ATI Pharmacology

Cephalosporin

-broad spectrum

-ceph/cefs

-Similar to PCN/ don't give if PCN allergy

-can cause bleeding w/ other bleeding meds monitor bleeding time (tonsil story)

- Disulfiram reaction (puke & puke & puke) just like Flagyl, the protozoal drug

- Store in fridge & take with food

ALL antibiotics have these side effects

- allergy, hypersensitivity

- suprainfection

- organ (kidney & ear) toxicity

- lowers OC effectiveness

Vancomyocin

- serious infections like MRSA

- colitis by c-diff

- ototoxicity: get hearing test, tell dr. if hearing getting worse

-given over 60 minutes

Tetracyclines

- Sumycin, Doxycycline (Vibramycin)

- broad, rocky mtn fever, lyme disease, acne, GI infections by H. Pylori

- bad GI discomfort

- Don't give to kids 8; teeth permanently yellow

- Bad photosensitivity- wear sunscreen!

- Can't take with milk, iron, or antacids

- Take on empty stomach with a full glass of water

When is Arythromycin given? What class of drugs is it? worse adverse effect?

When pt allergic to PCN and needs abx. Bacteriostatic inhibitor

bad GI issues

Aminoglycosides

ototoxicity, Renal toxicity, Can't take with PCN at all!

- gentamicin, neomycin, streptomycin

TMP-SMZ

-Contains Sulfa

- use for UTI

- Blood problems; get CBC baseline

-photosensitivity wear sunscreen and glasses!

- empty stomach with a full glass of water

Isoniazid (INH)

-antiTB

- take daily for 6-12 months and most likely with other meds too

-worked if 3 neg. sputum cultures, no temp.

- Liver toxicity (hepato) check liver fxn

- Don't take with alcohol (liver fxn remember?)

- Take on empty stomach

Antiviral: Acyclovir, Ganciclovir

Teratogenic preg. X; put on rubber gloves if topical! remember my purple glove experience

-thrombocytopenia, lowers WBC

What class of drugs if Flagyl? What is the weird effect it has?

Anti-protozoal. works on C. diff & H. Pylori PUD. Antibuse effect if taken with alcohol

Amphotericin B

anti-fungal. HIGHLY TOXIC

- infusin rxns (fever and chills)

- nephrotoxicity

- hypokalemia

- hepatoxicity

- gynecomasita

- C/I with aminoglycosides (just like PCN)

-azole

Fungal

______ causes malignant hyperthermia. Use ____ to stop it

succinylcholine, Dantrium/Dantrolene.

Morphine adverse effects

-Constipation

-Resp depression

-urinary retention

-Sedation

- Orthostatic HOTN

- Cough suppression

Morphine drug-drug interactions (think of what morphine does to the body)

- MAOIs
-anticholinergics

-CNS depressants

-hypotensive drugs

-opiod antagonists (narcan)

- antihistamines

Morphine patient education re how to take

Take with food for N/V, lie still will help

Opiod withdrawl (stop abruptly is taking 6weeks). Is it life-threatening? Will it subside?

sweating, restless, agitated, dilated pupils, tremors, tachycardia, increased BP, N/V, cramps, muscle
spasms with kicking movements. NO, subside in 7-10 days.

Migraine medicine & can you take them right after each other?

vasoconstriction, ergot's and triptans. NO, space out ergot and triptan by at least 24 hours.

What pain meds reduces fever?

ibuprofen, tylenol

What pain med reduces platelet aggregation?

NSAIDS (aspirin), reduce thrombus but will bleed easier, too

What pain med reduces fever but has NO anti-inflammatory effect and NO platelet effect?

tylenol

What can give child Reye's syndrome if they have viral illness?

Aspirin

NSAIDS education w/ how to take med. NSAIDS=

with food, milk, or full glass of water to reduce gastric discomfort. Ibuprofen, Celebrex, Naproxen, Aspirin
acetaminophen max dose/day?

4 grams

When to withhold morphine/opiates

RR <12/min & notify Dr

Triptans & pregnancy

Triptan= Teratogenic. Pregnancy X

Rheumatoid Arthritis Drugs name potent toxic drug

DMARDs, 1st choice: methotrexate. Bone Marrow Suppression and Fetal Death

Methotrexate: most concerned about...

bone marrow suppression; Baseline CBC and platelet counts,

What are the s/s of circulatory overload? Seen if giving too much fluids

flush, SOB, cough, heart palpitations

What type of diuretic is not effective in renal failure?

Thiazide - HCTZ

Bumex is ___x more potent than lasix

40

Thiazide diuretics are good for the ___ and perfect for the eldery __ with HTN

bones, woman

Lasix drug-drug interaction: for manic depressive ppl it'll get to toxic levels in the body

Lithium will become toxic

Signs of hypokalemia

weakness, dysrhymias, increased cardiac sensitivity of digoxin, ileus, Flat T wave

Aspirin toxicity symptoms

Tinnitus, HA

Glucocorticoids adverse effects

potent; suppress adrenal glad fxn, hyperglycemia, osteoporosis, if taken with NSAIDS, increase risk of GI
ulcer, mask infection and suppress immune system

Reo Pro (-mab) what is it for & adverse effects. What other use does Reo Pro have?

Immunosuppressant for RA, Lupus. toxic to bone marrow, acute pulm edema, infection risk, neoplasia
risk. Antiplatelet action.

Classic CNS depressant drug classes and what they're used for

Benzodiazepines, Barbituates. Anxiety.

-lam & -pam are the endings for ________

Benzodiazepines

Benzodiazepine Lorazepam (ativan) increases the possibility of ______.

seizures

Benzodiazepine antidote?

Romazicon 1/2 life of 1 hour

Other anxiolytics: and what they're for

-Valproic Acid: anti-seizure, bi-polar

- Phenergan: NV, anxiety, extrapyramidal effects

Amitriptiyline (Elavil) drug drug interactions and how to take med

Anticholinergics b/c TCA already have anticholinergic effects

- void prior to dosing & take at bedtime to sleep through fatigue side effect

MAOI's ___ line of choice for depression b/c of the adverse effects with _____. If eat _____ will cause
an _____ ______

2nd or 3rd, tyramine. Tyramine, hypertensive crisis

MAOI adverse effects are related to stimulation of the _____ and include:

SNS, CNS stimulation,

CV-hypertensive crisis, palpitations, Liver toxicity

1st drugs of choice for depression and are equally as effective as _ _ _ but don't see _____ & ____

SSRI, TCA, hypotension and sedation

SSRI drug examples: prototype and 2 popular drugs

Prozac, Celexa, Zolof

Atypical antidepressant _______ better use in elderly

Wellbutrin

SSRI uses

depresssion

OCD

bulimia

PTSD

Panic attacks
Social phobias

PMDD

What time of day to give SSRI

Give in the AM for optimal effects

Lithium is used for

Bipolar Disorder

Valproic Acid is used for

Anti-seizure

Lithium and Diuretics

toxicity if taking diuretics

Anti-depressants have ___________ effects

anticholinergic: dry mouth, constipation, lack of sweat, lack of voiding

Antidepressants and anti-anxiety meds may take _ to __ weeks to take effect

1-3 weeks

all anti-depressants have _____ ______ effect and pt must have their __ monitored

orthostatic hypotension. BP

If patient taking an antihypertensive and just got ordered MAOI, Nardil, Marplan, or Parnate, then...

monitor their BP and call the Dr if theres a significant drop and may need to reduce the anti-htn
dosage

Lithium and Triptans? Safe in pregnancy?

NO both lithium and triptans are teratogenic

Therapeutic Levels of Lithium

0.4-1.0 mEq/L. Take 2-3 times a day.

Chemotherapy Agents, name as much as you can!

neosar (cyclophosphamide), methotrexate, doxorubicin, tamoxifen

Cyclosporine is an _________

immunosuppressive drug

PTT lab value should stay at >_________ for what medication? What is the therapeutic PTT level?

2 times the baseline, Heparin. 60-80 seconds

To prevent HIT, stop heparin at platelet count of <________

100,000

How to inject heparin, starting from drawing up

draw up with 22-25 ga needle from vial, then use 25 or 26 ga to put into abdomen 2in from umbilicus.

Drug to help with heparin overdose

Protamine Sulfate

Warfarin C/I (2)

liver failure (no clotting proteins will lead to too much bleeding), alcoholism (additive risk of bleeding)

Lab values to watch with Warfarin

-PT (18-24 sec)

-INR (2-3)
patient education with aspirin (food-wise)

take with food

Prevention of strokes, MI, and reinfarctions can be accomplished with low-dose aspirin of ___mg

81 mg

Thrombolytic drug prototype

Streptokinase, dissolves clots that have already been formed

When should thrombolytics, streptokinase, be given?

4-6 of onset of symptoms

Do/Do not mix any medications in IV with thrombolytic agents

DO NOT

What medications are usually given with thrombolytics, streptokinase? (think when this drug is used)

Beta-blockers to lower myocardial oxygen consumption

H2 antagonists like Zantac or

PPI like Prilosec to prevent GI bleeding

Ferrous Sulfate use

Iron Deficiency Anemia

Ferrous Sulfate Patient Education (adverse effects, among other things)

-GI distress however can't take with food b/c that will decrease it's absorption greatly

-Teeth staining; drink w/ straw or dilute in water or juice and rinse mouth afer swallowing

- Don't take with tetracycline, or antacids

-Poop will be a harmless dark green or black color

- Drink more water and exercise more to counter constipation effects

why would a patient be given vitB12-cyanocobalamin

pernicious anemia, partial removal of stomach

What vit/min masks the signs of Vit b12 deficiency?

folic acid

E-alfa, hematopoietic growth factor, is dependent on adequate levels of ___ ___ & ___

Iron, Folic acid, Vitamin B12

In giving whole blood, what do you do before and during?

obtain vital signs, stay with the client and monitor VS q5 min for 15 minutes

When giving whole blood, what do you need the 2nd person for?

check identification of the donor blood and recipient, blood compatibility and expiration date.

Only give blood products with what type of IV fluid?

0.9% NS. anything else will cause lysis of the RBC

Bronchodilator albuterol: therapeutic uses

Prevention of asthma attack

long-term control of asthma

Short acting treatment for asthma attack

Bronchodilator side effects; overall stimulation of the B2-adrengeric receptors...

tachycardia, angina

How to use a MDI (metered dose inhaler)

shake the inhaler, 1/2-2 in away from mouth and tilt head back slightly and open mouth wide. press
inhaler same time you breath in deep. Hold breath for 10 seconds. Wait 1 full minute b4 another puff.

When prescribed a beta2-agonist and an glucocorticoid, which do they inhale first?

the beta-2 agonist promotes bronchodilation and enhances absorption of the glucocorticoid

What does the med theophylline do? short term or long-term control?

relaxes bronchial smooth muscle and does bronchodilation. Long-term control of asthma attacks.

Inhaled atrovent what class of medication is it

anti-cholinergic used for long term control of asthma

Glucocorticoids for asthma are used for _____ and oral glucocorticoids are only give for ___-___ days

long-term control of asthma attacks. 3-10 days

Codeine is used for ___. classification of drug?

chronic, non-productive cough. it's an opiod.

Codeine adverse effects

-CNS effects

-GI distress take with food and increase fluids!

Mucomyst (Acetylcysteine) is a mucolytic and it's therapeutic effect is to:

make nasal and bronchial secretions watery to enhance their passage

Mucomyst's adverse effects are: (think of its effect on mucus)

aspiration and bronchospasm

What does Mucomyst acetylcysteine smell like? How to take it?

rotten eggs. dilute with water or juice

What do nasal decongestants like phenylephrine do to the body?

CNS stimulation b/c they stimulate alpha-1 adrenergic receptors.

Vasoconstriction-watch HTN and CAD patients!

How fast do you infuse K chloride in IV pump?

no faster than 10 mEq/hr

You should dilute ___and give no more than 40 mEq/L to prevent vein irritation

KCl. remember in clinical he said it was really burning his vein.

SERMS raloxifene is used for _______

osteoporosis and prevent bone fractures

Raloxifiene can give the women ___ ____ and increase the risk for _ _ _s

hot flashs, DVTs

Bisphosphonates, like Fosamax or Boniva

sit or stand for 30 minutes afer taking

-have enough vit d and calcium

Neostigmine for myasthenia gravis; adverse reaction

diarrhea

Dilantin (phenytoin) and adverse effects

Anti-seizure; blurred vision, bad rash, beardy chesty, teratogenesis, dysrhythmias

Which vitamin promotes iron absorption but increases its side effects?
Vit C

Carbamazipine (Tegretol) 1) Use 2) cannot be used with _____ ______ (all of these meds can't)

anti-convulsant

-oral contraceptives

PTU is given for ______ & clinically see its working by:

hyperthyroidism

lowered Hr, weight gain, lowered T4 levels

-opril -april

ACE inhibitor

All ACE inhibitors cause: (2)

dry, persistant, irritating, cough and increases body's uptake of K causing hyperkalemia

70% of patients on an SSRI experience _____ ______

sexual dysfunction

Fentanyl is used for:

severe cancer pain, will cause constipation

____ will increase the toxicity of Lithium

NSAIDS, tylenol is NOT an NSAID

Carbonic Anhydrase inhibitor use

glaucoma

Metoclopramide
Ulcers, GERD,

Bupropion (Zyban) to help stop smoking has what action on the CNS system?

Stimulation

Therapeutic level of Digoxin?

0.5-2.0

Gold Salts for RA toxicity. RA drugs dosing

rash, sores in mouth, intense itching

- once-a-week at first then down to once-a-month

HBA1c goal for DM

<7%

Amitryptoline (Elavil) has _______ effects. What is Elavil drug class?

anticholinergics. TCA

Lithium adverse effects

hand tremors, thirst, GI upset

Digoxin toxicty can occur in the presence of ________ which can happen with what medication?

Hypokalemia, Lasix

Name 4 NSAIDS: Aspirin, celebrex, ibuprofen, naproxen

Neostigmine, for myasthenia gravis, side effects. Medication given to counteract neostigmine?

cholinergic effects: high GI motility, bradycardia, urinary urgency.

-Atropine
Dilantin (phenytoin) is used for _____ and it's side effects are

seizures, double vision, hirsuitism, skin rash, teratogenesis, dysrhythmias,

Dilantin (phenytoin) cannot be used with what two other drugs?

OC's and Warfarin

Beta1 heart meds are used to treat

Heart Failure and Cardiac arrest

Alpha1 agonsts like epinepherine is used for __

raising BP

Beta1 activation in the heart can cause ________

dysrhythmias

Dopamine is used for ____ and _____ ____

shock

Heart Failure

Multiple drug interactions with Heart medications:

MAOI, TCA enhance epinephrine effect (vasocontriction)

- Phentolamine -A blocker

- Propanolol B blocker

Alpha Adrenergic Blockers (minipress) all have a first-dose ____________ ___________ effect and
what OTC analgesics counteract the anti-hypertensive effect?

orthostatic hypotension b/c venous dilation

-NSAIDS
Clonidine (catapress) does what to the pt's BP and CO?

decrease BP and CO

Clonidine (catapress) and ______ (alpha blocker) counteract each other

Prazosin (Minipress)

Which Beta blocker is non-selective and causes bronchoconstriction, too?

Propanolol

-pril ACE inhibitors block Ang I from becoming II resulting in:

vasodilation, excretion of water & sodium, retain K,

Worse Adverse Effect seen with -prils?

Hyperkalemia

-sartan

Ang II receptor blockers

-prazole

PPI

-tidine

H2 receptor antagonists

-statins

Cholesterol drugs

-pine, -amil (verapamil: non-selective)

Ca channel blocker

Cardiac Glycoside drug

Digoxin
The main difference between ARB's and ACE inhibitors is that ______ and _______ are not side effects
of ARB

-cough

- hyperkalemia

Ca Channel Blocker (-ipine/-amil) vasodilate and adverse effects (2)

- reflex tachycardia

- Peripheral edema

Dysrhythmias are seen as a ________ QRS interval

widened

Action of Digoxin (2)

increase myocardial contraction

Lower Heart Rate giving ventricles more time to fill

The most dangerous adverse effect of Digoxin is it's ability to create ________, particularly in patients
who have _______

Dysrhythmias

- hypokalemia

ACE inhibitors (-prils), ARBs (-sartan), Thiazide & looop diuretics increase the likelihood of ________
and it's level should be monitored when taking _______ with these meds.

hypokalemia

-digoxin

Cimetidine (tagamet) is for: ulcers

cyclosporine is an: immunosuppressant

Clonidine (catapress) is a alpha agonist and has what two adverse effects
dry mouth

drowsiness & sedation

Ca Channel Blockers adverse effects are related to __________ & the immediate-acting drugs can
cause _____ ________

vasodilation: headache, dizziness, edema, flushing

-reflex tachycardia

Metoclopramide (Reglan)

controls post-op NV

Ranitidine Hydrochloride (Zantac) is a __ ____ ______ and is used for _____ and _____

H2 receptor antagonist

-PUD and GERD by suppressing the secretion of gastric acid

-tidines and -prazole's lowers gastric pH which promotes bacteria in the stomach and _______ _______
so use cautiously in pts who are at high risk for ______

-respiratory tract

-pneumonia

-tidine: H2 receptor antagonist used for ulcers and GERD

-prazole. is the gastric acid lowering reversible?

PPI. Irreversible inhibiting of gastric acid

Don't take -prazoles with ____ and ____

antibiotics and digoxin

Aluminum hydroxide gel (amphojel), Milk of Mag, Sodium Bicarb are all

antacids
Aluminum and Calcium cause ______ while milk of mag causes _______

-constipation

- diarrhea

How many times does the patient take antacids?

7 times a day! it'll relieve their pain and heal the ulcer

Take any medications at least _ ___ b4 or after antacids

1 hour

Misoprostol: who used them & intended use

-ppl taking long-term NSAID therapy and pregnant women

-prevent ulcers and induce labor

examples of anti-emetics

-Ondansetron (zofran)

-Dexamethasone

- Prochlorperazine (Compazine)

- Dramamine prevents motion sickness

-phenergan

- metoclopradmie (reglan)

All anti-emetics should not be used with these 3 medications b/c they intensify anti-emetic side-
effects

opiods- intensify CNS depression

anti-HTNs

Anticholinergics

Anti-diarrheals

diphenoxylate (lomotil)

loperamide (Imodium)
Caffeine makes diarrhea worse or better?

worse

Metoclopramide (reglan) use and side effects

-anti-emetic

-extra pyramidal effects

-diarrhea

- sedation

Insulin moves __ into cells along with Glucose

K+

Can synthroid be given to a pregnant woman?

yes- its a pregnancy level A

Is PTU safe to use in pregnancy? What side effects are there for PTU

NO c/i b/c neonatal hypothyroidism can occur

- overmedication goes to hypothyroidism

-can increase anticoagulant effects

Estrogens can decrease the effectiveness of ______, an anticoagulant drug

warfarin

What medication class lower the effectiveness of birth control? (4)

-benzodiazepines/ phenobarbital

-phenytoin (dilantin)

- rifampin (TB drug)

-antibiotics
True/False: TSH at 2 micro units indicates good treatment of hypothyroidism

True

True/False: Photosensitivity and blurred vision are anti-cholinergic side effects?

True

What are signs of an "infusion reaction" with amphotericin B?

fever and chills

Antifungals are safe to use with Warfarin?

False; antifungals inhibit the degradation of warfarin

pancrelipase

for pancreative enzyme deficiency used every time they eat

Stevens-Johnson Syndrome=

dry,crusty rash and should be reported to the PCP

INR therapeutic range: what about mechanical heart valve patients?

2-3.

3.5-4.5

PTT therapeutic range

60-80

What is the only immunization given at birth?

Hepatitis B vaccine
It could take __ to __ months for a person on RA drugs to start to feel better

4 to 6 months

Anticholinergic effects

dry mouth

constipation

photophobia

blurred vision

Tachycardia

Bisphosphanates for osteoporosis should be taken with food or on an empty stomach?

Empty stomach

Benzos

PAM, LAM (Xanex, Valium, Ativan)

CNS depression, amnesia, paradoxal response

Withdrawl: anxiety, diaphoresis, insomnia, tremor, lhd

Do not use with glaucoma, res dep, and sleep apnea

taper over several weeks

Avoide CNS depressants

Buspirone

BuSpar

AE: dizziness, n, HA, lhd, agiation

do not use w/ MAOI +-14 days

Avoid erythomycin, ketoconazole, st johns wort, and grapefruit

Take with food

3-6 wks to work

do not have tolerance/ dependence/ withdrawl effects

SSRIs

Parozetine, Seteraline, Escitalopram, flutonetine

(zolof, lexapro, paxil)

AE: early effects: n/sweating, tremor, fatigue, drowzy-usually subside on their own

Late AE: sexual dysfxn, weight gain, GI bleed, hyponatremia, bruxism(teeth grinding), and
withdrawl(n/anxiety,tremors,sensory disturbances,malaise,unease)

WATCH FOR 2-72 hours

Serotonin syndrome: agitation, confusion, diffculty concentrating, hallucinatins, hyperflexia,

incoordination, fever, sweating- stops afer DC

AVOID MAOI, TCA, Alch - can cause SS

Can take with food.

Take in AM

Fluoxetine(Prozac)

SSRI

AE: early effects: n/sweating, tremor, fatigue, drowzy-usually subside on their own WEIGHT LOSS

Late AE: sexual dysfxn, WEIGHT GAIN, GI bleed, hyponatremia, bruxism(teeth grinding), and
withdrawl(n/anxiety,tremors,sensory disturbances,malaise,unease)

WATCH FOR 2-72 hours

Serotonin syndrome: agitation, confusion, difficulty concentrating, hallucinatins, hyperflexia,

incoordination, fever, sweating- stops afer DC

DO NOT TAKE WITH MAOI or TCAs

 1- A nurse is caring for a client diagnosed with sickle cell anemia who is
taking hydroxyurea. Which of the following findings should the nurse
report to the provider? (select all apply)

Hemoglobin 4.2 g/dL

Platelets 75,000/mm
Neutrophils 1,400/mm

A nurse is assessing a client who is experiencing cardiogenic shock and is

receiving a continuous IV infusion of dopamine. Which of the following
findings indicates the medication is effective?

Increased blood pressure

A nurse in the emergency department is caring for a client who has

myasthenia gravis and is in a cholinergic crisis. Which of the following
medications should the nurse plan to administer?
Atropine

A nurse is providing teaching to a client who has a new prescription for a

prefilled epinephrine injector. Which of the following should the nurse include
in the teaching?
Massage the site for 10 seconds after injection

A nurse is caring for a client who has a prescription for 5 mg of warfarin.

