Unit II : MEDICATION SAFETY IN HIGH-RISK SITUATION

Question 1

T/F: many medication errors may not result in harm

Answer 1

True

Question 2

medication-related
harm can be reduced with:
appropriate ____________
responsible _____________
implementing ___________ that minimize risks

Answer 2

appropriate prescribing
responsible use
implementing strategies that minimize risks

Question 3

highest prevalence rates are in

Answer 3

children

Question 4

commonest type of prescribing error

Answer 4

dosage error

Question 5

Meaning of A PINCH

Answer 5

Anti-infectives
Potassium and electrolytes
Insulin
Narcotics
Chemoterapeutic agents
Heparin and anti-coagulants
Others

Question 6

Amphotericin, aminoglycosides

Answer 6

Anti-infectives

Question 7

may cause damage to hearing or the kidneys in a dose-related, type A adverse drug reaction

Answer 7

ANTI-INFECTIVE AGENTS

Question 8

pre-existing renal impairment, older
persons, obese individuals, patients with cystic fibrosis,
neonates and children

Answer 8

anti-infectives

Question 9

reduce their renal clearance that will result in renal damage

Answer 9

ANTI-INFECTIVE AGENTS

Question 10

rapid intravenous infusion of __________ increases the risk of anaphylactic-like reactions

Answer 10

vancomycin

Question 11

Amphotericin B’s _________-based form have less severe toxicity

Answer 11

lipid

Question 12

Amphotercin B form that may be inadvertently substituted at an
inappropriate dose, risking possible severe cardiotoxicity,
including cardiorespiratory arrest

Answer 12

conventional form

Question 13

How to reduce harm for aminoglycosides:doses (e.g. gentamicin) should be calculated based patient’s _____ and ______

Answer 13

doses (e.g. gentamicin) should be calculated based patient’s
weight and renal function

Question 14

How to reduce harm for vancomycin

Answer 14

improve safe use by providing monographs

Question 15

How to reduce harm for Amphotericin B:
________________________ in the fridge for different formulations of amphotericin (lipid-based and non-lipid based)
use of _____________________ to remind staff about the
differences

Answer 15

**segregatie storage areas **in the fridge for different formulations of amphotericin (lipid-based and non-lipid based)
use of cautionary labels or warning signs to remind staff about the
differences

Question 16

POTASSIUM AND OTHER SALTS OR ELECTROLYTES FOR IV
INJECTION examples

Answer 16

Potassium chloride, Potassium phosphate, magnesium and calcium salts and
hypertonic sodium chloride

Question 17

_____________ solution of Potassium chloride: used treat hypokalemia (to avoid serious
sequelae - cardiac arrest)

Answer 17

diluted

Question 18

____________ solution of KCl: occasionally administered in error,

Answer 18

concentrated

Question 19

also used mistakenly for sodium chloride

Answer 19

concentrated solution

Question 20

How to reduce harm in areas where high
concentrations of salts/electrolytes are necessary: a ____________ for safe ________, _________ and _________ should be
developed

Answer 20

a protocol for safe storage, preparation and use should be
developed

Question 21

How to reduce harm of salts/electrolytes in general ward:stock may be _________ if not necessary, replacement with
_____________ solutions could also be considered

Answer 21

stock may be removed if not necessary, replacement with
premixed solutions could also be considered

Question 22

How to reduce harm where potassium chloride ampoules and premixed solutions

Answer 22

should be stored separately
readily identifiable from preparations with similar
packaging

Question 23

insulin-related harm are due to:

Answer 23

1. complexity of dosing
2. variety of available products
3. pharmacology of the medicine

Question 24

ACTIONS TO REDUCE HARM for prescribing insulin

Answer 24

Abbreviations, unclear instructions and ambiguous doses should be avoided.
Insulin syringes and well-titrated doses should be used.
Prescribing by “brand name” and device could reduce error.

Question 25

ACTIONS TO REDUCE HARM for insulin storage

Answer 25

physically separating insulin from vaccines or LASA products

Question 26

nausea, vomiting, constipation and in severe cases respiratory depression or respiratory arrest which may result in death

Answer 26

NARCOTICS AND SEDATIVES

Question 27

T/F: wide range of alternative opioids (some short-acting and others long-acting) make the possibility of an error

Answer 27

True

Question 28

ACTIONS TO REDUCE HARM for morphine and diamorphine

Answer 28

select correct product in the correct dose

Question 29

ACTIONS TO REDUCE HARM for IV morphine (neonatal units)

Answer 29

clear and easy protocols in preparation and administration use of **prefilled syringes** from a central intravenous additive service and** smart pumps** could be considered

Question 30

CHEMOTHERAPEUTIC AND IMMUNOSUPPRESIVE AGENTS examples

Answer 30

Etoposide, Vincristine, Methotrexate, an anticancer agent

Question 31

alkylating agent

Answer 31

Etoposide

Question 32

Etoposide is availble in what forms

Answer 32

* etoposide base * etoposide phosphate salt

Question 33

used to treat certain leukemia, lymphomas, and some solid tumors, such as breast and lung cancer

Answer 33

Vincristine

Question 34

intrathecal administration of _______________ has caused severe ascending **radiculomyeloencephalopathy**, which is almost always fatal

Answer 34

Vincristine

Question 35

used in the treatment of **rheumatoid** **arthritis** and other **autoimmune** **conditions** due to its immunosuppressive properties

