Skin Isotretinoin

Vitamin A derivative

Drug name:
HESI Question
Vitamin A Register with iPledge
program
derivative Vitamin A

One negative pregnancy

test before refills
Indication:
Patient must agree to
report depressed mood/
Severe acne
suicidal thoughts

Major Adverse Effect:

1

Birth defects
VITAMIN A

Vitamin A

Suicide risk

Patient teaching:
Skin changes
· Avoid excessive sun
KEY POINTS
Dry Eyes
Avoid vitamin A supplements · May not be able to
Report Suicidal thoughts NCLEX TIP
wear contacts
No Pregnancy - 2 forms of
· Will need lubricating
contraception NCLEX TIP
Also mentioned by ATI as PRIORITY eye drops
above all else! Risk For - Increased ICP -
NO pregnancy is NO JOKE
Avoid tetracyclines
There were 5 criteria for
PREVENTING pregnancy

VITAMIN A

Vitamin A
Tetracyclines

Notes
Acetaminophen
(brand: Tylenol)

Indication:

Fever & mild pain. Used instead of

A – Alcohol history
(Liver Toxic)
NSAIDs to decrease bleeding risk
KEY Term
NSAIDs

Avoid ETOH

Key Points:

ESI uestion
• Like in patients with Peptic Ulcer
or Hemophilia Acetaminophen
high risk client?

54 year old male who

Peptic Ulcer Hemophilia
abuses alcohol
• Mild joint pain or Fever

Mild joint pain Fever

A – Acetylcysteine = Antidote
• Another Plus is that Tylenol & NSAIDS can be Acetylcysteine

used interchangeably to reduce fever

Memory Trick:
NSAIDs
Acetylcysteine blocks
Acetaminophen

• When you reach max dose on one you can

use the other
AIDs

ATI uestion
NS

During an Overdose to
• So it’s recommended for child with flu monitor for which labs?

ALT and AST

ALT AST

Notes
NSAIDS

Drug name: Aspirin Pt Education:

N Naproxen NCLEX TIP A Aspirin

A Avoid Kids NCLEX TIPS
S Salicylate acid (Aspirin) = possible Reye’s Syndrome
Early sign of toxicity is Tinnitus
A Acetylsalicylic acid (Aspirin) - report to HCP

I Ibuprofen & Indomethacin

K Ketorolac (brand: Toradol) NCLEX TIP

NCLEX Question ACETAMINOPHEN

Indication:

nti infl mm tor nti retic e er reducer

MOA:
ecre se rost l ndin res onse to EY ords
decre se in infl mm tion

HESI Question
out teac ing e ective
“I can use ibuprofen or
naproxen for pain”

Kaplan Question
ATI Question
Patient it r eumatoid
arthritis NSAIDS relieve
the symptoms
ESI uestion
Ibuprofen

N NOT GOOD FOR BODY - Do NOT take on an empty

(Kidneys, Heart Failure, Asthma, GI, clots ect) stomach YES
Patient it cid re u on RANITIDINE

S STICKY BLOOD “CLOTS” anitidine PP

Increased risk for thrombosis YES ok
- “I take occasional ibuprofen

A
for my knees” - YES
ASTHMA WORSENING

I INCREASED BLEED RISK! ESI uestion

DYSFUNCTIONAL KIDNEYS Patient it or

D Renal Injury (long term use)
reatinine over rine out ut ml r or ess ill call my HCP
IBUPROFEN

before taking ibuprofen”

S SWELLING HEART
eart failure orsening

Notes
Opioids

Drug name:
OXycodone

Opioids – O’s Memory Trick EY ORDS

mOrphine Sulfate
Opioids
O Y ODO E

HydrOmOrphOne
cOdeine
contin
OxycOdOne
LOW & SLOW
Fentanyl

Antidote:
Indication:

Severe pain (not anti lo one

infl mm tor nti retic brand arcan

eversal agent for o ioid

eroin overdose
iller Adverse E ects Atelectasis

Pneumonia
ow RR respiratory depression
KEY Number:
Hold dose for RR below 12
EY POI T ey terms
ow P ypotension
ort ostatic otension 1-2 hours alf ife belo
KEY Terms:
f client becomes di lig t Reassess Every 60 narousable
headed minutes alling aslee ile tal ing
Assist to se ted osition to ou
et n ssisted
Prepare or second dose
ow rain S sedation o arcan
KEY Terms:
oti y P
asil falls aslee en tal ing
narousable

A I M S
ong term Side E ects
Assess ABCs ntervention en Make HCP aware Second dose of naloxone
O STIPATIO st nd 3rd th

KEY TERM

AB
P stool so eners
O ygen
P
reventative AR A
measures

reatest Risk DEAT

I ADMI ISTRATIO
dvanced ge
nd olde
inutes Pus eassess a er
nderl ing ulmonar minutes
disease Ast NOT over 5 - 10
seconds OT a er hour
ost ey o s

Notes
PCA Pump vs.
Fentanyl
Drug name: Drug name:
ent nyl

Patient Controlled Fentanyl

Analgesia Pump
Indication:
Indication: Given for chronic ‘’persistent’’ pain,
NOT used for acute pain

Used for pain control after P – Patches

surgery or long term recovery P – Persistent Pain

nt e u to hours for full e ect

Key Points KEY Words

ot Ac te in
Client ONLY ost o in NCLEX TIP
NOT family nte i ent in NCLEX TIP

NOT nurse Clarify order with HCP!

NOT Dr. A o i te o lle y to codeine
CODEINE

l n estion
NCLEX TIPS ent nyl tc
“consti tion
use stool so eners
Nursing Care
Twice the dose of Meds given A estion

f atient still re orts ain ent nyl tc

st ction = in A “ ole nce
= need increase doses
for ain relief

estion
A I R AIR ent nyl tc
A Assessment before 1st! “ old patch
I – Intervention ne one
R – Re-assessment Clean area
Dry skin

Notes
Sulfonamides
& Fluoroquinolones

Sulfonamides MOA: KEY POINT

Stops bacteria folic Rash while on Glyburide?

Potential allerg to sulfa drugs
NOT Pregnancy Safe

Trimethoprim acid synthesis

sulfamethoxazole M
SULFA
H !
(Brand: Bactrim)
FOLIC ACID GLYBURIDE

Memory Trick: Key NCLEX Tips:

Contraindications:

S U L F Hypersensitivity to sulfa drugs

Assess for allergies to sulfonylureas like
Glyburide - An oral diabetic drug

SUNBURN URINE LOVE FOLIC ACID

(sunblock & avoid sun) r stals ecific ravit water!! 2-3L per day (take daily)
HIGH = DRY!

1
SULFA GLYBURIDE
FOLIC ACID M H

Gravity HIGH

Fluoroquinolones Indication:

KEY POINTS:
Given for Pneumonia & UTIs
Levo o acin Avoid Sun “direct sun exposure”
(Brand: Levaquin) TEST TIP
Achilles tendon RUPTURE!!
Cipro o acin REPORT NEW MUSCLE PAIN!

ontraindication endonitis FLUOROQUINOLONES

Key NCLEX Tips:

Many students want to avoid FLOXACIN
when creatinine & BUN is elevated. Memory Trick:
Floxacin sounds very simillar to MYCIN
(antibiotics that kill the kidneys) FLOXACIN = FALL XACIN
oo t the entire su so ou don’t end tric ed
E A I
!
DON’T
FLOXACIN MYCIN !
VancoMYCIN
entaMICIN

Notes
 Vancomycin
GLYCOPEPTIDES CLASS &
AMINOGLYCOSIDE CLASS

lycopeptides lass Key NCLEX Tips: Aminoglycosides lass

Vancomycin Tobramycin
EY ords: Gentamicin ystic ibrosis

Indication: REPORT Signs of Toxicity

Neomycin
MRSA DI

Given for serious infections like: Ear Damage “Ototoxicity”

S i in the ut E TIP - Vertigo (loss of balance) Indication:
E TIP - Tinnitus (ringing of the ears)

re t infections in c stic rosis

MOA: Kidney Damage “Nephrotoxic”

MOA:
nhi its cell w ll s nthesis REPORT OTI Y P

Creatinine loc s rotein s nthesis of the

OVER 1.3 = Bad Kidney
cteri to S cteri l
EY ords: rowth ut the
BUN Over 20
PEAK & Trough does not focus on this ut
Urine output 30ml/hr r ther on the w this dru
Check 15 – 30 minutes BEFORE
“next dose” or “administration”
or LESS = Kidney Distress c n
Draw & review levels

REPORT and HOLD E

Over 20 = Vancomycin
EY POI T:
Draw & Review levels
Assess site every 30 minutes for: EY POI T:
pain, redness & swelling U reatinine

Very Toxic in combo with

Red mans Syndrome Vancomycin
EY ords:
Rapid infusion
*** oti HCP of Increas-
Sudden onset of severe: Monitor BP
ing
Infuse SLOWLY at least U reatinine
Hypotension
over 60 minutes
Flushing & pruritis “itching” (<10mg/min)

Red rash on face, neck,

chest & extremities Common estion
120/80 atient in se sis is rescribed
90/60
several antibiotics during t eir
80/50
os ital sta W at atient teac ing
s ould be included
see e ibit for list of meds
evo o acin
o c cline
ANAPHYLAXIS Vancom cin
it rom cin

Hive void direct sun e osure

Wheezing ral birt control ine ective

IMMEDIATELY a e until s m toms subside

STOP infusion & administer onitor Q interval
Epinephrine!
u liment it vitamin
E – Edema “Angioedema”
P Pr riti & Hives onitor creatinine and
I – Insp. / Exp. “Wheezes”

Notes
Tetracyclines

Drug name: Indication:

Mainly used for SKIN ACNE

Tetracyclines
Doxycycline MOA:

It blocks protein synthesis to STOP

KEY Points: bacterial growth.

Patient Teaching:

e erm
Memory Trick:

se additional contraception
• Cycling is DANGEROUS - Not safe for a
pregnant mothers! Take on empty stomach
Sit Up 30 minutes a er ta in
DO NOT LAY DOWN!!!
• You can get BUGS in your teeth while alci m prod ct
cycling on a bike leading to tooth
discoloration 1. NO air mil chee e

2. NO ntacid t m Mil o M

3. NO ron
• Use SUN BLOCK - when out for cycling
around

Notes
Anti Infectives
- Aminoglycosides

How do they work? “Action” Nursing management

he mino l cosides e ert their ctericid l e ect • Before administering any antibiotic be sure to evaluate
by blocking the ribosome from reading the mRNA, the results of the culture and sensitivity test.
a step in protein synthesis necessary for bacterial • Take the drug at the prescribed time intervals. These
multiplication. time intervals are important because a certain amount
of the drug must be in the body at all times for the
infection to be controlled..
• Always report serious adverse reactions, such as a
se ere h ersensiti it re ction res ir tor di cult
Indications severe diarrhea, or a decided drop in blood pressure,
to the primary health care provider immediately,
• Infections caused by gram negative organisms because a serious adverse reaction may require
• efore domin l sur er to reduce norm l flor emergency intervention.
in the bowel • onitor tem er ture nd e lu te the e ecti eness of
the treatment via labs and vitals.
• Neuromuscular blockade or respiratory paralysis may
occur with the administration of aminoglycosides. It is
imperative to monitor respiratory status and report any
Adverse Reactions res ir tor di cult immedi tel
• To detect ototoxicity, carefully evaluate the patient’s
• Nausea complaints or comments related to hearing, such as a
• Vomiting ringing or buzzing in the ears.
• Anorexia
• Rash
Interactions:
• Urticaria
• Nephrotoxicity • Cephalosporins: Increased risk of nephrotoxicity
• Ototoxicity • Loop diuretics (water pills): Increased risk of
• Neurotoxicity ototoxicity
• Pavulon or Anectine (general anesthetics):
Increased risk of neuromuscular blockade

Contraindications & Caution Favorable Outcomes

• Hypersensitivity • Patient reports comfort without fever.

• Pre existing Hearing loss • Orientation and mentation remain intact.
• Myasthenia gravis • Patient has adequate renal tissue perfusion.
• No evidence of injury is seen due to visual or
• Parkinsonism
auditory disturbances.
• Pregnancy & lactation • Patient does not experience diarrhea. (Ford 91)

Generic Trade Use Dose

3 mg/kg/day in 3 divided doses IM or IV
Treatment of serious infections caused
Gentamicin N/A by susceptible strains of microorganisms
For life-threatening infection: 5
mg/kg/day in divided doses

Treatment of serious infections caused 15 mg/kg/day IM or 25–30 mg/kg IM 2–3

Streptomycin N/A by susceptible strains of microorganisms times per week

Treatment of serious infections caused

Tobramycin N/A by susceptible strains of microorganisms 3–5 mg/kg/day IM, IV in 3 equal doses
PLUS TREATMENT OF TB
 Anti Infectives
- Lincosamides

How do they work? “Action” Nursing management

They act by inhibiting protein synthesis in susceptible
bacteria, causing cell death. They disrupt the functional
ability of the ribosomes (which assemble amino acids in
the cell), causing cell death.
Indications
Treatment of infections caused by a range of
gram-negative and gram-positive microorganisms.
Lincosamides are used for the more serious infections
and may be used in conjunction with other antibiotics.
(Ford 87)
• Before administering any antibiotic be sure to evaluate
the results of the culture and sensitivity test.
• Complete the entire course of treatment. Do not stop
the drug, except on the advice of a primary health care
provider, before the course of treatment is completed,
even if symptoms improve or disappear. Failure to
complete the prescribed course of treatment may result
in a return of the infection.
• lu te the e ecti eness of the tre tment
monitoring temperature and vital signs.
• Evaluate lab results for decreasing WBC counts to ensure
the drug regamein is working.

Adverse Reactions
Interactions:
• Abdominal pain
• Esophagitis • Kaolin- or aluminum-based antacids: Decreased
• Nausea absorption of the lincosamides
• Vomiting • Neuromuscular blocking drugs: Increased action of
• Diarrhea neuro muscular blocking drug, possibly leading to
• Skin rash severe and profound respiratory depression
• Blood dyscrasias
• Pseudomembranous colitis

Contraindications & Caution Nursing Alert

• Hypersensitive to the lincosamides • Food impairs the absorption of lincomycin. The patient
• Taking cisapride (Propulsid) or the antipsychotic drug should take nothing by mouth (except water) for 1 to
pimozide (Orap) 2 hours before and after taking lincomycin. Clindamycin
• With minor bacterial or viral infections may be taken with food or a full glass of water.

Generic Trade Use Dose

Serious infection: 150–
Treatment of infections due to 450 mg orally q 6 hr; severe infection: 600–2700
Clindamycin Cleocin
susceptible microorganism mg/day in 2–4 equal doses; life-threatening
infection: up to 4.8 g/day IV, IM

Treatment of infections due 500 mg orally q 6–8 hr; 600 mg IM q 12–24 hr;
Lincomycin Lincocin
to susceptible microorganism up to 8 g/day IV in life-threatening situations
Phenazopyridine

Drug name: Indication: Memory Trick:

UTI Analgesic given for Pain Since its used to e se the re

relief during the burning & urn from ’s t turns od
Phenazopyridine irritation of UTIs fluids RED & ORANGE Like a FIRE
(Brand: Pyridium))
OT an Antibiotic
UTI
ANALGESIC

PYROdine
UTI
ANALGESIC

KEY POINT HESI Question

ormal – No need to Report REPORT:

Red + Orange urine bod uids Yellow SKIN / Sclera = Jaundice

Since it ro dine S S underwe r

clothing & bedding

Patient Teaching:

• Wear sanitary pads

• Wear glasses inste d of cont cts while t in medicine VE
NE P
R
STO
• NEVER STOP nti iotic ther UTI
ANALGESIC
ANTIBIOTIC

NOT EVEN when st rtin to feel etter

ommonl tients etter with this med lw s te ch clients to

thin the infection is So the S their FINISH THE ENTIRE COURSE OF ABX!
nti iotic th t’s BIG NO NO!

STOP
ANTIBIOTIC

NO
NO
NO

Notes
Penicillin &
Cephalosporins

Drug name: COMMON SIDE EFFECTS

Penicillin -Ceph = Diarrhea -Cillins = Bleeding

Amoxicillin (monitor platelet count)
Ampicillin
Piperacillin Tazobactam

Cephalosporins
Cephale in brand e e NCLEX TIP
Cefazolin
Ceftria one brand oce in

Penicillin end in CILLIN KEY POINT & MEMORY TRICK

Cephalosporins start with CEPH

C C C
MOA: CROSS SENSITIVITY CEPH / CEF CILLIN
CEPH CEF CILLIN

Weakens bacteria cell wall

Patient teaching:
AMOXACILLIN
CEFAZOLIN

ey o ds DURING A REACTION

l cont ce ti es e
STOP ASSESS EPINEPHRINE
ine ecti e (“HOLD”) MEDICATION
the type o reaction
(prepare to admin)
se ddition l cont ce tion uscultate ungs

Penicillin cause accidental pregnancy

EPINEPHRINE

CEPHALEX

since it BUMPs the PILL

Anaphylaxis allergy:
Common estion
“-Cillins” & “Cephs”
urse should W at is t e best action for t e
CLARIFY PRESCRIPTION nurse to ta e before
administering amoxicillin to a
Both are PREGNANCY SAFE and atient it allergies to
levo o acin ce ria one
BREASTFEEDING SAFE
CEFAZOLIN
larif t e order it armac
Administration s t e atient about t e t e of
reaction t e ave to ce ria one
“-Cillin”
otif t e P of t e allerg to
e s
· Take with food if GI upset ce ria one
(nausea/ vomiting/diarrhea) dminister meds se aratel it
· Shake well before use normal saline in bet een

Notes
Metronidazole

Indication:
ormal ide e ect
Metronidazole need to report
(brand: Flagyl)
Dark urine “Discoloration”
rug to treat di (brown & rusty)
infection Metallic taste
STI (Trichomoniasis) HESI TIP
(Metro-Metallic Taste)

KEY POINT: ide e ect

Avoid ETOH (alcohol)
eport any new rash or
uring da s a er in peelin
treatment
Patients ill ave violent teven ohn on ndrome
vomitin crampin if hich i o in
and m co mem rane
alcohol is consumed l a H patient
during and a er treatment to REPORT immediatel
Stevens-Johnson Syndrome

Memory Trick:

METALLIC ETOH TREATS RASH OH NOT

Taste & Dark Avoid C Di & ST or Skin Peeling “Da ole”ing
Urine (Trichomoniasis)

