CH 4 Pharmacy Practice and Medication Safety

Question 1

Prescriptions are

Answer 1

Written, oral, or electronic transmission directions for dispensing
medication
Used in clinics or community pharmacies such as CVS, Walgreens

Question 2

Prescription requirements… 7
patient’s…
drug’s…
‘sig’..
date…
prescribers…
DEA…
why…

Answer 2

Patient’s name and address

drug Name and quantity

Directions for use (also called the “sig”)

date prescription was written

prescriber’s name, telephone number, address, license classification, and signature

DEA number (for controlled substances)

purpose or condition for which the drug is being prescribed if requested by the patient

Question 3

Additional info but not required…

Answer 3

Refills

Any additional instructions deemed necessary by the prescriber

If generic substitutions are permitted

Question 4

Medication Orders are prescriptions…

Answer 4

issued and dispensed in an
institutional setting (hospitals or long-term care facilities)

Question 5

Medication Orders include…

Answer 5

name of the drug, dose, route

Often submitted electronically into a patient’s electronic health record (EHR)

Question 6

Stop orders

Answer 6

automatic stop time or date for certain drugs

Used for medications with a specific duration limit

Question 7

Drug Administration Rights
6 Right… P.R.D.D.D.T

Answer 7

Right Patient

Right Route

Right Drug

Right Dose

Right Documentation

Right Time

Question 8

Factors that Influence Drug Action
(7) maddaga

Answer 8

mental status
age
disease states

drug interactions
allergies
genetics
A.D.M.E.

Question 9

Meds forPediatric(kids) Patients

Answer 9

Medication doses are often based on their weight (kg)
big difference between age and the development of the organs that can affect drug pharmacokinetics

Question 10

Patient-Specific Factors on Drug and
Nondrug Therapy (4)…

Answer 10

cultural beliefs
disabilities
socioeconomic factors
language barriers

Question 11

Antihistamine Drugs

Answer 11

H1 Antagonists used for
seasonal allergies and cough and cold

Diphenhydramine (Benadryl)

Loratadine (Claritin)

Fexofenadine (Allegra)

&

H2 Antagonists used for
dyspepsia or heartburn, gastroesophageal
disease (GERD) or to prevent stress ulcers
famotidine (Pepcid)

cimetidine (Tagamet)

Question 12

Allergic Response

Answer 12

caused by med, env., food
mild to severe cases

Question 13

Tall man lettering

Answer 13

Drug name pairs or larger groupings with bolded and uppercase letters to
help draw attention to the dissimilarities in LASA medications

DOXOrubicin – IDArubicin

hydrALAZINE – hydrOXYzine

diazePAM – diltiaZEM

DACTINomycin – DAPTOmycin

Question 14

Dispensing Precautions

some drugs may be affected by…

Answer 14

light or moisture and should not be repackaged

Question 15

Medication Safety is enhanced with tech such as…

Answer 15

Bar codes and scanning

computerized physician order entry (CPOE) _Used in hospitals whereprescriber enters the order which is then verified and dispensed by the
pharmacy

Question 16

High Alert Medications are meds that have an increased…

Answer 16

risk of causing significant patient harm when
used in error

Question 17

High Alert Medications Examples:
a.i.c.h.a.i.n.o.

Answer 17

Antithrombotic agents

Insulin

Chemotherapy

Hypertonic sodium chloride

Adrenergic agonists/antagonists

IV potassium chloride (KCl)

Neuromuscular blocking agents
Opioids

Question 18

Medication errors

Answer 18

Occurs when any of the 6 “rights” of drug administration are incorrect

needs to be reported to help understand what caused the mistake and what can be
done to help prevent future errors

Example: the wrong drug or wrong dose is given to a patient

Question 19

Near misses

Answer 19

Medication errors that are caught before they reach the patient

needs to be documented and reported to help prevent future near misses of similar
fashion

Example: a technician fills metoprolol tartrate instead of metoprolol succinate
which is caught by the pharmacist upon final verification

Question 20

Reporting errors

Answer 20

needs to be documented and reported to help prevent future errors of similar fashion

The patient and the prescriber should be notified of the medication error

Errors should be documented in a database and should be reviewed using root cause analysis RCA

California Board of Pharmacy requires that every pharmacy must have a quality
assurance program to document medication errors to help prevent recurrence

Question 21

RCA

Answer 21

root cause analysis

used to identify the main cause or problems of medication error and find solutions

does not seek to place blame or punish individuals for making a mistake

Example: RCA could identify that errors were occurring due to a lack of training on
a new policy or procedure

Question 22

Automatic stop orders

Answer 22

specific date or time when a medication is to be discontinued

Medications can also be given a set number of doses, and then the order is stopped

Example: placing a medication order for an antibiotic to stop after 7 days of therapy

Question 23

Conditional orders must meet

Answer 23

certain conditions before they can be activated

Example: placing hold parameters on a blood pressure medication to hold the dose
if the systolic blood pressure is < 90 mmHg

Question 24

(REMS) Program

Risk Evaluation and Mitigation Strategy

Answer 24

for certain medications

Goal) benefits > risks

May involve special dispensing or prescribing requirements for
certain drugs

May require prescribers and/or pharmacists to complete special
training

Question 25

Inventory reports

Answer 25

Keeps track of all inventory in the pharmacy
Helps to notify staff when to re-order medication or supplies

Question 26

Diversion reports

Answer 26

Monitors the waste, access, administration, and return, of medications including controlled substances

Helps to identify theft, especially of controlled substances

Example: a partial vial of fentanyl is used in the OR but no waste was documented for the rest of it

Question 27

Discrepancy reports

Answer 27

Ensures all products are accounted for
Helps to identify lost or stolen inventory

Question 28

Override reports

Answer 28

Tracks which medications were accessed or used before being verified by the pharmacy
Example: RN pulls a medication to be given urgently to a patient

Question 29

Usage reports

Answer 29

Tracks how often certain medications are being used

Ex) high volumes of Tamiflu prescriptions given during wintertime

Question 30

Narcotic waste report

Answer 30

Used to document the waste of controlled substances

Requires signature of the person wasting the controlled substance and the signature of a witness

Example: RN pulls a morphine syringe (2 mg/mL) but only gives 1 mg to the patient and must waste the rest

Question 31

Business summary reports provides…

Answer 31

-productivity reports, losses and profits, net sales, employee satisfaction surveys, quality assurance, distribution costs, etc.

Question 32

Factors That Can Affect Compliance and Adherence

Answer 32

Side effects
Dosing frequency
Drug interactions
Cost
Patient counseling
Flavoring agents
Forgetfulness
Routes of administration
Dosage formulations
Pill boxes
Lack of awareness of disease
Polypharmacy

Question 33

Routes of admin

Answer 33

oral
sublingual
buccal
paternal and Topical routes of admin (other deck of flashcards)

Question 34

Institute for Safe Medication Practices (ISMP)

Answer 34

devoted to preventing medication errors

Publishes newsletters, guidelines, and educational tools for institutions to promote essential medication safety standards and practice

Question 35

Medication Reconciliation
is a detailed list of the…

Answer 35

patient’s home medications
Improves medication compliance with patients and medication safety during transitions of care