Pharmacy Foundations 2 Flashcards
What analysis is used to prospectively prevent med errors?
Failure mode and effects analysis (FMEA)
What analysis is used to retrospectively prevent med errors?
Root cause analysis (RCA)
What analysis is used to continuously prevent med errors?
Continuous quality improvement (CQI)
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)
Examples of high alert meds
Anesthetics
Arrhythmics
Anticoagulants
Chemo
Hypertonic NaCl
Sterile water
Insulin
Immunosuppressants
Opioids
TPNs
KCl
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
Type A ADRs
Predictable, dose dependent, most common
Type B ADRs
Non-dose dependent, unpredictable
(ex. allergies, intolerances)
Type I reactions
IgE-mediated
Occurs within 60 mins of drug exposure
(ex. angioedema)
Type II reactions
Antibody-mediated
Occurs 5-8 days after drug exposure
(ex. thrombocytopenia)
Type III reactions
Immune-complex reactions
Occurs >1 week after drug exposure
(ex. drug induced lupus)
Type IV reactions
Cell-mediated or delayed hypersensitivity rxns
Occur 48 hours to several weeks after drug exposure
(ex. Stevens-Johnson syndrome)
Drugs associated with thrombotic thrombocytopenic purpura
Clopidogrel
Sulfamethoxazole
-cyclovirs
Drugs associated with photosensitivity
Amiodarone
Diuretics
Methotrexate
Retinoids
FQ
St. Johns wort
Sulfa abx
Tacrolimus
Tetracyclines
Voriconazole
Drugs commonly associated with severe skin rxns
Abacavir
Allopurinol
Carbamazepine
Ethosuximide
Lamotrigine
Modafinil
Nevirapine
Penicillins
Phenytoin
Sulfamethoxazole
Where is the needle located on an Epipen?
Orange end
What drugs cannot be given with an egg allergy?
Propofol
Clevidipine
Yellow fever vaccine
All flu shots except Flublox and Flucelvax
What drugs cannot be given with a soy/peanut allergy?
Propofol
Clevidipine
Factors that favor drug distribution into tissues/across membranes
High lipophilicity
Low MW
Unionized
Low protein binding
Vd equation
Vd = dose given/concentration in plasma
Cl equation
Cl = rate of elimination/drug concentration
Cl = bioavailability * dose / AUC
ke equation
ke = Cl/Vd
ke = ln(c1/c2)/time
t1/2 equation
t1/2 = 0.693/ke
LD equation
LD = desired conc * Vd / bioavailabiltiy
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