Which of the following findings should the nurse report to the provider prior
to administration
-INR of 5

A nurse is caring for a client who has a new diagnosis of diabetes insipidus
and is to start taking desmopressin. Which of the following should the nurse
monitor? (select all apply)
Urine specific gravity
Creatine clearance
Serum osmolality

A client is receiving chemotherapy and tells the nurse that she is trying to
get pregnant. Which of the following statements by the nurse is the highest
priority?
"There is a high risk of fetal malformations while on chemotherapy."

A nurse is caring for a client who is receiving treatment for opioid addiction.
Which of the following medications should the nurse expect to administer?
Methadone
A client has been prescribed furosemide. Which of the following findings
should indicate to the nurse to withhold the medication?
Potassium of 3.1 mEq/L

A nurse is providing teachings for a client who has hypercholesterolemia and

has a new prescription for rosuvastatin. Which of the following instructions
should the nurse include in the teachings?
"This medication can cause muscle pain or tenderness."

A client receiving end-of-life care has been prescribed fentanyl patches

topically every 72 hrs. Which of the following instructions regarding adverse
effects of fentanyl should the nurse plan to give to the client and family?
A stool softener should be taken on a daily basis.

A nurse is caring for a client who has cancer and has been receiving
pegfilgrastim. which of the following indicates the medication has been
effective?
Increased WBC count

A client is experiencing acute angle closure glaucoma and IV mannitol 25% is

prescribed. Which of the following client findings should the nurse recognize
as being the best indication that the medication is achieving its therapeutic
effect?
Decrease in intraocular pressure

A nurse is preparing to administer medication to a client who has gout. The

nurse discovers that an error was made during the previous shift and the
client received atenolol instead of allopurionol. Which of the following actions
should the nurse take first?
Obtain the client's blood pressure.

A nurse is reviewing the prescriptions of a client who has tuberculosis. The

nurse should recognize that which of the following medications is used to
treat TB? (select all apply)
Notify the primary care provider.
Rifampicin
Isoniazid

A nurse is caring for a client with chronic back pain who is receiving 650 mg
acetaminophen every 4 hr for pain. The primary care provider has prescribed
oxycodone/acetaminophen every 4 to 6 hr PRN for breakthrough pain. Which
of the following actions should the nurse take?
Notify the primary care provider

A nurse is caring for several clients that report allergies. Which of the
following client statements indicates a medication allergy?
"I cannot take celecoxib because of the rash I developed taking
rimethoprim/sufamethoxazole."

A nurse is planning teaching for a client who has depression and is to start a
new prescription for tranylcypromine. Which of the following should the
nurse include in the teaching?
Move slowly when changing to a standing position.

A nurse is taking a medication history form a client who has a new

prescription for lithium. Which of the following over-the-counter medications
should the client discontinue?
Ibuprofen

A nurse at an urgent care clinic is collection a history form a female client

who has a UTI. The nurse anticipates a prescription for ciprofloxacin. Which o
the following client statements indicates a contraindication for this
medication?
"I have tendonitis, so I haven't been able to exercise."

A nurse is caring for a client who is postoperative following a

cholecysterctomy and is prescribed cefazolin 1 g by intermittent IV bolus
Q6H. The amount available is 1 g in 100 mL 0.9% sodium chloride to be
delivered in 30 min. The drop factor on the package of IV tubing is 15 gtt/mL.
The nurse should set the IV to deliver how many gtt/min? (round to the
nearest whole number)
50

A nurse is preparing t administer 0.9% sodium chloride 1,500 mL to infuse

over 8 hr to a client who is postoperative. The nurse should set the IV pump
to deliver how many mL per hr? (round nearest whole number)
188

A nurse is providing teaching to a client who has diabetes mellitus and is

learning how to administer NPH insulin and regular insulin in a single syringe.
The nurse should instruct the client to take the following steps in which
order?

Insert air into the NPH insulin into the syringe.

Insert air into the regular insulin into the syringe.
Draw up the regular insulin into the syringe.
Draw up the NPH insulin into the syringe.

A nurse is caring for a school-age child prescribed methylphenidate for

ADHD. The nurse has initiated interventions to minimize adverse effects.
Which of the following findings indicates a successful intervention?
Maintains age-appropriate weight
A nurse is providing teaching for a client who has a new prescription for
spironolactone. The nurse should instruct the client that which of the
following is an adverse effect of this medication?
Lethargy

A client diagnosed with acute bronchitis is beginning a short course of

prednisone therapy. The client asks the nurse to give him the required
vaccinations because he is joining the Peace Corps. The nurse appropriately
responds by stating, "You should...
wait until you have completed your medication therapy before receiving the
vaccinations."

A client tells the nurse that he is allergic to penicillins. The nurse should
recognize that the client can have a hypersensitivity to which of the following
medications?
Cephalexin

A client informs the nurse at the primary care provider's office that he
received a prescription for timolol to treat glaucoma. Which of the following
in the client's history should concern the nurse?
The client has a history of bradycardia.

A nurse is providing teaching to a client who is to start taking sumatriptan.

For which of the following should the nurse instruct the client to monitor and
report to the provider?
Chest pain

A nurse is providing teaching about self-administration of transdermal

medication for a client who has a new prescription for nitroglycerin. Which of
the following statements made by the client indicates a need for additional
teaching?
"I will check my blood pressure before applying the patch."

A nurse is caring for a client who has heart failure and is prescribed enalapril
and spironolactone. For which of the following potential side effects should
the nurse plan to monitor?
Hyperkalemia

A nurse is providing discharge teaching for a client who developed a deep

vein thrombosis and has a new prescription for warfarin. Which of the
following should the nurse include in the teaching?
"Report stools that appear black to the provider."

A nurse is caring for a 20 year old female client who has been prescribed
isotretinoin for severe nodulocystic acne vulgaris. Before the client can
obtain a refill, the nurse should advise the client that which of the following
tests will be required?
Pregnancy test

A nurse is caring for a client who is prescribed diphenoxylate/atropine. For

which of the following adverse effects should the nurse monitor?
Abdominal distention

A nurse working in a provider's office is taking a health history from a client

who has been taking prednisone on a long-term basis for rheumatoid
arthritis. The nurse should assess the client for which of the following
adverse effects of this medication?
Edema

A nurse in the emergency department is caring for a client whose family

reports she has taken large amounts of diazepam. Which of the following
medications should the nurse anticipate administering?
Flumazenil

A nurse is caring for a client who has had a myocardial infarction and is
taking metoprolol. For which of the following should the nurse monitor?
Bilateral crackles in the lungs

A nurse is providing teaching to a client who has rheumatoid arthritis and is

prescribed methotrexate. Which of the following statements by the client
indicates an understanding of the teaching?
"I should call my doctor if I develop sores in my mouth."

A nurse is providing teaching to a client who is prescribed

trimethoprim/sulfamethoxazole. Which of the following instruction should the
nurse include in her teaching?
Drink 8 to 10 glasses of water daily.

A nurse is providing teaching to a client who has hypertension and is to start

a new prescription for lisinopril. For which of the following should the nurse
instruct the client to monitor and report to the provider?
Dry cough

A nurse is caring for a client who is taking atenolol. Which of the following
client reports indicates the medication is effective?
Decreased blood pressure

A client who has diabetes mellitus is receiving insulin lispro and is prescribed
metoprolol for hypertension. Which of the following should the nurse observe
for in the client as an early indicator of hypoglycemia?
Sweating
A client is prescribed amitriptyline. Which of the following adverse effects
should the nurse instruct the client to report?
Urinary retention

A nurse is assessing a client who is receiving morphine for pain via

secondary IV infusion. The nurse notes that the client's respirations are 8/min
and shallow. After stopping the morphine infusion, what should the nurse
plan to do next?
Administer naloxone

A nurse is caring for a client who is receiving oxytocin IV for a post-term

pregnancy. Which of the following findings indicates the oxytocin should be
discontinued?
Contractions lasting for 2 min each

A nurse is to administer a new prescription for amoxicillin/clavulanic acid to a

client. The client tells the nurse she is allergic to penicillin. Which of the
following actions should the nurse take first?
Withhold the medication

A nurse is teaching a client who has a prescription for pilocarpine eye drops.
Which of the following client statements should indicate to the nurse a need
for additional teaching?
"I will stop using the drops as soon as my vision improves."

A nurse is teaching a client about the use of risedronate for the treatment of
osteoporosis. Which of the following client statements indicates an
understanding of the teaching?
"I should sit up for 30 min after taking the risedronate."

A nurse is planning teaching for a client who is to start a new prescription for
captopril. Which of the following instructions should the nurse include?
Change position slowly

A nurse is caring for a client that has undergone a liver transplant and is
taking cyclosporine. Which of the following laboratory findings indicates an
adverse effect of the medication
Serum creatinine 2.5 mg/dl

A nurse is obtaining the medication history of a client who is starting a new

prescription for allopurinol. Which of the following medications should the
nurse contact the provider regarding a potential interaction?
Warfarin
A nurse is caring for a client receiving zidovudine. For which of the following
laboratory results should the nurse plan to monitor?
Hemoglobin

A nurse is precepting a newly licensed nurse who is caring for four clients.
Which of the following actions should be noted in an incident report? The
nurse administers
Isosorbide mononitrate to a client who has blood pressure 82/60 mm Hg

A nurse is caring for a child who has cystitis. The following order has been
prescribed. Ciprofloxacin Elixir 15 mg/kg PO q 12 hr x 10 days. The client
weighs 44 lb. How many mg should the nurse administer per dose? (round to
nearest whole number)
300
A nurse in an oncology clinic is reviewing the laboratory values of a client
who is receiving chemotherapy for lung cancer and is taking epoetin alfa.
Which of the following laboratory tests is used to determine the effectiveness
of the medication?
Hemoglobin

A client who is postoperative has received 2 mg of hydromorphone IV bolus

every 2 hrs. The client continues to rate his pain at a 7 on a scale of 0 to 10.
Which of the following client findings should the nurse attend to first?
Hypotension

A nurse is assessing an older adult client who has Alzheimer's disease who is
nonverbal and has experienced frequent falls. To determine whether the
client is in pain, the nurse should....
observe the client for behavioral effects of pain.

A nurse is collecting a history from a client who is scheduled for an

intravenous pyelography. Which of the following food allergies places the
client at risk for an allergic reaction to the contrast medium?
Shrimp

An older adult client who has an infection is prescribed gentamicin. which of

the following client statements indicates a side effect of the medication and
should be reported to the provider immediately?
"I have to turn the volume up on the TV to hear it."

A nurse is caring for client who has been treated for diarrhea and has a
prescription for Lactbacillus acidophilus. The nurse should understand that
the purpose of this medication is which of the following?
Recolonizes the intestinal flora

ACE Inhibitor; hyperkalemia; cough; 1 hr before meals; ANGIOEDEMA

-Captopril

Slows calcium influx into smooth muscle = arterial dilation and low BP; avoid
grapefruit juice
-Calcium Channel Blocker

Constipation, reflex tachycardia, peripheral edema, toxicity

-CA Channel Blocker Adverse Effects

Used for A. Fib.; A. Flutter; SVT

-Verapamil/Dilitiazem

PRAZOSIN AND DOXAZOSIN MESYLATE peripheral arterial and venous dilation

& decreased BP
-Alpha Adrenergic Blockers (sympatholytics)

Take at bedtime; No NSAIDs

-Sympatholytics

Calcium Channel Blockers

-Nifedipine, Verapamil, Dilitiazem, Amlodipine

Centrally acting alpha 2 agonists; reduce peripheral vascular resistance,

heart rate and BP
-Clonidine (Catapress); Methyldopa (Aldomet)

Dry mouth, drowsiness/sedation, rebound hypertension, LEUKOPENIA, black

or sore tongue
-Centrally acting alpha 2 agonists adverse effects

Monitor CBC, HR, BP, Never skip a dose, take at bedtime, monitor for
rebound hypertension.
-Nursing Interventions (Clonidine, Methyldopa)
*Do not use in pts. on MAOIs, anticoagulant therapy and hepatic failure

ON CARDIAC and KIDNEY; decrease myocardial output, excitability, oxygen

demand and decrease release of renin in kidney (low BP)
-Beta Blockers

?metoprolol (lopressor), atenolol (tenorman) and metoprolol succinate (toprol

XL)
-Cardioselective beta blocker (beta 1)

Propranolol (inderal), labetalol (normodyne)

Nonselective beta blocker (beta 1 and 2)
Beta blocker adverse affects
-bradycardia, nasal stuffiness, AV block, BRONCHOSPASM; mask effects of
hypoglycemia

Beta blocker nursing interventions

xHold if sys. <100 or HR <60
xMonitor diabetics for signs of hypoglycemia

Vasodilators
Nitroglycerin; hydralazine; nitroprusside and enalaprit
*rapid reduction of BP

Vasodilator side effects

HEADACHE; cyanide toxicity; dizziness and profound hypotension

Vasodilator nursing interventions

Continuous ECG and BP monitoring; discard unused fluid after 24hr.; DO NOT
MIX nitroprusside

Digoxin action
improve stroke volume and cardiac output, slowed conduction rate =
increased ventricular filling

Statin Adverse Effects

Hepatotoxicity and Myopathy

Statins
GIVE IN EVENING; monitor liver and kidney functioning
Statin Drug Interactions
AVOID GRAPEFRUIT JUICE (no more than 1qt/day)
Erythromycin and Ketaconazole increase levels of statins
Gemfibrozil, Fenofibrate, and Ezetimibe (Zetia) increase myopathy

Normal PTT Time

40-75 seconds

Normal Platelet Count

150,000-400,000

How to give ophthalmic ointment

Discard first bead of ointment each administration

How to prepare Dilantin suspension

Shake container vigorously
Therapeutic Effect of Dramamine (dimenhydrinate)
ANTIEMETIC used for motion sickness

Micro tubing (gtt/min)

60 gtt/min

Sublingual Nitroglycerin Administration

Administer tablet, recheck pain in 5 minutes, if pain remains administer
another tablet
(can administer up to 3 tablets)

Therapeutic Effect of of H2-Blocker Therapy

Relief of heartburn, indigestion and sour stomach

H2- Recepter Blocker Action

Suppress secretion of gastric acid in ppl with gastric/peptic ulcers and GERD

Cimetidine Adverse Effects

Decreased libido, impotence and CNS effects (lethargy, depression and
confusion)
ACE INHIBITORS Pt. Teaching
Avoid salt substitutes

NPH Peak Time

4-12 hours after administration

Rapid Acting insulin Peak Time

30min - 1 hour

Short Acting Insulin Peak Time

2hr-3hr

NPH Duration
18-24hr

Therapeutic effect of Albuterol (Proventil)

prevents wheezing, opens airways, decreases coughing episodes

Adverse effects of Albuterol

tachycardia, angina and tremors

How to administer beta2 agonist and a glucocorticoid

Inhale beta2 agonist before inhaling the glucocorticoid

Albuterol
short acting beta2 agonist
Formoterol and Salmeterol
Inhaled long acting beta2 agonist

Terbutaline
Oral long acting beta2 agonist (long term control of asthma)

Theophylline therapeutic effect

relaxation of bronchial smooth muscle (bronchodilation)

Colace (Docusate) therapeutic effect

regular bowel movements (1-2 soft stools per day)

Blood product administration

verify clients ID number, blood group and type, blood unit number

Levothyroxine overdose signs and symptoms

Insomnia, diarrhea and hyperactive DTRs
Tamoxifen (Nolvadex) Adverse Effects
Pulmonary embolus, hot flushes, vaginal discharge or bleeding,
hypercalcemia, endometrial cancer

Tamoxifen pt. teaching

call the doctor if you notice any unusual menstrual bleeding

Beclomethasone adverse effects

oropharyngeal candidiasis (white patches in mouth or throat)

Therapeutic effects of Hydroxyzine (Vistaril)

ANTIHISTAMINE controls emesis, diminishes anxiety, reduces amount of
narcotics needed for pain relief and drys secretions

Therapeutic effect of Liothyronine (Cytomel)

Used to treat hypothyroidism; mood improvement, weight loss, increased
appetite, increased body temperature

Expected side effects for oral Erythromycin

diarrhea, epigastric pain, nausea and vomiting

Lithium pt. teaching

expect control of manic symptoms 7-10 days after starting lithium therapy

Lithium therapeutic dose

300 mg TID

Docusate administration
take with 8 ounces of water

Fab Antibody Fragments (Digibind)

Used to treat digoxin toxicity

Flumazenil
treats benzodiazepine toxicity/ overdose

Acute alcohol withdrawal delirium

treated with lorazepam (Ativan)

Therapeutic use of pancuronium (Pavulon)

induce paralysis and suppress respiratory effort in mechanically ventilated
pt.

Contraindications of warfarin therapy

pregnant client b/c it can cross the placenta
Calcium carbonate (antacid) administration
take medication with water

Correct administration of biscacodyl (Dulcolax) suppository

Lubricate index finger, LEFT lateral position, don gloves, and insert
suppository just beyond the internal sphincter

Gingko balboa drug interaction

proton pump inhibitors

St. Johns Wort drug interaction

decreases effectiveness of oral contraceptives

Black Cohosh drug interaction

fertility medications

Ginseng drug interaction

antidiabetic medications (increase hypoglycemia)

Aspirin contraindications
client w/ hemmorhagic stroke

Rifampin pt. teaching

urine and other secretions will turn orange
take 1 hour before or 2 hr after meals
may cause fatigue and drowsiness

Methotrexate drug administration

take on empty stomach; drink 2-3L of water per day to promote excretion;
DO NOT take with NSAIDs

Methotrexate Adverse Effects

Renal toxicity and drowsiness

Aspirin Adverse Effects

Bleeding, tinnitus, gastric ulceration, nausea and heartburn

Serious Adverse Reaction of Ifosfamide (Ifex)

painful urination and hematuria r/t hemorrhagic cystitis

Enoxaparin (Lovenox)
Low molecular weight heparin that does not require monitoring

Packed Red Blood Cell Administration

Administer PRBCs with 0.9% soda chloride to decrease risk for clotting and
hemolysis

Ginger root drug interaction

Warfarin (increases risk for bleeding)

Pt. teaching for baclofen (Lioresal) therapy

Avoid driving until drug effects are evident; take with milk or meals; may
cause constipation

Fluoxetine (Prozac) administration

take first thing in the morning to prevent insomnia; take with or without food

Reversal agent for Butorphanol

Naloxone

Digoxin administration
measure clients apical pulse

Digoxin toxicity
can be caused by HYPOKALEMIA; halos around objects

Adverse Reactions to Nalbuphine (Nubain)

Blurred vision, urinary urgency, headache and abdominal cramps

Nitroglycerin administration
take at first indication of chest pain

Transdermal Nitroglycerin administration

apply patch in the morning; leave on for minimum of 12hr; apply close to
chest area; if patch becomes loose or falls off put another one on a different
site; apply a new patch daily

Warfarin is incompatible with...

Multivitamins

Suppository insertion positioning

Sims position

Diphenhydramine side effects

sedation

Amphotericin B Adverse Effects

Renal toxicity

BUN lab value

10-20
Creatinine lab value
0.6-1.2 mg/dL

Pt. teaching for methotrexate

do not drink alcoholic beverages; report unexplained bruising to the provider;
avoid people who have infections; may take 4-6 weeks to see effects; take
folic acid to minimize effects

Glipizide (Glucotrol) method of action

stimulates pancreas to release adequate insulin

Nurse is caring for client who reports daily use of acetaminophen to manage
mild knee pain. Which of the following statements by the client should be of
most concern to the nurse
"I take three or four Vicodin ES tablets a day for severe knee and joint pain"
(risk for toxicity)

Adverse effect of rapid discontinuation of Prednisone

adrenocortical insufficiency

Oral medication administration to infant

position infant in semi upright position to decrease risk of aspiration; wrap
infant in blanket; administer medication with an oral syringe; insert
medication in buccal cavity

A nurse is monitoring a client receiving parenteral lipid infusion. Which of the

following findings is the HIGHEST priority to report to the provider
elevated temperature because this indicates allergic response or fat overload
syndrome

Appropriate infusion rate for PRBC administration

5ml/min during first 15 minutes to decrease risk for adverse reaction

Lactulose
used to reduce serum ammonia levels

Pt. teaching for Warfarin

use electric razor for shaving; avoid aspirin and alcohol

Contraindication to aspirin therapy

history gastric ulcers

Instilling ear drops in child

Pull auricle down and back

Allopurinol pt. teaching

drink at least 3 quarts of water a day; report rash to provider immediately;
take after meals; report fever to provider

Action of Expectorants
Treats cough by stimulating secretions

Alprazolam (Xanax)
CNS Depressant; can cause sedation, dizziness, lightheadedness and can
contribute to falls

Heparin Overdose Remedy

Protamine Sulfate

A nurse is caring for a client. The client states, "I don't want to take my
medication." What action should the nurse take?
Document that the client refuses the medication (DO NOT ASK WHY)

Manifestations of digoxin toxicity

Anorexia, vomiting, confusion, headache, and vision changes

Administration of timolol (Timoptic)

Drop medication into the conjunctival sac

Ibuprofen administration
Take with or immediately after meal to prevent gastric irritation
Therapeutic use of bethanechol (Urecholine)
stimulates urination in patient with the inability to void

Spironolactone (Aldactone)
Potassium sparing diuretic that can cause HYPERKALEMIA and
HYPONATREMIA

A nurse is preparing to administer prednisone (Deltasone) to a client for the

treatment of rheumatoid arthritis. Which of the following indicates effective
therapy?
improved range of motion (reduction in pain and inflammation)

Adverse Effects of Prednisone

Elevated blood glucose, increased blood pressure, alteration in memory
(chronic use); EDEMA r/t sodium and fluid retention

Beta blocker therapy

monitor patient orthostatic blood pressure
A nurse is caring for a client who has a diagnosis of diabetes mellitus and
hypertension and recently began taking Propranolol. When the client reports
dizziness upon standing the nurse should perform which of the following
actions?
Monitor blood pressure lying, sitting and standing

Diphenhydramine (Benadryl) administration

take most of daily dose at bedtime to minimize daytime sedation

A nurse is to administer subcutaneous short-acting insulin combined with

long-acting insulin to the client before he eats breakfast at 8:00 AM. What
should the nurse do?
Give the insulin at 7:30AM after checking the blood glucose level results

Sucralfate
Most effective when administered with little or no water

A nurse is caring for client taking Prednisone and has developed an infection.
Nurse should expect the provider will:
Increase the dosage of prednisone to prevent adrenal insufficiency b/c stress
increases need for glucocorticoids

A nurse is talking with a client about to start taking colestipol (bile acid
sequestrant) to lower LDL level. It comes in powder or tablet form. The nurse
should inform the patient that if he chooses the tablets:
he will have to take up to 30 tablets per day b/c each tablet contains about 1
g of medication and the therapeutic dosage range is 15-30g/day
Gentamicin cream administration
wash area with soap and water before applying cream; cover area with
sterile gauze after applying medication; DO NOT apply cream to large areas
to avoid toxicity

Expected finding in pt. taking pancreatic enzymes

decreased fat in stools

Ceftriaxone administration to older adult client

locate vastus lateralis injection site (administer in large muscle)

Order of Mixing NPH and Regular Insulin

Inspect vials for contaminants; roll NPH vial between palms of hands; inject
air into NPH insulin vial; inject air into regular insulin vial; withdraw short
acting insulin into syringe; add intermediate insulin to syringe

Blood samples for peak and trough levels for IV gentamycin should be
drawn...
immediately prior to and 30-60 minutes after the next dose

Ciprofloxacin pt. teaching

take on empty stomach w/ full glass of water; drink at least 1-2 quarts of
fluid each day while taking cipro; may cause photosensitivity (wear
protective clothing)

Phenylephrine hydrochloride (AK-Dilate)

used to widely dilate the pupils esp. in preoperative optic pts.

