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Drugs act in one of two ways:

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Locally or systemically

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Local effect is limited to:

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The site of administration and those tissues immediately surrounding it

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Most drugs applied topically exert a:

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local effect (nasal sprays in the nose, topical creams and ointments on the skin)

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A few drugs applied topically exert a systemic effect:

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Nicoderm CQ patch to stop smoking

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Except for some skin disease, most medical conditions and diseases cannot be treated by a:

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Drug that acts only at the site of administration, they must be treated by a drug that acts systemically

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A systemic effect is felt:

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througout the body

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Drugs taken orally usually exert a:

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Systemic local effect in the gastrointestinal tract

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Inhaled drugs exert either a local effect or a systemic effect:

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depending on the type of drug

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Drugs given subcutaneously, intramuscularly, or intravenously exert a:

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systemic effect

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Drugs given vaginally exert a:

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Local effect

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Drugs given rectally exert either a local or systemic effect:

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depending on the type of drug

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The same drug given by different routes can exert either a local or a systemic effect, for example:

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OTC antihistamine drug diphenhydramine (Benadryl) can be purchased as a spray or cream that has a local efect to relieve itching of the skin

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Benadryl can also be purchased as:

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A tablet or capsule that, when swallowed, has a systemic effect to relieve allergy symptoms of itching and hives anywhere on the skin, as well as nasal stuffiness and red, watery eyes

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Example: the prescription drug lidocaine (Xylocaine) has a local effect when it is gargled for topical anesthesia, or inject subcu for local anesthesia:

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however when it's given intravenously to treat cardia arrhythmias, it has a systemic effect

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Therapeutic effect is:

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the drug's main action for which it was prescribed by the physician or other healthcare provider

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The therapeutic effect of a drug is intended to:

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Prevent a disease, to diagnose a disease, or to treat a disease by controlling, improving, or curing the symptoms of the disease

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The therapeutic effect of a drug can be directed toward the specific area of the body that has the disease - toward a:

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Target organ

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A target organ:

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The heart, in patients with congestive heart failure for example

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The therapeutic effect is not always directed toward a target organ, for example:

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when a physician prescribes an antibiotic drug, the therapeutic effect is intended to destroy or inhibit the growth of disease-causing bacteria, wherever they are within the body

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Sometimes the therapeutic effect is actually one of the:

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Side effects of the drug

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Many antihistamine drugs, when given orally to treat allergies, produce:

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Significant drowsiness (this side effect is undesirable), particularly in patients who have to drive or operate machinery

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The side effect of drowsiness in antihistamines can be utilized as a therapeutic effect when:

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it is incorporated into a drug that is used to treat insomnia (antihistamines are a common ingredient in OTC sleep aids)

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Side effects of drugs:

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Effects other than the therapeutic effect; and can be mild and temporary, moderate and annoying, or severe enough that the patient must stop taking the drug

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A list of common side effects is developed as a new drug is tested, if the side effects are severe:

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The FDA may not approve the drug

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No drug is entirely safe and without:

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side effects and risks

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Even one of the oldest and most widely used OTC drugs aspirin:

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Can cause serious side effects, such as gastric bleeding and ulcers

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Examples of side effects vary widely with:

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The type of drug

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Most drugs are associated with at least:

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one or two side effects that are frequently observed after administration of the drug

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Common gastrointestinal side effects of many drugs include:

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Anorexia, nausea, vomiting, or diarrhea

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Common side effect of narcotic drugs is:

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Constipation

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Common central nervous system side effects include:

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Drowsiness, excitement, or depression

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Some antidepressant drugs cause significant side effects of:

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blurred vision, dry mouth, and fatigue

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Side effects common to chemotherapy:

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Nausea, vomiting, chills, fever, loss of hair, and depression of the bone marrow

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Even though these side effects are more severe than those of other drugs, the FDA does not take these drugs off the market because:

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chemotherapy drugs are used to treat cancer which is life-threatening

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Once a drug is approved by the FDA:

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Its advertisements, informational literature, prescribing information, and package inserts must list the drug's side effects

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Adverse side effects:

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Severe side effects are referred to as adverse; they are not as commonly observed as side effects

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Some adverse effects become apparent only after:

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A drug has been on the market for some time and has been prescribed for large numbers of patients

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The FDA can remove a drug from the market, even after:

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It has been approved, if there are reports of severe adverse effects

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Example: the drug tegaserod (Zelnorm) was approved by the FDA in 2002 for the treatment of irritable bowel syndrome and was also approved in 2004 for chronic constipation

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This drug was heavily advertised on t.v., but in 2007 was taken off the market bc of an increased risk of heart attack and stroke

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In 2000, the FDA proposed regulations to make the prescribing information provided with drugs:

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easier for doctors to use

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The FDA acknowledged that too few doctors:

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Read these lengthy, fine print info sheets

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The newly revised drug information begins with:

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A section describing the most important warnings for not prescribing a drug for particular types of patients and ends with a patient-counseling checklist that the dr can review with the patient

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Seven of the eleven drugs taken off the market by the FDA from 1997-2000 were taken off bc:

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Doctors kept prescribing these drugs to particular patients despite warnings to the contrary in the drug information

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in 1997, the FDA removed from the market one of the two drugs in the widely popular "fen-phen" combination drug for weight loss:

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Fenfluramine (Pondimin) was removed from the market; the other drug, phenteramine (Fastin), was allowed to remain on the market as an appetite suppressant

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At the same time, the chemically related drug dexfenfluramine (Redux) was also taken off the market

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Both fenfluramine and dexfenfluramine were linked to cases of patients developing primary pulmonary arterial hypertension and damage to the heart valves

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Before fen-phen was taken off the market:

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Redux had already been prescribed for 2 million people

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Often an adverse effect is so unusual and seemingly unrelated to the drug's usual effect that it:

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Takes some time before a causal relationship is established

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Isotretinoin (Accutane) is a vitamin-A (retinoid) drug that was first approved by the FDA:

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In 1982 for the treatment of severe cystic acne vulgaris of the skin

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It was not until 2001 that the FDA required patients to sign a consent form prior to taking Accutane bc of a:

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Possible link to suicide

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Pramipexole (Mirapex) was approved by the FDA in 1997 to treat:

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The symptoms of Parkinson's disease

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More recently pramipexole was approved to treat restless legs syndrome, however:

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Even the t.v. ads warn of the adverse reactions of compulsive gambling and sexual activity

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According to a study published in Archives of Internal Medicine, the incidence of death or adverse reactions to drugs:

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More than doubled between 1998 and 2005

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Adverse drug reactions account for:

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1.5 million hospitalizations each year, or about 4,000 every day

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An additional 770,000 patients develop an adverse drug reaction after:

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Being admitted to the hospital and receiving more drugs

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As many as 100,000 Americans die each year as a result of an:

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Adverse drug reaction

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It has been estimated that for every dollar spent on prescription drugs:

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Another dollar is spent to treat adverse reactions caused by those drugs

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Physicians and pharmacists can report adverse drug effects to:

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The FDA; the FDA's phone number must be published in bold type on all drug information, effective as of 2000

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The FDA also maintains the national Adverse Event Reporting System (AERS):

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Almost half of the reports of patients' deaths sent to the FDA were due to adverse drug reactions

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Toxic effects result when the serum level of a drug rises about:

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The therapeutic level to a higher level that is toxic

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Before FDA approval, the drug company must show that a drug:

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does not produce a toxic effect when administered in a therapeutic dose

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When a drug with a low therapeutic index such as the heart drug digoxin (Lanoxin) is administered:

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It is not uncommon to see toxic symptoms, particularly in elderly patients whose liver and kidneys are less able to metabolize and excrete the drug

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When toxic effects occur, the physician may elect to:

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Decrease the dose of the drug, lengthen the time between doses, or discontinue the drug altogether

