NLN Pharmacology Study Guide Final 6-3-2013 PDF

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 test-
taking tips to prepare for this exam also.
References:
Pearson nurses’s 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) 1
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.
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: □ Assess for opportunistic infection (1) all symptomatic HIV people
□ abacavir (ziagen) (cancer, neurological disease); HA, (presenting with a AIDS-defining illness)
□ stavudine (Zerit) fatigue, nausea, vomiting, diarrhea, or
□ zidovudine (AZT) abdominal discomfort, anemia, taste (2) with a CD4 count less than 350 mm3.
perversion, asthenia, circumoral (3) also start pregnant women (AZT is
Antiviral protease inhibitor. End in AVIR paresthesia with ritonivair, used to prevent maternal transmission
□ Use prophylactically. Adverse/toxicity of HIV)
□ Use in combination to decrease viral □ Hepatoxicity, Hepatotoxicity: AST, STOP if severe rash or other
load and increase CD4. ALT, bilirubin; observe for nausea, hypersensitivity reaction occurs.
Reverse transcriptase inhibitors: Ends in vomiting jaundice upper right Excluding reaction to medications
INE abdominal quad enlargement and and/or ineffectiveness of medication,
□ Stop replication/growth. Reduces tenderness. Reduce dose in liver treatment will be long-term.
viral load. dysfunction.
□ One major advantage is that they do □ Nephrotoxicity; creatinine, BUN, TEACH
not affect adversely affect creatinine clearance, urinalysis, keep □ Use neutropenic precautions
development of blood cells. accurate I& O, monitor for SE of □ Eat small frequent meals with
□ Use in combination with other meds neutropenic, observe occult signs of complete or complementary proteins
because resistant strains may rapidly infection. (lower back, flank or
evolve if used as single agent suprapubic pain, normal temp or low
therapy. grade fever related to UTI
□ Inhibit cell protein synthesis that
interfere with viral replication; block
protease activity in HIV.
□ Treat AIDS and AIDS-related complex
to decrease viral load
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 Adverse effects/toxicity: □ Take adequate amount to fluid 3000-
multiplication □ Hepatotoxicity 4000ml/day to promote urinary
□ Treat: UTI, Chlamydia causing □ Nephrotoxicity output, at least 1500ml/d to prevent
blindness, pneumonia, brain abscess, □ Stevens Johnson syndrome (an crystalluria/stone formation
ulcerative colitis, active Crohn’s adverse reaction of skin that □ May be taken after meals to prolong
disease, rheumatoid arthritis resembles appearance of partial time in intestine.
Examples: thickness burns) □ Collect C&S prior to beginning
□ 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 Adverse effects/toxicity: □ weigh self daily, report sudden
Potassium. □ Renal failure, weight gains or losses
□ Use for edema and mild to moderate □ aplastic anemia, agranulocytosis, Avoid use with:
hypertension thrombocytopenia □ Children
□ will see effect of within 1-4 wks. □ anaphylactic reaction □ anuria
Tricyclic Antidepressants □ Block the reuptake of norepinephrine □ Take at nights, it causes sedation.
or serotonins or both, leaving more □ Do not take with MAO it will cause
available in the CNS. It intensifies hypertensive crisis from excessive
□ Initial mechanism of TCA takes 1-3 the effect of norepinephrine and adrenergic stimulation of the heart
weeks to develop. serotonin which can elevate mood, and blood vessels,
□ Maximum response is achieved in 6-8 increase activity and alertness, □ monitor orthostatic BP of pt. in
wks. decrease preoccupation with hospital
□ Has long half-life. morbidity, improve appetite and
regulate sleep pattern.
Most Tricyclics ends in INE □ It is used to treat insomnia, attention Use with caution:
□ nortriptyline (Pamelor) deficit/hyperactivity and panic □ Glaucoma
□ amitriptyline (Elavil) disorder. □ Elderly
□ doxepin (sinequan) Side effects: □ constipation, prostatic hyperplasia,
□ imipramine (tofranil) □ orthostatic hypotension, as they are more sensitive to
□ sedation and anticholinergic effects. anticholinergic effect
Adverse effects/toxicity:
□ Most serious adverse effect is cardiac Avoid use with:
toxicity; in the absence of overdose □ hypersensitivity,
or preexisting cardiac impairment, □ MI, Cardiovascular disease
serious cardiotoxicity is rare.
□ URINARY RETENTION IS URGENT
□ Overdose may cause convulsions
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
Hepatitis A (formerly Hepatitis B. Hepatitis C Hepatitis D Hepatitis E
“infectious hepatitis”)
At risk: At risk: Cause: Occurs only with Cause: waterborne
Cause: enterovirus □ IV drug users □ IV drug users Hepatitis B and only virus
□ People on □ People receiving causes problems with
At risk: Hemodialysis frequent an acute HepB At risk:
□ Young children □ Health care transfusions infection. □ Travel to areas
□ Institutionalized personnel □ Healthcare where sewage
people personnel At risk: disposal is
□ Health care Transmission: □ common in Middle inadequate and/or
personnel □ blood and body Transmission: east, south Africa people bathe in
Transmission: fluids □ Same as Hep B and Mediterranean contaminated rivers
□ fecal-oral □ contaminated □ Blood and body □ same as HepB □ At higher risk with
□ ingestion of food or needles, parenteral fluids higher mortality:
liquids □ sexual activity Transmission: women in third
contaminated with Incubation period: 5-10 □ same as Hepatitis B. trimester of
the virus. Incubation: 6-24 weeks weeks pregnancy
□ person by person Incubation period: 7-8
contact s/s: s/s: similar to HBV but weeks Transmission:
□ progression of often less severe. □ Same as HepA
Incubation: 3-5 wks. symptoms is more HepD along with HepB
Infectious: usually 2 insidious and Complications: causes superinfection Incubation: 2-9 weeks
wks. before the onset prolonged than □ chronic liver disease and worsening of
of jaundice and 1 wk. Hep A virus. □ Cirrhosis. condition and rapid Complications:
after onset of jaundice. □ Initially may be progression of cirrhosis □ Maternal and fetal
asymptomatic. Complications: demise
s/s: May have no □ 1 week -2 months of As per Hep B
symptoms initially. Prodromal
symptoms: fatigue,
Complications: anorexia, transient
□ Fulminant hepatitis fever, abdominal
□ 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.
Drug Use and dosage Side effect Teaching and labs contraindication
Acetylsalicylic acid □ Blocks pain impulse □ Increases □ Monitor coagulation Do not use with:
(Aspirin) in peripheral and coagulation times studies □ children under 12
some CNS; □ Reye’s syndrome □ Take with full glass and/or children or
□ Non-narcotic □ antipyretic result; (encephalopathy of water, milk for teenagers with
analgesic □ inhibit platelets and fatty liver), food to prevent chicken pox or flu
□ Antipyretic aggregation □ GI bleed, stomach upset like symptoms
□ Antiplatelets □ tinnitus, □ Do not crush enteric (because of risk of
□ Treat TIA, Post MI, □ liver toxicity (dark coated Reye’s syndrome);
Stroke, angina urine, clay stool, □ given daily (81-325 □ pregnancy in 3rd
itching, yellowing mg) for cardiac trimester; and
sclera and skin), prophylaxis post MI, □ vitamin K deficiency
□ visual changes stents, strokes, etc.
Activated charcoal □ Treat poison and □ Vomiting with rapid □ Binding is Do not administer with
(Actidose) overdose following administration irreversible so Ingestion of:
oral ingestion. □ pulmonary cathartic such as □ caustic alkali agent,
□ Binds to poison and aspiration sorbitol may be □ high viscosity
□ Antidote prevent its added as well. petroleum products
□ Adsorbent absorption by the □ It allows certain OR when:
GI tract and then drugs/toxins to be □ convulsions are
eliminates in the drawn out of the occurring,
feces. blood and bind to □ cardiac
□ Administer within charcoal in the dysrhythmias are
60 minutes of intestine a kind of present, or
ingestion. “gut dialysis” □ there is emesis of
□ Give once or twice □ Stools will be black blood
depending on the □ Charcoal does not Implement antidote
level of toxin. change the stomach supportive care and
□ May come pre- PH. prevent aspiration are
mixed with water if gastric lavage is not
12.5-25 grams to be performed.
Acyclovir □ Used for herpes Side effects: □ Even after HSV
(Zovirax) simplex. Does not □ Headache, dizziness infection is
eradicate latent □ seizure controlled, latent
□ Antiviral herpes. It reduces □ nausea, vomiting, virus can be
- Herpes simplex viral shedding and diarrhea activated by stress,
virus – HSV formation of new □ acute renal failure trauma, fever
- Herpes zoster lesions and speeds □ thrombocytopenia exposure to
- varicella healing time. □ purpura hemolytic sunlight, sexual
(oral, IV and topical) □ uremia syndrome intercourse.
□ To decrease □ Refrain from sex if
symptoms with Adverse effects/toxicity: S/S of herpes.
varicella zoster □ nephrotoxicity
(chicken pox/
shingles).
Alteplase recombinant □ Dissolves or break □ Hemorrhage, □ Watch for s/s Do not give with:
(Activase) down clots to □ N/V, bleeding; VS □ pregnancy,
reestablish □ hypotension changes, s/s of □ active bleeding,
Streptokinase is similar. perfusion. □ cardiac impending shock □ recent Hx of CVA,
Urokinase is given □ Indicated for clients dysrhythmias. □ If bleeding is □ Uncontrolled HTN,
mostly in emergency at risk for occurring stop
situation. developing □ Dose related is the treatment and IM medication route is
thrombus with highest problem notify doctor. May contraindicated when
□ Thrombolytic agent resultant ischemia start on FFP and using thrombolytics.
such as MI, PRBC.
Cath-flo Activase – is ischemic stroke, □ Aminocaprionic acid □ Do not take NSAIDs
for occluded catheters arterial thrombosis, (Amicar) may be or Aspirin because
DVT, PE ordered for of enhanced
□ occlusion of IV overdose or bleeding.
catheters. excessive bleeding.
Aluminum hydroxide □ Neutralizes gastric □ Increases gastric pH,□ Given 2 hrs. apart from Do not use:
(Amphogel) acid, □ Decreases other drugs where □ abdominal pain,
□ antflatulent to absorption of other interaction may occur. N/V, diarrhea,
alleviate symptoms drugs such as dig, □ Observe for signs and □ severe renal
□ Antacid of gas and bloating antibiotic, iron symptoms of altered dysfunction,
supplement. phosphate levels; □ fecal impaction,
□ Toxicity causes anorexia, muscle rectal bleeding,
dementia, weakness and malaise. □ colostomy,
Hypercalcemia, □ Increase fluid, exercise ileostomy
metabolic alkalosis, and fiber to prevent □ dehydration
worsening of HTN, constipation. □ hypercalcemia and
heart failure from hypercalciuria
increased intake.
Ampicillin (Ampicin) Treat bacterial □ allergic reaction: □ Do not give with Avoid with:
infection Skin rash, urticaria, fruit juice, milk or □ Hypersensitivity to
IV, PO, IM. Commonly used with: swelling, pruritus, carbonated any penicillins; use
□ Shigella, angioedema. beverages because cautiously if history
□ Antibiotic □ salmonella, □ Severe allergy: of poor absorption. of hypersensitivity
□ Aminopenicillin Escherichia coli, hives, wheezing, □ Watch for to cephalosporins;
□ haemophilus anaphylactic hypokalemia □ Exfoliated
influenza, reaction. Medical □ Take on empty dermatitis
Similar side effects, □ Neisseria emergency requires stomach.
allergic reaction, etc. gonorrhea, immediate tx or can □ May not be □ Loop diuretic may
for all Penicillins (PCN) □ Neisseria lead to death. necessary to stop exacerbate
meningitis, □ side effects: GI, N/V, treatment if mild hypokalemia and
□ gram positive diarrhea, abdominal diarrhea develops. rash.
organism pain. □ Give yogurt or □ Potassium-sparing
□ Pruritic rash like buttermilk to diuretic may
measles is not a true restore normal flora contribute to
allergic reaction (or probiotics) hyperkalemia
Atropine Sulfate. □ Use to increase □ Dry mouth, □ Monitor dosage of □ Increased
heart rate (not constipation, urinary meds carefully, even anticholinergic
Two different uses: necessarily first retention or slight overdose can effect with
drug of choice). hesitancy headache, lead to toxicity. phenothiazine,
□ Anticholinergic □ Decreases dizziness □ Assess for antidepressant,
(such as for involuntary Adverse effects/toxicity: constipation and MAO’s amantadine.
Parkinson’s disease) movement and □ Paralytic ileus. urinary retention;
□ For ophthalmic use rigidity in □ Treat overdose increase fluids, bulk □ Contraindicated in
Parkinson’s disease (resp. depression and exercise, assess pt. with narrow
□ Pre-op to decrease and circulatory bowel sound to rule angle glaucoma,
secretions and collapse) out paralytic ileus, myasthenia gravis,
prevent aspiration symptomatically. □ Avoid driving or or GI obstruction.
Systemic effect is more of secretions while other hazardous
pronounced in infant under anesthesia Adverse effect when activities,
and children with blue used for the eye drowsiness may
eyes and blond hair. □ Use for □ Transient stinging, occur.
Also increased risk of inflammation of the □ increase IOP, For the Eye
toxicity with Down iris and uveal tract. photophobia, □ Acute glaucoma can
syndrome 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
Beclomethasone □ Used in bronchial Side Effects: □ Decrease dose if pt. Do not use with:
diproprionate asthma, allergic □ Pharyngeal irritation is on systematic □ children under
(Beclovent) rhinitis and sore throat, corticosteroid. □ Clients with known
coughing, dry mouth, □ Assess for impaired allergy
oral fungal infections, bone growth in
□ inhaled and sinusitis. children receiving □ May require
corticosteroid inhaled adjustment of
medication □ Increased corticosteroid antidiabetic agent
susceptibility to Considerations: as there is a
infection, □ Monitor for potential for
dermatologic effects hyperglycemia elevated blood
and osteoporosis, □ Rinse mouth after glucose levels with
note: also nasal diarrhea, N/V, HA, use for medication; corticosteroids are
inhalant as Beconase fever, dizziness oropharyngeal administered orally.
angioedema rash candidiasis and/or
urticaria and hoarseness can □ Not use in
paradoxical occur. bronchospasm or
bronchospasm □ Use bronchodilator status asthmaticus.
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
Benztropine mesylate □ Treat Parkinson Side effects: □ Monitor dose Avoid use with:
(Cogentin) symptoms: □ dry mouth, carefully; even slight □ narrow-angle
Suppresses □ urinary overdose can lead glaucoma,
□ Anticholinergic tremors and retention/hesitancy, to toxicity. □ myasthenia gravis,
(cholinergic rigidity, not tardive □ HA, □ GI obstruction
receptor dyskinesia □ dizziness. Nursing considerations:
antagonist) □ Decreases □ Monitor I&O’s,
hypersalivation and Adverse effects/toxicity:
□ Anti-Parkinson irregular □ paralytic ileus Education:
movement related □ Avoid driving, or
to Parkinson other hazardous
disease. activities;
□ Reduces extra- drowsiness may
pyramidal side occur.
effects □ Avoid cough
OTC medication
unless
prescribed.
Buspirone (Buspar) □ Anxiety Side effects: □ When switching to Avoid use with:
□ Dizziness Buspar, taper off □ MAO Inhibitors
□ anxiolytic □ Desired response 7- □ headache benzodiazepines □ Lactation
10 days; Make take □ drowsiness □ Less likely to have
3-4 weeks for full cognitive □ Caution with:
effect impairment than moderate to severe
other CNS meds renal impairment
□ Does not cause
withdrawal s/s and
thus does not need
to be tapered off
when stopping
Chlordiazepoxide □ To relieve tension Adverse effect: □ Give with milk or Avoid use with:
hydrochloride and/or anxiety □ respiratory distress, food to prevent GI □ Narrow angle
(Librium) □ To manage alcohol drowsy, dizziness, upset. glaucoma,
withdrawal lethargy, orthostatic □ Check BP and pulse □ under 12 year old
hypotension early in tx. If BP falls □ lactation
□ Anxiolytic □ photosensitivity delay medication
□ Sedative-hypnotic and notify dr. Use cautiously with:
benzodiazepine □ do not to stop Suicidal tendencies may □ Labs: Monitor CBC, □ impending
taking drug be present and renal and hepatic depression,
IM & tablet form abruptly – will have protective measures enzyme levels □ impaired hepatic or
withdrawal may be necessary. □ watch for renal function,
Peak: symptoms (usually dependency □ COPD
□ 1-4 hours PO, in 5-7 days) □ Monitor closely for Education:
□ 15-30 min IM. paradoxical □ Avoid alcohol
Half-life 5-30hr reactions – □ no OTC meds unless
excitement, prescribed
stimulation, acute □ Avoid driving and
rage – usually early other hazardous
in tx – withhold activities until
drug and notify dr. effects known.
Chloramphenicol □ severe infection for Side effects: □ obtain culture Avoid use with:
(Chloromycetin) susceptible dermatitis, itching, specimen from eye □ hypersensitivity
organisms when stinging, swelling before initiation of
Oral, injection, other anti-infective Adverse effects/toxicity treatment
ophthalmic drops and are ineffective. (oral and injection) □ remove exudates.
ointment □ Sty, conjunctivitis, □ edema □ Monitor for pain,
uveitis □ super infection, drainage, redness,
□ Anti-bacterial □ aplastic anemia. swelling.
□ Stevens-Johnson □ Monitor for
syndrome bleeding or bruising
Chlorothiazide (Diuril) □ Increases urinary Side effects: □ Take early in the Avoid use:
excretion sodium □ Dizziness, vertigo, morning to avoid □ Client with anuria.
□ Thiazide diuretic, and water by frequent urination, nocturia. □ Use cautiously with
non-Potassium inhibiting sodium electrolyte □ Give with food, impaired renal or
sparing reabsorption. imbalance, impaired □ allow for 3-4 weeks hepatic function.
□ Anti-hypertensive □ Use for edema and glucose tolerance, for maximum effect, □ If pregnant.
HTN, HF, cirrhosis, hyperuricemia, □ Will not be effective □ Will increase serum
corticosteroid and photosensitivity if creatinine lithium level
estrogen therapy, Adverse effects/toxicity: clearance Is less
diabetes insipidus, □ Renal failure, than 30ml/min
aplastic anemia, and
anaphylaxis
Chlorpromazine □ Block dopamine Side effects: □ get baseline ECG, □ Monitor diabetics
hydrochloride receptor in CNS to □ Sedation, thorough baseline closely for glucose
(Thorazine) □ Use: treat orthostatic evaluation lab tests intolerance
psychotic disorder hypotension, before treatment.
□ phenothiazine (schizophrenia, □ anticholinergic □ Give bromocripitine
□ Antipsychotic bipolar, and other effect (dry mouth, (Parlodel) and
medication mental illnesses); blurred vision, dantrolene
□ Anti-emetic prevent acute urinary retention, (Dantrium) for
exacerbation and photophobia, NMS.
maintain highest constipation, □ Withdrawal of drug
possible level of tachycardia) is necessary
□ Give bromocripitine function □ liver damage, □ Take measures to
(Parlodel) and □ Use to control tremor are two protect eyes
dantrolene manic phase major side effects. exposed to sunlight
(Dantrium) for (bipolar) □ photosensitivity
NMS. □ intractable hiccups Adverse effects/toxicity:
□ nausea/vomiting □ Neuroleptic
malignant
syndrome (NMS),
□ Low potency anti- catatonia, rigidity,
psychotic which stupor, unstable
can reduce the risk blood pressure
of EPSE (extra- profuse sweating,
pyramidal side dyspnea. Can be
effects) toxic effect and
MAY last for 5-10
days after
discontinuation of
the med.
Cimetidine (Tagamet) □ Works against Side effects: □ May be given with Avoid use:
histamine □ Cardiac dysrhythmia, meals and at □ hypersensitivity
□ GI meds, receptors, diarrhea, dry mouth, bedtime Use caution:
□ H2 receptor decreases gastric constipation □ Avoid smoking □ impaired renal or
antagonist secretion. Adverse effects/toxicity: which cause gastric hepatic function
□ Use short term for □ Rare but may stimulation
duodenal ulcer, include □ Avoid antacid use
benign gastric agranulocytosis within one hour of
ulcer, acute upper neutropenia , dose
GI bleed thrombocytopenia
aplastic anemia,
anaphylaxis
Cisplatin (Platinol) □ Treat ovarian and Side effects: □ maintain fluid at Avoid use:
testicular cancer by □ anorexia, least 3000 ml in 24 □ Hx of sensitivity to
Half-life 20-30 minutes interfering with uncontrolled N/V, hr. ; report reduced platinum-containing
DNA replication fluid retention, urine output compounds,
□ Antineoplastic weight gain □ Avoid food high in □ impaired renal
medication Adverse effects/toxicity: thiamine (beer, function and
□ Alkylating agent □ Major toxicities wine cheese, hearing,
occur in the blood, brewer’s yeast, □ Hx of gout, renal
** Major allergic GI, and reproductive chicken liver & stones.
reaction can occur system. banana) - may lead Incompatible with
within first 15 mins. of □ Watch urine output to hypertension & □ dextrose and
administration. and specific gravity- intracranial Reglan, Vanco
Anaphylaxis may occur nephrotoxicity may hemorrhage □ Lasix may increase
within minutes of drug occur within 2 wks. otoxicity
initiation. □ ototoxicity (tinnitus □ other nephrotoxic
or difficulty hearing drugs may increase
in the high nephrotoxicity and
frequency range) renal failure.
Codeine sulfate □ To treat mild to Side effects: Assess for: Do not use:
severe pain □ Constipation, urinary □ respiration and □ Hypersensitivity
□ most oral retention, dizziness, usually hold <12 □ Increased ICP, head
□ Opioid analgesic preparations lightheadedness. breaths per minute, injury
(agonist) combined with ASA Adverse effects/toxicity: □ CNS changes (LOC), □ Acute alcoholism
□ Antitussive (cough or acetaminophen □ Respiratory □ allergic reaction □ labor
suppressant) depression, TEACH:
□ hyperactive cough respiratory arrest, □ no alcohol
Rapid onset if IM or IV. circulatory □ no OTC pain meds
Peak 1-2 hrs., depression, ICP. unless ordered
Duration up to 7 hours. □ Long term use may □ Avoid driving until
cause withdrawal drug response is
symptoms when known.
stopped
Cyanocobalamin □ Vitamin B12 helps in Adverse effects/toxicity: Teach: Do not use:
(Vitamin B12) the formation of □ Anaphylactic shock, □ Injection is once per □ Hypersensitivity
red blood cells sudden death, month for life with □ Lactation
Half- life: 6 days essential for the □ severe optic nerve pernicious anemia .
proper production atrophy (may □ Oral preps may be
of blood platelets develop after years mixed with fruit
and red and white of use or with juice but give
blood cells and the Leber’s disease) immediately since
nervous system ascorbic acid (Vit. C)
□ Malabsorption affects stability of
syndrome B12.
□ Pernicious anemia □ Dietary B12: best are
organ meats, egg
□ water-soluble yolk, clams, oysters,
vitamin that is crabs, sardines,
stored in the liver. salmon
Cyclosporine □ Inhibit T helper and Side effects: □ Monitor labs: AST, □ Do not use:
(Sandimmune) T suppressor cells. □ Hypertension, ALT, BUN, creat, Pregnant/lactating
□ Prevent rejection of □ increased risk of platelet count, K, mom,
□ Immuno- kidney, liver and infection TEACH: □ Use cautiously in
suppressant heart transplants. □ Tremor is an □ Take with food to renal and hepatic
medication □ Treat chronic expected side effect reduce GI upset impairment
rejection in people □ mix with milk,
Metabolized in the who have received Adverse effects/toxicity: chocolate milk or □ Antiepileptic
liver. immuno- □ Renal toxicity, orange juice but not medications
Peak 4-5hr, suppressive agent, □ hepatotoxicity with Grapefruit juice decrease
Duration 20-54 hrs. rheumatoid □ Mix in glass, not cyclosporine levels
Half-life 19-27 hrs. arthritis, plastic
recalcitrant plaque □ Avoid use of live □ oral contraceptive
psoriasis vaccine increase levels
□ Prevention of
infection and report
signs of infections
□ Immunosuppressed
precautions
Debrox drops □ used to soften and Side effects: Use: Do not use:
loosen ear wax, □ temporary decrease □ Tilt head with ear □ With a ruptured ear
□ Ear drops to dewax making it easier to in hearing after facing upward. Pull drum.
remove. using the ear drops back on ear to open □ any signs of ear
□ mild feeling of up the ear canal. infection or injury
fullness in the ear Drop the correct □ Do not use this
□ mild itching inside number of ear drops medication in a
the ear. into the ear. child younger than
Adverse effects/toxicity: □ After using the ear 12 years old without
□ Get emergency drops, stay lying the advice of a
medical help if you down or with your doctor.
have any of these head tilted for at □ Do not use for
signs of an allergic least 5 minutes. You longer than 4 days
reaction: hives; may use a small in a row.
difficulty breathing; piece of cotton ball
swelling of your to plug the ear and
face, lips, tongue, or keep the medicine
throat 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.
Diazepam (Valium) □ Relieve pain and Side effects: ABCD. □ Watch for CNS Do not use:
discomfort from □ Anticholinergic (dry effect. □ compromised
□ Benzodiazepine musculoskeletal mouth), □ Monitor CBC WBC pulmonary
(have zep and zap disorders, □ Blurred vision, with diff. function,
in them) □ manage anxiety, □ Constipation, & □ notify dr. if drop in □ hepatic disease,
□ minor tranquilizers, □ Manage acute □ Drowsiness, BP of 20 mm Hg □ impaired
□ anticonvulsant, alcohol withdrawal □ Assess for allergic myocardial
□ anxiolytic □ cardiovascular reaction including function,
Maximum effect will collapse, idiosyncratic □ acute alcohol
□ Absorbed from GI, be seen in 1-2 weeks. laryngospasm, reaction, intoxication
metabolize in liver Can take 2-4 wks. It has dizzy, weakness, anaphylaxis, rash □ infant < 6 months
addictive effect. nausea fever resp distress □ narrow angle
Onset 30 min IM, 60 Adverse effects/toxicity: Teach glaucoma, open
PO, 15 IV. Works □ Erythema □ Do not stop angle glaucoma
quickly. multiforme, abruptly –
Peak 1-2hr PO, □ angioedema, withdrawal
Duration 15 min to 1hr □ anaphylaxis, symptoms will
IV; up to 3 hrs. PO. □ dysrhythmia occur (insomnia,
Half-life 20-50 min □ seizure nausea HA,
spasticity,
tachycardia).
□ No alcohol (will
increase CNS
depression)
□ Suicide prevention
precautions
Digoxin (Lanoxin) □ Positive inotropic Side effects: □ may give without Avoid use with:
effect □ Nausea, HA, loss of regard for food □ hypersensitivity to
□ Cardiac glycoside, □ In heart failure it usual appetite. □ IVP over 5 min, do dig
antiarrhythmic Increase Adverse effects/toxicity: not give IM, it will □ Caution with kidney
drug. contraction of the □ Toxicity may go cause tissue failure
heart muscle. unrecognized since irritation.
□ Therapeutic range: □ In atrial fib, it slows it presents with □ Monitor apical Interaction:
0.5-2.0ng/ml the heart rate same symptoms as pulse, if <60/min., □ IV calcium with dig
□ Toxic level > 2 flu (N/V, anorexia, usually hold meds may increase risk of
diarrhea, vomiting and notify doctor. cardiac
Antidote: digibind visual disturbance). □ Monitor labs (K, dysrhythmias,
(digoxin immune fab) □ Blurred green or calcium, □ erythromycin will
yellow vision or halo magnesium, increase dig level,
effect** creatinine □ quinidine,
□ In HF, early sign of clearance), verapamil and
toxicity includes □ Monitor Dig level amiodarone will
dysrhythmias. every 6 months. increase dig levels
□ Children rarely show □ weigh daily and and dig dose should
signs of N/V, report weight be decreased by
diarrhea, visual greater than 2 lbs. 50%
problem, anorexia per day □ Cyclophosphamide
(could become dig toxic combined with dig
without showing usual cause dig toxicity
s/s)
Disulfiram (Antabuse) □ Adjunct treatment Side effects: □ The effects of Do not use:
of patient with □ Rare in the absence disulfiram may □ In people who do
The only alcohol chronic alcoholism of alcohol persist for 2 weeks not want to stop
antagonist in use. who sincerely after last dose is drinking.
wants to maintain taken; alcohol must □ Severe cardiac
□ Enzyme inhibitor sobriety. Adverse not be consumed disease,
□ Anti-alcohol agent. □ At least 12 hours effects/toxicity: until this interval is □ psychoses,
should elapse from ** Acetaldehyde over. □ pregnancy,
the time of last syndrome □ Give in the morning □ multiple drug
Half-life 24-36 hour alcohol intake and □ hypotension to when the resolve dependence.
Onset up to 12 hrs. the initial dose shock level not to drink is the
Duration up to 2 wks. □ Use only in people arrhythmias, strongest. Give at
Absorbed from the GI with high physical □ acute congestive bedtime to
excreted in feces or in health. failure, minimize the effect
the breath as carbon □ Use for 1-2 wks. □ marked respiratory of drug
disulfide depression, □ avoid alcohol of all
INTENDED Reaction □ unconsciousness, forms include those
with alcohol ingestion: □ convulsions found in sauces,
□ flushing face, chest, □ sudden death cough mixture and
arms after shave lotions,
□ pulsating HA colognes and
□ Nausea liniments
□ violent vomiting
□ thirst
□ sweating
□ marked uneasiness
Epinephrine □ Reverses Side effects: Teach
(Adrenalin) anaphylactic □ nervousness, □ Report nervousness If use with MOA
reaction □ tremors, and sleeplessness - inhibitors may lead to
□ Restores cardiac □ increased HR, BP, dose should be hypertensive crisis.
□ alpha and beta rhythm in cardiac □ insomnia, reduced. □ Narrow angle
adrenergic agonist arrest □ anorexia □ Administer eye glaucoma,
□ vasopressor □ Acute asthmatic □ cardiac stimulation
drops at bedtime. □ hemorrhagic
□ bronchodilator attack □ vascular HA. May experience traumatic or
headache and cardiogenic shock,
□ If given IM, SQ - □ Also use in Adverse effects/toxicity: stinging but subside □ arrhythmias,
result seen in 5 min ophthalmic □ Tachyarrhythmias, with continued use. □ organic heart or
& lasts up to 4 hrs., decongestant, □ chest pain, Report if continues. brain disease.
manage open angle □ restlessness,
□ Also available eye glaucoma □ agitation, □ Monitor VS CAUTION in:
drops and □ nervousness and especially HR and □ older adults,
intranasal □ insomnia. BP because of □ HTN
□ Nasal burning
cardio effect. □ TB, long standing
stinging, bronchial asthma
□ eye burning and emphysema
□ children < 6
D/C if hypersensitivity □ No breastfeeding

