Drug Interactions

How do drugs interfere with clinical laboratory testing?

1. Cross-reaction with antibodies 2. Altering chemical reactions 3. Interference with enzyme reactions

To prevent drug errors, nurse managers should implement which concept?

1. Give ongoing recognition 2. Provide education for all employees 3. Embrace a nonpunitive culture

The nurse is preparing to administer morphine sulfate to a patient who just had an appendectomy. The electronic health record indicates that the patient has no drug allergies or history of adverse drug reactions. The patient reports, "The last time I received morphine, I got itchy and my eyes swelled shut." What is the appropriate nursing action?

1. Notify the health care provider and pharmacy of the patient's previous adverse reaction. 2. Contact the surgeon for an alternate pain control medication.

Who is responsible for reducing adverse drug reactions (ADRs)?

1. Patient 2. Patient's family 3. Health care provider 4. Pharmaceutical industry

Which causes of medication errors are human factors?

1. Performance deficits 2. Knowledge deficits 3. Dosage miscalculations 4. Transcription errors

Which method does the Food and Drug Administration (FDA) use for special alerts or medication guidelines?

1. Risk Evaluation and Mitigation Strategy (REMS) 2. Medication guides (MedGuide) 3. Boxed warnings

For which reasons does the nurse educate a patient about adverse drug reactions?

1. To allow the patient to be more involved in their care 2. To allow for early identification of adverse drug reaction and to seek timely treatment 3. To partially fulfill the nurse's accountability

Medication reconciliation

A process in which new medications are compared to those medications that a patient is currently taking

Synergistic effect

A synergistic effect occurs when two or more drugs are given together and the clinical effect is substantially greater than either drug alone.

Which type of drug interaction occurs when two drugs are administered in combination and the response is equal to the sum of the effect of the two drugs taken separately?

Additive effect

Drug-drug interaction

An altered or modified action or effect of a drug as a result of interaction with one or multiple other drugs

Antagonistic effect

An antagonistic effect occurs when two or more drugs are given together and one drug reduces or blocks the effect of the other.

Adverse Drug Reaction

An unintentional, unexpected reaction to drug therapy that occurs at a normal drug dosage.

The student nurse asks what an adverse drug reaction (ADR) is. What is the appropriate nursing instructor response?

An unintentional, unexpected reaction, which occurs at normal drug dosages

Which symptom would indicate to the nurse that a patient is experiencing an anaphylactic drug reaction?

Angioedema

Which method of documentation has been shown to reduce medication errors?

Computerized order entry

The nurse is reviewing a prescription for oxycodone that states, "take 5 to 10 mg by mouth every 4 to 6 hours." What is the appropriate nursing action?

Contact the health care provider and clarify the prescription.

A patient with a history of gastrointestinal esophageal reflux disease (GERD) reports taking an over-the-counter (OTC) medication to treat "heartburn discomfort." The nurse notices that the patient also takes two prescribed medications for hypertension. For which type of possible reaction does the nurse assess?

Drug-drug interaction

A nurse is providing a patient with education regarding grapefruit consumption while taking a medication. Which type of interaction is the nurse teaching the patient to avoid?

Drug-food interaction

During a routine physical examination, the patient reports muscle soreness to the nurse. Laboratory liver function tests are normal. The patient is taking simvastatin, and likes to eat grapefruit for breakfast. What does the nurse anticipate?

Drug-food interaction. The patient states that grapefruit is eaten regularly. Grapefruit is rich in vitamin C, which may raise the amount of statins in the blood. This patient is having a drug-food interaction.

Drug-laboratory interaction

Drugs often affect laboratory tests by interfering with enzyme reactions, altering chemical reactions, or cross-reacting with antibodies. Laboratory results may be misinterpreted or invalidated.

The nurse is caring for a patient with G6PD deficiency, an X-linked inherited condition that commonly occurs in people of African and Mediterranean ancestry. For which effect will the nurse monitor?

Idiosyncratic

A patient is given lorazepam, a benzodiazepine, to decrease symptoms of anxiety and restlessness on the evening prior to a planned surgery. The nurse knows that the patient is experiencing a paradoxical drug reaction when which of the following is assessed?

Increased agitation and insomnia

How are drug errors addressed in a system that operates according to principles associated with a just culture?

Individuals are encouraged to report drug errors so that the system may be repaired.

Teratogens

May cause birth deffects

Carcinogens

May cause cancer

Drug-supplement interaction

May occur when dietary supplements (vitamins, minerals, amino acids, and herbs or botanicals) interact with drugs. May lead to either drug toxicity or a reduction in the beneficial response of a drug

The nurse erroneously gives a patient 1 tablet of medication instead of the prescribed ½ tablet. The patient had no adverse reaction. What does this reflect?

Medication error

Drug-food interaction

Occurs when a food or beverage either increases or decreases the absorption of a drug

Idiosyncratic Reaction

Occurs when a person has a genetic difference or predisposition

Paradoxical Reaction

Occurs when the body responds in the opposite manner than what is expected or anticipated.

Additive effect (summative effect)

Occurs when two drugs are administered in combination and the response is equal to the sum of the effect of the two drugs taken separately. Additive effects can be either desirable or undesirable.

A patient reports insomnia and excitement after taking alprazolam. Which type of effect does the nurse recognize?

Paradoxical

A patient taking a new medication experiences a torso rash. The nurse does not see "rash" listed as a reported side effect of the new medication. What is the appropriate nursing action?

Report the side effect to MedWatch.

What occurs during a synergistic effect when two or more drugs are given together?

Response is substantially increased beyond what any drug given could produce alone.

Therapeutic Failure

Therapeutic failure occurs when food or other agents bind with a drug, causing less or slower drug absorption.

Delayed Reaction

Time related and occur with consistent exposure over a period of time. There are two types teratogenic and carcinogenic.

The nurse is preparing to administer the first dose of an oral antibiotic. What is the priority nursing action?

Verify patient allergies before administering the drug.

Allergic Reaction

When patients takes a medication that they are allergic to, this can stimulate an immune response, triggering the release of histamines

The electronic health record indicates that a patient's continuous infusion of heparin intravenously was to be stopped at 1000. At 1900, the nurse notices that the heparin is still running. Which type of medication error is this?

Wrong duration of treatment