NLN Pharmacology Study Guide Final 6-3-2013

NLN Pharmacology Study Guide
There is no official study guide for the NLN Pharmacology Exam. This guide is not meant to be all-inclusive of the information
you will need to know to successfully pass the NLN Pharmacology exam. You should utilize other resources as necessary to
prepare for the exam. Please note that after taking the exam, NLN provides access to review resources on-line.
The test is composed of 100 scored questions plus some trial questions (about 25). You will not know which are which. All are
multiple choice questions, including calculations.
Content is divided in three areas on the exam: calculations, principles of medication administration and medication effects. They
are pretty evenly divided. The questions are very similar to the NCLEX questions. You should also use traditional NCLEX testtaking tips to prepare for this exam also.
References:
Pearson nursess drug guide. (2013). Upper Saddle River, NJ: Pearson.
Silvestri, L. A. (2011). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Mosby.
Adams, M. P. & Urban, C. Q. (2013). Pharmacology: Connections to nursing practice (2nd ed.). Upper Saddle River, NJ: Pearson.
Calculations
Please remember this is about 1/3 of the pharmacology exam. It may be beneficial for you to practice calculations and/or review
a nursing math book to help prep. You may not have used all the calculation methods recently. Questions may include one or
more type of calculation.
Tips:
1. READ CAREFULLY. Always be sure you know what the end result should be (mg, pills, ml, etc.). This can help you select
the correct formula and eliminate unnecessary information.
2. Double (and triple) check actual math. Did you clear the calculator correctly?
3. Does the answer make sense?
4. There are both adult and pediatric calculations.
5. Watch per dose, per day.
6. How you calculate the answer does not matter (desired over have, ratio : proportion, etc.); accuracy does.
WSU CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
2Common calculations include (but are not limited to):

1. Kg to mg to mcg conversion (any which way)
L
K
H
D
M
D
C
M
mcg
G
liter
(kilo hecto deca meter deci centi milli skip skip micro)
gram
2. Dosage calculations
a. Tablets
b. mg. to tablets
c. mg. to ml
d. units to ml
e. kg to ml
f. Half-life calculation
g. IV rate calculation (hourly infusion rate) AND adjustment
h. IV rate dosage calculation (based on units per ml, etc.)
i. Macro- vs. micro-drop tubing
j. Calculating drops/minute (gtts/min)
Examples: (abbreviated to type of question; exam will add extra information)
1. Have 5 mg tablets; ordered dose 2.5 mg. How many tablets will the nurse administer?
2. Have 2 mg/2 ml; order is 1 mg. How many milliliters will the nurse administer?
3. Prepare a 20 mEq dose of a medication. Available solution is 40 mEq/10 ml. How many ml will be administered?
Note: calculation method is not different in examples 1 - 3, just the unit of measure (mg, units, mEq, etc.). BE SURE AVAILABLE
AND HAVE ARE THE SAME UNIT OF MEASURE.
4. Half-life conversion: Half-life is known to be 2 hours. What percentage will be left in the body after six hours?
5. A person weighs 165 lbs. How many kg does the person weigh?
6. The available medication has been reconstituted to 250 mg/5 ml. The order is 5 mg/kg/daily in two evenly divided doses.
Child weight 44 pounds. How many milliliters will be administered per dose? NOTE: More than one calculation method
must be used to answer this question.
7. IV was ordered at 1000 ml over 8 hour period. After two hours, only 900 ml has infused. Calculate the new infusion rate
for the medication to be administered within the original 8 hour period.
8. Order is for 3000 cc over a 24-hour period. What is the hourly flow rate? OR: What will the pump be set at per hour?
9. Order is for antibiotic to be mixed in 50 ml NS and administered over 45 minutes. What is the hourly flow rate? OR:
What will the pump be set at per hour?
10. Volume is 1000 ml. Ordered infusion time is 8 hours. Have tubing of 15 drops/ml. How many drops need to be counted to
deliver the identified milliliters per minute?
11. Available solution = 25,000 units in 250 ml NS. Order is to administer at 22 ml/hour. How many units will be given per
hour?
12. Available solution = 25,000 units in 250 ml NS. Administer at 2000 units/hour. How many ml will be given be hour? OR:
What will the pump be set at per hour?
Principles of Pharmacology
These include the basics! Review:
1. Routes of administration benefits and problems
2. Sizes of needles and syringes for injections
3. Six Rights of Medication Administration; Three Checks
4. Side effects; adverse effects; paradoxical reactions; toxicity; antagonists
5. Half-life calculation
6. Allergic or hypersensitivity reactions
7. Absorption, metabolism, distribution and excretion
8. There may be questions on lab values as relevant.
9. There are pediatric and adult questions.
10. Immunosuppression precautions (due to meds for cancer, HIV/AIDS, etc.)
Administration routes: some key points

Sublingual administration
absorbed in mucosa of oral cavities
rapid onset of action
Place tablet on floor of mouth, close mouth. Do not swallow, hold under tongue until dissolve.
Use spray on floor of mouth under tongue and close mouth.
Buccal
place tablet between gum and cheek near back of mouth, close mouth and keep in place until dissolve
slower to dissolve and absorb than sublingual
Intramuscular injections
Given in the vastus lateralis in children up to 3
Spread skin taught to bring muscle near surface of skin, with dart-like motion insert needle at 90 degrees
Aspirate to determine if needle enter a blood vessel. If there is blood return discard the needle and meds and start
procedure over.
NGtube / Gtube
NG usually temporary; G-tube for longer term
Follow instructions re crushing, dissolving medication no sustained release meds
Eye drop administration
Clean exudates from eye; (2) tilt head toward side of affected eye; (3) pull lower eyelid down; (4) have pt. look up; (5)
instill drops in conjunctival sac formed by lower lid (not onto the eye); (6) Apply gentle pressure for 30 sec to 1 min over
inner cantus next to nose (this prevents absorption through the tear duct and drainage of the medication). Close eyes
gently massage the eyes to distribute the meds.
Slow absorption except in infants where they readily absorb
EYE OINTMENT
Same as eye drop except it is expressed directly into the conjunctival sac from the inner canthus to the outer canthus. Close
eyes and gently massage to distribute the medication
Definitions:
Agranulocytosis / Neutropenia / agranulocytopenia
Definition: Acute decrease in the number of granulocytes/leukopenia (WBC) in peripheral blood
Causes include: treatment with broad spectrum PCN, sulfonamides or cephalosporin (piperacillin, tazobactam, cetazidime,
ticarcillin, gentamycin), bone marrow transplant, chemotherapy, radiation.
Generally is impaired resulting from bone marrow depression by drugs and chemicals or replacement by a neoplasm(oral
lesion, ulcer necrotic, gingivitis, buccal mucosa
Lymphadenopathy, lymphadenitis may be prevalent.
Could lead to respiratory infection, ulceration of mouth colon, high fever, UTI. But may be asymptomatic
Chelating agents
A form of detoxification
Chelating therapy involves an injection or oral administration of ethylene diamine Tetra acetic avide (a synthetic amino acid
which attaches to toxic substance such as lead, cadmium, aluminum and other metal in the blood to facilitate their removal
from the body.)
May be used to treat hardening of the arteries, heart attack, stroke, arthritis and gangrene because of its ability to remove
excess calcium from the body.
EDTA: Ethylenediaminetetraacetic acid
Use in children with lead level between 45&70 micron/dl.
EDTA binds to lead in blood and excreted by the bowel and kidney. EDTA may be toxic to kidney. Monitor urine output.
Give this by IV. Dose depends on weight of child, severity of the poison. Agent is given every 4 hours for 5 days. A second
course may be needed if there is a rebound in the blood level. Give oral and IV fluid to enhance excretion
Do not use EDTA with hypocalcemia or hypokalemia.
OTHER AGENTS
British antiLewisite (BAL) does not give with iron supplement and avoid in pt. with plant allergy. Give this by IM
Succimer (Chemer)
Chemet oral medication - Do not give in pt. with encephalopathy
Epistaxis
Nose bleed. Can be anterior or posterior. Posterior is more serious.
due to rupture of blood vessels within richly perfuse nasal mucosa spontaneous or initiated by trauma
blood can come up through the eye, can also flow down the stomach causing nausea, vomiting
Treat epistaxis
cauterization with silver nitrate, calcium alginate mesh, nasal cavity packed with sterile dressing ribbon gauze, absorbent
dressing or saline sprayed into the nose
Ice pack to forehead or back of the neck
pinch septum of nose for 5 minutes
Do not pack nose with tissue or gauze
Half-life
The time it takes for a medication to lose half of its pharmacologic or physiologic effect
To calculate half-life: There is a formula but the easiest way to decrease count.
Example: half- life is 1 hour.
Start 100%
1 hr.
50%
2 hrs. 25%
3 hrs. 12.5%
4 hrs.
6.25%
Question Half-life of xyz medication is 1 hour. After 3 hours, what percentage of the medication will be left? A = 12.5%
Osmotic agent - see entry under Mannitol
Paradoxical reaction
A response to a drug (or medical treatment) that is the opposite to the usual response, such as agitation produced in an
individual patient by a drug which is ordered to sedate or calm a person.
Sustained release / time released / extended release / controlled release
Pills or capsule formulated to dissolve slowly and release drug over time.
They can often be taken less frequently, keep steadier levels of the drug in the bloodstream
Contain in a matrix of insoluble substance (e.g. Acrylics) the drug swells up to form a gel so that the drug has first to dissolve
in matrix then exit through the outer surface.
Cannot be crushed, dissolved or opened
Medication Effects
There is a bit of an overlap here with Principles of Pharmacology. These questions tend to be medication (or classification)
specific. There are many medications on the test and many could be. As applicable, both brand and generic names are used.
We recognize the attached grid is very lengthy, but have included some of the key components as identified below. Most
medications addressed are either high usage or high risk. Please note that auto-corrections will change generic names to
starting with caps. In the grid, we have tried to list generic first, then brand names.
Areas to know:
1. Use, dose, side effects, contraindications
2. Since there are a limited number of questions, not all medications are addressed. You may be asked to select which
medication would be given for a particular diagnosis. When studying, focus on the classifications this may enable you
to answer without knowing the actual medication.
3. Focus on what are the major side effects of a medication or class? What makes it high risk? Why might one particular
med be used other than another?
4. Patient teaching is a major focus. What would you tell the patient about the medication? What would indicate
understanding? What would indicate need for further teaching?
Common classification of medications
Note letters in medication name and look for those letters that identify a particular classification:
Androgens: end with terone: testosterone (Testoderm)
ACE Inhibitors: end with pril: enalapril (Vasotec)
Antidiuretic hormones: end with pressin: desmopressin (DDAVP)
Antilipidemic: end with statin: atorvastatin (Lipitor)
Antiviral: contain -vir: ritonavir (Norvir)
Benzodiazepines: include alprazolam (Xanax), chlordiazepoxide (Librium), clorazepate (Tranxene),

estazolam (ProSom), and triazolam (Halcion). Most others end with pam: diazepam (Valium)
Beta Blockers: end with lol: atenolol (Tenormin)
CCB: end with pine: amlodipine (Norvasc); some exceptions include diltiazem (Cardizem), verapamil
(Isoptin)
Carbonic anhydrase inhibitors: end with mide: acetazolamide (Diamox)
Estrogens: contain est: conjugated estrogen (Premarin)
Glucocorticoids and corticosteroids: end with sone: prednisone (Deltasone)
Histamine H2 receptor antagonists: end with dine: cimetidine (Tagamet)
Nitrates: contain nitr: nitroglycerin (Nitrostat)
Pancreatic enzyme replacements: contain pancre: pancrelipase (Pancrease)
Phenothiazines: end with zine: chlorpromazine (Thorazine)
Proton Pump Inhibitors: end with zole: lansoprazole (Prevacid)
Sulfonamides: include sulf: sulfasalazine (Azulfidine)
Thiazide diuretics: end with zide: hydrochlorothiazide (HydroDIURIL)
Thrombolytics: end with -ase: alteplase (Activase)
Thyroid hormones: contain thy: levothyroxine (Synthroid)
Xanthine bronchodialators: end with line: theophylline
Specific Diseases or treatments:

Aminoglycoside
antibiotics - Treats serious life threatening gram negative (and some positive) infections
All aminoglycoside ends Mycin but not all drugs that ends in Mycin are aminoglycosides such as (Erythromycin and
azithromycin)
Examples:
Gentamycin
Tobramycin
Vancomycin
Neomycin
Generally IM or IV.
Oral route is not recommended. It is only use for bowel prep prior to surgery (see Neomycin)
Adverse effects/toxicity:
Two most common MAJOR adverse effects: Nephrotoxicity and ototoxicity.
Also:
Photosensitivity
risk for superinfections
Pseudomembranous colitis (c-diff): stop med and treat with PO Flagyl
Peak level:
Drawn 15-30 min after the infusion is completed.
Peak concentration determines that toxic level does not occur.
If peak is too high, may reduce dose.
Trough level:
Drawn immediately (within 30 minutes) before next IV dose
Assures that therapeutic level of drug is maintained. Trough level is 1-2 g/ml between doses.
Dose will be adjusted if level is not sustained
Blood administration
Start blood transfusion slow 2 ml/min. Remain with pt. for the first 15-30 min. if there is no sign of side effect, increase rate
to the desired rate
Administer using largest gauge IV access as possible.
Observe for acute reaction such as: allergic s/s rash, itching, localized edema; febrile (even low grade); septic; air embolism;
circulatory overload.
Observe for delayed reaction: Graft vs. host; hepatitis; hemolysis
Crack abuse effect on newborns
Crack crosses the placenta and enters the fetus.
Common presentation: Infant may appear normal or develop neurological problem. Child may develop depression or
excitability, they may be lethargy, have poor suck; weak cry and difficulty in arousing, hypotonicity, rigidity, irritability,
inability to console and intolerance to change, small head, decreased birth length
Late symptoms: Some infant showed late symptoms 2-8 wks. There may be growth retardation - head growth is one of the
best indication
Diabetes treatment in children
Hypoglycemic reaction takes place most time before meals or when insulin effect is peaking.
First teaching: (1) let child wear bracelet or tag; (2) Teach how to give injection. Inject at 90 degree angle.
Teach only the essentials on the first few visits and intense later. Keep session for children to 14-20 min and adult may go up
to 45-60
Have same meal as normal child time intake of food. Eat at the same time each day.
Children can start learn to assume responsibility for self-management as soon as age 4-5. At age 9, they can start giving
their own insulin with supervision.
Exercise: do not restrict exercise. Have extra snack before and after exercise. Exercise very regularly as it decreases the
need for insulin
Carry a source of glucose at all times (hard candy, sugar cubes glucose tablets, insta glucose). The rapid releasing sugar is
followed by complex CHO and protein such as slice of bread or cracker spread with peanut butter
After glucagon injection, vomiting may occur. Place child on the side to prevent aspiration.
Preferred way of treating ketoacidosis is by insulin IV of low dosing. Note. Run a mixture of insulin through the tubing
before starting the drip because the insulin can chemically bind to plastic. Replace fluid over 24-48 hrs.
10
Diabetes Intravenous insulin administration

Can only be done with regular insulin in management of DKA, HHNK.
Premature discontinuation can cause prolongation of DKA.
Begin SQ insulin therapy before stopping the infusion. If not, there might be prolonged hyperglycemia.
Hepatitis see below
HIV treatment antiretinoviral therapy
Side effects:
START therapy:
Common meds:
(1) all symptomatic HIV people
Assess for opportunistic infection
(presenting with a AIDS-defining illness)
abacavir (ziagen)
(cancer, neurological disease); HA,
or
fatigue, nausea, vomiting, diarrhea,
stavudine (Zerit)
abdominal discomfort, anemia, taste (2) with a CD4 count less than 350 mm3.
zidovudine (AZT)
(3) also start pregnant women (AZT is
perversion, asthenia, circumoral
used to prevent maternal transmission
paresthesia with ritonivair,
Antiviral protease inhibitor. End in AVIR
of HIV)
Adverse/toxicity
Use prophylactically.
STOP if severe rash or other
Hepatoxicity, Hepatotoxicity: AST,
Use in combination to decrease viral
hypersensitivity reaction occurs.
ALT, bilirubin; observe for nausea,
load and increase CD4.
Excluding reaction to medications
vomiting jaundice upper right
Reverse transcriptase inhibitors: Ends in
and/or ineffectiveness of medication,
abdominal quad enlargement and
INE
treatment will be long-term.
tenderness. Reduce dose in liver
Stop replication/growth. Reduces
dysfunction.
viral load.
TEACH
One major advantage is that they do Nephrotoxicity; creatinine, BUN,
creatinine clearance, urinalysis, keep Use neutropenic precautions
not affect adversely affect
Eat small frequent meals with
accurate I& O, monitor for SE of
development of blood cells.
complete or complementary proteins
neutropenic, observe occult signs of
Use in combination with other meds
infection. (lower back, flank or
because resistant strains may rapidly
suprapubic pain, normal temp or low
evolve if used as single agent
grade fever related to UTI
therapy.
Inhibit cell protein synthesis that
interfere with viral replication; block
protease activity in HIV.
Treat AIDS and AIDS-related complex
to decrease viral load
11
Inotropic medications:
Positive inotropic meds increase cardiac contractility examples: epinephrine, norepinephrine, dopamine
Negative inotropic meds decrease cardiac contractility, lower BP: examples quinidine; betablockers (most end in olol)
Sulfonamides
Side effects:
CAUTION: do not use:
Rash common; most are urticaria and known allergies to sulfa drugs
Anti-infective.
maculopapular.
In polyuria, advanced renal or hepatic
Bacteriostatic which action on
GI symptoms
dysfunction
bacteria results from interference
Bone marrow depression
with intestinal and urinary blockage,
with the functioning of enzyme
Headache, dizziness, vertigo, ataxia,
asthma
systems necessary for normal
convulsion, depression
metabolism, growth and
Take adequate amount to fluid 3000multiplication
Hepatotoxicity
4000ml/day to promote urinary
Treat: UTI, Chlamydia causing
output, at least 1500ml/d to prevent
Nephrotoxicity
blindness, pneumonia, brain abscess, Stevens Johnson syndrome (an
crystalluria/stone formation
ulcerative colitis, active Crohns
May be taken after meals to prolong
adverse reaction of skin that
disease, rheumatoid arthritis
time in intestine.
resembles appearance of partial
Examples:
Collect C&S prior to beginning
thickness burns)
Bactrim
therapy
Thiazide diuretics:
Side effects:
Take early in the day to avoid
Examples:
Dizziness, vertigo, HA, weakness,
nocturia
chlorothiazide (Hydrodiuril),
dehydration, orthostatic hypotension Take with food to avoid GI upset.
hydrochlorothiazide (HCTZ, Diuril)
N/V, abdominal pain, diarrhea,
Thiazide is ineffective if creatinine
Name ends in ZIDE
constipation, frequent urination
clearance is < 30ml/min
non-potassium sparing diuretic.
dermatitis and rash
Eat foods high in potassium, restrict
Acts on distal tubes, blocks
Electrolyte imbalance
sodium, do not use salt substitute if
reabsorption of sodium, chloride and impaired glucose tolerance
taking potassium supplement
water. Leads to increased loss of
weigh self daily, report sudden
Potassium.
weight gains or losses
Renal failure,
Use for edema and mild to moderate aplastic anemia, agranulocytosis,
Avoid use with:
hypertension
Children
thrombocytopenia
will see effect of within 1-4 wks.
anuria
anaphylactic reaction
12
Tricyclic Antidepressants
Initial mechanism of TCA takes 1-3
weeks to develop.
Maximum response is achieved in 6-8
wks.
Has long half-life.
Most Tricyclics ends in INE
nortriptyline (Pamelor)
amitriptyline (Elavil)
doxepin (sinequan)
imipramine (tofranil)
Block the reuptake of norepinephrine

or serotonins or both, leaving more
available in the CNS. It intensifies
the effect of norepinephrine and
serotonin which can elevate mood,
increase activity and alertness,
decrease preoccupation with
morbidity, improve appetite and
regulate sleep pattern.
It is used to treat insomnia, attention
deficit/hyperactivity and panic
disorder.
Side effects:
orthostatic hypotension,
sedation and anticholinergic effects.
Most serious adverse effect is cardiac
toxicity; in the absence of overdose
or preexisting cardiac impairment,
serious cardiotoxicity is rare.
URINARY RETENTION IS URGENT
Overdose may cause convulsions
Take at nights, it causes sedation.

Do not take with MAO it will cause
hypertensive crisis from excessive
adrenergic stimulation of the heart
and blood vessels,
monitor orthostatic BP of pt. in
hospital
Use with caution:

Glaucoma
Elderly
constipation, prostatic hyperplasia,
as they are more sensitive to
anticholinergic effect
Avoid use with:
hypersensitivity,
MI, Cardiovascular disease
Vesicant Chemotherapy
See precautions under Vincristine
Hepatitis: inflammation of liver caused by virus, bacteria or exposure to meds or hepatotoxins
Stages of viral hepatitis:
(1) Pre-icteric precedes appearance of jaundice, may have flulike symptoms
(2) Icteric appearance of jaundice, elevated bilirubin, dark or tea colored urine, clay-colored stools
(3) Post-icteric convalescent stage; jaundice improves; color of urine and stool returns to normal
13
Hepatitis A (formerly
infectious hepatitis)
Cause: enterovirus
At risk:
Young children
Institutionalized
people
Health care
personnel
Transmission:
fecal-oral
ingestion of food or
liquids
contaminated with
the virus.
person by person
contact
Incubation: 3-5 wks.
Infectious: usually 2
wks. before the onset
of jaundice and 1 wk.
after onset of jaundice.
s/s: May have no
symptoms initially.
Complications:
Fulminant hepatitis
Hepatitis B.
Hepatitis C
Hepatitis D
Hepatitis E
At risk:
IV drug users
People on
Hemodialysis
Health care
personnel
At risk:
IV drug users
People receiving
frequent
transfusions
Healthcare
personnel
Cause: Occurs only with

Hepatitis B and only
causes problems with
an acute HepB
infection.
Cause: waterborne
virus
Transmission:
blood and body
fluids
contaminated
needles, parenteral
sexual activity
Incubation: 6-24 weeks
s/s:
progression of
symptoms is more
insidious and
prolonged than
Hep A virus.
Initially may be
asymptomatic.
1 week -2 months of
Prodromal
symptoms: fatigue,
anorexia, transient
fever, abdominal
Transmission:
Same as Hep B
Blood and body
fluids
Incubation period: 5-10
weeks
s/s: similar to HBV but
often less severe.
Complications:
chronic liver disease
Cirrhosis.
At risk:
common in Middle
east, south Africa
and Mediterranean
same as HepB
Transmission:
same as Hepatitis B.
Incubation period: 7-8
weeks
HepD along with HepB
causes superinfection
and worsening of
condition and rapid
progression of cirrhosis
Complications:
As per Hep B
At risk:
Travel to areas
where sewage
disposal is
inadequate and/or
people bathe in
contaminated rivers
At higher risk with
higher mortality:
women in third
trimester of
pregnancy
Transmission:
Same as HepA
Incubation: 2-9 weeks
Complications:
Maternal and fetal
demise
14
death
discomfort N/V, HA.

Then expanding to:
Hepatic S/S,
photophobia,
angioedema, rash,
vasculitis, jaundice
in Icteric phase
Complication:
Cirrhosis
Fulminant hepatitis
A grid follows with a listing of medications that may be on the exam.
15
Drug
Acetylsalicylic acid
(Aspirin)
Non-narcotic
analgesic
Antipyretic
Antiplatelets
Activated charcoal
(Actidose)
Antidote
Adsorbent
Use and dosage

Blocks pain impulse
in peripheral and
some CNS;
antipyretic result;
inhibit platelets
aggregation
Side effect
Increases
coagulation times
Reyes syndrome
(encephalopathy
and fatty liver),
GI bleed,
tinnitus,
Treat TIA, Post MI, liver toxicity (dark
Stroke, angina
urine, clay stool,
itching, yellowing
sclera and skin),
visual changes
Treat poison and
Vomiting with rapid
overdose following
administration
oral ingestion.
pulmonary
Binds to poison and
aspiration
prevent its
absorption by the
GI tract and then
eliminates in the
feces.
Administer within
60 minutes of
ingestion.
Give once or twice
depending on the
level of toxin.
May come premixed with water
12.5-25 grams
Teaching and labs

Monitor coagulation
studies
Take with full glass
of water, milk for
food to prevent
stomach upset
Do not crush enteric
coated
given daily (81-325
mg) for cardiac
prophylaxis post MI,
stents, strokes, etc.
Binding is
irreversible so
cathartic such as
sorbitol may be
added as well.
It allows certain
drugs/toxins to be
drawn out of the
blood and bind to
charcoal in the
intestine a kind of
gut dialysis
Stools will be black
Charcoal does not
change the stomach
PH.
contraindication
Do not use with:
children under 12
and/or children or
teenagers with
chicken pox or flu
like symptoms
(because of risk of
Reyes syndrome);
pregnancy in 3rd
trimester; and
vitamin K deficiency
Do not administer with
Ingestion of:
caustic alkali agent,
high viscosity
petroleum products
OR when:
convulsions are
occurring,
cardiac
dysrhythmias are
present, or
there is emesis of
blood
Implement antidote
supportive care and
prevent aspiration are
if gastric lavage is not
to be performed.
16
Drug
Acyclovir
(Zovirax)
Antiviral
- Herpes simplex
virus HSV
- Herpes zoster
- varicella
Alteplase recombinant
(Activase)
Streptokinase is similar.
Urokinase is given
mostly in emergency
situation.
Thrombolytic agent
Cath-flo Activase is
for occluded catheters
Use and dosage

Used for herpes
simplex. Does not
eradicate latent
herpes. It reduces
viral shedding and
formation of new
lesions and speeds
healing time.
(oral, IV and topical)
To decrease
symptoms with
varicella zoster
(chicken pox/
shingles).
Dissolves or break
down clots to
reestablish
perfusion.
Indicated for clients
at risk for
developing
thrombus with
resultant ischemia
such as MI,
ischemic stroke,
arterial thrombosis,
DVT, PE
occlusion of IV
catheters.
Side effect
Side effects:
Headache, dizziness
seizure
nausea, vomiting,
diarrhea
acute renal failure
thrombocytopenia
purpura hemolytic
uremia syndrome
Teaching and labs