Pilocarpine (Pilocar) therapeutic use

used to great glaucoma

Timolol maleate (Timoptic) therapeutic use

used to treat glaucoma

How to inject heparin into the deep subcutaneous route.

Inject medication into the abdomen above the level of the iliac crest at least
2 inches from the umbilicus; 25-26 gauge needle; 1/2-5/8 inch needle; apply
firm pressure for 1-2 minutes after injection without massage

What to evaluate before administering Digoxin

evaluate client for nausea, vomiting and anorexia (may be signs of digoxin
toxicity)

Pt. teaching for insulin therapy

keep open vial of insulin at room temperature; inject subq; DO NOT ASPIRATE
Clozapine (Clozaril) adverse effects
fatigue, seizures and orthostatic hypotension

Clozapine therapeutic use

treatment of psychotic findings such as auditory hallucinations

Dantrolene pt. teaching

apply sunscreen when going outside (causes photosensitivity); take
medication daily NOT prn; may take a week + to notice improvement in
symptoms but muscle strength may decline

Furosemide pt. teaching

eat food w/ plenty of potassium; avoid Aspirin and NSAIDs; take Tylenol
instead

Adverse effects of Zileuton (Zyflo)

conjunctivitis, ABDOMINAL PAIN, jaundice (hepatotoxicity), constipation and
headache

Client taking oral contraceptive reports that she forgot to take one pill. What
instruction should be given?
Take the missed dose along with the next dose

Tardive dyskinesia
persistent following discontinuation of an antipsychotic

Tardive dyskinesia S&S

jerky choreiform movements; lip smacking; neck and back tonic contractions

Pseudoparkinsonism
temporary manifestation usually disappearing after discontinuation of
medication

Therapeutic effect of dopamine

peripheral vasoconstriction and increased systolic blood pressure; lower
pulmonary capillary wedge pressure

Theophylline adverse effects

tachycardia, urinary frequency, diarrhea and insomnia

Adverse effect of calcium supplements

renal stones (increase water intake; report any blood in urine or flank pain)

Adverse effect of Doxorubicin (Adriamycin)

irreversible cardiomyopathy
Contraindication for receiving live attenuated influenza vaccine
just turned 62 (must be between 2-49 yo); pregnancy and
immunocompromised

Indication of toxic reaction to hydroxychloroquine (Plaquenil)

decreased visual acuity (retinopathy); headache; hematologic effects;
abdominal cramps

Methods to decrease dry mouth associated with Benadryl therapy

chew on sugarless gum or suck on hard, sour candies

Universal blood recipient

AB

Universal blood donor

O

Side effect of aluminum based antacids

chalky taste and constipation

Ipratropium bromide (Atrovent)

could increase intraocular pressure (monitor in pts. with glaucoma) VISUAL
CHANGES should be reported

Heparin pt. teaching

Heparin does not dissolve clots; it stops new clots from forming

Medication used for client with prostate cancer

Leuprolide (Lupron)

Cyclophosphamide (Cytoxan) use

leukemia, multiple myeloma, lymphomas, head, ovary, great and lung cancer

Finasteride (Proscar) use

benign prostatic hypertrophy

Tamoxifen (Nolvadex) use

breast cancer

z track technique
aspirate for 5-10 seconds; insert at 90 degree angle; insert needle quickly
and smoothly; pull skin 1 inch to the side

Pt. teaching for chlorpropamide (Diabinese)

avoid alcohol consumption while taking this medication to prevent disulfram
reaction

Pt. teaching for Bumetanide (Bumex)

(high ceiling loop diuretic); can cause ototoxicity report changes in hearing

High ceiling loop diuretics

can cause ototoxicity

Nurse caring for patient taking naproxen; which comments by the client
requires further discussion by the nurse
NSAIDS like Naprosyn can cause serious adverse GI reactions such as
bleeding, ulceration and perforations. Warning manifestations such as N/V; GI
burning and blood in still should be reported by the client and require further
investigation

Findings associated with phlebitis

erythema, throbbing, warmth at injection site and streak formation

Pt. teaching on ferrous iron administration

administer with fruit juice and NOT with milk, meals or yogurt

Early sign of circulatory overload

dyspnea

S&S of circulatory overload

dyspnea, cough, rales, tachycardia and JVD

Adverse effect of cyclophosphamide therapy

bone marrow suppression (report sore throat, fever or chills immediately)

Risk for lithium toxicity

hyponatremia

Primary action of spironolactone

increase sodium excretion (spare potassium)

Adverse effects of alendronate (Fosamax)

(used to read osteoporosis)
jaw pain, blurred vision and dysphagia

Pt. teaching for nitroglycerin sublingual tablets

dial 911 if one tablet does not relieve pain and then take up to 2 more 5 min.
apart while waiting
Severe adverse effect of zidovudine
Aplastic anemia

Headache after nitroglycerin therapy...

is expected

Controlled substance guidelines

count each dose of narcotic in inventory, match number of available doses to
record and sign acceptance of narcotic count if correct

Prophylactic anticoagulant therapy in pt. w/ hip fracture

use heparin

Phenytoin medication administraiton

administer a saline solution after injection

Phenytoin adverse effects

Rash -> SJS (report skin rash to provider immediately)

Montelukast (Singulair) pt. teaching

take this medication once a day in the evening

Lantus teaching
Lantus is not used on a sliding scale in diabetics
Colchicine (Colsalide) use
decrease joint inflammation

Action with expired medication

return the medication to the pharmacy

Priority intervention for client with Wernicke's encephalopathy

administration of thiamine (Vitamin B1)

Cimetidine pt. teaching

do not take this medication if you start taking blood thinning medications

Feverfew herb contraindication

pregnancy

Therapeutic use of cyclobenzaprine (Flexeril)

relieve muscle spasms

Therapeutic effect of Levothyroxine (Synthroid)

decreased TSH

Appropriate references to ensure safe medication administration

-published journals, pharmacists, Physicians Desk Reference

Disulfiram (Antabuse)
Aversion therapy to help maintain abstinence from alcohol. Therapy must not
begin until client has abstained for alcohol for at least 12 hr and preferably
for 48 hr

Gentamicin Adverse Effects

Ototoxicity

Sumatriptan therapeutic use

SELECTIVE SEROTONIN RECEPTOR used to treat migraine headaches

Sumatriptan adverse effects

chest pain secondary to coronary vasospasm resulting in angina

Zidovudine adverse effects

severe anemia; nurses should monitor patient hemoglobin levels

Nitroglycerin transdermal patch pt. teaching

Call the doctor if you experience a headache; apply patch to area that is free
of hair; rotate location of patch; check BP 1 hour after applying the patch

TB medications
rifampicin and isoniazid

Mirtazapine therapeutic use

depression

Temazepam therapeutic use

insomnia

Infliximab therapeutic use

severe Chron's disease and arthritis

Epinephrine auto injector pt. teaching

administer IM; store @ room temp. in dark area; should only need one
injection; massage site for 10 seconds after injection

Trimethoprim/sulfamethoxazole (Bactrim) pt. teaching

increase water intake to 8-10 glasses daily in order to decrease the chance of
renal damage from crystalluria

Findings to report in client taking hydroxyurea

Hemoglobin 4.2 g/dL
Platelets 75,000/ mm3
Neutrophils 1,400/ mm3

Hydroxyurea therapeutic use

sickle cell anemia

Timolol precautions
client with history of bradycardia

Ciprofloxacin contraindication
tendonitis r/t risk for tendon rupture

Methylphenidate adverse effects

hypertension, linear growth suppression and appetite suppression (weight
loss)

Methylphenidate therapeutic effects

decreased activity and increased attention span

Methylphenidate therapeutic use

ADHD

Diphenoxylate/atropine adverse effects

abdominal distention and dry mouth

Cross sensitivity for penicillins

cephalosporins (cephalexin)

APTT - 60-80
Hemoglobin - 12-16
Hematocrit - 35-45

Oprelvekin
Thrombopoietic factor

Digoxin therapeutic levels

0.8-2.0

Amitriptyline adverse effects

anticholinergic effects such as urinary retention

Pegfilgastim therapeutic effect

increased WBC count
Amoxicillin/Clavulanic acid contraindications
patient with penicillin allergy

Things to monitor in patient taking Desmopressin

Urine specific gravity; creatinine clearance; serum osmolality

Tranylcypromine pt. teaching

MAOIs; causes orthostatic hypotension

Tranylcypromine therapeutic use

depression

Methadone therapeutic use

opioid addiction

Fentanyl
opioid analgesic

Fentanyl adverse effects

urinary retention, constipation, respiratory depression, orthostatic
hypotension and cough suppression

Beta blockers adverse cardiac effect

heart failure (decreased cardiac output) monitor for bilateral lung crackles

Lithium drug interaction

do not use with NSAIDS (ibuprofen, indomethacin)

therapeutic INR value

2-3

Oxytocin discontinuation criteria

contractions longer than 60 seconds; 50mmHg or greater; more often than 2-
3 minutes;
elevated uterine resting tone (over 15-20)

Spironolactone adverse effect

lethargy

High ceiling loop diuretic adverse effect

ototoxicity/tinnitus !!!

Methotrexate patient teaching

call doctor if you develop sores in mouth; may take 3-6 weeks to work;
should be taken weekly and not daily; may cause drowsiness
Isotretinoin pt. teaching
medication is teratogenic; pt. should receive pregnancy tests before
receiving refills for medication

Dopamine therapeutic use

cariogenic shock

Dopamine therapeutic effect

increased blood pressure

Isosorbide mononitrate adverse effect

hypotension

Mannitol therapeutic use

decrease intraocular pressure

Cyclosporine adverse effect

nephrotoxicity (monitor for elevated serum creatinine)

Allopurinol drug interaction

warfarin (increased risk for bleeding)
Risedronate pt. teaching
"rise after taking" sit up for 30 minutes after taking the medication to avoid
esophagitis and dyspepsia

Cholinergic crisis reversal agent

ATROPINE

Early indicator of hypoglycemia

sweating; tachycardia (may be masked by beta blocker)

_________ refers to how medications travel through the body.

pharmacokinestics

______ is the transmission of medications from the location of administration

(GI tract, muscle, skin, or subcutaneous tissue) to the bloodstream.
absorption

The most common routes of administration are _____ (____ ____) and _____ (by
______).
enteral, GI tract, parenteral, injection

The rate of medication absorption determines how _____ the medication will
take effect.
Soon
The amount of medication absorbed determines its ______.
intensity

The route of administration affects the _____ and _____ of absorption.

rate, amount

Through the ____ route, medications must pass through the layer of epithelial
cells that line the GI tract.
oral

Through the oral route, medications must pass through the layer of ______
cells that line the ____ tract.
epithelial, GI

_______/_______ medications are absorbed quickly systemically through highly

vascular mucous membrane.
sublingual/buccal

If sublingual/buccal medications are swallowed before being dissolved, _____

_____ may inactivate medication.
gastric pH
Rectal and vaginal suppositories can be easily absorbed with both ______ and
_______ effects.
local, systemic

Medications that are _____ are rapidly absorbed through the alveolar capillary
network.
inhaled

Inhalation of medications are rapidly absorbed through _____ ______ network.

alveolar capillary

With ______/______ medications, absorption is slow and gradual. The effects

are primarily local, but systemic as well, especially with lipid soluble
medications passing through subcutaneous fatty tissue.
intradermal/topical

Absorption with intradermal/tropical medication is _____ and _____. The

effects are primarily _____, but _____ as well, especially with lipid soluble
medications passing through subcutaneous fatty tissue.
slow, gradual, local, systemic

The rate of absorption in_______ and ______ medications is determined by the

solubility of medication in water and blood perfusion at the site of injection.
subcutaneous, intramuscular
The rate of absorption in subcutaneous and intramuscular medications is
determined by the _____ of medication in water and _____ _____ at the site of
injection.
solubility, blood perfusion

In subcutaneous and intramuscular medications, highly soluble medications

will be absorbed in ___-___ min. Sites with high blood perfusion at the site of
injection will have ______ absorption, while sites with low blood perfusion will
have _____ absorption.
10-30, rapid, slow

_______ medications will have immediate and complete absorption.

intravenous

Intravenous medications will have ______ and ______ absorption.

immediate, complete

When two medications can compete for the same binding sites, it can result
in either _____ or ______ ________.
toxicity, decreased bioavailability

Medications that are _____ soluble or have a ______ system can cross the
blood-brain barrier or the placenta.
lipid, transport

________ (or _______) changes medications into less active or inactive forms
by the action of enzymes. This occurs primarily in the ______, but also takes
place in the ____, lungs, bowels, and _____.
metabolism, bioavailability, liver, kidneys, blood

The ______ process can also influence medication metabolism but it varies by
individual.
aging

In general, ______ medication metabolism tends to decline with age.

hepatic

The ____-____ effect occurs with some oral medications are inactivated on
their first pass through the liver and may require a higher dose to achieve a
therapeutic effect, or must be given by a nonenteral route.
first-pass

The _______ ______ pathway is when two medications are metabolized by the
same pathway, they can interfere with the metabolism of one or both of the
medications.
similar metabolic
A malnourished client may be deficient in the factors that are necessary to
produce specific ______-______ enzymes. Consequently, _____ ______ may be
impaired.
medication-metabolizing, medication metabolism

_______ is the elimination of medications from the body primarily through the
kidneys. It can also take place through the liver, lungs, bowel, and exocrine
glands.
excretion

A ____-____ (___) refers to the period of time needed for the medication to be
reduced by 50% in the body.
half-life, t1/2

A half-life (t1/2) refers to the period of time needed for the ______ to be
reduced by ____% in the body.
medication, 50

It usually takes ____ half-lives to achieve a steady state of _____

concentration (medication intake = medication _______ & _______).
4, serum, metabolism, excretion

An _______ is a medication that can block normal receptor activity regulated

by endogenous compounds.
antagonist

An _______ is a medication that can block normal receptor activity regulated

by endogenous compounds or receptor activity caused by other medications.
antagonist

When administering oral or enteral medications, make sure that the PT has
an ______ stomach, __ hour(s) before meals and ___ hour(s) after meals.
empty, 1, 2

When giving sublingual medication, the PT shouldn't ____ or _____ while the
tablet is in place.
eat, drink

When administering transdermal medication, place patch on a ______ area of

the skin, and _____ sites to prevent skin irritation. Verify removal of _____
_____ before applying new one.
hairless, rotate, previous patch
When administering eye medication, hold the dropper about __-__ cm above
______ ____ and drop medication into the center. Then have the PT close their
eye _____.
1-2, conjunctival sac, gently

When administering ear medication, hold the dropper about ___ cm above
ear.
1

When administering nose medication, hold the dropper about ___ cm above
nose. Afterwards, advise PT not to blow their nose for ___ min.
1.5, 5

When administering nasogastric or gastronomy tube medication, do not mix

it with _____ _____. To prevent clogging, flush the tubing _____ and ____ each
medication with ___ mL of warm sterile water. When the administration of
meds. is complete, flush with ___ mL of warm sterile water.
enteral feedings, before, after, 15, 15

When administering rectal suppositories, position the PT in ____ _____ position

and insert just beyond the ____ ___. Instruct the client to retain the
medication __-__ min for stimulation of defecation and __ min for stimulation
absorption.
left lateral, internal sphincter, 20-30, 60

When administering vaginal suppositories, position the PT in the ____ _____

position and insert using an _____.
modified lithotomy, applicator

A MDI in inhalation med. administration stands for...

metered dose inhaler

When using a MDI, instruct the client to shake the inhaler __-__ times, and to
hold it approx. __-__ cm away from front of mouth. The PT should take a slow
inhalation breath that lasts about __-__ sec. while pressing down on the
inhaler. After inhaling, they should hold their breath for __ sec.
5-6, 2-4, 3-5, 10

A DPI in inhalation med. administration stands for...

dry powdered inhaler

When using a DPI, instruct the PT ___ to shake the inhaler. The PT should take
a _____ inhalation breath while pressing down on the inhaler. After inhaling,
they should hold their breath for __-__ sec. Rinse the inhaler, cap, and spacer
___ per day and dry completely.
not, slow, 5-10, once

A ______ name is the official or nonproprietary name that is given to a

medication.
generic

A ____ name is the brand or proprietary name given by the company that
manufactures the medication.
trade

_______ substances require monitoring by a provider, but do not pose risk of

abuse and/or addiction (e.g. antibiotics).
uncontrolled

_______ substances have a potential for abuse and dependence, and are
categorized into schedules I-IV. Schedule I has ___ medical use while
schedules II-IV have approved _____. Each level has a(n) _____ risk of abuse
and dependence.
controlled, no, applications, decreasing

A medication ______ is how a medication may be organized according to

therapeutic effect, pharmacological action, body system, chemical makeup,
and safe use during pregnancy.
classification

A _____ _____ ____ is how the medication produces the desired therapeutic
effect.
mechanisms of action

The _____ _____ is the preferred and expected effect for which the medication
is administered to a specific PT.
therapeutic effect
_____ ______ are usually expected and inevitable outcomes when a
medication is given at a therapeutic dose.
side effects

The _____ _____ is an undesired, inadvertent, and unexpected dangerous

effects of the medication on the body.
adverse effect

_____ ______ are when medications have specific risks and manifestations of
toxicity.
toxic effects

______ _______ occur when medications interact with each other resulting in
desired or undesired effects.
medication interactions

______/______ occur when medications may be contraindicated for a PT who

has a specific disease or condition.
precautions/ contraindications

A ______ prescription is given only once and it is given immediately.

stat

PRN stands for ____ ____.

as needed

What are the 6 rights of safe medication administration?

right PT, right medication, right dose, right time, right route, right
documentation

Doses are usually one to two _____ or one single-dose ____.

tablets, vial

A nurse is reviewing a PT's health record and notes a new prescription by the
provider for lisinopril (Zestril) 10mg PO every day. The nurse should
recognize this as what type of prescription?
routine prescription

In CNS adverse effects, if CNS stimulation is to be expected, PTs may be at

risk for ______.
seizures

In CNS adverse effects, if CNS depression is likely, advise the PT not to ____
or participate in other activities that can be _____.
drive, dangerous

Extrapyramidal symptoms (EPS), which are abnormal body movements, are

more often associated with medications affecting the _____.
CNS

Anticholinergic effects are effects that are a result of _____ _____ blockade.
Most effects are seen in the eyes, ____ muscle, ____ glands, and the _____.
muscarinic receptor, smooth, exocrine, heart

Antihypertensive medications can cause _____ _____.

orthostatic hypotension

Bone marrow depression/suppression is generally associated with _____

medications, and hemorrhagic disorders with _______ and _____.
anticancer, anticoagulants, thrombolytics
Nephrotoxicity may occur with a number of medications, but it is primarily
the result of certain _____ agents, and _____.
antimicrobial, NSAIDs

______ reactions is a life-threatening, immediate allergic reaction that causes

respiratory distress, severe bronchospasm, and cardiovascular collapse. It
can be treated with _____, _____, and ____.
anaphylactic, epinephrine, bronchdilators, antihistamines

Vitamin K decreases the therapeutic effects of ____ (____) and places the PT s
at risk from developing ____ ___.
warfarin, Coumadin, blood clots

A nurse is reviewing a PT's health record and notes that the PT experiences
permanent extrapyramidal effects caused by a previous medication. The
nurse recognizes that the medication affects the PT's _____.
CNS

A nurse is caring for a PT who is taking oral oxycodone (Percolone). The PT

also states that is is taking ibuprofen (Advil) in three recommended doses
daily. The interactions between these two medications will cause...
an increase in the expected therapeutic effect of both medications

Reduced responsiveness to a medication administered over time to a client is

termed _____ ____.
pharmacodynamic tolerance

A term used to describe positive medication effects influenced by

psychological factors is the _____ ____.
placebo effect

______ causes oral medications to pass too quickly through the GI tract to be
absorbed.
Diarrhea

Pediatric dosages are based on ____ or ____ _____ __, though some are based
on _____ due to a greater risk for decreased skeletal bone growth.
weight, body surface area, age

Therapeutic Drug Levels: Aminophylline - 10 to 20 mcg/ml

Toxic Level: greater than 20 mcg/ml

Therapeutic Drug Levels: Carbamazepine - 5 to 12 mcg/ml

Therapeutic Drug Levels: Digoxin - 0.8 to 2.0 ng/ml

Toxic Level: greater than 3.4 ng/ml

Therapeutic Drug Levels: Gentamicin - 0.5 to 0.8 ng/ml

Therapeutic Drug Levels: Lidocaine - 1.5 to 5.0 mcg/ml

Toxic Level: greater than 5 mcg/ml

Therapeutic Drug Levels: Lithium - 0.4 to 1.0 mEq/L

Toxic Level: greater than 2.0 mEq/L

Therapeutic Drug Levels: Magnesium Sulfate - 4 to 8 mg/dL

Toxic Level: greater than 9 mg/dL

Therapeutic Drug Levels: Phenobarbital - 10 to 30 mcg/ml

Toxic Level: greater than 40 mcg/ml

Therapeutic Drug Levels: phenytoin (Dilantin) - 10 to 20 mcg/ml

Toxic Level: greater than 30 mcg/ml

Therapeutic Drug Levels: Quinidine - 2 to 5 mcg/ml

Toxic Level: greater than 10 mcg/ml

Therapeutic Drug Levels: Salicylate - 100 to 250 mcg/ml

Toxic Level: greater than 300 mcg/ml

Therapeutic Drug Levels: Theophylline - 10 to 20 mcg/ml

Therapeutic Drug Levels: Tobramycin

5 to 10 mcg/ml

Toxic Drug Levels: Acetaminophen - greater than 250 mcg/ml

-dipine

Calcium Channel Blocker (nifedipine, amlodipine)

