rash -scaling -fever -enlarged lymph node -enlarged liver -fatal erythema multiforme exudativum (Stevens-Johnson Syndrome)
Dermatological Reactions: intervention:-In mild cases, discomfort of skin lesions: provide frequent skin care. -Instruct patient to avoid rubbing, avoid rough and tight clothing, avoid harsh soaps or perfumed lotion -administer antihistamines as appropriate. -in severe cases, D/C drug and notify AP -topical corticosteroids, antihistamines and emollients are used.
Stomatitis:Inflammation of the mucous membranes. Direct toxic reaction to the drug deposits in the end capillaries in the mucous membranes, leading to inflammatin.
Stomatitis: Assessment:- Swollen gums - Inflamed gums (gingivitis) - Swollen and red tongue (glossitis) - Difficulty swallowing - Bad breath -Pain in the mouth and throat
Stomatitis: Interventions:-Provide frequent mouth care - Frequent small meals -Dental consultation -Antifungal agents and/or local anesthetics are sometimes used.
Superinfections:When normal flora are destroyed by drugs (antibiotics)
Superinfections: Assessment:Fever, diarrhea, black or hairy tongue, inflamed or swollen tongue, mucous membrane lesions, vaginal discharges with or without itching.
Superinfections: Interventions:Provide supportive measures: - Frequent mouth care - Skin care - Access to bathroom facilities - Small, frequent feeding - Antifungal agents as appropriate - D/C drug responsible for superinfection.
Blood Dyscrasia:Any abnormal condition of the blood Is bone marrow suppression Bone marrow cells multiply rapidly Multiple Cell division, highly susceptible to any agents that disrupts cell function.
Blood Dyscrasia: Use of?antineoplastics and antibiotics.
Blood Dyscrasia: Assessment:Fever, chills, sore throat, weakness, back pain, dark urine Decreased/low platelet count (thrombocytopenia) Decreased/low WBC (leukopenia) decreased/low cellular elements of CBC (pancytopenia)
Blood Dyscrasia: Interventions:Monitor blood counts Provide supportive measures: - Rest - Protection from exposure to infections - Protection from injury - Avoidance of activities that might result in injury or bleeding - D/C drug or stop administration until the bone marrow recovers to a safe level.
Toxicity:1. Liver injury 2. Renal injury
Toxicity: Most drugs are metabolized here, many "metabolites" are irritating or the toxic will affect its integrity.Liver injury
Toxicity: Liver injury: Assessment:Fever, malaise, nausea, vomiting, jaundice, change in color of urine or stools, abdominal or colic pain. "Increased/high Liver enzymes (AST & ALT)" Alterations in bilirubin levels Change in clotting factor (PTT).
Toxicity: Liver injury: Assessment: Liver enzymes:AST and ALT
Toxicity: Liver injury: Intervention:D/C drug and notify AP Supportive measures: -Rest -Small, frequent meals -Skin care -Cool environment
Toxicity: Drugs have the potential to directly irritate renal tubule and alter normal absorption and secretion process.Renal injury
Toxicity: Renal injury: Enzymes or to watch for:Crea or creatinine: 0.6 to 1.3 milligrams per deciliter (53 to 115 micromoles per liter) BUN- is an indication of renal health. Normal ranges 8-20 mmol/L
Toxicity: Renal injury: Assessment:Increased or high BUN, creatinine concentration Decreased or low HCT Electrolyte imbalances Fatigue, malaise, edema, irritability Skin rashes
Toxicity: Renal injury: Intervention:Notify AP and D/C drug Supportive measures: -Positioning -Diet and fluid restrictions - skin care, - electrolyte therapy - rest periods - controlled environment If severe, DIALYSIS!!!
Alterations in Glucose Metabolism:1. Hypoglycemia 2. Hyperglycemia
Alterations in Glucose Metabolism: Drugs affect metabolism and use of glucose, causing a low blood glucose concentration.Hypoglycemia
Alterations in Glucose Metabolism: Hypoglycemia: Assessment:Fatigue, drowsiness, hunger, anxiety, headache; cold clammy skin; shaking; lack of coordination. Increased or high HR, Bp Numbness and tingling of mouth, tongue, lips. Confusion Rapid, shallow respirations Sever cases: Seizures or coma
Alterations in Glucose Metabolism: Hypoglycemia: Interventions:Restore glucose, IV or P.O. Supportive measures: -skin care, environmental control of light and temperature, rest. Institute safety measures to prevent fall or injury.
Alterations in Glucose Metabolism: Drugs stimulate the breakdown of glycogen or alter metabolism causing high serum glucose levels. Examples: Ephidrine (aminophylline, chlorphenalamine, guaifenessin). Can breakdown stored glycogen and cause an elevation of blood glucose by its effect on sympathetic nervous system.Hyperglycemia
Alterations in Glucose Metabolism: Hyperglycemia: Assessment:Fatigue Polyuria Polydipsia Kussmaul respiration (deep respiration) Restlessness Polyphagia Nausea Hot or flushed face Fruity odor to breath
Alterations in Glucose Metabolism: Hyperglycemia: Intervention:Administer insulin to decrease blood glucose Provide support to help the patient deal with S/S. -Access to bathroom -Controlled environment -Reassurance -Mouth care
Electrolyte Imbalances:1. Hypokalemia 2. Hyper kalemia
Electrolyte Imbalances: Drugs affecting the kidney can cause the renal exchange system. Example: Loop diuretics -Loss of K+ -K+ is essential for the normal functioning of nerves and muscles.Hypokalemia
Electrolyte Imbalances: Hypokalemia: Assessment:- Lower K+ levels, decreased or lower than 3.5 milliequivalent/Liter - Weakness - Numbness and tingling in the extremities - Muscle cramps - N&V, diarrhea, decreased or low bowel sounds, irregular pulse, weak pulse. - Orthostatic hypotension - Disorientation - Severe cases, paralytic ileus, abdominal distention, absent bowel sounds, acute abdomen
Electrolyte Imbalances: Hypokalemia: Intervention:- Replace serum K+ - Monitor serum K+ levels and patient response. - Provide support: - Safety precaution to prevent falls and injury -Orientation of the patient -Comfort measures for pain and discomfort.
