Editing Pharmacology (section)

== High-Alert Medications ==

High-alert medications carry a heightened risk of significant harm when used in error. Commonly designated classes include:

* Insulins, especially concentrated formulations
* Anticoagulants including heparin, warfarin, and direct oral agents
* Opioids and other sedating agents including patient-controlled and epidural analgesia
* Concentrated electrolytes, especially potassium chloride, hypertonic sodium chloride, and magnesium sulfate
* Chemotherapeutic and other cytotoxic agents
* Neuromuscular blocking agents such as succinylcholine, rocuronium, and vecuronium, which cause paralysis without sedation or analgesia and must never be given to a patient who is not intubated and ventilated
* Vasoactive and inotropic infusions
* Moderate sedation agents

Safety controls for these drugs include independent double checks, standardized concentrations, smart pump dose-error reduction software, removal of concentrated electrolytes from floor stock, and tall man lettering for look-alike names.

'''Potassium chloride is never given by intravenous push.''' It must be diluted, given by infusion pump, and typically infused no faster than 10 mEq per hour through a peripheral line, with faster rates only in a monitored setting with central access per policy. Assess urine output before administering potassium.