RxTechExam Module 3 - High Alert Medications & Common Drug Interactions

What does ISMP stand for?

Institute of Safe Medication Practices

What is the role of the Institute for Safe Medication Practices (ISMP)?

maintains the list of high-alert medications

What does TJC stand for?

The Joint Commission

What is the role of the Joint Commission (TJC) and USP?

sets guidelines for safe handling of high-risk drugs

What are the classes of common high-alert medications?

anticoagulants; insulins; opioids; chemotherapy; electrolyte concentrates; neuromuscular blockers

Why are Insulin and sulfonylureas considered HAMs?

potent blood sugar lowering leading to possible coma

Why are Opioids (pain medication) considered HAMs?

respiratory depression

Why are Anticoagulants (blood thinners) considered HAMs?

increased risk of bleeding leading

Why are Chemotherapy drugs (cancer treatment) considered HAMs?

extreme toxicity

Why are Neuromuscular Blockers (movement prevention) considered HAMs?

paralysis / permanent injury

Why are Electrolyte Concentrates considered HAMs?

if misdosed can lead to cardiac arrest

Warfarin

Drug Interactions: NSAIDs, Antibiotics, Fish Oil, Garlic Supplements, Coenzyme 10, Vitamin K

Side Effects: Excessive Bruising / Bleeding

Contraindication: Pregnancy Category X

NSAIDs

Drug Interactions: Toxicity with Lithium or Methotrexate supplementation

Interactions: Increased risk of bleeding with Coumadin

HMG-CoA Reductase Inhibitors (statins)

Food Interaction: Grapefruit inhibits metabolism leading to muscle damage (rhabdomyolysis)

Contraindication: Pregnancy Category X

Benzodiazepines & Opioids

Drug Interaction: When taken together can cause respiratory depression

Contraindication: Pregnancy Category D (benzodiazepines)

Clopidogrel and PPIs

Drug Interaction: PPIs can reduce effectiveness of clopidogrel

Antibiotics

Drug Interaction: 1) reduced effectiveness of birth control 2) increased risk of bleeding with anticoagulants

Contraindication: Pregnancy category varies; doxycycline is D

ACE Inhibitors (ACEi)

Contraindication: Pregnancy Category D

SSRIs & SNRIs

Drug Interaction: When SSRIS or SNRIs are taken with MAOIs, can cause serotonin syndrome

Lithium

Drug Interactions: Alcohol, methotrexate, NSAIDs should be avoided

Contraindication: Pregnancy Category D

What are common side effects of ACE inhibitors?

dry cough; hyperkalemia; angioedema

What are common side effects of Angiotensin-II Receptor Blockers?

hyperkalemia; hypotension

What are common side effects of Beta Blockers?

bradycardia; fatigue; dizziness

What are common side effects of Calcium Channel Blockers?

constipation; edema

What are common side effects of Statins?

muscle pain

What are common side effects of Alpha blockers?

hypotension; dizziness

What are common side effects of Penicillin and Cephalosporin Antibiotics?

allergies; diarrhea

What are common side effects of Macrolide Antibiotics?

GI discomfort; teeth discoloration

What are common side effects of tetracycline antibiotics?

photosensitivity

What are common side effects of Fluoroquinolone antibiotics?

photosensitivity; tendon tenderness

What are common side effects of Anti-fungals?

liver toxicity; GI discomfort

What are common side effects of Anti-virals?

headache; nausea

What are common side effects of Benzodiazepines?

drowsiness; dependence

What are common side effects of SSRIs and SNRIs?

serotonin syndrome... nausea; insomnia; sexual dysfunction

What are common side effects of Tricyclic Antidepressant?

dry mouth; constipation

What are common side effects of migraine agents?

tingling; chest pain

What are common side effects of Biguanides?

GI discomfort; lactic acidosis

What are common side effects of DPP-4 Inhibitors?

headache; nasopharyngitis

What are common side effects of SGLT-2 Inhibitors

increased urination; UTIs

What are common side effects of NSAIDs?

GI bleeding; kidney damage

What are common side effects of COX-2 Inhibitors?

cardiovascular risk; kidney damage

What are common side effects of Beta Agonists?

tremor; tachycardia

What are common side effects of Anticholinergics?

dry mouth; urinary retention

What are common side effects of Leukotriene antagonists?

headache; mood changes