NORMAL REPORT

Notes
 Drugs that disrupt the cell wall:
Penicillins

o do t e or Act o Nursing management

Penicillin is a widely used antibiotic prescribed to treat staphylococci and • View the culture and sensitivity results
stre tococci cteri l infections enicillin elon s to the et l ct m • onitor s m toms of h ersensiti it or n h l is
f mil of nti iotics the mem ers of which use simil r mech nism of • ro h l is e the dru s rescri ed until the rim r he lth c re
ction to inhi it cteri l cell rowth th t e entu ll ills the cteri provider discontinues therapy.
• nfection om lete the full course of ther o not sto t in the
dru e en if the s m toms h e dis e red
Indications • e the dru t the rescri ed times of d ec use it is im ort nt to
ee n de u te mount of dru in the od throu hout the entire
hours of e ch d
• rin r tr ct infections s
• enicillin or l e the dru on n em t stom ch either hour
• Se ticemi efore or hours fter me ls e ce tions enicillin nd mo icillin
• Meningitis • e e ch dose with full ounce l ss of w ter
• ntr domin l infections • oid drin in lcoholic e er es when t in the ce h los orins nd
• Se u ll tr nsmitted infections s hilis for d s fter com letin the course of ther ec use se ere
• neumoni nd other res ir tor infections re ctions m occur
• ro h l is for ntici ted cteri l infections • o reduce the ris of su erinfection durin nti iotic ther t e
o urt uttermil or cido hilus c sules
• f ou re wom n who h s een rescri ed m icillin nd enicillin
Adverse eact o s nd who t es irth control ills cont inin estro en use ddition l
contr ce tion me sures
• otif the rim r he lth c re ro ider immedi tel should one or
• lossitis infl mm tion of the ton ue when i en or ll
more of the followin occur s in r sh hi es urtic ri se ere di rrhe
• Stom titis infl mm tion of the mouth dr mouth in l or n l itchin l c furr ton ue sores in the mouth swellin
• Gastritis round the mouth or e es re thin di cult or distur nces such
• use omitin s n use omitin nd di rrhe o not t e the ne t dose of the
• i rrhe domin l in dru until the ro lem h s een discussed with the rim r he lth
• n n h l ctic re ction care provider.
• nemi low red lood cell count • Never give this drug to another individual even though his or her
• hrom oc to eni low l telet count s m toms e r to e the s me s ours
• eu o eni low white lood cell count • e er s i doses or sto ther unless told to do so the rim r
• one m rrow de ression he lth c re ro ider see tient e chin for m ro ed tient
utcomes re entin nti nfecti e esist nce hen enicillin is
to e t en for lon time for ro h l is ou m feel well des ite
o tra d cat o s a to the need for lon term nti iotic ther here m e tendenc
to omit one or more doses or e en ne lect to t e the dru for n
• Hypersensitivity to penicillin or cephalosporins e tended time ord

er a o s derat o s
Interactions:
Goldenseal (Hydrastis canadensis) is an herb found growing in certain
• r l contr ce ti es with estro en ecre sed e ecti eness of areas of the northeastern United States, particularly the Ohio River
contr ce ti e ent with m icillin enicillin lle oldense l h s een used to w sh infl med or infected e es nd
• etr c clines ecre sed e ecti eness of enicillins in m in ellow d e here re m n more tr dition l uses of the her
• ntico ul nts ncre sed leedin ris s with l r e doses of includin s n ntise tic for the s in s mouthw sh for c n er sores
penicillins) nd in the tre tment of sinus infections nd di esti e ro lems such s
• drener ic loc in dru s incre se the ris for n peptic ulcers and gastritis. In the 19th century, goldenseal was touted as
anaphylactic reaction n her l nti iotic for tre tin onorrhe nd s hou h used o er
time meric n ndi n tri es s n insect re ellent stimul nt nd
diuretic there is no scienti c e idence to su ort its ene t for these
o tra d cat o s a to ur oses nother m th surroundin oldense l use is th t t in the
her m s s the resence of illicit dru s in the urine idence does
support the use of goldenseal to treat diarrhea caused by bacteria or
•A e t com in tion of mo icillin nd cl ul nic cid
intestin l r sites such s i rdi he her is contr indic ted durin
• Timentin com in tion of tic rcillin nd cl ul nic cid re n nc nd in tients with h ertension d erse re ctions re r re
• as com in tion of m icillin ndsul ct m when the her is used s directed owe er this her n h l is
• os com in tion of i er cillin nd t o ct m ord should not e t en for more th n wee ord

Generic Trade Use Dose

ect o s d e to s sce t e to o ts da
e c
er e croor a s s e ococca or M dosa e a a so e ased
a eo s e t s se t ce a on weight
ect o s d e to s sce t e
e c eet ds ora r or r
organisms
Macrolides
Azithromycin

Drug name: Key NCLEX Tips:

Macrolides end in ‘’-t ro c ’’
They are also: Hepatotoxic or LIVER TOXIC.
So monitor Liver Labs (ALT/AST):
YES it’s TRUE, they sound
e ort increase to HCP
a lot like our other mysins,
Azythromycin but these are THROmycin.

Erythromycin THROmycin
AST/ALT

“mysin”
Be careful with acetaminophen for Fever
They are not too hard on RENALS or EARS but during infection. Tylenol is liver TOXIC
they are DANGEROUS in their own way.

de Effects:
Key Words:
Common SIDE EFFECTS - Now don’t be tricked!
Common test questions ask If you stop giving during
for Nausea, vomiting, fever & decreasing WBC’s
KEY POINT:
Prolonged QT

MONITOR ECG and report

changes to Dr. or HCP!!!!!

Nausea and vomiting is common since

it’s taken on empty stomach
MEMORY TRICKS
T
Q Fever is expected during an infection,
Thromycin so keep on giving
T

Throws ECG waves

“Prolonged QT intervals”
Decreasing WBC means infection is
improving so DON’T BE TRICKED!

Notes
 Anti Infectives
Drugs that interfere with protein synthesis

How do they work? “Action” Nursing management

• Daptomycin is a member of a new category of
antibacterial agents called cyclic lipopeptides.
• ine olid o is the rst dru in new dru cl ss
the oxazolidinones
• Spectinomycin (Trobicin) is chemically related to but
di erent from the mino l cosides
• Quinupristin/dalfopristin has bactericidal action against
both methicillin-susceptible and methicillin-resistant
staphylococci.
Indications
• Daptomycin is used to treat complicated skin and skin
structure bacterial infections as well as Staphylococcus
aureus infections of the blood.
• Linezolid is used in the treatment of vancomycin
resistant Enterococcus faecium (VREF) , health
care–and community-acquired pneumonias, and skin
and skin structure infections.
• Spectinomycin is used for treating gonorrhea in patients
who are allergic to penicillins, cephalosporins, or
probenecid
• Quinupristin/dalfopristin is a bacteriostatic agent also
used in the treatment of VREF.
• Before administering any antibiotic be sure to
evaluate the results of the culture and sensitivity
test.
• Complete the entire course of treatment. Do not
stop the drug, except on the advice of a primary
health care provider, before the course of
treatment is completed, even if symptoms
improve or disappear. Failure to complete the
prescribed course of treatment may result in a
return of the infection.
Interactions:
• Antiplatelet drugs (aspirin or the nonsteroidal
nti infl mm tor dru s S s incre sed
risk of bleeding and thrombocytopenia
• Monoamine oxidase inhibitor (MAOI)
ntide ress nts decre sed e ecti eness
• Large amounts of food containing tyramine
e ed cheese c ein ted e er es o urt
chocolate, red wine, beer, pepperoni)
-risk of severe hypertension

Contraindications Adverse Reactions

• Linezolid: Known hypersensitivity, PKU, pregnancy. • Nausea

• Daptomycin, spectinomycin, and • Vomiting
quinupristin/dalfopristin: known hypersensitivity to the • Diarrhea or constipation
• Headache and dizziness
drug, and it should not be used during pregnancy • Insomnia
(pregnancy category B) or lactation. • Rash
• Chills
Nursing Alert • Fatigue
• Depression
• Nervousness
uinu ristin d lfo ristin is irrit tin to the ein fter • Photosensitivity
eri her l infusion the ein should e flushed with • Pseudomembranous colitis and thrombocytopenia
de trose in w ter ec use the dru is incom ti le are the most serious adverse reactions caused by
with s line or he rin flush solutions ord linezolid.

Generic Trade Use Dose

Complicated skin and skin structure infections, 4 mg/kg IV daily for 7–14 days
Daptomycin Cubicin C Staphylococcus aureus blood infections

Infections with VREF; pneumonia from

Staphylococcus aureus and penicillin-susceptible 600 mg orally or IV q 12 hr
Linezolid Zyvox Streptococcus pneumoniae; skin and skin structure
infections

Quinupristin-
Synercid VREF 7.5 mg/kg IV q 8 hr
dalfopristin S
 Anti Infectives
- Tetracycline

How do they work? “Action” Nursing management

Tetracyclines interfere with protein synthesis and are composed
of natural and semisynthetic compounds. They are used in lieu
of penicillin when there is an allergy resent to penicillin or
cephalosporins
Indications
• Rickettsial diseases (Rocky Mountain spotted fever, typhus
fever, and tick fevers)
• Intestinal amebiasis
• Some skin and soft tissue infections
• Uncomplicated urethral, endocervical, or rectal infections
caused by Chlamydia trachomatis
• Severe acne as an adjunctive treatment
• Infection with Helicobacter pylori in combination with
metronidazole and bismuth subsalicylate
• Before administering any antibiotic be sure to evaluate the
results of the culture and sensitivity test.
• Take the drug at the prescribed time intervals. These time
intervals are important because a certain amount of the drug
must be in the body at all times for the infection to be
controlled..
• Always report serious adverse reactions, such as a severe
h ersensiti it re ction res ir tor di cult se ere di rrhe
or a decided drop in blood pressure, to the primary health care
provider immediately, because a serious adverse reaction may
require emergency intervention.
• When a tetracycline has been prescribed, avoid exposure to the
sun or any type of tanning lamp or bed. When exposure to
direct sunlight is unavoidable, completely cover the arms and
legs and wear a wide-brimmed hat to protect the face and neck.
lic tion of sunscreen m or m not e e ecti e
Therefore, consult the primary health care provider before
using a sunscreen to prevent a photosensitivity reaction.

Adverse Reactions
• Nausea or vomiting Interactions:
• Diarrhea
• Antacids containing aluminum, zinc, magnesium, or
• Epigastric distress
bismuth salts: ecre sed e ecti eness of tetr c cline
• Stomatitis
• Oral anticoagulants: Increased risk for bleeding
• Sore throat
• Oral contraceptives: ecre sed e ecti eness of contr ce ti e
• Skin rashes
agent (breakthrough bleeding or pregnancy)
• Photosensitivity reaction (demeclocycline seems to cause the
• Digoxin: Increased risk for digitalis toxicity
most serious photosensitivity reaction, whereas minocycline
is least likely to cause this type of reaction)

Contraindications & Caution
• Hypersensitivity to sulfonamides
• During lactation & pregnancy
• In children younger than 9 because it can discolor the teeth
Nursing Alert
• Women of childbearing age should be assessed for oral
contraception use whenever tetracyclines are prescribed.
• Do not give tetracyclines along with dairy products (milk or
cheese), antacids, laxatives, or products containing iron.
• When the aforementioned drugs are prescribed, make sure
they are given 2 hours before or after the administration of a
tetracycline. Food or drugs containing calcium, magnesium,
aluminum, or iron prevent the absorption of the tetracyclines
if ingested concurrently. (Ford 89)
Education
Diarrhea may be an indication of a superinfection or
pseudomembranous colitis, both of which can be serious.
Inspect all stools for blood or mucus. If diarrhea is dark or there
is mucus in the stool, save a sample and test for occult blood
using a test such as Hemoccult. If the stool tests positive for
blood, save a sample of the stool for possible further laboratory
analysis.
Teach the patient to avoid the following dairy products
before or after taking tetracycline:
• Milk (whole, low fat, skim, condensed, or evaporated) and
milkshakes
• re m h lf nd h lf he li ht sour cre m co ee
creamers, and creamy salad dressings
• Eggnog
• Cheese (natural and processed) and cottage cheese
• Yogurt and frozen yogurt
• Ice cream, ice milk, and frozen custard (Ford 91)

Generic Trade Use Dose

Atridox, Doryx, Monodox, 150 mg orally QID or 300 mg orally BID;
Treatment of infections due to
Doxycycline Periostat, Oracea, gonorrhea: 600 mg orally initially then
susceptible microorganisms
Vibra-Tabs, Vibramycin 300 mg orally q 12 hr for 4 days

Treatment of infections due to 1–2 g/day orally in 2–4 divided

Tetracycline n/a
susceptible microorganisms doses
 Anti Infectives
- Fluoroquinolones

How do they work? “Action” Nursing management

he fluoro uinolones e ert their ctericid l e ect
interferin with the s nthesis of cteri l
interference prevents cell reproduction, causing death
of the bacterial cell (Ford 96)
Indications
• Lower respiratory infections
• Bone and joint infections
• Urinary tract infections
• Infections of the skin
• Sexually transmitted infections
Adverse Reactions
• Nausea
• Diarrhea
• Headache
• domin l in or discomfort
• Dizziness
• Photosensitivity
• Before administering any antibiotic be sure to evaluate
his the results of the culture and sensitivity test.
• onitor l s nd e lu te the e ecti eness of the
treatment
• Monitor vitals and temperature
• Complete the entire course of treatment. Do not stop
the drug, except on the advice of a primary health care
provider, before the course of treatment is completed,
even if symptoms improve or disappear. Failure to
complete the prescribed course of treatment may
result in a return of the infection.
• here is ris with ll fluoro uinolone dru s of c usin
in infl mm tion or ru ture of tendon he chilles
tendon is particularly vulnerable. Those 60 years of age
and older who take corticosteroids are at greatest risk
for tendon rupture.

Favorable Outcomes
Contraindications & Caution
• su erinfection c n de elo r idl nd is otenti ll
• Hypersensitivity serious nd e en life thre tenin nti iotics c n
• Children younger than 12 or adults older than 60 disru t the norm l flor non tho enic cteri in the
who are on corticosteroids because of the risk of
bowel), causing a secondary infection or superinfection.
achilles tendonitis
This new infection is “superimposed” on the original
infection. The destruction of large numbers of
Interactions: non tho enic cteri norm l flor the nti iotic
alters the chemical environment. This allows
uncontrolled growth of bacteria or fungal
• Theophylline: Increased serum theophylline level
microor nisms th t re not ected the nti iotic
• Cimetidine: Interferes with elimination of the
ein dministered su erinfection m occur with
antibiotic
the use of any antibiotic, especially when these drugs
• Oral anticoagulants: Increased risk of bleeding
are given for a long time or when repeated courses of
• Antacids, iron salts, or zinc: Decreased absorption
therapy are necessary. (Ford 96)
of the antibiotic
• o stero da a t a ator dr s A s:
Risk of seizure.

Generic Trade Use ose

Treatment of infections due to 250–750 mg orally q 12 hr;

ro o ac Cipro susceptible microorganisms 200–400 mg IV q 12 hr

Bronchitis and
e o ac Factive 320 mg/day orally
community-acquired pneumonia

Treatment of infections due to

evo o ac Levaquin 250-750 mg/day orally
susceptible microorganisms
Antibiotics:
6 TEST TIPS OF ABX

1. Finish med 2. Accident l e n ncy 3. NO lco ol

o e ent in ection
C - C ild Care
A e d on li e
illins enicillin, Amoxicillin
Key Words ycline o ycycline, Tetracycline

e ntil ll ed is nis ed Key Words

DO NOT sto en eelin
e e l cont ce ti es ine ecti e
se ddition l cont ce tion
li e

4. NO FOOD 5. NO sun 5. NO sun

MTF “Move The Food A “Fun The S n Others
M c olides A ithromycin F - Fl o o inolones e o o acin
T - Tetraclycine – Doxycycline l onyl e s ly ide
T - Tetracycline – Doxycycline
F l o o inolones e o o acin S l d s= ns i etics t i ide loo s
Trimethoprim – sul a et o ole
nd ct i
Key Words
Key Words
otosensiti ity
Take on EMPTY stomach A oid di ect s n e os e
ll l ss o te n ns e n loc
A oid n

Don’t let
6. SUPER Toxic 6. SUPER Toxic NCLEX TRICK YOU
idney s idney s
Key Words
Vancomycin
ent micin i ns o o icity
e Ototoxicity
Neomycin - Vertigo (loss of balance)
- Tinnitus (ringing of the ears) Mycins
Key Words idney e Nephrotoxic
A
A o Creatinine OVER 1.3 ad Kidney o ycin li e A iTHROmycin
Too HIGH = Kidneys DIE BUN Over 20 o cin li e i o o cin
oo o = n ections o s rine output
30ml/hr or LESS Kidney Distress
 Anti Infectives
- Sulfonamides

o do t e or Act o rs a a e e t
Bacteriostatic agents that are used to halt the growth of bacteria. Their • Before administering any antibiotic be sure to evaluate the results of
ability to inhibit the activity of folic acid in bacterial cell metabolism. They the culture and sensitivity test.
are often used to control infections caused by both gram-positive and • Take the drug at the prescribed time intervals. These time intervals are
gram-negative bacteria, such as Escherichia coli, Staphylococcus aureus, important because a certain amount of the drug must be in the body
and Klebsiella and Enterobacter species. (Ford 62) at all times for the infection to be controlled..
• Do not increase or omit the dose unless advised to do so by the primary
health care provider.
Indications • Complete the entire course of treatment. Do not stop the drug, except
on the advice of a primary health care provider, before the course of
• Urinary tract infections (UTIs) and acute otitis media treatment is completed, even if symptoms improve or disappear.
• Ulcerative colitis Failure to complete the prescribed course of treatment may result in a
• Mafenide (Sulfamylon) and silver sulfadiazine (Silvadene) are topical return of the infection.
sulfonamides used in the treatment and prevention of infections in • Take drugs that must be taken on an empty stomach 1 hour before or
second- and third-degree burns. 2 hours after a meal.
• Distinguish between immediate- and extended-release medications.
Do not break, chew, or crush extended-release medications.
Adverse Reactions • Notify the primary health care provider if symptoms of the infection
become worse or if original symptoms do not improve after 5 to 7 days
• Nausea, vomiting, anorexia of drug therapy.
• Diarrhea, abdominal pain • Avoid any exposure to sunlight or ultraviolet light (tanning beds,
• Stom titis infl mm tion of the mouth sunlamps) while taking these drugs and for several weeks after
• Chills, fever completing the course of therapy. Wear sunblock, sunglasses, and
• Crystalluria (crystals in the urine) protective clothing when exposed to sunlight.
• Photosensitivity • S eci c nstructions e rdin Sulfon mides
• Steven johnson syndrome • e sulf s l ine ul dine with food or immedi tel fter me l
• TEN • When taking sulfasalazine, the skin or urine may turn orange-yellow;
• e o e a - decrease in the number of white blood cells this is normal. Soft contact lenses may acquire a permanent yellow
• ro oc to e a - decrease in the number of platelets stain. It is a good idea to seek the advice of an ophthalmologist
• A ast c a e a de cient red lood cell roduction in the one
marrow

Interactions:
o tra d cat o s a to
• ra a t coa a ts: Increased action of the anticoagulant
• Hypersensitivity to sulfonamides • Methotrexate: Increased bone marrow suppression
• During lactation • da to s: Increased serum hydantoin level
• In children younger than 2

rs A ert
• f sulfon mides re i en ne r the end of re n nc si ni c ntl hi h
blood levels of the drug may occur, causing jaundice or hemolytic
anemia in the neonate. In addition, the sulfonamides are not used for
infections c used rou et hemol tic stre tococci ec use
the sulfon mides h e not een shown to e e ecti e in re entin
the complications of rheumatic fever or glomerulonephritis.
(Ford 63)
• When diabetic patients are prescribed sulfonamides, assess for a
possible hypoglycemic reaction. Sulfonamides may inhibit the
(hepatic) metabolism of the oral hypoglycemic drugs tolbutamide and
chlorpropamide (Diabinese). (Ford 63)
er a o s derat o s
Cranberries and cranberry juice are commonly used folk remedies for
preventing and relieving symptoms of UTIs. The use of cranberries in
combination with antibiotics has been recommended by physicians for
the long-term suppression of UTIs. Cranberries are thought to prevent
bacteria from attaching to the walls of the urinary tract. The suggested
dose is 6 ounces of juice twice daily. Cranberry capsules are not
recommended ec use the fluid for h dr tion m e s hel ful s the
berries (Brown, 2012). Extremely large doses can produce GI
disturbances, such as diarrhea or abdominal cramping. Although
cranberries may relieve symptoms or prevent the occurrence of a UTI,
their use will not cure a UTI. If an individual suspects a UTI, medical
attention is necessary. (Ford 63)

Generic Trade Use Dose

UTIs, chancroid, acute otitis media,
oad dose: ora a te a ce
ae o s e ae a d
ad a e er e e ococca e ts r e at c
dose: da ora d v ded
doses
fever
t a t era : da ora d v ded
A d e ac te ot t s ed a ae o s
asa a e A d eE ta s e ae e ococca e ts
doses a te a ce dose: da ora
eve s aced doses
 Anti Infectives
- Macrolides

How do they work? “Action” Nursing management

The macrolides are bacteriostatic or bactericidal in • Before administering any antibiotic be sure to evaluate
susceptible bacteria. The drugs act by causing changes in the results of the culture and sensitivity test.
protein function and synthesis. • Take the drug at the prescribed time intervals. These
time intervals are important because a certain amount
Indications of the drug must be in the body at all times for the
infection to be controlled..
• A wide range of gram-negative and gram-positive • Do not increase or omit the dose unless advised to do so
infections by the primary health care provider.
• Acne vulgaris and skin infections • Complete the entire course of treatment. Do not stop
• Upper respiratory infections caused by Haemophilus the drug, except on the advice of a primary health care
influen e with sulfon mides provider, before the course of treatment is completed,
(Ford 86) even if symptoms improve or disappear. Failure to
complete the prescribed course of treatment may result in
Adverse Reactions a return of the infection.

