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32 Cards in this Set
- Front
- Back
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What ADEs should be reported?
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SERIOUS ADEs defined by the FDA as type A or B reactions where the outcome is:
Death Life-threatening event Hospitalization (initial or prolonged) Disability Congenital anomaly Medical or surgical intervention was required to prevent permanent damage ADEs related to newly released agents are particularly important |
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Top medication errors were the result of ...
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overdosing
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Preventable ADE occurred most often at the stage of...
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ordering the medication (Rx).
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Common Prescriber Problems related to medication errors...
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Illegible handwriting
Incomplete medication orders Use of improper abbreviations Use of improper drug names (5-FU, 6-MP) Ambiguous drug orders Improper expression of drug strengths Unnecessary verbal orders |
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Some tips for preventing medication errors...
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maintain current knowledge, avoid verbal orders, use a personal drug formulary, double check rx or medication order writing, include a reason for rx, always use a leading s=zero but never a trailing zero
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Define fiduciary relationship between patient an provider...
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• Has specialized knowledge or expertise
• Holds the trust of others • Held to high standards of conduct • Avoids conflicts of interest • Is accountable or obligated (ethically and legally) |
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What MATTERS with exposure and toxicology?
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M- what medication
A-amount of med ingested T- time of ingestion or exposure T- therapy that has been tried E - emesis R- Reason for or route of exposure S - symptoms |
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When assessing patient exposed to toxin do the following
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Assess ABC, Do the DONT - check BG, oxygen, give narcan, give thiamine
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Physical Tox exam includes...
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The Harris 5 - vitals, neuro exam, skin exam, eyes, and odor.
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Mees lines signify...
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heavey metal poisoning
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Anticholinergic toxidrome includes...
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Mad as a hatter, dry as a bone, red as a beet, blind as a bat, naked as a jay bird
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Cholinergic Toxidrome...
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DUMBBELS - diarrhea, urination, myosis, bronchospasms, bradycardia, and emesis
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Opiate toxidrome..
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classic triads of CNS depression, respiratory, and pinpoint pupils
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Sweaty or mydriasis is a sx of which overdose
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a sympathommetic toxidrome
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What is the dfference in mechanisms between barbituates and benzo?
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benzo affects the frequency with Ca opening, barbs increase the duration of Ca channels being open
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Activated Charcoal is contraindicated in ...
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patients with an airway that is no intact.
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Whole bowel irrigation is only indicated in patients...
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who have ingested extended release substances or enteric coated drugs in patients that ingested them over 2 hours prior to...
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N-acetylcystein (NAC) is used to treat..
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Acetaminaphen overdose - regenerates GSH to metabolize the harmful metabolite NAPQ1 which causes liver failure
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How do you determine when to treat with NAC in an acetaminaphen dose?
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Check AST at 4 hours, and compare to pneumogram
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Steps to manage Salicylate overdose (ASA overdose)...
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fluid restriction, charcoal, bicarb for urinary alkalization - optimize potassium, and dialysis
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Toxic dose of TCA...
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10 mg/kg
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Mechanisms of TCA - antihistamine
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leads to altered mental status - so give benzo
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Mech of TCA - anticholinergic
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leads to anti-DUMBBBELS
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Mech of TCA - 5HT and NE re-uptake
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leads to serotonin syndrome, tx with cryohretadine
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Mech of TCA - GABA antagonist
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leads to seizures, and treated with benzo, d/n use phenytoin as works on sodium channels making it worse
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Mech of TCA - Na Channel blocker
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leads to wide QRS, tx with bicarb amps
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Mech of TC - K channel blocker
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leads to prolonged QT interval, treat with K and Mg
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Mech of TCA - alpha andrenergic blockcade
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leads to hypotension, and treat with IV and pressors
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TCA effects in overdose
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QT elongation, wide QRS, seizure, hypotension, and initial hypertension
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Toxic dose of iron..
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60 mg/kg
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Effects of iron overdose after 12 hours include...
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metabolis acidosis which should be treated with deferoxamine
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Treatment of cyanide posioning...
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nitrites
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