Electrolyte Imbalances: K+ retention and a resultant increasing serum K+ levelsHyperkalemia
Electrolyte Imbalances: Hyperkalemia: Assessment:Serum levels, increased or higher than 5.0 milliequivalent/ liter Weakness, muscle cramps, diarrhea, numbness and tingling Slow HR, low Bp low urine output DOB
Electrolyte Imbalances: Hyperkalemia: Intervention:Institute measures to decrease serum K+ levels, by the use of sodium polystyrene sulfonate (trade names such as kayexalate, Kionex, and Resonium A). Supportive measures: - Supportive measures to prevent injury or falls Monitor cardiac effects and be prepared for cardiac emergency Severe cases, dialysis may be needed.
Sensory Effect:1. Ocular Toxicity 2. Auditory Damage
Sensory Effect: Retina blood vessels are very tiny; some drugs are deposited into these tiny arteries, causing inflammation and tissue damage. Causing retinal damage and blindness.Ocular toxicity (Oculotoxic drugs)
Sensory Effect: Ocular toxicity: Assessment:Blurring of vision Color vision change Cornea damage Blindness
Sensory Effect: Ocular toxicity: Intervention:Monitor patient's vision If S/S present, D/C drug. Supportive measure. Monitor lighting and exposure to sunlight.
Sensory Effect: Tiny vessels and nerves in the 8th cranial nerves are easily irritated and damaged by certain drugs. Examples: Macrolides (clarithromycin, erythromycin), Aspirin.Auditory Damage
Sensory Effect: Auditory Damage: Assessment:Dizziness Tinnitus Loss of balance Loss of hearing
Sensory Effect: Auditory Damage: Intervention:Monitor patient perceptual losses of changes. Provide protective measures to prevent falling or injury Consult
Neurological Effects:1. CNS Effects 2. Atropine-like (anticholinergic) Effects 3. Parkinson-like Syndrome 4. Neuroleptic Malignant Syndrome
Neurological Effects: Though fairly well protected by blood-brain barrier, some drugs do affect by altering electrolyte or glucose levels. Example: beta-blockers causes insomnia, anxiety and nightmares.CNS Effects
Neurological Effects: CNS Effects: Assessment:- Confusion - Delirium -Insomnia - Drowsiness - Hyperreflexia or hyporeflexia - Bizarre dreams - Hallucinations
Neurological Effects: CNS Effects: Interventions:- Provide safety measures to prevent injuries - Caution patient not to operate dangerous machines and drive care. - Orient patient and provide support -Consult with AP and decrease dose.
Neurological Effects: Directly or indirectly mimic the effect of the parasympathetic nervous systemAtropine-like (anticholinergic) Effects
Neurological Effects: Atropine-like (anticholinergic) Effect: Anticholinergic drugs block ____. This/which inhibits nerve impulses responsible for involuntary muscle movements and various bodily functions.the action of a neurotransmitter called acetylcholine.
Neurological Effects: Atropine-like (anticholinergic) Effect: Assessment: Symptoms:Dry mouth, altered taste perception, dysphagia, heartburn, constipation, bloating, paralytic ileus, urinary hesitancy and retention, impotence, blurred vision, cycloplegia, photophobia, headache, mental confusion, nasal congestion, palpitations, decreased sweating, and dry skin.
Neurological Effects: Atropine-like (anticholinergic) Effect: Signs:- Lack of activity - Akinesia - Muscular tremors, - Drooling, changes in gait - Rigidity, Extreme restlessness or "jitters" (akathsia) or spasm (dyskinesia).
Neurological Effects: Atropine-like (anticholinergic) Effect: Interventions:-Provide sugar-less lozenges and mouth care to help prevent mouth dryness - Arrange bowel program as appropriate. - Have patient void before taking drug -Provide safety measures if vision changes occur. -Arrange medication for headache and nasal congestion as appropriate. - Advice pt. to avoid hot environment - Protective measures to prevent falling and to prevent dehydration, which may cause by exposure to heat owing to decrease sweating. - D/C drug, if necessary -provide small, frequent meals if swallowing becomes difficult. - Provide safety measures if ambulation becomes a problem
Neurological Effects: Drugs that directly or indirectly affect dopamine levels in the brain can cause a syndrome that resembles Parkinson's disease. Examples: Antipsychotic and neuroleptic drugs.Pakinson-like Syndrome
Neurological Effects: Parkinson-like Syndrome: Assessment:Extrapyramidal symptoms Hyperthermia Autonomic disturbances
Neurological Effects: Parkinson-like Syndrome: Intervention:D/C drug Supportive care to lower the body temperature.
Neurological Effects: General anesthetics and other drugs that have direct CNS effects.Neuroleptic Malignant Syndrome.
Drugs that cause/reach the developing fetus or embryo or congenital defects.Teratogenicity
Teratogenicity: Includes:skeletal and limb abnormalities, CNS alterations, heart defects etc.
Teratogenicity: Predictable syndrome occurs when?a drug is given to pregnant woman.
Teratogenicity: Should be given advice of possible ??? on the baby.effects
Teratogenicity: "actual benefits should be weighed against?the potential risks."
Teratogenicity: All pregnant women should be advised not to ??? during pregnancy.self-medicate
Teratogenicity: Intervention:Provide emotional and physical support for dealing with fetal death or birth defects