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Drug-Drug Interactions
May increase/decrease therapeutic effects.

May increase/decrease adverse effects.
Over the Counter Medications (OTC) carry the potention to react with Rx medications.
Perform complete medication Hx.

Advise pts to take antacids 1 hr apart from other medications.
Drug-Food Interactions
Certain foods may interact with medications.
A pt is prescribed a Monoamine oxidase inhibitor (MAOI). The nurse should instruct the pt to avoid foods containing what?
The pt should avoid foods containing tyramine.

The combination may lead to a hypertensive crisis.
Vitamin K has what effect when combined with warfarin (Coumadin)?
Vitamin K will decrease the therapeutic effect of warfarin (Coumadin) --> pt is at r/f developing blood clots.

Vitamin K is the antedote for warfarin (Coumadin) over-dose.

Advise pt to avoid foods high in Vitamin K (leafy, dark green veggies).
A pt is prescribed tetracycline. What should the nurse inform the pt in regards to food-drug interactions?
The nurse should instruct the pt to avoid drinking milk (or any chelating agent) within 2 hours of administration.

Chelating agent + tetracycline = the formation of an insoluble, unabsorbably compound. The tetracycline is rendered ineffective.
Grapefruit Juice
Is thought to act by inhibiting presystemic medication metabolism in the small bowel.

Decreases absorption or enhances adverse reactions.

Pt prescribed any oral medication should avoid.
Adverse Drug Effect
Any unintended or undesired effect that may occur at a normal medication dose.
Side Effects
Secondary medication effects that occur at therapeutic doses.

Usually predictable.
Adverse Medication Effects - CNS
CNS stimulation - r/f seizures (***place pt on seizure precautions!!***)

CNS depression - advise pt not to drive, drowsiness.
Adverse Medication Effects - Extrapyramidal symptoms (EPS)
Associated with medications that affect CNS

E.G., medications to tx mental disorders.

Abnormal body movements - fine motor treamors, rigidity, restlessness, and acute dystonias (spastic movements &/or muscle regidity to head, neck, eyes, facial area, and limbs).
Adverse Medication Effects - Anticholinergic
Results from muscarinic receptor blockade.

Effects are seen in eyes, smooth muscle, exocrine glands, and heart.

Dry mouth, photophobia, urinary retention.
Adverse Medication Effects - Cardiovascular
Effects both the blood vessels and heart.

Antihypertensives may cause orthostatic hypotension.

Instruct pt on s/s of orthostatic hypotension. May be minimized by getting up slowly.
Adverse Medication Effects - GI
Typically results from - 
Local irritation of GI tract
Stimulation of emetic center of brain
Increased peristalsis

Example - opoids often cause constipation. Advise clients to increase fluids/fiber.
Adverse Medication Effects - Hematologic
Bone marrow suppression, excessive bleeding, increased r/f blood clots.
Adverse Medication Effects - Hepatotoxicity
Damage to liver cells impacts metabolism and can lead to accumulation & toxicity.

Many medications may alter normal liver function tests with no obvious clinical signs of liver dysfunction.

Liver function studies should be done when a pt starts a hepatoxic medication and periodically afterwards.
Adverse Medication Effects - Nephrotoxicity
May occur with many meds.

Typically results from antimicrobial agents & NSAIDs.

Damage results in increased accumulation and r/f toxicity.

E.G., aminoglycosides

Monitor serum creatinine and BUN
Toxicity
An adverse medication effect that is considered severe and my be life threatening.

May occur at therapeutic lvls.
Allergic Reaction
Occurs when an individual develops an immune response to a medication.

Requires previous exposure and development of antibodies to medication.

Tx mild rashes and hives with diphenhydramine (Benadryl).

Prior to any medication administration take a complete medication Hx.
Anaphylactic Reaction
A life-threatening, immediate allergic reaction that causes respiratory distress, severe bronchospasm, and cardiovascular collapse.

Tx with epinephrine, bronchodilators, and antihistamines.
Immunosuppression
Occurs when there is a decreased or absent immune response.

Glucocorticoids - monitor pt for s/s of infection.
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