Even after HSV
infection is
controlled, latent
virus can be
activated by stress,
trauma, fever
exposure to
sunlight, sexual
intercourse.
Refrain from sex if
S/S of herpes.
nephrotoxicity
contraindication
Do not give with:

pregnancy,
active bleeding,
recent Hx of CVA,
Uncontrolled HTN,
Hemorrhage,
N/V,
hypotension
cardiac
dysrhythmias.
Dose related is the

highest problem
Watch for s/s

bleeding; VS
changes, s/s of
impending shock
If bleeding is
occurring stop
treatment and
notify doctor. May
start on FFP and
PRBC.
Aminocaprionic acid
(Amicar) may be
ordered for
overdose or
excessive bleeding.
IM medication route is
contraindicated when
using thrombolytics.
Do not take NSAIDs
or Aspirin because
of enhanced
bleeding.
17
Drug
Aluminum hydroxide
(Amphogel)
Antacid
Ampicillin (Ampicin)
IV, PO, IM.
Antibiotic
Aminopenicillin
Similar side effects,

allergic reaction, etc.
for all Penicillins (PCN)
Use and dosage

Neutralizes gastric
acid,
antflatulent to
alleviate symptoms
of gas and bloating
Treat bacterial
infection
Commonly used with:
Shigella,
salmonella,
Escherichia coli,
haemophilus
influenza,
Neisseria
gonorrhea,
Neisseria
meningitis,
gram positive
organism
Side effect
Increases gastric pH,
Decreases
absorption of other
drugs such as dig,
antibiotic, iron
supplement.
Toxicity causes
dementia,
Hypercalcemia,
metabolic alkalosis,
worsening of HTN,
heart failure from
increased intake.
allergic reaction:
Skin rash, urticaria,
swelling, pruritus,
angioedema.
Severe allergy:
hives, wheezing,
anaphylactic
reaction. Medical
emergency requires
immediate tx or can
lead to death.
side effects: GI, N/V,
diarrhea, abdominal
pain.
Pruritic rash like
measles is not a true
allergic reaction
Teaching and labs

Given 2 hrs. apart from
other drugs where
interaction may occur.
Observe for signs and
symptoms of altered
phosphate levels;
anorexia, muscle
weakness and malaise.
Increase fluid, exercise
and fiber to prevent
constipation.
contraindication
Do not use:
abdominal pain,
N/V, diarrhea,
severe renal
dysfunction,
fecal impaction,
rectal bleeding,
colostomy,
ileostomy
dehydration
hypercalcemia and
hypercalciuria
Do not give with

fruit juice, milk or
carbonated
beverages because
of poor absorption.
Watch for
hypokalemia
Take on empty
stomach.
May not be
necessary to stop
treatment if mild
diarrhea develops.
Give yogurt or
buttermilk to
restore normal flora
(or probiotics)
Avoid with:
Hypersensitivity to
any penicillins; use
cautiously if history
of hypersensitivity
to cephalosporins;
Exfoliated
dermatitis
Loop diuretic may
exacerbate
hypokalemia and
rash.
Potassium-sparing
diuretic may
contribute to
hyperkalemia
18
Drug
Atropine Sulfate.
Use and dosage

Use to increase
heart rate (not
Two different uses:
necessarily first
drug of choice).
Anticholinergic
Decreases
(such as for
involuntary
Parkinsons disease)
movement and
For ophthalmic use
rigidity in
Parkinsons disease
Pre-op to decrease
secretions and
prevent aspiration
Systemic effect is more
of secretions while
pronounced in infant
under anesthesia
and children with blue
eyes and blond hair.
Use for
Also increased risk of
inflammation of the
toxicity with Down
iris and uveal tract.
syndrome
Side effect
Dry mouth,
constipation, urinary
retention or
hesitancy headache,
dizziness
Paralytic ileus.
Treat overdose
(resp. depression
and circulatory
collapse)
symptomatically.
Adverse effect when
used for the eye
Transient stinging,
increase IOP,
photophobia,
Teaching and labs

contraindication
Monitor dosage of
Increased
meds carefully, even
anticholinergic
slight overdose can
effect with
lead to toxicity.
phenothiazine,
antidepressant,
Assess for
MAOs amantadine.
constipation and
urinary retention;
increase fluids, bulk Contraindicated in
and exercise, assess
pt. with narrow
bowel sound to rule
angle glaucoma,
out paralytic ileus,
myasthenia gravis,
or GI obstruction.
Avoid driving or
other hazardous
activities,
drowsiness may
occur.
For the Eye
Acute glaucoma can
be precipitated by
papillary dilation; if
not recognized and
treat, acute
glaucoma can result
in blindness.
Wear dark sunglass
and avoid bright
light for
photophobia,
Monitor intraocular
pressure and vision
19
Drug
Beclomethasone
diproprionate
(Beclovent)
inhaled
corticosteroid
medication
note: also nasal

inhalant as Beconase
Use and dosage

Used in bronchial
asthma, allergic
rhinitis
Side effect
Side Effects:
Pharyngeal irritation
and sore throat,
coughing, dry mouth,
oral fungal infections,
and sinusitis.
Teaching and labs

Decrease dose if pt.
is on systematic
corticosteroid.
Assess for impaired
bone growth in
children receiving
inhaled
Increased
corticosteroid
susceptibility to
Considerations:
infection,
Monitor for
dermatologic effects
hyperglycemia
and osteoporosis,
Rinse mouth after
diarrhea, N/V, HA,
use for medication;
fever, dizziness
oropharyngeal
angioedema rash
candidiasis and/or
urticaria and
hoarseness can
paradoxical
occur.
bronchospasm
Use bronchodilator
inhalant before
Adverse effects/toxicity
corticosteroid when
Adrenocortical
both are ordered.
insufficiency
Do not abruptly
fluid and electrolyte
stop meds taper
disturbances,
over 2 weeks.
nervous system
Be aware of steroids
effects and
symptoms - Moon
endocrine effects if
face, acne, edema,
absorbed
increased fat pads
systemically.
- notify doctor.
Report weight gain
contraindication
Do not use with:
children under
Clients with known
allergy
May require
adjustment of
antidiabetic agent
as there is a
potential for
elevated blood
glucose levels with
corticosteroids are
administered orally.
Not use in
bronchospasm or
status asthmaticus.
20
Drug
Benztropine mesylate
(Cogentin)
Anticholinergic
(cholinergic
receptor
antagonist)
Anti-Parkinson
Use and dosage

Treat Parkinson
symptoms:
Suppresses
tremors and
rigidity, not tardive
dyskinesia
Decreases
hypersalivation and
irregular
movement related
to Parkinson
disease.
Reduces extrapyramidal side
effects
Buspirone (Buspar)
Anxiety
anxiolytic
Desired response 710 days; Make take

3-4 weeks for full
effect
Side effect
Side effects:
dry mouth,
urinary
retention/hesitancy,
HA,
dizziness.
Teaching and labs

Monitor dose
carefully; even slight
overdose can lead
to toxicity.
Nursing considerations:
Monitor I&Os,
Education:
paralytic ileus
Avoid driving, or
other hazardous
activities;
drowsiness may
occur.
Avoid cough
OTC medication
unless
prescribed.
Side effects:
When switching to
Dizziness
Buspar, taper off
benzodiazepines
headache
Less likely to have
drowsiness
cognitive
impairment than
other CNS meds
Does not cause
withdrawal s/s and
thus does not need
to be tapered off
when stopping
contraindication
Avoid use with:
narrow-angle
glaucoma,
myasthenia gravis,
GI obstruction
Avoid use with:

MAO Inhibitors
Lactation
Caution with:
moderate to severe
renal impairment
21
Drug
Chlordiazepoxide
hydrochloride
(Librium)
Anxiolytic
Sedative-hypnotic
benzodiazepine
IM & tablet form
Peak:
1-4 hours PO,
15-30 min IM.
Half-life 5-30hr
Use and dosage

To relieve tension
and/or anxiety
To manage alcohol
withdrawal
Side effect
Adverse effect:
respiratory distress,
drowsy, dizziness,
lethargy, orthostatic
hypotension
photosensitivity
do not to stop
taking drug
abruptly will have
withdrawal
symptoms (usually
in 5-7 days)
Suicidal tendencies may

be present and
protective measures
may be necessary.
Monitor closely for
paradoxical
reactions
excitement,
stimulation, acute
rage usually early
in tx withhold
drug and notify dr.
Teaching and labs

Give with milk or
food to prevent GI
upset.
Check BP and pulse
early in tx. If BP falls
delay medication
and notify dr.
Labs: Monitor CBC,
renal and hepatic
enzyme levels
watch for
dependency
Education:
Avoid alcohol
no OTC meds unless
prescribed
Avoid driving and
other hazardous
activities until
effects known.
contraindication
Avoid use with:
Narrow angle
glaucoma,
under 12 year old
lactation
Use cautiously with:
impending
depression,
impaired hepatic or
renal function,
COPD
22
Drug
Chloramphenicol
(Chloromycetin)
Oral, injection,
ophthalmic drops and
ointment
Anti-bacterial
Chlorothiazide (Diuril)
Thiazide diuretic,
non-Potassium
sparing
Anti-hypertensive
Use and dosage

severe infection for
susceptible
organisms when
other anti-infective
are ineffective.
Sty, conjunctivitis,
uveitis
Side effect
Side effects:
dermatitis, itching,
stinging, swelling
Adverse effects/toxicity
(oral and injection)
edema
super infection,
aplastic anemia.
Stevens-Johnson
syndrome
Teaching and labs

obtain culture
specimen from eye
before initiation of
treatment
remove exudates.
Monitor for pain,
drainage, redness,
swelling.
Monitor for
bleeding or bruising
contraindication
Avoid use with:
hypersensitivity
Increases urinary
excretion sodium
and water by
inhibiting sodium
reabsorption.
Use for edema and
HTN, HF, cirrhosis,
corticosteroid and
estrogen therapy,
diabetes insipidus,
Side effects:
Dizziness, vertigo,
frequent urination,
electrolyte
imbalance, impaired
glucose tolerance,
hyperuricemia,
photosensitivity
Renal failure,
aplastic anemia, and
anaphylaxis
Take early in the

morning to avoid
nocturia.
Give with food,
allow for 3-4 weeks
for maximum effect,
Will not be effective
if creatinine
clearance Is less
than 30ml/min
Avoid use:
Client with anuria.
Use cautiously with
impaired renal or
hepatic function.
If pregnant.
Will increase serum
lithium level
23
Drug
Chlorpromazine
hydrochloride
(Thorazine)
Use and dosage

Block dopamine
receptor in CNS to
Use: treat
psychotic disorder
phenothiazine
(schizophrenia,
Antipsychotic
bipolar, and other
medication
mental illnesses);
prevent acute
Anti-emetic
exacerbation and
maintain highest
possible level of
function
Give bromocripitine
Use to control
(Parlodel) and
manic phase
dantrolene
(bipolar)
(Dantrium) for
intractable hiccups
NMS.
nausea/vomiting
Low potency antipsychotic which
can reduce the risk
of EPSE (extrapyramidal side
effects)
Side effect
Side effects:
Sedation,
orthostatic
hypotension,
anticholinergic
effect (dry mouth,
blurred vision,
urinary retention,
photophobia,
constipation,
tachycardia)
liver damage,
tremor are two
major side effects.
photosensitivity
Neuroleptic
malignant
syndrome (NMS),
catatonia, rigidity,
stupor, unstable
blood pressure
profuse sweating,
dyspnea. Can be
toxic effect and
MAY last for 5-10
days after
discontinuation of
the med.
Teaching and labs

get baseline ECG,
thorough baseline
evaluation lab tests
before treatment.
Give bromocripitine
(Parlodel) and
dantrolene
(Dantrium) for
NMS.
Withdrawal of drug
is necessary
Take measures to
protect eyes
exposed to sunlight
contraindication
Monitor diabetics
closely for glucose
intolerance
24
Drug
Cimetidine (Tagamet)
GI meds,
H2 receptor
antagonist
Cisplatin (Platinol)
Half-life 20-30 minutes
Antineoplastic
medication
Alkylating agent
** Major allergic
reaction can occur
within first 15 mins. of
administration.
Anaphylaxis may occur
within minutes of drug
initiation.
Use and dosage

Works against
histamine
receptors,
decreases gastric
secretion.
Use short term for
duodenal ulcer,
benign gastric
ulcer, acute upper
GI bleed
Treat ovarian and
testicular cancer by
interfering with
DNA replication
Side effect
Side effects:
Cardiac dysrhythmia,
diarrhea, dry mouth,
constipation
Rare but may
include
agranulocytosis
neutropenia ,
thrombocytopenia
aplastic anemia,
anaphylaxis
Side effects:
anorexia,
uncontrolled N/V,
fluid retention,
weight gain
Major toxicities
occur in the blood,
GI, and reproductive
system.
Watch urine output
and specific gravitynephrotoxicity may
occur within 2 wks.
ototoxicity (tinnitus
or difficulty hearing
in the high
frequency range)
Teaching and labs

May be given with
meals and at
bedtime
Avoid smoking
which cause gastric
stimulation
Avoid antacid use
within one hour of
dose
contraindication
Avoid use:
hypersensitivity
Use caution:
impaired renal or
hepatic function
maintain fluid at
least 3000 ml in 24
hr. ; report reduced
urine output
Avoid food high in
thiamine (beer,
wine cheese,
brewers yeast,
chicken liver &
banana) - may lead
to hypertension &
intracranial
hemorrhage
Avoid use:
Hx of sensitivity to
platinum-containing
compounds,
impaired renal
function and
hearing,
Hx of gout, renal
stones.
Incompatible with
dextrose and
Reglan, Vanco
Lasix may increase
otoxicity
other nephrotoxic
drugs may increase
nephrotoxicity and
renal failure.
25
Drug
Codeine sulfate
Opioid analgesic
(agonist)
Antitussive (cough
suppressant)
Use and dosage

To treat mild to
severe pain
most oral
preparations
combined with ASA
or acetaminophen
hyperactive cough
Rapid onset if IM or IV.