• Nausea
• Vomiting
• Diarrhea
• Abdominal pain or cramping
• Visual disturbances (associated with telithromycin)
may also occur.
Education
• Take the drug at the prescribed time intervals. These intervals
are important because a certain amount of the drug must be in
the body at all times for the infection to be controlled.
• Do not increase or omit the dose unless advised to do so by the
primary health care provider.
• Complete the entire course of treatment. Never stop the drug,
except on the advice of a primary health care provider, before
the course of treatment is completed even if symptoms
improve or disappear. Failure to complete the prescribed
course of treatment may result in a return of the infection.
• Take each dose with a full (8-ounce) glass of water. Follow the
directions given by the clinical pharmacist regarding taking the
drug on an empty stomach or with food (see Patient Teaching
for Improved Patient Outcomes: Avoiding Drug–Food
Interactions).
Interactions:
• Antacids (kaolin, aluminum salts, or magaldrate):
ecre sed sor tion nd e ecti eness of the
macrolides
• Digoxin: Increased serum levels
• Anticoagulants: Increased risk of bleeding
• Clindamycin, lincomycin, or chloramphenicol:
Decreased therapeutic activity of the macrolides
• Theophylline: Increased serum theophylline
Contraindications & Caution
These drugs are contraindicated in patients with
hypersensitivity to the macrolides and in patients with
pre-existing liver disease. Telithromycin (Ketek) should
not be ordered if a patient is taking cisapride (Propulsid)
or pimozide (Orap).
(Ford 86)

Generic Trade Use Dose

Treatment of infections due to ora rst da t e
Azithromycin Zithromax, Zmax
susceptible microorganism mg/day orally

Helicobacter pylori therapy,

Clarithromycin Biaxin Treatment of infections due to ora r
susceptible microorganism

E-Glades, Eryc, Treatment of infections due to ora r or

Erythromycin
Ery-Ped, E.E.S. susceptible microorganism r to da
 Anti Infectives
- Cephalosporins

How do they work? “Action” Nursing management

e h los orins h e l ct m rin nd t r et the cteri l cell • efore dministerin n nti iotic e sure to e lu te the
w ll m in it defecti e nd unst le his ction is simil r to results of the culture nd sensiti it test
the ction of enicillin he ce h los orins re usu ll • e sure to uestion the tient out ller to enicillin or
ctericid l ord ce h los orins efore dministerin the rst dose e en when
n ccur te dru histor h s een t en
• fter dministerin enicillin in the out tient settin s
Indications the tient to w it in the re for t le st minutes
n h l ctic re ctions re most li el to occur within
• es ir tor infections
minutes fter in ection
• titis medi e r infection
• e the dru t the rescri ed time inter ls
• one oint infections
• om lete the entire course of tre tment o not sto the dru
• enitourin r tr ct nd other infections c used
e ce t on the d ice of rim r he lth c re ro ider efore
cteri
the course of tre tment is com leted e en if s m toms
im ro e or dis e r ilure to com lete the rescri ed
course of tre tment m result in return of the infection
Adverse Reactions
• e dru s th t must e t en on n em t stom ch hour
efore or hours fter me l
• Nephrotoxicity
• Malaise • istin uish etween immedi te nd e tended rele se
medic tions o not re chew or crush
• Steven johnson syndrome
e tended rele se medic tions
• use
• omitin
• i rrhe
• Headache Nursing Alert
• i iness
• e rt urn • tient who is ller ic to enicillin lso m e ller ic to the
• e er ce h los orins
• l stic nemi de cient red lood cell • disul r m li e nt use re ction m occur if lcohol is
roduction consumed within hours fter dministr tion of cert in
• o ic e iderm l necrol sis de th of the e iderm l cephalosporins
l er of the s in • to s o a d s ra e react o : include flushin
thro in in the he d nd nec res ir tor di cult
omitin swe tin chest in nd h otension Se ere
Contraindications & Caution re ctions m c use d srh thmi s nd unconsciousness
• eo le with hen l etonuri need to e w re th t the
• o not dminister ce h los orins if the tient h s histor or l sus ension cef ro il ef il cont ins hen l l nine
of ller ies to ce h los orins su st nce th t eo le with c nnot rocess
• e h los orins should e used c utiousl in tients with
ren l dise se he tic im irment leedin disorder
re n nc re n nc c te or nd nown enicillin
ller ord Generations Of Cephalosporins
• irst ener tion ce h le in efle cef olin ncef
Interactions: • Second ener tion cef clor niclor cefo itin efo in
cefuro ime in cef
• mino l cosides ncre sed ris for ne hroto icit • hird ener tion cefo er one efo id
• r l ntico ul nts ncre sed ris for leedin cefot ime l for n ceftri one oce hin
• oo diuretics ncre sed ce h los orin lood le el • ourth ener tion cefe ime i ime

Generic Trade Use Dose

Infections due to susceptible
Cefadroxil n/a 1–2 g/day orally in divided doses
microorganisms,
Infections due to susceptible
Cefoxitin Mefoxin microorganisms, 250 mg orally q 8 hr
perioperative prophylaxis
 Antivirals

o do t e or Act o rs a a e e t
Antiviral drugs work by interfering with the virus’s ability to • Antiviral drugs are not a cure for viral infections, but they will
reproduce in a cell. Antiviral drugs can be toxic to human cells, shorten the course of disease outbreaks and promote healing
and viruses can develope resistance to antiviral drugs of the lesions. The drugs will not prevent the spread of the
disease to others. Topical drugs should not be applied more
frequently than prescribed but should be applied with a
n er cot or lo es ll lesions should e co ered here should
Indications be no sexual contact while lesions are present. Notify the
primary health care provider if burning, stinging, itching, or
• tome lo irus in tr ns l nt reci ients rash worsens or becomes pronounced.
• er es sim le irus S nd enit l nd her es oster • Some drugs cause photosensitivity, so precautions should be
• um n immunode cienc irus taken when going outdoors, such as wearing sunscreen, head
• nfluen nd res ir tor tr ct illness coverings, and protective clothing. Patients should also refrain
• es ir tor s nc ti l irus S se ere lower res ir tor tr ct from using tanning beds.
infection rim ril ectin children
• Some patients have experienced an acute exacerbation of the
disease when medications used to treat hepatitis B are
• Hepatitis B and C stopped. Hepatic function should be closely monitored in
these patients.
• Those taking antiretrovirals should be cautioned that there is
Adverse react o s an increased risk of adverse reactions (hypotension, visual
disturbances, prolonged penile erection) when the drug
• Nausea, vomiting silden l i r is used S m toms should e re orted
• Diarrhea promptly to the primary health care provider.
• Headache • Some dru s ect ment l st tus cti ities re uirin ment l
• Rash alertness, such as driving a car, should be delayed until the
• Fever e ect of the dru is rent ec use ision nd coordin tion
c n e ected tients should rise slowl from rone to
• Insomnia sitting position to decrease the possibility of lightheadedness
caused by orthostatic hypotension. Changes such as
nervousness, tremors, slurred speech, or depression should
o tra d cat o s a to be reported.
• Some patients are on an alternate-dosage schedule. In this
Do not administer antivirals if the patient has a history of case, it is important to designate the days the drug is to be
ller ies to the dru or other nti ir ls idofo ir istide should taken; calendars are helpful aids to track schedules.
not be given to patients who have renal impairment or in • Zanamivir (Relenza) is taken every 12 hours for 5 days using a
“Diskhaler” delivery system. If a bronchodilator is also
combination with medications that are nephrotoxic, such as
prescribed for use at the same time, the bronchodilator is used
aminoglycosides. Ribavirin should not be used in patients with before the zanamivir. The drug may cause dizziness. The
unstable cardiac disease. These drugs should be used during patient should use caution when driving an automobile or
pregnancy (pregnancy categories B and C) and lactation only operating dangerous machinery. Treatment with this drug
when the ene t outwei hs the ris to the fetus or child does not decre se the ris of tr nsmission of influen to
(ribavirin is a pregnancy category X). others.

rs a ert
• Zanamivir (Relenza) is taken every 12 hours for 5 days using a
“Diskhaler” delivery system. If a bronchodilator is also
prescribed for use at the same time, the bronchodilator is
used before the zanamivir. The drug may cause dizziness.
The patient should use caution when driving an automobile or
operating dangerous machinery. Treatment with this drug
does not decre se the ris of tr nsmission of influen to
others.
Interactions
• Probenecid: Increased serum levels of the antivirals
• Cimetidine:Increased serum level of the antiviral valacyclovir
• Ibuprofen: Increased serum level of the antiviral adefovir
• Imipenem-cilastatin: With ganciclovir only, increased risk of
seizures
• Anticholinergic agents: With amantadine only, increased
adverse reactions of anticholinergic agent
• Theophylline: With acyclovir only, increased serum level of
theophylline

Generic Trade Use Dose

Oral: 200–800 mg q 4 hr for 5 doses per day,
er es oster var ce a
acyclovir Zovirax treat for 5–10 days; IV: 5–10 mg/kg q 8 hr;
oster
Topical: apply to lesions q 3 hr

Prevention and treatment of ora or da s

oseltamivir a
e aAa d
Antifungal
& Anti-viral

Drug names: Indication: Drug name: Indication:

Mainly used to Treat Candida For serious fungus

First up end in Amphotericin B
FUNGAL infections. So think & causes SERIOUS TERROR
“-Nazole”
NAZOLE treats NAIL fungus!!! on the body!
Fluconazole Taken for 2-6 weeks & very ots of side e ects
Ketoconazole Liver toxic like most Anti-fungal

NAZOLE

ADVERSE EFFECT

KEY POINT RENAL INJURY

Creatinine
“-Dazole”
Does NOT “-Nazole” OVER 1.3 = Bad Kidney
TREAT Di Nail Fungus Da Gut
i acteria
rine 30 ml/hr or Less =
Kidney Distress

Oliguria ow Urine

Drug name: Indication: Anti-Viral

Given to treat candida infections
statin Of the mouth, GI, skin, even
Acyclovir
vagina.
“-Cyclovir”
Valacyclovir
NYSTATIN
herpes (genital & cold sores)
NYSTATIN

herpes oster (shingles)

KEY Points:
KEY POINTS
a en dail

reat oral candidia i NO re nl lo the ir

ha e ell i id pen ion AVOID e hile le ion are pre ent
nspect mucus membranes for
Drink extra uids
irritation
Remove and soak client s dentures E ective ess fre uent eruption of
lesions
Teach to swish in mouth for several T
minutes then swallow NO
DO TOP
S NYSTATIN

Continue FTER S/S subside NYSTATIN

Notes
 Antiretrovirals

How do they work? “Action” Nursing management

rote se inhi itors which loc the rote se en me so the • nti ir l dru s re not cure for ir l infections ut the will
new ir l rticles c nnot m ture e erse tr nscri t se shorten the course of dise se out re s nd romote he lin
inhi itors which loc the re erse tr nscri t se en me so the of the lesions. The drugs will not prevent the spread of the
m teri l c nnot ch n e into in the new cell re entin dise se to others o ic l dru s should not e lied more
fre uentl th n rescri ed ut should e lied with n er
new co ies from ein cre ted on ucleoside re erse
cot or lo es ll lesions should e co ered here should e
tr nscri t se inhi itors which l tch on to the re erse
no se u l cont ct while lesions re resent otif the rim r
tr nscri t se molecule to loc the ilit to m e ir l he lth c re ro ider if urnin stin in itchin or r sh
ntr inhi itors which re ent the tt chment or fusion of worsens or ecomes ronounced
to host cell for initi l entr nte r se inhi itors which re ent • Some dru s c use hotosensiti it so rec utions should e
en mes from insertin enetic m teri l into the cell’s t en when oin outdoors such s we rin sunscreen he d
ord co erin s nd rotecti e clothin tients should lso refr in
from usin t nnin eds
• Some tients h e e erienced n cute e cer tion of the
dise se when medic tions used to tre t he titis re
Indications
sto ed e tic function should e closel monitored in
these patients.
ntiretro ir l dru s re used in the tre tment of infection
and AIDS.
Nursing alert
tients recei in ntiretro ir l dru s for infection m
continue to contr ct o ortunistic infections nd other
Adverse reactions com lic tions of dise se onitor ll tients closel for
si ns of infection such s fe er e en low r de fe er m l ise
• use omitin sore thro t or leth r ll c re i ers re reminded to use ood
• Diarrhea h nd h iene techni ue ord
• Altered taste
• Rash Interactions
• um ness nd tin lin in the circumor l re round the
mouth or eri her ll or oth • ntifun ls incre sed serum le el of the ntiretro ir l
• l rithrom cin ncre sed serum le el of oth dru s
• Silden l ncre sed d erse re ctions of silden l
• ioid n l esics is of to icit with riton ir
HERBAL CONSIDERATIONS • ntico ul nt nticon uls nt nti r sitic ents ecre sed
e ecti eness when t in riton ir
• Individuals have tried St. John’s wort for both the • r l contr ce ti es decre sed irth control e ecti eness
ntide ressi e nd nti ir l e ects of the su lement
ese rchers h e found th t in tients with infection who
recei e rescri ed rote se inhi itors the e ecti eness of
Contraindications & Caution
dru ther is reduced if the tient lso t es St ohn’s wort o not dminister ntiretro ir ls if the tient h s histor of
tients need to e instructed to disclose the use of ll ller ies to the dru or other ntiretro ir ls omen who re
o er the counter medic tions nd su lements to their l ct tin should not use ntiretro ir l dru s ntiretro ir ls
rim r he lth c re ro ider to re ent otenti ll h rmful should not e rescri ed to the tient who is usin cis ride
imo ide tri ol m mid ol m or n er ot deri ti e iton ir
inter ctions ord
is contr indic ted if the tient is t in u ro ion ell utrin
ol idem m ien or n nti rrh thmic dru ord

Generic Trade Use Dose

HIV infection, prevention of 600 mg/day orally in divided

zidovudine Retrovir
maternal–fetal HIV transmission doses; 1 mg/kg IV q 4 hr

HIV: 150 mg orally BID

lamivudine (3TC) Epivir, Epivir-HB HIV infection, chronic hepatitis B
HBV: 100 mg/day orally daily
infection
 Anthelmintic

How do they work? “Action” Nursing management

• Albendazole (Albenza) interferes with the s nthesis of
the r site’s microtu ules resultin in de th of
susce ti le l r e his dru is used to tre t l r l forms
of or t eworm nd to tre t li er lun nd eritoneum
dise se c used the do t eworm
• Mebendazole loc s the u t e of lucose the
helminth resultin in de letion of the helminths own
l co en his dru is used to tre t whi worm inworm
roundworm meric n hoo worm nd the common
hoo worm
• The activity of pyrantel (Antiminth) is ro l due to
its ilit to r l e the helminth ord
Indications
oundworms inworms whi worms hoo worms nd
t eworms re e m les of helminths hese dru s re
used to er dic te helminths out of the od
Adverse reactions
• rowsiness di iness
• use omitin
• domin l in nd cr m s di rrhe
ord
• ollow the dos e schedule e ctl s rinted on the rescri tion
cont iner t is solutel necess r to follow the directions for t in
the dru to er dic te the r site
• ollow u stool s ecimens will e necess r ec use this is the onl
w to determine the success of dru ther
• hen n infection is di nosed multi le mem ers of the f mil m
e infected nd ll household mem ers m need to e tre ted
l m tes of the infected child m lso need to e tre ted
• t is im ort nt to w sh ll eddin nd ed clothes once tre tment
h s st rted
• il thin showerin is est is recommended isinfect toilet
f cilities d il nd disinfect the thtu or shower st ll immedi tel
fter thin se the disinfect nt recommended the rim r
he lth c re ro ider or use chlorine le ch Scru the surf ces
thorou hl nd llow the disinfect nt to rem in in cont ct with the
surf ces for se er l minutes
• urin tre tment for rin worm infection ee towels nd f cecloths
for thin se r te from those of other f mil mem ers to oid the
s re d of the infection t is im ort nt to ee the ected re cle n
nd dr
• sh the h nds thorou hl fter urin tin or defec tin nd efore
re rin nd e tin food le n under the n ern ils d il nd oid
uttin n ers in the mouth or itin the n ils
• ood h ndlers should not resume wor until full course of tre tment
is com leted nd stools do not cont in the r site
• hild c re wor ers should e es eci ll c reful of di er dis os l nd
ro er h nd w shin to re ent the s re d of infections
• e ort n s m toms of infection low r de fe er or sore thro t or
throm oc to eni e s ruisin or leedin
• l end ole c n c use serious h rm to de elo in fetus nform
women of child e rin e of this l in th t rrier contr ce ti e
is recommended durin the course of ther nd for month fter
discontinuin the ther
ord

Interactions

Contraindications & Caution Albendazole (Albenza)

• Dexamethasone: ncre sed e ecti eness of
• he nthelmintic dru s re contr indic ted in tients l end ole
with nown h ersensiti it to the dru s nd durin • Cimetidine: ncre sed e ecti eness of l end ole
re n nc re n nc c te or ord
• he should e used c utiousl in l ct tin tients Mebendazole
tients with he tic or ren l im irment nd tients • Hydantoins and carbamazepine: ower le els of
with m lnutrition or nemi me end ole

Generic Trade Use Dose

Parenchymal neurocysticercosis due
Weight greater than or equal to 60 kg:
to pork tapeworms, hydatid disease
albendazole Albenza 400 mg
(caused by the larval form of the dog
Weight less than 60 kg: 15 mg/kg/day
tapeworm)

Treatment of whipworm, pinworm, 100 mg orally morning and evening for

mebendazole N/A roundworm, common and American 3 consecutive days
hookworm Pinworm: 100 mg orally as a single dose

pyrantel Antiminth, Reese’s Treatment of pinworm 11 mg/kg orally as a single dose;

