Pharmacy Foundations 2 Flashcards
Root Cause Analysis (RCA)
-a retrospective investigation of an event that has already occurred. The information obtained in the analysis is used to design changes that will hopefully prevent future errors
At risk behaviors that can compromise patient safety: Drug and Patient - Related
-failure to check/reconcile home medications and doses
-dispensing medications without complete knowledge of the medication
-not questioning unusual doses
-not checking/verifying allergies
At risk behaviors that can compromise patient safety: Communication
-not addressing questions/concerns
-rushed communication
At risk behaviors that can compromise patient safety: Technology
-overriding computer alerts without proper consideration
-not using available technology
At risk behaviors that can compromise patient safety: Work environment
-trying to do multiple things vs focusing on a single complex task
-inadequate supervision of orientation/training
The Joint Commission
Independent, not for profit organization that accredits and certifies hospitals –> main focus = safety
TJC: National Patient Safety Goals
-label all medication on and off the sterile field
-reduce hard associated with anticoagulant therapy (bleeding risk)
-maintain and communicate accurate patient medical information
-report critical results (labs and diagnostic) on a timely basis
-comply with CDC hand hygiene guidelines
-reduce health-care associated infections
avoid “do not use” abbreviations
-U, u –> write units
-IU –> write international units.
-QD,qd, QOD,qod –> write daily or every other day
-trailing zero: X mg or 0.X mg
-MS,MO4 –> write morphine sulfate, magnesium sulfate
High alert medications
-anesthetics (propofol)
-antiarrhythmics (amiodarone)
-Anticoagulants/antithrombotics (heparin, warfarin)
-Chemo (methotrexate)
-Epidural/intrathecal
-hypertonic saline
-Immunosuppressants (cyclosporin)
-Ionotropics (digoxin)
-Insulins
-Magnesium sulfate
-Neuromuscular blocking agents (vecuronium)
-opioids
-oral hypoglycemics
-parenteral nutrition
-potassium chloride
-sterile water
what kind of pts have contact precautions?
–> intended to prevent transmission of infectious agents which are spread by direct and indirect contact with the patient and the patients environment
-MRSA
-VRE
-C. diff
Universal precautions to prevent droplet transmission
-B pertussis
-influenza
-RSV
-adenovirus
-rhinovirus
-N. meningitides
-group A strep
Airborne precautions
-isolation room
-KN95 mask
Safe injection practices for healthcare facilities
-never administer an oral solution/suspension IV, use oral syringes
-never reinsert used needles into a multiple dose vial or solution container, single dose vials are preferred over multiple dose vials
-use engineered sharp protection needles, drawing the needle into the syringe barrel after use
-never touch the tip or plunger os syringe
-throw the entire needle/syringe assembly (needle attached to the syringe) into the red plastic sharps container
Type A reactions
-most ADRs
-dose-dependent and are predictable based on the drugs pharmacology
Type B reactions
idiosyntric- not predictable from drugs pharmacology (hard to predict and bad)
-can be influenced by patient specific factors
Type 1 hypersensitivity reaction
Immediate (within 15-30 mins of drug exposure).
-severity ranges from minor inconvenience to death :)
Type 2 hypersensitivity reaction
-minutes to hours after drug exposure
-hemolytic anemia and thrombocytopenia
Type 3 hypersensitivity reactions
-immune complex reactions
-they occur 3-10 hours after drug exposure
ex) drug induced lupus and serum sickness
Type 4 hypersensitivity reactions
-delayed reactions, they can occur anywhere from 48hrs to several weeks after drug exposure.
ex: PPD skin test
iPLEDGE program
progran for isotretinoin, requires a monthly pregnancy test
-get 30 ds at a time
Where are drugs and vaccine adverse events reported to?
-FAERS (FDA adverse event reporting system)
-VAERS (Vaccine adverse event reporting system)
Allergies
due to immune system response and can affect multiple areas (bronchoconstruction and severe drop in BP from taking codeine)
Intolerence
less severe complaints, such as nausea or constipation. Since the drug bothers the patient, it should be avoided if possible
Histamine release & tx
Urticaria: erythematous swelling of the skin, with prutitis (itching)
Angioedema: swellings caused by edema in the deeper dermal, cutaneous and sub-mucosal tissue
–> Prutitus & hives only?