Therapeutic Use: Angina, HTN

-afil

Erectile Dysfunction

-caine

Anesthetics

-pril

ACE Inhibitor (Captopril, lisinopril)

Therapeutic Use: HTN, HF, MI, Diabetic Neuropathy

-pam, -lam

Benzodiazepine

-statin

Antilipidemic (lovastatin, simvastatin)

Therapeutic Use: Hypercholesterolemia, Prevention of Coronary Events, Protection against MI and stroke
in clients with disbetes
-asone, -solone

Corticosteroid (prednisone, prednisolone)

Therapeutic Use: status asthmaticus, acute asthma attack, asthma attack PPX

-olol

Beta Blocker (propranolol, metoprolol)

Therapeutic Use: HTN, Angina, Tachydysrhythmia, HF, MI

-cillin

Penicillin

-ide

Oral Hypoglycemic (Biguanides, glipizide)

Therapeutic Use: Used in conjunction of diet and exercise to control blood glucose levels in type 2
diabetes mellitus

-prazole

Proton Pump Inhibitor (omeprazole, lansoprazole)

Therapeutic Use: gastric and peptic ulcer, GERD, Zollinger-Ellison syndrome

-vir

Antiviral

-ase

Thrombolytic

-azine

Antiemetic (promethazine)

Therapeutic Use: Postoperative, Chemotherapy, N/V associated with disease process

-phylline

Bronchodilator (aminophylline, theophylline)

Therapeutic Use: Relief of bronchospasm, long-term control of asthma

-arin

Anticoagulant (heparin, enoxaparin)

Therapeutic Use: Evolving stroke, PE, DVT, Cardiac Cath, MI, DIC

-zine

Antihistamine

-cycline

Antibiotic

-mycin

Aminoglycoside

-floxacin

Antibiotic

-tyline

Tricyclic Antidepressant (amitriptyline, imipramine, nortriptyline)

-pram, -ine

SSRIs (fluoxetine, sertraline, paroxetine, citalopram, escitalopram)

-zosin

Alpha Adrenergic Blockers (Sympathomimetics) ((prazosin, doxazosin mesylate))

Therapeutic Use: HTN

doxazosin mesylate may be used to treat BPH

Antidote/Reversal Agent: Acetaminophen

Acetylcysteine

Antidote/Reversal Agent: Benzodiazepine

flumazenil (Romazicon - GABA receptor antagonist)

Antidote/Reversal Agent: Digitalis

digoxin immune FAB

Antidote/Reversal Agent: Heparin and enoxaparin (Lovenox)

Protamine Sulfate

Antidote/Reversal Agent: Warfarin

phytonadione (vitamin k)

Antidote/Reversal Agent: Narcotics

naloxone (narcan)

decongestants

can constrict blood vessels; causing Hypertension

tamoxifen (side effects)

menstrual irregularities

hot flashes

bruising

cefazolin allergic reaction (tx)

parenteral epinephrine (induce vasoconstriction and bronchodilation)
metoprolol use post MI (what to monitor)
bilateral crackles in the lungs (sign of heart failure)

over the counter drug to AVOID when taking Lithium

NSAIDs (increases lithium levels)

therapeutic value for INR

2 to 3; for coumadin

sulfa allergy (cross sensitivity to which drugs)

thiazide diuretics

enalapril use for Heart failure (what to monitor)

hyperkalemia

methotrexate (what to monitor/report)

fever, sore throat, sores in mouth, infection

pilocarpine
Tx: glaucoma, Sjogren syndrome
Class: saliva production stimulator & glaucoma rx

Teaching: eye drops for glaucoma need to be taken for the rest of their life

When should Oxytocin IV post-term pregnancy be discontinued?

(contractions)
uterine contractions last > 60 sec

when should Oxytocin IV post-term pregnancy be discontinued? (resting

uterine pressure)
greater than 15-20mmHg
when should Oxytocin IV post-term pregnancy be discontinued? (uterine
contraction frequency)
more than every 2-3 mins

trimethoprim/sulfamethoxazole (Bactrim) (adverse effect to report)

vesicular, crusty rash (Steven Johnson syndrome)

trimethoprim/sulfamethoxazole (teaching)
drink 8-10 glasses of water daily to prevent renal damage from
CRYSTALLURIA

donepezil (adverse effects)

dyspnea (priority), dizziness, diarrhea, dyspepsia

spironolactone (adverse effect)

lethargy r/t HYPERKALEMIA

potassium-sparing diuretic (drug)

spironolactone

digoxin toxicity (sign to monitor and report)

yellow-tinged vision (halo), tinnitus

TSH therapeutic level

0.5-2 microunits

T3 therapeutic level
0.0001-0.0002 mcg

T4 therapeutic level
4.5-11.2 mcg

methotrexate toxicity (sign to monitor and report)

sores in mouth (stomatitis)

oxybutynin (adverse effects)

dry mouth
blurred vision
photophobia
constipation
TACHYCARDIA (anticholinergic effects)

urinary incontinence (tx drug)

oxybutynin (anticholinergic)

Isotretinoin (required test before use/obtaining a refill)

pregnancy test (teratogenic)

severe nodulocystic acne vulgaris (tx drug)

Isotretinoin

Dopamine IV (therapeutic use during cardiogenic shock)

increased blood pressure (catecholamine effect)
increased HR
increased renal output/voiding

candidiasis (tx drug)

Fluconazole (antifungal)

Sodium Polystyrene Sulfate (Kayexalate) (therapeutic use)

decrease serum potassium to prevent cardiac dysrhythmias r/t
HYPERKALEMIA

warning for chemo Pt. trying to get pregnant

high risk of fetal malformations while on chemotherapy

Sucralfate (therapeutic use)

forms a protective barrier over ulcers (mucosal protectant); gel-like
substance; PEPTIC ULCER tx

Isosorbide mononitrate
Tx: CHF, atherosclerosis
Class: nitrates
AE: hypotension (BP <90/60); hold drug; NOTIFY MD

Neostigmine
Tx: MYASTHENIA GRAVIS
Class: cholinesterase inhibitor
AE: increased salivation, bradycardia, ***NAUSEA, diarrhea

Cyclosporine
Tx: psoriasis, liver (organ) transplant (graft vs host disease), lupus, aplastic
anemia
Class: immunosuppressant
AE: NEPHROTOXICITY (elevated SERUM CREATININE)

serum creatinine therapeutic level

0.6-1.3 mg/dL

Allopurinol (drug to avoid)

Warfarin; CONTACT MD; risk for bleeding

Ferrous Sulfate (administration teaching)

take on an empty stomach (for better absorption)

Warfarin (antidote)
Vitamin K

Furosemide (lab findings of adverse effect/hold drug)

K+ level <3.5 mEq/L; HYPOKALEMIA; hold drug; NOTIFY MD

Magnesium therapeutic level

2 mEq/L

when Magnesium levels are HIGH

Calcium levels are LOW
Hypermagnesemia (s/s)
hypotension (LOW BP)
AV heart block
respiratory paralysis (Mg 12-15 mEq/L)
muscle weakness
(HYPOCALCEMIA)

Hypercalcemia (s/s)
tetany
kidney stones
(HYPOMAGNESEMIA)

Morphine Sulfate use 24hr post-op (adverse effect to monitor)

urinary retention

Ergotamine
Tx: migraine headaches
Class: ergot alkaloids
Teaching: take one tablet at onset of MIGRAINE SL

Insulin Glargine for type 1 DM (administration instructions)

do not mix this medication in a syringe with other insulins

Risedronate (risedronic acid), "-dronate"

Tx: OSTEOPOROSIS
Class: bisphosphonate
Teaching: sit up for at least 30-60min after taking the drug to reduce adverse
GI effects of esophagitis and dyspepsia

Tetracycline PO (adverse effect teaching)

take the medication with applesauce (food) to reduce GI distress

Aspirin toxicity/ salicylate poisoning (s/s to report to MD immediately)

hyperventilation (priority)/RESPIRATORY ALKALOSIS;
tinnitus

cholinergic crisis r/t MYASTHENIA GRAVIS (drug tx)

Atropine (anticholinergic); respiratory support

Insulin Lispro + Metoprolol (adverse effect)

sweating (HYPOGLYCEMIA)

Prednisone/Glucocorticoids (long-term use adverse effect to assess)

edema d/t sodium and water retention
how to administer NPH insulin & Regular insulin in one syringe
1. inject air into the NPH insulin vial (cloudy)
2. inject air into the Regular insulin vial (clear)
3. draw up the Regular insulin into the syringe
4. draw up the NPH insulin into the syringe

Gentamicin antibiotic (adverse effect to report immediately)

tinnitus

Sumatriptan
Tx: MIGRAINES
Class: 5-HT agonist
AE: angina d/t coronary vasospasm

Levothyroxine (therapeutic use)

tx for HYPOTHYROIDISM

Indomethacin (therapeutic use)

reduces pain & inflammation

Chlordiazepoxide (therapeutic use r/t alcohol withdrawal)

prevents delirium tremens

Acetazolamide (adverse effect to monitor and report)

tingling of fingers (PARESTHESIA)
HYPERGLYCEMIA

Acetazolamide (therapeutic use)

tx for CHRONIC OPEN ANGLE GLAUCOMA

Furosemide (adverse effects r/t HF)

HYPOKALEMIA
dizziness (d/t LOW BP)
urinary frequency
HYPERGLYCEMIA

Magnesium Sulfate (IV) for preterm labor Toxicity (s/s)

decreased LOC
CNS depression (LOW BP, lethargy)
depressed DEEP TENDON REFLEX

Diazepam overdose (antidote)

Flumazenil

Flumazenil (therapeutic use)

Benzodiazepine drugs (Diazepam) toxicity

Acute asthma attack (tx drug)

Albuterol

Phenytoin (lifestyle teaching)

inform the dentist about medication use; d/t gingival hyperplasia

Baclofen (therapeutic use)

decrease in flexor and extensor spasticity in tx of Spinal Cord Injury;
improved muscle function

Enalapril (adverse effect to monitor r/t HF)

HYPERKALEMIA d/t Potassium retention/sparing diuretic effects

Salmeterol (therapeutic use)

improved breathing; prevents BRONCHOSPASM; long

Propylthiouracil/PTU (therapeutic use)

increased ability to focus; tx for GRAVES' DISEASE
increased amount of sleep
decreased appetite

PTU myelosuppression (lab findings of adverse effect)

decrease in WBC

Oprelvekin (therapeutic lab findings in chemo tx)

increased platelet count

Platelet count (normal range) - 150,000 - 400,000

Hemoglobin (normal range) - female: 12-16
male: 14-18
Hematocrit (normal range) - female: 37-47%
male: 42-52%
WBC (normal range) - 5,000 - 10,000
RBC (normal range) - 4.2 - 6.2 million
Calcium (normal range) - 8.2 -10
Serum Osmolality (normal range) - 280-310
Magnesium (normal range) - 1.5 - 2.5
Potassium (normal range) - 3.5 - 5.0
LDL level - <130
HDL level - >45

Oral contraceptives (medications to AVOID)

Warfarin

Carbamazepine (anticonvulsant)

Digoxin (adverse effect to monitor and report)

yellow-tinged vision r/t toxicity
levels > 2

Valproic acid/Depakote (therapeutic use)

Tx: EPILEPSY (SEIZURE), BIPOLAR DISORDER, MIGRAINE PPX
Class: Anticonvulsants
AE: jaundice r/t liver failure

Tamoxifen
Tx: BREAST CANCER
Class: antiestrogen
AE: menstrual irregularities, hot flashes, bruising

Fluticasone Propionate
Tx: CHRONIC ASTHMA
Class: corticosteroid
Teaching: use spacer to minimize the risk of Candidiasis of the mouth;
dysphonia (difficulty speaking)

Clindamycin (adverse effect Pt needs to report to MD)

watery diarrhea r/t C-diff
Verapamil
Tx: SVT, Afib, Aflutter, angina
Class: calcium channel blocker
AE: HYPOTENSION, palpitations, GI distress (take with food)
Teaching: change positions slowly r/t hypotension and dizziness, DO NOT D/C
ABRUPTLY

metronidazole (Flagyl) (what to AVOID during course of tx)

Tx: bacterial vaginosis, vaginitis, trichomoniasis, pelvic inflammatory
disease, seborrheic
dermatitis, gastritis, diverticulitis
Class: antibiotic
Teaching: beer (alcohol); can cause Disulfiram-like reaction

Disulfiram-like reaction (s/s)

severe vomiting
HYPOTENSION
weakness

Epoetin alfa
Tx: ANEMIA, chemotherapy-induced Anemia, chronic RENAL FAILURE, HIV Pts.
taking Zidovudine
Class: colony-stimulating factor
AE: HTN
Teaching: DO NOT shake vial

benztropine (Cogentin)
Tx: Parkinson's
Class: anticholinergic
AE: TACHYCARDIA, blurred vision, dry eyes

Antiobiotics to AVOID during pregnancy

Doxycycline; Tetracycline antibiotics; d/t adverse effects on developing bones
and teeth

Mannitol
Tx: GLAUCOMA
Class: osmotic diuretic
MOA: decrease intraocular pressure by increase urine output
AE: peripheral edema r/t risk of HF (IV use)

TB (tx drugs)
Isoniazid
Rifampin
Pyrazinamide
Ethambutol

TB 4 tx drugs (reason)
to eliminate various combinations of resistant strains of TB

diagnostic tests d/t long-term use of Prednisone

bone density scans r/t osteoporosis

Atorvastatin
Tx: high cholesterol, HLD, CAD, stroke
Class: statin
Teaching: monitor Creatinine Kinase (elevated CK = muscle injury)

Haloperidol
Tx: psychosis, schizophrenia, bipolar disorder
Class: antipsychotic
AE: akathisia (EPS), acute dystonia, Parkinsonism, tardive dyskenesia

Fluoxetine (Prozac)
Tx: depression, OCD, bulimia nervosa, panic disorder
Class: SSRI
Teaching: DO NOT take St. John's Wort, may cause RASH, DO NOT use
NSAIDs

Ferrous sulfate (teachings)

DO NOT take with Antacids;
take the tablet on an EMPTY STOMACH for best absorption; can take with
food to minimize GI distress

Metoclopramide (Reglan)
Tx: GERD, gastroparesis, post-op nausea
Class: Antiemetic
AE: sedation (CNS effect), EPS, diarrhea

Hydroxyurea
Tx: SICKLE CELL ANEMIA
Class: chemotherapy
AE: low Hemoglobin, low Platelets, neutrophils; indicates toxicity to
Hydroxyurea; report to MD

Desmopressin (lab values to monitor)

Tx: diabetes insipidus
Class: antidiuretic hormone
Teaching: monitor Specific Gravity, Creatinine clearance, Serum osmolality

Opioid addiction (drug tx)

Methadone

Nicotine addiction (drug tx)

Bupropion

Alcohol addiction (drug tx)

Disulfiram

Methamphetamine addiction (drug tx)

Modafinil

Pegfilgrastime (therapeutic use)

increased WBC; tx for CANCER

Tranlycypromine
Tx: depression
Class: antidepressant
Teaching: move slowly; report Orthostatic HYPOTENSION

Lithium (over the counter drugs to AVOID)

Ibuprofen (NSAIDs)
Ciprofloxacin tx for UTI (contraindications)
tendonitis/deep tendon rupture

Spironolactone (adverse effects)

lethargy r/t HYPERKALEMIA
diarrhea

Timolol
Tx: glaucoma
Class: beta blocker
AE: BRADYCARDIA, HYPOTENSION

Nitroglycerin patch (teachings)

check BP 1 hour AFTER applying patch
call MD to report headaches
rotate location of patch

diphenoxylate-atropine (Lomotil)
Tx: diarrhea
Class: antidiarrheal; anticholinergic
MOA: slows the movement of the intestines
AE: abdominal distention

Allopurinol (drug to AVOID)

Warfarin

zidovudine (Retrovir)
Tx: HIV
Class: antiretroviral
AE: paresthesia, N/V, lactic acidosis,
Teaching: monitor hemoglobin

Cephalosporin
-broad spectrum
-ceph/cefs
-Similar to PCN/ don't give if PCN allergy
-can cause bleeding w/ other bleeding meds monitor bleeding time (tonsil
story)
- Disulfiram reaction (puke & puke & puke) just like Flagyl, the protozoal drug
- Store in fridge & take with food

ALL antibiotics have these side effects

- allergy, hypersensitivity
- suprainfection
- organ (kidney & ear) toxicity
- lowers oral contraceptive effectiveness

Vancomyocin
- serious infections like MRSA
- colitis by c-diff
- ototoxicity: get hearing test, tell dr. if hearing getting worse
-given over 60 minutes

Tetracyclines
- Sumycin, Doxycycline (Vibramycin)
- broad, rocky mtn fever, lyme disease, acne, GI infections by H. Pylori
- bad GI discomfort
- Don't give to kids 8; teeth permanently yellow
- Bad photosensitivity- wear sunscreen!
- Can't take with milk, iron, or antacids
- Take on empty stomach with a full glass of water

erythromycin
Tx: gonorrhea, pink eye, scarlet fever, strep throat, acne
Indication: When pt allergic to PCN and needs abx
Class: antibiotic
MOA: Bacteriostatic inhibitor
AE: GI issues

Aminoglycosides
ototoxicity, Renal toxicity, Can't take with PCN at all!
- gentamicin, neomycin, streptomycin

sulfamethoxazole/trimethoprim (Bactrim)
Tx: UTI
Class: antibiotic
Teaching: contains Sulfa; Blood problems (get CBC baseline); photosensitivity
wear sunscreen and glasses; empty stomach with a full glass of water

Isoniazid (INH)
-antiTB
- take daily for 6-12 months and most likely with other meds too
-worked if 3 neg. sputum cultures, no temp.
- Liver toxicity (hepato) check liver fxn
- Don't take with alcohol (liver fxn remember?)
- Take on empty stomach

Antiviral: Acyclovir, Ganciclovir

Teratogenic preg. X; put on rubber gloves if topical! remember my purple
glove experience
-thrombocytopenia, lowers WBC

What class of drugs if Flagyl? What is the weird effect it has?

protozoal. works on C. diff & H. Pylori PUD. Antibuse effect if taken with
alcohol

Amphotericin B
anti-fungal
HIGHLY TOXIC
- infusion rxns (fever and chills)
- nephrotoxicity
- hypokalemia
- hepatoxicity
- gynecomastia
- C/I with aminoglycosides (just like PCN)

-azole
Fungal

______ causes malignant hyperthermia. Use ____ to stop it

succinylcholine, Dantrium/Dantrolene.

Morphine adverse effects

SLOWS EVERYTHING DOWN
- Constipation
- Resp depression
- Urinary retention
- Sedation
- Orthostatic HTN
- Cough suppression

Morphine drug-drug interactions (think of what morphine does to the body)

- MAOIs
-anticholinergics
-CNS depressants
-hypotensive drugs
-opiod antagonists (narcan)
- antihistamines

Morphine patient education re how to take

Take with food for N/V, lie still will help

Opioid withdrawal sx (if stopped abruptly after 6 weeks). Is it life-

threatening? Will it subside?
sweating, restless, agitated, dilated pupils, tremors, tachycardia, increased
BP, N/V, cramps, muscle spasms with kicking movements. NO, subside in 7-
10 days.

Migraine medications? Can you take them right after each other?
vasoconstriction, ergot's and triptans.
NO, space out ergot and triptan by at least 24 hours.

What pain med reduces platelet aggregation?

NSAIDS (aspirin), reduce thrombus but will bleed easier, too

What pain med reduces fever but has NO anti-inflammatory effect and NO
platelet effect?
tylenol

What can give child Reye's syndrome if they have viral illness?
Aspirin

NSAIDS education w/ how to take med. NSAIDS=

with food, milk, or full glass of water to reduce gastric discomfort. Ibuprofen,
Celebrex, Naproxen, Aspirin

acetaminophen max dose/day?

4 grams

When to withhold morphine/opiates

RR <12/min & notify Dr
Triptans (for migraines) & pregnancy
Triptan= Teratogenic. Pregnancy X

Rheumatoid Arthritis Drugs name potent toxic drug

DMARDs, 1st choice: methotrexate. Bone Marrow Suppression and Fetal
Death

Methotrexate: most concerned about...

bone marrow suppression; Baseline CBC and platelet counts,

What are the s/s of circulatory overload? Seen if giving too much fluids
flush, SOB, cough, heart palpitations

What type of diuretic is not effective in renal failure?

Thiazide - HCTZ

Bumex is ___x more potent than lasix

40
Thiazide diuretics are good for the ___ and perfect for the eldery __ with HTN
bones, woman

Lasix drug-drug interaction: for manic depressive ppl it'll get to toxic levels in
the body
Lithium will become toxic

Signs of hypokalemia
weakness, dysrhythmias, increased cardiac sensitivity of digoxin, ileus, Flat T
wave

Aspirin toxicity symptoms

Tinnitus, HA

Glucocorticoids adverse effects

potent; suppress adrenal glad fxn, hyperglycemia, osteoporosis, if taken with
NSAIDS, increase risk of GI ulcer, mask infection and suppress immune
system

Reo Pro (-mab) what is it for & adverse effects. What other use does Reo Pro
have?
Immunosuppressant for RA, Lupus. toxic to bone marrow, acute pulm edema,
infection risk, neoplasia risk. Antiplatelet action.

Classic CNS depressant drug classes and what they're used for
Benzodiazepines, Barbituates. Anxiety.