Pinworm and roundworm maximum dose, 1000 mg
 Antiprotozoal

How do they work? “Action” Nursing management

Antiprotozoal drugs interfere with, or are active against,
the life cycle of the protozoan.
Indications
• Malaria
• Giardiasis
• Toxoplasmosis
• Intestinal amebiasis
• Sexually transmitted infections (trichomoniasis)
• Pneumocystis pneumonia
• Antimalarial drugs are used for suppressing
(i.e.,preventing) malaria
Adverse reactions
Anorexia
• Nausea, vomiting
• Abdominal cramping and diarrhea
• Headache and dizziness
• Visual disturbances or tinnitus
• Hypotension or changes detected on an
electrocardiogram (ECG;associated with chloroquine)
• Cinchonism —a group of symptoms associated with
quinine administration, including tinnitus, dizziness,
headache, GI disturbances, and visual disturbances.
These symptoms usually disappear when the dosage
is reduced.
• Peripheral neuropathy (numbness and tingling of the
extremities), with metronidazole
• Nephrotoxicity and ototoxicity, with paromomycin
Contraindications & Caution
Quinine should not be prescribed for patients with
myasthenia gravis, because it may cause respiratory
distress and dysphagia.
• Follow the dosage schedule exactly as printed on the
prescription container. It is absolutely necessary to follow the
directions for taking the drug to eradicate the parasite.
• Follow-up stool specimens will be necessary because this is the
only way to determine the success of drug therapy.
• When an infection is diagnosed, multiple members of the family
may be infected, and all household members may need to be
treated. Playmates of the infected child may also need to be
treated.
• It is important to wash all bedding and bed clothes once
treatment has started.
• Daily bathing (showering is best) is recommended. Disinfect
toilet facilities daily, and disinfect the bathtub or shower stall
immediately after bathing. Use the disinfectant recommended
by the primary health care provider or use chlorine bleach.
Scrub the surfaces thoroughly and allow the disinfectant to
remain in contact with the surfaces for several minutes.
• During treatment for a ringworm infection, keep towels and
facecloths for bathing separate from those of other family
members to avoid the spread of the infection. It is important
to ee the ected re cle n nd dr
• Wash the hands thoroughly after urinating or defecating and
efore re rin nd e tin food le n under the n ern ils
d il nd oid uttin n ers in the mouth or itin the n ils
• Food handlers should not resume work until a full course of
treatment is completed and stools do not contain the parasite.
• Child care workers should be especially careful of diaper
disposal and proper hand washing to prevent the spread of
infections.
• Report any symptoms of infection (low-grade fever or sore
throat) or thrombocytopenia (easy bruising or bleeding).
• Albendazole can cause serious harm to a developing fetus.
Inform women of childbearing age of this. Explain that a barrier
contraceptive is recommended during the course of therapy
and for 1 month after discontinuing the therapy.
(Ford 132-133)
Interactions
• Antacids: Decrease absorption of the antimalarial
• Iron: Decreased absorption of the antimalarial
• Digoxin: Increased risk of digoxin toxicity
• Cimetidine: Decreased metabolism of metronidazole
• Phenobarbital: Increased metabolism of metronidazole
Quinine
• Warfarin: Increased risk of bleeding

Generic Trade Use Dose

Treatment and prevention Treatment: 160–200 mg IM and repeat in 6 hr if necessary
chloroquine Aralen of malaria, extraintestinal Prevention: 300 mg orally weekly; begin 1–2 wk before
amebiasis travel and continue for 4 wk after return from endemic area

Monodox, Vibramycin, Short-term prevention of 100 mg orally daily, 1–2 days before travel and for 4 wk
doxycycline
Vibra-Tabs malaria after return from endemic area (Ford 135)

quinine Qualaquin Treatment of malaria 260–650 mg TID for 6–12 days

 Antifungals

o do t e or Act o Nursing management

Antifungal drugs may be fungicidal (able to destroy fungi) or Renal damage is the most serious adverse reaction to the use of
fungistatic (able to slow or retard the multiplication of fungi). m hotericin en l im irment usu ll im ro es with modi c tion
of the dosage regimen (reduced dosage or increased time between
• m hotericin un i one micon ole onist t n st tin doses). Serum creatinine levels and blood urea nitrogen (BUN) levels are
oricon ole fend mic fun in c mine nd etocon ole checked frequently during the course of therapy to monitor kidney
i or l re thou ht to h e n e ect on the cell mem r ne function. If the BUN exceeds 40 mg/dL or the serum creatinine level
of the fungus. exceeds 3 mg/dL, the primary health care provider may discontinue
• lucon ole ifluc n h s fun ist tic cti it th t e rs to the drug or reduce the dosage until renal function improves. (Ford 128)
efore dministerin flucon ole to n older dult or tient with ren l
result from the depletion of sterols (a group of substances impairment, the primary health care provider may order a creatinine
related to fats) in the fungus cells. (Ford 125) clearance test. Watch for and report the laboratory results to the
• riseoful in ris ctin e erts its e ect ein de osited in primary health care provider because the dosage may be adjusted
keratin precursor cells, which are then gradually lost (because based on the test results. (Ford 128)
of the constant shedding of top skin cells) and replaced by new,
non infected cells.
• Clean the involved area and apply the ointment or cream to the skin
• Flucytosine (Ancobon) inhibits DNA and RNA synthesis in the as directed by the primary health care provider.
fungus. • Do not increase or decrease the amount used or the number of times
• lotrim ole otrimin cele inds with hos holi ids in the ointment or cream should be applied unless directed to do so by
the fungal cell membrane, increasing permeability of the cell the primary health care provider.
• riseoful in ene ci l e ects m not e noticed for some time
and resulting in loss of intracellular components. (Ford 125) therefore, take the drug for the full course of therapy. Avoid exposure
to sunlight and sun lamps because an exaggerated skin reaction
(which is similar to severe sunburn) may occur even after a brief
exposure to ultraviolet light. Notify the primary health care provider if
Indications fever, sore throat, or skin rash occurs. (Ford 128)
• etocon ole om lete the full course of ther s rescri ed
• Su er ci l nd dee fun l infections the primary health care provider. Do not take this drug with an antacid.
• Systemic infections such as aspergillosis, candidiasis, and In addition, avoid the use of nonprescription drugs unless use of a
s eci c dru is ro ed the rim r he lth c re ro ider
cryptococcal meningitis (Ford 128)
• Su er ci l infections of n il eds nd or l n l nd in l • tr con ole he dru is t en with food her continues for t
areas (Ford 125) least 3 months until infection is controlled. Report unusual fatigue,
yellow skin, darkened urine, anorexia, nausea, and vomiting. (Ford 128)

o tra d cat o s a to Interactions

• Known hypersensitivity Amphotericin B
• Pregnancy • ort costero ds: Risk for severe hypokalemia
• oth oricon ole nd itr con ole re contr indic ted in • o : increased risk of digitalis toxicity
tients t in cis ride imo ide or uinidine he s stemic •A o cos des e a os or s: increased risk of
ent itr con ole should not e used to tre t fun l n il nephrotoxicity
infections in patients with a history of heart failure. (Ford 127) Fluconazole
• ra o ce cs: incre sed h o l cemic e ects
• e to : decre sed e ects of hen toin
r seo v
Herbal Considerations • ar t rates: decre se sed ti e e ect
ese rchers h e identi ed se er l ntifun l her s th t re
• ra co trace t ves: decre sed e ects of irth control
e ecti e inst s in infections such s te tree oil el leuc
lternifoli nd rlic llium s ti um e tree oil comes from Adverse reactions
n e er reen tree n ti e to ustr li he her h s een used s
a non irritating antimicrobial for cuts, stings, wounds, burns, and • Headache
cne t c n e found in sh m oos so s nd lotions e tree • Rash
oil should not e in ested or ll ut is e ecti e when used • Anorexia and malaise
topically for minor cuts and stings. • Abdominal, joint, or muscle pain
• Nausea, vomiting, diarrhea (Ford 127)

Generic Trade Use Dose

Abelcet, AmBisome, ste c a ect o s cr tococca eso c o ate: da

amphotericin B
Amphotec, Fungizone e ts at e ts t ect o d ased: da

oad dose o o ed
cas o Cancidas vas ve as er os s e at c s ce c
da or at east da s
 TB Drugs:
Ethambutol

How do they work? “Action” Nursing management

Many antitubercular drugs are bacteriostatic against the M. • Ask the patient what he or she thinks causes the symptoms;
tuberculosis bacillus. These drugs usually act to inhibit bacterial promote health literacy by integrating the patient’s beliefs and
cell wall synthesis, which slows the multiplication rate of the fears into how the bacteria invades the body and how the
bacteria. Isoniazid is bactericidal, with rifampin and
drugs work to kill it.
streptomycin having some bactericidal activity.
• Discuss tuberculosis, its causes and communicability, and the
need for long-term therapy for disease control using simple,
non medical terms.
Indications • Review the drug therapy regimen, including the prescribed
drugs, doses, and frequency of administration.
• Treatment of TB in a protocol • Reassure the patient that various combinations of drugs are
e ecti e in tre tin tu erculosis
• Urge the patient to take the drugs exactly as prescribed and
Adverse reactions not to omit, increase, or decrease the dosage unless directed
to do so by the health care provider.
• Anaphylactoid reactions • Instruct the patient about possible adverse reactions and the
(unusual or exaggerated need to notify the prescriber should any occur.
allergic reactions)
• Arrange for direct observation therapy with the patient and
• Optic neuritis
• Dermatitis and pruritus family.
(itching) • Instruct the patient in measures to minimize gastrointestinal
• Joint pain upset.
• Anorexia • Advise the patient to avoid alcohol and the use of
• Nausea and vomiting nonprescription drugs, especially those containing aspirin,
unless use is approved by the health care provider.
• Reassure the patient and family that the results of therapy will
Contraindications & Caution be monitored by periodic laboratory and diagnostic tests and
follow-up visits with the health care provider.
Ethambutol is not recommended for patients with a history of
hypersensitivity to the drug or children younger than 13 years. The drug
is used with caution during pregnancy (category B), in patients with
hepatic or renal impairment, and in patients with diabetic retinopathy or Phases of treatment
cataracts. (Ford 105)
• The recommended treatment regimen is for the
administration of the primary drugs—rifampin (Rifadin),
Interactions isoniazid (INH), pyrazinamide, and ethambutol
(Myambutol)—for a minimum of 2 months
• Antacids containing aluminum
salts: Reduced absorption of isoniazid
• The second or continuation phase includes only the
• Anticoagulants: Increased risk for drugs rifampin and isoniazid. The CDC recommends this
bleeding phase for 4 months or up to 7 months in special
• Phenytoin: Increased serum levels of populations.
phenytoin
• Alcohol: Higher incidence of
drug-related hepatitis
Special populations
Nursing alert • Positive sputum culture after completion of initial
treatment
Older adults are particularly susceptible to a potentially fatal • Cavitary (hole or pocket of) disease and positive sputum
hepatitis when taking isoniazid, especially if they consume
alcohol on a regular basis. Two other antitubercular drugs, culture after initial treatment
rifampin and pyrazinamide, can cause liver dysfunction in the • When pyrazinamide was not included in the initial
older adult as well. Careful observation and monitoring for signs treatment
of liver impairment are necessary (e.g., increased serum • Positive sputum culture after initial treatment in a
aspartate aminotransferase [AST], alanine aminotransferase patient with previously diagnosed HIV infection
[ALT], and bilirubin levels, and jaundice). (Ford 107)

Generic Trade Use Dose

Ethambutol
Myambutol Pulmonary TB 15–25 mg/kg/day orally
Primary drug
TB DRUGS

5 TB Tips Memory Trick

5 NCLEX TIPS ALL are LIVER TOXIC!!!!

So some instructors just use the acronym:
1. Meds Last 6 - 12 months
2. s o n ll t e ti e
3. Family tested for TB
4. Sputum samples every 2 - 4 Weeks
5. e ti e cultures on
di e ent d ys = on e in ectio s

RIFAMPIN INH #1 TESTED

R P ISONIAZID TB DRUG

KEY Points: I - Interferes with absorbtion of6

(pyridoxinde)
- Low Vitamin B6 = Peripheral Neuropathy
1. NORMAL
- Take Vitamin B6 25 - 50mg/day
- Red, Orange: Tears, Urine, Sweat
Teach:
N - Neuropathy
REPORT:
- Wear glasses instead of contacts due - New Numbness
- Tingling extremities
to discoloration of tears NCLEX TIP - Ataxia
2. ral contrace tives ine ective
H - Hepatotoxicity
“Use non-hormonal REPORT Immediately!!!
- Jaundice (yellow) Skin / Sclera
Back-up birth control” - Dark urine NCLEX TIP
3. Monitor for Jaundice - Fatigue
- Elevated liver enzymes (AST/ALT)
HOLD the Med
- Teach: NO ETOH!!

A ye

KEY POINT:
REPORT!

• lurred vision
PYRAZINAMIDE

id not come u in uestions • Color changes

it’s a nice to know but NOT A NEED TO KNOW
is information as come u in multi le sections
to ave baseline e e e ams and
routine a ointments or t ambutol
TB Drugs:
Rifampin

How do they work? “Action” Nursing management

Many antitubercular drugs are bacteriostatic against the M.
tuberculosis bacillus. These drugs usually act to inhibit bacterial
cell wall synthesis, which slows the multiplication rate of the
bacteria. Isoniazid is bactericidal, with rifampin and
streptomycin having some bactericidal activity.
Indications
• Treatment of TB in a protocol
Adverse reactions
• Nausea and vomiting
• Epigastric distress, heartburn, fatigue
• Vertigo (dizziness)
• Rash
• eddish or n e discolor tion of od fluids urine te rs
saliva, sweat, and sputum)
• em tolo ic ch n es ren l insu cienc
(Ford 106)
Contraindications & Caution
Rifampin is contraindicated in patients with a history of
hypersensitivity to the drug. The drug is used with caution
during pregnancy (category C) and lactation and in patients
with hepatic or renal impairment.
(Ford 106)
• Ask the patient what he or she thinks causes the symptoms;
promote health literacy by integrating the patient’s beliefs and
fears into how the bacteria invades the body and how the
drugs work to kill it.
• Discuss tuberculosis, its causes and communicability, and the
need for long-term therapy for disease control using simple,
non medical terms.
• Review the drug therapy regimen, including the prescribed
drugs, doses, and frequency of administration.
• Reassure the patient that various combinations of drugs are
e ecti e in tre tin tu erculosis
• Urge the patient to take the drugs exactly as prescribed and
not to omit, increase, or decrease the dosage unless directed
to do so by the health care provider.
• Instruct the patient about possible adverse reactions and the
need to notify the prescriber should any occur.
• Arrange for direct observation therapy with the patient and
family.
• Instruct the patient in measures to minimize gastrointestinal
upset.
• Advise the patient to avoid alcohol and the use of
nonprescription drugs, especially those containing aspirin,
unless use is approved by the health care provider.
• Reassure the patient and family that the results of therapy will
be monitored by periodic laboratory and diagnostic tests and
follow-up visits with the health care provider.
Interactions

Nursing alert • Antiretrovirals (efavirenz, nevirapine): Decreased serum

levels of antiretrovirals
• Leprosy , also referred to as Hansen’s disease, is caused by • Digoxin: Decreased serum levels digoxin
the bacterium Mycobacterium leprae. Leprosy is a chronic, • Oral contraceptives: ecre sed contr ce ti e e ecti eness
communicable disease that is not easily spread and has a • Isoniazid: Higher risk of hepatotoxicity
long incubation period. Since 1985, the prevalence of leprosy • Oral anticoagulants: Increased risk for bleeding
has dropped by 90%. About 100 new cases are diagnosed • Oral hypoglycemics: ecre sed e ecti eness of or l
yearly in the United States (primarily the southern states,
hypoglycemic agent
Hawaii, and U.S. possessions).
• Chloramphenicol: Increased risk for seizures
• eri her l ner es re ected c usin sensor loss nd
• Phenytoin: ecre sed e ecti eness of hen toin
muscle weakness. The traditional fear of leprosy relates to
s in in ol ement which m resent with lesions con ned • Verapamil: ecre sed e ects of er mil
to a few isolated areas or may be fairly widespread over the
entire body. Dapsone, clofazimine (Lamprene), rifampin
(Rifadin), and ethionamide (Trecator) are drugs currently used
to treat leprosy (Ford 106)

Generic Trade Use Dose

Active TB, Hansen’s disease 10 mg/kg (up to 600 mg/day)

Rifampin Rifadin, Rimactane
(Ford 109) orally, IV (Ford 109)
 TB Drugs:
Isoniazid

How do they work? “Action” Nursing management

Many antitubercular drugs are bacteriostatic against the M. • Ask the patient what he or she thinks causes the symptoms;
tuberculosis bacillus. These drugs usually act to inhibit bacterial promote health literacy by integrating the patient’s beliefs and
cell wall synthesis, which slows the multiplication rate of the fears into how the bacteria invades the body and how the
bacteria. Isoniazid is bactericidal, with rifampin and streptomycin drugs work to kill it.
having some bactericidal activity. • Discuss tuberculosis, its causes and communicability, and the
need for long-term therapy for disease control using simple,
non medical terms.
Indications • Review the drug therapy regimen, including the prescribed
drugs, doses, and frequency of administration.
• Treatment of TB in a protocol • Reassure the patient that various combinations of drugs are
e ecti e in tre tin tu erculosis
• Urge the patient to take the drugs exactly as prescribed and
not to omit, increase, or decrease the dosage unless directed
Adverse reactions
to do so by the health care provider.
• Peripheral neuropathy With • Instruct the patient about possible adverse reactions and the
toxicity need to notify the prescriber should any occur.
• Severe hepatitis • Arrange for direct observation therapy with the patient and
• Nausea and vomiting family.
• Epigastric distress • Instruct the patient in measures to minimize gastrointestinal
• Fever
upset.
• Skin eruptions
• Advise the patient to avoid alcohol and the use of
• Hematologic changes
• Jaundice nonprescription drugs, especially those containing aspirin,
• Hypersensitivity unless use is approved by the health care provider.
• Reassure the patient and family that the results of therapy will
be monitored by periodic laboratory and diagnostic tests and
follow-up visits with the health care provider.
Contraindications & Caution
Isoniazid is contraindicated in patients with a history of
hypersensitivity to the drug. The drug is used with caution
during pregnancy (category C) or lactation and in patients with
hepatic and renal impairment. Interactions
(Ford 105)
• Antacids containing aluminum salts:
Reduced absorption of isoniazid
Nursing alert • Anticoagulants: Increased risk for bleeding
• Phenytoin: Increased serum levels of phenytoin
• Isoniazid is taken with foods containing tyramine, such as aged • Alcohol (in beverages): Higher incidence of drug-related
cheese and meats, bananas, yeast products, and alcohol, an hepatitis
exaggerated sympathetic-type response can occur (i.e.,
hypertension, increased heart rate, and palpitations).
(Ford 105)
• Older adults are particularly susceptible to a potentially fatal
hepatitis when taking isoniazid, especially if they consume
alcohol on a regular basis.

Generic Trade Use Dose

Isoniazid Active TB: 5 mg/kg (up to 300
Primary NA Active TB; prophylaxis for TB mg/day) orally or 15 mg/kg 2–3
treatment times weekly
 TB Drugs:
Pyrazinamide

How do they work? “Action” Nursing management

Many antitubercular drugs are bacteriostatic against the • Ask the patient what he or she thinks causes the
M. tuberculosis bacillus. These drugs usually act to inhibit symptoms; promote health literacy by integrating the
bacterial cell wall synthesis, which slows the multiplication patient’s beliefs and fears into how the bacteria invades
rate of the bacteria. Isoniazid is bactericidal, with rifampin the body and how the drugs work to kill it.
and streptomycin having some bactericidal activity. • Discuss tuberculosis, its causes and communicability,
and the need for long-term therapy for disease control
using simple, non medical terms.
• Review the drug therapy regimen, including the
prescribed drugs, doses, and frequency of
Indications administration.
• Reassure the patient that various combinations of drugs
• Treatment of TB in a protocol re e ecti e in tre tin tu erculosis
• Urge the patient to take the drugs exactly as prescribed
and not to omit, increase, or decrease the dosage unless
directed to do so by the health care provider.
• Instruct the patient about possible adverse reactions
Adverse reactions and the need to notify the prescriber should any occur.
• Arrange for direct observation therapy with the patient
• Hepatotoxicity and family.
• Nausea • Instruct the patient in measures to minimize
• Vomiting gastrointestinal upset.
• Diarrhea • Advise the patient to avoid alcohol and the use of
• Myalgia nonprescription drugs, especially those containing
• Rash aspirin, unless use is approved by the health care
provider.
• Reassure the patient and family that the results of
therapy will be monitored by periodic laboratory and
diagnostic tests and follow-up visits with the health
Contraindications & Caution care provider
• Hypersensitivity
• Gout
• Severe hepatic damage
Interactions

• When pyrazinamide is administered with the anti gout

Nursing alert medications allopurinol (Zyloprim), colchicine, or
ro enecid its e ecti eness decre ses
• Pyrazinamide should be used cautiously in patients
during pregnancy (category C) and lactation and in
patients with hepatic and renal impairment, HIV
infection, and diabetes mellitus.
(Ford 106)

Generic Trade Use Dose

15–30 mg/kg/day orally,
Pyrazinamide
n/a Active TB maximum 3 g/day orally; 50–70
Primary treatment
mg/kg twice weekly orally
 Anti-Coagulants
Heparin vs. Warfarin

Indication: Memory Trick:

KEY WORD NCLEX

Heparin Warfarin
PREVENTING
PREVENTION H Therapeutic Range WAR Therapeutic Range
GROWTH
of NEW clots
of existing clots 46 – 70 PTT 2 – 3 INR
HEPARIN
Memory Trick: WARFARIN
Memory Trick:
“HePTT” the FROG “War-K-IN”
H – Heparin W – Warfarin
P Protamine ulfate ntidote K itamin ntidote
PTT – 46 – 70 Max range IN – INR 2 -3 range
S eci c ll with tients reco erin from
n he rt tt c or those t S for *FAST onset = Frogs are FAST *Slow onset = “Is it even WARkin?”

