Pharmacology and Medication Management
The Pharmacology and Medication Management domain tests safe administration, high-alert medications, monitoring, and patient teaching. Questions often ask what to do before giving a drug or what finding should stop administration.
Core rules and concepts
- Apply the rights of administration: patient, drug, dose, route, time, reason, and documentation. Use two identifiers and verify allergies.
- High-alert medications include insulin, heparin, opioids, chemotherapy, and PCA infusions. Many require an independent double-check and targeted monitoring.
- Look-alike, sound-alike names and error-prone abbreviations cause harm. Use tall-man lettering and question unclear orders.
- Adjust for weight, renal and hepatic function, and age. Older adults need extra caution with sedatives, anticoagulants, and anticholinergics.
- Monitor therapeutic and adverse effects with relevant labs, such as INR for warfarin, aPTT or anti-Xa for heparin, and potassium with digoxin.
- Antidotes include naloxone for opioids, protamine for heparin, vitamin K for warfarin, flumazenil for benzodiazepines, and acetylcysteine for acetaminophen.
- Do not crush extended-release or enteric-coated products unless the order and labeling permit it.
Worked example
A patient on a heparin infusion has an aPTT markedly above the therapeutic range and new gum bleeding. The nurse holds the infusion per protocol, assesses for bleeding and neurologic change, notifies the provider, and anticipates protamine. Vitamin K would be wrong because it reverses warfarin, not heparin. Reasoning: the priority is stopping further anticoagulation, assessing harm, and using the correct reversal agent.
Traps that cost marks
- Giving a due medication without checking renal function or recent labs.
- Relying on the five rights alone; reason and monitoring matter.
- Crushing an extended-release tablet for a feeding tube.
- Choosing vitamin K for heparin or protamine for warfarin.