-lam & -pam are the endings for ________

Benzodiazepines

Benzodiazepine Lorazepam (ativan) increases the possibility of ______.

seizures

Other anxiolytics: and what they're for

-Valproic Acid: anti-seizure, bi-polar
-Phenergan: NV, anxiety, extrapyramidal effects

Amitriptiyline (Elavil) drug drug interactions and how to take med

Anticholinergics b/c TCA already have anticholinergic effects
- void prior to dosing & take at bedtime to sleep through fatigue side effect

MAOI's ___ line of choice for depression b/c of the adverse effects with ___,
which can cause ___
2nd or 3rd, tyramine, hypertensive crisis
MAOI adverse effects are related to stimulation of the _____ and include:
SNS, CNS stimulation,
CV-hypertensive crisis, palpitations, Liver toxicity

1st drugs of choice for depression ___, which is equally as effective as ___,
but without the SE of ___ & ___
SSRI, TCA, hypotension and sedation

SSRI drug examples: prototype and 2 popular drugs

Prozac, Celexa, Zoloft

Atypical antidepressant _______ better use in elderly

Wellbutrin

SSRI uses
depresssion
OCD
bulimia
PTSD
Panic attacks
Social phobias
PMDD

What time of day to give SSRI

Give in the AM for optimal effects

Lithium is used for

Bipolar Disorder

Lithium and Diuretics

toxicity if taking diuretics

Anti-depressants have ___________ effects

anticholinergic: dry mouth, constipation, lack of sweat, lack of voiding

Antidepressants and anti-anxiety meds may take ___ to ___ weeks to take
effect
2-3 weeks

all anti-depressants have _____ ______ effect and pt must have their __
monitored
orthostatic hypotension. BP

If patient taking an antihypertensive and just got ordered MAOI, Nardil,

Marplan, or Parnate, then...
monitor their BP and call the Dr if theres a significant drop and may need to
reduce the anti-htn dosage

Lithium and Triptans? Safe in pregnancy?

NO both lithium and triptans are teratogenic

Therapeutic Levels of Lithium

0.4-1.0 mEq/L. Take 2-3 times a day.

Chemotherapy Agents
neosar (cyclophosphamide), methotrexate, doxorubicin, tamoxifen

Cyclosporine is an _________
immunosuppressive drug

PTT lab value should stay at >_________ for what medication? What is the
therapeutic PTT level?
2 times the baseline, Heparin. 60-80 seconds

To prevent HIT, stop heparin at platelet count of <________

100,000

How to inject heparin, starting from drawing up

draw up with 22-25 ga needle from vial, then use 25 or 26 ga to put into
abdomen 2in from umbilicus.

Drug to help with heparin overdose

Protamine Sulfate

Warfarin C/I (2)

liver failure (no clotting proteins will lead to too much bleeding), alcoholism
(additive risk of bleeding)

Lab values to watch with Warfarin

-PT (18-24 sec)
-INR (2-3)

patient education with aspirin (food-wise)

take with food

Prevention of strokes, MI, and reinfarctions can be accomplished with low-

dose aspirin of ___mg
81 mg

Thrombolytic drug prototype

Streptokinase, dissolves clots that have already been formed
When should thrombolytics, streptokinase, be given?
4-6hr of onset of symptoms

Do/Do not mix any medications in IV with thrombolytic agents

DO NOT

What medications are usually given with thrombolytics, streptokinase? (think

when this drug is used)
Beta-blockers to lower myocardial oxygen consumption
H2 antagonists like Zantac or
PPI like Prilosec to prevent GI bleeding

Ferrous Sulfate
Tx: iron deficiency anemia
Class: mineral & electrolytes
Teaching:
- GI distress however can't take with food b/c that will decrease it's
absorption greatly;
- Teeth staining (drink w/ straw or dilute in water or juice and rinse mouth
after swallowing);
- Don't take with tetracycline or antacids;
- Poop will be a harmless dark green or black color;
- Drink more water and exercise more to counter constipation effects

why would a patient be given vitB12-cyanocobalamin

pernicious anemia, partial removal of stomach

What vit/min masks the signs of Vit b12 deficiency?

folic acid

E-alfa, hematopoietic growth factor, is dependent on adequate levels of ___

___ & ___
Iron, Folic acid, Vitamin B12

In giving whole blood, what do you do before and during?

obtain vital signs, stay with the client and monitor VS q5 min for 15 minutes

When giving whole blood, what do you need the 2nd person for?
check identification of the donor blood and recipient, blood compatibility and
expiration date.

Only give blood products with what type of IV fluid?

0.9% NS. anything else will cause lysis of the RBC

Bronchodilator albuterol: therapeutic uses

Prevention of asthma attack
long-term control of asthma
Short acting treatment for asthma attack

Bronchodilator side effects; overall stimulation of the B2-adrengeric

receptors...
tachycardia, angina

How to use a MDI (metered dose inhaler)

shake the inhaler, 1/2-2 in away from mouth and tilt head back slightly and
open mouth wide. press inhaler same time you breath in deep. Hold breath
for 10 seconds. Wait 1 full minute b4 another puff.

When prescribed a beta-2 agonist and an glucocorticoid, which do they

inhale first?
the beta-2 agonist promotes bronchodilation and enhances absorption of the
glucocorticoid

What does the med theophylline do? short term or long-term control?
relaxes bronchial smooth muscle and does bronchodilation. Long-term
control of asthma attacks.

Inhaled atrovent what class of medication is it

anti-cholinergic used for long term control of asthma

Glucocorticoids for asthma are used for _____ and oral glucocorticoids are
only give for ___-___ days
long-term control of asthma attacks. 3-10 days

Codeine is used for ___. classification of drug?

Tx: chronic, non-productive cough
Class: opioid
AE: CNS effects, GI effects (take with food)
Teaching: increase fluids

Mucomyst (Acetylcysteine) is a mucolytic and it's therapeutic effect is to:

Tx: cystic fibrosis, emphysema, bronchitis, pneumonia, TB
Class: mucolytic
MOA: make nasal and bronchial secretions watery to enhance their passage
AE: aspiration and bronchospasm
Teaching: smells like rotten eggs, dilute with water or juice

What do nasal decongestants like phenylephrine do to the body?

CNS stimulation b/c they stimulate alpha-1 adrenergic receptors.
Vasoconstriction-watch HTN and CAD patients!
How fast do you infuse K chloride in IV pump?
no faster than 10 mEq/hr

You should dilute ___and give no more than 40 mEq/L to prevent vein
irritation
KCl. remember in clinical he said it was really burning his vein.

SERMS raloxifene is used for _______

osteoporosis and prevent bone fractures

Raloxifene (Evista)
Tx: osteoporosis
Class: estrogen modulator
AE: hot flashes, DVTs

Bisphosphonates, like Fosamax or Boniva

sit or stand for 30 minutes after taking
-have enough vit d and calcium

phenytoin (Dilantin)
Tx: epilepsy, subarachnoid hemorrhage, trigeminal neuralgia
Class: anti-seizure
AE: gingivial hyperplasia, blurred vision, bad rash, beardy chesty,
teratogenesis, dysrhythmias

Which vitamin promotes iron absorption but increases its side effects?
Vit C

Carbamazipine (Tegretol) 1) Use 2) cannot be used with _____ ______ (all of

these meds can't)
anti-convulsant
-oral contraceptives

PTU is given for ______ & clinically see its working by:
hyperthyroidism
lowered Hr, weight gain, lowered T4 levels

-opril -april
ACE inhibitor

All ACE inhibitors cause: (2)

dry, persistant, cough AND hyperkalemia (increases body's uptake of K+)

70% of patients on an SSRI experience _____ ______

sexual dysfunction
Fentanyl is used for:
severe cancer pain, will cause constipation
____ will increase the toxicity of Lithium
NSAIDS, tylenol is NOT an NSAID

Carbonic Anhydrase inhibitor use

glaucoma

Metoclopramide
Ulcers, GERD,

Bupropion (Zyban) to help stop smoking has what action on the CNS system?
Stimulation

Therapeutic level of Digoxin?

0.5-2.0

Gold Salts for RA toxicity. RA drugs dosing

rash, sores in mouth, intense itching
- once-a-week at first then down to once-a-month

HBA1c goal for DM

<7%

Amitryptyline (Elavil) has _______ effects. What is Elavil drug class?

"-triptyline or -pramine"
anticholinergics. Tricyclic antidepressant (TCA)

Lithium adverse effects

hand tremors, thirst, GI upset
Digoxin toxicity can occur in the presence of ________ which can happen with
what medication?
Hypokalemia, Lasix

Name 4 NSAIDS
Aspirin, celebrex, ibuprofen, naproxen
Antidote/Reversal Agent: Neostigmine
Atropine

Dilantin (phenytoin) is used for _____ and it's side effects are
seizures, double vision, hirsuitism, skin rash, teratogenesis, dysrhythmias,

Dilantin (phenytoin) cannot be used with what two other drugs?

oral contraceptives and warfarin

Beta 1 heart meds are used to treat

Heart Failure and Cardiac arrest

Alpha 1 agonists like epinepherine is used for __

raising BP

Beta 1 activation in the heart can cause ________

dysrhythmias

Dopamine is used for ____ and ____

shock
Heart Failure

Multiple drug interactions with Heart medications:

MAOI, TCA enhance epinephrine effect (vasocontriction)
- Phentolamine -A blocker
- Propanolol B blocker

Alpha Adrenergic Blockers ("-zosin;" prazosin/Minipress) all have a first-dose

___ effect. What OTC analgesics counteracts the anti-hypertensive effect?
orthostatic hypotension b/c venous dilation
-NSAIDS

Clonidine (catapress) does what to the pt's BP and CO?

decrease BP and CO
Clonidine (catapress) and ______ (alpha blocker) counteract each other
Prazosin (Minipress)

Which Beta blocker is non-selective and causes bronchoconstriction, too?

Propanolol

-pril ACE inhibitors block Ang I from becoming II resulting in:

vasodilation, excretion of water & sodium, retain K,

-sartan
Angiotensin II Receptor Blockers (ARBs)
-statins

Cholesterol drugs
-pine, -amil (verapamil: non-selective)

Ca channel blocker

The main difference between ARB's and ACE inhibitros is that ______ and
_______ are not side effects of ARB
-cough
- hyperkalemia

Ca Channel Blocker (-ipine/-amil) vasodilate and adverse effects (2)

- reflex tachycardia
- Peripheral edema

Dysrhythmias are seen as a ________ QRS interval

widened

Action of Digoxin (2)

increase myocardial contraction
Lower Heart Rate giving ventricles more time to fill

The most dangerous adverse effect of Digoxin is it's ability to create ________,
particularly in patients who have _______
Dysrhythmias
- hypokalemia

ACE inhibitors (-prils), ARBs (-sartan), Thiazide & looop diuretics increase the
likelihood of ________ and it's level should be monitored when taking _______
with these meds.
hypokalemia
-digoxin

Cimetidine (tagamet) is for

ulcers
cyclosporine is an
immunosuppressant

Clonidine (catapress) is a alpha agonist and has what two adverse effects
dry mouth
drowsiness & sedation

Ca Channel Blockers adverse effects are related to __________ & the

immediate-acting drugs can cause _____ ________
vasodilation: headache, dizziness, edema, flushing
-reflex tachycardia

Ranitidine Hydrochloride (Zantac) is a __ ____ ______ and is used for _____ and
_____
H2 receptor antagonist
-PUD and GERD by suppressing the secretion of gastric acid
-tidines and -prazole's lowers gastric pH which promotes bacteria in the
stomach and _______ _______ so use cautiously in pts who are at high risk for
______
-respiratory tract
-pneumonia

-tidine
H2 receptor antagonist used for ulcers and GERD

-prazole. is the gastric acid lowering reversible?

PPI. Irreversible inhibiting of gastric acid

Don't take -prazoles with ____ and ____

antibiotics and digoxin

Aluminum hydroxide gel (amphojel), Milk of Mag, Sodium Bicarb are all
antacids

Aluminum and Calcium cause ______ while milk of mag causes _______
-constipation
- diarrhea

How many times does the patient take antacids?

7 times a day! it'll relieve their pain and heal the ulcer

Take all medications at least ___hr b4 or after antacids

1 hour

Misoprostol: who used them & intended use

-ppl taking long-term NSAID therapy and pregnant women
-prevent ulcers and induce labor

examples of anti-emetics
-Ondansetron (zofran)
-Dexamethasone
- Prochlorperazine (Compazine)
- Dramamine prevents motion sickness
-phenergan
- metoclopradmie (reglan)

All anti-emetics should not be used with these 3 medications b/c they
intensify anti-emetic side-effects
opiods- intensify CNS depression
anti-HTNs
Anticholinergics
Anti-diarrheals
diphenoxylate (lomotil)
loperamide (Imodium)

Caffeine makes diarrhea worse or better?

worse

Insulin moves __ into cells along with Glucose

K+

Can synthroid be given to a pregnant woman?

yes- its a pregnancy level A

Is PTU safe to use in pregnancy? What side effects are there for PTU
NO c/i b/c neonatal hypothyroidism can occur
- overmedication goes to hypothyroidism
-can increase anticoagulant effects

Estrogens can decrease the effectiveness of ______, an anticoagulant drug

warfarin

What medication class lower the effectiveness of birth control? (4)

-benzodiazepines/ phenobarbital
-phenytoin (dilantin)
- rifampin (TB drug)
-antibiotics

True/False: TSH at 2 micro units indicates good treatment of hypothyroidism

True

True/False: Photosensitivity and blurred vision are anti-cholinergic side

effects?
True

What are signs of an "infusion reaction" with amphotericin B?

fever and chills

Antifungals are safe to use with Warfarin?

False; antifungals inhibit the degradation of warfarin

pancrealipase
for pancreative enzyme deficiency used every time they eat

Stevens-Johnson Syndrome
dry,crusty rash and should be reported to the PCP
INR therapeutic range: what about mechanical heart valve patients?
2-3.
3.5-4.5

PTT therapeutic range

60-80

What is the only immunization given at birth?

Hepatitis B vaccine

It could take __ to __ months for a person on RA drugs to start to feel better

4 to 6 months

Anticholinergic effects
dry mouth
constipation
photophobia
blurred vision
Tachycardia

Bisphosphanates for osteoporosis should be taken with food or on an empty

stomach?
Empty stomach

Ceftriazone (Rocephin)
broad spectrum cephalosporin
Ceftriazone (Rocephin) drug-drug interactions
Piperacillin sodium; Clients with allergies to piperacillin sodium, a penicillin,
may have a cross-sensitivity to Ceftriaxone, a third-generation
cephalosporin. This should be reported to the primary care provider.
Onset time for IV route
10-15 minutes
What is the preferred site for heparin injection?
Subcutaneous tissue of the abdomen
Gemfibrozil (Lopid)
Monitor periodically liver function; Gemfibrozil (Lopid) is converted by the
liver to active metabolites, and therefore, it is necessary to undergo periodic
liver function studies to monitor for active hepatic disease or elevated
transaminase levels.
What follow up diagnostic test would be necessary for an individual on
valproic acid (Depakene)?
Platelet count, aspartate aminotransferase (ASTL), and alanine
aminotransferase (ALT)
Chlorothiazide (Diuril) and digoxin (Lanoxin)...monitor for what?
Muscle weakness; The client is at risk for hypokalemia due to fluid loss from
chlorothiazide, which places him at greater risk for digoxin toxicity. Muscle
weakness is a sign of hypokalemia.
What is the indicated action of lactulose (Cephulac)?
To reduce serum ammonia levels
diphenoxylate and atropine (Lomotil) monitor what what?
Toxic megacolon; a condition characterized by paralysis of colonic peristalsis
resulting in rapid dilation of the bowel.
Aspirin therapy is CI in children with viral illnesses due to increased risk of...?
Reyes syndrome
What should the nurse implement what precautions for in a patient taking
clopidogrel (Plavix)?
Bleeding; it is an antithrombotic and antiplatelet aggregate used to lessed
the chance of heart attack or stroke.
Isotonic solutions
Dextrose 5% in Water (D5W), Lactated Ringer's (LR), NS
Hypertonic solution
Dextrose 5% in lactated Ringer's (D5LR)
Rifampin (Rifadin) common side effect
Rifampin will turn body fluids, such as tears, sweat, saliva, and urine, an
orange-red color. Advise the client that this effect does not cause harm.
What is the purpose of filgrastim (Neupogen)?
To raise the client's absolute neutrophil count; used for clients that have a
decreased neutrophil count as a result of chemotherapy of other caused of
neutropenia.
What is filgrastim?
A glycoprotein that specifically stimulated the proliferation of neutrophils.
epoetin alfa (Epogen) is used to do what?
Treat anemia; it stimulated erythropoiesis in the bone marrow to increase red
blood cells production.

monitor effectiveness using hemoglobin

AE of gentaminin sulfate (Garamycin)?
Proteinuria; this drug can lead to nephrotoxicitity....proteinuria is an
indication that renal damage has occured
Metoclopramide (Reglan) is CI in a client that has...
An intestinal obstruction; Reglam promotes gastric emptying; it should not
be given to a client with an intestinal obstruction.
What is the best indicator of renal function?
Serum creatinine levels
ACE inhibitor...monitor for what?
Monitor serum potassium levels
Common side effect of phenazopyridine (Pyridium)?
Pyridium is a dye that causes a red or orange coloration to the urine. This
coloration is harmless, although it may stain clothing. It is expected, and
does not need to be reported to the health care provider.
Magnesium sulfate can cause what?
Respiratory depression; a rate of 12/min or less places the client at risk for
inadequate oxygenation
What medication should be administered to a patient with a headache that
has PUD?
Acetaminophen (APAP) (Tylenol); it does not affect blood coagulation and
places no risk of GI bleeding
ACE inhibitor drug-drug interactions
Lithium-can cause toxicity
NSAIDs-may reduce effectiveness
ACE inhibitor generic name ending
-pril
What should the nurse assess for before administering the first dose of
enalapril maleate (Vasotec)?
Blood pressure; greatest risk for orthostatic hypotension
Oxytocin (Pitocin)
Administered to stimulate contractions
Nifedipine (Procardia)
Tocolytic that is given to stop preterm labor
Betamethasone (Celestone)
Given in the intrapartum period to promote lung development if early
delivery is indicated
Rho (D)
given in the antepartum period to Rh-negative mothers to prevent hemolytic
disease of the newborn.
ARB generic name ending
-sartan
allopurinol (Zyloprim) side effect that should be monitored for
Fever; nurse should instruct the client to discontinue the medication
allopurinol (Zyloprim) expected side effect
Metallic taste; client should be instructed not to d/c the medication
What should the nurse monitor for for a client that just received epinephrine
hydrochloride (Adrenalin)?
Tachycardia; epinephrine stimulates the CNS...AE include rapid heart rate
and HBP
When should the client take hydrochlorothiazide (Oretic)?
In the morning to allow for diuresis during the day without interferring with
sleep
cromolyn sodium (Intal) onset
Very slow onset and used only prophylactically
ergotamine tartrate (Ergomar) indication
Mirgaine headaches; it blocks the alpha-adrenergic receptors in the cranial
peripheral vascular smooth muscle to cause constriction of dilated cerebral
blood vessels
ergotamine tartrate (Ergomar) CI
Clients with anemia
What diagnostic test should the nurse anticipate for a client about to be
started on amitriptyline (Elavil)?
ECG to obtain a baseline; an older adult client is at greated risk for
cardiovascular side effects
tamoxifen (Nolvadex) action
Anti-estrogenia; used to treat cancer of the breast in both pre- and post-
menopausal women
The nurse should monitor for __________ for a client on zolpidem (Ambien)?
Confusion; especially in an older adult client
erythromycin (Erythrocin) PO may cause....
superinfection; candida fungus is normally present in the mouth, the
antibiotic effect of erythrymycin allows the fungus to grow out of control
prednisone (Deltasone) AE
Stress fractures; it causes demineraliation of the bones and leads to
osteoporosis and stress fractures
treatment of chlorpromazine hydrochloride (Thorazine) [typical
antipsychotic] induced EPS
Amantadine (Symmetrel)
Bupropion (Wellbutrin)
atypical antidepressant
Phenelzine (Narvil)
MAO inhibitor
Hydroxyzine (atarax)
antihistamine used to treat mild to moderate anxiety states
Preferred injection site for infant
Vastus lateralis
client is feeling nauseated on digoxin (Lanoxin). what should the nurse do?
check apical pulse (top priority to assess for slow HR which is a sign of
toxicity)
tolerance
indicated when a larger dose of the medication is needed to achieve the
original pain relief. It may occur even over a short period of time.
addiction
a pattern of compulsive drug use characterized by a craving for the drug and
a need to use the drug for effects other than pain relief
physical dependence
results in withdrawal symptoms when the drug is abruptly stopped. It does
not affect pain relief.
physiological dependence
used interchangeably with the term addiction. The drug taken is frequently
used for effects other than pain relief.
Betamethasone is what/has what action?
glucocorticoid that acts to accelerate fetal lung maturity in the client with
preterm labor
What is saw palmetto used for?
primarily for symptoms related to prostatic conditions such as benign
prostatic hypertrophy (BPH).
Buspirone (Wellbutrin) onset of action
delayed; may take 7 to 10 days for effects to be evident and 3 to 4 weeks for
therapeutic levels to be reached
Buspirone half-life
2 to 4 hr, one of the shortest of the antianxiety medications.
Buspirone abuse potential
low potential for abuse
osmotic laxative mechanism of action
work by pulling water into the colon and feces, thereby increasing bulk and
stimulating peristalsis
Bismuth subsalicylate is effective in treating peptic ulcer disease because of
its.....
antimicrobial action
The onset of action for Regular insulin is
30 to 60 min, with a peak effect in 2 to 4 hr.
The onset of action for NPH insulin when given alone....
The nurse should expect an onset of 1 to 2 hr
A pt comes to the ER with a DVT....plan to administer.....(drug & route)
Heparin sodium IV; will have immediate effects
Ticlopidine (Ticlid) onset
24 to 48 hours
Warfarin (Coumadin) onset
1 to 3 days
verapamil (Calan) is a ___________ (class)
calcium channel blocker
verapamil (Calan) uses
hypertension and anginal pain
cyclosporin (Sandimmune) is an ________
Immunosuppressive agent. It is used to reduce the body's natural immunity
in clients who receive organ transplants and prevent rejection. Clients will
need to take immunosuppressive therapy for the remainder of their lives.
Theophylline is a _________
Bronchodilator
Earliest manifestation of toxicity in a patient taking theophylline
Central nervous system stimulation, often seen as tremors. Other
manifestations include insomnia, confusion, and irritability.
To administer a Mantoux skin test for tuberculosis (TB), the appropriate
nursing action is to
Insert the needle with the bevel up.
Rationale:
The tuberculin syringe should be held close to the skin so that the hub of the
needle touches it as the needle is introduced bevel up. This reduces the
needle angle at the skin surface and facilitates the injection of tuberculin just
beneath the surface of the skin in order to form a wheal.
Client is taking Dexamethasone prior to surgery, what are they at increased
risk for?
Risk for infection because Dexamethasone is an immunosuppressant
Glucocorticosteroids lead to hypo- or hyper- glycemia?
hyperglycemia
furosemide (Lasix), what should the nurse monitor for?
Hypokalemia