Key Point:
Don’t let
Deep Vein Thrombosis NCLEX
TRICK YOU
tPA

Heparin:

• e rin wor s QUICKLY or e rin wor s nti co s SS S

ell FAST within minutes nl throm ol tics do th t li e or lte l se

Key Words:

• e rin st rts in hurr ut is one in hurr oth medic tions i en

for se er l d s his i es rf rin
• t c n onl e in ected into the tient or S some time to c tch u
li e Enoxaparin the lower li hter wei ht he rin

LABS:
S the i est on
Enoxaparin
est uestions S ’S S
Warfarin: So ust thin if s
• rf rin h s we er S t ic ll t in t will leed out DIE
d s to re ch e ect So w rf rin t es then S will GROW
LONGER TIME to ic in ut it l st LONGER
c n e t en lon er
LABS

15
• So thin of the WAR in rf rin li e
WAR th t l sts LONG TIME!

Notes
Thrombolytics

o do t e or Act o rs a a e e t

hese dru s re down rin clots • M st ad ster t o rs ost

converting plasminogen to plasmin. t ro s or at o
l smin is n en me th t re s down the • Assess the patient for bleeding every 15
rin of lood clot his reo ens lood minutes durin the rst minutes of
vessels after their occlusion and prevents ther e er to minutes for the ne t
tissue necrosis. hours, and at least every 4 hours until therapy
is completed. Vital signs are monitored
continuously. If pain is present, the primary
health care provider may order an opioid
analgesic. Once the clot dissolves and blood
do e ve t easo flows freel throu h the o structed lood
vessel, severe pain usually decreases.
• cute stro e or l sis re in u of ord
blood clots in the coronary arteries • a est o s derat o s: Monitor activated
• Blood clots causing pulmonary emboli and rti l throm o l stin time nd
DVT hematocrit before and after and periodically.
• Suspected occlusions in central venous hen intermittent ther is used dr w
c theters ord le els min efore e ch dose durin
initial therapy and then periodically.
• r co t o s administration, monitor
aPTT levels every 4 hr during early therapy.

Adverse effects
• Bleeding

teract o s:
Contraindications • hen throm ol tic is dministered with
medications that prevent blood clots, such
• Active bleeding as aspirin, dipyridamole, or an anticoagulant,
• History of stroke the patient is at increased risk for bleeding.
• History of aneurysm
• Recent intracranial surgery

Generic Trade Use Dose

Act vase at o Act vase or Ac te M ac te sc e c stro e ota dose o

Alteplase
catheter occlusions only) E cat eter c eara ce ve as a to r so
 Factor XA
Inhibitors
Drug name:
MEMORY TRICK Rivaroxaban
Rivaroxaban
(brand name Xarelto)
RIVAROXABAN

Edoxaban RIVAROXABAN

Apixaban

Key Points: RIVER ROCK band! Blood flows like RIVER

ASPIRIN
NSAIDs

• AVOID ASPIRIN while taking this med

Bad News:

• AVOID any & all over the counter meds that • Risk for neurological impairment
increase bleeding! Especially NSAIDS!
Rock Band can cause brain bleeding,
think too much head banging
• The supplements - EGGO

- E - Vitamine E E
- G - Garlic
- G - Ginger Ginkgo
- O - Omega 3’s
OMEGA 3’S

Good News:

• There is a lower risk of bleeding compared HESI -Common Question

to warfarin
• NO need for routine clotting studies Rivaroxaban
• NO need to avoid Vit K food such as leafy · Teach client methods to
greens or liver. Eat up that liver & spinach reduce bleeding.

RIVAROXABAN

RIVAROXABAN

RISK OF BLEEDING

Notes
 Anti-Coagulants
LMW Heparin

Heparin SQ Indication: Administration:

· -parin Key term 1 2
· Enoxaparin (Lovenox)
In e
· Dalteparin Prevention of DVT ee e n
90 degree angle

Less heavy and less after surgery

chances of major bleeding
90º

Common I uestion HESI uestion

Enoxaparin “Client on ENOXAPARIN”

Report to HCP:
3 LOCATION
“Which statements needs
FURTHER TEACHING” NCLEX KEY WORD
1. H & H decreased
I will inject the med into my thigh 2. BP drops by 20 points 2 inches from Umbilicus NOT thigh NOT IV route
I will need Frequent Blood tests

n es

NCLEX Key Term:

Notify HCP and clarify order for enoxaparin if H/H Slightly low! 4 NO NO’S

Open fractures & H&H LOW - Enoxaparin is a NO GO!

Never aspirate SQ NEVER RUB site!
H
E um e s
Another risk is HIT - Heparin
Induced Thrombocytopenia!
Platelets should be
If Platelets decrease by HALF
150k – 400k
in 24 hours after starting Normal to have mild ‘’pain, bruising,
HOLD MED Plt heparin of any type,
less than 50,000 irritation, redness at site’’
this typically indicates HIT and
it’s VERY DEADLY!

Enoxaparin Labs:
H H H
Eno n s

HIT is when HALF platelets

GONE in ou s!
Heparin 30% o ee s
STUDENTS WRONG
NOT aPTT or INR
os ommon

? osen s o
HEPARIN

PRIORITY ACTION P – Parin P – Platelet

(Enoxaparin) FOCUSED
e e HC

HCP
Notes
Patient Teaching
Bleeding

Key Numbers:

Heparin Warfarin As irin Clo idogrel Enoxa arin

H e euti n e e euti n e
I S I I
CLOPIDOGREL

HE I
emo I
emo
“HePTT” the FROG “War-K-IN”
H – Heparin – Warfarin
– Protamine Sulfate (Antidote) – Vitamin K (Antidote)
– 46 – 70 Max range I – INR 2 -3 range latelets
“Less than = Risky”
*FAST onset = Frogs are FAST *Slow onset = “Is it even WARkin?”
Thrombocytopenia
HOLD All he arin HE I

,000
Nursing Care:

EE I EC I S
- Active Bleed
- “peptic ulcer” C E I AVOID Trauma: HESI E E S
NO small rugs or dim halls
= Well Light Halls
CH E S NO hard brushing
= soft bristle tooth brush
C - Cirrhosis E - Vitamin E NO flossing
H - Hepatitis - Ginseng NO alcohol based mouth wash
- Alcohol HESI E - Ginkgo Biloba NO razors = electric shaver
- NSAIDS IE - Garlic NO constipation = Fiber + Fluids C E I
T - Tylenol overdose - - Omega 3 NO contact sport
Liver damage S - St Johns Wort Medic Alert Braclet

SI S EE I
NOTIFY the HCP ASAP!! E S
Black Tarry Stools - GI bleed
Hematuria (blood tinged urine)
Epistaxis – nose bleed
Petechiae on chest
Easy Bruising

Notes
Anti-Coagulants
Fondaparinux

Drug name: Caution:

Fondaparinux DON’T GIVE IT:

(related to low weight heparins) To patient who report severe back
pain, decreased LOC or paralysis.
Major Advantage: Always call the HCP and HOLD the meD!
No risk for HIT
HIT HCP

Fondaparinux

HEPARIN

Major Disadvantage:

NCLEX KEY TERMS

Key Term:
NO Fondaprinux for
Fondaparinux can cause at least 6 hours e su e
NO Anti oa ulant
with spinal e u ee
an epidural bleed!

Fondaparinux

Notes
 Thrombolytics
tPA & Alteplase

Drug name:
C E e Con n tions
tPA
AVOID giving to:
“-Ase” A ti e bleeding
Alteplase KEY TERM: Pe ti
Reteplase n ontrolled 180/110 +
3. Recent surgery within 2 weeks
Streptokinase
C es tion o e
· A – Accidents “Re ent rauma NCLEX TIP
· A – Aneur m of emorr a i VA
· A AV malformation NCLEX TIP NCLEX TIP

Key Point:

• Clot Busters - our ATOMIC BOMB! KEY TERMS

The MOST powerful 1 time push drugs!
ou from
ONSET of m tom
• These are the ONLY ones that dissolve clots!

• Aspirin & Clopidogrel - NOT clot busters,

they are Anti-Platelets
KEY TERMS

• Heparin & Warfarin - NOT clot busters, aution ere i

HEPARIN WARFARIN they prevent new clots & existing clots the MASSIVE - BLEEDING
from getting bigger. IS

• The big caution here is the MASSIVE -

BLEEDING RISK! And it’s the MOST DEADLY!
KEY TERMS

e e dru an onl e i en
in a om re i le ite li e an
• NO injections at all! eri eral V
Yes i tin eri eral V
• NO NEW: NOT entral ine

NO IV’S NO SUB Q NO IMS NO ABG

Notes
Antiplatelets
Acetylsalicylic & Clopidogrel

Drug name: A C
A C ASPIRIN CLOPIDOGREL HESI KEY TERM:
ANTI CLOT
ASPIRIN CLOPIDOGREL
(Salicylic Acid) Use for post - PCI
- percutaneous coronary intervention

ASPIRIN IX
AV
PL

KEY Numbers
HGB < 7
MOA: Hgb < 7 = HEAVEN
Platelets: (normal 150 – 400K) 150,000 - 400,000
They prevent the platelets from - Less than 150,000 NOTIFY HCP !!!

aggregating together. Sort of - Less than 50K VERY RISKY!! !

Spreading platelets out from each other. * These meds SHOULD NOT
decrease plt levels

< 150,000 < 50,000

Memory Trick:

COMMON QUESTION
Don’t let

ANTI PLATELETS Platelet count of 75,000 … or 40,000

CLOPIDOGREL
NCLEX TRICK YOU

PRIORITY? PLT

1. HOLD the DRUG IRN & PT

T

IRN &
They LOWER platelet aggregation, so we have Question the prescription ASPIRIN

PTT
3. NOTIFY the Health Care provider
less chances of them sticking together.

A nti C logging
Aspirin Toxicity:

HESI & ATI Exit Exams

KEY SIGNS
of Aspirin toxicity
Indication: e men
Tinnitus
Activated harcoal
perventilation
Mainly for Clot prophylaxis KEY TERM:
oti the
nitial treatment o salic late
(Aspirin) toxicity
• Heart: MI / CVA prevention
• Narrowed arteries
- ACS (heart)
- TIA (brain)
- PAD (extremities) Activated
Charcoal

• Prevention of stent/bypass re-occlusion

ATI ue tion
ong term aspirin
“Assess or tinnitus”
ASPIRIN

ACS TIA PAD

Notes
Anti-Coagulants
Heparin

Key Numbers for NCLEX ATI ue tion

Patient on e arin it
PTT: 46 - 70
PTT
46 - 70

Bleeding at IV SITE!!
PROTAMINE
SULFATE

nti o e Priorit a tion

Protamine Sulfate
oo o n
su n s on
Be careful, NCLEX, will yty & trick you!
NOT INR & NOT PTT OVER 70!

INR
<70
o tion

H -HaPTT
1 STOP the Heparin oti HC HEPARIN

Memory Trick:

“HePTT” the FROG

H – Heparin
2 Pre are Antidote Protamine Sulfate PROTAMINE
SULFATE

3
P - Protamine Sulfate ntidote HEPARIN
Reassess labs (1 hour)
PTT - 46 – 70 Max range

HESI ue tion He n
aPTT 85 or 100!
NCLEX MEMORY TRICK!

HePTT
HEPARIN

o tion

1 STOP the Heparin

– otif P 2 Pre are Antidote
o m ne Su e 3 Reassess labs (1 hour)

Heparin goes FAST!!

PROTAMINE
SULFATE
HEPARIN

Notes
Antiplatelets
Abciximab

Drug name: Nursing care:

KEY TERM:
1. Assess
Glycoprotein (GP)
receptor inhibitors HEMOGLOBIN PLATELETS PLATELETS
<7 <150,000 <50,000
Abciximab
E ti ti e
o n
!
Indication:
2. Assess for bleeding
Mainly used after cardiac procedures
like heart cath - Coronary Stent Placement REPORT TO HCP!
to prevent reocclusion
ed tinged urine “hematuria”
ar tarr tool
la or blood tool
o itor roi i sertio site
for s/s bleeding

Adverse Effects:

3. Place client on
Adverse ects cardiac monitor
Thrombocytopenia
Bleeding EC n es

4. NO needles!
(no ne or )

Notes
Anti-Coagulants
Warfarin

5.0

Key Numbers for NCLEX 4.5 Vitamin K Foods

i er
4.0
INR 3.5
era euti an e 3.0 reen leaf e eta le
– ( eart al e re la ement )
2.5 ( ro oli S ina )
nti o e Vitamin K 2.0
“K = Kill arfarin 1.5
e tien ea in
NCLEX KEY TERMS:
1.0 - on i tent oderation
Vitamin K Kee K – on i tent
- NOT! i en if warfarin it in - Key words:
e euti n e
· NOT in rea ed
- NOT! until AT LEAST 5 days of *2.5-3.5 for heart valve · NOT de rea ed
warfarin en it in from V e
replacements · NOT a oid A

NCLEX MEMORY TRICK!

NICE to KNOW!!
W– arfarin
WARFARIN
W– arKIN ntibioti INCREASE ri or ee n

INCREASING INR
W K IN
Since the ABX KILL the intestinal bacteria
arfarin Vitamin K nti o e ( ran e) that produce vitamin K...We have vitamin
5.0

4.5
K deficiency & INCREASED risk for bleeding
4.0

3.5

3.0
WARFARIN 2.5

2.0
VITAMIN K

1.5
1.0

ATI ue tion Common Question on E I E S

PATIENT TEACHING
INR of 4 or 5 !!! Key Term:
· Assess for leedin
· et Vitamin K antidote
A
1. ife on era
ill in rea e m 2. e ani al Val e
inta e o dar green INR of 2.0 in an e la ement
lea egetable ischemic CVA client 3. re uent lood e t
· GIVE t e arfarin to et to

Notes
Blood Thinners

Generally comes in 3 sizes:

Small, Medium, LARGE
Small Medium Large

By comparison think of:

Antiplatelets like Aspirin & Clopidogrel

like a water gun - those are small ones

Anticoagulants - Heparin & Warfarin,

like bazooka - those are the medium

Thrombolytic Clot busters - TPA & Alteplase

like an ATOMIC BOMB.
Those are large ones and MOST deadly,
since THEY HAVE the HIGHEST BLEED RISK!

!
Notes
Dabigatran
& Argatroban

Indication:

Used to prevent clot in high risk A Fib patients

KEY POINTS
DO NOT STOP THE MED FOR GI ISSUES

STOP med if black tarry STOOLS

NOT Stores IN PILL BOX ... in original
container!!!
NOT crushed, taken whole
Memory Trick = Take DA BIG pill whole!
• HOLD clopidogrel
• HOLD before surgery

ATI QUESTION HESI QUESTION

Meds to Hold before Pt on Dabigatran Do

Surgery Dabigatran not take with clopidogrel

CLOPIDOGREL

Notes
Diuretics
- Thiazides

t r s Act rs e e t

• Diuretics work by altering the reabsorption or • Monitor BP and pulse frequently .

e cretion of electrolytes and alter fluid volume.
de ret cs: Inhibit reabsorption in the
ascending portion of the loop of henle and early
distal tubule. Excrete sodium, chloride, and H2O
d e ve t e s
• Hypertension
• Used with antihypertensives
• To reduce edema
• Glaucoma
• Seizures
• Renal disease.
Adverse effects
Neuro: Dizziness, headache, encephalopathy,
lightheadedness,weakness, fatigue
EENT: Hearing loss, tinnitus
CV: Orthostatic hypotension
GU: Electrolyte imbalances, glycosuria
GI: Anorexia, nausea, vomiting
Derm: Rash, photosensitivity
Endo: Hyperglycemia, hyperuricemia.
F & E: Dehydration, hypocalcemia,
hypochloremia, hypokalemia, hypomagnesemia,
hyponatremia, hypokalemia, metabolic alkalosis
MS: Arthralgia, muscle cramps, myalgia.
• Monitor intake and output ratios and daily weight.
• Do not stop the drugs abruptly unless you speak
with the DR.
• If GI upset occurs then take the med with food
or milk.
• Take early in the morning.
• o not reduce fluid intake.
• Avoid alcohol and non prescription drugs.
• Notify the healthcare provider if: muscle cramps,
weakness, dizziness, diarrhea, restlessness,
excessive thirst, general weakness, rapid pulse,
increased heart rate or pulse, gi distress.
• Weight yourself daily.
• These drugs may cause hypokalemia, monitor
serum potassium levels.
• May cause in serum and urine glucose in diabetic
patients. May cause anqin serum bilirubin, calcium,
creatinine, and uric acid.
ter ct s:
•A r : increased risk of hypersensitivity to
allopurinol
• A est et cs: increased anesthetic e ects
•A t e st c dr s: extended leukopenia
• A t d et c dr s: hyperglycemia

tr dc t s e rs r ts

• Hypersensitivity • de d : liver disease, lupus, diabetes,

• Electrolyte imbalances a cross sensitivity may occurs with thiazides and
• Severe kidney or liver dysfunction sulfonamides
• Anuria. • Yellow dye may cause allergic reactions or
• t : active intracranial bleeding except bronchial asthma with thiazides.
during craniotomy

