Pharmacology and Medication Administration
Core concepts
This domain tests the rights of medication administration, safe calculation, routes and techniques, and drug knowledge: mechanism, key side effects, interactions, and monitoring. Know high-alert medications (insulin, heparin, opioids, chemotherapy, concentrated electrolytes), the antidotes, and the parameters that determine whether a dose can be given (e.g., hold digoxin for bradycardia, hold heparin for low platelets, check apical pulse before digoxin).
Traps candidates fall for
- Failing to check the parameters before giving a drug: blood pressure for antihypertensives, heart rate for digoxin, INR for warfarin, aPTT for heparin, potassium before digoxin.
- Calculation errors with unit conversions and infusion rates; always check whether the order is per kg or per dose.
- Confusing similar drug names and classes (e.g., metoprolol vs metoclopramide).
- Forgetting that IV push medications have specific rates and that some drugs must never be given IV.
- Ignoring interactions: warfarin with NSAIDs, MAOIs with tyramine, grapefruit with certain statins.
Rule of thumb
Before every dose, run the rights and the parameters: patient, drug, dose, route, time, documentation, and the specific clinical check that makes this dose safe right now.
Worked example
An order reads digoxin 0.25 mg PO daily. The nurse checks the apical pulse and finds 52 bpm. The correct action is to hold the dose and notify the provider, because digoxin slows conduction and bradycardia is a reason to withhold. Documenting and giving the dose would be unsafe.