Furosemide is a potent loop diuretic. With Lasix, potassium excretion is

increased and may lead to hypokalemia
Total Parenteral Nutrition (TPN) should have what appearance?
The TPN should have a uniform (usually milky white) consistency and
appearance. Gently shaking the solution will not change the consistency
clonidine (Catapres), what should the nurse tell the client?
Change positions slowly; may cause orthostatic hypotension
cefazolin (Kefzol) can be used to treat
periorbital cellulitis
lorazepam (Ativan), what should the nurse monitor for?
Profound sedation

Lorazepam is a benzodiazepine with anti-anxiety and sedative effects. Older

adult clients are at greater risk for central nervous system depression even
with low doses of benzodiazepines. Clients over the age of 50 years may
have a more profound and prolonged sedation than younger clients.
phenazopyridine (Pyridium)
relieves urinary tract pain and discomfort
Ciprofloxacin hydrochloride is an effective antibiotic for _______
UTIs
nitroglycerin (Nitrostat) tablets to be taken sublingual for angina pain
sequence patient should follow
The client should first stop all activity, place a tablet under his tongue. Next,
he should wait 5 min. If chest pain is not relieved, he should call 911.
How should the patient avoid Lanoxin toxicity?
Eat fruits and vegetables every day that have a high-potassium content in
them

it is important to maintain the K+ level between 3.5 to 5.0 mg/dL

hydrochlorothiazide (Oretic) used to treat....
hypertension
hydrochlorothiazide (Oretic), what should the client eat?
Potassium-rich foods since it can cause hypokalemia
client taking isoniazid (INH) will need frequent monitoring of which of the
following
Aspartate aminotransferase (AST)

AST is part of liver function studies. These liver enzymes are monitored to
detect the effects of INH that might be toxic to the liver. They should be
monitored before drug therapy is started and at least monthly during the
course of therapy.
What type of antidepressant should be avoided during pregnancy?
Amitriptyline (Elavil) is a tricyclic antidepressant. Tricyclic antidepressants
should be avoided during pregnancy, especially during the first trimester
because they are associated with fetal anomalies.
bismuth subsalicylate (Pepto Bismol) has what action?
antimicrobial action

Bismuth subsalicylate is effective in treating peptic ulcer disease when the

ulcer is caused by the bacteria, H. Pylori. It also coats the stomach and ulcer
providing protection from gastric juices.
procainamide (Pronestyl), what should the nurse monitor for?
Hypotension

Blood pressure should be monitored continuously throughout intravenous

administration. If the blood pressure drops more than 15 mm Hg, intravenous
administration is usually discontinued. The client should remain supine to
minimize hypotension.
Nitroglycerin
vasodilator, drops BP, instruct patient to lay down
Common side effect of nitroglycerin therapy
throbbing headache
life-threatening side effect seen more often in clients receiving lidocaine
Seizures; severe adverse effect
nifedipine (Adalat) action
Inhibiting uterine contractions by blocking calcium channels

Adalat does cause uterine relaxation by blocking the flow of calcium to the
myometrial cells.
A patient on warfarin (Coumadin) should....
Carry a medic alert ID card at all times

A client taking warfarin is at increased risk for bleeding. In the case of an

emergency, it is important that any medical personnel are aware of the
client's medication history.

report black stools to the provider (could indicate GI bleeding)

Dark green vegetables are high in vitamin K and will....
decrease the effectiveness of warfarin
buspirone (BuSpar) has a ________
delayed onset of action, low abuse potential
Albuterol (Proventil)
a beta 2-adrenergic agonist that is used to provide immediate relief for an
acute asthma attack
Avoid what medication with nitroglycerin?
Sildenafil (viagra)
dextran (Infed) should be given IM in _____ (what muscle)
vastus lateralis muscle

a large muscle used when iron dextran is administered using the Z-tract
method.
mannitol, what should the nurse monitor for?
peripheral edema (due to heart failure)
sucralfate has what action?
Forms a protective barrier over ulcers

Sucralfate a mucosal protectant forms a gel like substance coating the ulcer
creating a barrier to hydrochloric acid
H2 receptor agonists action?
decrease stomach acid secretion
antacids action?
neutralize acid in the stomach
client has been taking morphine sulfate, what should the nurse monitor for?
urinary retention

increases bladder sphincter and detrusor muscle tone as well as dulling the
client's ability to perceive bladder fullness, resulting in urinary retention.
what can morphine cause?
bradycardia, hypothermia, pupil constriction
insulin glargine client teaching
inject once per day, perferably at the same time each day
do not mix in syringe with other insulins
acetazolamide for chronic open angle glaucoma, what should the nurse
monitor for?
tingling of fingers

Paresthesia, such as tingling sensations in the extremities, is an adverse

effect of acetazolamide
long term use of glucocorticoids, such as prednisone, what diagnostic test
should the patient get?
bone density scans
Adverse effects of glucocorticoids include osteoporosis, which is monitored
with regularly scheduled bone density scans
what is the greatest risk to the client with hyperkalemia?
cardiac dysrhythmias
Doxycycline is CI in pt who is....
pregnant

Pregnancy is a contraindication for doxycycline, a tetracycline antibiotic, due

to the medication's adverse effects on developing bones and teeth
Docusate sodium is a.......
stool softener
enalapril (ACE inhibitor), what should the nurse monitor for?
Hyperkalemia due to potassium retention by the kidneys
aspirin regimen may cause.....
respiratory alkalosis which is manifested as hyperventilaton. this is an urgent
finding.
client has warfarin tixicity, what should the nurse plan to administer?
vitamin K
what is the antidote for heparin?
Protamine sulfate
What is the antidote for magnesium sulfate toxicity?
Calcium gluconate
What is the antidote for acetaminophen toxicity?
Acetylcysteine
Magnesium toxicity results in.....
CNS depression (decreased LOC), depressed deep tendon reflexes,
decreased BP, lethargy
tamoxifen is a (class)?
An anti-estrogen medication
What are SE of tamoxifen?
Menstrual irregularities, hot flashes, and bruising
benzodiazepine toxicity antidote?
Flumazenil
reversal agent for opioid toxicity?
Naloxone
propylthiouracil for a client who has graves disease...when it is effective,
what will happen?
Increase in ability to focus
fluoxetine supresses....
platelet aggregation, which increases the risk of bleeding when used
concurrently with NSAIDs and anticoagulants. Therefore, clients who are
taking fluoxetine should avoid taking NSAIDs
benztropine, what should the nurse monitor for?
Tachycardia
A client taking benztropine, an anticholinergic agent, can develop
tachycardia due to parasympathetic blockade of the heart.
Montelukast (leukotriene modifier) is ______treatment of asthma
long-term
metronidazole, what should the client avoid?
Beer (alcohol)

The combination of metronidazole and alcohol can cause a disulfiram-like

reaction that can include severe vomiting, hypotension, and weakness.
epinephrine induces....?
vasoconstriction and bronchodilation
ferrous sulfate client teaching?
take on a empty stomach
black stools are common
do not take with antacids (decreased absorption)
When should the client take tetracycline?
in the morning to prevent esophageal ulceration
the nurse knows levothyroxine was effective when....
thyroid-stimulating hormone (TSH) level is 2 microunits/mL
Phenytoin commonly causes?
gingival hyperplasia. As a result, the client should notify the dentist
digoxin toxicity will manifest as what signs?
yellow tinged vision

dysrrthmias secondary to dig=cardiotoxicity

maintain sodium WNL (hypokalemia=increased risk of developing toxicity)

ceftazidime interacts with _________ and can cause____________
penicillin, anaphylaxis, manifested by shortness of breath
indomethacin is an NSAID which
reduces pain and inflammation
oral decongestants can cause....
vasoconstriction
oxybutynin SE
Dry mouth, blurry vision, photophobia
Methotrexate
An immunosupressant
can cause bone marrow supression
nurse should monitor for fever or sore throat

donepezil, what should the nurse monitor for?

dyspnea

Using the ABC priority setting framework, the greatest risk to the client is
dyspnea as a result of bronchoconstriction caused by elevated acetylcholine
levels in the lungs.
Fluconazole is a (class)?
antifungal medication effective for treating oropharyngeal and systemic
candidiasis.
baclofen action
decreases the frequency and severity of muscle spasms, allowing for
improved muscle function
ergotamine sublingual should be taken.....(when)?
One tablet should be taken immediately after the onset of aura or headache
chlordiazepoxide for alcohol withdrawal is treating...?
delirium tremens
propranolol for alcoholic
decrease craving during alcohol withdrawal
haloperidol can cause what EPS
Akathisia
metoclopramide, what should the nurse monitor for?
sedation (CNS depression)
salmeterol is effective if patient reports.....
improved breathing

Salmeterol is a long-acting bronchodilator that prevents bronchospasm and

improves breathing
epoetin alfa, what should the nurse monitor for?
Increased BP if hematocrit rises too quickly
Patient teaching for Verapamil?
Change positions slowly as orthostatic hypotension may occur
client receiving warfarin therapy., what should the nurse monitor?
INR
atorvastatin, what should the nurse monitor?
CK

Mild injury, causing muscle weakness or aches, develops in some clients

taking statins, and this occasionally progresses to myositis. Creatinine kinase
(CK) levels rise in response to enzymes released with muscle injury.
oprelvekin action
a thrombopoietic growth factor and therefore a platelet count within the
expected reference range indicates the medication is effective
furosemide potential adverse effects
dizziniess, hypokalemia, urinary frequency
amphotericin B potential signs of infusion reaction
fever and chills
What effect of trimethoprim/sulfamethoxazole should be reported to the
provider?
A vesicular, crusty rash

is a sign of Stevens-Johnson syndrome, an adverse effect the nurse should

report to the provider.
valproic acid can cause.....
liver failure
instruct the client to look for signs such as jaundice
neostigmine AE
nausea, bradycardia, increased salivation
heparin-induced thrombocytopenia
platelet count less than 100,000/mm3
trimethoprim/sulfamethoxazole, what should the nurse report to the
provider?
A vesicular, crusty rash is a sign of Stevens-Johnson syndrome
clients taking an anticoagulant should report __________ to a client
bruising
What is the most sensitive method for determining thyroid activity?
measuring thyroid stimulating hormone
Fluconazole is useful in treating...
antifungal medication effective for treating oropharyngeal and systemic
candidiasis.
warfarin antedote
vitamin k
heparin antedote
protamine sulfate
magnesium sulfate antedote
calcium gluconate
acetaminophen antedote
acetylcysteine
client taking morphine sulfate, what should the nurse monitor for?
urinary retention, bradycardia, hypothermia, and pupil constriction
clindamycin AE
wattery diarrhea
neostigmine AE
nausea
sumatriptan
monitor for chest pain; may cause coronary vasospasms resulting in angina
zidovudine
can cause severe anemia. the nurse should plan to monitor hemoglobin
levels during treatment
Medications used to treat TB
Rifampicin and isoniazid
mirtazapine
used to treat depression
temazepam
used to treat insomnia
infliximab
used to treat moderate to severe Crohn's disease or rheumatoid arthritis
epinephrine injector
-Administer IM
-Massage the injection site for 10 seconds to promote absorption
-Store at room temperature
Trimethoprim/sulfamethozaole
Teach patient to drink 8 to 10 glasses of water daily
IV pyelogram allergy
shrimp; a shellfish allergy increases the client's risk for an allergic reaction to
contrast medium
Hydroxyurea, what findings should e reported?
low hemoglobin, low platelets, and low neutrophils
ondansetron
anti-emetic; used to treat n/v
magnesium sulgate
electrolyte replacement and can be used as an anti-convulsant
Timolol
beta blocker; caution in pts with bradycardia (as it can worsen the
bradycardia)
Ciproflaxacin
Tendonitis is a CI due to the risk of tendon rupture
lisinopril
client should be taught to repost a dry cough; a buildup of bradykinin from
this medication can cause a dry cough and lead to life-threatening
consequences; client should stop medication.
Methylphenidate
can result in weight loss d/t appetite suppression
diphenoxylate/atropine
causes dry mouth
decreases intesetinal motility and peristalsis--> monitor for abdominal
distension
client is allergic to penicillins, what med might he have hypersensitivity to?
cephalexin (a cephalosporin)
how should the nurse monitor the effectiveness of atenolol?
the clients blood pressure should decrease
atenolol
beta adenergic blocker
reduces CO, which reduces urinary output
can decrease sexual ability
catopril
ACE inhibitor
can cause hypotension-->teach client to change positions slowly
monitor for hyperkalemia
spironolactone
potassium sparing diuretic-->potassium retention

monitor for lethargy (an indication of hyperkalemia)

amitriptyline
anticholinergic effect of uninary retention
purpose of pegfilgrastim
to increase the clients WBCs
Pt with DI taking desmopressin
Monitor
Urine specific gravity (because of risk of water intoxication)
creatinine clearance (decreased renal function increases risk of water
intoxication)
serum osmolality (risk for water intoxication)
tranycypromine AE
OH; teach pt to move slowly when changing to a standing position
Lactobacillus acidophilus....why would it be prescribed?
to recolonize the intestinal flora
AE of rosuvastatin
myopathy; teach patient to report muscle pain as this could lead to a fatal
condition (rhabdomyolysis)
What medication should be administered for an opioid addiction?
methadone
what medication should be administered for an alcohol addiction?
disulfiran
What medication should be administered for a nicotine addiction?
bupropion
what medication should be administered for a methamphetamine addiction?
modafinil
fentanyl AE
constipation

a common SE of opioid use. stool softners can decrease the severity of this
effect
metoprolol
can lead to decreased BG levels
can cause a decrease in platelet count
monitor for bilateral crackles in the lungs; thic can indicate reduced CO and
heart failure, which is an AE of metoprolol
patient taking lithium should not take.....
ibuprofen...NSAIDs can significant;y increase lithium levels; therefore, the
client should not take ibuprofen and lithium concurrently
therapeutic INR for a patient on warfarin
2 to 3
clients who have a hypersensitivity to a sulfonamide (such as celecoxib) may
have.....
a cross sensitivity to thiazide diuretics
pilocarpine
used to treat glaucoma; patient will need to use drops for the rest of their life
MAX daily does of acetaminophen
4,000 mg
glucocorticoids
-reduce antibody response to vaccines and can increase the risk of infection
from live virus vaccines
-cause sodium and water retention-->edema
prednisone
immunosuppressant
Methotrexate AE
Stomatitis is an indication of toxicity; client should report sores in mouth to
provider
isotretinon, what test will be required?
pregnancy test; it is teratogenic
dopamine
caecholamine used to increased BP in the event of cardiogenic shock (causes
cardiac stimulation)
chemotherapy
may cause fetal malformation
isosorbide mononitrate
can cause hypotension
digoxin should be withheld when....
client's HR is <60
how should the nurse monitor the effectiveness of mannitol?
there should be a decreased in IOP
cyclosporine
may cause nephrotoxicity manifested by elevated serum creatinine level
allopurinol drug interactions
WARFARIN; may interfere with the hepatic drug-metabolozing enzymes that
are responsible for inactivating warfarin and thereby extend the
anticoagulant effects.
risedronate client teaching
sit upright for at least 30 to 60 minutes after taking risedronate; this will
reduce the adverse GI effects of esophagitis and dyspepsia
signs of hypoglycemia
sweating, tachycardia, hunger
atropine
anticholinergic agent; should be administered to reverse cholinergic toxicity
sequence for mixing NPH and regular insulin
1. insert air into NPH insulin
2. insert air into the regular insulin
3. draw up the regular insulin into the syringe
4. draw up the NPH insulin into the syringe

clear to cloudy when drawing up

transdermal patch
-should be applied to hairless area
-rotate sites daily
how should the nurse obtain a trough level of a medication?
draw blood immediately before the next dose of medication
drug with long half life is most likely given ______
1 time per day; they remain at their therapeutic levels between doses for
long periods of time
what are reasons medication dose may need to be decreased?
liver failure, concurrent use of medication metabolized by the same pathway
six rights
-client
-medication
-dose
-time
-route
-documentation
*to refuse
standing prescription
written for specific circumstances or a specific unit
routine prescription
identifies a medication that is given on a regular schedule. administer as
written until d/c.
EPS affect which body system?
central nervous system
client teaching when taking an antihypertensive
change positions slowly (orthostatic hypotension is common)
Check blood pressure on a daily basis
eat plenty of fruits and vegetables
acetaminophen OD will affect what organ?
liver (hepatotoxic)
administer what medication for a client experiencing n/v from
chemotherapy?
ondansetron hydrochloride (Zofran), an antiemetic
hypnotic medications work better at what time?
when given at the usual sleep time than at any other time `
pharmacology and older adults
increased gastric pH
decreased GI motility & gastric emptying
decreased BF through cardiovascular system, liver, and kidneys
decreased hepatic enzyme function
decreased kidney function and GFR
decreased protein binding sites
decreased body water, increased body fat, and decreased lean body mass
nursing interventions for client experiencing acute oral toxicity of alprazolam
(xanax)
gastric lavage followed by administration of activated charcoal or saline
cathartics
nursing interventions for client experiencing IV toxicity of alprazolam (xanax)
manifested as respiratory depression, severe hypotension, or
cardaiac/respiratory arrest)

administer flumazenil
alprazolam (xanax) AE
CNS depression
anterograde amnesia
paradoxical response
alprazolam (xanax) CI
clients who have sleep apnea, respiratory depression, or glaucoma
buspirone (BuSpar) medication/food interactions
Erythromycin, ketoconazole
St. Johns Wort
Grapefruit juice
buspirone (BuSpar) onset
it may take a week to notice the first therapeutic effects and 3 to 6 weeks for
the full benefit
when should the nurse teach the client to take paroxetine (paxil), a SSRI?
in the morning because it causes CNS stimulation which can lead to insomnia
muscarinic agonists
bethanechol
muscarnic antagonists
atropine
adrenergic agonists
epinephrine
adrenergic antagonists (alpha)
prazosin
Adrenergic antagonists (beta)
propanolol
muscarinic receptors
decrease secretions from lungs, stomach, intestines, sweat glands
decrease HR
smooth muscle contraction in bronchi and GI tract
miosis (sphincter contraction) and accommodation (cilliary contraction)
dopamine receptors
dilates blood vessels in the kidneys
beta 1 receptors
predominant receptor found on the heart
beta 2 receptors
dilates bronchi
relaxes uterine smooth muscle
skeletal muscle contraction
bipolar disorder
managed with mood stabilizers
neostigmine
prevents ACh degradition
neostigmine client teaching
wear med alert bracelet
dopaminergics
levodopa, carbidopa, sinemet
carbidopa
aurments levodopa by preventing conversions to dopamine in intestine and
periphery (increase DA in CNS)

levodopa actions
symptomatic relief from dyskinesias
dopamine agonists
pramipexole
pramipexole action
acts directly on dopamine receptors
benztropine AE
anticholinergic effects
benztropine CI
narrow-angle glaucoma
amantadine action
stimulate dopamine release, prevent dopamine reuptake, and may block
cholinergic and glutamate receptors
amantadine
CNS effects, discolorations of skin (temporary) and anticholinergic effects
hydantoins (antiepileptic)
phenytoin (Dilantin)
phenytoin (Dilantin)
gingival hyperplasia
phenytoin (Dilantin) interactions
oral contraceptives, warfarin, glucocorticoids
valproic acid CI
avoid in children younger than 3 (hepatotoxicity)
liver disorders
Gabapentin
used for seizures
aldosterone
promotes Na and H2O retention retention by kidneys
low dose dopamine
renal vasodilation
mod dopamine dose
renal vasodilation + increased HR, increased contractility, and increased AV
conduction
high dopamine dose
renal vasodilation + increased HR, increased contractility, and increased AV
conduction + vasoconstriction
alpha 1 receptors
vasoconstriction of arterioles in skin, viscera, and mucous membranes, and
veins
prazosin AE
first-dose OH (monitor BP for at leas 2 hours)
prazosin Interactions
antihypertensives--> additive hypotensive effect
NSAIDS/clonidine --> decreased antihypertensive effects
A client is taking Zidovudine, what lab test should the nurse plan on?
Hemoglobin

