Drug Criteria & Outcomes-Ready for a pop quiz?
Drug Criteria & Outcomes-Ready for a pop quiz?
Now that prevention of medication errors is on your mind, test your skills. Look at the list of orders below and see if you can identify any potential problems. Answers immediately follow:
Orders
1. Verbal order for alteplase 15 mg bolus, 0.75 mg/kg over 30 minutes and 0.5 mg/kg over 60 minutes for a 48-year-old, 78 kg male.
2. Glyburide ½ tablet of a 12.5 mg tablet daily.
3. Catapres TTS 0.1 mg to skin qd.
4. Motrin 800 mg tid with food. Patient is on Clinoril.
5. Trovan 500 mg IV qd.
6. Demerol 50 mg with 25 mg Vistaril IV q3h p.r.n. severe pain.
7. Kefzol 1 g IV q6h. 89-year-old patient with creatinine of 2.4.
Answers
1. Verbal orders are not accepted for alteplase. Weight-based dosing is only to be used for patients less than 65 kg to avoid increases in intracranial bleeding associated with higher doses.
2. Glyburide is available as 1.25 mg, 2.5 mg, and 5 mg tablets. In addition, a micronized form, Glynase, is available in 1.5 mg, 3 mg, and 6 mg doses. Daily doses range between 1.5 mg and 20 mg per day. Had it not been for the unusual dose of 12.5 mg, the potential for a fivefold dosage error existed since the prescriber had intended the dose to be ½ of a 2.5 mg tablet.
3. These patches are changed every seven days, not daily.
4. An example of duplicate therapy. Review the medication Kardex or pharmacy printout for current patient medications. Be sure to discontinue any medications you no longer wish the patient to have.
5. Trovan (alatrofoxacin) is a new extended-spectrum fluoroquinalone with a dosage range of 100 mg to 300 mg IV daily. The prescriber may have been thinking of levofloxacin, whose usual dose is 250 mg to 500 mg daily.
6. Hydroxyzine (Visatril) should not be given via the IV route. IV use results in hemolysis. Intra-arterial or subcutaneous injection has resulted in tissue necrosis. Intra-arterial administration also has led to necrosis of an extremity resulting in amputation of digits. Hydroxyzine should only be given by deep IM administration. For an IV alternative consider promethazine or droperidol.
7. The appropriate dose for this patient based on his renal function would be 500 mg every 12 hours.
Source: Holyoke (MA) Hospital Department of Pharmacy.
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