Hospital Pharmacy Operations Flashcards

A pharmacist is reviewing nutritional support for a critically ill patient. Which route of nutrition is preferred in a patient with a functioning GI tract?

Answer: Enteral nutrition (EN) via nasogastric or nasoenteric tube — preserves gut integrity, reduces bacterial translocation, cheaper, and safer than TPN

Enteral nutrition is preferred when the GI tract is functioning because it: preserves intestinal mucosal integrity, reduces bacterial translocation and infection risk, supports gut-associated immunity, is cheaper, and avoids TPN complications (catheter infection, metabolic complications). The adage 'if the gut works, use it.'

A hospital pharmacist monitors a patient receiving TPN. Which complication should be monitored daily?

Answer: Blood glucose — hyperglycemia is the most common TPN complication due to high dextrose content

Hyperglycemia is the most frequent complication of TPN due to the high dextrose concentration. Blood glucose should be monitored every 4–6 hours, targeting <180 mg/dL (10 mmol/L) in critically ill patients. Insulin may need to be added to the TPN bag or administered separately.

A patient is admitted with severe hypokalemia (K+ 2.2 mEq/L) and requires IV potassium replacement. What is the maximum concentration of potassium that can be infused through a peripheral vein?

Answer: 40 mEq/L (or 10 mEq/hour) via peripheral line

Peripheral IV potassium should be limited to ≤40 mEq/L concentration and ≤10 mEq/hour rate to prevent phlebitis, pain, and the risk of cardiac arrest from accidental rapid infusion. Higher concentrations and rates (up to 40 mEq/hour) require central venous access with continuous cardiac monitoring.

A pharmacist is making recommendations for pain management in a patient with a morphine allergy. Which alternative opioid can be used?

Answer: Fentanyl or hydromorphone — different chemical structures with lower cross-reactivity risk

True allergy to morphine (immune-mediated) is rare; most 'morphine reactions' are non-immune histamine release (pseudo-allergy). True morphine allergy (IgE-mediated) has limited cross-reactivity with other opioids of different chemical classes (phenylpiperidines: fentanyl; phenanthrene series: hydromorphone has less cross-reactivity risk than codeine).

The hospital pharmacy director reviews productivity data and notes that the clinical pharmacist's ward round participation has increased physician acceptance of recommendations to 85%. What is the significance of this metric?

Answer: High acceptance rate indicates clinical pharmacists are providing relevant, evidence-based recommendations that directly improve patient care quality

Pharmacist recommendation acceptance rate (typically 70–90% in high-performing units) reflects the quality and clinical relevance of pharmacist interventions. High acceptance rates with documented patient outcomes (ADEs prevented, appropriate dose changes, IV-to-oral conversions) demonstrate the clinical pharmacist's contribution to multidisciplinary care.

A pharmacist is calculating the osmolarity of a TPN formulation. Which component contributes most significantly to TPN osmolarity?

Answer: Dextrose concentration — high dextrose TPN can exceed 1,500 mOsm/L requiring central venous administration

Dextrose (glucose) is the main energy source in TPN and is the primary determinant of TPN osmolarity. Dextrose 70% solutions are highly hypertonic. TPN with >900–1,000 mOsm/L should be administered via central venous catheter (CVC) because peripheral veins cannot tolerate hypertonic solutions without severe phlebitis.