develops (develops of
lids, itching, discharge,
crusting eyelid). Notify
doctor
Famotidine (Pepcid) □ Decreases output Side effects: □ May be taken with □ Use cautiously with
of gastric acid □ diarrhea, food. impaired renal or
□ Histamine □ Short term constipation, dry □ pain relief may not hepatic function.
□ H2 antagonist. treatment in mouth be experienced for □ Do not breastfeed
Onset 1 hr. Peak 1-3hr duodenal ulcer or Adverse effects/toxicity: several days
Duration 10-12 hrs. benign gastric □ thrombocytopenia □ avoid antacid use
Half-life 2.5-4hr ulcer. within 1 hour of
□ Metabolized in dose
liver, excreted in
urine
Fluoxetine □ Major depressiveCommon side effects: □ DO NOT stop □ MI, cerebrovascular
hydrochloride (Prozac) disorder □ Orthostatic abruptly. disease.
□ Obsessive hypotension □ Give meds once a □ If suicide risk,
□ psych med. compulsive □ sedation day at about noon should not have
□ Tricyclic disorder, □ Anticholinergic because it causes access to a large
antidepressant. □ bulimia, □ Hypomania insomnia. If quantity.
□ Selective Serotonin □ panic disorder □ Sexual dysfunction prescribed 2 times □ Do not take while
Reuptake inhibitors □ obesity Adverse effects/toxicity: daily give dose in pregnant
(SSRI) □ alcoholism □ Cardiac toxicity the morning early
□ □ chronic pain. Selective Serotonin and 12 noon to □ ** The combination
Half-life 1-6 days. syndrome (early s/s: prevent insomnia of TCA and MAOI
Onset 2-3 weeks to be Such as rash. Wait 4-6 diaphoresis, agitation, □ Teach side effects can lead to
effective. weeks before switch to low grade temp.) Then of drugs hypertensive crisis
Peak 4-8hrs. MAO Inhibitor increase in BP, muscle □ Therapeutic from excessive
Metabolized in liver, rigidity, temp, resp, response takes adrenergic
absorbed from GI tract, pulse. Mental status some weeks to be stimulation of the
excreted in urine and changes, tremors, established. heart and blood
face. hyperthermia, sweating vessels.
hypersalivation.
Notify dr ASAP.
Fluphenazine (Prolixin)□ Potent medication □ Produces EPS which Monitor LFTs Avoid with:
for treatment of are reversible. □ Caution with
□ phenothiazine; Ends antipsychotic ** Treat EPS with TEACH narrow angle
with azine symptoms, Cogentin, Artane, □ Avoid alcohol use glaucoma, hepatic
□ antipsychotic including Benadryl, Symmetrel and other CNS or renal dysfunction
schizophrenia. Side effects: ABCDE depressants and seizure
Half-life > 24 hours □ Treatment is not □ Anticholingergic □ Do not alter dose or disorder.
Onset: 1 hr., curative. (dry mouth), Blurred stop abruptly □ Do not breastfeed
peak 0. 5 hr. meds □ Adjust dose to vision, Constipation, □ Avoid sun exposure □ Dose should be
symptoms. Drowsiness, EPS reduced in the
effect can be seen 1-2 □ Photosensitivity □ With oral elderly.
days but full effect □ Use injectable form □ may increase risk of concentrate, avoid
several weeks for long term agranulocytosis spills. Rinse skin
maintenance □ gynecomastia, with warm water
- the rate of relapse is □ amenorrhea immediately if there
usually reduced and is □ weight gain is contact
more favorable Adverse effects/toxicity:
Neuroleptic malignant □ Dilute liquid drug
syndrome (NMS) a fatal with fruit juice
side effect. Presents water, carbonated
with catatonia, rigidity, beverage, milk,
stupor, unstable blood soup – avoid mixing
pressure, hyperthermia with caffeine, tea,
profuse sweating, apple juice.
dyspnea, incontinence.
Stop drug. Tx with
Dantrium and Parlodel.
Condition lasts for 5-10
days after stopping
med.
Furosemide (Lasix) □ Rapid acting loop Side effects: TEACH Avoid with:
diuretic □ Ototoxicity □ change position □ anuria, electrolyte
□ Inhibits □ headache slowly to avoid depletion,
reabsorption of □ Dizziness dizziness and increasing oliguria,
□ Loop diuretics, sodium and water □ Orthostatic orthostatic anuria
□ Anti-hypertensive (in Loop of Henle) hypotension hypotension □ hepatic coma,
□ Lowers BP by □ weakness □ report ringing in the □ pregnancy,
decreasing edema ear immediately lactation
Peak 60-70 min PO, 20- and intravascular □ Take with food or
60 min IV. fluid Adverse effects/toxicity: milk □ Interaction with
Onset 30-60 min PO, 5 □ s/s hypokalemia – □ Give early in day to digitalis can
min IV, Treat □ Hyponatremia, avoid nocturia increase
Duration 2 hrs., □ acute pulmonary □ hypochloremia, □ Replace potassium arrhythmias.
Half-life 30 min edema, edema, □ hypomagnesaemia (dietary or meds)
□ heart failure, □ hypocalcemia □ Interaction with
□ chronic renal □ Monitor labs, aminoglycosides
impairment, especially increases risk of
□ hypertension, IV form: electrolytes. Also ototoxicity.
□ hypercalcemia □ Administer slowly; hgb, hct, platelet as
hearing loss can these increase d/t
occur if injected hemoconcentration
rapidly (ototoxicity).
□ Give over 1-2 □ Monitor body
minutes to prevent weight and I&O.
hypotension.
Gentamicin □ Broad-spectrum Side effects: Avoid with:
(Garamycin) antibiotic □ HA, parenthesia, □ Maintain hydration □ Pre-existing renal
□ Aminoglycosides. □ Parenteral use skin rash fever to protect kidney disease
□ Antibiotic limited to severe damage. Fluid □ Use caution with
infections, Adverse effects/toxicity: intake should be pre-existing hearing
Peak level: unresponsive to □ Nephrotoxicity 2,500-3000 ml/day loss
□ Drawn 15-30 min other antibiotics. □ Ototoxicity. □ give high protein □ Pregnancy,
after the infusion is This may cause foods lactation
completed. irreversible auditory LABS □ Increased risk with
□ Peak concentration Ophthalmic: impairment and □ WBC to monitor the nephrotoxic drugs,
determines that □ treat superficial vestibular damage effectiveness of prolonged
toxic level does not infection of the Signs of ototoxicity therapy treatment with
occur. eye. include HA, NV unsteady □ Watch kidney aminoglycosides,
□ If peak is too high, □ Have pt. keep eyes gait, tinnitus, vertigo, function tests (BUN, impaired renal
may reduce dose. closed for 1-2 min high frequency, hearing Creat) closely due to function and other
Trough level: after instillation. loss and dizziness toxicity risk ototoxic drug such
□ Drawn immediately □ Vision will be □ Hypersensitivity as Lasix, Vanco.
(within 30 minutes) blurred initially reactions □ Report sore throat,
before next IV dose □ Superinfection: a watery stools
□ Assures that secondary infection greater than 4-6 per
therapeutic level of caused by day, severe nausea
drug is maintained. eradication of or vomiting,
Trough level is 1-2 normal flora: indicating possible
g/ml between Candidiasis, skin and super infection
doses. mucous membrane
□ Dose will be
adjusted if level is
not sustained
Peak 30-90 min
Half-life 2-4 hr.
Glipizide (Glucotrol) □ Stimulates Side effects: □ Monitor labs Avoid with:
pancreatic beta □ GI distress including glucose, □ Pregnancy,
□ oral antidiabetic cells to secrete □ dizziness Hgb A1C lactation
□ Sulfonylurea insulin. □ drowsiness □ Allergy to sulfa or
□ Type 2 diabetes □ headache TEACH urea
duration: 12-24 hours mellitus □ Take with first daily □ Diabetic
Onset: 15-30 min meal. ketoacidosis
Peak: 1-2hr □ Give dose 1-3 time Adverse effects/toxicity: □ Take any missed Caution with:
daily □ Severe skin rash, dose as soon as □ impaired renal and
Metabolized by the pruritus remembered. hepatic function
liver □ may use alone or in □ Hypoglycemia □ Report s/s of □ Adrenal or pituitary
combination with hypoglycemia if insufficiency.
insulin they occur
□ Avoid alcohol
Glucagon □ Emergency Side effects: □ Should awaken □ Incompatible with
treatment of □ Nausea/ vomiting within 5-20 min sodium chloride
□ Anti-hypoglycemic severe after giving. solution.
hypoglycemia in Adverse effects/toxicity: □ Give 50% glucose if
Onset 5-20 min, unconscious client □ Hypersensitivity no response to
Peak 30 min or those unable to reaction, glucagon
Duration 1-1.5 hr., swallow □ hyperglycemia Teach
Half-Life; 3-10 minutes □ Comes in powder □ Hypokalemia □ test blood sugar,
form. Reconstitute □ teach family how to
with provided administer SQ or IM
Metabolizes in liver, diluent.
plasma and kidneys □ Give IV, IM or SQ
immediately
□ Give IV through
D5W only, not NS
Glyburide □ Lowers blood sugar Side effects: □ Give once in the Avoid use with:
(Micronase, DiaBeta) concentration in □ Hypoglycemia, morning with □ diabetic
diabetics and □ epigastric fullness breakfast or with ketoacidosis
□ Oral antidiabetic, nondiabetics by □ heartburn first main meal □ Type I diabetes
□ more potent drug sensitizing □ pruritus □ Monitor labs
□ Sulfonylurea pancreatic beta including glucose, Caution with:
cells to release Adverse effects/toxicity: HgbA1c □ renal or hepatic
Onset 15-60 min insulin in the □ hypoglycemia Teach insufficiency
Peak 1-2 hrs. presence of serum □ Report reaction □ older adult
Duration up to 24 hrs. glucose. □ Loss of control of □ malnourished pt.
Half-life 10 hours □ Type 2 diabetes blood glucose level □ adrenal or pituitary
□ Use as adjunct to may be due to insufficiency
Metabolized in the diet and exercise to fever, surgery,
liver, excreted in urine lower blood sugar trauma, stress,
and feces. infection.
Haloperidol (Haldol) □ Psychotic disorders Side effects: ABCDE: □ EPSE: usually first Avoid with:
□ Long acting drug □ Anticholinergic (dry few days of tx, dose □ Parkinson’s disease
High potency drug for maintenance – mouth) related, controlled □ seizure disorder
□ Antipsychotic to control □ Blurred vision by dose or anti- □ severe mental
□ Butyrophenone symptoms □ Constipation Parkinson’s drugs depression
□ Antiemetic □ Tourette’s □ Drowsiness □ Oral: Give with milk
syndrome □ Extrapyramidal or food. Use caution:
Onset: 30-45 min IM syndrome (such as □ Taper dose slowly □ older adults,
Effects can be seen in 1- Parkinson’s s/s) when stopping. □ lithium therapy
2 days. Substantial □ Photosensitivity □ Injection: deep IM – □ HTN
improvement 2-4 wks. Adverse effects/toxicity: risk for orthostatic □ Lactation
Full effect several □ Elderly patient may hypotension
months. develop Neuroleptic □ no alcohol or driving
Malignant until response
Syndrome (NLMS) known
Heparin □ As anticoagulant – Side effects: □ Does not dissolve Avoid use with:
given IV or SQ □ Bleeding clots – prevents □ Hemorrhage, active
□ Anticoagulant □ Use as continuous □ Heparin-induced enlargement and bleeding
IV infusion for DVT, Thrombocytopenia development of
Antidote = Protamine Pulmonary (HIT) – may appear new clots.
sulfate (see separate embolus, angina, up to several weeks □ Use bleeding □ Do not give IM.
listing) acute MI later. precautions
□ SQ for prevention □ Monitor labs: aPTT
Normal = 25-40
□ Hep-lock (flush) is Coagulated = 1.5-2
to maintain times normal = 60-80
patency of IV
catheters; not for □ Adjust IV dose
anticoagulant based on labs.
therapy
Hydrochlorothiazide □ Act on distal Side effects: □ Give with food or Avoid with:
hydrochloride tubules of nephron □ Glucose intolerance, mild to reduce GI □ Anuria
(Hydrodiuril, HCTZ) and increases hyperglycemia upset. □ Hypersensitivity to
urinary excretion of □ Hypokalemia (low □ Give dose(s) early in thiazide
□ Electrolyte and sodium, chloride, K+) the day to avoid Use caution:
water balance potassium, water, nocturia □ Bronchial asthma
□ Thiazide diuretic bicarbonate □ Limit Sodium intake □ hepatic cirrhosis
□ Decreases edema □ Eat foods high in K+. □ renal dysfunction
□ Effects noted 3-4 and lowers blood – replacement med □ history of gout
days; max effect pressure usually not needed □ diabetes
takes 3-4 weeks □ photosensitivity □ SLE
reaction occur 10-14 □ Lactation
□ Most widely days after initial sun
prescribed diuretic exposure
for HTN
Hydroxyzine HCl □ Treat N/V (use Side effects: IM: Avoid with:
(Atarax, Vistaril) anticipatorily) □ CNS depression, □ Administer deep IM, □ CNS depression and
□ Relieve anxiety □ Drowsiness Z-track – gluteus coma.
□ Anti-emetics □ Reduce narcotic □ Dizziness maximum or vastus □ Other CNS meds
□ Anti-histamine (H1 requirement before □ dry mouth, lateralis in adults; Use caution with:
receptor and after surgery. anticholinergic vastus lateralis in □ glaucoma
antagonist) □ Treat acute or effect children □ seizure
□ antipruritic chronic alcoholism □ constipation □ intestinal
with withdrawal □ visual changes □ monitor mouth daily obstruction
Onset 15-30 min PO symptom or DTs □ photosensitivity □ no alcohol □ prostatic
Peak 4-6 hrs. □ Pruritus □ hard candy, ice hyperplasia
Duration chips or rinse mouth □ asthma
Usually PO for with warm water □ cardiac, pulmonary
Absorbed form GI. maintenance frequently to relieve or hepatic disease
Metabolized in the liver dry mouth
Ibuprofen □ Treat mild to Side effects: □ Increases toxicity of Avoid with:
(Advil, Motrin) moderate pain □ CNS, renal system, anticoagulant, □ GI bleed
□ absorbed in GI; eyes lithium □ Reaction to other
□ Analgesic metabolized in liver □ Nephrotoxicity NSAIDs
□ Non-steroidal anti- □ dysuria, hematuria, □ Avoid alcohol, ASA, □ Children under 6
inflammatory oliguria, azotemia, other NSAIDs months
(NSAID) □ Blurred vision.
□ Ototoxicity
□ For high dose Children toxicity:
therapy: □ Rash, Stevens-
therapeutic effect Johnson syndrome
may take up to one
month
INSULINS □ Diabetes mellitus, Side effects: □ obtain med alert □ Do not use
type 1 or type 2 □ Hypoglycemia bracelets beef/pork insulin if
- quick acting: (anxiety, confusion, □ Open vial can be sensitivity
- short acting □ Could be made of: nervousness, stored at room
- intermediate acting pork/beef, pork or hunger, diaphoresis, temp for up to one
- long acting human insulin type. cool, clammy skin) month.
□ Lipodystrophy □ Rotate sites
□ Short acting and (abnormal deposits □ Alcohol will increase
Insulin is also available intermediate acting of subcutaneous fat blood sugar
in a premixed form of insulin may be at injection sites),
Regular and NPH given more than □ local allergic
(example: 70/30 = 30% once per day. reaction □ Requires long-term
regular, 70% NPH). Adverse effects/toxicity: monitoring of blood
□ Somogyi sugar control and
phenomenon: a potential
rebound response complications.
with high blood
sugar in response to
low level at night.
□ Coma
□ Hyperosmolar
hyperglycemic state
(HHS)
□ Diabetic
ketoacidosis (DKA)
Insulin – Regular □ Short acting insulin □ hypoglycemia □ Regular insulin is
(Humulin R) □ Given IV or SQ clear and colorless.
□ type 1 and type 2
**THIS IS THE ONLY TYPE diabetes mellitus
OF INSULIN WHICH CAN BE and ketoacidosis.
GIVEN IV. ** □ given before meals
according to blood
levels
Isophane (NPH) insulin □ Intermediate □ If given before □ NPH Insulin is a
(Humulin N) acting insulin breakfast, cloudy suspension.
□ Give 30 min before hypoglycemic □ Roll the bottle to
first meal of the episode is most mix; do not shake.
day. If necessary, a likely to occur □ NOTE: NPH may be
second smaller between mid- mixed with Regular
dose may be afternoon and insulin injection
prescribed 30 min dinner, when it without altering
before bedtime. peaks. Eat snack in either solution.
midafternoon and
carry sugar candy.
Insulin – Glargine □ Long acting insulin □ With Type 2