e er c Trade Safe Dose te

12.5– 100 mg/day in 1–
dr c r t de cr de PO
2 doses

et e r 2.5– 5 mg/day PO
 PNS Drugs
- Adrenergics
How do they work? “Action”
The purpose of stimulating the sympathetic (adrenergic) nerves is to
divert blood flow to the vital organs so that the body can deal with a
stressful situation the ght-or-flight response . In general adrenergic
drugs produce one or more of the following responses in varying
degrees:
• Central nervous system—wakefulness, quick reaction to stimuli,
uickened refle es
• utonomic nervous system rela ation of the smooth muscles of the
bronchi, constriction of blood vessels, sphincters of the stomach,
dilation of coronary blood vessels, decrease in gastric motility
• Heart—increase in the heart rate
• Metabolism—increased use of glucose (sugar) and liberation of
fatty acids from adipose tissue
Indications
• Hypovolemic and septic shock
• Moderate to severe episodes of hypotension
• Control of super cial bleeding during surgical and dental
procedures of the mouth, nose, throat, and skin
• Cardiac decompensation and arrest
• Allergic reactions (anaphylactic shock, angioneurotic edema)
• Temporary treatment of heart block
• Ventricular arrhythmias (under certain conditions)
• Respiratory distress (as bronchodilators)
• Nasal congestion and glaucoma (topical formulation)
Adverse Reactions
• Cardiac arrhythmias (bradycardia and tachycardia)
• Headache
• Nausea and vomiting
• Increased blood pressure which may reach dangerously high levels
Contraindications
Known hypersensitivity
Isoproterenol: Tachyarrhythmias. Tachycardia, heart block caused by
digitalis to icity ventricular arrhythmias and angina pectoris.
Dopamine is contraindicated in those with pheochromocytoma (adrenal
gland tumor unmanaged arrhythmias and ventricular brillation.
Epinephrine is contraindicated in patients with narrow-angle glaucoma
and as a local anesthetic ad unct in ngers and toes.
Norepinephrine is contraindicated in patients who are hypotensive
from blood volume de cits.
Midodrine causes severe hypertension in the patient who is lying down
(supine).
Nursing in Practice
Regardless of the actual numeric reading of the blood pressure, a
progressive decrease in blood pressure is serious. Report any progres-
sive decrease in blood pressure, a decrease in systolic blood pressure
below 100 mm Hg, or any decrease of 20 mm Hg or more of the patient’s
normal blood pressure.
Generic Trade Use
Cardiac decompensation due to depressed
Dobutamine N/A contractility caused by organic heart
disease or cardiac surgical procedures
Shock due to myocardial infarction, trauma, open
Dopamine N/A heart surgery, renal failure, and chronic cardiac
decompensation in congestive heart failure
Nursing management
• Use an electronic infusion pump to administer these drugs.
• o not mi dopamine with other drugs especially sodium bicarbonate
or other alkaline intravenous IV solutions. Check with the clinical
pharmacist before adding a second drug to an IV solution containing
this drug.
• o not dilute norepinephrine or dopamine IV solutions before adminis
tration. The primary health care provider orders the IV solution the
amount of drug added to the solution, and the initial rate of infusion.
• Blood pressure is monitored continuously from the beginning of
therapy until the desired blood pressure is achieved, and until the
patient is transferred to a less supervised unit.
• Adjust the rate of drug administration according to the patient’s blood
pressure. The rate of administration of the IV solution is increased or
decreased to maintain the patient’s blood pressure at the systolic
pressure ordered by the primary health care provider.
• Read ustment of the rate of flow of the IV solution is often necessary.
The frequency of adjustment depends on the patient’s response to the
vasopressor.
• Inspect the needle site and surrounding tissues at fre uent intervals for
leakage e travasation in ltration of the solution into the subcutane
ous tissues surrounding the needle site. If leakage occurs establish
another IV line immediately then discontinue the IV containing the
vasopressor, and notify the primary health care provider. These drugs
are particularly damaging when they leak into surrounding tissues. You
should know the e travasation protocol and have orders signed by the
primary health provider to implement the protocol whenever these
drugs are used.
• Never leave the patient receiving these drugs unattended. (Ford 249)
Herbal Consideration
Ephedra (Ma Huang) and the many substances of the Ephedra genus
have been used medicinally (e.g., E. sinica and E. intermedia). Ephedra
(ephedrine) preparations have traditionally been used to relieve cold
symptoms and improve respiratory function, and as an adjunct in weight
loss. Large doses may cause a variety of adverse reactions, such as
hypertension and irregular heart rate. The use of ephedra has shifted
from relief of respiratory problems to an aid to weight loss and enhanced
athletic performance. Before taking this herb, the patient should consult
a primary health care provider. Ephedra should not be used with the
cardiac glycosides halothane guanethidine monoamine o idase
inhibitor OI antidepressants or o ytocin or by patients taking
St. John’s wort. The U.S. Food and Drug Administration (FDA) warns the
public not to take ephedrine-containing dietary supplements. Stroke and
heart attack have resulted from taking these products. Many producers
of weight loss supplements are removing the ephedra component
because of potential legal liability (DerMarderosian, 2003). (Ford 247)
Shock
Monitoring the patient in shock requires your vigilance. The patient’s
heart rate, blood pressure, and electrocardiogram are monitored
continuously. Urine output is measured often (usually hourly), and
accurate intake and output measurements are taken. (Ford 249)
Interactions
• Antidepressants: Increased sympathomimetic e ect
• Oxytocin: Increased risk of hypertension
Dose
. mcg kg min IV up to
mcg/kg/min); titrate to patient’s
hemodynamic and renal status
mcg kg min IV infusion rate
determined by patient’s response)
Emergency Drugs
- Adrenergic Vasopressors

How it works? “Action” Nursing management

To divert blood to the important organs • Monitor BP, heart rate, ECG, cardiac output,
stimulates the sympathetic nervous system via CVP, and urinary output continuously.
vasoconstriction. This will also increase BP and • Report signi cant changes in vital signs or
perfusion. arrhythmias.
• Palpate peripheral pulses and assess
appearance of extremities routinely.
Why do we give it? ‘’Reason’’ • Notify physician if quality of pulse deteriorates
or if extremities become cold or mottled.
• Hypovolemic shock • Lab Test Considerations: Monitor potassium
• Severe hypotension concentrations during therapy; may cause
• uper cial bleeding hypokalemia.
• Cardiac decomp/ arrest • Monitor electrolytes, BUN, creatinine, and
• Allergic reactions prothrombin time weekly during prolonged
• Ventricular arrhythmia therapy.
• Respiratory distress
• Glaucoma
• Adjunct to local anesthetic
• Bronchodilators
Interactions:
Adverse effects • Antidepressants: increase adrenergic e ects.
CV: increase blood pressure to dangerously • Oxytocin: increases the risk for hypertension.
high levels.
Derm: dopamine can cause necrosis of the
vein.
Simple Nursing Brain bits
Contraindications
• These are the drugs you will mostly see in
Dopamine: pheochromocytoma v b a CODE situation.
arrhythmia. • hen giving epi do not administer in ngers
Epinephrine: narrow angle glaucoma, and toes it can cause severe vasoconstriction
anesthetic for ngers and toes no no and cause the area to become ischemic.
Norepinephrine: hypotension from blood loss,
Midodrine: causes severe hypertension when
the patient is lying down.

Generic Trade Safe Dose Route

Dopamine Intropin 1– 5 mcg/kg/min. IV titration

Epinephrine Adrenalin 0.1– 0.5 mg (single dose) IM, sub Q ,IV push

0.5– 1 mcg/min initially.

Norepinephrine Levophed IV
maintenance of 2– 12 mcg/min

Midodrine ProAmatine 10 mg three times daily PO

 Atropine
Symptomatic Bradycardia

Drug name: Memory tricks Side Note

AtroPINE ATROPINE

m tomati brad ardia

ATROPINE

If drugs do not work to the problem then we

Indication: have to put the patient on e ternal pacing
Given to speed up a slow heart rate with

Key word 1 2
Correct sequence:
1. Atropine
m tomati ATROPINE
2. External pacing

bradycardia

MOA:
tropine acts to increase the heart rate by blocking the
action of the vagus nerve to block the N parasympathetic
igns mptomatic brad cardia nervous system RE T & IGE T and turns ON the N
?
? ght & flight in the heart like flicking a light switch.
Mental Status changes
?
? ?
?
1. Confusion
2. Irrritability
3. A itation
SNS
ATROPINE

PNS
ara m at eti ner ou tem

Key points
tropine is e ective when we see normal inus
rhythm and reversal of the sympoms. They will Common ue tion
show you normal sinus rhythm like this & no Atropine for a client with a heart rate of 38,
more hypo ic symptoms like confusion agitation bp of 88/65, reports confusion and dizziness.
i tri ould o medi ation
hypotension or synocope. e e ti ene

1. 60-100
Normal Sinus rhythm R peak x 10
and reversal of the symptoms 2.
8 x 10 = 80

3.

ATROPINE

4. CORRECT
 Diuretics
- Potassium Sparing

t r s Act rs e e t

• Diuretics work by altering the reabsorption or • Monitor BP and pulse frequently

e cretion of electrolytes and alter fluid volume. • Monitor intake and output ratios and daily weight.
• Do not stop the drugs abruptly unless you speak
t ss r ret cs: reduce the excretion
with the HCP.
of potassium, block the reabsorption of sodium
into the kidney. And thereby increasing sodium • If GI upset occurs then take the med with food or
and h20 in the urine and reduces excretion of K+ milk.
• Take early in the morning
• o not reduce fluid intake
• Avoid alcohol and non prescription drugs.
d e ve t e s
• Notify the healthcare provider if: muscle cramps,
• Hypertension weakness, dizziness, diarrhea, restlessness,
• Used with antihypertensives excessive thirst, general weakness, rapid pulse,
• To reduce edema increased heart rate or pulse, GI distress.
• Glaucoma • Weight yourself daily.
• Seizures • These drugs may cause hyperkalemia, monitor
serum potassium levels.

Adverse effects

Neuro: Dizziness, headache, encephalopathy,

lightheadedness,weakness, fatigue
EENT: Hearing loss, tinnitus
CV: Orthostatic hypotension ter ct s:
GU: Electrolyte imbalances, glycosuria •A te s c vert e e t ss
GI: Anorexia, nausea, vomiting s e e t:
Derm: Rash, photosensitivity Increased risk of hyperkalemia
• s ds tc ts: decreased diuretic e ect
Endo: Hyperglycemia, hyperuricemia.
F & E: Dehydration, hypocalcemia,
hypochloremia, hyperkalemia,
hypomagnesemia, hyponatremia, hypokalemia,
metabolic alkalosis
MS: Arthralgia, muscle cramps, myalgia. e rs r ts

Av d ds t ss :
tr dc t s Avocado, Acorn squash, Spinach, Sweet potato,
• Hypersensitivity Wild-caught salmon, Dried apricots, Pomegranate,
• Electrolyte imbalances, hyperkalemia Coconut water, White beans, Banana
• Severe kidney or liver dysfunction
• Anuria.
• t : active intracranial bleeding
except during craniotomy

e er c Trade Safe Dose te

d
r ct e A d ct e PO
s s e d se
 Diuretics
- Osmotic

t r s Act rs e e t

• Diuretics work by altering the reabsorption or • Monitor BP and pulse frequently

e cretion of electrolytes and alter fluid volume. • Monitor intake and output ratios and daily weight
s tc ret cs: increase the density of the • Assess patient for anorexia, muscle weakness,
ltrate in the glomerulus preventing selective numbness, tingling, paresthesia, confusion, and
reabsorption of h20 and it passes as urine. excessive thirst. Report signs of electrolyte
imbalance.
• Avoid alcohol
• Hypokalemia, monitor serum potassium levels and
d e ve t e s electrolyte levels

Adjunct in the treatment of:

• Acute oliguric renal failure
• Edema
• Increased intracranial or intraocular pressure
• Toxic overdose.
• GU irrigant During transurethral procedures
(2.5– 5% solution only).
ter ct s:

• : Hypokalemia increases the risk of

dig toxicity
Adverse effects

CNS: Confusion, headache.

EENT: Blurred vision, rhinitis.
CV: Transient volume expansion, chest pain, HF,
pulmonary edema, tachycardia.
GI: Nausea, thirst, vomiting.
GU: Renal failure, urinary retention. e rs r ts
F and E: Dehydration, hyperkalemia, hypernatremia,
hypokalemia, hyponatremia. ymptoms of fluid and electrolyte imbalance include
dry mouth, thirst, weakness, lethargy, drowsiness,
Local: Phlebitis at IV site.
restlessness confusion, muscle pain or cramps,
confusion, gastrointestinal disturbances,
hypotension, oliguria, tachycardia, and seizures.

tr dc t s

• t : active intracranial bleeding

except during craniotomy
• Hypersensitivity
• Anuria
• Dehydration
• Severe pulmonary edema or congestion.

e er c Trade e se te
s
t s tr IV
s t
 PNS Drugs
- Peripherally Acting Antiadrenergics
d t e r Act
Inhibits the release of norepinephrine from certain
adrenergic nerve endings in the peripheral nervous
system. ord
Indications
• Hypertension
• BPH
Adverse Reactions
• Dry mouth, drowsiness, sedation, anorexia, rash,
malaise, and weakness are generalized reactions to
antiadrenergic drugs that work on the CNS.
• Hypotension, weakness, lightheadedness, and
bradycardia are adverse reactions associated with the
administration of peripherally acting antiadrenergic
drugs. (Ford 257)
Contraindications
The peripherally acting antiadrenergic drugs are
contraindicated in patients with a hypersensitivity to any
of the drugs. Reserpine (Serpasil) is contraindicated in
patients who have an active peptic ulcer or ulcerative
colitis and in patients who are mentally depressed.
Interactions
• Adrenergic drugs: Increased risk of hypertension
• Levodopa: ecreased e ect of the levodopa
hypotension
• Anesthetic agents: Increased e ect of the anesthetic
• c ers: Increased risk of hypertension
• Lithium: Increased risk of lithium toxicity
• er d : Increased risk of psychotic behavior
Generic Trade
Doxazosin Cardura Hypertension, BPH
Prazosin Minipress
Education
Instruct patients to rise slowly from a sitting or lying
position. Provide assistance for the patient getting out of
bed or a chair if symptoms of postural hypotension are
severe. Place the call light nearby and instruct patients to
ask for assistance each time they get in and out of bed or
a chair. Assist the patient in bed to a sitting position and
have the patient sit on the edge of the bed for about 1
minute before ambulating. Help seated patients to a
standing position and instruct them to stand in one place
for about 1 minute before ambulating. Remain with the
patient while he or she is standing in one place, as well as
during ambulation. Instruct the patient to avoid standing
in one place for prolonged periods. This is rarely a prob-
lem in the hospital but should be included in the patient
and family discharge teaching plan. Teach the patient to
avoid taking hot showers or baths, which tend to increase
vasodilation. (Ford 259)
Nursing management
• Do not stop taking the drug abruptly, except on the
advice of the primary health care provider. Most of these
drugs require that the dosage be gradually decreased to
prevent precipitation or worsening of adverse e ects.
• Notify the primary health care provider promptly if
adverse drug reactions occur.
• Observe caution while driving or performing other
ha ardous tasks because these drugs -adrenergic
blockers) may cause drowsiness, dizziness, or
lightheadedness.
• Immediately report any signs of weight gain di culty
breathing, or edema of the extremities).
• o not use any nonprescription drug e.g. cold or flu
preparations or nasal decongestants) unless you have
discussed use of a speci c drug with the primary health
care provider.
• Inform dentists and other primary health care providers
of therapy with this drug.
• Keep all primary health care provider appointments
because close monitoring of therapy is essential.
• Check with a primary health care provider or clinical
pharmacist to determine if the drug is to be taken with
food or on an empty stomach. ord -
Use Dose
Hypertension: 1–8 mg orally daily
B mg orally daily
mg orally daily in divided
Hypertension
doses
Antihypertensives
Beta Blockers

t r s Act rs e e t
Block beta receptors in the heart to decrease cardiac • Monitor BP, heart rate, ECG, cardiac output, CVP,
workload to decrease HR and dilate blood vessels, and urinary output continuously
provides membrane stabili ing e ects. Timolol • Abrupt withdrawal of propranolol may precipitate
treats glaucoma. life-threatening arrhythmias, hypertension, or
myocardial ischemia
• Take R and B immediately prior to administering
d e ve t e s medication and 30 minutes after. Observe
provider’s parameters to hold drug if BP and/or
• Hypertension HR are low.
• Cardiac arrhythmia • Advise patient to notify health care professional if
• Heart failure slow pulse di culty breathing whee ing cold
• Angina hands and feet, dizziness, lightheadedness,
• Glaucoma confusion, depression, rash, fever, sore throat,
• Prevention of MI unusual bleeding, or bruising occur. If diabetic
monitor for hypoglycemia. Teach not to stop taking
abruptly.
Adverse effects

CV: Orthostatic hypotension, bradycardia, ter ct s:

PULMONARY EDEMA, • A t de ress ts: bradycardia and increase beta
ENDO: May cause ^ BUN, serum lipoprotein, blocker e ects
potassium, triglyceride, and uric acid levels. • NSAID: decrease beta blocker e ects
May cause ^ blood glucose levels. In labile • ret cs: increase beta blocker
e ects hypotension
diabetic patients, hypoglycemia may be • d e: parado ical hypertensive e ects
accompanied by precipitous ^ of BP. • et d e: beta blocker toxicity
RESP: bronchospasm (hx of asthma) • d c e: beta blocker toxicity

e rs r ts
tr dc t s
• Never give a beta blocker to a client with a history of
• Sinus bradycardia asthma because it can cause bronchospasm.
• Heart block • Beta Blockers end in -OLOL
• Heart Failure 4 B'S
• Asthma • Bradycardia
• Emphysema • Blood pressure decrease
• Hypotension • Bronchial constriction (relief)
• Blood sugar masking

e er c r de e se te
der der A d d v ded
r r E
r doses

et r :
ress r d s s e d se E
ress r

t
et ce et ce
ve t ce d PO
AF
e t st c
e dr e e dr s t
v e c ffected e e s t ce d t c
t c
r te rs rt
 Diuretics
- Loop Diuretics

How it works? “Action” Nursing management

• Diuretics work by altering the reabsorption or • Monitor BP and pulse frequently
e cretion of electrolytes and alter fluid volume. • Monitor intake and output ratios and daily weight.
Loop diuretics: inhibit the reabsorption of sodium • Do not stop the drugs abruptly unless you speak
chloride in the proximal and distal convoluted with the HCP.
tubules and the loop of henle. This site increase • If GI upset occurs then take the med with food
their e ectiveness .
or milk.
• Take early in the morning.
Why do we give it? ‘’Reason’’ • o not reduce fluid intake.
• Avoid alcohol and non prescription drugs.
• Hypertension • Notify the healthcare provider if: muscle cramps,
• Used with antihypertensives
• To reduce edema weakness, dizziness, diarrhea, restlessness,
• Glaucoma excessive thirst, general weakness, rapid pulse,
• Seizures increased heart rate or pulse, gi distress.
• Renal disease. • Weight yourself daily.
• These drugs may cause hypokalemia, monitor
Adverse effects serum potassium levels

Neuro: Dizziness, headache, encephalopathy,

lightheadedness,weakness, fatigue
EENT: Hearing loss, tinnitus
CV: Orthostatic hypotension
GU: Electrolyte imbalances, glycosuria
GI: Anorexia, nausea, vomiting
Derm: Rash, photosensitivity
Endo: Hyperglycemia, hyperuricemia.
F & E: Dehydration, hypocalcemia,
hypochloremia, hypokalemia, hypomagnesemia,
hyponatremia, hypokalemia, metabolic alkalosis
MS: Arthralgia, muscle cramps, myalgia.
Interactions:
• Cisplatin/aminoglycosides: increased risk
of ototoxicity
• Anticoagulant/thrombotic: increased risk of
bleeding
• Digitalis: increase risk of arrhythmia
• Lithium: increased risk of lithium toxicity
• ydantoins decreased diuretic e ect
• Nsaid decreased iuretics e ect

Contraindications
Simple Nursing Brain bits
• Hypersensitivity
• Electrolyte imbalances
• Severe kidney or liver dysfunction • Taking this medication early in the day can
• Anuria. prevent injury r/t getting out of bed at night
• Mannitol: active intracranial bleeding except for the client.
during craniotomy

