Pharmacy & Medication Management Flashcards

A prescriber orders 'potassium chloride 40 mEq IV push STAT' for a patient with hypokalemia. What is the pharmacist's correct response?

Answer: Refuse to dispense and contact the prescriber — IV potassium push is absolutely contraindicated as it causes fatal cardiac arrest; must be diluted and given by slow infusion

Concentrated IV potassium MUST NEVER be given by IV push. Rapid infusion causes fatal cardiac arrhythmias (VF/asystole) due to sudden rise in serum potassium. Safe administration: maximum 10–20 mEq/hr via peripheral vein (maximum 40 mEq/hr via central line with cardiac monitoring). This is a critical pharmacy safety intervention.

What is the primary purpose of antimicrobial stewardship programs (ASPs) in DHA-licensed hospitals?

Answer: To optimize antimicrobial use by promoting appropriate selection, dose, and duration while reducing resistance, adverse effects, and costs

Antimicrobial stewardship programs aim to optimize antimicrobial therapy: ensuring patients receive the right antibiotic, at the right dose, via the right route, for the right duration. This reduces selective pressure driving resistance, minimizes adverse effects (C. diff, renal toxicity), and reduces costs without compromising patient outcomes.

A patient on carbamazepine for epilepsy develops a widespread blistering skin rash with mucosal involvement. This presentation is most consistent with:

Answer: Stevens-Johnson Syndrome (SJS)/Toxic Epidermal Necrolysis (TEN) — a life-threatening drug reaction

Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis are severe life-threatening hypersensitivity reactions characterized by widespread epidermal detachment and mucosal involvement. Carbamazepine is one of the most common triggers. SJS involves 30% BSA. Immediate hospitalization and drug withdrawal are required.

In medication error prevention, what does the 'LASA' abbreviation stand for and why is it important?

Answer: Look-Alike Sound-Alike medications — drugs that can be confused due to similar names or packaging, leading to dispensing or administration errors

LASA (Look-Alike Sound-Alike) medications are drugs that resemble each other in name or appearance. They are a leading cause of medication errors. Examples: hydroxyzine/hydralazine; metformin/metronidazole; prednisolone/prednisone; Amaryl/Reminyl. DHA and ISMP require LASA pairs to be identified and managed with tall-man lettering, storage separation, and alerts.

What is meant by 'zero-order kinetics' in drug metabolism and which commonly used drug demonstrates this property?

Answer: The drug is eliminated at a constant rate regardless of plasma concentration (constant amount per time); ethanol and high-dose aspirin/phenytoin demonstrate this

Zero-order (saturable/nonlinear) kinetics occurs when metabolic enzymes are saturated — the drug is eliminated at a constant rate (fixed amount per time) regardless of concentration. Ethanol is the classic example. Phenytoin at therapeutic doses also shows zero-order kinetics — small dose increases cause disproportionately large rises in levels.

A patient is admitted with supratherapeutic digoxin levels (3.8 ng/mL) and presents with bradycardia, visual disturbances (yellow-green halos), and confusion. What is the antidote?

Answer: Digoxin-specific antibody fragments (Digibind/DigiFab)

Digoxin toxicity is treated with digoxin-specific antibody fragments (Fab fragments — Digibind/DigiFab). These antibodies bind free digoxin in the bloodstream, rapidly reversing toxicity. Atropine can be used for symptomatic bradycardia as a temporary measure. Calcium is contraindicated in digoxin toxicity as it can precipitate fatal arrhythmias ('stone heart').