OTC: diphenhydramine
RX: hydroxyzine
–> more than that?
-get airway open with epinephrine
-reduce swelling with steroids
-give antihistamine
Photosensitivity & Type -IV Hypersensitivity (delayed)
P: sunlight + drug = severe sunburn on sun-exposed areas
T IV: sunlight + drug = red, itchy rash that can spread to areas that were not exposed to sun; occurs within days of the sun exposure
Drugs most associated with photosensitivity
-Aminodarone
-Diuretics (thiazide and loop)
-Methotrexate
-Oral and topical retinoids
-Quinolones
-St. John’s wort
-Sulfa drugs
-Tacrolimus
-Tetracyclines
-Voriconazole
Photosensitivity protection/counseling points
-stay out of the sun 10am-4pm, including on cloudy days
-wear sun-protective clothing
-recommend ~SPF 30, broad spectrum (UVA-aging and UVB-burning)
-apply liberally and at least Q2 hrs and reapply after swimming or sweating
-keep infants out of the sun
SPF calculation =
take the usual time the person would burn and multiply by SPF –> 20 SPF x 15 min = 300 min –> BUT reapply q 2 hrs
Different types of spots & rashes
-Papules: raised spots
-Macules: flat spots
-Purpura: red/purple skin spots (lesions) due to bleeding underneath the skin
–> Petechiae: smaller lesions, < 3 mm
–> Ecchymoses: larger lesions, > 5 mm
-Hematoma: due to trauma; a collection of blood under the skin, visible or not
Thrombotic Thrombocytopenia Purpura (TTP)
-a blood clotting disorder in which clots form throughout the body, the clotting process consumes platelets and leads to bleeding under the skin with purpura
–> TTP can be fatal and should be treated immediately with plasma exchange
*KEY drugs associated: clopidogrel, ticlopidine, acyclovir, famiciclovir, quinine, sulfamethoxozole, valcyclovir
Key drugs associated with severe skin reactions
-allopurinol
-lamotrigine
-penicillins
-phenytoin
-piroxicam
-sulfamethoxazole
Key drugs associated with SJS/TEN
-Abacavir
-Carbamazepine
-Caspofungin
-Clindamycin
-Clopidogrel
-Deferasinox
-Ethosuximide
-Fosphenytoin
-Hydroxychloroquine
-Isavucinazonium
-Letrozole
-Minocycline
-Nevirapine
-Oseltamivir
-Oxacarbazepine
-Peramivir
-Phenobarbital
-quinine
-Terbinafine
-Tiagabine
Drugs associated with DRESS
-Carbamazepine
-Celecoxib
-Doxycycline
-Ethosuximide
-Fosphenytoin
-Gabapentin
-Ibuprofen
-Lacosamide
-Minocycline
-Olanzapine
-Oxacarbozempine
-Sulfasalazine
-Terbinafine
-Valpraote
-Vancomycin
Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TENS)
S&S: 1-3 weeks after start of the offending drug, symptoms develop: malaise, fever, headache, cough and keratoconjunctivitis
-macules then appear suddenly, usually on the face,neck and upper trunk and then spread elsewhere on the body, coalescing inot large flaccid bullae and slough over a period of 1-3 days
TX: supportive care, cyclosporine, plasma exchange or IVIG and steroids
SJS rash: < 10%
TENS rash: > 30%
Erythema Multiforme (ME)
–> causes: herpes simplex virus, hep C, SLE, drugs
-morbilliform rash (looks like measles), with 1-20 mm lesions - in between the lesions is healthy skin
Drug classes that are likely to cause drug allergies
–>beta lactam: penicillin’s
–> sulfa allergies: sulfamethoxazole
–> opioids, heparin, biologics
–> ASA/NSAIDs = breathing difficulty
Drugs likely to cause allergic reaction with peanut/soy allergy
-Clevidipine (Cleviprex)
-Propofol (Diprivan)
-Progesterone in Prometrium capsules
Drugs likely to cause allergy with egg allergy
-Clevidine (Cleviprex)
-Propofol (Diprivan)
-Influenza vaccine, ok if only hives but with severe allergies: use FLBLOK
-yellow fever