it can cause serious anemia, the nurse should plan to monitor hemoglobin
levels during treatment
client teaching regarding blood pressure for a client taking nitro?
check 1 hr after applying patch
how often should methotrexate be taken
weekly
onset of methotrexate
3 to 6 weeks
Dinoprostone (cervadil)
prostaglandin used to promote cervical ripening and to stimulate uterine
contractions
oxytocics
increase the strength, frequency, and length of uterine contractions
manifestations of hypertensive crisis
headache, nausea, vomiting, high blood pressure
goal of contractions
last 1 min or less every 2 to 3 minutes
tocolytic pharmacological action
selectively activates beta 2 adrenergic receptors, resulting in uterine smooth
muscle relaxation
CI of tocolytic use
Greater than 34 weeks gestation, acute fetal distress, severe Gestational
HTN, vaginal bleeding ,cervical dilation >6cm
how should the nurse administer terbutaline?
subcutaneously due to high first pass effect with
evidence of effectiveness of terbutaline...
cessation of preterm labor (20 to 36 weeks)
indomethacin
acts to suppress labor by inhibiting synthesis of prostaglandins
butorphanol and nalbuphine
pain relief without significant respiratory depression in mother or fetus
opiate given too soon
can delay progression of labor
opiate given too late
can depress neonatal respirations
pharmacological management of RA
provides symptomatic relief and some delay in progression of the disorder
wo resulting in cure
DMARDs
slow joint degeneration and progression of RA
glucocorticoids
provide symptomatic relief of inflammation and pain
NSAIDs (RA)
provide rapid, symptomatic relief of inflammation and pain
glucocorticoids/immunosuppressants
prevention of organ rejection in transplant clients such as kidney, liver, and
heart transplants
hydroxychloroquine
antimalarial agent
hydroxychloroquine AE
retinal damage (blindness)-->advise clients to have baseline eye
examination and follow-up eye exams every 6 months with an
ophthalmologist
cyclosporine Ae
risk of infection
hepatotoxicity-->monitor liver function
nephrotoxicity-->monitor BUN & creatinine
hirsutism
adalimumab (Humira) administration
subcutaneous
indomethacin (indocin)
NSAID indicated for relief of arthritis pain and inflammation but will not stop
the progression of the disease
abacept
T-cell inhibitor, which slows the progression of RA
therapeutic use of CNS stimulants
ADHD, conduct disorder
sustained-release tablets
swallow hole, do not chew or crush
Daytrana teaching
place the patch on one hip daily in the morning and leave it in place for no
longer than 9 hours. alternate hips daily.
atomoxetine (Strattera)
norepinephrine selective reuptake inhibitor
atomoxetine (Strattera) action
block reuptake of norepinephrine at synapses in the CNS; not a stimulate
medication
anticholinergic effects
Blurred vision
Urinary retention
Dry mouth
Constipation
Anhidrosis
Tachycardia
abstinence syndrome
occurs when clients abruptly withdraw from a substance to which they are
physically dependent
effects of withdrawal usually start....
within 4 to 12 hours after last intake
peak of withdrawal
24 to 48 hours
timeframe withdrawal subsides
usually 5 to 7 days, unless DT occurs
alcohol detoxification medications
benzos--
-chlordiazepoxide
-diazepam
-lorazepam
abstinence maintenance meds for alcohol
disulfiram
what will happen if disulfiram is taken with alcohol
acetaldehyde syndrome will occur; n/v, weakness, sweating, palpitations,
and hypotaneion-->respiratory depression, cardiovascular suppression,
seizures, and death
acamprosate
decreases unpleasant effects resulting from abstinence (anxiety,
restlessness)
nicotine replacement patch education
apply to clean, dry area of skin each day
AVOID USE OF NICOTINE PRODUCTS WHILE IN PLACE
stop if skin reaction occur
remove prior to MRI
patient is prescribes new prescription of clontidine, what should the nurse do
before administration?
obtain baseline vitals
primary open-angle glaucoma (POAG)
peripheral vision is lost gradually, with central visual field loss occuring if
damage to the optic nerve continues
angle-closure glaucoma (narrow-angle)
acute disorder with a sudden onset, resulting in irreversible blindness within
1 to 2 days without emergency treatment
angle-closure glaucoma clinical manifestations
acute onset of ocular pain, seeing halos around lights, blurred vision,
photophobia
first line treatment for angle-closure glaucoma
osmotic agents-->surgery
acute otitis media
bacterial or viral infection causes a buildup of fluid in the middle ear (middle
ear effusion)
otitis externa
"swimmers ear"
caused by bacterial infection of the external auditory canal
how to beta blockers impact aqueous humor
by decreasing the amount of aqueous humor produced
stinging or discomfort in the eye immediately after instilling beta blocker
eyedrop
educate client that this is temporary and transient
betaxolol CI
clients who have bradycardia and AV heart block; use carefully in patients
with heart failure
brimonidine
alpha 2 adrenergic agonist;
decreased production and may also increase outflow of aqueous humor to
lower IOP
first line treatment for POAG
lantanoprost
increases aqueous humor outflow through relaxation of ciliary muscle
AE of lantanoprost
-permanent increased brown pigment, usually occurring in individuals with
brown-colored iris
-stinging, burning, reddened conjunctiva
-blurred vision
-migraine (rare)
mannitol
osmotic agent; decrease intraocular pressure by making the plasma
hypertonic, thus drawing fluid from the anterior chamber of the eye
heparin uses
evolving stroke, pulmonary embolism, massive DVT;; treatment of DIC
stop heparin if platelet count is below...
100,000/mm3
nonheparin anticoagulants
lepirudin, argatroban
protamine sulfate administration
no faster than 20mg/min or 50 mg in 10 minutes
warfarin overdose
administer vitamin K-->if still uncontrolled, administer fresh frozen plasma or
whole blood
alteplase antedote
aminocaproic acid
how can the nurse tell if epotein alfa has been effective?
AEB hgb of 10-11 and max hct of 33%
sargramostim
granulocyte colony stimulating factor;
acts on bone marrow to increase production of white blood cells (neutrophils,
monocytes, macrophages, eosinophils)
d/c sargramostim if...
neutrophil count 20,000 or greater
WBC 50,000 or greater
platelets 500,000 or greater
expected outcome for oprelvekin
platelet count greater than 50,000/mm3`
bone pain is a dose related effect to
filgrastim; it can be treated with APAP or opioid, if necessary
acute hemolytic reaction
chills, fever, LOW BACK PAIN, tachycardia, tachypnea, hypotension
febrile nonhemolytic reaction
most common; sudden chills, fever, headache
anaphylactic reaction
anxiety, urticaria, wheezing, shock, and cardiac arrest
mild allergic reaction
flushing, itching, urticaria
circulatory overload
cough, shortness of breath, crackles, hypertension, tachycardia, distended
neck veins
platelets should be admiistered...
quickly (over 15 to 30 mins) to prevent clumping
fresh frozen plasma should be administered..
within 30 to 60 mins
whole blood or PRBCs should be administered...
within 2 to 4 hour
medications to treat PUD
amoxicillin, bismuth compounds, clarithromycin
histamine2 receptor agonists genertic ending
-tidine
histamine2 receptor agonists action
suppress secretion of gastric acid by selectively blocking receptors in parietal
cells lining the stomach
therapeutic uses of histamine2 receptor agonists
gastric and peptic ulcers, GERD, and hypersecretory conditions (Zollinger-
Ellison syndrome)
Cimetidine AE
decreased libido and impotence; CNS effects in older adults
cimetidine drug interactions
warfarin, phenytoin, theopylline, and lidocaine
concurrent use of ________ can decrease absorption of H2-receptor agonists
antacids
client teaching for antacids
take 1 hour before or after taking H2 receptor agonists
proton pump inhibitor generic ending
-prazole
PPI action
reduce gastric acid secretion by irreversibly inhibiting the enzyme that
produces gastric acid
PPI use
gastril and duodenal ulcers, erosive esophagitis, GERD, and hypersecretory
conditions
long-term use of PPI increases the risk of
osteoporosis
omeprazole drug interactions
dig, phenytoin, warfarin (increased)
when should a client take omeprazole?
once a day, in the morning, before breakfast
sucralfate
mucosal protectant; think substance that adheres to an ulcer; protects the
ulcer from further injury.
sucralfate administration
should be taken 4 times a day. 1 hour before meals and again at bedtime
aluminum hydroxide
antacid; neutralize gastric acid and inactivate pepsin
aluminum hydroxide and calcium carbonate may cause...
constipation
magnesium hydroxide (MOM) may cause....
diarrhea
misoprostol (cytotec) action
acts as an endogenous prostaglandin in the GI tract to decrease acid
secretion, increase secretion of bicarbonate and protective mucus, and
promote vasodilation to maintain submucosal blood flow
prostaglandin E analog (misoprostol) CI
pregnancy because it can induce labor by causing cervical ripening
misoprostol administration
take with meals and at bedtime
avoid using cannabinoids in clients...
who have mental health disorders
iron preparations
needed for RBC development and oxygen transport to cells
ferumoxytol
iron preparation that is limited to clients who have chronic kidney disease,
regardless if on dialysis or administered erythropoietin
vitamin b12 is necessary to
convert folic acid from its inactive form to its active form; all cells rely on
folic acid for DNA production
signs of vitamin b12 deficiency
beefy red tongue, pallor, neuropathy
potassium is essential for...
conducting nerve impulses, maintaining electrical excitability or muscle, and
regulation of acid/base balance
hypomagnesemia
magnesium level less than 1.3mEq/L
dietary sources of mg. sulfate
whole grain cereals, nuts, legumes, green leafy vegetables, bananas
black cohosh
acts as an estrogen substitute; treats symptoms of menopause
echinacea
stimulates immune system
valerian
prevent insomnia
reduce anxiety
RISK OF PHYSICAL DEPENDENCE
infuse potassium chloride no faster than ____
10mEq/hr to prevent vein irritation, phlebitis, and infiltration
feverfew
can decrease number and severity of migraine headaches
Kava can cause
liver damage; monitor liver enzymes
superinfection
type of infection caused when normal flora are killed by use of an antibiotic,
thus favoring the emergence of a new infection that is difficult to eliminate
narrow-spectrum antibiotics
sensitive to only a few types of bacteria
broad-spectrum antibiotics
sensitive to a wide variety of bacteria
bactericidal
directly lethal to the micro-organism
bacteriostatdic
slow the growth of the micro-organism, but it is usually destroyed by the
client's immune response of phagocytic cells
culture should be obtained....(when?)
prior to treatment with antibiotics
an immunocompromised person needs....(what kind of antibiotic?)...
strong bactericidal as opposed to bacteriostatic
gentamicin causes....(what in the fetus if given to pregnant woman?)
hearing loss
tetracyclines cause.....(what in the fetus if taken during pregnancy?)
discoloration of the developing teeth
sensitivity test
identifies the most effective antibiotic to be used to treat a specific micro-
organism
gram stain
determines whether a gram- or gram + organism is causing the infection
culture
determines the type of micro-organism that may be causing the infection
penicillins
destroy bacteria by weakening the bacterial cell wall
what is the medication of choice for meningitis?
penicillins
1st generation cephalosporin
cephalexin
each subsequent generation of cephalosporins is...
-more likely to reach cerebrospinal fluid
-less likely to be destroyed by beta-lactamase
-more effective against gram-negative organisms and anaerobes
cephalorsporins
broad-spectrum bactericidal medications with a high therapeutic index that
treat UTIs, postop. infections, pelvic infections, and meningitis
cephalosporins should not be given to...
clients who have a history of severe allergic reactions to penicillins
medications that can cause ototoxicity
vancomycin
loop diuretics
aminoglycoside antibiotics
vancomycin CI
patients with allergy to corn/corn products
patients with renal impairment, hearing impairment, and older adults
tetracyclines
broad-spectrum antibiotics that inhibit micro-organism growth by preventing
protein synthesis (bacteriostatic)
do not take tetracyclines just before laying down because....
increased risk for esophageal ulceration and should be avoided
paresthesias of the hands and feet may occur in patients taking...
streptomycin
RBCs
4.2-6.1
WBCs
5,000-10,000/mm3
MCV
80-95/mm3
platelets
150,000-400,000/mm3
hemoglobin males
14-18
hemoglobin females
12-16
hematocrit
27-52%
PT
11-12.5
INR
0.7-1.8
sodium
135-145
chloride
98-106
calcium
9-10.5
magnesium
1.3-2.1
phosphorus
3-4.5
AST
5-40 units/l
total bilirubin
0.1-1
protein
6-8
albumin
3.5-5
serum creatinine
0.5-1.2
BUN
10-20
urine output
30ml per hour
urine specific gravity
1.010-1.025
t3
70-205
t4
4-12
tsh
0.3-5
cholesterol
<200
rapid-acting insulin
lispro (humalog)
lispro (humalog) onset
15-30 mins
lispro (humalog) peak
0.5-2.5 hrs
lispro (humalog) duration
3-6 hrs
regular insulin (short-acting)
humulin R
Humilin R onset
0.5-1 hr
humilin R peak
1-5 hours
humilin R duration
6-10 hours
intermediate acting insulin
NPH (humulin N)
NPH insulin (humilin N) onset
1-2 hours
NPH insulin (humilin N) peak
6-14 hours
NPH insulin (humilin N) duration
16-24 hours
long acting insulin
insulin glargine (lantus)
insulin glargine (lantus) onset
70 minutes
insulin glargine (lantus) peak
none
insuling glargine (lantus) duration
24 hours
ACE (enzyme)
converts angiotension I to angiotensin II
angiotensin II
vasoconstricts and stimulates aldosterone release
aldosterone action
na and water retention, K excretion
primary uses of ACE inhibitors
hypertension, heart failure, prevention of MI/stroke, diabetic and nondiabetic
neuropathy
AE of ACE inhibitors
first-dose hypotension
cough
angioedema
renal failure (CI in pt with renal artery stenosis)
fetal injury
ACE inhibitors drug interactions
lithium-levels become toxic
NSAIDs-may reduce effectiveness
ARBs generic name ending
-sartan
eplerenone (what type of med is it?)
aldosterone antagonists
direct renin inhibitor (something about food..?)
high fat meals decrease absorption
calcium channels open=
vasoconstriction
calcium channels closed=
vasodilation
common side effect of verapamil
constipation (especially in older adults)
hydralazine
vasodilator

hydralazine AE
relfex tachycardia, retention of water and sodium
sodium nitroprusside (nipride)
potent and quick acting vasodilator
indicated for hypertensive emergencies
MONITOR BP CAREFULLY
prolonged infusion of sodium nitroprusside can result in....
toxic accumulation of cyanide and thiocynate
acr inhibitors produce their effects by...
blocking the conversion of ANG I to ANG II
neutropenia is a rare but serious side effect of... (ACE inhibitor)
catopril--monitor client's WBC every 2 weeks for 3 months
"flox"
don't give to <18yo
tendon rupture!
extreme photosensitivity
-dipine
ca channel blocker
-vir
antiviral
calcium channel blockers...use caution in patient taking?
digoxin and beta blockers
acyclovir is....(toxic?)
nephrotoxic
febrile non-hemolytic reaction
FEVER (or 1 degree over baseline in 15 mins)
allergic transfusion reaction
itching, hives, assess patient before to get baseline
beta blocker masks the signs of....
hypoglycemia (by masking the tachycardia)
CI in diabetic patients
verapamil
calcium channel blocker
what is the initial treatment of HBP?
HCTZ--> potassium waisting diuretic, need kidney function
albuterol
relaxes bronchial smooth muscle, beta 2 agonist, can cause tremors and
tachycardia
what should the nurse administer to a patient in cholinergic crisis?
atropine
ginko bilobo
enhances memory by increasing circulation
meperidine does not cause....
respiratory depression
when should the nurse teach the patient to administer sucralfate?
1 hour before meals and at bedtime
acyclovir AE
phlebitis and inflammation at infusion site
nephrotoxicity
mild discomfort (GI)
ganciclovir AE
bone marrow suppression, including leukocytes and thrombocytes
fever, headache, nausea, diarrhea
Acyclovir CI
renal impairment, dehydration, or already takin nephrotoxic medications
acyclovir therapeutic uses
treat herpes simplex and varicella-voster viruses
ganciclovir therapeutic uses
treatment and prevention of cytomegalovirus (CMV); prevention therapy for
clients who have HIV/AIDs, organ transplants, and other
immunocompromised
highly active antiretrival therapy (HAART)
involves using 3+ different medications to reduce the amount of virus and
CD4 counts
zidovudine action
reduces HIV symptoms by inhibiting DNA synthesis and thus viral replication
zidovudine therapeutic use
first line antiretroviral to treat HIV infection
zidovudine AE
bone marrow suppression
lactic acidosis, hepatomegaly/fatty liver, nausea, vomiting, diarrhea
cardiac glycosides
used in treatment of clients who have cardiac failure or ineffective pumping
mechanism of the heart muscle
CI of organic nitrates
clients with head injury
patient taking ERECTILE DYSFUNCTION MEDICATIONS
amiodarone action
prolongs repolarization, relaxes smooth muscle, decreases vascular
resistance
adenosine treats what kind of antidysrhythimic?
SVT! (converts if to sinus rhythm)
adenosine nursing implications
Rapid IV push! (over 1-2 secs)
flush immediately with NS
amiodarone
treats v.fib. and unstable ventricular tachycardia
antilipemic medications action
aid in lowering LDLs and increasing HDLs in addition to diet, exercise, and
weight control
when should antilipemic medications be taken?
in the evening (cholesterol synthesis increases)
statin medications action
interfere with hepatic enzyme HMG COA to reduce formation of cholesterol
precursors
statin medications precautions
prolonged bleeding in clients taking warfarin
cholesterol absorption inhibitor prototype
ezetimibe
cholesterol absorption inhibitor action
inhibits the absorption of cholesterol secreted in the bile and from food. often
used in combination with other antilipemic medications
advise the client to take ________ before inhaled glucocorticoid...why?
beta2 agonist; to increase absorption
beta 2 adrenergic agonists action
promote bronchodilation by activating beta2 receptors in bronchial smooth
muscle
albuterol is _______ acting
short
formoterol is ______ acting
long
beta 2 adrenergic agonistsside effects
tachycardia, palpitations, tremors
methylxanthines CI
patient with PUD
methylxanthines client teaching
avoid caffeine
avoid smoking
avoid drinking alcohol
inhaled anticholinergics prototype
ipratropium (atrovent)
inhaled anticholinergics CI
Contraindicated for clients with peanut allergy
EXTREME CAUTION WITH NARROW-ANGLE GLAUCOMA AND BPH
glucocorticoids action
prevent inflammatory response by suppression of airway mucus production,
immune response, and adrenal function
clients who have _______ ______ may require higher doses of glucocorticoids
diabetes mellitus
codeine
suppress cough through action in the CNS; used for non productive cough
guaifenesin (Mucinex)
promote increased mucous section to increase cough production
MDI client teaching
wait one minue between puffs
how will the nurse know if omeprazole was effective?
improvement of GERD
phenanzopyridine
reddish orange discoloration of urine may occur
vantomycin
ototoxic; check trough levels (very narrow therapeutic range)
mucomyst
increase mucus in respiratory tract
monitor for bronchospasm and aspiration
CI in patient with asthma
cholinesterase inhibitor prototype
neostigmine
neostigmine therapeutic uses
MG and reversal of nondepolarizing neuromuscular blocking agents
how should the nurse monitor for effectiveness of neostigmine?
fewer episodes of fatigue; improvement in strength as demonstrated by
chewing, swallowing, and performing ADLs
COMT inhibitors action
enahances the effect of levodopa by blocking its breakdown
MAO-B action
prevents dopamine breakdown
MAO-B prototype
selegiline
Amantadine
dopamine releaser prevents dopamine reuptake
amantadine AE
CNS effects
Atropine-like effects
Discoloration of skin (livedo reticilaris)
levodopa/carbidopa...advise client to avoid...(FOOD)
high-protein meals and snacks
how should benzodiazepines for detox be adminnistered?
around the clock or PRN
obtain baseline vitals!
what medication will help a person in alcohol detox with craving?
propranolol
when in alcohol detox, what medication is given to a person to decrease
seizures?
carcabazepine
when in alcohol detox, what medications will decrease the persons automatic
response? (decrease in BP, heart rate)
clonidine, propranolol
naltrexone
pure opioid antagonist that supresses te craving and pleasurable effects of
alcohol (also used for opioid withdrawal)
buprenorphrine action
agonist-antagonist opioid used for detoxification and maintenance;
decreases feelings of craving and may be effective in maintaining adherence
bupropion nursing interventions
to treat dry mouth, encourage clients to chew sugarless gum or suck on hard
candy and to sip on small amounts of water and ice chips;
advise clients to avoid caffeine and other CNS stimulants to control insomnia
what is the max amount of time a client should use the nicotine replacement
therapy gum, nicorette?
6 months
varenicline action
nicotine receptor agonist that promotes the release of dopamine to stimulate
the pleasurable effects of nicotine
varenicline nursing implications
instruct client to take after meal
monitor BP, blood sugar
atropine counteracts the effects of.....? (medication)
neostigmine; so it is used for toxicity!
carbidopa action
decreases the amount of levodopa that is converted to DA in the intestine
and periphery. this results in larger amounts of levodopa reaching the CNS
MOA-B and MOAI....teach client to avoid...
tyramine containing foods
tyramine containing foods....
avocados, soybeans, figs, smoked meats, dried or cured fish, cheese, yeast
products, beer, chanti wine, chocolate, caffeiated beverages
antiepileptic medications
phenobarbital, phenytoin, gabapentin (newer)
phenytoin adverse effects
CNS effects
gingival hyperplasia
skin rash
teratogenic
cardiovascular effects
phenytoin decreases the effects of... (medications)?
oral contraceptives, warfarin, glucocorticoids
what medications increase phenytoin levels?
alcohol
diazepam
cimetidine
valproic acid
CAUTION!
valproic acid should not be given to a patient under.....(age)?
2 years old
gabapentin AE
somnolence, dizziness, ataxia, fatigue, nystagmus, peripheral edema--
>these will diminish in time
bethanechol use
urinary retention; stimulates muscarine receptors in the GU tract, theryby
causing relaxation of the trigone and sphinctor muscles and contraction of
the detrusor muscle
oxybutynin
muscarinic antagonist; used for neurogenic bladder
baclofen AE
nausea, constipation, urinary retention
dantrolene AE
hepatotoxic!; muscle weakness
bethanechol therapeutic use
nonobstructive urinary retention (usually post-op or PP)
succinycholine action
neuromuscular blocking agent blocks acetylcholine (ACh) at the
neuromuscular junction, resulting in muscle relaxation and hypotension;
does not cross the BBB
succinycholine use
used as adjunct to general anesthesia to promote muscle relaxation
succinycholine can cause....(something bad?)
malignant hyperthermia
malignant hyperthermia symptoms
muscle rigidity accompnaied by increased temperature, reaching levels as
high as 109.4F (43C)
treatment for malignant hyperthermia
initiate cooling measures including administration of iced 0.9% sodium
chloride, applying a cooling blanket, and placing ice bags in the groin and
other areas; ADMINISTER DANTROLENE to decrease metabolic activity of
skeletal muscle
baclofen therapeutic uses
relief of spasticity related to cerebral palsy, spinal cord injury, and MS
all muscle relaxants and antispasmodics can cause...
CNS depression (sleepiness, lightheadedness, fatigue)
Baclofen AE
nausea, constipation, and urinary retention
bethanechol CI
urinary or GI obstruction
peptic ulcer disease
coronary insufficiency
asthma
hyperthyroidism
therapeutic uses of oxybutynin
overactive bladder
AE of oxybutynin
anticholinergic effects, CNS effects
oxybutynin is an anticholinergic and can increase....
IOP; therefore it is contraindicated in patients with glaucoma
phenylephrine
decongestant; reduces inflammation of nasal membranes
diphenhydramine (benadryl)
antihistamine; decrease allergic response by competing for histamine
receptor sites
biguanides
metformin (glucophage)
metformin indications
withhold 48 hr prior to and 48 hr after a test with contrast media; CI in client
with severe infection, shock, hypoxic conditions
emergency treatment for severe hypoglycemia
glucagon
levothyroxine treats....
hypothyroidism
levothyroxine should be taken....
in the morning (before first meal)
dabigatran
prevents thrombus formation by directly inhibiting thrombin formation
chronoic gout
alllopurinal; decreases uric acid production
antiplatelets therapeutic uses
prevention of acute myocardial infarction or acute coronary syndromes;
prevention of stroke; intermittent claudication
antiplatelets contraindications
pt with thrombocytopenia, caution in pt with PUD
antiplatelets client teaching
monitor for signs of prolonged bleeding;
teach client to report tarry stools, ecchymosis
thrombolytic medications action
dissolve clots that have already formed by converting plasminogen to
plasmin, which destroys fibrinogen and other clotting factors
thrombolytic must be administered....
within 4 to 6 hours of symptom onset
antacids must be administered....
up to 7 times per day: 1 hr and 3 hr after meals and at bedtime
psyllium (metamucil) action
decreases diarrhea (bulk-forming)
docusate sodium (colace)
relieve constipation (surfactant)
bisacodyl (dulcolax)
stiumlant laxative
clonidine (catapres)
centrally acting alpha agonists
beta2 blockade
avoid in clients who have asthma
if a client has asthma and hypertension, what medication should they get to
treat the HTN?
a beta1 selective agent (propranolol)
beta blockers should not be admininstered with ________
calcium channel blockers; they will intensify the effects
sodium nitroprusside action
direct vasodilation of arteries and veins resulting in rapid reduction of blood
pressure (decreased preload and afterload)
sodium nitroprusside may be.....(color)?
light brown; discard solution of any other color

Which Schedule 2 med is at greater risk for abuse and dependence than
which Schedule 4 med?
Morphine (S2)
Luminal (S4)

What is the nursing evaluation for effectiveness of High Ceiling Loop

Diuretics?
1. Decrease in pulmonary or peripheral edema
2. Weight loss
3. Decrease in blood pressure
4. Increase in urine output

What is the nursing evaluation for effectiveness of Thiazide Diuretics?

