Pharmacology and Medication Safety
This domain tests pharmacokinetics, high-alert medications, dose calculation, interactions, monitoring, and reporting of adverse drug events within Israeli medication-safety requirements.
Core rules
- Follow the rights of medication administration and verify patient identity with at least two identifiers.
- High-alert medications include insulin, heparin, opioids, potassium chloride concentrate, chemotherapy, and anticoagulants; use independent double-checks where required.
- Calculate doses carefully and avoid unclear abbreviations, trailing zeros, and unapproved shorthand.
- Adjust doses for renal and hepatic function and for extremes of age or weight.
- Monitor therapeutic drugs such as digoxin, lithium, vancomycin, and warfarin.
- Reconcile medications at admission, transfer, and discharge; report adverse drug reactions through the required channels.
Worked example
A patient taking warfarin for atrial fibrillation asks for ibuprofen for knee pain. Do not give an NSAID without review. NSAIDs increase bleeding risk and can displace warfarin from protein binding. Check the INR, assess for bleeding, and contact the prescriber about a safer analgesic such as acetaminophen. Reason: the combination raises gastrointestinal and systemic bleeding risk.
Traps
- Confusing milligrams and micrograms or misplacing a decimal point.
- Crushing extended-release tablets.
- Ignoring renal function when prescribing antibiotics or anticoagulants.
- Failing to report a medication error or adverse reaction.