(Lantus) □ Type 1 children & diabetes, may or
adults; Type 2 may not be given
** LANTUS CANNOT BE adults concurrently with
MIXED IN SAME SYRINGE □ SQ injection oral agents.
WITH ANY OTHER
INSULIN.** □ Usually given one
per day at bedtime.
May be given two
times per day.
Iron □ Mineral Side effects: □ Taking on empty
replacement □ Nausea/vomiting stomach preferred
□ Staining of teeth with full glass of
□ Constipation water or citrus juice
□ Black stools □ Calcium inhibits iron
(normal) absorption – do not
take with milk.
□ Vitamin C increases
iron absorption
□ Liquid form can
stain teeth
Ipecac Syrup □ For overdose on Adverse effects/toxicity: □ Use of this Do not use:
certain drug or □ Cardiotoxicity is medication is not □ With reduced level
□ Emetic poison most serious if automatic – verify of consciousness or
□ Antidote □ stimulates vomiting vomiting does not appropriateness convulsions
within 20-30 min occur and the with Poison control □ poison by
substance is center Petroleum
Alternate: Activated retained. distillates, strong
Charcoal (see separate alkaline, acid or
listing) strychnine
Lidocaine HCl □ Treat VENTRICULAR Side effects: LAB Avoid with:
(Xylocaine) arrhythmias, PVC’s, □ Drowsiness, □ Monitor Lidocaine □ Sinus bradycardia
V-Tach. headache, dizziness, levels assess, □ Severe degrees of
□ Antiarrhythmic □ Use for rapid mild hypotension. therapeutic level is SA, AV and
□ Topical Anesthetic control of Adverse effects/toxicity:1.5 -6mcg/ml intraventricular
ventricular □ convulsions, □ Assess electrolyte, heart block.
Bolus dose – may dysrhythmias respiratory check baseline liver
repeat – then start during acute MI or depression and renal blood Use caution:
continuous infusion – Cardiac cath □ CV: hypotension, studies. □ hepatic or renal
stop when stable. bradycardia, heart Report: disease
Therapeutic level: 1.5- □ Use microdrip block CV collapse, □ lightheadedness, □ CHF
6mcg/ml tubing and infusion and arrest □ dizziness, confusion, □ Hypovolemia
pump. □ numbness or □ shock
□ Stop infusion with tingling of lips, □ hyperthermia
EKG changes such as tongue or fingers □ elderly
prolonged PR, □ visual changes or
widened QRS, heart □ ringing in ears □ BETA BLOCKERS
block. increase the effect
□ Correct of lidocaine
hypokalemia before
giving Lidocaine
Lithium carbonate □ Drug of choice to □ This med does not □ Give with meals Do not use with:
(Eskalith) control manic cause sedation. □ Hydration is □ Dehydration,
episodes in bipolar Mild Side effects: essential – severe debilitating,
□ Mood stabilizer disorder □ fine tremor, nausea, dehydration will severe
□ Antipsychotic □ Anti manic effects thirst, polyuria, increase levels cardiovascular.
are usually seen in Adverse effects/toxicity: □ Watch for weight
□ Therapeutic level 5-7 days after initial □ Vomiting, diarrhea, gain (fluid Use caution:
0.8-1.5meq/L. doses, but full slurred speech, lack retention) □ elderly,
□ Toxic level >2. effect does not of coordination, □ Avoid NSAIDs and □ pt. with cardiac,
□ Lithium has short occur for 2-3 wks. drowsiness, muscle diuretics. renal, thyroid or
half-life (about 1 □ Lithium is a salt; weakness, or □ Essential to monitor diabetes
day) and high exact action twitching) – mood and behaviors □ pregnancy
toxicity. uncertain withhold dose and □ Labs: Lithium level
notify provider but every 3 months
DO NOT stop initially, then every
abruptly. 6 months.
Lorazepam (Ativan) □ anxiety disorder Side effects: □ Avoid alcohol Do not use with:
□ short term for relief □ Drowsiness □ Taper dose when □ Acute narrow-angle
□ Anxiolytic of symptoms of □ sedation stopping to avoid glaucoma,
□ Sedative-hypnotic anxiety □ Mild medication withdrawal □ Primary depression
□ Benzodiazepines. □ Pre-anesthetic with limited toxic symptoms □ acute alcohol
medication to potential □ Watch for suicidal intoxication.
Onset produce sedation □ respiratory risk □ Pregnancy and
1-5 min IV, 15-30 IM, and reduce anxiety. depression is rate Lactation
Peak □ Status epilepticus Use caution:
60-90 min IM, 2 hrs. PO Paradoxical reactions □ renal or hepatic
Duration 12-24 hrs. (nightmares, mania, impairment
etc.) may occur in □ myasthenia gravis
children, psych patients □ suicidal tendencies
and the elderly.
Magnesium Sulfate □ Oral: laxative (by Side effects: s/s hypomagnesemia: Avoid with:
osmotic retention □ Flushed warm □ irritability □ MI, heart block,
iron(Epsom salt – oral of fluid which feeling □ tremors, tetany cardiac arrest
form) distend the colon, □ fluid and electrolyte □ tachycardia except for certain
increase content of imbalance □ hypertension arrhythmias.
feces and cause □ hyponatremia □ psychotic behavior Use caution:
Onset 1-2 hrs. PO; 1 hr. bowel stimulation) □ N/V □ impaired kidney
IM. □ Parenteral: CNS □ Monitor urinary function
Duration 30 min IV, 3-4 depressant; used in Adverse effects/toxicity: output and hydrate □ other cardiac
hr. PO seizures of Early indication of adequately with glycosides
Eliminated by kidneys toxemia; for magnesium toxicity parenteral □ Lactating moms
hypomagnesemia □ Respiratory administration. and children
Normal Magnesium depression
level: 1.8-3 mEq/L □ Cathartic effect
□ 4 gm. loading dose □ profound thirst
is give over 20-20 □ feeling of warmth
min via pump. □ sedation
□ confusion
□ depressed deep
tendon reflexes
□ muscle weakness
□ can lead to cardiac
arrest
Mannitol (Osmitrol) □ Use in oliguria and Side effects: □ Use filter needle Do not use:
acute renal failure. □ HA, confusion, and/or filter in □ severely impaired
□ Electrolyte and Help to prevent syncope infusion tubing renal function
water balance renal failure and □ fluid and electrolyte because crystals □ marked
agent reduce increased imbalance, esp. may form in the dehydration
□ osmotic diuretic intracranial or hyponatremia solution. □ breast feeding
intraocular □ pulmonary □ Mannitol is held if □ hepatic failure,
Onset pressure congestion, rhinitis serum osmolality □ active ICP
1-3 hr. diuresis; 30 to 60 □ It acts by increasing □ Water intoxication exceeds 310 -320. □ anuria
min IOP, 15 min. for ICP the osmolality of □ Daily weights □ Intracranial bleed
Duration plasma, glomerular Adverse effects/toxicity: Teach shock
4-6 hr. IOP, filtrate, and tubular □ Seizure, □ Non-narcotics such
3-8 hr. ICP fluid. This □ thrombophlebitis, as Tylenol if there is
decreases the □ CHF, Cardiovascular headache □ Question the
Serum osmolality is 275- reabsorption of collapse □ Therapy is based on administration of
300 mmol/kg. fluid and □ Hyponatremia urine flow rate. mannitol if the
electrolytes, which □ Reassure pt. that patient has cor
increases excretion Warning: There may be excessive thirst, pulmonae (right
of water, chloride a rebound increase in blurred vision, sided heart failure)
Give IV. and sodium and ICP about 12 hours after rhinitis should because Mannitol
Usually give test dose slightly increase the administration of med. subside when pulls fluid and it
which should result in excretion of Pt may complain of HA, Mannitol is may lead to
Output of 30 to 50 Potassium. or confusion. discontinued circulatory overload
ml/hr. and is produced □ In intraocular (IOP) which the heart
2-3 hrs. after and CSF (ICP), it could not handle.
administration. pulls the fluid and This client would
sends it to the need loop diuretic
plasma and to prevent serious
extravascular complications
systems
Meperidine HCl □ Given for moderate Side effects: Assess: Avoid use with:
(Demerol) to severe pain. □ N/V, Anorexia □ LOC □ acute bronchial
□ Potent, long acting □ Sedation, dizziness □ rash, urticaria asthma, upper
□ Narcotic analgesic □ elevated BP □ respiratory rate. airway obstruction
(opioid agonist) □ rash, urticaria If respirations < 12 per □ increased
□ tremors minute – withhold intracranial
Give Narcan for □ hyperventilation meds. pressure
toxicity - It is use to Adverse effects/toxicity: □ convulsive disorder
reverse respiratory □ Resp depression, □ pancreatitis, acute
depression induced by □ respiratory arrest, ulcerative colitis
overdose □ circulatory □ severe liver or
depression, kidney insufficiency
Onset: 15 mins. PO, 10 □ increased Caution with:
mins. IM, 5 mins IV intracranial pressure □ children and elderly
duration 2-4 hours
Metoprolol tartrate □ Decreases heart Side effects: □ Give with or w/o Avoid use with:
(Lopressor, Toprol) rate and cardiac □ Usually well food, but consistent □ Heart block greater
output tolerated □ Do not stop than 1st degree
□ Beta adrenergic □ Lowers BP □ Nausea, vomiting abruptly; may cause □ Sinus brady,
antagonist □ Weight gain rebound effect. □ cardiogenic shock
(beta blocker) □ Mild to severe HTN □ worsening CHF Gradually decrease Use caution:
□ Antihypertensive □ angina pectoris □ insomnia over 1-2 wks. □ hyperactive airway
□ **Post - acute MI** Adverse effects/toxicity: □ Hold meds if BP < 90 syndrome ( asthma
□ profound or pulse < 60 or bronchospasm)
□ Antianginal = same □ Max effect may bradycardia □ Watch for s/s heart
action as with take 1 week □ heart block failure □ Increases chance of
propanolol □ acute CHF, □ Can lead to elevated both Dig and
□ bronchospasm BUN, creat. Lithium toxicity
□ laryngospasm □ May mask
hypoglycemia
Morphine Sulfate □ Produces effect by Side effects: Avoid use with:
binding to opioid □ Nausea vomiting □ Avoid alcohol use □ Hypersensitivity to
(MS Contin = sustained receptors anorexia, GI, opiates)
release form) throughout the □ pruritus, □ Hold medication if □ acute bronchial
CNS. □ light headedness respirations < 12/min asthma or upper
□ Schedule II drug, □ constipation airway obstruction,
□ Narcotic analgesic major drug abuse. Adverse effects/toxicity: □ Hydrate adequately □ ICP
(Opioid agonist) □ Classic triad of to prevent □ convulsive
symptoms: constipation disorders
□ For severe, chronic respiratory □ pancreatitis, acute
Give Narcan for or acute pain. depression, coma, ulcerative colitis
toxicity. □ Most commonly pinpoint pupils. □ severe liver or
use in post- □ Withdrawal begins kidney disease
Onset, Peak, Duration operative setting. 6-8 hrs. After the
depend on route of □ mild bronchodilator last dose, reach □ Do not give
medication. to improve peak intensity within morphine to
Onset: Immediate IV, breathing 48-72 hrs. S/S children
rapid if given IM or oral, include craving,
except MS Contin □ 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.
Naloxone HCl (Narcan) □ Competes with Side effects: □ Watch vital signs Avoid use with:
opioids at the □ Increased BP, HR, and respiratory □ Known allergy
opiate receptor hyperpnea function closely □ Respiratory
□ Opioid antagonist. sites, blocking the □ tremors, with administration depression d/t non-
effects of the □ hyperventilation, of medication opioids
Onset opioids □ drowsiness, □ Substance abuse
1-2 min IV; □ Reverses effects of □ nervousness □ Titrate dose slowly - (may lead to
2-5 mins. SQ or IM opiates, including □ N/V if too much is given withdrawal
respiratory the client will swing symptoms)
Duration depression, Adverse effects/toxicity: from a state of
1 hr. IV; up to 4 hrs. IM sedation and □ Hypotension, intoxication to one
but start to diminish hypotension. □ V-tach and V-fib of withdrawal
after 20 mins. □ convulsion,
□ May need given □ hepatitis
every few hours □ pulmonary edema,
until the opioids
has dropped to a
nontoxic level
Nedocromil (Tilade) □ asthma prophylaxis Adverse effect: □ Rinse mouth after Avoid use with:
NOT for acute □ abnormal bitter taking medication □ acute
□ Inhaled non- asthma attacks taste to avoid dry mouth bronchospasm or
steroidal □ up to a week for □ N/V, HA, dizziness, □ Do not use for status asthmaticus.
medication full effectiveness sore throat. acute attack □ Hypersensitivity
□ anti-inflammatory □ Must be taken □ Non-compliance is a
and antiasthmatic. regularly to be concern due to Use with caution:
effective bitter taste □ hepatic or renal
function
(also available as optic
form – for ocular
allergic conjunctivitis)
Neomycin sulfate Antibacterial – ORAL Side effects: skin rash □ Poorly tolerated GI
(Mycifradin) □ GI tract (esp. topical) so it is usually for
□ Hepatic coma bowel cleansing.
□ ORAL Adverse effects/toxicity:
aminoglycoside Main form is topical for □ Nephrotoxicity
□ antibiotic eye, ear and skin □ Ototoxicity.
infection.
NEOMYCIN IS NOT GIVEN IV