Generic Trade Safe Dose Route

0.5– 2 mg/day given in
Bumetanide Bumex PO
1– 2 doses

20– 80 mg/day as a
Furosemide: Lasix PO, IM, IV
single dose

Torsemide Demadex 2.5– 5 mg once daily PO

 Nitrates
How it works? “Action”
The nitrates act by rela ing the smooth muscle layerof
blood vessels increasing the lumen of the artery or
arteriole and increasing the amount of blood flowing
through the vessels. ord 3
Why do we give it? ‘’Reason’’
• Relieve pain of acute anginal attacks
• revent angina attacks prophyla is
• Treat chronic stable angina pectoris ord 3
Adverse effects
• Central nervous system (CNS) reactions, such as
headache (may be severe and persistent), dizziness,
weakness, and restlessness
• Other body system reactions, such as hypotension,
flushing caused by dilation of small capillaries near the
surface of the skin and rash ord 3
Contraindications
• ypersensitivity to the drugs severe anemia
closed-angle glaucoma postural hypertension early
myocardial infarction sublingual form head trauma
cerebral hemorrhage may increase intracranial
hemorrhage allergy to adhesive transdermal system
or constrictive pericarditis. atients taking
phosphodiesterase inhibitors drugs for erectile
dysfunction should not use nitrates. ord 3
Generic Trade
Isordil, Dilatate SR, Treatment and
Isosorbide
Monoket prevention of angina
Nursing management
• The dose of sublingual nitroglycerin may be repeated every
minutes until pain is relieved or until the patient has received
three doses in a -minute period. One to two sprays of
translingual nitroglycerin may be used to relieve angina but
no more than three metered doses are recommended within
a -minute period.
• o not rub the nitroglycerin ointment into the patient’s skin
because this will immediately deliver a large amount of the
drug through the skin. E ercise care in applying topical
nitroglycerin and do not allow the ointment to come in
contact with your ngers or hands while measuring or
applying the ointment because the drug will be absorbed
through your skin causing a severe headache.
• The primary health care provider is noti ed if any of the
following occur
• eart rate of bpm or more above the normal rate
• Rapid weight gain of lb or more
• nusual swelling of the e tremities face or abdomen
• yspnea angina severe indigestion or fainting
• void the use of alcohol unless use has been permitted by the
primary health care provider.
• Notify your emergency response providers if the drug does not
relieve pain or if pain becomes more intense despite use of
this drug.
• ollow the recommendations of the primary health care
provider regarding fre uency of use.
• Keep an ade uate supply of the drug on hand for events such
as vacations, bad weather conditions, and holidays.
• Keep a record of the fre uency of acute anginal attacks date
time of the attack drug and dose used to relieve the acute
pain and bring this record to each primary health care
provider or clinic visit.
Interactions:
• Aspirin: Increased nitrate plasma concentrations and
action may occur
• Calcium channel blockers: Increased symptomatic
orthostatic hypotension
• Dihydroergotamine: Increased risk of hypertension and
decreased antianginal e ect
• Heparin: ecreased e ect of heparin
• Phosphodiesterase inhibitors: Severe hypotension and
cardiovascular collapse may occur
• Alcohol: Severe hypotension and cardiovascular collapse
may occur
Use Route
Initial dose 5–20 mg orally;
maintenance dose 10–40 mg BID,
TID orally
Sublingually: 2.5–5 mg
Prevention: 5–10 mg sublingually,
5 mg chewable
 CNS Drugs
Central Acting Antiadrenergics
d t e r Act
Acts on the central nervous system (CNS) rather than
on the peripheral nervous system. This group a ects
speci c CN centers thereby decreasing some of the
activity of the sympathetic nervous system.
ord
Indications
• Hypertension
• BPH
Adverse Reactions
• Dry mouth, drowsiness, sedation, anorexia, rash,
malaise, and weakness are generalized reactions to
antiadrenergic drugs that work on the CNS.
• Hypotension, weakness, lightheadedness, and
bradycardia are adverse reactions associated with
the administration of peripherally acting
antiadrenergic drugs. (Ford257)
Contraindications
Centrally acting antiadrenergic drugs are
contraindicated in active hepatic disease, in
antidepressant therapy using MAOIs, and in patients
with a history of hypersensitivity to these drugs.
(Ford 257)
Interactions
• Adrenergic drugs: Increased risk of hypertension
• Levodopa: ecreased e ect of the levodopa
hypotension
• Anesthetic agents: Increased e ect of the
anesthetic
• c ers: Increased risk of hypertension
• Lithium: Increased risk of lithium toxicity
• er d : Increased risk of psychotic behavior
Generic Trade
Hypertension, severe pain
Catapres Catapres-TT
d e in patients with cancer
(transdermal
Hypertension,
et d N
hypertensive crisis
rs A ert
If a signi cant decrease in blood pressure a drop of
mm g systolic or a systolic pressure below
mm Hg) occurs after a dose of an adrenergic
blocking drug, withhold the next drug dose and
notify the primary health care provider immediately.
A dosage reduction or discontinuation of the drug
may be necessary. Some adrenergic blocking drugs
e.g. pra osin or tera osin may cause a rst-dose
e ect. rst-dose e ect occurs when the patient
experiences marked hypotension (or postural
hypotension) and syncope with sudden loss of
consciousness with the rst few doses of the drug.
(Ford 259)
Nursing management
• Do not stop taking the drug abruptly, except on the
advice of the primary health care provider. Most of
these drugs require that the dosage be gradually
decreased to prevent precipitation or worsening of
adverse e ects.
• Notify the primary health care provider promptly if
adverse drug reactions occur.
• Observe caution while driving or performing other
ha ardous tasks because these drugs -adrenergic
blockers) may cause drowsiness, dizziness, or
lightheadedness.
• Immediately report any signs of HF (weight gain,
di culty breathing or edema of the e tremities .
• Do not use any nonprescription drug (e.g., cold or
flu preparations or nasal decongestants unless you
have discussed use of a speci c drug with the
primary health care provider.
• Inform dentists and other primary health care
providers of therapy with this drug.
• Keep all primary health care provider appointments
because close monitoring of therapy is essential.
• Check with a primary health care provider or
clinical pharmacist to determine if the drug is
to be taken with food or on an empty stomach.
ord -
Use Dose
mcg day orally
Transdermal release rate . .3
mg hr
mg orally BI or TI
maintenance dose g day
mg hr IV
Heart Failure

Patho Nursing Care

HF–HEART FAILURE (failure to PUMP forward) DR. BEDS
HF–HEAVY FLUID (lungs & body) D–Diet: Low SCC (Sodium, Calories, Cholesterol)
Low Sodium & Fluid (2L + 2g or LESS/day)
Memory Trick: NO OTC meds (Cough or Flu, Antacids
or NSAIDS NCLEX TIP
S–Sodium Swells NO Canned or packaged foods (chips, sauces, meats, cheeses,
W–Weight Gain = Water Gain Crisis! wine)
R–Risk for Falls! (Change positions slowly!)
B–Blood Pressure & BNP (shoud NOT be increasing)
Signs & Symptoms E–Elevate HOB & Legs (with pillows) high fowlers
R–RIGHT sided HF L–LEFT sided HF D–Daily Weights and Is and Os (0ver 3 lbs/day or
R–ROCKS the BODY with fluid L–LUNG fluid 5 lbs in 7 days) = Worsening! NCLEX TIP
Peripheral Edema “Pulmonary Edema” S–Stairs No se until able to climb flights of stairs
Weight Gain = Water Gain Crackles “rales” that don't clear without dyspnea)
Edema (pitting) with cough (NOT rhonchii or wheeze) S–Stocking (TED hose) (decreases blood pooling, remove daily)
JVD (big neck veins) Frothy Pink “blood tinged” sputum
Abdominal Growth orthopnea dyspnea while lying flat NEVER massage calves (CHF patients) NCLEX TIP

Ascites
Hepatomegaly (big liver) Pharmacology
Splenomegaly (big spleen)
A–ACTS on BP only (not HR)
Causes A–ACE (-pril) Lisinopril “chill pril” 1st choice
R–RIGHT sided HF L–LEFT sided HF A–ARBS (-sartan) Losartan “relax man” 2nd choice
Left sided HF can cause Right HF (weak heart = weak pump) A–Avoid Pregnancy
MI (heart attack) A–Angioedema (Airway Risk) *only Ace
Pulmonary HTN
Ischemic Heart Disease C–Cough *only Ace
ibrotic ungs sti lungs
E–Elevated K+ (normal 3.5-5.0)
(CAD, ACS)
B–BETA BLOCKERS (-lol) AtenoLOL “LOL = LOW”
Treatment Priority Blocks both BP & HR (AVOID Low HR & BP)
Caution: HOLD IF:
B–Bradycardia (LESS than 60) & BP low (90/60)
KEY WORDS: new, sudden, worsening, rapid = only hold if the patient is in an acute exacerbation of CHF
Pulmonary Edema CRISIS (Lung Fluid!) B–Breathing problems “wheezing” (Asthma, COPD)
B–Bad for Heart Failure patients
#1 Furosemide “Body Dried drain fluid B–Blood sugar masking “hides S/S” (Diabetics)
H–HOB 45 degrees + (semi fowlers, high fowlers, orthopneic C–CALCIUM CHANNEL BLOCKERS
position) Calms BP & HR (AVOID Low HR & BP)
O–Oxygen (Nifedipine)
P–Push Furosemide + Morphine, Positive inotropes -dipine “declined BP & HR
E–End sodium & fluids Sodium Swells) -amilipine “chill heart”
NO drinking fluids TO IV fluids D–DIURETICS Drain Fluid
D–Drains Fluid “Diurese” “Dried”
Diagnostic tests K+ Wasting–Furosemide & Hydrochlorothiazide
(caution: Low K+, Eat melons, banana & green leafy)
Labs: BNP–”Broken Venticles” K+ Sparing–Spironolactone “Spares potassium”
(AVOID Salt Substitues, melons & green leafy)
300+ Mild • 600+ Moderate • 900+ SEVERE HF D–DILATORS (Vasodilators)
Echo Nitroglycerin, Isosorbide
Ejection Fraction 40% or LESS is HF! (normal-55-70%) Nitroglycerin “Nitro = Pillow for heart”
LVH–Left Ventricular Hypertrophy Caution: NO Viagra “ ” Sliden = DEATH!
Nitro drip: STOP = Systolic BP below 90 or 30 mmHg Drop
Hemodynamic Monitor “Swan Ganz" (Pulmonary artery catheter)
dverse e ect
CVP (norm: 2-8) Over 8 = NOT GREAT side e ect
ow B adverse e ect O position changes
Risk Factors D–DIGOXIN (Inotropic)
Digs for a DEEP contraction
#1 risk factor is HTN Increased contractility
ECG Dysrhythmias (Atrial Fibrillation) Apical Pulse x 1 minute
Valvular Malfunction (mitral valve regurgitation) Toxicity (over 2.0) Vision changes, N/V TEST TIP
Cardiomyopathy Potassium 3.5 or less (higher r/f toxicity)

Notes
Cholesterol
Lowering Agents

Drug name: Memory Trick:

C ution

s tin s tin s tin

NYSTATIN

S - S tin S - S tin
NYSTATIN

Atorvast tin S - Stay Clean S - Smooth Tin Can

“StaaaTIN”
Simvas tin
Lovas tin NOT Nystatin – that’s an antifungal
Rosuvas tin medicine for treating YEAST infections

Indication: MOA:
It does this by preventing cholesterol production in the liver. Technically
H o es e o e e s by preventing an enzyme the LIVER needs to make the cholesterol!
• Hyper o es e olemia
• Hyper emia Bad Good
Total Cholesterol 200 HDL “HIGH Lipids” 40
(Different names for the same thing)
Triglycerides 150
LDL “Loser Lipids” 100

NORMAL
HIGH
LOW

KEY POINTS S TAT ATI ue tion

Patient on o a tatin en ould t e
“MUSCLE CRAMPS
nur e noti t e H ?”
“MUSCLE spasms
n er u le a e ram
Sore MUSCLES “MUSCLE ACHES

n ue tion
Toxic Liver (ALT & AST) “Report ne mu le tenderne to the HCP”

AV ra efruit St o n art
HESI ue tion
Take at NIGHT C E em “Report mu le ain enderne it out n ur
a e at nne time or e time” n er o u a tatin

Notes
 Antihypertensives: Adrenergic blocking drugs
- Alpha

How it works? “Action” Nursing management

Block Alpha receptors causing vasodilation by
relaxing the smooth muscle of the blood vessels.
In ophthalmic preps they constrict the pupil.
Why do we give it? ‘’Reason’’
• Monitor BP, pulse, and ECG every 2 min until stable
during IV administration. If hypotensive crisis
occurs, epinephrine is contraindicated and may
cause paradoxical further decrease in BP.
• Norepinephrine may be used
• Instruct client to change positions slowly to
minimize orthostatic hypotension.
• Instruct patient to notify health care professional if
chest pain occurs during IV infusion.

• Hypertension caused by pheochromocytoma

• Hypertension caused by pre op prep.
• Treat tissue damage caused by dopamine in ection.

Interactions:

• Epinephrine or methoxamine
Adverse effects Severe hypotension
• Ephedrine or phenylephrine:
CNS: CEREBROVASCULAR SPASM, dizziness, Decreased pressor response
weakness.
EENT: nasal stu ness.
CV: HYPOTENSION, MI, angina, arrhythmias,
tachycardia.
GI: abdominal pain, diarrhea, nausea, vomiting,
aggravation of peptic ulcer.
Derm: flushing. ocal in ection site pain local .
Interactions

Simple Nursing Brain bits

If you are giving multiple meds remember, If it makes

you hyper or shaky check the drug book before
administering it with Alpha Adrenergic blockers
Contraindications

• Coronary artery disease

Generic Trade Safe Dose Route

5 mg given 1– 2 hr pre
op, repeated PRN. can
Phentolamine Oraverse, Regitine IM, IV, Local
infuse at 0.5– 1 mg/min
during surgery.
 Antihypertensives
Angiotension Receptor Blockers

t r s Act rs e e t
Block the binding of angiotensin 2 at various sites • Monitor BP and pulse frequently
on smooth muscle, blocking the vasoconstriction • Assess patient for signs of angioedema
e ects of the renin-angiotensin-aldosterone system
(dyspnea, facial swelling).
thus causing a decrease in blood pressure.
• Heart Failure: Monitor weight and assess patient
routinely for resolution of fluid overload
(peripheral edema, rales/crackles, dyspnea,
weight gain, jugular venous distention).
d e ve t e s • May cause hyperkalemia.
• Instruct your clients to get up slowly and avoid salt
• Treatment of hypertension substitutes.

Adverse effects
ter ct s:
CNS: dizziness, fatigue, headache, insomnia,
weakness. • NSAIDS: Reduced hypotensive e ects
• : ecreased ace e ects
CV: chest pain, edema, hypotension. •A r : Increased risk of hypersensitivity
EENT: nasal congestion. • Digoxin: Decreased dig levels
Endo: hypoglycemia, weight gain. • d ret cs: ecrease diuretic e ects
• t : Possible lithium toxicity
GI: diarrhea, abdominal pain, dyspepsia, nausea. • ce cs s : Increase risk of
GU: impaired renal function. hypoglycemia
F and E: hyperkalemia. • t ss s r d ret cs: Elevated potassium
levels ( hyperkalemia )
MS: back pain, myalgia.
Misc: ANGIOEDEMA, fever.

e rs r ts

• Be mindful of su es! ll RB end in A

tr dc t s These replace ACE in african american population
and when the side e ects of ace become too much
• ACE1/Angiotensin receptor blockers: HF, salt or
volume depletion, bilateral stenosis, angioedema, the client.
pregnancy 2nd/3rd trimester due to neonatal
death.

Generic Trade e se te

r es rt A r v 150 mg once daily PO

s rt Cozaar 50 mg once daily PO

80 mg or 160 mg once
s rt Diovan PO
daily
 Adenosine

Drug name: MEMORY TRICK Indication:

1st line drug to treat
- supraventricular tachycardia
AdenoSINE
uts the own beat min
in a DEN with aDENosine

MOA: SUPRAventricular tach cardia

SUPER tach heart rate

It works by slowing impulse conduction through the AV

node to slow down the heart rate. Therefore can work too
well & stop the heart all together - soo SAFETY is the main
concern.
KEY Points

SVT ORDER of treatment

1. Vasovagal maneuver FIRST!
BEFORE adenosine (bearing down
1 2
like having a BOWEL MOVE

Common ue tion 2. Adenosine u ra idl o er

e ond ollo ed b a sali e ush
Which drug does the nurse 3. Cardioversion to Convert the heart
anti i ate t e ro ider to order rhythm - “Push the SYNCHRO
SYNC

Adenosine #1 NIZE BUTTON” for Cardioversion

SYNC

on t let
THE NCLEX TRICK YOU
CARDIOVERSION DEFIBRILLATION

Cardioversion De brillation
C- ardio er ion D e rillation if ou
C- ount a ul e D on t a e a ul e
C- ontrolled t m D eadl r t m (V i Vta no ul e)
S n roni ed u on edation D on t S n ( o a a )
PULSE NO PULSE

SYNC
SYNC

SYNC
 Cardiotonic Drugs

How it works? “Action” Nursing management

Cardiotonics such as digoxin increase cardiac output The physical assessment should include the following:
through positive inotropic activity (an increase in the • Taking blood pressure, apical-radial pulse rate,
force of the contraction). They slow the conduction respiratory rate
velocity through the atrioventricular (AV) node in the • Auscultating the lungs, noting any unusual sounds
heart and decrease the heart rate through a during inspiration and expiration
negative chronotropic e ect. • Examining the extremities for edema
Milrinone has inotropic action and is used in the • Checking the jugular veins for distention
short-term management of severe heart failure • Measuring weight
that is not controlled by the digitalis preparation. • Inspecting sputum raised (if any) and noting the
appearance (e.g., frothy, pink tinged, clear, yellow)
(Ford 403)
• Looking for evidence of other problems such as cyanosis,
shortness of breath on exertion (if the patient is allowed
Why do we give it? ‘’Reason’’ out of bed or when lying flat and mental changes
(Ford 405)
• Heart failure • Pediatric
• trial brillation • The drug is withheld and the primary health care
provider noti ed before administration of the drug if
the apical pulse rate in a child is below 70 bpm, or
Contraindications below 90 bpm in an infant.
• Daily weights
• Digitalis toxicity
• known hypersensitivity
• ventricular failure, ventricular tachycardia, cardiac Interactions:
tamponade, restrictive cardiomyopathy, or AV block.
(Ford 404) • Thyroid hormone: ecreased e ects of digo in
• Thiazide and loop diuretics: Increased diuretic
t ct e ectr te ces electrolyte disturbances, especially hypokalemia

• Plasma digoxin levels are monitored closely. Blood for

plasma level measurements should be drawn Adverse effects
immediately before the next dose or 6 to 8 hours after
the last dose regardless of route. Therapeutic drug • Headache
levels are between 0.8 and 2 nanograms/mL. Plasma • Weakness, drowsiness
digoxin levels greater than 2 nanograms/mL are • Visual disturbances (blurring or yellow halo)
considered toxic and are reported to the primary health
care provider Hypokalemia makes the heart muscle • Arrhythmias
more sensitive to digitalis, thereby increasing the • Nausea and anorexia
possibility of developing digitalis toxicity. At frequent
intervals, observe patients with hypokalemia closely for
signs of digitalis toxicity. (Ford 405)

Generic Trade Use Route

Loading dose:* 0.75–1.25 mg
orally or 0.6–1 mg IV
Heart failure,
Digoxin Lanoxin Maintenance: 0.125–0.25 mg/day
tr r t orally
Lanoxicaps: 0.1–0.3 mg/day orally

Short-term management Short-term management Loading dose: 50 mcg/kg IV

Milrinone.
of heart failure of heart failure IV: Up to 1.13 mg/kg/day
Diuretics
- Carbonic Anhydrase Inhibitors

How it works? “Action” Nursing management

• Diuretics work by altering the reabsorption or • Monitor BP and pulse frequently

e cretion of electrolytes and alter fluid volume. • Assess for allergy to sulfonamides
Carbonic anhydrase inhibitors: sulfonamides • Monitor intake and output ratios and daily weight.
without bacteriostatic action, inhibit CAH • Do not stop the drugs abruptly unless you speak
enzyme thus results in excretion of Na+ K+ HC03 with the DR.
and H20 • If GI upset occurs then take the med with food
or milk
• Take early in the morning
Why do we give it? ‘’Reason’’ • o not reduce fluid intake
• Hypertension • Avoid alcohol and non prescription drugs
• Used with antihypertensives • Notify the healthcare provider if: muscle cramps,
• To reduce edema weakness, dizziness, diarrhea, restlessness,
• Glaucoma excessive thirst, general weakness, rapid pulse,
• Seizures
• Renal disease. increased heart rate or pulse, gi distress.
• Weight yourself daily.
• These drugs may cause hypokalemia, monitor
Adverse effects serum potassium levels and electrolytes.

Neuro: Dizziness, headache, encephalopathy,

lightheadedness,weakness, fatigue
EENT: Hearing loss, tinnitus
CV: Orthostatic hypotension
GU: Electrolyte imbalances, glycosuria Interactions:
GI: Anorexia, nausea, vomiting
Derm: Rash, photosensitivity • Primidone: decreased e ectiveness of primidone
• Barbiturates & aspirin: decrease diuretic
Endo: Hyperglycemia, hyperuricemia. e ectiveness
F & E: Dehydration, hypocalcemia, • tricyclic antidepressants: can lead to toxicity
hypochloremia, hypokalemia, hypomagnesemia,
hyponatremia, hypokalemia, metabolic alkalosis
MS: Arthralgia, muscle cramps, myalgia.

