Unit 2 lec

• High-risk situations in medication safety involve circumstances associated with a significant risk of medication-related harm
• Multicellular organisms require specialized exchange surfaces for efficient gas exchange due to a higher surface area to volume ratio
• Medication factors in high-risk situations include high-alert medications like anti-infectives, potassium and other salts, insulin, narcotics and sedatives, chemotherapeutic and immunosuppressive agents, heparins and oral anticoagulants, and other medications
• Provider and patient factors influencing medication safety in high-risk situations include how patients take their medications
• Systems factors influencing medication safety in high-risk situations include systems factors influencing medication safety and strategies to reduce medication errors
• High-alert medications are drugs that bear a heightened risk of causing significant patient harm when used in error
• Examples of high-alert medications include anti-infectives like aminoglycosides and amphotericin B, potassium and other salts or electrolytes for IV injection, insulin, narcotics and sedatives, chemotherapeutic agents, heparins and oral anticoagulants, and other high-risk medications
• Aminoglycosides like amikacin, gentamicin, streptomycin, and tobramycin may cause damage to hearing or kidneys in a dose-related adverse drug reaction
• Amphotericin B is used for fungal infections and protozoan infections like leishmaniasis, but has risks of cardiotoxicity and nephrotoxicity
• Potassium chloride, when administered in error, can lead to fatal outcomes due to severe hyperkalemia
• Potassium Chloride is a major intracellular cation
• Sodium Chloride is a major extracellular cation
• Normal Saline is 0.9% NaCl
• Hypertonic solutions cause cells to shrink
• Hypotonic solutions cause cells to swell and lyse
• Dehydration can be treated with ORS (Oral Rehydration Solution)
• Potassium phosphate, magnesium, calcium salts, and hypertonic sodium chloride can cause harm if not administered properly
• To reduce harm, a protocol for safe storage, preparation, and use should be developed in areas where high concentrations are necessary
• In general wards, unnecessary stock may be removed and replaced with premixed solutions
• Insulin is commonly used for Type II Diabetes to regulate blood glucose levels
• Insulin-related harm can occur due to dosing complexity, variety of products, and pharmacology of the medicine
• Common errors with insulin include using non-insulin syringes and misreading abbreviations for units
• Insulin allows glucose to be utilized by glucose-dependent organs
• Alpha-amylase helps in the breakdown of complex sugars into simpler forms
• Acarbose inhibits alpha-glucosidase and alpha-amylase, preventing starch conversion to glucose
• Hypoglycemia is a common side effect of antidiabetic drugs
• To reduce harm with antidiabetic drugs, avoid unclear instructions, use well-titrated doses, and educate patients on symptoms and corrective measures
• Narcotics and sedatives like buprenorphine, fentanyl, and morphine can cause side effects like nausea, vomiting, and respiratory depression
• Educate patients on the correct use of transdermal opioid medications
• To reduce harm with narcotics and sedatives, always triple check doses and follow Standard Operating Procedures
• Chemotherapeutic and immunosuppressive agents like etoposide and methotrexate can lead to bone marrow suppression and pulmonary complications
• Prescription and administration processes should be in place to avoid errors with these agents
• Heparin and oral anticoagulants like warfarin are used for anticoagulation
• Unfractionated heparin is monitored using activated partial thromboplastin time (aPTT)
• Low molecular weight heparins are administered subcutaneously and dose is based on weight and renal function
• Warfarin and other vitamin K antagonists are used for the treatment and prevention of thrombosis
• Warfarin, Phenindione, Acenocoumarol (Nicoumalone), and Phenprocoumon are orally active vitamin K antagonists used for the treatment and prevention of thrombosis, but they can cause hemorrhage
• These medications should be monitored throughout treatment using the international normalized ratio (INR)
• Common Brand Name: Coumadin
• Used for Monitoring:

  • Prothrombin Time (PT)
  • INR = (Patient PT/Standard PT)