Nifedipine (Procardia) □ angina Side effects: □ Do not give 1-2 wks. Avoid use with:
□ mild to moderate □ Usually well after an acute MI. □ Known
□ Calcium Channel HTN (sustained tolerated □ Do not give with hypersensitivity
Blocker release form) □ Headache grapefruit juice □ Unstable angina
□ Antianginal □ fatigue (could lead to □ Lactation
□ Antihypertensive □ Dilates coronary □ Dizziness toxicity)
arteries and relaxes □ Postural □ Report gradual
□ Negative inotropic coronary spasm hypotension weight gain and
□ Increases cardiac □ peripheral edema evidence of edema;
output; decreases may indicate onset
peripheral vascular Adverse effects/toxicity: of CHF.
resistance. □ Gingival hyperplasia □ Do not stop
□ Blocks calcium ion suddenly (will have
flow into cells of rebound symptoms)
myocardial and □ Smoking decreases
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.
Oxytocin (Pitocin) □ To initiate or Side effects: □ Careful monitoring Avoid use with:
improve uterine □ subarachnoid bleed of uterine □ Hypersensitivity
□ Oxytocic contractions at □ fetal trauma contraction pattern, □ Cepahalopelvic
Labor and delivery. term □ seizure, coma fetal heart rate and disproportion
□ Induce labor Adverse effects/toxicity: maternal BP. □ Obstetric
Onset is immediate. □ Management of Hypertensive crisis. emergencies
After stopping med, incomplete or □ Postpartum;
contractions should missed abortion For fetal anoxia: monitor lochia and
stop in 2-3 minutes (miscarriage) □ stop infusion, turn BP.
Half-life 3-5 min □ reduce postpartum mom on left side,
bleeding oxygen prn □ Do not increase
Stop infusion for: dose after desired
contraction pattern
□ Contractions which
is achieved
occur more often
(contraction
than every 2 mins.
frequency of 2-3 min
or last over 90 sec.
lasting 60 sec).
Pancrelipase □ Help to breakdown Side effects: □ Take with or just Drug interaction:
(Creon, Pancrease) fat, proteins and □ Nausea, diarrhea, prior to eating □ Allergy to med or
carbs for better and cramps □ Do not mix brand pork
□ Pancreatic enzyme absorption. names; there is a □ Do not give with
replacement Adverse effects/toxicity: variance in magnesium-
therapy □ cystic fibrosis Hyperuricemia. concentration of containing antacid.
□ chronic □ Report joint or enzymes May be ordered
pancreatitis, post swelling pain (high □ Swallow tablet or with H2 blockers or
pancretectomy uric acid level) capsule whole; do with proton pump
□ steatorrhea not crush or chew. inhibitors.
□ malabsorption □ Can mix powder or □ Iron will decrease
syndrome open capsule with effectiveness of
food. med.
Phenobartial □ Long-term Side effects: □ Okay to crush and Avoid use with:
(Phenobarbital Sodium management of □ Somnolence, mix with food or □ Hypersensitivity
= Luminal) – this is the grand mal, partial hangover effect fluids □ Resp or kidney
short-acting form. seizure and status Adverse effects/toxicity: □ Monitor IV infusion failure
epilepticus. □ CNS depression, closely. □ Pregnancy and
For status epilepticus: □ Stevens-Johnson □ Do not stop lactation
Administer slow IV □ Sedative effect to □ Blood dyscrasias abruptly
decrease anxiety □ Paradoxical □ Avoid alcohol and
and tension. reactions may occur other CNS
□ Anticonvulsant in children, older depressants
□ Sedative-hypnotic □ No analgesic effect adults and
debilitated people
Pilocarpine □ For acute or Side effects: □ Apply gentle Avoid use with:
hydrochloride (Pilocar) chronic Glaucoma – □ Visual blurring, pressure for 1-2 □ Asthma, COPD
decreases myopia, irritation, mins. to □ HTN
□ Eye preparation. intraocular brow pain and HA. nasolacrimal □ Acute eye
□ Miotic (Anti- pressure (with ophthalmic) drainage area after infections, retinal
glaucoma agent). □ Normal: Increased administering eye detachment,
□ Direct acting pigmentation of iris gtts contact lens use
cholinergic agent □ Will reverse the and eyelids; long □ Eye therapy will
for ophthalmic use. effects of Atropine eyelashes. continue long term
(and Atropine will Adverse effects/toxicity:
□ It is an antidote to reverse the effects □ Retinal detachment
Atropine of Pilocarpine). □ Ataxia
□ Confusion
□ seizure
Prazosin hydrochloride □ Mild to moderate Side effects: □ monitor for Avoid use with:
(Minipress) HTN – mainly □ Dizziness, decreased BP, □ Prior sensitivity
diastolic drowsiness especially with □ hypotension
□ Antihypertensive □ little effect on □ Fatigue, weakness. initial administration
□ Alpha-adrenergic cardiac output and □ Priapism, impotence □ Monitor urine vol. Use caution with:
receptor antagonist HR □ Orthostatic □ change position □ impaired hepatic
□ vasodilator □ BPH (due to hypotension slowly to prevent function
□ Treat benign vasodilator effects) Adverse effects/toxicity: orthostatic □ older adults
prosthetic □ First-dose hypotension
hyperplasia (BPH) phenomenon: □ stop smoking and
syncope within 30 avoid alcohol intake
Optimal effects may min to 1 hr. Effect is □ avoid driving and
take 4-6 weeks transient, may hazardous tasks
diminish by giving until effect of med
at bedtime. is known
Prochlorperazine □ Severe nausea and Side effects: □ Avoid excessive Avoid use with:
(Compazine) vomiting □ drowsiness, sunlight – may turn □ Hypersensitivity
□ Management of dizziness, skin gray-blue □ Blood dyscrasias
□ Antiemetic psychotic □ EPSE □ Urine may turn □ Dementia related
□ Antipsychotic disorders, Adverse effects/toxicity: reddish brown psychosis in elderly
□ Phenothiazine excessive anxiety □ Persistent tardive □ Use sugarless hard □ Young children
and agitation dyskinesia candy or ice chips to □ Seizures
□ Tremor, twitching avoid dry mouth. □ Lactation
□ Take 30-60 min □ Agranulocytosis, □ Avoid skin contact
before any activity □ thrombocytopenia with concentrate
that causes nausea □ After 1-2 months: □ Do not crush or
for best effect. Akathisia (inner chew – swallow
restless, inability to whole
□ Start doses low and sit still) – may tx □ Deep IM, not SQ
increase slowly with propranolol. injection
Promethazine □ Long-acting med Side effects: □ Decrease GI distress Avoid use with:
(Phenergan) □ motion sickness □ Resp depression, by giving oral dose □ Acute MI, angina,
□ nausea □ drowsiness, with milk or food. atrial fib
□ Antiemetic confusion □ May crush and mix Use caution with:
□ Antihistamine □ IM route: Give deep □ agranulocytosis with food. □ Narrow angle
□ Anti-vertigo IM; not SQ (can □ blurred vision □ Avoid sunlight glaucoma
cause necrosis) □ dry mouth exposure □ peptic ulcer
□ Avoid intra-arterial □ EPSE □ Avoid alcohol and □ duodenal
injection – can other CNS obstruction
cause necrosis. depressants
Protamine sulfate □ Antidote for Side effect: □ Monitor vital signs Avoid use with:
Heparin overdose □ Abrupt drop in BP if and labs closely □ Hemorrhage not
□ Antidote for □ Given IV; maximum administered too (aPTT) induced by heparin
Heparin toxicity. dose of 50 mg in 10 rapidly. overdose.
□ Heparin antagonist min time period;
should be titrated
Onset = 5 minutes according to the See listing for HEPARIN
Duration = 2 hours time and length of
Longer half-life than time the heparin
heparin was administered
Ranitidine □ Reduce gastric Side effects: □ Give without regard Avoid use with:
hydrochloride (Zantac) secretion. □ headache to meals □ Hypersensitivity
□ Active duodenal □ taste disorder, □ Usually give 1 x day Use caution with:
□ H2-receptor ulcer, maintenance diarrhea, □ reduce dose in renal □ Impaired renal of
antagonist. after healing constipation patient hepatic function.
□ Higher potency □ GERD □ dry mouth □ avoid smoking to □ May increase
than cimetidine □ benign gastric ulcer Adverse effects/toxicity: □ avoid antacid within effects of alcohol,
(Tagamet) (short-term) □ hepatotoxicity 1 hour of dose aspirin, Coumadin
□ thrombocytopenia and sulfonylureas
Rh0(D) immune □ Given to Rh- Side effects: □ Send sample of Avoid use with:
globulin (RhoGAM) negative moms □ Injection site newborn cord blood □ Known sensitivity
with RH positive irritation to lab for cross to human
□ Biological response babies. □ slight fever match and typing immunoglobulins.
modifier □ myalgia immediately after
□ Immunoglobulin □ Provides passive □ lethargy delivery before
(IgG) immunity by administer RHo (D)
suppressing active □ Give to mom IM via
Peak 2 hour antibody response deltoid. (Only a few
Half-life 25 days and formation of forms can be given
anti-RHo when (1) IV).
positive fetal RBC □ Give immediately
enters maternal after reconstitution
circulation during □ Recommended at
the third stage of 28 weeks gestation
labor; (2) there is and then within 72
fetal maternal hours after delivery
hemorrhage or other or 3 hrs. of
trauma during termination of
pregnancy; (3) pregnancy or
termination of miscarriage.
pregnancy or □ Keep epinephrine
miscarriage; or (4) available; systemic
following a Rh+ allergic reactions
transfusion. sometimes occur.
□ TEACH it will
prevent hemolytic
disease in a
subsequent
pregnancy
Setraline □ panic disorders Side effects: □ Give with food in Avoid use:
hydrochloride (Zoloft) □ Anxiety disorders □ Cause fewer the morning to □ Within 14 days of
□ OCD disorders than other prevent insomnia using MAO inhibitor
□ PTSD antidepressants □ Watch for suicide □ Seizure disorder
□ Antidepressant □ fewer side effects risk
□ SSRI (selective on HR and HTN □ Increases effect of
serotonin reuptake □ 2-3 wks. to be □ Sexual dysfunction Coumadin
inhibitor) effective □ Weight gain □ Avoid grapefruit
Major complication juice
□ (Selective Serotonin
Syndrome): Pt. can
die from it. Elevated
temp up to 105.
Every speed up. BP,
HR, Temp. May
progress to coma.
Spironolactone □ Increases sodium Side effects: □ Take with food Avoid use with:
(Aldactone) excretion; does not □ Headache □ avoid salt substitute □ Serum K+ level > 5.5
decrease □ dizziness, weakness high in K+ □ anuria, acute and
