Pharmacology and Medication Management
Pharmacology and Medication Management tests safe prescribing support, pharmacokinetics, high-alert medications, calculations, adverse effects, interactions, and patient education. The exam emphasizes preventing medication errors and recognizing early toxicity.
Core rules and concepts
- Rights and verification. Confirm the right patient with two identifiers, right drug, dose, route, time, reason, documentation, and response. Check allergies and interactions. For high-alert drugs, use independent double checks and smart pumps.
- Pharmacokinetics. Absorption, distribution, metabolism, and excretion determine onset and duration. First-pass metabolism reduces oral bioavailability. Half-life predicts steady state and dosing intervals. Liver and kidney impairment can cause accumulation.
- High-alert medications. Insulin, heparin, opioids, chemotherapy, and concentrated potassium are high risk. Never give potassium IV push. Verify insulin type and dose with another nurse per policy. Monitor anticoagulants with platelet counts and signs of bleeding.
- Calculations. Set up units so they cancel. Confirm the ordered dose is within the safe range, especially for children and renal impairment.
- Adverse effects and antidotes. Naloxone reverses opioids; flumazenil reverses benzodiazepines; protamine reverses heparin; vitamin K reverses warfarin; acetylcysteine treats acetaminophen overdose; digoxin immune Fab treats digoxin toxicity.
- Education. Teach timing, food interactions, missed doses, and when to call. Warn about alcohol with sedatives and about sun sensitivity with some antibiotics.
Worked example
An order reads amoxicillin 500 mg PO every 8 hours. The suspension is 250 mg/5 mL. Set up: 500 mg × 5 mL / 250 mg = 10 mL. The nurse should verify the order, measure with an oral syringe, check allergies, and document the dose and response.
Traps that cost marks
- Misplacing decimal points or failing to convert units.
- Crushing extended-release tablets or opening capsules without checking.
- Assuming two brands with the same drug are interchangeable without checking.
- Monitoring for therapeutic effect but not for toxicity.