Peak 1-2 hrs.,
Duration up to 7 hours.
Cyanocobalamin
(Vitamin B12)
Half- life: 6 days
Vitamin B12 helps in

the formation of
red blood cells
essential for the
proper production
of blood platelets
and red and white
blood cells and the
nervous system
Malabsorption
syndrome
Pernicious anemia
Side effect
Side effects:
Constipation, urinary
retention, dizziness,
lightheadedness.
Respiratory
depression,
respiratory arrest,
circulatory
depression, ICP.
Long term use may
cause withdrawal
symptoms when
stopped
Anaphylactic shock,
sudden death,
severe optic nerve
atrophy (may
develop after years
of use or with
Lebers disease)
water-soluble
vitamin that is
stored in the liver.
Teaching and labs

Assess for:
respiration and
usually hold <12
breaths per minute,
CNS changes (LOC),
allergic reaction
TEACH:
no alcohol
no OTC pain meds
unless ordered
Avoid driving until
drug response is
known.
contraindication
Do not use:
Hypersensitivity
Increased ICP, head
injury
Acute alcoholism
labor
Teach:
Injection is once per
month for life with
pernicious anemia .
Oral preps may be
mixed with fruit
juice but give
immediately since
ascorbic acid (Vit. C)
affects stability of
B12.
Dietary B12: best are
organ meats, egg
yolk, clams, oysters,
crabs, sardines,
salmon
Do not use:
Hypersensitivity
Lactation
26
Drug
Cyclosporine
(Sandimmune)
Immunosuppressant
medication
Metabolized in the
liver.
Peak 4-5hr,
Duration 20-54 hrs.
Half-life 19-27 hrs.
Use and dosage

Inhibit T helper and
T suppressor cells.
Prevent rejection of
kidney, liver and
heart transplants.
Treat chronic
rejection in people
who have received
immunosuppressive agent,
rheumatoid
arthritis,
recalcitrant plaque
psoriasis
Side effect
Side effects:
Hypertension,
increased risk of
infection
Tremor is an
expected side effect
Teaching and labs

Monitor labs: AST,
ALT, BUN, creat,
platelet count, K,
TEACH:
Take with food to
reduce GI upset
mix with milk,
chocolate milk or
orange juice but not
Renal toxicity,
with Grapefruit juice
hepatotoxicity
Mix in glass, not
plastic
Avoid use of live
vaccine
Prevention of
infection and report
signs of infections
contraindication
Do not use:
Pregnant/lactating
mom,
Use cautiously in
renal and hepatic
impairment
Antiepileptic
medications
decrease
cyclosporine levels
oral contraceptive
increase levels
Immunosuppressed
precautions
27
Drug
Debrox drops
Ear drops to dewax
Use and dosage

used to soften and
loosen ear wax,
making it easier to
remove.
Side effect
Side effects:
temporary decrease
in hearing after
using the ear drops
mild feeling of
fullness in the ear
mild itching inside
the ear.
Get emergency
medical help if you
have any of these
signs of an allergic
reaction: hives;
difficulty breathing;
swelling of your
face, lips, tongue, or
throat
Teaching and labs

Use:
Tilt head with ear
facing upward. Pull
back on ear to open
up the ear canal.
Drop the correct
number of ear drops
into the ear.
After using the ear
drops, stay lying
down or with your
head tilted for at
least 5 minutes. You
may use a small
piece of cotton ball
to plug the ear and
keep the medicine
from draining out.
A bubbling sound
inside may be heard
after putting in the
drops. This is caused
by the foaming
action of carbamide
peroxide, which
helps break up the
wax
May come with bulb
syringe.
contraindication
Do not use:
With a ruptured ear
drum.
any signs of ear
infection or injury
Do not use this
medication in a
child younger than
12 years old without
the advice of a
doctor.
Do not use for
longer than 4 days
in a row.
28
Drug
Diazepam (Valium)
Benzodiazepine
(have zep and zap
in them)
minor tranquilizers,
anticonvulsant,
anxiolytic
Absorbed from GI,
metabolize in liver
Onset 30 min IM, 60
PO, 15 IV. Works
quickly.
Peak 1-2hr PO,
Duration 15 min to 1hr
IV; up to 3 hrs. PO.
Half-life 20-50 min
Use and dosage

Relieve pain and
discomfort from
musculoskeletal
disorders,
manage anxiety,
Manage acute
alcohol withdrawal
Maximum effect will
be seen in 1-2 weeks.
Can take 2-4 wks. It has
addictive effect.
Side effect
Side effects: ABCD.
Anticholinergic (dry
mouth),
Blurred vision,
Constipation, &
Drowsiness,
Teaching and labs

Watch for CNS
effect.
Monitor CBC WBC
with diff.
notify dr. if drop in
BP of 20 mm Hg
Assess for allergic
reaction including
cardiovascular
idiosyncratic
collapse,
reaction,
laryngospasm,
anaphylaxis, rash
dizzy, weakness,
fever resp distress
nausea
Adverse effects/toxicity: Teach
Do not stop
Erythema
abruptly
multiforme,
withdrawal
angioedema,
symptoms will
anaphylaxis,
occur (insomnia,
dysrhythmia
nausea HA,
seizure
spasticity,
tachycardia).
No alcohol (will
increase CNS
depression)
contraindication
Do not use:
compromised
pulmonary
function,
hepatic disease,
impaired
myocardial
function,
acute alcohol
intoxication
infant < 6 months
narrow angle
glaucoma, open
angle glaucoma
Suicide prevention
precautions
29
Drug
Digoxin (Lanoxin)
Cardiac glycoside,
antiarrhythmic
drug.
Therapeutic range:
0.5-2.0ng/ml
Toxic level > 2
Antidote: digibind
(digoxin immune fab)
Use and dosage

Positive inotropic
effect
In heart failure it
Increase
contraction of the
heart muscle.
In atrial fib, it slows
the heart rate
Side effect
Side effects:
Nausea, HA, loss of
usual appetite.
Toxicity may go
unrecognized since
it presents with
same symptoms as
flu (N/V, anorexia,
diarrhea, vomiting
visual disturbance).
Blurred green or
yellow vision or halo
effect**
In HF, early sign of
toxicity includes
dysrhythmias.
Children rarely show
signs of N/V,
diarrhea, visual
problem, anorexia
(could become dig toxic
without showing usual
s/s)
Teaching and labs

may give without
regard for food
IVP over 5 min, do
not give IM, it will
cause tissue
irritation.
Monitor apical
pulse, if <60/min.,
usually hold meds
and notify doctor.
Monitor labs (K,
calcium,
magnesium,
creatinine
clearance),
Monitor Dig level
every 6 months.
weigh daily and
report weight
greater than 2 lbs.
per day
contraindication
Avoid use with:
hypersensitivity to
dig
Caution with kidney
failure
Interaction:
IV calcium with dig
may increase risk of
cardiac
dysrhythmias,
erythromycin will
increase dig level,
quinidine,
verapamil and
amiodarone will
increase dig levels
and dig dose should
be decreased by
50%
Cyclophosphamide
combined with dig
cause dig toxicity
30
Drug
Disulfiram (Antabuse)
The only alcohol
antagonist in use.
Enzyme inhibitor
Anti-alcohol agent.
Half-life 24-36 hour

Onset up to 12 hrs.
Duration up to 2 wks.
Absorbed from the GI
excreted in feces or in
the breath as carbon
disulfide
Use and dosage

Adjunct treatment
of patient with
chronic alcoholism
who sincerely
wants to maintain
sobriety.
At least 12 hours
should elapse from
the time of last
alcohol intake and
the initial dose
Use only in people
with high physical
health.
Use for 1-2 wks.
Side effect
Side effects:
Rare in the absence
of alcohol
Adverse
effects/toxicity:
** Acetaldehyde
syndrome
hypotension to
shock level
arrhythmias,
acute congestive
failure,
marked respiratory
depression,
INTENDED Reaction
unconsciousness,
with alcohol ingestion: convulsions
flushing face, chest, sudden death
arms
pulsating HA
Nausea
violent vomiting
thirst
sweating
marked uneasiness
Teaching and labs

The effects of
disulfiram may
persist for 2 weeks
after last dose is
taken; alcohol must
not be consumed
until this interval is
over.
Give in the morning
when the resolve
not to drink is the
strongest. Give at
bedtime to
minimize the effect
of drug
avoid alcohol of all
forms include those
found in sauces,
cough mixture and
after shave lotions,
colognes and
liniments
contraindication
Do not use:
In people who do
not want to stop
drinking.
Severe cardiac
disease,
psychoses,
pregnancy,
multiple drug
dependence.
31
Drug
Epinephrine
(Adrenalin)
alpha and beta
adrenergic agonist
vasopressor
bronchodilator
If given IM, SQ result seen in 5 min
& lasts up to 4 hrs.,
Also available eye
drops and
intranasal
Use and dosage

Reverses
anaphylactic
reaction
Restores cardiac
rhythm in cardiac
arrest
Acute asthmatic
attack
Side effect
Side effects:
nervousness,
tremors,
increased HR, BP,
insomnia,
anorexia
cardiac stimulation
vascular HA.
Teaching and labs

Teach
Report nervousness
and sleeplessness dose should be
reduced.
Administer eye
drops at bedtime.
May experience
headache and
stinging but subside
Also use in
with continued use.
ophthalmic
Tachyarrhythmias,
Report if continues.
decongestant,
chest pain,
manage open angle restlessness,
Monitor VS
glaucoma
agitation,
especially HR and
nervousness and
BP because of
insomnia.
cardio effect.
Nasal burning
stinging,
eye burning
D/C if hypersensitivity
develops (develops of
lids, itching, discharge,
crusting eyelid). Notify
doctor
contraindication
If use with MOA
inhibitors may lead to
hypertensive crisis.
Narrow angle
glaucoma,
hemorrhagic
traumatic or
cardiogenic shock,
arrhythmias,
organic heart or
brain disease.
CAUTION in:
older adults,
HTN
TB, long standing
bronchial asthma
and emphysema
children < 6
No breastfeeding
32
Drug
Famotidine (Pepcid)
Histamine
H2 antagonist.
Onset 1 hr. Peak 1-3hr
Duration 10-12 hrs.
Half-life 2.5-4hr
Fluoxetine
hydrochloride (Prozac)
Use and dosage

Decreases output
of gastric acid
Short term
treatment in
duodenal ulcer or
benign gastric
ulcer.
Metabolized in
liver, excreted in
urine
Major depressive
disorder
Obsessive
compulsive
disorder,
bulimia,
panic disorder
obesity
alcoholism
chronic pain.
Side effect
Teaching and labs
Side effects:
May be taken with
diarrhea,
food.
constipation, dry
pain relief may not
mouth
be experienced for
several days
thrombocytopenia
contraindication
Use cautiously with
impaired renal or
hepatic function.
Do not breastfeed
DO NOT stop
abruptly.
Give meds once a
day at about noon
because it causes
insomnia. If
prescribed 2 times
daily give dose in
the morning early
and 12 noon to
prevent insomnia
Teach side effects
of drugs
Therapeutic
response takes
some weeks to be
established.
MI, cerebrovascular
disease.
If suicide risk,
should not have
access to a large
quantity.
Do not take while
pregnant
Common side effects:

Orthostatic
hypotension
psych med.
sedation
Tricyclic
Anticholinergic
antidepressant.
Hypomania
Selective Serotonin
Sexual dysfunction
Reuptake inhibitors
(SSRI)
Cardiac toxicity
Selective Serotonin
Half-life 1-6 days.
syndrome (early s/s:
Onset 2-3 weeks to be
diaphoresis, agitation,
Such as rash. Wait 4-6
effective.
weeks before switch to low grade temp.) Then
Peak 4-8hrs.
increase in BP, muscle
MAO Inhibitor
Metabolized in liver,
rigidity, temp, resp,
absorbed from GI tract,
pulse. Mental status
excreted in urine and
changes, tremors,
face.
hyperthermia, sweating
hypersalivation.
Notify dr ASAP.
avoid antacid use

within 1 hour of
dose
** The combination
of TCA and MAOI
can lead to
hypertensive crisis
from excessive
adrenergic
stimulation of the
heart and blood
vessels.
33
Drug
Fluphenazine (Prolixin)
Use and dosage

Potent medication
for treatment of
phenothiazine; Ends
antipsychotic
with azine
symptoms,
including
antipsychotic
schizophrenia.
Half-life > 24 hours
Treatment is not
Onset: 1 hr.,
curative.
peak 0. 5 hr. meds
Adjust dose to
symptoms.
effect can be seen 1-2
days but full effect
Use injectable form
several weeks
for long term
maintenance
- the rate of relapse is
usually reduced and is
more favorable
Side effect
Produces EPS which
are reversible.
** Treat EPS with
Cogentin, Artane,
Benadryl, Symmetrel
Side effects: ABCDE
Anticholingergic
(dry mouth), Blurred
vision, Constipation,
Drowsiness, EPS
Photosensitivity
may increase risk of
agranulocytosis
gynecomastia,
amenorrhea
weight gain
Neuroleptic malignant
syndrome (NMS) a fatal
side effect. Presents
with catatonia, rigidity,
stupor, unstable blood
pressure, hyperthermia
profuse sweating,
dyspnea, incontinence.
Stop drug. Tx with
Dantrium and Parlodel.
Condition lasts for 5-10
days after stopping
med.
Teaching and labs

Monitor LFTs
TEACH
Avoid alcohol use
and other CNS
depressants
Do not alter dose or
stop abruptly
Avoid sun exposure
With oral
concentrate, avoid
spills. Rinse skin
with warm water
immediately if there
is contact
contraindication
Avoid with:
Caution with
narrow angle
glaucoma, hepatic
or renal dysfunction
and seizure
disorder.
Do not breastfeed
Dose should be
reduced in the
elderly.
Dilute liquid drug

with fruit juice
water, carbonated
beverage, milk,
soup avoid mixing
with caffeine, tea,
apple juice.
34
Drug
Furosemide (Lasix)
Loop diuretics,
Anti-hypertensive
Peak 60-70 min PO, 2060 min IV.

