Medication Safety, Monitioring And Interactions

Question 1

What are adverse drug events? (ADE’s)

Answer 1

1. Side effects (side effects does not mean error)
2. The effects the drug had on the patient, not an error in the medication process
3. All ADE cause patient harm

Question 2

In which demographic are side effects most common?

Answer 2

1. Extreme age (very young, very old)
2. Women

Question 3

What is a medication error? ME

Answer 3

1. Any preventable event that ay cause or lead to inappropriate medication use or patient harm
2. Some type of process error
   EX: Samantha adams received Samuel Adams Rx

Question 4

Are MEs preventable?

Answer 4

Yes ME are preventable, but do not always cause patient harm

Question 5

What is a sentinel event?

Answer 5

1. A patient safety event that results in death, permanent harm, or severe temporary harm
   *debilitating to both patients and HCP
2. Includes
   *medication error, adverse drug events, and medication misadventures (wrong patient got the wrong drug)

Question 6

What does The Joint Commission (TJC) do?

Answer 6

Inspect the hospital, notes any sentinel events

Question 7

True or false a medication error can broadly be described as a negative clinical outcome?

Answer 7

False

Question 8

What are the impacts of ME?

Answer 8

1. Emotional toll
2. “Second victim”
3. Trust
4. Costs (direct and indirect)

Question 9

What was implemented in 2007 to try and reduce medication errors?

Answer 9

1. Computerized physician order entry (CPOE)
2. Bar-code assisted medication administration (BCMA)
3. Multidisciplinary communication
4. Active patient involvement in treatment

Question 10

What is the goal of medication therapy?

Answer 10

1. Achieving defined therapeutic goals to improve a patients quality f life while minimizing harm

Question 11

What are the steps to the medication use process?

Answer 11

1. Selection and procurement
2. Storage
3. Ordering and transcribing
4. Preparing and dispensing
5. Administration
6. Monitoring

Question 12

What falls under the error, harm category?

Answer 12

Reached patient
1. Temporary harm, intervention
2. Temporary harm, hospitalizations
3. Permanent harm
4. Intervention to sustain life

Question 13

What falls under the error, no harm category?

Answer 13

Error by omission
Reached patient
1. No harm
2. Monitoring/intervention to preclude harm

Question 14

What are some examples of latent errors?

Answer 14

1. Poor handwriting
2. Incomplete information.
3. Unclear labeling
4. High workload

Question 15

Definition of human error?

Answer 15

Inadvertently doing other than what should have been done; a slip, lapse, or mistake

Question 16

What is the definition of at-risk behavior

Answer 16

A behavioral choice that increases risk where risk is not recognized, or is mistakenly believed to be justified

Question 17

What is the definition of reckless behavior?

Answer 17

A behavioral choice to consciously disregard a substantial and unjustifiable risk

Question 18

How to manage human error, at-risk behavior, reckless behavior?

Answer 18

Human: Choices, procedures, training, design, environment
At-risk: Removing incentives for at-risk behaviors, creating incentives for healthy behaviors, increasing situational awareness
Reckless: remedial action, punitive action

Question 19

How to avoid Rx errors?

Answer 19

1. Avoid abbreviations
2. TALLman lettering
3. Avoid verbal order unless in emergencies

Question 20

What does A-PINCH stand for? (High risk medications)

Answer 20

A: Anti-infective
P: Potassium and other electrolytes
I: Insulin
N: Narcotics and other sedatives
C: chemotherapy
H: Heparin and other anticoagulants

Question 21

What are the principles for medication monitoring?

Answer 21

1. Administration
2. Adherence (patient engagement)
3. Disease related efficacy and safety
4. Tolerability

Question 22

What is efficacy and safety?

Answer 22

E: os the desired effect occurring
S: what adverse effects are being experienced

Question 23

What is the definition of drug interactions?

Answer 23

When one drug modifies the action of another drug

Question 24

What are pharmacokinetic alterations?

Answer 24

Changes in distribution, elimination
EX: lower the dose depending on the changes with the patient

Question 25

What are pharmacodynamic changes?

Answer 25

Additive, synergistic, antagonistic
*2 BP meds can increase the risk of hypotension

Question 26

What are drug incompatibilities?

Answer 26

Interactions between drugs in vitro

Question 27

What is Cytochrome P450s (CYP)

Answer 27

Superfamily of enzymes responsible for the metabolism of a wide range of structurally diverse substrates

Question 28

What is the Narrow therapeutic index? (NTI)

Answer 28

1. Drug with a <2 fold difference in the median lethal dose and median effective dose between values
   *Effective dose and lethal dose are close in values

Question 29

What does TD50 stand for?

Answer 29

Dose require to produce a toxic effect in 50% of the population

Question 30

What is the LD50

Answer 30

The dose of the drug that produces death in 50% of the animal population tested

Question 31

What is ED50

Answer 31

The dose at which 50% of individual exhibit the specified therapeutic effect

Question 32

What are examples are NTI drugs?

Answer 32

1. Carbamazpine
2. Digoxin
3. Levothyroxine
4. Lithium Carbonate
5. Phenytoin
6. Theophylline
7. Warfarin
   *Small increases in a dose or blood/serum concentration could lead to toxic effects

Question 33

What are the DDI of antacids

Answer 33

Will decrease absorption

Question 34

What are the DDI of beta blockers for insulin

Answer 34

1. Masking symptoms of hypoglycemia

Question 35

What are the DDI of beta blockers with insulin

Answer 35

Will make the symptoms of hypoglycemia