NCLEX: High Alert Medications in Acute Care Settings

Factor Xa inhibitors

type of anticoagulant that work by selectively and reversibly blocking the activity of clotting factor Xa, preventing clot formation. Fondaparinux Apixaban Rivaroxaban

Joint Commission Top 5 High Alert Medications:

1) Insulin - subcutaneous and IV 2) Opiates and Narcotics - IV, transdermal, oral 3) Injectable Potassium Chloride or Phosphate Concentrate 4) Intravenous Anticoagulants (Heparin) 5) Sodium Chloride Solutions above 0.9 percent concentration

Dextrose, hypertonic

20% or greater

Liposomal medications

A liposome is a tiny bubble (vesicle), made out of the same material as a cell membrane. Liposomes can be filled with drugs, and used to deliver drugs for cancer and other diseases. Liposomal Amphotericin B Amphotericin B desoxycholate

Independent double Check

Another licensed nurse will perform a second check to identify the medication, dose, and route to be administered.

Sedation agents are especially high alert in children

Chloral hydrate, a sedative, is used in the short-term treatment of insomnia (to help you fall asleep and stay asleep for a proper rest) and to relieve anxiety and induce sleep before surgery.

Adrenergic Agonists

Drugs that stimulate and mimic the actions of the sympathetic nervous system. Also called sympathomimetics. Epinephrine Phenylephrine Norepinephrine

Sterile Water

Serious patient harm can result when sterile water is administered by direct IV infusion due to hemolysis related to the hypotonic nature of the product.

Adrenergic antagonists

The most common Sympatholytic Agent (Drugs that inhibit the actions of the sympathetic nervous system by any mechanism) Propranolol Metoprolol Labetalol

Anticoagulants

Warfarin Heparin Low molecular wt heparin

What diabetes medications are high alert?

hypoglycemics and insulin

Direct Thrombin Inhibitors

class of medication that act as anticoagulants (delaying blood clotting) by directly inhibiting the enzyme thrombin Argatroban Bivalirudin Dabigatran etexilate

High Alert medications

drugs that bear a heightened risk of causing significant client harm when they are used in error. Although mistakes may or may not be more common with these drugs, the consequences of an error are clearly more devastating to clients. These medications require special safeguards to reduce the risk of errors.

Thrombolytics

medicines that may be used for the emergency treatment of an ischemic stroke (a stroke caused by a blood clot), a heart attack (myocardial infarction), or a massive pulmonary embolism (PE). Alteplase Reteplase Tenecteplase

Glycoprotein IIb/IIIa Inhibitors

prevent the binding of fibrinogen, thereby blocking platelet aggregation Eptifibatide