Onset 30-60 min PO, 5
min IV,
Duration 2 hrs.,
Half-life 30 min
Use and dosage

Rapid acting loop
diuretic
Inhibits
reabsorption of
sodium and water
(in Loop of Henle)
Lowers BP by
decreasing edema
and intravascular
fluid
Treat
acute pulmonary
edema, edema,
heart failure,
chronic renal
impairment,
hypertension,
hypercalcemia
Side effect
Side effects:
Ototoxicity
headache
Dizziness
Orthostatic
hypotension
weakness
Teaching and labs

TEACH
change position
slowly to avoid
dizziness and
orthostatic
hypotension
report ringing in the
ear immediately
Take with food or
milk
Give early in day to

s/s hypokalemia
avoid nocturia
Hyponatremia,
Replace potassium
hypochloremia,
(dietary or meds)
hypomagnesaemia
hypocalcemia
Monitor labs,
especially
electrolytes. Also
IV form:
hgb, hct, platelet as
Administer slowly;
these increase d/t
hearing loss can
hemoconcentration
occur if injected
rapidly (ototoxicity).
Monitor body
Give over 1-2
weight and I&O.
minutes to prevent
hypotension.
contraindication
Avoid with:
anuria, electrolyte
depletion,
increasing oliguria,
anuria
hepatic coma,
pregnancy,
lactation
Interaction with
digitalis can
increase
arrhythmias.
Interaction with
aminoglycosides
increases risk of
ototoxicity.
35
Drug
Gentamicin
(Garamycin)
Aminoglycosides.
Antibiotic
Peak level:
Drawn 15-30 min
after the infusion is
completed.
Peak concentration
determines that
toxic level does not
occur.
If peak is too high,
may reduce dose.
Trough level:
Drawn immediately
(within 30 minutes)
before next IV dose
Assures that
therapeutic level of
drug is maintained.
Trough level is 1-2
g/ml between
doses.
Dose will be
adjusted if level is
not sustained
Peak 30-90 min
Half-life 2-4 hr.
Use and dosage

Broad-spectrum
antibiotic
Parenteral use
limited to severe
infections,
unresponsive to
other antibiotics.
Ophthalmic:
treat superficial
infection of the
eye.
Have pt. keep eyes
closed for 1-2 min
after instillation.
Vision will be
blurred initially
Side effect
Side effects:
HA, parenthesia,
skin rash fever
contraindication
Avoid with:
Maintain hydration
Pre-existing renal
to protect kidney
disease
damage. Fluid
Use caution with
intake should be
pre-existing hearing
2,500-3000 ml/day
Nephrotoxicity
loss
give high protein
Ototoxicity.
Pregnancy,
foods
This may cause
lactation
LABS
irreversible auditory
Increased risk with
WBC to monitor the
impairment and
nephrotoxic drugs,
vestibular damage
effectiveness of
prolonged
Signs of ototoxicity
therapy
treatment with
include HA, NV unsteady Watch kidney
aminoglycosides,
gait, tinnitus, vertigo,
function tests (BUN,
impaired renal
high frequency, hearing
Creat) closely due to
function and other
loss and dizziness
toxicity risk
ototoxic drug such
Hypersensitivity
as Lasix, Vanco.
reactions
Report sore throat,
Superinfection: a
watery stools
secondary infection
greater than 4-6 per
caused by
day, severe nausea
eradication of
or vomiting,
normal flora:
indicating possible
Candidiasis, skin and
super infection
mucous membrane
Teaching and labs
36
Drug
Glipizide (Glucotrol)
oral antidiabetic
Sulfonylurea
duration: 12-24 hours
Onset: 15-30 min
Peak: 1-2hr
Metabolized by the
liver
Glucagon
Anti-hypoglycemic
Onset 5-20 min,
Peak 30 min
Duration 1-1.5 hr.,
Half-Life; 3-10 minutes
Metabolizes in liver,
plasma and kidneys
Use and dosage

Stimulates
pancreatic beta
cells to secrete
insulin.
Type 2 diabetes
mellitus
Give dose 1-3 time
daily
may use alone or in
combination with
insulin
Emergency
treatment of
severe
hypoglycemia in
unconscious client
or those unable to
swallow
Comes in powder
form. Reconstitute
with provided
diluent.
Give IV, IM or SQ
immediately
Give IV through
D5W only, not NS
Side effect
Side effects:
GI distress
dizziness
drowsiness
headache
Teaching and labs

Monitor labs
including glucose,
Hgb A1C
TEACH
Take with first daily
meal.
Adverse effects/toxicity: Take any missed
dose as soon as
Severe skin rash,
remembered.
pruritus
Report s/s of
Hypoglycemia
hypoglycemia if
they occur
Avoid alcohol
Side effects:
Should awaken
Nausea/ vomiting
within 5-20 min
after giving.
Adverse effects/toxicity: Give 50% glucose if
Hypersensitivity
no response to
reaction,
glucagon
Teach
hyperglycemia
test blood sugar,
Hypokalemia
teach family how to
administer SQ or IM
contraindication
Avoid with:
Pregnancy,
lactation
Allergy to sulfa or
urea
Diabetic
ketoacidosis
Caution with:
impaired renal and
hepatic function
Adrenal or pituitary
insufficiency.
Incompatible with
sodium chloride
solution.
37
Drug
Glyburide
(Micronase, DiaBeta)
Oral antidiabetic,
more potent drug
Sulfonylurea
Onset 15-60 min
Peak 1-2 hrs.
Duration up to 24 hrs.
Half-life 10 hours
Metabolized in the
liver, excreted in urine
and feces.
Haloperidol (Haldol)
High potency drug
Antipsychotic
Butyrophenone
Antiemetic
Onset: 30-45 min IM
Effects can be seen in 12 days. Substantial
improvement 2-4 wks.
Full effect several
months.
Use and dosage

Lowers blood sugar
concentration in
diabetics and
nondiabetics by
sensitizing
pancreatic beta
cells to release
insulin in the
presence of serum
glucose.
Type 2 diabetes
Use as adjunct to
diet and exercise to
lower blood sugar
Psychotic disorders
Long acting drug
for maintenance
to control
symptoms
Tourettes
syndrome
Side effect
Side effects:
Hypoglycemia,
epigastric fullness
heartburn
pruritus
Teaching and labs

Give once in the
morning with
breakfast or with
first main meal
Monitor labs
including glucose,
HgbA1c
Teach
hypoglycemia
Report reaction
Loss of control of
blood glucose level
may be due to
fever, surgery,
trauma, stress,
infection.
Side effects: ABCDE:
EPSE: usually first
Anticholinergic (dry
few days of tx, dose
mouth)
related, controlled
by dose or anti Blurred vision
Parkinsons drugs
Constipation
Oral: Give with milk

Drowsiness
or food.
Extrapyramidal
Taper dose slowly
syndrome (such as
when stopping.
Parkinsons s/s)
Injection: deep IM
Photosensitivity
risk for orthostatic
hypotension
Elderly patient may
develop Neuroleptic no alcohol or driving
until response
Malignant
known
Syndrome (NLMS)
contraindication
Avoid use with:
diabetic
ketoacidosis
Type I diabetes
Caution with:
renal or hepatic
insufficiency
older adult
malnourished pt.
adrenal or pituitary
insufficiency
Avoid with:
Parkinsons disease
seizure disorder
severe mental
depression
Use caution:
older adults,
lithium therapy
HTN
Lactation
38
Drug
Heparin
Anticoagulant
Antidote = Protamine
sulfate (see separate
listing)
Hydrochlorothiazide
hydrochloride
(Hydrodiuril, HCTZ)
Electrolyte and
water balance
Thiazide diuretic
Effects noted 3-4
days; max effect
takes 3-4 weeks
Use and dosage

As anticoagulant
given IV or SQ
Use as continuous
IV infusion for DVT,
Pulmonary
embolus, angina,
acute MI
SQ for prevention
Side effect
Side effects:
Bleeding
Heparin-induced
Thrombocytopenia
(HIT) may appear
up to several weeks
later.
Hep-lock (flush) is
to maintain
patency of IV
catheters; not for
anticoagulant
therapy
Side effects:
Act on distal
tubules of nephron Glucose intolerance,
and increases
hyperglycemia
urinary excretion of Hypokalemia (low
sodium, chloride,
K+)
potassium, water,
bicarbonate
Decreases edema
and lowers blood
pressure
Most widely
prescribed diuretic
for HTN
Teaching and labs

Does not dissolve
clots prevents
enlargement and
development of
new clots.
Use bleeding
precautions
Monitor labs: aPTT
Normal = 25-40
Coagulated = 1.5-2
times normal = 60-80
contraindication
Avoid use with:
Hemorrhage, active
bleeding
Do not give IM.
Adjust IV dose
based on labs.
Give with food or
mild to reduce GI
upset.
Give dose(s) early in
the day to avoid
nocturia
Limit Sodium intake
Eat foods high in K+.
replacement med
usually not needed
photosensitivity
reaction occur 10-14
days after initial sun
exposure
Avoid with:
Anuria
Hypersensitivity to
thiazide
Use caution:
Bronchial asthma
hepatic cirrhosis
renal dysfunction
history of gout
diabetes
SLE
Lactation
39
Drug
Hydroxyzine HCl
(Atarax, Vistaril)
Anti-emetics
Anti-histamine (H1
receptor
antagonist)
antipruritic
Onset 15-30 min PO
Peak 4-6 hrs.
Duration
Absorbed form GI.
Metabolized in the liver
Ibuprofen
(Advil, Motrin)
Analgesic
Non-steroidal antiinflammatory
(NSAID)
For high dose
therapy:
therapeutic effect
may take up to one
month
Use and dosage

Treat N/V (use
anticipatorily)
Relieve anxiety
Reduce narcotic
requirement before
and after surgery.
Treat acute or
chronic alcoholism
with withdrawal
symptom or DTs
Pruritus
Side effect
Side effects:
CNS depression,
Drowsiness
Dizziness
dry mouth,
anticholinergic
effect
constipation
visual changes
photosensitivity
Teaching and labs

IM:
Administer deep IM,
Z-track gluteus
maximum or vastus
lateralis in adults;
vastus lateralis in
children
Side effects:
CNS, renal system,
eyes
Nephrotoxicity
dysuria, hematuria,
oliguria, azotemia,
Blurred vision.
Ototoxicity
Children toxicity:
Rash, StevensJohnson syndrome
Usually PO for
maintenance
Treat mild to
moderate pain
absorbed in GI;
metabolized in liver
contraindication
Avoid with:
CNS depression and
coma.
Other CNS meds
Use caution with:
glaucoma
seizure
intestinal
monitor mouth daily
obstruction
no alcohol
prostatic
hard candy, ice
hyperplasia
chips or rinse mouth asthma
with warm water
cardiac, pulmonary
frequently to relieve
or hepatic disease
dry mouth
Increases toxicity of Avoid with:
GI bleed
anticoagulant,
lithium
Reaction to other
NSAIDs
Avoid alcohol, ASA, Children under 6
other NSAIDs
months
40
Drug
INSULINS
-
quick acting:
short acting
intermediate acting
long acting
Insulin is also available

in a premixed form of
Regular and NPH
(example: 70/30 = 30%
regular, 70% NPH).
Use and dosage

Diabetes mellitus,
type 1 or type 2
Could be made of:
pork/beef, pork or
human insulin type.
Short acting and
intermediate acting
insulin may be
given more than
once per day.
Side effect
Side effects:
Hypoglycemia
(anxiety, confusion,
nervousness,
hunger, diaphoresis,
cool, clammy skin)
Lipodystrophy
(abnormal deposits
of subcutaneous fat
at injection sites),
local allergic
reaction
Somogyi
phenomenon: a
rebound response
with high blood
sugar in response to
low level at night.
Coma
Hyperosmolar
hyperglycemic state
(HHS)
Diabetic
ketoacidosis (DKA)
Teaching and labs

obtain med alert
bracelets
Open vial can be
stored at room
temp for up to one
month.
Rotate sites
Alcohol will increase
blood sugar
contraindication
Do not use
beef/pork insulin if
sensitivity
Requires long-term
monitoring of blood
sugar control and
potential
complications.
41
Drug
Insulin Regular
(Humulin R)
**THIS IS THE ONLY TYPE
OF INSULIN WHICH CAN BE
GIVEN
IV. **
Isophane (NPH) insulin

(Humulin N)
Insulin Glargine
(Lantus)
** LANTUS CANNOT BE
MIXED IN SAME SYRINGE
Use and dosage

Side effect
Short acting insulin hypoglycemia
Given IV or SQ
type 1 and type 2
diabetes mellitus
and ketoacidosis.
given before meals
according to blood
levels
Intermediate
If given before
acting insulin
breakfast,
hypoglycemic
Give 30 min before
episode is most
first meal of the
likely to occur
day. If necessary, a
between midsecond smaller
afternoon and
dose may be
dinner, when it
prescribed 30 min
peaks. Eat snack in
before bedtime.
midafternoon and
carry sugar candy.
Teaching and labs

Regular insulin is
clear and colorless.
Long acting insulin

Type 1 children &
adults; Type 2
adults
SQ injection
With Type 2
diabetes, may or
may not be given
concurrently with
oral agents.
contraindication
NPH Insulin is a
cloudy suspension.
Roll the bottle to
mix; do not shake.
NOTE: NPH may be
mixed with Regular
insulin injection
without altering
either solution.
WITH ANY OTHER

