Pharmacy Foundations 2 Flashcards by Emily Brassell

What analysis is used to prospectively prevent med errors?

Failure mode and effects analysis (FMEA)

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What analysis is used to retrospectively prevent med errors?

Root cause analysis (RCA)

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What analysis is used to continuously prevent med errors?

Continuous quality improvement (CQI)

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What abbreviations should be avoided in SIGs?

U (for unit)
IU (for international unit)
QD, qd, qod, QOD
Trailing zeros (1.0)
Lack of leading zero (.1)
MS (morphine)
MgSO4 (mag sulfate)

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Examples of high alert meds

Anesthetics
Arrhythmics
Anticoagulants
Chemo
Hypertonic NaCl
Sterile water
Insulin
Immunosuppressants
Opioids
TPNs
KCl

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What are the 5 rights of med administration?

1) Right pt
2) Right time and frequency
3) Right dose
4) Right route
5) Right drug

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Type A ADRs

Predictable, dose dependent, most common

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Type B ADRs

Non-dose dependent, unpredictable
(ex. allergies, intolerances)

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Type I reactions

IgE-mediated
Occurs within 60 mins of drug exposure
(ex. angioedema)

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Type II reactions

Antibody-mediated
Occurs 5-8 days after drug exposure
(ex. thrombocytopenia)

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Type III reactions

Immune-complex reactions
Occurs >1 week after drug exposure
(ex. drug induced lupus)

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Type IV reactions

Cell-mediated or delayed hypersensitivity rxns
Occur 48 hours to several weeks after drug exposure
(ex. Stevens-Johnson syndrome)

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Drugs associated with thrombotic thrombocytopenic purpura

Clopidogrel
Sulfamethoxazole
-cyclovirs

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Drugs associated with photosensitivity

Amiodarone
Diuretics
Methotrexate
Retinoids
FQ
St. Johns wort
Sulfa abx
Tacrolimus
Tetracyclines
Voriconazole

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Drugs commonly associated with severe skin rxns

Abacavir
Allopurinol
Carbamazepine
Ethosuximide
Lamotrigine
Modafinil
Nevirapine
Penicillins
Phenytoin
Sulfamethoxazole

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Where is the needle located on an Epipen?

Orange end

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What drugs cannot be given with an egg allergy?

Propofol
Clevidipine
Yellow fever vaccine
All flu shots except Flublox and Flucelvax

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What drugs cannot be given with a soy/peanut allergy?

Propofol
Clevidipine

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Factors that favor drug distribution into tissues/across membranes

High lipophilicity
Low MW
Unionized
Low protein binding

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Vd equation

Vd = dose given/concentration in plasma

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Cl equation

Cl = rate of elimination/drug concentration
Cl = bioavailability * dose / AUC

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ke equation

ke = Cl/Vd
ke = ln(c1/c2)/time

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t1/2 equation

t1/2 = 0.693/ke

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LD equation

LD = desired conc * Vd / bioavailabiltiy

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Drugs affected by HLA-B*5701 genotype

Abacavir (Triumeq, Epzicom)

Drugs affected by HLA-B*5801 genotype

Allopurinol

Drugs affected by HLA-B*1502 genotype

Carbamazepine Oxcarbazepine Phenytoin Fosphenytoin

Drug affected by CYP2C19 polymorphism

Clopidogrel

Drug affected by CYP2D6 polymorphism

Codeine

Drug affected by CYP2C9 and VKORC1 polymorphism

Warfarin

Drugs that require genetic testing prior to administration

Abacavir Azathioprine Carbamazepine Cetuximab Trastuzumab

Supplements that increase risk of bleeding

Garlic Ginger Ginko Ginseng Glucosamine Fish oils (high dose) Vit E Cong Quai Willow bark

Supplement with risk of hepatotoxicity

Black cohosh Kava Comfrey

Supplements with risk of cardiac toxicity

Ephedra Bitter orange Yohimbe Caffeine

Supplements used for anxiety

Valerian Passionflower Kava St. Johns Wort

Supplements used for cold/flu

Echinacea Zinc Vit C

Supplements used for dementia

Ginkgi Vit E

Supplements used for depression

St. Johns wort SAMe Valerian 5-HTP

Supplements used for diabetes

Chromium Alpha lipoic acid Cassia cinnamon

Supplements used for dyslipidemia

Red yeast rice Fish oils

Supplements used for energy/weight loss

Bitter orange Caffeine Green tea

Supplements used for ED

Ginseng L-arginine Yohimbe

Supplements used for HF

CoQ-10 Hawthorn (positive ionotrope) Fish oils

Supplements used for HTN

Fish oils L-arginine CoQ-10 Garlic

Supplements used for inflammation

Fish oils Flax seeds/oil Turmeric

Supplements used for insomnia/sleep

Melatonin Valerian Chamomile

Supplements used for liver disease

Milk thistle

Supplements used for menopause

Black cohosh Dong quai Evening primrose oil Soy/red clover

Supplements used for migraine

Feverfew Butterbur Mg Riboflavin

Supplements used for OA

Glucosamine sulfate Chondroitin SAMe Turmeric

Supplements used for prostate health

Saw palmetto Lycopene

When can charcoal be used for OD?

For some oral ingested drugs Most effective if given within 1 hour of ingestion Dose = 1 g/kg CI w/ obstructed airway, intestinal obstruction, and decreased peristalsis

Phases of APAP OD

Phase 1 (1-24 hrs) - usually asymptomatic Phase 2 (24- 48 hrs) - hepatotoxicity evident on labs Phase 3 (48-96 hrs) - symptoms (jaundice, hepatic failure, coagulopathy, renal failure, death) Phase 4 (>96 hrs) - recovery or liver transplant

Toxic metabolite of APAP

NAPQI

Antidote to APAP

N-acetylcysteine

Antidote to opioids

Naloxone

Antidote to anticholinergics

Mostly supportive Can give physostigmine

Antidote to antipsychotics

Mostly supportive Can give benztropine for symptoms

Antidote to BZDs

Flumazenil

Antidote to BB

glucagon

Antidote to CCBs

calcium glucagon

Antidote to cyanide

hydroxocobalamin

Antidote to digoxin

DigiFab

Antidote to heavy metals

Dimercaprol (arsenic, gold, mercury) Penicillamine (copper)

Antidote to isoniazid

Pyridoxine (B6)

Antidote to iron

deferoxamine

Antidote to organophosphates

Atropine Pralidoxime

Antidote to salicylates

Sodium bicarb (increases excretion in urine)

Antidote to TCAs

Sodium bicarb (decreases QRS complex to correct QT prolongation)

Antidote to VPA or topiramate-induced hyperammonemia

Levocarnitine

Symptoms of organophosphate OD

Salivation Lacrimation Urination Diarrhea Defecation