Which of these scenarios represents a potential prescriber error?

A patient asks to purchase a box of Sudafed from behind the counter. You know the patient has elevated blood pressure and that a warning appears on the back of the box that it should not be taken by an individual with hypertension. What should you do?

Inform the pharmacist of the situation.

Which of the following medications is found on the ISMP’s list of high-alert medications?

Methotrexate

The following medications appear on the ISMP’s “high-alert medication” list: epoprostenol (Flolan), magnesium sulfate injection, methotrexate (oral, non-oncologic use), opium tincture, oxytocin (IV), nitroprusside sodium for injection, potassium chloride for injection concentrate, potassium phosphates injection, promethazine (IV), and vasopressin ( IV).

For which of the following could the abbreviation “OS” be misinterpreted?

All of the above

Both The Joint Commission (TJC) and the Institute for Safe Medication Practices (ISMP) have identified the abbreviation “os” to be mistaken with “od,” “ou,” “as,” “ad,” and “au.”

A prescriber writes the following order: "Take one Zoloft tablet by mouth daily." What order instructions are missing from this prescription?

strength

Prescribers should write complete instructions to include the drug name, route, strength, frequency, quantity, and directions for use. In this case, the dose of Zoloft was omitted, which could contribute to a medication error if the incorrect dose was dispensed or administered.

Which of these notations is on the Institute for Safe Medication Practice's list of error-prone abbreviations, symbols, and dose designations?

HS

"HS" may be interpreted to mean "half strength" or "bedtime"; as such, it is most appropriate to write out the term intended. "PO" is one of the few abbreviations supported by the Institute for Safe Medication Practice. Other options for "PO" include "by mouth" or "orally," but not "per os."

Which of the following is a type of medication error?

All of the above

Medication errors are of one of three types: prescribing errors are caused by physicians; dispensing errors occur in the pharmacy; and ad- ministration errors may be caused by nurses, patients, or caregivers.

Which organization is responsible for overseeing Medmarx?

USP

The United States Pharmacopoeia (USP) is responsible for MEDMARX.

Which organization has made recommendations regarding verbal prescriptions?

MERP

MERP has made the following recommendations that an institution initiate policies that describe limitations or prohibitions on use of verbal orders, provide a mechanism to ensure the validity or authenticity of the prescriber, list the elements required for inclusion in a complete verbal order, describe situations in which verbal orders may be used, and list and define the individuals who may send and receive verbal orders.

What is the term for "any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer"?

medication error

Medication errors may be the result of patient misuse, practitioner error, or an error in the pharmacy. Deficits in knowledge or performance may be underlying causes of medication errors. Prescription drug abuse implies that a person is taking a medication with the express purpose of getting high.

Which oral dosage form of medication can be crushed or chewed if needed?

immediate-release

Immediate-release oral medications can generally be crushed or chewed if needed. Extended-release, sustained-release, and other special-release formulations should not be crushed or chewed, as the drug will release all at once instead of slowly or over time as intended. Orally disintegrating tablets should not be crushed or chewed either, as they are intended to be absorbed through the buccal mucosa. Finally, enteric-coated formulations, such as that of aspirin, may irritate the gastric mucosa if chewed or crushed instead of swallowed whole. The Institute for Safe Medication Practices maintains a list of medications that should not be crushed or chewed.

Which of these is a source of information that is directed toward pharmacy staff instead of patients?

package insert

The package insert is approved by the FDA and attached to stock medication bottles. This information, while accessible to patients, is geared toward pharmacy staff. Drug and administration information is typically presented to patients by way of prescription labels, patient package inserts, and/or medication guides.

Which of these scenarios represents a potential prescriber error?

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