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Flashcards in Prescribing errors Deck (19)
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1
Q

any preventable event that may cause or lead to inappropriate medication use or patient harm, while medication is in the control of the health care professional, patient or consumer.

A

medication error

2
Q

Majority of medication errors happen in

A

secondary care

3
Q

Drugs commonly associated with ADE related hospital admissions:

A
IV antibiotics  (common medication error)
NSAIDs 
Anti-platelets
Diuretics
Anticoagulants
4
Q

…. prevent medication error

A

Pharmacists

5
Q

prescribing decision or prescription writing process

A

prescribing error

6
Q

deciding which drug to use and how

A

Prescribing Faults

7
Q

writing process that result in wrong instructions

A

Prescription Errors

8
Q

errors that arise from poor planning or inadequate knowledge

A

Mistakes

9
Q

imperfect execution of well-formulated plans when an erroneous (wrong) act is committed

A

slips

10
Q

lapses when a correct act is omitted.

A

lapses (missing out)

11
Q

….. are the drugs most commonly involved in medication errors in hospital

A

Intravenous antibiotic

12
Q

Medication error rates in hospital are higher in ….. and ……

A

paediatric

ICU

13
Q

Elderly and NSAIDs

A

high lipid solubility of NSAIDs - widespread distribution due to increased age-related adipose tissue stores.

NSAIDs are extensively protein bound - increased concentration of unbound drug due to reduction in plasma protein found in many older persons.

NSAIDs have decreased renal clearance in older patients, potentially resulting in excessive drug levels and toxicity

14
Q

Adverse Reaction of NSAIDs in elderly

A

Increase BP
Produce renal insufficiency (both acute renal failure and worsening of chronic renal insufficiency)
Hyperkalaemic and fluid retention
GI side effects including GI bleeds

Need to monitor renal func regularly !!

15
Q

hydrophillic drug that has a narrow therapeutic index

A

Digoxin

Problem in elderly

Low lean body mass and total body water - decreased Vd of hydropphillic drug - High in plasma
Reduced renal clearance of digoxin:
↓ serum albumin → Higher active unboud drug concentrations
NSAID reduce renal clearance of Digoxin

Monitoring
Appropriate use of digoxin in the elderly
Monitor electrolytes frequently
Renal function (dose

16
Q

long half-life - problem if prolonged
active metabolite “nordazepam” - half life of about 60 hours
some are more lipid soluble than others

A

Benzodiazepines

With a decrease in hepatic function, there is obviously an increase in half life of the benzo.

With respect to benzos elderly people are more sensitive to their effects- e.g. excessive sedation. Older people show a response to a lower plasma level of benzos than do younger patients

Short acting benzos with low lipid solubility and no active metabolites should be prescribed for elderly when a benzo is indicated—for short term use only. E.g. alprazolam, lorazepam.

17
Q

The 5 Rs

A
Right patient
Right drug
Right route
Right time
Right dose

Right Formulation?
Sustained Release Preparations
Drugs that must be prescribed by brand
Changing between formulations

18
Q

Cytochrome P450 Inducers

CRAP GPS induce me to madness!!

A

Carbemazepines (anti-epileptics) and antidepressants (St Johs worts)
Rifampicin
Alcohol (chronic)
Phenytoin & Primidone (Anti-epileptics)

GI drugs (omeprazole)
Phenobarbitone
Sulphonylureas and Smoking

19
Q

P450 Inhibitors

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A
Sodium valproate 
Isoniazid (antibact)
Cimetidine (GI drugs)
Ketoconazole (antifungals)
Fluconazole (antifungals)
Alcohol..binge drinking 
Chloramphenicol 
Erythromycin (Antibact)
Sulfonamides 
Ciprofloxacin (antibact)
Omeprazole (GI)
Metronidazole (anti-bact)
Grapefruit juice