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