Pharmacology and Medication Administration
Core concepts
Pharmacology questions combine the rights of medication administration with drug-specific knowledge and monitoring. Know the rights (patient, drug, dose, route, time, documentation, reason, and the patient's right to refuse), high-alert medication handling, and the key monitoring parameters for anticoagulants, insulin, digoxin, opioids, and aminoglycosides.
Traps to expect
- High-alert drugs: insulin, heparin, opioids, and concentrated electrolytes require independent double-checks.
- Narrow therapeutic index: digoxin (watch for bradycardia, nausea, visual changes), lithium (tremor, toxicity), and warfarin (INR) need monitoring.
- Antidotes: naloxone for opioids, protamine for heparin, vitamin K for warfarin, flumazenil for benzodiazepines, acetylcysteine for paracetamol overdose.
- Administration detail: never crush enteric-coated or sustained-release tablets without guidance; check compatibility before mixing IV drugs.
- Error response: if an error occurs, assess the patient first, then report and document honestly.
Worked example
A patient on digoxin has a heart rate of 48 and reports nausea. Hold the dose, assess the patient, check the digoxin level and potassium, and notify the prescriber. Bradycardia plus gastrointestinal symptoms is the classic toxicity picture; giving the dose would be the wrong answer.
Study approach
For each drug class, learn the one parameter that must be checked before administration.