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Professor, University of Alaska at Fairbanks

Proactive risk assessment: the process of identifying and systematically analyzing the risks and hazards embedded in the process and structure of care to prevent adverse events from occurring medicine escitalopram buy cheap betahistine 16mg online. Knowing where the risks and hazards are helps to inform the design medicine x ed purchase cheap betahistine line, planning treatment tendonitis order betahistine 16mg without prescription, and development of appropriate interventions that will eliminate or minimize risks and hazards before patient injuries occur medicine ball slams purchase betahistine 16mg overnight delivery. Rescue: An intervention (usually provided urgently) used to reverse an adverse drug effect. Safety culture: Refers to a safety-supportive model of shared accountability where healthcare institutions are accountable for the systems they design; for supporting the safe behavioral choices of patients, visitors, and staff; and for responding to staff behaviors in a fair and just manner. In turn, staff are accountable for the quality of their behavioral choices (human error is not a behavioral choice) and for reporting hazards, errors, and system vulnerabilities. Simulation training: Hands-on training through virtual, live, or constructive experiences that are provided outside of day-to-day practice to teach various skills associated with a complex or hazardous task. Simulation training involves acting out or mimicking an actual or probable real-life condition, event, or situation to gain or sharpen skills associated with responding to these conditions, events, or situations. Smart infusion pump/technology: An infusion pump with integral computer software (see dose error-reduction software) that is, at a minimum, capable of: 1) maintaining a drug library of standard drug concentrations, which when enabled, is used to support dose calculations and alert the user to incorrect orders, calculation errors, or programming errors that would result in significant over- and underdelivery of a drug, electrolyte, or other fluid; and 2) capturing administrative infusion data in a systematic, objective manner to support improvement in medication use. If the programmed dose is outside the preset limits, the pump alerts clinicians and can either require confirmation before beginning delivery (soft limit) or not allow delivery at all (hard limit). A list of look-alike drug names with recommended tall man letters can be found at: Time-out: A formal process of active communication among all team members involved in a procedure by which, immediately prior to the procedure, healthcare providers pause to review a standardized checklist to confirm key aspects of the procedure, such as verification of the patient, the procedure to be performed, laterality, drugs to be administered, and a patient monitoring and rescue plan. This is where this cram sheet can help- it contains condensed facts about the licensure exam and key nursing information. When exam time comes, you can write and transfer these vital information from your head to a blank sheet of paper provided by the testing center. Read the question and answers carefully-do not jump into conclusions or make wild guesses. Look for keywords-Avoid answers with absolutes like always, never, all, every, only, must, except, none, or no. Eliminate answers that are clearly wrong or incorrect-to increase your probability of selecting the correct answer! If the question is an incomplete sentence, the correct answer should complete the question in a grammatically correct manner. Rephrase the question-putting the question into your own words can pluck the unneeded info and reveal the core of the stem. Vital Signs Heart rate: 80-100 bpm Respiratory rate: 12-20 rpm Blood pressure: 110-120/60 mmHg Temperature: 37 °C (98. Therapeutic Drug Levels Carbamazepine (Tegretol): 4-10 mcg/ml Digoxin (Lanoxin): 0. Conversions 1 teaspoon (t) = 5 ml 1 tablespoon (T) = 3 t = 15 ml 1 oz = 30 ml 1 cup = 8 oz 1 quart = 2 pints 1 pint = 2 cups 1 grain (gr) = 60 mg 1 gram (g) = 1,000 mg 1 kilogram (kg) = 2. Maternity Normal Values Fetal Heart Rate: 120-160 bpm Variability: 6-10 bpm Amniotic fluid: 500-1200 ml Contractions: 2-5 minutes apart with duration of < 90 seconds and intensity of <100 mmHg. Done at 1 and 5 minutes with a score of 0 for absent, 1 for decreased, and 2 for strongly positive. Scores 7 and above are generally normal, 4 to 6 fairly low, and 3 and below are generally regarded as critically low. Pregnancy Category of Drugs Category A-No risk in controlled human studies Category B-No risk in other studies. Drug Schedules Schedule I-no currently accepted medical use and for research use only. Anticoagulants-prevents clot formation, Anticonvulsants-used for management of seizures and/or bipolar disorders. Anti-infectives-used for the treatment of infections, Bronchodilators-dilates large air passages in asthma or lung diseases. Medications Digoxin (Lanoxin)-Assess pulses for a full minute, if less than 60 bpm hold dose. Developmental Milestones 2-3 months: able to turn head up, and can turn side to side. Cultural Considerations African Americans-May believe that illness is caused by supernatural causes and seek advice and remedies form faith healers; they are family oriented; have higher incidence of high blood pressure and obesity; high incidence of lactose intolerance with difficulty digesting milk and milk products. Females avoid eye contact with males; use same-sex family members as interpreters.