1. Decrease in blood pressure
2. Decrease in edema
3. Increase in urine output

What is the nursing evaluation for effectiveness of Potassium-Sparing

Diuretics?
1. Maintenance of normal potassium levels
2. Wt Loss
3. Decrease in BP/Edema
What is the nursing evaluation for effectiveness of Osmotic Diuretics?
1. Urine output of at least 30 mL/hr
2. Crea 0.6-1.2 (Men) 0.5-1.1 (Women)
3. Bun 10-20
4. Decrease in intracranial/intraocular pressure

What to report if taking Methotrexate?

1. Sore throat
2. Anorexia
3. Abd fullness
4. Jaundice
5. Check gums
6. Don't take if pregnant

What to report if taking Auraofin?

1. Bruising
2. Gum bleeding

What to report if taking Hydroxychloroquine?

Blurry Vision

What to report if taking Etanercept/Infliximab?

1. Infection s/s
2. Crackles
3. Bleeding
4. Bruising
5. Hep B Testing

What to report if taking Predisone?

1. Crackles
2. Wt Gain
3. Edema
4. GI bleeding
5. Monitor K

What is the platelet count where you stop Heparin/Lovenox/Fondaparinux?

<100,000

What is the normal PTT levels of Heparin?

60-80 seconds

What is the normal PT levels?

18-24

What is the normal INR levels?

2-3
What adverse effects do you document for psychotic d/o?
1. Acute dystonia
2. Parkinsonism
3. Akathisia
4. Tardive Dyskinesia
5. Neuroleptic syndrome
6. Anticholi Effects
7. Gynecomastia
8. Galactorrhea

When do use opioid agonists?

1. Relief of moderate to severe pain (postop, MI, pain)
2. Sedation
3. Reduction of bowel motility
4. Codeine - Cough Suppression

What do you assess for when giving opioid agonists?

1. For cancer, Opioids have a fixed schedule
2. Patch will take several hours to achieve desired effect.
3. Don't d/c abruptly, if have dependence.

What do you assess for when giving Agonist-Antagonist Opioids?

1. Check for dependence
2. Advise not to get out of bed or operate machinery

What are antihistamines for URI?

1. Diphenhydramine
2. Promethazine
3. Dimenhydrinate
4. Loratadine

What is the client teaching for Cyanocobalamin?

1. Monitor K
2. Watch for Low K s/s (Muscle weakness, abnormal cardiac rhythm)

When do you need to adjust the dosage for DM?

1. May need to be increased in response to increase in caloric intake,
infection, stress, growth spurts, and in the 2nd and 3rd trimesters of
pregnancy
2. May need to be decreased in response to level of exercise or first tri of
pregnancy.

How do you know Lioresal is working?

Relief of spasticity r/t cerebral palsy, spinal cord injury, and MS
What is a medication interaction for meds for Angina?
1. Alcohol
2. Beta Blockers
3. Calcium Channel Blockers
4. Diuretics
5. Sildenafil
6. Nitro
7. Sotalol
8. Digoxin
9. Simvastatin

How do you recognize the s/e for Opioids Agonists and Antagonists?
1. Report RR <12
2. Increase fiber
3. Advise to sit down if dizzy
4. Void every 4 hrs
5. Increase fluids

How do you evaluate PCA use?

1. Encourage PCA use prior to activites
2. When switching from PCA to oral, make sure client has enough PCA til oral
kicks in.

What is a expected effect of Clonodine?

1. Decreased HR
2. Decreased myocardial contractility
3. Decreased rate of conduction through the AV node

What is the patho for Fosinopril?

ACE inhibitors produce their effects by blocking the conversion of Angio I to
Angio II leading to:
- Vasodilation
- Excretion of Na and H2O, and retention of K

What is the expected action of retroviral?

Decrease in manifestations of HIV infection and remain free from
opportunistic infections

What is contraindicated with Cephalosporins?

1. Warfarin
2. Administer Vit K
3. Observe clients for bleeding

How can insulin be administered?

1. SubQ
2. Continous infusion
3. IV

When can insulin not be administered?

1. When cloudy or disscolored
2. Glargine/Detemir should not be mixed with other insulins

What is seen with digoxin toxicity?

1. Dysrhythmias
2. Anorexia
3. Blurred vision
4. Yellow-Green or white halos around objects

How do you evaluate client teaching for bipolar d/o?

1. Give with milk
2. Withhold med for Lithium toxicity

When do you discontinue a med for blood pressure?

1. Stop taking Diuretic, if starting ACE inhibitor
2. Pregnancy

What is the client teaching for Methlyphenidate?

1. Don't chew or crush
2. Give before and after meals

What are physiologic changes that affect pharmokinetics?

1. Increased gastric pH
2. Decreased GI motility and gastric emptying time.
3. Impaired memory or altered vision
4. Changes in vision/hearing
5. Poor adherence
6. Reduced financial resources

What is client teaching regarding S/E for Amoxicillin?

1. Don't take with allergy to Penicillin
2. Allergy band

What is meds for Inflammatory bowel disease?

Dexmethasone

What is the therapeutic effect of Metformin HCl?

Treat Polycytic Ovary Syndrome

What are medication interactions with Oral contraceptives?

1. Coumadin
2. Dilantin
3. Tegretol
4. Rifampin

What is the outcome of iron therapy?

1. Increased reticuloyte count
2. Increased Hemoglobulin
3. Increased energy

What is the expected response of ACE inhibitors?

1. Excrete Na and water
2. Retention of K

When do you withhold lithium?

1. Lithium < 1.5 - 2.0

How should Nitroprusside be titrated?

Shouldn't be taken for prolonged use.

When does Medication Reconciliation occur?

1. Admission
2. Transferring between units

What is the expected outcome of Nonopioid analgesics?

1. Reduction in inflammation
2. Reduction in fever
3. Relief from mild to moderate pain
4. Absence of injury

What is the expected outcome of Alluprinol?

Inhibit uric production

Why should short acting opioids be given while giving fentanyl patches?
For breakthrough pain

What should you monitor when taking Beta blocker eye drops?
1. Overdose can cause or increase systemic effects
2. Monitor pulse rate for bradycardia
3. Occasional conjunctivitis
4. Blurred vision
5. Photophobia
6. Dry eyes
What adverse effects will you see from Antimyobacterial?
1. Peripheral neuropathy
2. Hepatotoxicity
3. Hyperglycemia
4. Izoniazid inhibits metabolism of phenytoin

What requires further teaching with vitamins?

1. Vitamin C when taking Iron meds
2. Not taking potassium supplements with meals

Can a benzo be dicontinuted abruptly?

No, must be tapered.

When should a nonbenzo be taken?

Bedtime

How do you know the TB meds worked?

Improvement of TB s/s
1. Clear breath sounds
2. No night sweats
3. Increased appetite
4. No afternoon rises of temp

When should patients take Repaglinide?

Instruct clients to eat within 30 mins of taking the dose

What drug cannot be given after biliary tract surgery?

Morphine

What are the side effects of Verapamil?

1. Orthostatic hypotension
2. Constipation
3. Bradycardia
4. Dysrhythmias
5. Verapamil can increase digoxin toxicity

What medication will interact with Wellbutrin?

MAOIs increase the risk of toxicity

What are the side effects of Sinemet?

1. N/V
2. Dyskinesia
3. Hallucinations
4. Bradycardia
5. Discoloration of sweat and urine
What are adverse effects of Infliximab?
1. Injection site irritation
2. Flu like symptoms
3. Hypotension
4. Possible anaphylaxis

What do you teach patients regarding Nicotrol?

1. No eating or drinking 15 mins prior to or while chewing the gum
2. Remove patch prior to MRI scan and replace after.

What do you do if there was a medication error?

Occurrence report

What are contraindications for Urinary Tract Infections?

1. Patients with folate deficiency
2. ACE inhibitors
3. Angio 2 receptor blockers
4. Cipro increases risk of C.Diff

What is the max dosage of Acetaminophen?

4g/day

What is s/e of Vancomycin?

1. Check for hearing loss
2. Administer over 1 hr to prevent red man syndrome
3. Contraindicated to pt with corn allergies

What is the tx for anginal attack??

1. 3 tablets max, 5 mins each
2. Call 911 if first tab not effective.

What do you do with penicillin if patient has a allergy?

Withhold the medicine

What are three diuretics often used?

Furosemide (Lasix)
bumetinide (Bumex)
hydrochlorothiazide (HCTZ)

What are diuretics' most common adverse affects?

All cause dizziness (orthostatic hypotension)
All cause hypokalemia (except spironolactone)
All cause Hyperglycemia!
All cause urinary frequency
What is a drug used in hyperthyroidism (Graves Disease)? And what is the
expected outcome?
Propothiouracil (PTU) ; So they should maintain normal weight, sleep
regularly, and FOCUS better!

What are some adverse reactions of Prednisone (Deltasone)? What is

Prednisone?
Prednisone (Deltasone) is a steroid.
Adverse reactions: Increased chance of infection, blood sugars increase, and
long term they are at risk for osteoporosis.

How long can you use nasal decongestants for?

Limit use to 3-5 days.

What are some adverse effects of oral decongestants?

They cause systemic effects, and can cause HTN and blood vessel
constriction.

What do ACE Inhibitors do? (Provide examples) What are some adverse
effects of ACE I?
Dilates arteries and veins by blocking the secreting effects of angiotensin II.
Decreases preload/afterload on heart. They're cardioprotective/renal
protective.
(End in -pril; captopril, enalapril, lisinopril)
ADVERSE EFFECTS: Dry cough (can switch to ARB), angioedema,
hyperkalemia

What would you educate a patient on antibiotics?

Report watery stools (C. Diff/colitis), crusty rashes (Steven's Johnsons
Syndrome) and it interacts with oral contraceptives so use other protection.

Which of the following should the nurse monitor for with administration of
amphotericin B (Fungizone) IV for histoplasmosis?
Fever; infusion reaction.

What is Donepezil (aricept) indicated for? What can be a life threatening

adverse reaction?
Alzheimer's. Dyspnea is important to look for in a patient.

What is phenytoin (Dilantin) indicated for?

To treat seizures.

A nurse is providing teaching to a client who has a prescription for phenytoin

(Dilantin). Which of the following statements by the client indicates an
understanding of the teaching?
"I should let my dentist know I am taking this drug"causes gingival
hyperplasia.

What classification is Verapamil (Calan)? What is a common adverse

reaction? What would you teach this patient?
It is a calcium channel blocker (antihypertensives).
Adverse reaction: hypotension
Teaching: Change positions slowly

What is epinephrine indicated for? What are some adverse reactions of

epinephrine?
Anaphylaxis, severe allergic reaction
Adverse reactions: urticaria, dizziness, hypotension (b/c of vasodilation)

What would you give to a patient with a skin rash and normal vital signs from
a medication?
Benadryl- call for a change in medication.

What is salicylism?
A toxic condition produced by the excessive intake of salicylic acid or
salicylates (aspirin) and marked by tinnitus, N/V, and hyperventilation (resp.
alkalosis)

What puts a patient at risk for salicylism?

Aspirin (Bayer) daily for the last year
Bismuth subsalycilate (Pepto Bismol) regularly.

What medications do we give in tuberculosis?

We give multiple drugs to eliminate various combinations of resistant strains
However, commonly we give; INH, Rifampin, PZA [INH/Rifampin are the go-to
drugs]

What side effect is normal in Iron (Ferrous sulfate)? Will they bruise easily?
-Black tarry stools are normal.
-They will not bruise easily because this is not an anticoagulant, it will
increase RBCs and reticulocytes.

What medication do you NEVER take with Iron (Ferrous sulfate)? How do you
take Iron?
NEVER take antacids. Take the medication with food because it prevents GI
upset. We also have them sit up after administration for 30 minutes.

What is Mannitol indicated for? What happens when edema occurs?

We give it to decrease intraocular pressure and intracranial pressure. NOT for
edema.
If edema occurs, know that this drug can cause heart failure.
Which of the following should we monitor for and report to the provider for a
patient taking Valproic Acid (Depakote)?
A. Jaundice
B. Muscle pain
C. Dry mouth
D. Blurred vision
Jaundicemeds either clear through the liver or kidney!

What is Valproic Acid (Depakote) indicated for?

Treats seizures (epilepsy). Also used to treat mood disorders and prevent
migraine headaches.

What is Cogentin (Benztropine) indicated for?

It's an Antiparkinsonian drug. Used with anti-psychotics to reduce EPS
effects.

What are adverse reactions of Cogentin (Benztropine)?

Anticholinergic (Can't see, pee, spit or shit), and tacyhycardia.

What is important to remember about SSRIs (Fluoxetine, Prozac)?

Never stop suddenly. Taper even if a rash occurs, give antihistamines also.
Also remember to assess for suicidal ideation.

What is most important to monitor for in patient's taking Methotrexate?

Monitor for signs of infection!!

What is Metoclopramide (Reglan) indicated for? What adverse effect can it

have?
Indicated for delayed gastric emptying, gastroesophageal reflux, N/V
ADVERSE EFFECT: EPS Effects, and sedation

What lab levels are we looking for in a patient with hypothyroidism? What
labs would we look at to know synthroid is working?
-TSH elevates because it isn't being converted into T3 or T4.
-Effective outcome is TSH(0.3 and 3.0 mIU/L) in effective range as well as
T4(4-12 mcg/dL).

What do antilipemics do?

Drugs used to reduce lipid levels in blood in patients with a history of
coronary heart disease or diabetes mellitus

What critical adverse reaction are we watching for when giving "statins"?
What lab would we look at?
-Muscle pain= Rhabdomyolysis
-Creatine kinase level is what we assess because it correlates with muscle
injury

What medications do we give in acute alcohol withdrawal?

We are worried about seizures so we give chlordiazepoxide (Librium), or
lorazepam (Ativan).

What antihypertensive do we know frequently causes hyperkalemia?

ACE Inhibitors (-pril)

What is the only potassium sparing diuretic?

Spironolactone (Aldactone)

What is Cyclosporine (Sandimmune) indicated for? What adverse reaction

would we be watching for?
Prevent organ rejection (kidney/liver/heart), rheumatoid arthritis, psoriasis
Watch for nephrotoxicity, post transplant diabetes mellitus

What is timolol (timoptic)? What does it do? Who do we not want to give it
to?
It is a beta blocker.
It slows down the heart rate.
Pts with a hx of bradycardia.

What is myasthenia gravis?

-An autoimmune neuromuscular disease leading to fluctuating muscle
weakness and fatigue.
-Atropine

What is the antidote for myasthenia gravis?

A. Naloxone
B. Protamine
C. Flumazenil
D. Atropine
Naloxoneopioid reversal
Protamineheparin reversal
Flumazenilbenzodiazepine reversal
****Atropine even if you didn't know that atropine is an
anticholinergic...process of elimination will get you there!

What is the go-to medication for an UTI? What allergy should you assess for?
-Bactrim
-Assess for sulfa allergies

How do you draw up two different insulins?

Air into cloudy
Air into clear
Draw up clear
Draw up cloudy

What teaching would you give to your patient going home with an Epi-pen?
It is only one injection, keep with you at ALL times, and give
INTRAMUSCULARLY.
Massage the site afterwards.

What medication is indicated in HIV/AIDS?

Retrovir (zidovudine)
Since, this a viral problem- you give an antiretroviral (usually have -vir)

What medication is most commonly indicated for herpes?

Acyclovir

What lab value would you assess for a patient getting an antiretroviral?
You would monitor the CBC intensely

You have a patient on a long term prednisone for rheumatoid arthritiswhat

do we worry about with steroids?
Weight GAIN (moon faces, buffalo hump)
Hyperglycemia
Osteoporosis
And because they cause sodium and fluid retention, Edema can mean we
have many problems!

What effects are we concerned about in a patient taking lomotil

(diphenoxylate/atropine)?
Anticholinergic effects so we are worried about abdominal distenstion,
absent bowel sounds, etc.!

Your patient taking methotrexate (trexall) has stomatitis (mouth sores), what
are you concerned about?
This med causes infection so open wounds in the mouth can indicated
adverse reactions to this med.

What is dopamine and what does it do?

Dopamine is a vasopressor and increases blood pressure!

What is DDAVP indicated for? What would we watch for?

Diabetes insipidus to stop the massive urine output (4-5000 ml/hr). We would
watch for anything to do with kidney function.
You have a patient with lithium toxicity, what would you not want to give for
pain relief?
Ibuprofen, because it is an NSAID and increases lithium toxicity.

What are normal lithium levels?

0.4-1.0 mEq/L

What do we ask for routinely when we ask for allergies?

Are you allergic to any medications? Latex? Shellfish? Betadine?
[We ask about shellfish because hospitals have tests that involve IV contrast]

What kind of labs do we watch when we give INH (isoniazid) and rifampin?
We watch for liver toxicity.

What is the most important thing to know about oxytocin (pitocin)?

If contractions are lasting longer than 60 seconds, you stop the infusion.

You're giving rosuvastatin (crestor), what are you watching for?

This is an antilipemic so you're watching for MUSCLE PAIN which is a sign of
RHABDOMYOLYSIS.

What is Amitriptyline (Elavil)? Which side effect are we most worried about?
A. Diarrhea
B. Cough
C. Decreased libido
D. Urinary retention
It is a TCA antidepressant. We are most worried about the urinary rentention
because the bladder is limited size.

What are signs of hypoglycemia in patients who are diabetic taking

metoprolol?
Sweating because they will not have tachycardia because of the metoprolol.

What should you teach your patient about applying a nitroglycerin patch?
-Put on hair free site
-Rotate locations
-Check BP for regular use of patch
-Can cause a headache

What adverse reactions are we concerned about in gentamicin?

Ototoxicity, which usually means nephrotoxicity.
[Mice have big EARS and KIDNEYS! OTOTOXICITY! NEPHROTOXICITY!]

What antihypertensive is contraindicated in heart failure?

Beta blockers (ending in -olol), it slows down the heart rate which puts the
heart at greater risk for failure.
Tylenol Facts
- No more than 325 mg per tablet
- Do NOT exceed 4,000 mg
- NOT an NSAID
- Stomach safe
- INCREASE warafrin effects (INR testing)

Volume Excess S/S

- Crackles
- Periorbital edema, NOT peripheral
- INCREASED HR

Epinephrine
- INCREASE HR
- Bronchodilation
- Counteracts anaphylaxis

Nitroglycerine
- Take on an empty stomach with water
- do NOT abruptly stop taking the medication

Pain has what effect on the body

-- INCREASE HR
- INCREASE oxygen demand

Allopurinol
Gout medication - DECREASES amount of uric acid - INCREASE water intake -
Take with food

Atropine
- Anticholinergic
- Treats muscarinic effects ( sweating, diarrhea)

Laxative use
- NOT indicated for SBO
- Short term use
- No milk or antacids

Theophylline S/E
- Tachycardia
- Urinary Frequency
- Diarrhea
- Insomnia
Circulatory Overload S/S
- Dyspnea, Crackles, JVD
- Tachycardia

Central Venous Catheter Important Points

- Position Pt. in Left Trendelenberg
- Provide Oxygen
- ALWAYS clamp catheter FIRST if adverse RXN occurs

Left Sided Heart Faliure S/S

- Dypnea
- Orthopnea
- Proximal noctural dyspnea

Right Sided Heart Faliure S/S

- GI bloating
- JVD

Methotrexate
- Can cause RENAL toxicity
- INCREASE daily water intakke
- Take on an empty stomach
- Do NOT take NSAIDs
- Causes drowsiness

Asthma drug Side Effects

- Liver toxicity ( jaundice)
-

Tamoxofin
-TREATS Breast cancer
- Changes in period are expected
- May cause weight loss
- May cause vision changes
- Yellowing of skin

Lab Tests
Warfarin= PT
Heparin = aPTT

Antacids
- S/E = constipation
- Take with water
Ex: aluminum hydroxide 0r calcium carbonate
Gout
- Increase amount of fluid intake
- Do NOT take aspirin/ salicylates
- Avoid Purines in diet
- Limit alcohol intake
- colchicine: Will reduce joint inflammation

Lithium
- Toxicity= course hand tremors, V/D
- Level= 0.6- 1.4
- S/E= Polyurie, fine hand tremors, weight gain, Gi upset
- RENAL toxicity
- Treats Biplor

Inhaler protocol
- Hold breath for 10 seconds AFTER inhaling medication
- Wait 1 to 2 minutes between dosing

Anti N/V/D Meds

- Imodium ( D)
- Phenergan ( N/V): Anticholingeric
- Metocolpromide (N): Promotes gastric emptying

Proper PEAK and TROUGH Level sampling

- 15 min to immediately prior to dosing to 30-60 after dosing

Muscle Relaxants
EX: Cyclobenzaprine, Baclofen
- S/E: Ach Effcts, Seratonin syndrome, dependence
- Hepatotoxic

NSAIDs
EX: Aspirin, Naproxen, Ibuprofen
- Inhibits Cox 1 or Cox2
- Take with food
- S/E Gi upset, Reye syndrome, N/V, and decreased urine output

Narcotic Analgesic
Ex: Fentanyl,Oxycodone, codeine, Meperdine, Morphine, Methadone
- s/E: Decreased RR, CNS depression, Constipation, Urinary Retention