Chapter 3

This allergy involves an antibody that reacts with specific sites in the body to cause the release of chemicals, including histamine, that produce immediate reactions (mucous membrane swelling and constricting bronchi) that can lead to respiratory distress and even respiratory arrest.

anaphylactic reaction

What are the types of allergic reactions?

anaphylactic cytotoxic serum sickness delayed allergic

Examples of adverse drug reactions

-The drug may have other effects on the body besides the therapeutic effect. -The patient is sensitive to the drug being given. -The drug's action on the body causes other responses that are undesired or unpleasant. -The patient may be taking/given too much or too little of the drug.

Assessment Findings: Dry mouth, urinary retention, blurred vision Interventions: Sugarless lozenges to keep mouth moist; have the patient void before administration of the medication

Atropine-like (Anticholinergic) Effects

How would we intervene for stomatitis?

Frequent mouth care diet accommodations local anesthetic

Assessment Finding: Low serum blood glucose level Intervention: Restore glucose to the body

Hypoglycemia

Assessment Findings: Extrapyramidal symptoms Interventions: Discontinue medication as appropriate

Neuroleptic Malignant Syndrome

Assessment Findings: Muscle tremors, changes in gait Interventions: Discontinue medication as appropriate

Parkinson-like Syndrome

occurs when an overdose of a drug damages multiple body systems Damage to multiple systems can lead to a fatal reaction. Treatment varies accordingly with drug

Poisoning

How would we intervene for superinfections?

Supportive care (mouth and skin care) administer antifungal medications as needed may also need to stop drug responsible for the superinfection

Any drug that causes harm to the developing fetus or embryo

Teratogenicity

How would we intervene for blood dyscrasia?

monitor blood counts protective isolation

Undesired effects that may be unpleasant or even dangerous

adverse drug reactions

Assessment Findings: Dizziness, ringing in the ears (tinnitus), loss of balance, and loss of hearing Interventions: Monitor for hearing loss; discontinue medication as appropriate if a decrease in hearing is noted on assessment.

auditory damage

Bone marrow suppression Assessment: Fever, chills, weakness; low WBC, platelet count, hematocrit

blood dyscrasia

This allergy involves antibodies that circulate in the blood and attack antigens (the drug) on cell sites, causing death of that cell. This reaction is not immediate but may be seen over a few days

cytotoxic reaction

This reaction occurs several hours after exposure and involves antibodies that are bound to specific white blood cells

delayed allergic reaction

How would we intervene for rash/hives?

discontinue medication administer antihistamine and/or corticosteroid

How would we intervene for liver injury?

discontinue medication supportive measures

Occurs when the body forms antibodies, resulting in an immune response

drug allergies

Assessment Findings: Altered level of consciousness Interventions: Prevent injury

general CNS effects

Assessment Finding: High serum glucose level Intervention: Administer medications to decrease glucose level

hyperglycemia

Assessment Finding: Increase in serum potassium level Interventions: Decrease the serum potassium concentration (Sodium Polystyrene Sulfonate, IV glucose and insulin, IV calcium), monitor serum levels of potassium, and monitor cardiac rhythm

hyperkalemia

Types of Adverse Reaction: Excessive or exaggerated response to primary or secondary effect of drug usually from an underlying condition Examples: drug induced blood dyscrasia, organ injury or allergy

hypersensitivity

What are examples altered glucose metabolism?

hypoglycemia hyperglycemia

Assessment Finding: Decrease in serum potassium levels Interventions: Replace serum potassium (IV or oral supplement) and monitor serum levels of potassium

hypokalemia

toxicity: Change in urinary pattern, elevated BUN and creatinine and/or electrolyte imbalance

kidney/renal injury

toxicity: Fever, malaise, nausea, jaundice, change in color of urine or stool, elevated liver enzymes

liver injury

What are examples of toxicity?

liver injury kidney/renal injury

How would we intervene for kidney/renal injury?

notify physician may need to stop medication or decrease the dosage diet and fluid modifications

Assessment Findings: Visual changes Interventions: Monitor for any visual changes when giving any medication that is known to cause ocular damage; discontinue medication as appropriate.

ocular toxicity

Types of Adverse Reaction: Overdose; extension of the desired effect Examples: Anticoagulants, Diabetic agents

primary

What are the types of adverse reactions?

primary secondary hypersensitivity

Types of Adverse Reaction: Undesired effects produced in addition to the pharmacologic effect Examples: drowsiness, n/v, constipation

secondary

Dermatological Reaction: Abnormalities in the skin, red area, blisters

rash/hives

What are the dermatological reactions?

rash/hives, stomatitis

This allergy involves antibodies that circulate in the blood and cause damage to various tissues by depositing in blood vessels. This reaction may occur up to 1 week or more after exposure to the drug

serum sickness reaction

Dermatological Reaction: Inflammation of the mucous membranes

stomatitis

Destruction of the body's normal flora Assessment: Fever, diarrhea, vaginal discharge

superinfection

What are examples of drug-induced tissue and organ damage?

superinfections blood dyscrasia

A noxious or toxic affect from prescribed drug

toxicity