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Advertisement of Prescription Drugs or Devices Notwithstanding any other provision of law medicine while breastfeeding buy 16 mg betahistine overnight delivery, prescription drugs or devices may be advertised if the advertisement conforms with the requirements of Section 651 medications reactions order betahistine 16 mg with visa. Actions by Board to Prevent Sales of Preparations or Drugs Lacking Quality of Strength; Penalties for Knowing or Willful Violation of Regulations Governing Those Sales (a) the board may institute any action or actions as may be provided by law and that medicine 93 2264 purchase betahistine master card, in its discretion medications removed by dialysis buy discount betahistine 16 mg on line, are necessary, to prevent the sale of pharmaceutical preparations and drugs that do not conform to the standard and tests as to quality and strength, provided in the latest edition of the United States Pharmacopoeia or the National Formulary, or that violate any provision of the Sherman Food, Drug, and Cosmetic Law (Part 5 (commencing with Section 109875) of Division 104 of the Health and Safety Code). Buildings: Prohibition Against the Use of Certain Signs Unless Licensed Pharmacy Within No building shall have upon it or displayed within it or affixed to or used in connection with it a sign bearing the word or words "Pharmacist," "Pharmacy," "Apothecary," "Drugstore," "Druggist," "Drugs," "Medicine," "Medicine Store," "Drug Sundries," "Remedies," or any word or words of similar or like import; or the characteristic symbols of pharmacy; or the characteristic prescription sign (Rx) or similar design, unless there is upon or within the building a pharmacy holding a license issued by the board pursuant to Section 4110. Impaired Pharmacists: Legislative Intent the board shall operate a pharmacists recovery program to rehabilitate pharmacists and intern pharmacists whose competency may be impaired due to abuse of alcohol, drug use, or mental illness. The intent of the pharmacists recovery program is to return these pharmacists and intern pharmacists to the practice of pharmacy in a manner that will not endanger the public health and safety. Definitions (a) "Participant" means a pharmacist or intern pharmacist who has entered the pharmacists recovery program. Function of Program: Board Referrals; Voluntary, Confidential Participation (a) A pharmacist or intern pharmacist may enter the pharmacists recovery program if: (1) the pharmacist or intern pharmacist is referred by the board instead of, or in addition to , other means of disciplinary action. However, if the board receives information regarding the conduct of the pharmacist or intern pharmacist, that information may serve as a basis for discipline or other enforcement by the board. Criteria for Participation to be Established by Board (a) the board shall establish criteria for the participation of pharmacists and intern pharmacists in the pharmacists recovery program. Contracting with Employee Assistance Program: Selection the board shall contract with one or more qualified contractors to administer the pharmacists recovery program. Function of the Employee Assistance Program the functions of the contractor administering the pharmacists recovery program shall include, but not be limited to , the following: (a) To evaluate those pharmacists and intern pharmacists who request participation in the program. The name and license number of a pharmacist or intern pharmacist who is terminated from the pharmacists recovery program and the basis for the termination shall be reported to the board. Review of Program Activities (a) the executive officer of the board shall designate a program manager of the pharmacists recovery program. The program manager shall have background experience in dealing with substance abuse issues. As part of this evaluation, the program manager shall review files of all participants in the pharmacists recovery program. Confidential Records; Exception for Disciplinary Proceeding All board records and records of the pharmacists recovery program pertaining to the treatment of a pharmacist or intern pharmacist in the program shall be kept confidential and are not subject to discovery, subpoena, or disclosure pursuant to Chapter 3. However, board records and records of the pharmacists recovery program may be disclosed and testimony provided in connection with participation in the pharmacists recovery program, but only to the extent those records or testimony are relevant to the conduct for which the pharmacist or intern pharmacist was terminated from the pharmacists recovery program. Immunity from Civil Liability No member of the board shall be liable for any civil damages because of acts or omissions that may occur while acting in good faith pursuant to this article. Resale of Preferentially Priced Drugs: Prohibition; Exceptions (a) the resale, by any person, of drugs acquired at preferentially low prices permitted under federal law only because of the 287 Nonprofit Institutions Act (15 U. In addition to injunctive relief, the plaintiff in any action shall recover three times the amount of his or her actual damages, if any, as well as three times the actual damages, if any, sustained by any person who has assigned to the plaintiff a claim for damages resulting from a violation of this section. Board May Audit Sales to Walk-In Customers the board may audit persons for compliance with the limits established in paragraph (3) of subdivision (a) of Section 4380 except that in the case of a facility or pharmacy that predominately serves members of a prepaid group practice health care service plan, those audits may be undertaken solely by the Department of Managed Health Care pursuant to its authority to audit those plans. Revenue and Renewal this section shall become inoperative on July 1, 2021, and as of January 1, 2022, is repealed. Fees the amount of fees and penalties prescribed by this chapter, except as otherwise provided, is that fixed by the board according to the following schedule: (a) the fee for a nongovernmental pharmacy license shall be five hundred twenty dollars ($520) and may be increased to five hundred seventy dollars ($570). The fee for the issuance of a temporary nongovernmental pharmacy permit shall be two hundred fifty dollars ($250) and may be increased to three hundred twenty-five dollars ($325). If an error in grading is found and the applicant passes the examination, the regrading fee shall be refunded. The fee for transfer of intern hours or 291 verification of licensure to another state shall be twenty-five dollars ($25) and may be increased to thirty dollars ($30). The annual fee for renewal of the license shall be three hundred twenty-five dollars ($325) for each license and may be increased to three hundred sixty dollars ($360). The fee for renewal of a pharmacy technician license shall be one hundred forty dollars ($140) and may be increased to one hundred ninety-five dollars ($195).

