Pharmacology and Medication Management
Core concepts
Know drug classes, mechanisms, key adverse effects, monitoring parameters, and antidotes. High-alert medications (insulin, heparin, opioids, chemotherapy, concentrated electrolytes) require independent double-checks. The rights of medication administration include right patient, drug, dose, route, time, documentation, reason, and response. Pharmacokinetics covers absorption, distribution, metabolism, and excretion; pay attention to hepatic and renal impairment, which alter dosing and toxicity risk.
Traps in questions
Questions test whether you hold a dose when parameters are abnormal. Know thresholds: hold digoxin for bradycardia or potassium abnormalities; hold metformin before contrast; monitor aPTT for heparin and INR for warfarin; watch for ototoxicity with aminoglycosides and loop diuretics. Another trap: confusing therapeutic effect with adverse effect, or forgetting that a patient's report of a new symptom may be a drug reaction.
Worked example
A patient on warfarin has an INR of 6.0 without bleeding. Rule of thumb: hold the dose, notify the provider, and anticipate vitamin K depending on severity; avoid giving additional anticoagulants and assess for bleeding. The answer is not to give the next scheduled dose and recheck later.
Study strategy
Build a one-page table of drug, monitoring lab, antidote or reversal agent, and the one adverse effect most likely to be tested.