INSULIN.**
Usually given one

per day at bedtime.
May be given two
times per day.
42
Drug
Iron
Use and dosage

Mineral
replacement
Ipecac Syrup
Adverse effects/toxicity: Use of this

For overdose on
Cardiotoxicity is
certain drug or
medication is not
poison
most serious if
automatic verify
vomiting does not
appropriateness
stimulates vomiting
occur
and
the
with Poison control
within 20-30 min
substance is
center
retained.
Emetic
Antidote
Alternate: Activated
Charcoal (see separate
listing)
Side effect
Side effects:
Nausea/vomiting
Staining of teeth
Constipation
Black stools
(normal)
Teaching and labs

Taking on empty
stomach preferred
with full glass of
water or citrus juice
Calcium inhibits iron
absorption do not
take with milk.
Vitamin C increases
iron absorption
Liquid form can
stain teeth
contraindication
Do not use:
With reduced level
of consciousness or
convulsions
poison by
Petroleum
distillates, strong
alkaline, acid or
strychnine
43
Drug
Lidocaine HCl
(Xylocaine)
Antiarrhythmic
Topical Anesthetic
Bolus dose may
repeat then start
continuous infusion
stop when stable.
Therapeutic level: 1.56mcg/ml
Use and dosage

Treat VENTRICULAR
arrhythmias, PVCs,
V-Tach.
Use for rapid
control of
ventricular
dysrhythmias
during acute MI or
Cardiac cath
Use microdrip
tubing and infusion
pump.
Side effect
Side effects:
Drowsiness,
headache, dizziness,
mild hypotension.
convulsions,
respiratory
depression
CV: hypotension,
bradycardia, heart
block CV collapse,
and arrest
Teaching and labs

LAB
Monitor Lidocaine
levels assess,
therapeutic level is
1.5 -6mcg/ml
Assess electrolyte,
check baseline liver
and renal blood
studies.
Report:
lightheadedness,
dizziness, confusion,
numbness or
Stop infusion with
tingling of lips,
EKG changes such as
tongue or fingers
prolonged PR,
visual changes or
widened QRS, heart ringing in ears
block.
Correct
hypokalemia before
giving Lidocaine
contraindication
Avoid with:
Sinus bradycardia
Severe degrees of
SA, AV and
intraventricular
heart block.
Use caution:
hepatic or renal
disease
CHF
Hypovolemia
shock
hyperthermia
elderly
BETA BLOCKERS
increase the effect
of lidocaine
44
Drug
Lithium carbonate
(Eskalith)
Mood stabilizer
Antipsychotic
Therapeutic level
0.8-1.5meq/L.
Toxic level >2.
Lithium has short
half-life (about 1
day) and high
toxicity.
Lorazepam (Ativan)
Anxiolytic
Sedative-hypnotic
Benzodiazepines.
Onset
1-5 min IV, 15-30 IM,
Peak
60-90 min IM, 2 hrs. PO
Duration 12-24 hrs.
Use and dosage

Drug of choice to
control manic
episodes in bipolar
disorder
Anti manic effects
are usually seen in
5-7 days after initial
doses, but full
effect does not
occur for 2-3 wks.
Lithium is a salt;
exact action
uncertain
Side effect
This med does not
cause sedation.
Mild Side effects:
fine tremor, nausea,
thirst, polyuria,
Vomiting, diarrhea,
slurred speech, lack
of coordination,
drowsiness, muscle
weakness, or
twitching)
withhold dose and
notify provider but
DO NOT stop
abruptly.
Side effects:
anxiety disorder
short term for relief Drowsiness
sedation
of symptoms of
anxiety
Mild medication
Pre-anesthetic
with limited toxic
medication to
potential
produce sedation
respiratory
and reduce anxiety.
depression is rate
Status epilepticus
Paradoxical reactions
(nightmares, mania,
etc.) may occur in
children, psych patients
and the elderly.
Teaching and labs

Give with meals
Hydration is
essential
dehydration will
increase levels
Watch for weight
gain (fluid
retention)
Avoid NSAIDs and
diuretics.
Essential to monitor
mood and behaviors
Labs: Lithium level
every 3 months
initially, then every
6 months.
Avoid alcohol
Taper dose when
stopping to avoid
withdrawal
symptoms
Watch for suicidal
risk
contraindication
Do not use with:
Dehydration,
severe debilitating,
severe
cardiovascular.
Use caution:
elderly,
pt. with cardiac,
renal, thyroid or
diabetes
pregnancy
Do not use with:

Acute narrow-angle
glaucoma,
Primary depression
acute alcohol
intoxication.
Pregnancy and
Lactation
Use caution:
renal or hepatic
impairment
myasthenia gravis
suicidal tendencies
45
Drug
Magnesium Sulfate
iron(Epsom salt oral
form)
Onset 1-2 hrs. PO; 1 hr.

IM.
Duration 30 min IV, 3-4
hr. PO
Eliminated by kidneys
Use and dosage

Oral: laxative (by
osmotic retention
of fluid which
distend the colon,
increase content of
feces and cause
bowel stimulation)
Parenteral: CNS
depressant; used in
seizures of
toxemia; for
hypomagnesemia
Normal Magnesium
level: 1.8-3 mEq/L
4 gm. loading dose
is give over 20-20
min via pump.
Side effect
Side effects:
Flushed warm
feeling
imbalance
hyponatremia
N/V
Early indication of
magnesium toxicity
Respiratory
depression
Cathartic effect
profound thirst
feeling of warmth
sedation
confusion
depressed deep
tendon reflexes
muscle weakness
can lead to cardiac
arrest
Teaching and labs

s/s hypomagnesemia:
irritability
tremors, tetany
tachycardia
hypertension
psychotic behavior
Monitor urinary
output and hydrate
adequately with
parenteral
administration.
contraindication
Avoid with:
MI, heart block,
cardiac arrest
except for certain
arrhythmias.
Use caution:
impaired kidney
function
other cardiac
glycosides
Lactating moms
and children
46
Drug
Mannitol (Osmitrol)
Use and dosage

Use in oliguria and
acute renal failure.
Electrolyte and
Help to prevent
water balance
renal failure and
agent
reduce increased
intracranial or
osmotic diuretic
intraocular
pressure
Onset
1-3 hr. diuresis; 30 to 60 It acts by increasing
min IOP, 15 min. for ICP
the osmolality of
Duration
plasma, glomerular
4-6 hr. IOP,
filtrate, and tubular
3-8 hr. ICP
fluid. This
decreases the
Serum osmolality is 275reabsorption of
300 mmol/kg.
fluid and
electrolytes, which
increases excretion
of water, chloride
Give IV.
and sodium and
Usually give test dose
slightly increase the
which should result in
excretion of
Output of 30 to 50
Potassium.
ml/hr. and is produced In intraocular (IOP)
2-3 hrs. after
and CSF (ICP), it
administration.
pulls the fluid and
sends it to the
plasma and
extravascular
systems
Side effect
Side effects:
HA, confusion,
syncope
imbalance, esp.
hyponatremia
pulmonary
congestion, rhinitis
Water intoxication
Teaching and labs

Use filter needle
and/or filter in
infusion tubing
because crystals
may form in the
solution.
Mannitol is held if
serum osmolality
exceeds 310 -320.
Daily weights
Adverse effects/toxicity: Teach
Non-narcotics such
Seizure,
as Tylenol if there is
thrombophlebitis,
headache
CHF, Cardiovascular
Therapy is based on
collapse
urine flow rate.
Hyponatremia
Reassure pt. that
excessive thirst,
Warning: There may be
blurred vision,
a rebound increase in
rhinitis should
ICP about 12 hours after
subside when
administration of med.
Mannitol is
Pt may complain of HA,
discontinued
or confusion.
contraindication
Do not use:
severely impaired
renal function
marked
dehydration
breast feeding
hepatic failure,
active ICP
anuria
Intracranial bleed
shock
Question the
administration of
mannitol if the
patient has cor
pulmonae (right
sided heart failure)
because Mannitol
pulls fluid and it
may lead to
circulatory overload
which the heart
could not handle.
This client would
need loop diuretic
to prevent serious
complications
47
Drug
Meperidine HCl
(Demerol)
Narcotic analgesic
(opioid agonist)
Use and dosage

Given for moderate
to severe pain.
Potent, long acting
Give Narcan for

toxicity - It is use to
reverse respiratory
depression induced by
overdose
Onset: 15 mins. PO, 10
mins. IM, 5 mins IV
duration 2-4 hours
Metoprolol tartrate
(Lopressor, Toprol)
Beta adrenergic
antagonist
(beta blocker)
Antihypertensive
Antianginal = same
action as with
propanolol
Side effect
Side effects:
N/V, Anorexia
Sedation, dizziness
elevated BP
rash, urticaria
tremors
hyperventilation
Resp depression,
respiratory arrest,
circulatory
depression,
increased
intracranial pressure
Decreases heart
rate and cardiac
output
Lowers BP
Side effects:
Usually well
tolerated
Nausea, vomiting
Weight gain
Mild to severe HTN worsening CHF
angina pectoris
insomnia
**Post - acute MI** Adverse effects/toxicity:
profound
Max effect may
bradycardia
take 1 week
heart block
acute CHF,
bronchospasm
laryngospasm
Teaching and labs

Assess:
LOC
rash, urticaria
respiratory rate.
If respirations < 12 per
minute withhold
meds.
contraindication
Avoid use with:
acute bronchial
asthma, upper
airway obstruction
increased
intracranial
pressure
convulsive disorder
pancreatitis, acute
ulcerative colitis
severe liver or
kidney insufficiency
Caution with:
children and elderly
Give with or w/o

food, but consistent
Do not stop
abruptly; may cause
rebound effect.
Gradually decrease
over 1-2 wks.
Hold meds if BP < 90
or pulse < 60
Watch for s/s heart
failure
Can lead to elevated
BUN, creat.
May mask
hypoglycemia
Avoid use with:

Heart block greater
than 1st degree
Sinus brady,
cardiogenic shock
Use caution:
hyperactive airway
syndrome ( asthma
or bronchospasm)
Increases chance of
both Dig and
Lithium toxicity
48
Drug
Morphine Sulfate
(MS Contin = sustained
release form)
Narcotic analgesic
(Opioid agonist)
Use and dosage

Produces effect by
binding to opioid
receptors
throughout the
CNS.
Schedule II drug,
major drug abuse.
Give Narcan for

toxicity.
Onset, Peak, Duration

depend on route of
medication.
Onset: Immediate IV,
rapid if given IM or oral,
except MS Contin
Side effect
Side effects:
Nausea vomiting
anorexia, GI,
pruritus,
light headedness
constipation
Classic triad of
symptoms:
For severe, chronic
respiratory
or acute pain.
depression, coma,
Most commonly
pinpoint pupils.
use in post Withdrawal begins
operative setting.
6-8 hrs. After the
mild bronchodilator
last dose, reach
to improve
peak intensity within
breathing
48-72 hrs. S/S
include craving,
MS Contin is
chills, sweating
sustained release;
piloerection (goose
it will not control
flesh), abdominal
break-through pain
pain and cramps,
because it is time
diarrhea, runny
release.
nose, irritability.
Morphine induced
CNS stimulation
paradoxical reaction
common in women
and older adults.
Teaching and labs
contraindication
Avoid use with:
Avoid alcohol use
Hypersensitivity to
opiates)
Hold medication if
acute bronchial
respirations < 12/min
asthma or upper
airway obstruction,
Hydrate adequately ICP
to prevent
convulsive
constipation
disorders
pancreatitis, acute
ulcerative colitis
severe liver or
kidney disease
Do not give
morphine to
children
49
Drug
Use and dosage
Naloxone HCl (Narcan) Competes with
opioids at the
opiate receptor
Opioid antagonist.
sites, blocking the
effects of the
Onset
opioids
1-2 min IV;
Reverses effects of
2-5 mins. SQ or IM
opiates, including
respiratory
Duration
depression,
1 hr. IV; up to 4 hrs. IM
sedation and
but start to diminish
hypotension.
after 20 mins.
May need given
every few hours
until the opioids
has dropped to a
nontoxic level
Nedocromil (Tilade)
asthma prophylaxis
NOT for acute
Inhaled nonasthma attacks
steroidal
up to a week for
medication
full effectiveness
anti-inflammatory
Must be taken
and antiasthmatic.
regularly to be
effective
Side effect
Side effects:
Increased BP, HR,
hyperpnea
tremors,
hyperventilation,
drowsiness,
nervousness
N/V
Teaching and labs

Watch vital signs
and respiratory
function closely
with administration
of medication
contraindication
Avoid use with:
Known allergy
Respiratory
depression d/t nonopioids
Substance abuse
Titrate dose slowly (may lead to
if too much is given
withdrawal
the client will swing
symptoms)
from a state of
intoxication to one
Hypotension,
of withdrawal
V-tach and V-fib
convulsion,
hepatitis
pulmonary edema,
Adverse effect:
abnormal bitter
taste
N/V, HA, dizziness,
sore throat.
Rinse mouth after

taking medication
to avoid dry mouth
Do not use for
acute attack
Non-compliance is a
concern due to
bitter taste
Avoid use with:

acute
bronchospasm or
status asthmaticus.
Hypersensitivity
Use with caution:
hepatic or renal
function
(also available as optic

form for ocular
allergic conjunctivitis)
50
Drug
Neomycin sulfate
(Mycifradin)
ORAL
aminoglycoside
antibiotic
Nifedipine (Procardia)
Calcium Channel
Blocker
Antianginal
Antihypertensive
Negative inotropic
Use and dosage

