High risk meds

[btbucb]

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We all know that hospitals have a high risk med list but i don't think there's one to cater to community pharmacy.

What are some meds that you slow down and triple check when verifying or that you spend a little extra time explaining to a patient?

Some meds that could be on the list are:

Warfarin (duh)- high risk of bleeds, frequent lab monitoring and highly dependent upon the patient's diet and lifestyle, patient population tends to be elderly
Acetaminophen- contained in several combination products, lots of hospitalizations due to overuse and a misunderstanding of the max dose and general safety
Lithium- narrow therapeutic window, DDI with ACEi, NSAIDs, etc and everybody is on those, also dehydration and salt intake can affect levels
Diltiazem- high risk of med errors since there are several formulations that are not interchangeable

Any more? (Actually, i know there's a lot more)

 

[btbucb]

Bump


Be The Best U Can Be

 

[PharmdA07]

All insulin products
All HIV meds
All pediatrics prescription: double check on these: check dosing if you can (e.g. cefdinir); check age if you can (e.g. singulair, zyrtec); check allergy; check admin route
All prescription for pregnant patients
For me, I always double-check or even triplecheck on combo products such as azor, simcor, vytorin, fioricet, esgic/ esgic plus etc. to ensure the right dose for each individual ingredients
That's all I can think now during this 15 minutes break I have LOL

 

[Ramzy]

Anything that needs to be titrated, check previous fill history if new rx... (ex. Antidepressants)... or even high dose methadone 40mg+ should never be given as initial dose for naiive pt

 

[btbucb]

All insulin products
All HIV meds
All pediatrics prescription: double check on these: check dosing if you can (e.g. cefdinir); check age if you can (e.g. singulair, zyrtec); check allergy; check admin route
All prescription for pregnant patients
For me, I always double-check or even triplecheck on combo products such as azor, simcor, vytorin, fioricet, esgic/ esgic plus etc. to ensure the right dose for each individual ingredients
That's all I can think now during this 15 minutes break I have LOL

That's great! Exactly what I'm looking for. Thank you.


Be The Best U Can Be

 

[btbucb]

Double post

 

[btbucb]

Anything that needs to be titrated, check previous fill history if new rx... (ex. Antidepressants)... or even high dose methadone 40mg+ should never be given as initial dose for naiive pt

That's a great tip. Thanks.

This is the kind of info I hope I'll be getting as a grad intern but I have a feeling that won't be the case.


Be The Best U Can Be

 

[Rouelle]

I don't verify yet, but mistakes I commonly see include:

Fioricet vs. Fiorinal
any cream vs. ointment vs. gel vs. lotion vs. other topical dosage forms

Not necessarily high risk, but error prone nonetheless

Also, I very commonly will counsel on refills for things like levothyroxine and bisphosphonates and realize that even though some patients have been on these drugs for years many have never been counseled on how to take them.

 

[Ramzy]

I don't verify yet, but mistakes I commonly see include:

Fioricet vs. Fiorinal
any cream vs. ointment vs. gel vs. lotion vs. other topical dosage forms

Not necessarily high risk, but error prone nonetheless

Also, I very commonly will counsel on refills for things like levothyroxine and bisphosphonates and realize that even though some patients have been on these drugs for years many have never been counseled on how to take them.

I agree with the counseling part... it is amazing how many patients I have found who never knew how to take their omeprazole or levothyroxine heh

 

[pezdispenser]

I still see lots of mistakes in calculations. For example:

Morphine 20 mg/mL and 20 mg/5 mL get mixed up, and if the prescription has the dose in mg, this needs to be converted to mL for the label, but that often gets calculated incorrectly.

They are currently changing the strengths of acetaminophen in combinations with hydrocodone, Fioricet, Fiorinal, etc, so you have to be careful with those. Also with the Lortab or Hycet elixir, the dose is given per 15 mL. Most other liquid concentrations are given per 5 mL, so people get used to that and mistakenly write 5 mL or 1 teaspoonful on the Lortab rx as well.

 

[nextyearrx]

Fentanyl 25mcg vs. Fentanyl 75mcg
Lovonex Injections
Amnasteem for acne

 

[Ramzy]

Yep... Fentanyl 25mcg q72hr put in as 75mcg