| 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+ levels | Hyperkalemia |
| 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 system | Atropine-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 |
