Advantage and Disadvantage of Different Medication Administration Routes:
● Bioavailability: ability of drugs to reach systemic circulation from site of administration
○ IV- drug is 100% bioavailable
○ PO- bioavailability decreases due to first-pass metabolism of the liver
How to Prevent Medical Errors:
● Replacing handwritten medication orders with computerized or entry has reduced
medication errors by 50%
● Having a senior clinical pharmacist accompany physicians on rounds in ICUs has
reduced errors by 66%
● Using bar-code systems that match the patient’s armband barcode to a drug barcode has
decreased errors in some institutions as much as 85%
● Incorporating medication reconciliation has resulted in decreasing errors by 70% and
reducing ADRs by 15%
Terms Related to Adverse Drug Reactions:
● Allergic Reaction
○ Immune response
○ Determined primarily by the degree of sensitization of the immune system - not
by the dosage
○ Patient’s sensitivity to a drug can change over time
○ Very few drugs cause severe allergic reaction
■ Penicillins are the most common
● Iatrogenic Disease
○ Iatros = greek word for “physician”
○ Genic = “to produce”
○ Iatrogenic = “a disease produced by physicians” and is also used to refer to a
disease caused by drugs (antipsychotic drugs can cause parkinsons-like
symptoms)
○ Sometimes called drug-induced disease
● Carcinogenic Effect
, ○ Having the potential to cause cancer
○ Only a few therapeutic agents are carcinogenic
○ Several drugs used to treat cancer have the greatest carcinogenic effect
● Teratogenic
○ A drug-induced birth defect
● Paradoxical Effect
○ Opposite of the intended drug response
○ Insomnia and excitement for some children and old adults when taking sedatives
like benzodiazepines
● Physical Dependence
○ A state in which the body functions normally only in the presence of a drug
○ Physical disturbance when the drug is removed
Major Lab Indicators and Clinical Symptoms for Hepatic and Renal Toxicity Monitoring:
● During metabolism, some drugs are converted to toxic products that can injure liver cells
● Combining hepatotoxic drugs increases risk (acetaminophen and alcohol)
● Monitor two liver enzymes:
○ AST (aspartate aminotransferase)
○ ALT (alanine aminotransferase) for liver injury
○ If these levels are high, it could be liver damage
● Watch for signs of liver injury and educate patients!
○ Jaundice, dark urine, light colored stool, nausea, vomiting, abdominal discomfort,
anorexia
● Serum BUN
○ Can tell if the patient is dehydrated if high
● Serum Creatinine
● 24 hr urine for creatinine clearance
● GFR
Individual Variations in Drug Response:
● Gender
● Bioavailability: ability of drugs to reach systemic circulation from site of administration
○ IV- drug is 100% bioavailable
○ PO- bioavailability decreases due to first-pass metabolism of the liver
How to Prevent Medical Errors:
● Replacing handwritten medication orders with computerized or entry has reduced
medication errors by 50%
● Having a senior clinical pharmacist accompany physicians on rounds in ICUs has
reduced errors by 66%
● Using bar-code systems that match the patient’s armband barcode to a drug barcode has
decreased errors in some institutions as much as 85%
● Incorporating medication reconciliation has resulted in decreasing errors by 70% and
reducing ADRs by 15%
Terms Related to Adverse Drug Reactions:
● Allergic Reaction
○ Immune response
○ Determined primarily by the degree of sensitization of the immune system - not
by the dosage
○ Patient’s sensitivity to a drug can change over time
○ Very few drugs cause severe allergic reaction
■ Penicillins are the most common
● Iatrogenic Disease
○ Iatros = greek word for “physician”
○ Genic = “to produce”
○ Iatrogenic = “a disease produced by physicians” and is also used to refer to a
disease caused by drugs (antipsychotic drugs can cause parkinsons-like
symptoms)
○ Sometimes called drug-induced disease
● Carcinogenic Effect
, ○ Having the potential to cause cancer
○ Only a few therapeutic agents are carcinogenic
○ Several drugs used to treat cancer have the greatest carcinogenic effect
● Teratogenic
○ A drug-induced birth defect
● Paradoxical Effect
○ Opposite of the intended drug response
○ Insomnia and excitement for some children and old adults when taking sedatives
like benzodiazepines
● Physical Dependence
○ A state in which the body functions normally only in the presence of a drug
○ Physical disturbance when the drug is removed
Major Lab Indicators and Clinical Symptoms for Hepatic and Renal Toxicity Monitoring:
● During metabolism, some drugs are converted to toxic products that can injure liver cells
● Combining hepatotoxic drugs increases risk (acetaminophen and alcohol)
● Monitor two liver enzymes:
○ AST (aspartate aminotransferase)
○ ALT (alanine aminotransferase) for liver injury
○ If these levels are high, it could be liver damage
● Watch for signs of liver injury and educate patients!
○ Jaundice, dark urine, light colored stool, nausea, vomiting, abdominal discomfort,
anorexia
● Serum BUN
○ Can tell if the patient is dehydrated if high
● Serum Creatinine
● 24 hr urine for creatinine clearance
● GFR
Individual Variations in Drug Response:
● Gender
