Difference between revisions of "List of 39 Warning Messages Targeting Prescribing Decisions Designed to Prevent Adverse Drug Events in Long-Term Care"
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<td align=left>Any new prescription for thiazide or loop diuretic therapy</td> | <td align=left>Any new prescription for thiazide or loop diuretic therapy</td> | ||
<td> WARNING—HYPOKALEMIA RISK -- Hypokalemia can result from use of thiazide and loop diuretics. Check POTASSIUM level in 7–10 days and continue monitoring. <tr> | <td> WARNING—HYPOKALEMIA RISK -- Hypokalemia can result from use of thiazide and loop diuretics. Check POTASSIUM level in 7–10 days and continue monitoring. <tr> | ||
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+ | <td align=left>Anticholinergic medications (e.g., nortriptyline)</td> | ||
+ | <td>WARNING—RISK OF ANTICHOLINERGIC EFFECTS -- This drug poses a high risk of dry mouth, constipation, urinary retention, and delirium. Use the lowest feasible dose. Monitor closely for these effects. <tr> | ||
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+ | <td align=left>Oxybutynin and tolterodine</td> | ||
+ | <td>WARNING—RISK OF URINARY RETENTION -- Order a bladder scan 7 days after initiation of therapy or any change in dose and monitor. <tr> |
Revision as of 22:44, 10 February 2009
Warning Messages Targeting Prescribing Decisions Designed to Prevent Adverse Drug Events in Long-Term Care | |||||||||||||||||||||||||
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Scenario Description | Warning/Message |
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Warfarin order in setting of most-recent INR of >3 | WARNING—BLEEDING RISK -- INR is ——. Current INR is high. Reduce WARFARIN dose and/or monitor closely. |
Warfarin interaction with trimethoprim/sulfamethoxazole, amoxicillin/clavulanate | WARNING—BLEEDING RISK -- This drug can interact profoundly with WARFARIN. Consider an alternative antibiotic or monitor very closely. Repeat the INR in 3 days and consider reducing warfarin dose. |
Warfarin-antibiotic interaction | WARNING—BLEEDING RISK -- This drug interacts with WARFARIN. Repeat the INR in 3 days. Consider reducing warfarin dose. |
Warfarin-nonantibiotic interaction (e.g., amiodarone) | WARNING—BLEEDING RISK -- This drug interacts with WARFARIN. Monitor very closely. Repeat the INR in 3 days. |
Warfarin-antiplatelet drug or NSAID interaction | WARNING—BLEEDING RISK -- The use of WARFARIN with NSAIDs and/or ANTIPLATELET AGENTS increases bleeding risk. Reevaluate need for concomitant therapy. |
Warfarin-nonantibiotic interaction (e.g., amiodarone) | WARNING—BLEEDING RISK -- This drug interacts with WARFARIN. Monitor very closely. Repeat the INR in 3 days. |
Antiplatelet drug—NSAID interaction | WARNING—BLEEDING RISK -- The use of ANTIPLATELET AGENTS with NSAIDs increases bleeding risk. Evaluate need for concomitant therapy. |
Any use of NSAIDs, ACE inhibitors, diuretics in resident with BUN and/or creatinine above certain threshold level | WARNING—RENAL INSUFFICIENCY RISK -- Current BUN=——, Creatinine=——. Worsening renal insufficiency can result from ACE inhibitors, angiotensin receptor blockers (e.g., losartan), diuretics, and NSAIDs. Evaluate medication regimen and monitor BUN and CREATININE closely. |
Any drug therapy that can increase potassium level (ACE inhibitors, potassium-sparing diuretics, potassium supplements, NSAIDs) | WARNING—HYPERKALEMIA RISK -- Most recent POTASSIUM is —. HYPERKALEMIA can result from therapy with any of the following: ACE inhibitors, angiotensin receptor blockers (e.g., losartan), potassium-sparing diuretics, NSAIDs, and mineralocorticoids. Reevaluate medication regimen and monitor POTASSIUM level closely. |
Any new prescription for thiazide or loop diuretic therapy | WARNING—HYPOKALEMIA RISK -- Hypokalemia can result from use of thiazide and loop diuretics. Check POTASSIUM level in 7–10 days and continue monitoring. |
Anticholinergic medications (e.g., nortriptyline) | WARNING—RISK OF ANTICHOLINERGIC EFFECTS -- This drug poses a high risk of dry mouth, constipation, urinary retention, and delirium. Use the lowest feasible dose. Monitor closely for these effects. |
Oxybutynin and tolterodine | WARNING—RISK OF URINARY RETENTION -- Order a bladder scan 7 days after initiation of therapy or any change in dose and monitor. |