Antibacterial ORAL
GI tract
Hepatic coma
Side effect
Side effects: skin rash
(esp. topical)
Teaching and labs

Poorly tolerated GI
so it is usually for
bowel cleansing.
contraindication
Main form is topical for Nephrotoxicity
eye, ear and skin
Ototoxicity.
infection.
NEOMYCIN IS NOT GIVEN IV
angina
mild to moderate
HTN (sustained
release form)
Do not give 1-2 wks.

after an acute MI.
Do not give with
grapefruit juice
(could lead to
toxicity)
Dilates coronary
Report gradual
arteries and relaxes
coronary spasm
weight gain and
evidence of edema;
Increases cardiac
may indicate onset
output; decreases
of CHF.
peripheral vascular Adverse effects/toxicity:
Do not stop
resistance.
Gingival hyperplasia
suddenly (will have
Blocks calcium ion
rebound symptoms)
flow into cells of
Smoking decreases
myocardial and
arterial smooth
efficacy of med
muscle (cardiac and
Monitor pulse rate
peripheral blood
report irregular or
vessels)
slower than normal
Slows HR;
rate. Hold for BP
decreases O2 need
below 90/60.
Side effects:
Usually well
tolerated
Headache
fatigue
Dizziness
Postural
hypotension
peripheral edema
Avoid use with:

Known
hypersensitivity
Unstable angina
Lactation
51
Drug
Oxytocin (Pitocin)
Oxytocic
Labor and delivery.
Onset is immediate.
After stopping med,
contractions should
stop in 2-3 minutes
Half-life 3-5 min
Pancrelipase
(Creon, Pancrease)
Pancreatic enzyme
replacement
therapy
Use and dosage

To initiate or
improve uterine
contractions at
term
Induce labor
Management of
incomplete or
missed abortion
(miscarriage)
reduce postpartum
bleeding
Help to breakdown
fat, proteins and
carbs for better
absorption.
cystic fibrosis
chronic
pancreatitis, post
pancretectomy
steatorrhea
malabsorption
syndrome
Side effect
Teaching and labs
Side effects:
Careful monitoring
subarachnoid bleed
of uterine
contraction pattern,
fetal trauma
fetal heart rate and
seizure, coma
maternal BP.
Hypertensive crisis.
Postpartum;
monitor lochia and
For fetal anoxia:
BP.
stop infusion, turn
contraindication
Avoid use with:
Hypersensitivity
Cepahalopelvic
disproportion
Obstetric
emergencies
mom on left side,

oxygen prn
Stop infusion for:
Contractions which
occur more often
than every 2 mins.
or last over 90 sec.
Do not increase
dose after desired
contraction pattern
is achieved
(contraction
frequency of 2-3 min
lasting 60 sec).
Side effects:
Take with or just
Nausea, diarrhea,
prior to eating
and cramps
Do not mix brand
names; there is a
variance in
Hyperuricemia.
concentration of
Report joint or
enzymes
swelling pain (high
Swallow tablet or
uric acid level)
capsule whole; do
not crush or chew.
Can mix powder or
open capsule with
food.
Drug interaction:
Allergy to med or
pork
Do not give with
magnesiumcontaining antacid.
May be ordered
with H2 blockers or
with proton pump
inhibitors.
Iron will decrease
effectiveness of
med.
52
Drug
Phenobartial
(Phenobarbital Sodium
= Luminal) this is the
short-acting form.
For status epilepticus:
Administer slow IV
Anticonvulsant
Sedative-hypnotic
Pilocarpine
hydrochloride (Pilocar)
Eye preparation.
Miotic (Antiglaucoma agent).
Direct acting
cholinergic agent
for ophthalmic use.
It is an antidote to
Atropine
Use and dosage

Long-term
management of
grand mal, partial
seizure and status
epilepticus.
Sedative effect to
decrease anxiety
and tension.
No analgesic effect
For acute or
chronic Glaucoma
decreases
intraocular
pressure
Will reverse the
effects of Atropine
(and Atropine will
reverse the effects
of Pilocarpine).
Side effect
Side effects:
Somnolence,
hangover effect
CNS depression,
Stevens-Johnson
Blood dyscrasias
Paradoxical
reactions may occur
in children, older
adults and
debilitated people
Teaching and labs

Okay to crush and
mix with food or
fluids
Monitor IV infusion
closely.
Do not stop
abruptly
Avoid alcohol and
other CNS
depressants
Side effects:
Apply gentle
Visual blurring,
pressure for 1-2
myopia, irritation,
mins. to
brow pain and HA.
nasolacrimal
(with ophthalmic)
drainage area after
administering eye
Normal: Increased
gtts
pigmentation of iris
Eye therapy will
and eyelids; long
eyelashes.
continue long term
Retinal detachment
Ataxia
Confusion
seizure
contraindication
Avoid use with:
Hypersensitivity
Resp or kidney
failure
Pregnancy and
lactation
Avoid use with:

Asthma, COPD
HTN
Acute eye
infections, retinal
detachment,
contact lens use
53
Drug
Prazosin hydrochloride
(Minipress)
Antihypertensive
Alpha-adrenergic
receptor antagonist
vasodilator
Treat benign
prosthetic
hyperplasia (BPH)
Use and dosage

Mild to moderate
HTN mainly
diastolic
little effect on
cardiac output and
HR
BPH (due to
vasodilator effects)
Optimal effects may

take 4-6 weeks
Prochlorperazine
(Compazine)
Antiemetic
Antipsychotic
Phenothiazine
Side effect
Side effects:
Dizziness,
drowsiness
Fatigue, weakness.
Priapism, impotence
Orthostatic
hypotension
First-dose
phenomenon:
syncope within 30
min to 1 hr. Effect is
transient, may
diminish by giving
at bedtime.
Severe nausea and Side effects:
drowsiness,
vomiting
dizziness,
Management of
EPSE
psychotic
disorders,
excessive anxiety
Persistent tardive
and agitation
dyskinesia
Tremor, twitching
Take 30-60 min
Agranulocytosis,
before any activity thrombocytopenia
that causes nausea After 1-2 months:
for best effect.
Akathisia (inner
restless, inability to
Start doses low and
sit still) may tx
increase slowly
with propranolol.
Teaching and labs

monitor for
decreased BP,
especially with
initial administration
Monitor urine vol.
change position
slowly to prevent
orthostatic
hypotension
stop smoking and
avoid alcohol intake
avoid driving and
hazardous tasks
until effect of med
is known
Avoid excessive
sunlight may turn
skin gray-blue
Urine may turn
reddish brown
Use sugarless hard
candy or ice chips to
avoid dry mouth.
Avoid skin contact
with concentrate
Do not crush or
chew swallow
whole
Deep IM, not SQ
injection
contraindication
Avoid use with:
Prior sensitivity
hypotension
Use caution with:
impaired hepatic
function
older adults
Avoid use with:

Hypersensitivity
Blood dyscrasias
Dementia related
psychosis in elderly
Young children
Seizures
Lactation
54
Drug
Promethazine
(Phenergan)
Antiemetic
Antihistamine
Anti-vertigo
Protamine sulfate
Antidote for
Heparin toxicity.
Heparin antagonist
Onset = 5 minutes
Duration = 2 hours
Longer half-life than
heparin
Ranitidine
hydrochloride (Zantac)
H2-receptor
antagonist.
Higher potency
than cimetidine
(Tagamet)
Use and dosage

Long-acting med
motion sickness
nausea
Side effect
Side effects:
Resp depression,
drowsiness,
confusion
IM route: Give deep agranulocytosis
blurred vision
IM; not SQ (can
cause necrosis)
dry mouth
Avoid intra-arterial EPSE
injection can
cause necrosis.
Teaching and labs

Decrease GI distress
by giving oral dose
with milk or food.
May crush and mix
with food.
Avoid sunlight
exposure
Avoid alcohol and
other CNS
depressants
contraindication
Avoid use with:
Acute MI, angina,
atrial fib
Use caution with:
Narrow angle
glaucoma
peptic ulcer
duodenal
obstruction
Antidote for
Heparin overdose
Given IV; maximum
dose of 50 mg in 10
min time period;
should be titrated
according to the
time and length of
time the heparin
was administered
Reduce gastric
secretion.
Active duodenal
ulcer, maintenance
after healing
GERD
benign gastric ulcer
(short-term)
Monitor vital signs

and labs closely
(aPTT)
Avoid use with:

Hemorrhage not
induced by heparin
overdose.
Side effect:
Abrupt drop in BP if
administered too
rapidly.
See listing for HEPARIN
Side effects:
headache
taste disorder,
diarrhea,
constipation
dry mouth
hepatotoxicity
thrombocytopenia
Give without regard

to meals
Usually give 1 x day
reduce dose in renal
patient
avoid smoking to
avoid antacid within
1 hour of dose
Avoid use with:

Hypersensitivity
Use caution with:
Impaired renal of
hepatic function.
May increase
effects of alcohol,
aspirin, Coumadin
and sulfonylureas
55
Drug
Rh0(D) immune
globulin (RhoGAM)
Biological response
modifier
Immunoglobulin
(IgG)
Peak 2 hour
Half-life 25 days
Use and dosage

Given to Rhnegative moms
with RH positive
babies.
Provides passive
immunity by
suppressing active
antibody response
and formation of
anti-RHo when (1)
positive fetal RBC
enters maternal
circulation during
the third stage of
labor; (2) there is
fetal maternal
hemorrhage or other
trauma during
pregnancy; (3)
termination of
pregnancy or
miscarriage; or (4)
following a Rh+
transfusion.
Side effect
Side effects:
Injection site
irritation
slight fever
myalgia
lethargy
Teaching and labs

contraindication
Avoid use with:
Send sample of
newborn cord blood Known sensitivity
to lab for cross
to human
match and typing
immunoglobulins.
immediately after
delivery before
administer RHo (D)
Give to mom IM via
deltoid. (Only a few
forms can be given
IV).
Give immediately
after reconstitution
Recommended at
28 weeks gestation
and then within 72
hours after delivery
or 3 hrs. of
termination of
pregnancy or
miscarriage.
Keep epinephrine
available; systemic
allergic reactions
sometimes occur.
TEACH it will
prevent hemolytic
disease in a
subsequent
pregnancy
56
Drug
Setraline
hydrochloride (Zoloft)
Antidepressant
SSRI (selective
serotonin reuptake
inhibitor)
Spironolactone
(Aldactone)
Fluid & electrolyte
balance
antihypertensive
Potassium sparing
diuretic
Use and dosage

panic disorders
Anxiety disorders
OCD
PTSD
2-3 wks. to be
effective
Increases sodium
excretion; does not
decrease
potassium
treatment of
primary
aldosteronism
Use for edema and
HTN associated
with heart failure.
Side effect
Side effects:
Cause fewer
disorders than other
antidepressants
fewer side effects
on HR and HTN
Sexual dysfunction
Weight gain
Major complication
(Selective Serotonin
Syndrome): Pt. can
die from it. Elevated
temp up to 105.
Every speed up. BP,
HR, Temp. May
progress to coma.
Side effects:
Headache
dizziness, weakness
orthostatic
hypotension
Hyperkalemia
(nausea, vomiting,
diarrhea, cramps,
tachycardia then
bradycardia)
aplastic anemia
thrombocytopenia
Teaching and labs

Give with food in
the morning to
prevent insomnia
Watch for suicide
risk
Increases effect of
Coumadin
Avoid grapefruit
juice
contraindication
Avoid use:
Within 14 days of
using MAO inhibitor
Seizure disorder
Take with food

avoid salt substitute
high in K+
Avoid excessive
ingestion of foods
high in potassium.
no potassium
supplement needed
Monitor VS and
urine output
Avoid direct
sunlight
Avoid use with:

Serum K+ level > 5.5
anuria, acute and
chronic renal
insufficiency
diabetic
nephropathy
hypersensitivity
impaired hepatic
function
Decreases effect of
Dig;
increases chance of
lithium toxicity
57
Drug
Sucralfate (Carafate)
Antiulcer
Gastro-protective
agent
Theophylline
(Theo-dur)
Bronchodilator
(resp. smooth
muscle relaxant)
xanthines
Normal level 10-20.
toxic level (> 20)
may develop
quickly
Use and dosage

Protects the ulcer
from gastric acid by
forming an
adherent coating; it
absorbs pepsin
decreasing its
activity.
Duodenal ulcer
Short term with
gastric ulcer
esophageal ulcer
related to radiation
or chemotherapy
bronchospasms
asthma
bronchitis
emphysema
Side effect
Side effects:
constipation
nausea
Side effects:
Tachycardia
Seizures
N/V, anorexia,
restlessness,
agitation, HA, and
insomnia
note: restlessness
could be due to
toxicity or hypoxia
so close assessment
is required
Teaching and labs

No antacid use
within hour of
this medication
contraindication
Avoid use with:
Chronic kidney
failure
Avoid gastric
irritants such as
caffeine, alcohol,
smoking and spicy
foods.
Decreases
absorption of Cipro,
Dig, Dilantin,
Tetracycline (so take
these med 2 hours
apart from Sucralfate)
PO: take with water

and after meals.
Wait 4-6 hours after
IV to start PO.
Take same time
each day
Avoid use with:

