N596 Exam 2 Study Guide
Most medication errors occur at which steps? - Answer Ordering and administration
steps
#1 allegation for NP liability claims is - Answer Medication error (mostly improper rx of
controlled drugs, improper med management, giving wrong dose, and giving something
out of scope were the biggest offenders)
Rxing of extended release opioids - Answer -Never to be rx'd to opioid-naive pt
-Only for pts tolerant to opioids with severe chronic pain
Drug classes involved most often in wrong dose/overdose medication errors - Answer
-Opioids
-Insulin
-Anticoagulants
Give a few examples of high alert drugs - Answer -Potassium chloride
-Insulins
-Heparin
-Warfarin
-Antiretrovirals
-Oral chemo
-Immunosuppressants
-Opioids
-Pediatric liquid meds that require measurement
-Pregnancy category x drugs
Medications associated with angioedema - Answer -Ace inhibitors
-Some abx like bactrim, levofloxacin, cipro
Trailing and preceding zero rules for rxing - Answer -Always use a leading zero
-Never use a trailing zero
"Always lead and never follow"
These can lead to 10 fold rxing errors
,STOPP Criteria's differences from BEERS Criteria - Answer -Organized by physiological
system
-International
-Emphasis on potential drug-drug interactions and duplicate drug class rx
The most progressive thinking about reducing medication errors is based on the
fundamental premise that:
A. Medication errors will never be eliminated from the system
B. Most medication errors are human errors that can be engineered out with better
technology
C. Reducing the number of errors is the most important objective for systems who
monitor errors - Answer A
T/F: Evidence suggests that it takes about 5 to 10 years to identify significant adverse
effects associated with newly marketed drugs. - Answer True
HPA Axis - Answer Hypothalamus sends CRH to pituitary gland, which releases ACTH
that acts on the adrenal glands. Adrenal medulla releases the catecholamines epi and
norepi. Adrenal cortex releases corticosteroids of aldosterone and cortisol.
MOA steroids - Answer Regulation of gene expression:
-Hormone binds to receptor within the cell and enters nucleus. DNA transcription and
translation is then altered.
-Produce or inhibit certain RNA molecules
-Phagocytosis not affected but killing of macs and monos is decreased
-Inhibit macs from producing cytokines
Are the effects of steroids slow or fast? - Answer Slow. Anti-inflammatory effect takes
hours.
Side effects of steroids - Answer -May promote opportunistic infections
-Decreased mucous production
-Insulin resistance
-Salt/water retention > HTN
-Skin thinning
-Osteoporosis
-LH/FSH release > fertility changes, amenorrhea
, -Visceral obesity/*wt gain*
-Hyperlipidemia
-CNS effects like anxiety, psychosis, insomnia
-Growth impairment in children
-Diminished vax response
-Glaucoma/cataracts
-Striae, Hirsutism
Pulmonary deposition of inhaled steroids - Answer 10-60%, depending on device, drug
size, technique
MDI: 10-15%
MDI with spacer: 15-25%
Turbohaler: 20-30%
Hydroflouroalkane inhaler MDI: 60%
Inhaled steroids and dose-response - Answer Not much increased effect with higher
dosing
Inhaled steroids' relationship to bronchodilators - Answer Inhaled steroids potentiate
the action of bronchodilators, increasing the number and sensitivity of adrenergic
receptors. Might allow for lowered dose of oral steroids.
Benefits of fluticasone (Flovent) - Answer -Higher potency
-Higher receptor binding affinity
-Longer half life
-Low oral bioavailability (good to reduce systemic effects and only get effects in lung)
How long until clinical effects of inhaled steroids are seen? - Answer About 2 weeks
Pt education regarding inhaled steroids - Answer -Oropharyngeal candidiasis is
possible, so tell them to rinse mouth after use
-Dysphonia
-Cough/sore throat/hoarseness
-HA
-Not meant for rescue purposes
Most medication errors occur at which steps? - Answer Ordering and administration
steps
#1 allegation for NP liability claims is - Answer Medication error (mostly improper rx of
controlled drugs, improper med management, giving wrong dose, and giving something
out of scope were the biggest offenders)
Rxing of extended release opioids - Answer -Never to be rx'd to opioid-naive pt
-Only for pts tolerant to opioids with severe chronic pain
Drug classes involved most often in wrong dose/overdose medication errors - Answer
-Opioids
-Insulin
-Anticoagulants
Give a few examples of high alert drugs - Answer -Potassium chloride
-Insulins
-Heparin
-Warfarin
-Antiretrovirals
-Oral chemo
-Immunosuppressants
-Opioids
-Pediatric liquid meds that require measurement
-Pregnancy category x drugs
Medications associated with angioedema - Answer -Ace inhibitors
-Some abx like bactrim, levofloxacin, cipro
Trailing and preceding zero rules for rxing - Answer -Always use a leading zero
-Never use a trailing zero
"Always lead and never follow"
These can lead to 10 fold rxing errors
,STOPP Criteria's differences from BEERS Criteria - Answer -Organized by physiological
system
-International
-Emphasis on potential drug-drug interactions and duplicate drug class rx
The most progressive thinking about reducing medication errors is based on the
fundamental premise that:
A. Medication errors will never be eliminated from the system
B. Most medication errors are human errors that can be engineered out with better
technology
C. Reducing the number of errors is the most important objective for systems who
monitor errors - Answer A
T/F: Evidence suggests that it takes about 5 to 10 years to identify significant adverse
effects associated with newly marketed drugs. - Answer True
HPA Axis - Answer Hypothalamus sends CRH to pituitary gland, which releases ACTH
that acts on the adrenal glands. Adrenal medulla releases the catecholamines epi and
norepi. Adrenal cortex releases corticosteroids of aldosterone and cortisol.
MOA steroids - Answer Regulation of gene expression:
-Hormone binds to receptor within the cell and enters nucleus. DNA transcription and
translation is then altered.
-Produce or inhibit certain RNA molecules
-Phagocytosis not affected but killing of macs and monos is decreased
-Inhibit macs from producing cytokines
Are the effects of steroids slow or fast? - Answer Slow. Anti-inflammatory effect takes
hours.
Side effects of steroids - Answer -May promote opportunistic infections
-Decreased mucous production
-Insulin resistance
-Salt/water retention > HTN
-Skin thinning
-Osteoporosis
-LH/FSH release > fertility changes, amenorrhea
, -Visceral obesity/*wt gain*
-Hyperlipidemia
-CNS effects like anxiety, psychosis, insomnia
-Growth impairment in children
-Diminished vax response
-Glaucoma/cataracts
-Striae, Hirsutism
Pulmonary deposition of inhaled steroids - Answer 10-60%, depending on device, drug
size, technique
MDI: 10-15%
MDI with spacer: 15-25%
Turbohaler: 20-30%
Hydroflouroalkane inhaler MDI: 60%
Inhaled steroids and dose-response - Answer Not much increased effect with higher
dosing
Inhaled steroids' relationship to bronchodilators - Answer Inhaled steroids potentiate
the action of bronchodilators, increasing the number and sensitivity of adrenergic
receptors. Might allow for lowered dose of oral steroids.
Benefits of fluticasone (Flovent) - Answer -Higher potency
-Higher receptor binding affinity
-Longer half life
-Low oral bioavailability (good to reduce systemic effects and only get effects in lung)
How long until clinical effects of inhaled steroids are seen? - Answer About 2 weeks
Pt education regarding inhaled steroids - Answer -Oropharyngeal candidiasis is
possible, so tell them to rinse mouth after use
-Dysphonia
-Cough/sore throat/hoarseness
-HA
-Not meant for rescue purposes
