Explanation: NIOSH (National Institute for Occupational Safety and Health) publishes a list of hazardous drugs due to their potential to cause cancer, reproductive toxicity, organ toxicity, or genotoxicity in healthcare workers. Raloxifene is classified as a hazardous drug because it has estrogenic activity and poses a risk to individuals handling it, especially pregnant healthcare workers. It requires special handling and protective equipment. Rabeprazole (a proton pump inhibitor), Ramipril (an ACE inhibitor), and Ranolazine (an anti-anginal agent) are not classified as hazardous by NIOSH.

Explanation: Fentanyl is a potent synthetic opioid analgesic that is used for pain management, especially in acute and critical care settings. It carries a high risk of causing significant patient harm if used in error due to its potency and potential for respiratory depression. That’s why it is classified as a high-alert medication. It is not an adrenergic agonist, insulin, or neuromuscular blocker.

Explanation: Clindamycin is a lincosamide antibiotic, not a macrolide. Therefore, it can be a safe alternative for patients who are allergic to macrolides. Erythromycin, Azithromycin, and Clarithromycin are all macrolide antibiotics and should be avoided in patients with known macrolide allergies.

Explanation: 1 tablespoonful (tbsp) is equal to 15 mL. Since the prescription says 15 mL per dose, this equals 1 tablespoonful per dose. Thus, the patient should take 1 tablespoonful three times a day (t.i.d.).

Explanation: Grapefruit juice can inhibit the enzyme CYP3A4 in the liver and intestines, which is responsible for metabolizing simvastatin. This can lead to increased levels of simvastatin in the blood, raising the risk of serious side effects like muscle toxicity (myopathy or rhabdomyolysis). Ibuprofen, lisinopril, and doxycycline are not significantly affected by grapefruit juice.