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Not all infections require specific antimicrobial treatment and careful clinical judgement is essential to determine whether symptomatic treatment is sufficient treatment menopause generic 16mg betahistine amex. Microbiological investigations should always be carried out before treatment where possible when the etiology is uncertain symptoms yeast infection men buy betahistine 16 mg fast delivery, in severe infections when patients fail to respond to empirical therapy or develop a new infection during the course of treatment medicine 9 minutes cheap betahistine 16mg free shipping, or for public health purposes symptoms 3dpo cheap betahistine. Appropriate specimens for Gram-staining, culture 1 Available on request from Anti-infective Drug Resistance and Containment, Communicable Disease Surveillance and Response, World Health Organization, 1211 Geneva 27, Switzerland. In many situations microbiological identification of the pathogen is vital to determine the appropriate antimicrobial treatment. In contrast, group A b-haemolytic streptococci are routinely susceptible to benzylpenicillin and phenoxymethylpenicillin, making mandatory susceptibility testing unnecessary. General principles of antimicrobial prescribing Spectrum of activity Ideally, the antimicrobial susceptibility of an organism should be known and the most effective and safe agent targeted to the infection should be used. This reduces the likelihood of selection of resistant microorganisms and superinfection. However, in most cases the suspected organism is assumed to be susceptible to a particular antimicrobial because of its known characteristics from surveillance data. Pharmacokinetics and pharmacodynamics the pharmacokinetics and pharmacodynamics of an antimicrobial are determined by three factors: the serum half-life, its distribution in the body tissues and fluids. Drugs that achieve high intracellular levels are necessary for infections with intracellular pathogens such as Chlamydia and Legionella spp. Binding of a small fraction of the drug to serum proteins contributes to the achievement of high extravascular concentrations; conversely, serum protein binding levels above 80­85% have an impact on passage from the blood to extravascular compartments, but are not per se indicative of tissue concentrations below therapeutic levels. In patients with renal or hepatic impairment, reduction of the dose may be required. The excellent absorption of many oral antimicrobials (including b-lactams, chloramphenicol, doxycycline and fluoroquinolones) and the associated costbenefits make oral administration usually the most appropriate form of antimicrobial therapy. Adherence and ease of administration Oral formulations are more convenient, generally cheaper and associated with less adverse effects than parenteral ones. Parenteral formulations also require trained medical staff for their administration and can have specific adverse effects not seen with orally administered drugs. Impact on normal microbial flora If two antimicrobial agents have similar probable cure rates, cost and tolerance in a particular case, the agent having the least deleterious impact on the normal human microbial flora should be chosen. This may reduce or prevent adverse effects such as antimicrobial-associated diarrhoea and vaginal superinfections with Candida spp. Cost of treatment the drug with the lowest cost is preferred if efficacy, adherence and tolerance are comparable. However, the cost of the total treatment, and not only the unit cost of the drug, must be considered. Antimicrobial combinations In certain clinical settings it may be necessary to use two or more antimicrobials to achieve the desired effect. The common indications for combination therapy are: to obtain antimicrobial synergy. Effect of commercial promotion Individuals responsible for prescribing drugs and drug committees are commonly subject to commercial promotion in making choices about antimicrobials. Objective data and evidence of clinical efficacy should provide the basis for decisions for including antimicrobials in drug formularies. Drug formularies the list of antimicrobials to be included in the drug formulary of an institution should be established by consensus among the users in the institution represented in the drug committee. For each particular antimicrobial, the clinical indication (therapeutic, prophylactic or empirical) and the dosage (for adults, children and, if appropriate, patients with hepatic or renal impairment) must be mentioned. Objective information should be distributed by the committee, based on data from the manufacturer and independent drug information. The committee should conduct periodic evaluations of the functioning of the formulary. Choice of antimicrobial and options for treatment In this book, the recommendations for initial empirical treatment of infection are based on current knowledge of the prevalence of antimicrobial resistance. Most infections are treated initially on the basis of clinical evidence, without full knowledge of the causative organism or its susceptibility. As the prevalence of resistance varies considerably from one community to another, the recommendations are presented as a series of options.

