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Dispensing II > Unit II : MEDICATION SAFETY IN HIGH-RISK SITUATION > Flashcards

Unit II : MEDICATION SAFETY IN HIGH-RISK SITUATION Flashcards

1
Q

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

A

True

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2
Q

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

A

appropriate prescribing
responsible use
implementing strategies that minimize risks

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3
Q

highest prevalence rates are in

A

children

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4
Q

commonest type of prescribing error

A

dosage error

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5
Q

Meaning of A PINCH

A

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

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6
Q

Amphotericin, aminoglycosides

A

Anti-infectives

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7
Q

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

A

ANTI-INFECTIVE AGENTS

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8
Q

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

A

anti-infectives

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9
Q

reduce their renal clearance that will result in renal damage

A

ANTI-INFECTIVE AGENTS

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10
Q

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

A

vancomycin

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11
Q

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

A

lipid

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12
Q

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

A

conventional form

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13
Q

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

A

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

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14
Q

How to reduce harm for vancomycin

A

improve safe use by providing monographs

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15
Q

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

A

**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

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16
Q

POTASSIUM AND OTHER SALTS OR ELECTROLYTES FOR IV
INJECTION examples

A

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

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17
Q

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

A

diluted

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18
Q

____________ solution of KCl: occasionally administered in error,

A

concentrated

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19
Q

also used mistakenly for sodium chloride

A

concentrated solution

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20
Q

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

A

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

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21
Q

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

A

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

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22
Q

How to reduce harm where potassium chloride ampoules and premixed solutions

A

should be stored separately
readily identifiable from preparations with similar
packaging

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23
Q

insulin-related harm are due to:

A
  1. complexity of dosing
  2. variety of available products
  3. pharmacology of the medicine
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24
Q

ACTIONS TO REDUCE HARM for prescribing insulin

A

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.

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25
Q

ACTIONS TO REDUCE HARM for insulin storage

A

physically separating insulin from vaccines or LASA products

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26
Q

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

A

NARCOTICS AND SEDATIVES

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27
Q

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

A

True

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28
Q

ACTIONS TO REDUCE HARM for morphine and diamorphine

A

select correct product in the correct dose

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29
Q

ACTIONS TO REDUCE HARM for IV morphine (neonatal units)

A

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

30
Q

CHEMOTHERAPEUTIC AND IMMUNOSUPPRESIVE AGENTS examples

A

Etoposide, Vincristine, Methotrexate, an anticancer agent

31
Q

alkylating agent

A

Etoposide

32
Q

Etoposide is availble in what forms

A
  • etoposide base
  • etoposide phosphate salt
33
Q

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

A

Vincristine

34
Q

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

A

Vincristine

35
Q

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

A

Methotrexate

36
Q

Methotrexate is administered ________ rather than _____ dose

A

weekly; daily

37
Q

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

A

Methotrexate

38
Q

ACTIONS TO REDUCE HARM in chemotherapeutic administration

A

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

39
Q

ACTIONS TO REDUCE HARM in chemotherapeutic prescription

A

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

40
Q

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

A

UFH

41
Q

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

A

non-linear

42
Q

overdosing of ____________ is associated with an increased risk of
hemorrhage

A

UFH

43
Q

administered subcutaneously, excreted unchanged in the
urine

A

LMWH

44
Q

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

A

weight
and renal function

45
Q

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

A

inefficacy; hemorrhage

46
Q

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

A

Warfarin, phenindione, acenocoumarol (nicoumalone) and
phenprocoumon

47
Q

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

A

Warfarin, phenindione, acenocoumarol (nicoumalone) and
phenprocoumon

48
Q

one of the 10 medications most frequently related to
dispensing errors

A

Warfarin

49
Q

agents acting directly on clotting factor II or X

A

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

50
Q

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 ________

A

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

51
Q

ACTIONS TO REDUCE HARM for LMWH

A

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

52
Q

ACTIONS TO REDUCE HARM FOR Vitamin K
antagonists

A

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

53
Q

ACTIONS TO REDUCE HARM FOR NOACs/DOACs

A

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

54
Q

OTHER MEDICATIONS include

A

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

55
Q
  • 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
A

NSAIDs

56
Q

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

A

Paracetamol

57
Q

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

A

Lithium salts

58
Q

T/F: Lithium salts have a narrow therapeut

A

T

59
Q

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

A

Lithium salts

60
Q

Lithium salts may interfere with ______ and ______ fx

A

interfere with kidney and thyroid function

61
Q

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

A
  • Lithium salts
62
Q

most severe allergic reaction iin Penicillin is

A

anaphylaxis

63
Q

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

A

diuretics, cardiac glycosides and neuroleptics

64
Q

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

A

ibuprofen/naproxen

65
Q

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

A

co-prescribing proton pump inhibitors

66
Q

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

A

True

67
Q

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

A

True

68
Q

prescribing assessment tools for potentially inappropriate medication use
in older adults

A

Beers Criteria

69
Q

prescribing assessment tools for potentially inappropriate medications

A

STOPP criteria

70
Q

prescribing assessment tools for potentially beneficial treatments in
older people

A

START (Screening Tool to Alert Doctors to Right
Treatment)

Dispensing II (5 decks)

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