□ Fluid & electrolyte potassium □ orthostatic □ Avoid excessive chronic renal
balance □ treatment of hypotension ingestion of foods insufficiency
□ antihypertensive primary Adverse effects/toxicity: high in potassium. □ diabetic
□ Potassium sparing aldosteronism □ Hyperkalemia □ no potassium nephropathy
diuretic □ Use for edema and (nausea, vomiting, supplement needed □ hypersensitivity
HTN associated diarrhea, cramps, □ Monitor VS and □ impaired hepatic
with heart failure. tachycardia then urine output function
bradycardia) □ Avoid direct □ Decreases effect of
□ aplastic anemia sunlight Dig;
□ thrombocytopenia □ increases chance of
lithium toxicity
Sucralfate (Carafate) □ Protects the ulcer Side effects: □ No antacid use Avoid use with:
from gastric acid by □ constipation within ½ hour of □ Chronic kidney
□ Antiulcer forming an □ nausea this medication failure
□ Gastro-protective adherent coating; it
agent absorbs pepsin □ Avoid gastric □ Decreases
decreasing its irritants such as absorption of Cipro,
activity. caffeine, alcohol, Dig, Dilantin,
□ Duodenal ulcer smoking and spicy Tetracycline (so take
□ Short term with foods. these med 2 hours
gastric ulcer apart from Sucralfate)
□ esophageal ulcer
related to radiation
or chemotherapy
Theophylline □ bronchospasms Side effects: □ PO: take with water Avoid use with:
(Theo-dur) □ asthma □ Tachycardia and after meals. □ CAD, angina
□ bronchitis □ Seizures □ Wait 4-6 hours after □ Renal or liver
□ Bronchodilator □ emphysema □ N/V, anorexia, IV to start PO. disease
(resp. smooth Adverse effects/toxicity: □ Take same time □ Pregnancy,
muscle relaxant) □ restlessness, each day lactation
□ xanthines agitation, HA, and □ children
insomnia □ Limit caffeine □ CHF and acute viral
□ Normal level 10-20. □ note: restlessness □ can cause seizure
toxic level (> 20) could be due to □ Smoking decreases (with high
may develop toxicity or hypoxia effect of med doses/levels) so
quickly so close assessment avoid with seizure
is required □ Increases lithium disorder unless
excretion bronchospasm is
unresponsive to
other treatments
Tobramycin sulfate □ broad spectrum Side effects: □ Doses are based on Do not use with:
antibiotic □ HA, paresthesia, skin weight □ Known sensitivity
□ Aminoglycoside □ Kills bacteria cell by rash, fevers. □ Do not other meds to other
□ Antibiotic affecting protein Adverse effects/toxicity: In the same IV aminoglycosides
synthesis. Kill Gram □ Nephrotoxicity and LAB □ Preexisting renal
IV/IM negative infection. ototoxicity are two □ Peak and Trough disease.
Inhalation (TOBI) □ Inhalation – common toxicities □ serum creatinine,
Ophthalmic (Tobrex) preventative with associated with BUN to monitor
cystic fibrosis (28 aminoglycosides. renal function
days on, 28 days Eye – itching, swelling
off) REFER to sections on
□ Eye – external eye aminoglycosides
infections (Gentamycin)
Tolbutamide (Orinase) □ Mild to moderately Side effects: □ Monitor blood Avoid use with:
severe, stable Type □ GI distress sugars including □ Allergy to sulfa or
□ Antidiabetic 2 Diabetes □ Pruritus, rash (may fasting and HgbA1C urea
□ Sulfonylureas □ May be used as stop on own) Teach
adjunct therapy for □ Photosensitivity □ Signs and symptoms □ Beta adrenergic
Peak: 3-5 hours Type 1 Diabetes but Adverse effects/toxicity: of hypoglycemia blocking agents
Duration: 6-12 hours not sole medication □ Alcohol may cause and notify (betablockers) can
disulfiram like prescriber if they suppress insulin
□ Give 1-2 x day after reaction (flushing, occur. release and delay
meals palpation and □ Wear medic alert response to
□ 1-2 weeks of nausea, flushing of bracelet or tag hypoglycemia
medication may be skin). □ Avoid alcohol
required for full □ Hypoglycemia due □ Consult dr. when
therapeutic effect to too much med, pregnant
drug interactions,
N/V, inadequate
food intake.
Triazolam (Halcion) □ short term □ Drowsiness, □ Do not use in Avoid use with:
management of lethargy, confusion addictive prone pt. □ Known sensitivity
□ sedative hypnotic insomnia (4 weeks) □ sleepwalking □ Monitor symptoms □ Alcohol intoxication
□ Anxiolytic characterized by Adverse effects/toxicity: of overdose (slurred □ Suicidal ideas
□ Benzodiazepine difficulty falling □ Physical speech, confusion, □ Pregnancy,
asleep, frequent dependence somnolence, lactation
Has rapid onset (15-30 wakeful periods □ Seizures (with rapid impaired
mins.) withdrawal) coordination and
Peak 1-2 hours □ With overdose: coma).
Duration 6-8 hours coma, respiratory □ following long term
depression, use, tolerance may
paradoxical anxiety develop so do not
stop taking abruptly
Trihexyphenidyl HCl □ Treat Parkinson’s Side effects: □ Monitor I& O Avoid use with:
(Artane) disease. □ Drowsiness □ increase fluids, bulk □ narrow angle
□ Diminishes hyper- □ Decrease urine and exercise glaucoma,
□ Anticholinergic salivation; rigidity output, retention or □ void before taking □ myasthenia gravis
□ Antispasmodic and irregular hesitancy to reduce urinary □ GI obstruction
movements in □ Dry mouth retention
Parkinson’s. □ Constipation □ Avoid driving or
□ Use to control Adverse effects/toxicity: other hazardous
drug-induced extra- □ Paralytic ileus activities as
pyramidal side drowsiness may
effects occur.
□ Avoid OTC such as
cough medicine
with alcohol.
□ Very dose sensitive
Vincristine sulfate □ Acute □ Major toxicities □ Neutropenic Avoid use with:
(Oncovin) lymphoblastic and occur in the precautions prn □ Obstructive
other leukemias hematopoietic, □ Assess hand grasp jaundice
□ Antineoplastic □ lymphosarcoma, integumentary, and deep tendon □ Pre-existing
□ Vinca alkaloids □ Hodgkin’s disease neurologic and reflexes neuromuscular
(from plant) □ breast and lung reproductive, disease
□ mitotic inhibitor cancers system. □ Maintain a regimen □ Active infection
□ Peripheral against constipation □ Pregnancy,
neuropathy and paralytic ileus; lactation
□ IS a vesicant; □ Paralytic ileus (more report a change in
administer into the common in young bowel habits. □ Bronchospasm may
side arm portal of a children) occur in pt
freely flowing IV. □ Alopecia Vesicant safety previously treated
Adverse effects/toxicity: precautions: with mitomycin
□ Hyaluronidase is □ Neurotoxicity - loss □ Good vein, prefer
given if this of sensation of the central line access
vesicant should soles of feet and or fresh butterfly
infiltrate. May fingertips stick
apply heat to site to □ Depression of the □ chemo-trained
disperse drug and Achilles reflex is the nurse
minimize sloughing. earliest sign of □ remain during
neuropathy infusion
□ Children are □ have antidote
especially likely to handy
develop neuro
changes
Vitamin B6 □ Prevention and Causes of deficiency: Use with caution:
(Pyridoxine HCl) treatment of Side effects: □ Alcoholism □ Renal disease
pyridoxine □ Pain at injection site □ Malabsorption □ Cardiac disease
□ Water-soluble deficiency (see Adverse effects/toxicity: disorders
vitamin causes) □ Neuropathy □ Oral contraceptives Common drug
Absorbed by GI tract □ Co-enzyme in □ Ataxia Dietary sources: interactions:
amino acid □ seizures □ green leafy veg. □ INH, hydralazine,
s/s of deficiency: metabolism and □ organ meats, fish, oral contraceptives
□ Lack of energy red blood cell poultry □ Reverses or
□ Decreased brain production □ legumes, chickpeas antagonizes effects
functioning □ Treats acute □ bananas of levodopa.
□ skin lesions, toxicity of INH, □ whole grains,
□ conjunctivitis hydralazine. □ potatoes
Vitamin B12 (see entry under
Cyanocobalamin)
Vitamin C □ Protects Side effects: □ Mix oral solutions Avoid use with:
(Ascorbic acid) connective tissue, Rare at normal doses with food □ Prone to kidney
strengthens blood stones
□ Water soluble vessel walls, forms Adverse effects/toxicity: Causes of deficiency:
vitamin scar tissue, □ crystalluria □ Normal aging
provides matrix for □ Alcohol □ Megadoses of Vit. C
s/s of Deficiency which bone growth □ Other meds can interfere with
is called Scurvy □ Supports immune absorption of
□ Malaise, lethargy system □ Increases Dietary Sources: Vitamin B12.
□ pinpoint □ helps in absorption absorption of Iron □ citrus fruits,
hemorrhages of iron and to cantaloupe,
□ bleeding gums, metabolize amino strawberries,
rough skin and acid □ broccoli, cabbage,
blotchy spots □ acidifies urine cauliflower
especially legs □ tomatoes
Vitamin D2 □ Calcium and Side effects: Causes of deficiency: Avoid use with:
(Ergocalciferol) phosphate □ Uncommon at □ Inadequate sunlight □ Hypersensitivity to
metabolism normal doses □ Dietary intake Vit. D
□ Fat-soluble vitamin Remember calcium □ Metallic taste □ hypoparathyroid □ Hypercalcemia
and phosphorus are □ Hyper-
inverse (high one, Adverse effects/toxicity: Dietary Sources: phosphatemia
s/s deficiency which is lower other) □ n/v, □ Egg yolks
called rickets □ Necessary to □ fatigue, headache, □ fortified cereals and
□ bones fail to calcify develop and □ hallucinations milk
□ bowed legs maintain strong □ dysrhythmias □ Cod liver oil
□ osteomalacia bones □ Hypercalcemia □ some fish
□ muscle spasm □ osteomalacia and □ Stones
osteoporosis □ Also obtained from
□ hypo- sunlight
parathyroidism
□ Treat and prevent
rickets
Vitamin E □ Dietary supplement Side effects: Causes of deficiency: Use with caution:
(alpha-tocopherol) □ Hemolytic anemia □ Uncommon at □ normal aging □ Bleeding disorders
in neonates normal doses □ Prematurity □ Pregnancy
□ Fat-soluble vitamin □ Topical to chapped □ Malabsorption
skin Adverse effects/toxicity: diseases □ Avoid mineral oil
s/s deficiency: □ Prevents cell □ N/V Dietary Sources:
□ Hemolytic anemia membrane damage □ fatigue, □ Wheat germ
protects against □ headache □ Vegetable oils
blood clot □ blurred vision □ Green leafy
development Toxic: vegetables
□ jaundice □ Nuts
□ brain damage □ Dairy, eggs
Vitamin K1 □ Promotes liver Side effects: □ SQ administration Avoid use with:

(Aquamephyton) synthesis of □ Swelling and pain at
preferred over IM. □ Known
(Phytonadione) clotting factors injection site□ Labs: Monitor hypersensitivity to
PT/INR (see note med
□ Fat soluble vitamin □ Given to newborns Adverse effects/toxicity: under ‘warfarin’)
to prevent bleeding □ Hypersensitivity or Causes of deficiency:
s/s deficiency: □ Given as antidote anaphylaxis – like □ fat malabsorption
□ Deficiency causes for coumadin reaction □ medication
hemorrhage. toxicity. □ Bronchospasm, Dietary Sources:
□ Also reverses hypo- Cardiac arrest □ Asparagus, broccoli,
Given as antidote for prothrombinemia cabbage, Green
Coumadin (warfarin) from various leafy vegetables
overdose. causes □ Green tea
Onset IV = 6 hours □ Tomatoes
See entry under

Warfarin (Coumadin)
□ Coumadin Side effects: □ Coumadin may be Avoid use with:
Warfarin sodium interferes with □ Ecchymotic skin started while pt is □ hemorrhaging or
(Coumadin) synthesis of □ GI & skin problem still on continuous bleeding
clotting factor(s) □ Hypotension IV heparin therapy). tendencies
□ ORAL anticoagulant that require Vit. K. □ thrombocytopenia Heparin is tapered □ malignant
off slowly over 2-3 hypertension
To reserve □ Given PO. Adverse effects/toxicity: days. Pt. remains on □ past history of
hyperanticoagulation – □ Bleeding is the oral Coumadin. allergic reaction to
(1) Hold and/or skip □ Has narrow major adverse □ Often given in the Coumadin
doses of Coumadin therapeutic range. effect. evening with lab
(2) Antidote which is Can take 1 week for draws in the □ Many, many meds
Vitamin K1 Therapeutic effect morning – it must have drug
(Aquamephyton) be taken same time interactions with
□ PT level will be each day Coumadin
maintained at 1.5 – □ Avoid or use
2.5 the times the consistently foods
control value high in Vit. K
(which is 12-15 sec.) □ May be long-term
□ INR range from 2.0- medication
3.0 (control 1.0) depending on
□ Labs need reason for
monitored often medication
(sometimes 2-3 x □ Teach bleeding
week) initially, precautions
then are decreased □ Observe closely and
over time report s/s bleeding

NLN Pharmacology Study Guide Final 6-3-2013 PDF

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NLN Pharmacology Study Guide

Examples: (abbreviated to type of question; exam will add extra information)

These include the basics! Review:

1. Use, dose, side effects, contraindications

Common classification of medications

Crack abuse effect on newborns

Diabetes treatment in children

Hepatitis: inflammation of liver caused by virus, bacteria or exposure to meds or hepatotoxins

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

D/C if hypersensitivity □ No breastfeeding

Insulin – Glargine □ Long acting insulin □ With Type 2

NEOMYCIN IS NOT GIVEN IV

Vitamin K1 □ Promotes liver Side effects: □ SQ administration Avoid use with:

See entry under

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