CAD, angina
Renal or liver
disease
Pregnancy,
lactation
children
CHF and acute viral
can cause seizure
(with high
doses/levels) so
avoid with seizure
disorder unless
bronchospasm is
unresponsive to
other treatments
Limit caffeine
Smoking decreases
effect of med
Increases lithium
excretion
58
Drug
Tobramycin sulfate
Aminoglycoside
Antibiotic
IV/IM
Inhalation (TOBI)
Ophthalmic (Tobrex)
Tolbutamide (Orinase)
Antidiabetic
Sulfonylureas
Peak: 3-5 hours
Duration: 6-12 hours
Use and dosage

broad spectrum
antibiotic
Kills bacteria cell by
affecting protein
synthesis. Kill Gram
negative infection.
Inhalation
preventative with
cystic fibrosis (28
days on, 28 days
off)
Eye external eye
infections
Mild to moderately
severe, stable Type
2 Diabetes
May be used as
adjunct therapy for
Type 1 Diabetes but
not sole medication
Give 1-2 x day after
meals
1-2 weeks of
medication may be
required for full
therapeutic effect
Side effect
Side effects:
HA, paresthesia, skin
rash, fevers.
Nephrotoxicity and
ototoxicity are two
common toxicities
associated with
aminoglycosides.
Eye itching, swelling
REFER to sections on
aminoglycosides
(Gentamycin)
Side effects:
GI distress
Pruritus, rash (may
stop on own)
Photosensitivity
Alcohol may cause
disulfiram like
reaction (flushing,
palpation and
nausea, flushing of
skin).
Hypoglycemia due
to too much med,
drug interactions,
N/V, inadequate
food intake.
Teaching and labs

Doses are based on
weight
Do not other meds
In the same IV
LAB
Peak and Trough
serum creatinine,
BUN to monitor
renal function
contraindication
Do not use with:
Known sensitivity
to other
aminoglycosides
Preexisting renal
disease.
Avoid use with:

Monitor blood
Allergy to sulfa or
sugars including
fasting and HgbA1C
urea
Teach
Signs and symptoms Beta adrenergic
of hypoglycemia
blocking agents
and notify
(betablockers) can
prescriber if they
suppress insulin
occur.
release and delay
response to
Wear medic alert
hypoglycemia
bracelet or tag
Avoid alcohol
Consult dr. when
pregnant
59
Drug
Triazolam (Halcion)
sedative hypnotic
Anxiolytic
Benzodiazepine
Has rapid onset (15-30
mins.)
Peak 1-2 hours
Duration 6-8 hours
Trihexyphenidyl HCl
(Artane)
Anticholinergic
Antispasmodic
Use and dosage

short term
management of
insomnia (4 weeks)
characterized by
difficulty falling
asleep, frequent
wakeful periods
Side effect
Drowsiness,
lethargy, confusion
sleepwalking
Physical
dependence
Seizures (with rapid
withdrawal)
With overdose:
coma, respiratory
depression,
paradoxical anxiety
Teaching and labs

Do not use in
addictive prone pt.
Monitor symptoms
of overdose (slurred
speech, confusion,
somnolence,
impaired
coordination and
coma).
following long term
use, tolerance may
develop so do not
stop taking abruptly
contraindication
Avoid use with:
Known sensitivity
Alcohol intoxication
Suicidal ideas
Pregnancy,
lactation
Treat Parkinsons
disease.
Diminishes hypersalivation; rigidity
and irregular
movements in
Parkinsons.
Use to control
drug-induced extrapyramidal side
effects
Side effects:
Drowsiness
Decrease urine
output, retention or
hesitancy
Dry mouth
Constipation
Paralytic ileus
Monitor I& O
increase fluids, bulk
and exercise
void before taking
to reduce urinary
retention
Avoid driving or
other hazardous
activities as
drowsiness may
occur.
Avoid OTC such as
cough medicine
with alcohol.
Very dose sensitive
Avoid use with:

narrow angle
glaucoma,
myasthenia gravis
GI obstruction
60
Drug
Vincristine sulfate
(Oncovin)
Antineoplastic
Vinca alkaloids
(from plant)
mitotic inhibitor
IS a vesicant;
administer into the
side arm portal of a
freely flowing IV.
Hyaluronidase is
given if this
vesicant should
infiltrate. May
apply heat to site to
disperse drug and
minimize sloughing.
Use and dosage

Acute
lymphoblastic and
other leukemias
lymphosarcoma,
Hodgkins disease
breast and lung
cancers
Side effect
Major toxicities
occur in the
hematopoietic,
integumentary,
neurologic and
reproductive,
system.
Peripheral
neuropathy
Paralytic ileus (more
common in young
children)
Alopecia
Neurotoxicity - loss
of sensation of the
soles of feet and
fingertips
Depression of the
Achilles reflex is the
earliest sign of
neuropathy
Children are
especially likely to
develop neuro
changes
Teaching and labs

Neutropenic
precautions prn
Assess hand grasp
and deep tendon
reflexes
Maintain a regimen
against constipation
and paralytic ileus;
report a change in
bowel habits.
Vesicant safety
precautions:
Good vein, prefer
central line access
or fresh butterfly
stick
chemo-trained
nurse
remain during
infusion
have antidote
handy
contraindication
Avoid use with:
Obstructive
jaundice
Pre-existing
neuromuscular
disease
Active infection
Pregnancy,
lactation
Bronchospasm may
occur in pt
previously treated
with mitomycin
61
Drug
Vitamin B6
(Pyridoxine HCl)
Water-soluble
vitamin
Absorbed by GI tract
s/s of deficiency:
Lack of energy
Decreased brain
functioning
skin lesions,
conjunctivitis
Vitamin B12
Vitamin C
(Ascorbic acid)
Water soluble
vitamin
s/s of Deficiency which
is called Scurvy
Malaise, lethargy
pinpoint
hemorrhages
bleeding gums,
rough skin and
blotchy spots
especially legs
Use and dosage

Prevention and
treatment of
pyridoxine
deficiency (see
causes)
Co-enzyme in
amino acid
metabolism and
red blood cell
production
Treats acute
toxicity of INH,
hydralazine.
(see entry under
Cyanocobalamin)
Protects
connective tissue,
strengthens blood
vessel walls, forms
scar tissue,
provides matrix for
bone growth
Supports immune
system
helps in absorption
of iron and to
metabolize amino
acid
acidifies urine
Side effect
Teaching and labs

Causes of deficiency:
Side effects:
Alcoholism
Pain at injection site Malabsorption
disorders
Neuropathy
Oral contraceptives
Ataxia
Dietary sources:
seizures
green leafy veg.
organ meats, fish,
poultry
legumes, chickpeas
bananas
whole grains,
potatoes
Side effects:
Rare at normal doses
Mix oral solutions

with food
Adverse effects/toxicity: Causes of deficiency:

crystalluria
Normal aging
Alcohol
Other meds
Increases
absorption of Iron
Dietary Sources:
citrus fruits,
cantaloupe,
strawberries,
broccoli, cabbage,
cauliflower
tomatoes
contraindication
Use with caution:
Renal disease
Cardiac disease
Common drug
interactions:
INH, hydralazine,
oral contraceptives
Reverses or
antagonizes effects
of levodopa.
Avoid use with:

Prone to kidney
stones
Megadoses of Vit. C
can interfere with
absorption of
Vitamin B12.
62
Drug
Vitamin D2
(Ergocalciferol)
Fat-soluble vitamin
s/s deficiency which is

called rickets
bones fail to calcify
bowed legs
osteomalacia
muscle spasm
Use and dosage

Calcium and
phosphate
metabolism
Remember calcium
and phosphorus are
inverse (high one,
lower other)
Necessary to
develop and
maintain strong
bones
osteomalacia and
osteoporosis
hypoparathyroidism
Treat and prevent
rickets
Side effect
Side effects:
Uncommon at
normal doses
Metallic taste
Teaching and labs

Inadequate sunlight
Dietary intake
hypoparathyroid
n/v,
fatigue, headache,
hallucinations
dysrhythmias
Hypercalcemia
Stones
Dietary Sources:
Egg yolks
fortified cereals and
milk
Cod liver oil
some fish
contraindication
Avoid use with:
Hypersensitivity to
Vit. D
Hypercalcemia
Hyperphosphatemia
Also obtained from

sunlight
63
Drug
Vitamin E
(alpha-tocopherol)
Fat-soluble vitamin
s/s deficiency:
Hemolytic anemia
Vitamin K1
(Aquamephyton)
(Phytonadione)
Fat soluble vitamin
s/s deficiency:
Deficiency causes
hemorrhage.
Given as antidote for
Coumadin (warfarin)
overdose.
Onset IV = 6 hours
Use and dosage

Dietary supplement
Hemolytic anemia
in neonates
Topical to chapped
skin
Prevents cell
membrane damage
protects against
blood clot
development
Side effect
Side effects:
Uncommon at
normal doses
Teaching and labs

normal aging
Prematurity
Malabsorption
diseases
N/V
Dietary Sources:
fatigue,
Wheat germ
headache
Vegetable oils
blurred vision
Green leafy
Toxic:
vegetables
jaundice
Nuts
brain damage
Dairy, eggs
Promotes liver
synthesis of
clotting factors
Side effects:
Swelling and pain at
injection site
SQ administration
preferred over IM.
Labs: Monitor
PT/INR (see note
Given to newborns Adverse effects/toxicity:
under warfarin)
to prevent bleeding Hypersensitivity or
anaphylaxis
like
Given as antidote
fat malabsorption
reaction
for coumadin
medication
Bronchospasm,
toxicity.
Dietary Sources:
Cardiac arrest
Also reverses hypo Asparagus, broccoli,
prothrombinemia
cabbage, Green
from various
leafy vegetables
causes
Green tea
Tomatoes
contraindication
Use with caution:
Bleeding disorders
Pregnancy
Avoid mineral oil
Avoid use with:

Known
hypersensitivity to
med
See entry under

Warfarin (Coumadin)
64
Drug
Use and dosage

Coumadin
Warfarin sodium
interferes with
(Coumadin)
synthesis of
clotting factor(s)
ORAL anticoagulant
that require Vit. K.
To reserve
hyperanticoagulation
(1) Hold and/or skip
doses of Coumadin
(2) Antidote which is
Vitamin K1
(Aquamephyton)
Side effect
Side effects:
Ecchymotic skin
GI & skin problem
Hypotension
thrombocytopenia
Teaching and labs

Coumadin may be
started while pt is
still on continuous
IV heparin therapy).
Heparin is tapered
off slowly over 2-3
days. Pt. remains on
Given PO.
oral Coumadin.
Bleeding is the
Often given in the
Has narrow
major adverse
evening with lab
therapeutic range.
effect.
draws in the
Can take 1 week for
morning it must
Therapeutic effect
be taken same time
each day
PT level will be
Avoid or use
maintained at 1.5
consistently foods
2.5 the times the
high in Vit. K
control value
May be long-term
(which is 12-15 sec.)
medication
INR range from 2.0depending on
3.0 (control 1.0)
reason for
Labs need
medication
monitored often
Teach bleeding
(sometimes 2-3 x
precautions
week) initially,
Observe closely and
then are decreased
over time
report s/s bleeding
contraindication
Avoid use with:
hemorrhaging or
bleeding
tendencies
malignant
hypertension
past history of
allergic reaction to
Coumadin
Many, many meds
have drug
interactions with
Coumadin
65

NLN Pharmacology Study Guide Final 6-3-2013

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NLN Pharmacology Study Guide Final 6-3-2013

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NLN Pharmacology Study Guide

2Common calculations include (but are not limited to):

Administration routes: some key points

Androgens: end with terone: testosterone (Testoderm)

ACE Inhibitors: end with pril: enalapril (Vasotec)

Antidiuretic hormones: end with pressin: desmopressin (DDAVP)

Antilipidemic: end with statin: atorvastatin (Lipitor)

Antiviral: contain -vir: ritonavir (Norvir)

Benzodiazepines: include alprazolam (Xanax), chlordiazepoxide (Librium), clorazepate (Tranxene),

Beta Blockers: end with lol: atenolol (Tenormin)

Carbonic anhydrase inhibitors: end with mide: acetazolamide (Diamox)

Estrogens: contain est: conjugated estrogen (Premarin)

Glucocorticoids and corticosteroids: end with sone: prednisone (Deltasone)

Histamine H2 receptor antagonists: end with dine: cimetidine (Tagamet)

Nitrates: contain nitr: nitroglycerin (Nitrostat)

Pancreatic enzyme replacements: contain pancre: pancrelipase (Pancrease)

Phenothiazines: end with zine: chlorpromazine (Thorazine)

Proton Pump Inhibitors: end with zole: lansoprazole (Prevacid)

Sulfonamides: include sulf: sulfasalazine (Azulfidine)

Thiazide diuretics: end with zide: hydrochlorothiazide (HydroDIURIL)

Thrombolytics: end with -ase: alteplase (Activase)

Thyroid hormones: contain thy: levothyroxine (Synthroid)

Xanthine bronchodialators: end with line: theophylline

Specific Diseases or treatments:

Diabetes Intravenous insulin administration

Block the reuptake of norepinephrine

Take at nights, it causes sedation.

Use with caution:

Cause: Occurs only with

discomfort N/V, HA.

A grid follows with a listing of medications that may be on the exam.

Use and dosage

Teaching and labs

Use and dosage

Teaching and labs

Do not give with:

Dose related is the

Watch for s/s

Similar side effects,

Use and dosage

Teaching and labs

Do not give with

Use and dosage

Teaching and labs

note: also nasal

Use and dosage

Teaching and labs

Use and dosage

Desired response 710 days; Make take

Teaching and labs

Avoid use with:

Use and dosage

Suicidal tendencies may

Teaching and labs

Use and dosage

Teaching and labs

Take early in the

Use and dosage

Teaching and labs

Use and dosage

Teaching and labs

Use and dosage

Rapid onset if IM or IV.

Vitamin B12 helps in