Answer 35

Methotrexate

Question 36

Methotrexate is administered ________ rather than _____ dose

Answer 36

weekly; daily

Question 37

resulted in bone marrow suppression, pulmonary complications and, in some cases, even death

Answer 37

Methotrexate

Question 38

ACTIONS TO REDUCE HARM in chemotherapeutic administration

Answer 38

processes **should be in place** to avoid wrong medication, dose, route, concentration, duration or frequency

Question 39

ACTIONS TO REDUCE HARM in chemotherapeutic prescription

Answer 39

should be carried out to the **same standard as parenteral anticancer** therapy and should be monitored in the same way

Question 40

used with monitoring of the blood using the activated partial thromboplastin time (aPTT)

Answer 40

UFH

Question 41

there is a ________________(non-linear/linear) relationship between the dose of UFH infused and the aPTT

Answer 41

non-linear

Question 42

overdosing of ____________ is associated with an increased risk of hemorrhage

Answer 42

UFH

Question 43

administered subcutaneously, excreted unchanged in the urine

Answer 43

LMWH

Question 44

LMWH's safe and effective dose is determined by the patient’s ________ and ___________

Answer 44

weight and renal function

Question 45

LWMH underdosing risks ___________ while overdosing may increase the risk of _________________

Answer 45

inefficacy; hemorrhage

Question 46

orally active vitamin K antagonists, for the treatment and prevention of thrombosis, cause hemorrhage

Answer 46

Warfarin, phenindione, acenocoumarol (nicoumalone) and phenprocoumon

Question 47

should be monitored throughout treatment using the international normalized ratio (INR)

Answer 47

Warfarin, phenindione, acenocoumarol (nicoumalone) and phenprocoumon

Question 48

one of the 10 medications most frequently related to dispensing errors

Answer 48

Warfarin

Question 49

agents acting directly on clotting factor II or X

Answer 49

Newer oral anticoagulats (NOACs), also known as Direct-acting oral anticoagulants (DOACS):

Question 50

ACTIONS TO REDUCE HARM for **UFH**: all patients should have a baseline _________ performed before initiation of therapy _________ should also be measured just before therapy regular monitoring of platelet counts may be required if administered for longer than ________

Answer 50

all patients should have a baseline **aPTT** performed before initiation of therapy **platelet counts** should also be measured just before therapy regular monitoring of platelet counts may be required if administered for longer than **four days**

Question 51

ACTIONS TO REDUCE HARM for LMWH

Answer 51

**weight** of the patient is used to calculate the treatment dose required **renal** **function** should be taken into account

Question 52

ACTIONS TO REDUCE HARM FOR Vitamin K antagonists

Answer 52

**baseline prothrombin time (or INR)** should be determined and measured regularly

Question 53

ACTIONS TO REDUCE HARM FOR NOACs/DOACs

Answer 53

before prescribing, **creatinine clearance** should be calculated (e.g. using the **Cockcroft Gault** equation and ideal body weight)

Question 54

OTHER MEDICATIONS include

Answer 54

NSAIDs, Paracetamol, Lithium salts, Penicillin, diuretics, cardiac glycosides and neuroleptics

Question 55

* may cause gastrointestinal effects (e.g. ulceration) and cardiotoxicity (including exacerbation of heart failure, worsening of hypertension and myocardial infarction due to increased thrombotic risk

Answer 55

NSAIDs

Question 56

responsible for a high rate of medication errors in children, including several instances of dose-related liver failure

Answer 56

Paracetamol

Question 57

used in the treatment of psychiatric disorders, including the treatment and prevention of mania, bipolar disorder and recurrent depression

Answer 57

Lithium salts

Question 58

T/F: Lithium salts have a narrow therapeut

Answer 58

T

Question 59

may cause gastrointestinal and central nervous system disturbances, and cardiac conduction disturbances

Answer 59

Lithium salts

Question 60

Lithium salts may interfere with ______ and ______ fx

Answer 60

interfere with kidney and thyroid function

Question 61

special consideration is required for women of childbearing age, so a pregnancy test should also be performed

Answer 61

* Lithium salts

Question 62

most severe allergic reaction iin Penicillin is

Answer 62

anaphylaxis

Question 63

included in the Screening Tool of Older Person’s Prescriptions (STOPP) criteria

Answer 63

diuretics, cardiac glycosides and neuroleptics

Question 64

To reduce the harm for nsaids use _________ or __________ if needed

Answer 64

ibuprofen/naproxen

Question 65

To reduce the harm for **nsaids** consider co-prescribing ____________ in those with risk of **gastric bleeding** or when used for long-term treatment of **osteoarthritis**, **rheumatoid** **arthritis** and **lower back pain**

Answer 65

co-prescribing proton pump inhibitors

Question 66

T/F: prescribing error rates were higher in hospitalized patients than in the community

Answer 66

True

Question 67

T/F: anticoagulant-related adverse events still occurred during hospitalization, despite mostly being preventable, since they were often related to dosage errors

Answer 67

True

Question 68

prescribing assessment tools for potentially inappropriate medication use in older adults

Answer 68

Beers Criteria

Question 69

prescribing assessment tools for potentially inappropriate medications

Answer 69

STOPP criteria

Question 70

prescribing assessment tools for **potentially** beneficial treatments in older people

Answer 70

START (Screening Tool to Alert Doctors to Right Treatment)