Pharmacology and Medication Administration
The Rights and the Checks
The classic rights - right patient, drug, dose, route, time, documentation, and reason - are the minimum. High-alert medications (insulin, heparin, opioids, concentrated electrolytes, chemotherapy) require independent double checks and standardized concentrations. Verify allergies, weight-based dosing for pediatrics, renal and hepatic function, and interactions before administration.
Pharmacokinetics and Monitoring
Understand absorption, distribution, metabolism, and excretion well enough to predict onset, peak, and duration. Know which drugs require therapeutic drug monitoring (aminoglycosides, vancomycin, digoxin, phenytoin, warfarin via INR) and the signs of toxicity. Antidotes and reversal agents are frequent test items: naloxone for opioids, flumazenil for benzodiazepines, protamine for heparin, vitamin K and factor replacement for warfarin, acetylcysteine for acetaminophen.
Administration Safety
Calculate doses carefully and cross-check unusual volumes. Never administer a drug prepared by someone else without verification. Do not crush extended-release formulations without confirmation. Report adverse drug reactions and errors through the facility system; the purpose is system improvement, not blame.
Traps
Questions often pair a correct drug with a wrong route, a missing hold parameter (for example, holding digoxin for bradycardia or holding insulin for hypoglycemia), or a rate that is too fast for intravenous push. Watch for "administer" options when the correct action is to withhold and notify.
Rule of Thumb
If a parameter says hold, hold first and call second. For example, apical pulse below the ordered threshold before digoxin: withhold the dose, reassess, and notify the prescriber.