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Where applicable symptoms genital warts order generic betahistine online, this shall also include records of certification(s) of facilities or equipment treatment of hemorrhoids cheap betahistine 16mg overnight delivery. Documentation of each such calibration shall be recorded in a form which is not alterable and these records of calibration shall be maintained and retained in the pharmacy treatment for 6mm kidney stone generic 16 mg betahistine with visa. Application for any waiver shall be made by the licensee in writing medications for gout generic betahistine 16 mg on line, and the request shall identify the provision(s) requiring physical construction or alteration, and the timeline for any such change(s). The board or its designee may grant the waiver when, in its discretion, good cause is demonstrated for such waiver. Reference: Sections 4005, 4029, 4036, 4037, 4051, 4052 and 4127, Business and Professions Code. Training of Compounding Staff (a) A pharmacy engaged in compounding shall maintain documentation demonstrating that personnel involved in compounding have the skills and training required to properly and accurately perform their assigned responsibilities and documentation demonstrating that all personnel involved in compounding are trained in all aspects of policies and procedures. Reference: Sections 4005, 4036, 4037, 4051, 4052 and 4127, Business and Professions Code 1735. Compounding Quality Assurance (a) Any pharmacy engaged in compounding shall maintain, as part of its written policies and procedures, a written quality assurance plan designed to monitor and ensure the integrity, potency, quality, and labeled strength of compounded drug preparations. All qualitative and quantitative analysis reports for compounded drug preparations shall be retained by the pharmacy and maintained along with the compounding log and master formula document. The quality assurance plan shall include a schedule for routine testing and analysis of specified compounded drug preparations to ensure integrity, potency, quality, and labeled strength, on at least an annual basis. Reference: Sections 4005, 4036, 4037, 4051, 4052 and 4127, Business and Professions Code. Pursuant to Business and Professions Code Section 4074, a pharmacist shall inform the patient or his or her representative of the harmful effects of certain drugs dispensed by prescription. The pharmacist shall make a notation of the quantity supplied on the face of the written prescription. The remaining portion of the prescription may be filled within 72 hours of the first partial filling. If the remaining portion is not filled within the 72-hour period, the pharmacist shall notify the prescriber. The pharmacist may not supply the drug after 72 hour period has expired without a new prescription. Reference: Section 4301, Business and Professions Code; and Sections 11055, 11153, 11154, 11166, 11200, Health and Safety Code. Treatment may be initiated up to five days (120 hours) after unprotected intercourse. In addition, the pharmacist shall collect the information required for a patient medication record required by Section 1707. The pharmacist shall comply with all state mandatory reporting laws, including sexual abuse laws. Patients will be provided information concerning dosing and potential adverse effects. In addition to the products specified in this paragraph, generic equivalent products may be furnished. Estrogen containing regimens are not preferred and should be used only when the other options are not available. The patient shall complete the selfscreening tool annually, or whenever the patient indicates a major health change. A copy of the most recently completed self-screening tool shall be securely stored within the originating pharmacy or health care facility for a period of at least three years from the date of dispense. This self-screening tool should be made available in alternate languages for patients whose primary language is not English. The pharmacist shall answer any questions the patient may have regarding selfadministered hormonal contraception. A patient who is determined not to be an appropriate candidate for selfadministered hormonal contraception shall be advised of the potential risk and referred to an appropriate health care provider for further evaluation. An equivalent, curriculum-based training program completed on or after the year 2014 in an accredited California school of pharmacy is also sufficient training to participate in this protocol.

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