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Patients taking drugs that are known to cause toxic effects are scheduled for:

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Blood tests to monitor the drug level and other lab tests to monitor the function of particular organs that might be affected

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Collaborative communication between doctors and pharmacists:

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one way to avoid adverse drug effects

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Example: the antibiotic drugs gentamicin and kanamycin are known to exert toxic effects on the ears (ototoxicity) and kidneys (nephrotoxicity):

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Patients on these drugs have audiograms to monitor hearing acuity and their BUN and creatinine levels are also monitored by blood tests to assess kidney function

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The word ototoxicity contains the combining form ot/o- which means:

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ear

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Nephrotoxicitiy contains nephr/o which means

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neprhon or kidney

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Example: Liver function tests are done for patients on:

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some cholestrol-lowering drugs (Lipitor, Mevacor, Zocor) because of their possible toxic effect on the liver

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Allergic reaction is a type of side effect that differs from other side effects bc of its specific underlying cause:

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the release of histamine that occurs even when a drug is at a therapeutic level

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The word allergy was introduced in the early

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1900s

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An allergy is a:

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Reaction that occurs when the body's immune system identifies a foreign substance (which is known as antigen) and initiates an antibody response against it

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An antigen

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a foreign substance; pollen, dust, or a drug

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The antigen does not provoke an allergic reaction

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in everyone, only in certain hypersensitive people

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The presence of the antigen combined with an antibody:

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stimulates the release of histamine

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Histamine produces mild-to-severe allergic symptoms:

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depending on the amount release

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Mild allergic reactions are characterized by:

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itching, swelling, redness, and sneezing

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Severe or life-threatening allergic reactions involve:

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Bronchospasms, edema, shock, and death

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The most severe symptoms of an allergic reaction are collectively known as:

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anaphylaxis or anaphylactic shock

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Anaphylactic shock is not common, but is often associated with:

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antibiotic drugs, although other drugs may also produce it

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interestingly, a patient may take several courses of an antibiotic drug over the years without any reaction, but then:

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The next course of the drug will cause an allergic reaction

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once a patient is sensitized to a particular drug, even a small dose can:

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trigger an allergic reaction

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some drugs show cross allergies to other drug groups because of:

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similarities in their molecular structurs

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Patients allergic to penicillin should avoid drugs in the penicillin group, such as ampicillin, and may also exhibit hypersensitivity to cephalosporin antibiotic drugs:

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Keflex, Velosef, Cecolor because of their similar chemical structure

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A drug idiosyncrasy is:

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A type of drug reaction that is not a side effect and is not based on an allergic reaction; it's an individual's unique reaction to a drug, and it differs from side effects commonly associated with that drug

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A drug idiosyncrasy has its basis in:

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The genetic makeup of the individual, as certain genetic factors are responsible for variations in the metabolism and action of a drug

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Certain ethnic groups, such as those of:

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Asian, Jewish, and African descent, have well-studied idiosyncratic reactions to certain drugs

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Example: Malignant hyperthermia (uncontrolled elevated body temp) is a type of:

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Drug idiosyncrasy; and occurs in 1 out of every 20,000 patients who are given the inhaled general drug halothane

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The idiosyncratic reaction is caused by:

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A genetic variation in one known gene that controls a particular receptor, but the reaction may involve up to six different genes

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The patient experiences severe, continued muscle contractions followed by malignant hyperthermia

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Unless the symptoms are treated quickly, they can result in death

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Drug-drug interactions occur:

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Because of polypharmacy, synergism, and antagonism

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Polypharmacy:

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Many patients take more than one drug on a daily basis; increases the likelihood of a drug-drug interaction

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the elderly make up 15% of the population of the US, but take

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33% of the prescription drugs

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The risk of an adverse reaction to a drug is one-third higher in:

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people ages 50-59 than in those just 10 years younger; this is bc there is a marked increase in the number of drugs prescribed to the average person after age 50

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Many patients also take both:

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prescription drugs and several OTC drugs of their own choice

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Synergism:

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When administered simultaneously, some drugs interact with each other in a particular way that either accentuates or diminishes the action of each

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Synergism occurs when:

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Two drugs combine to produce an effect that is greater than the independent effect of the drug

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In many cases, synergism is:

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beneficial

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The way to optimize the therapeutic effect of a drug and minimize the occurrence of adverse or toxic effects is to:

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Take the drug exactly as prescribed

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Multiple drugs elderly take can vary and be confusing, add to that the common problems of memory and vision loss, and this:

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increases the possibility of noncompliance (missed drug doses) or toxicity (overdoses)

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A drug dose container purchased at a drug store:

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can be an inexpensive solution

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A new FDA-approved computerized unit the size of a bread box and known as EMMA

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Electronic medication management assistant hold individualized doses of a month's worth of drugs

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EMMA plugs into:

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a regular outlet and has a wireless connection to the internet to access the patient's electronic medication administration record

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When it's time for a dose, EMMA has:

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An audible alert sounds; patient then pushes a button on the touch screen, and the drug does is dispensed

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Desirable side effect of synergism example: Tylenol combined with codeine to:

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provide more complete pain relief than either drug alone can provide

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Undesirable type of synergism can also occur:

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Drug combination of tranquilizer drugs taken with alcohol or antihistamine drugs taken with alcohol; drowsiness is heightened often with fatal results

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Elvis:

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died of heart attack in 1977 and was prescribed some 12,000 pills in the 18 months prior to death

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Prozac and alcohol taken by the chauffeur driving Princess Diana's car in 1997

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may have contributed to the tragic accident

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IN 1988, astemizole (Hismanal) and terfendadine (Seldane) antihistamine drugs were:

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hailed as superior to older antihistamine drugs bc they did not cause sedation

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After being on the market 10 years, the FDA required astemizole (Hismanal) and terfendadine (Seldane) to carry a warning label that they should not be used by patients taking:

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the antibiotic drug erythromycin or the anitungal drugs ketoconazole or itraconazole

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Taking just a little more than the prescribed dose of either of these antihistamine drugs in combo with the antibiotic or antifungal drug could cause:

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Fatal cardiac arrhythmia

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In 1999, the FDA removed both of these antihistamine drugs from the market:

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astemizole (Hismanal) and terfendadine (Seldane)

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Antagonism:

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Another type of drug-drug interaction

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Antagonism occurs when:

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Two drugs combine to produce an effect that is less than the intended effect for either drug

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The pharmacist applies labels to the prescription bottle to:

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warn the patient of a possible drug-drug interaction; drug-food interaction, and side effects

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Example of a drug antagonism:

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when the antibiotic drug tetracycline is taken with an antacid, these two drugs combine in the stomach to form an insoluble compound that prevents either drug from exerting a therapeutic effect

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Drug-Food interaction:

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Synergistic and antagonistic drug-food interactions also occur

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Grapefruit and grapefruit juice:

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These can cause serious adverse effects and even toxic effects when taken together with certain drugs

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Grapefruit juice blocks:

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an enzyme in the intestine that normally breaks down part of a drug dose before it even enters the blood

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With decreased levels of this enzyme, much

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more active drug enters the blood, and this can result in a toxic level of the drug

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Example of a drug-food interaction:

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Tetracycline cannot be taken with milk bc together they form an insoluble compound in the stomach

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Another example of a drug-food interaction:

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MAO inhibitors, a class of antidepressant drugs, cannot be taken with foods rich in the amino acid tyramine bc that will cause hypertension, headache, and a possible stroke

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Patients taking MAO inhibitor drugs must avoid these foods:

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Containing Tyramine, which is present in aged cheeses, alcoholic beverages, bananas, liver, avocados, and chocolate

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Pharmacogenetics is the:

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study of how the genetic makeup of different people affects their response to certain drugs

Pharm: Drug effects and interactions – Flashcards

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