Contraindications Simple Nursing Brain bits

• Hypersensitivity If a client has an allergy to sulfonamides this

• Electrolyte imbalances drug should not be given.
• Severe kidney or liver dysfunction
• Anuria.
• Mannitol: active intracranial bleeding except
during craniotomy

Generic Trade Safe Dose Route

250– 1000 mg/day in
Acetazolamide Diamox PO
1– 4 divided doses

50– 100 mg 2– 3 times

Methazolamide Neptazane PO
daily.
Antihypertensives: Adrenergic blocking drugs
- Alpha & Beta

t r s Act rs e e t

Block Alpha receptors causing v s d t by • Monitor BP, pulse, and ECG every 2 min until stable
relaxing the smooth muscle of the blood vessels in during IV administration. If hypotensive crisis
ophthalmic preps they constrict the pupil occurs, epinephrine is contraindicated and may
cause paradoxical further decrease in BP.
Norepinephrine may be used
• Instruct client to change positions slowly to
minimize orthostatic hypotension.
• Instruct patient to notify health care professional if
chest pain occurs during IV infusion
d e ve t e s

• Carvedilol: essential HTN, HF to reduce progression

• Labetalol: HTN usually as an adjunct to a Diuretic

ter ct s:

• A t de ress ts: tremors

Adverse effects
CNS: Dizziness, fatigue, weakness, anxiety,
depression, drowsiness, insomnia, memory loss,
mental status changes, nervousness, nightmares.
EENT: Blurred vision dry eyes intraoperative floppy
iris syndrome nasal stu ness.
Resp: bronchospasm, wheezing.
CV: BRADYCARDIA, HF, PULMONARY EDEMA
GI: diarrhea, constipation, nausea. GU: erectile
dysfunction,plibido.
Derm: STEVENS-JOHNSON SYNDROME, TOXIC
EPIDERMAL NECROLYSIS, itching, rashes, urticaria.
Endo: hyperglycemia, hypoglycemia.
MS: arthralgia, back pain, muscle cramps.
Neuro: paresthesia.
Misc: ANAPHYLAXIS, ANGIOEDEMA, drug-induced
lupus syndrome.
• et d e: increased adrenergic blocker e ect
• d e: increase clonidine e ects
• : digoxin toxicity
tr dc t s
• History of serious hypersensitivity reaction.
• Stevens-Johnson syndrome, angioedema,
anaphylaxis
• Pulmonary edema
• Cardiogenic shock
• Bradycardia, heart block or sick sinus syndrome
• Uncompensated HF requiring IV inotropic agents
(wean before starting carvedilol); Severe hepatic
impairment; Asthma or other bronchospastic
disorders.

e er c Trade Safe Dose te

Carvedilol re re t ce d PO

et r d te t ce d PO, IV
 Antihypertensives
Ace Inhibitors

t r s Act rs e e t
Suppress the renin-angiotensin-aldosterone system • Monitor BP and pulse frequently
and prevent the activity of ACE which converts • Assess patient for signs of angioedema
angiotensin 1 to angiotensin 2 (vasoconstrictor). (dyspnea, facial swelling).
Inhibiting the conversion causes Na+ and H2O to • Heart Failure: Monitor weight and assess patient
not be retained thus sodium and BP will decrease. routinely for resolution of fluid overload
(peripheral edema, rales/crackles, dyspnea,
weight gain, jugular venous distention).
• May cause hyperkalemia.
d e ve t e s
• Instruct your clients to get up slowly and avoid salt
• Treatment of hypertension substitutes.

Adverse effects ter ct s:

CV: Orthostatic hypotension, syncope • NSAIDS: Reduced hypotensive e ects
tachycardia, hypotension, chest pain • : ecreased ace e ects
CNS: Dizziness, fatigue, headache, weakness. •A r : Increased risk of hypersensitivity
GI: Abdominal pain, diarrhea, nausea, vomiting • : Decreased dig levels
GU: Erectile dysfunction, impaired renal • d ret cs: ecrease diuretic e ects
• t : Possible lithium toxicity
function.proteinuria • ce cs s : Increase risk of
Derm: Rashes. F and E: hyperkalemia. hypoglycemia
Misc: ANGIOEDEMA • t ss s r d ret cs: Elevated potassium
RESP: Upper respiratory infections and cough, levels ( hyperkalemia )
HEMAT: Neutropenia

e rs r ts

• Be mindful of su es! ll CE inhibitors end in

tr dc t s r Use caution with African American population
• ACE1/Angiotensin receptor blockers: HF, salt or as drugs may not be e ective and or may cause
volume depletion, bilateral stenosis, angioedema, e tremely uncomfortable side e ects
pregnancy 2nd/3rd trimester due to neonatal
death.

e er c r de t t t d e d se te

t r te t t d 12.5– 25 mg 2– 3 PO
t es d

s r r v t d ce d PO

E r s tec t t t ce PO , IV
d

r A t ce t t t ce d PO
 Calcium Channel Blockers

t r s Act tr dc t s
ystemic and coronary arteries are influenced by • Calcium channel blockers: sick sinus syndrome,
Ca++ moving across cell membranes. CCB act by 2nd/3rd degree atrioventricular block, ventricular
inhibiting the movement of calcium across the cell dysfunction, cardiogenic shock.
membrane of cardiac and arterial muscles. Resulting
in less calcium available for nerve impulse
transmission and relax blood vessels to increase 02
supply to decrease cardiac workload

rs e e t

• Monitor BP and pulse frequently

• Monitor intake and output ratios and daily weight.
d e ve t e s Assess for signs of HF (peripheral edema,
• Hypertension rales/crackles, dyspnea, weight gain, jugular
• Angina pectoris venous distention).
• Vasospastic (Prinzmetal’s) angina • Angina: Assess location, duration, intensity, and
precipitating factors of patient’s anginal pain
• Avoid large amounts (6– 8 glasses of grapefruit
juice/day)
• Have the client check pulse and report any sudden
changes

Adverse effects

CNS: dizziness, fatigue.

CV: peripheral edema, angina, bradycardia,
hypotension, palpitations.
GI: gingival hyperplasia, nausea.
erm flushing
ter ct s:
• et d e: increase e ects of CCB
• e e: to ic e ects of theophylline
• : Dig toxicity
• : decreased CCB e ects

e er c r de e se te

A d e rv sc ce d PO

t e rd e PO
t es d

er PO, IV
t es d
Antihypertensives: Adrenergic blocking drugs
/ Alpha & Beta Central and Peripherally Acting

How it works? “Action” Nursing management

Peripherally acting: Inhibits norepinephrine in the
PNS ( treats BPH, HTN)
Centrally acting: Decreases CNS activity (HTN)
Why do we give it? ‘’Reason’’
• Certain cardiac arrhythmias
• BAH
• HTN
• Monitor intake and output ratios and daily weight
• Assess for edema daily, especially at beginning of
therapy.
• Monitor BP and pulse prior to starting, frequently
during initial dose adjustment and dose increases
and periodically throughout therapy.
• Titrate slowly in patients with cardiac conditions or
those taking other sympatholytic drugs.
Report signi cant changes.
• Transdermal: Instruct patient on proper application
of transdermal system. Do not cut or trim unit.
Transdermal system can remain in place during
bathing or swimming.

Adverse effects Interactions:

EENT: dry eyes. • Adrenergic: risk of HTN
CV: AV block, bradycardia, hypotension (with • Levodopa: hypotension, decrease levodopa
epidural), palpitations. • Anesthetic agents: increase anesthetic
GI: dry mouth, constipation, nausea, vomiting. • Beta blockers: hypertension
GU: erectile dysfunction. • Lithium: lithium toxicity
Derm: rash, sweating. • Haloperidol: psychotic behavior
F&E: sodium retention, hyperkalemia
Metab: weight gain.
Neuro: paresthesia.
Misc: withdrawal phenomenon
Contraindications

• Central: Hepatic disease ( active ) , MAOI

antidepressant therapy
• Peripheral: ulcerative colitis , peptic ulcer

Generic Trade Central / peripheral Safe dose Route

100 mcg (0.1 mg)
Clonidine Catapres Central PO, TD
BID

250– 500 mg 2– 3
Methyldopa N/A Central PO
times daily

Cardura, Cardura
Doxazosin Periphera 1 mg once daily PO
XL

1 mg 2– 3 times
Prazosin Minipress Periphera PO
daily
Steroids

Drug name: ADDISON vs. CUSHING TREATMENTS:

S S
STEROIDS Stress & Swelling 7 S’s STEROID PRECAUTIONS
hormone
‘’-sone’’ prednisone, h dro ortisone, dexamethasone

STEROIDS

s SWOLLEN (Water gain = Weight gain)

KEY TERMS: ‘’Sudden’’ ‘’excessive’’, ‘’rapid’’
REPORT: 1 Lb. in 1 day, or 2-3lbs in a few
S – STEROIDS
S – Stress & Swelling hormone Prednisone Dexamethasone s SEPSIS ( nfe tion or llne )
‘’Low WBC’’ Fever is PRIORITY NCLEX TIP

s
“-Sone”
- Prednisone SUGAR INCREASED
- Dexamethasone
dro ortisone H o o tisone
u o o tisone
‘’Hyperglycemia’’ NCLEX TIP

s
ludro ortisone
SKINNY
Muscle & Bones ‘’Osteoporosis’’ (R/F Fx)
Indication:

Given to help the body respond to

inflammation & TRE !
Commonly for
s SIGHT
(Cataracts risk) refer to Optometrist

• Inflamed ung like COPD

COPD
PREVENT CRISIS:
• Inflamed oints like Rheumatoid Arthritis
• Inflamed KIN like Psoriasis
• Inflamed body - like Lupus where the body
s SLOWLY ta er o
(NEVER abruptly stop) NCLEX TIP

attacks itself
• Allergic reaction where EVER T ING swells s STRESS or Surgery
(increase dose)

TOP 3 MISSED ue tion

The nurse should be concerned Which priority teaching is Which of the follow is an
en t e lient tate re uired for a atient re ri ed indi ation t at t e lient need
“I have a sore on my leg that prednisone for Lupus? additional tea in
won’t go away”. ile ta in udro ortisone?
i medi ation ould e 1. Report slight increases in blood
reviewed with HCP.
sugar to HCP immediately. ill not di ontinue t i
Select all that apply
2. Increase dose before surgery medi ation a ru tl
o u n times o s ess 2. New bilateral pedal edema
1. Naproxen
3. Monitor weight weekly. is normal
2. Dihydromorphinone
4. Take with full meal at breakfast. 3. The most important value
3. Dexamethasone
to monitor is my weight.
4. Hydrocodone
4. I will report signs &
H o o tisone
m tom of infe tion

Notes
 Anabolic Steroids

How do they work? “Action” Adverse Reactions

nabolic steroids are synthetic drugs chemically
related to the androgens. ike the androgens they
promote tissue-building processes. Given in normal
doses they have a minimal e ect on the accessory
se organs and secondary se characteristics.
ord
Indications
• Virili ation in women
• cne
• Nausea vomiting diarrhea fluid and electrolyte
imbalances
• testicular atrophy aundice anore ia and muscle
cramps may also be seen.
• Blood- lled cysts of the liver and sometimes the
spleen malignant and benign liver tumors an
increased risk of atherosclerosis and mental
changes

nabolic steroid use includes the Nursing management

following
• anagement of anemia of renal insu ciency
• Control of metastatic breast cancer in women
• romotion of weight gain in those with weight
loss after surgery trauma or infections
ord - and serum electrolytes and serum lipid levels.
It’s not always about them gains!
The use of anabolic steroids to promote an increase
in muscle mass and strength has become a serious
problem. nabolic steroids are not intended for this
use. nfortunately deaths in young healthy
individuals have been directly attributed to the use
of these drugs. oung men and women should be
discouraged from the illegal use of anabolic steroids
to increase muscle mass. ord
• ssess and document the patient’s physical and
nutritional status before starting therapy
• Baseline laboratory studies may include a
complete blood count hepatic function tests
Review these studies and note any abnormalities.
• odium and water retention may also occur with
androgen or anabolic steroid administration
causing the patient to become edematous. In
addition other electrolyte imbalances such as
hypercalcemia may occur. onitor the patient for
fluid and electrolyte disturbances.
• nabolic steroids may cause nausea and GI upset.
Take this drug with food or meals.
• Keep all primary health care provider or clinic
visits because close monitoring of therapy is
essential.
• emale patients Notify the primary health care
provider if signs of virili ation occur.

Contraindications Interactions:
• Known hypersensitivity • Oral anticoagulants: Increased antidiuretic
• iver disorders e ect
• erious cardiac disease • Imipramine and androgen: Increased risk of
• rostate gland disorders paranoid behavior
• regnancy category do not give • Sulfonylureas and anabolic steroids: Risk of
to pregnant or lactating women hypoglycemia

Generic Trade Use Route

nemia of renal insu ciency human
Nandrolone n/a immunode ciency virus IV wasting mg wk I
syndrome

Oxymetholone Anadrol -50 Anemia mg kg day orally

Bone pain weight gain protein . mg day orally

Oxandrolone Oxandrin
catabolism in divided doses
 Androgens

How do they work? “Action” Adverse Reactions

Testosterone and its derivatives are male hormones that cause the Electrolyte imbalances
reproductive maturation in the adolescent male. From puberty onward, • Hypernatremia
androgens continue to aid in the development and maintenance of • Hypercalcemia
secondary sex characteristics: facial hair, deep voice, body hair, body fat In males:
distribution, and muscle development. Testosterone also stimulates the
• Breast enlargement “ gynecomastia”
growth in size of the sex organs (penis, testes, vas deferens, prostate) at
• Testicular atrophy
the time of puberty. The androgens also promote tissue-building
processes (anabolism ) and reverse tissue-depleting processes
• May inhibit testicular function
(catabolism ). (Ford 491) • Impotence
• Penile enlargement
• vomiting, jaundice, headache, anxiety,
Indications • male-pattern baldness, acne, and depression.
• Fluid and electrolyte imbalances, which include
Androgen therapy may be given as replacement to treat: sodium, water, chloride, potassium, calcium, and
• Testosterone de ciency phosphate retention.
• Hypogonadism (failure of the testes to develop) In females:
• Delayed puberty • Amenorrhea
• evelopment of testosterone de ciency after puberty ndrogens • Virilization “ male characteristics”
may given to females to treat
• Menstrual irregularities
• Postmenopausal, metastatic breast carcinoma
• Male pattern baldness
• Premenopausal, hormone-dependent metastatic breast carcinoma
Transdermal testosterone system
• Acne
• replacement therapy when endogenous (produced by the body)
testosterone is de cient or absent.
Anabolic steroid use is indicated for Nursing management
• anagement of anemia of renal insu ciency
• Control of metastatic breast cancer in women •Monitor vitals every 4 or 8 hrs
• Promotion of weight gain in those with weight loss after surgery, • Monitor weight for patients with advanced breast
trauma, or infections (Ford 491-492) carcinoma. Contact the HCP if the patient gains or loses
5 pounds
• Monitor for edema
Contraindications • onitor for fluid and electrolyte imbalance
• Older adults with cardiac problems or kidney disease
• Known hypersensitivity are at increased risk for sodium and water retention
• Liver disorders when taking androgens or anabolic steroids. (Ford 493)
• Serious cardiac disease • Anabolic steroids may cause nausea and GI upset.
• Prostate gland disorders Take this drug with food or meals.
• Pregnancy category x do not give to pregnant or • Keep all primary health care provider or clinic visits,
lactating women
because close monitoring of therapy is essential.
• Female patients: Notify the primary health care provider
if signs of virilization occur. (Ford 494)
Interactions: • When the androgens are administered to a patient with
diabetes, blood glucose levels should be measured
• Oral anticoagulants: Increased antidiuretic e ect frequently because glucose tolerance may be altered.
• Imipramine and androgen: Increased risk of paranoid behavior Adjustments may need to be made in insulin dosage,
• Sulfonylureas and anabolic steroids: Risk of hypo glycemia oral antidiabetic drugs, or diet. (Ford 493)

Generic Trade Use Route

Males: Hypogonadism, delayed puberty
Males: 5–20 mg/day orally
Fluoxymesterone n/a Females: Inoperable advanced breast
Females: 10–40 mg/day orally
cancer

Males: Hypogonadism, delayed puberty Males: 10–50 mg/day orally

Methyltestosterone Testered
Females: Inoperable advanced breast cancer Females: 50–200 mg/day orally

Buccal: 30 mg BID
Gel: apply daily
Androgel, androderm, Primary or hypogonadotropic
testosterone Injectable: 50–400 mg every 2–4 wk
depo-testosterone hypogonadism, delayed puberty Transdermal: 6 mg/day, apply patch daily
Spray: 30–120 mg daily
 Somatotropins

How do they work? “Action” Contraindications

omatropin is identical to human G and produces • Closure of epiphyses
skeletal growth in children. This drug is administered • ctive neoplasia
to children who have not grown because of a • ypersensitivity to growth hormone or m-cresol
de ciency of pituitary G it must be used before preservative
closure of the child’s bone epiphyses. ord • cute critical illness therapy should not be
initiated
• Respiratory failure
Indications • iabetic retinopathy
• rader- illi syndrome with obesity and respiratory
• Growth failure in children due to rader- illi impairment risk of fatal complications can be
syndrome. Growth failure in children due to used only if growth hormone de ciency is
de ciency of growth hormone. Growth failure in documented .
children born small for gestational age G who
fail to manifest catch-up growth by age
Nursing management

Adverse Reactions • onitor bone age annually and growth rate

determinations height and weight every 3 mo
• Edema of the hands and feet during therapy.
• yperglycemia • onitor bone age annually and growth rate
• hypothyroidism insulin resistance determinations height and weight every 3 mo
• PANCREATITIS. during therapy.
• pain at in ection site local lipoatrophy or • ssure parents and child that these dose forms are
lipodystrophy with subcutaneous use synthetic and therefore not capable of transmitting
• arthralgia.
Creut feldt- akob disease as was the original
somatropin which was e tracted from human
cadavers.
Interactions:
• dvise parents to monitor blood glucose closely in
• E cessive corticosteroid use e uivalent to children with diabetes mellitus. arents should also
mg m day may decrease response to growth be advised to report persistent severe abdominal
hormone. pain may be a symptom of pancreatitis.
• Emphasi e need for regular follow-up with
endocrinologist to ensure appropriate growth rate
to evaluate lab work and to determine bone age by

Generic Trade Use Dose

Genotropin, Humatrope, Growth failure due to de ciency of Doses are individualized,

Somatropin
Norditropin, Nutropin, pituitary G in children replacement administered by subcut
• Growth hormone
Serostim of endogenous GH in adults in ection weekly

Octreotide
Reduction of G in acromegaly mcg subcut
• Growth hormone Sandostatin
and treatment of certain tumors or IV BID or TID
inhibitor
 PATHOPHYSIOLOGY BASICS
INsulin = puts INto the cell (sugar & K+) DIABETES MELLITUS TREATMENT—PATIENT EDUCATION
D–DIET –Low carbs
GLycogen = Stored GLucose in Liver TYPE 1 vs. TYPE 2 AVOID: Simple Sugars (soda, candy, white bread/rice, juices)
• Good High Fiber = BROWN (bean, rice, bead, peanut butter)
“whole wheat/grain/milk”
PATHO & CAUSES DIAGNOSTIC LABS • Bad Low fiber = White (bread, rice, bread potatoes (fries), low fat milk)
Type ONE Type TWO D–DIABETIC FEET “Delicious Feast for bacteria”
HgBA1C
GOAL: Clean, Dry, Injury Free
DON't-produce insulin (Born) FEW-insulin receptors work AVOID
Autoimmune “body attacks itself” “Insulin resistance” (Diet) F–Flip Flops, high heels, Nylon,
SON-hereditary YOU-diet “high simple sugars” O–OTC corn removal
& sedentary lifestyle O–Overly HOT (baths, pads etc.)
T–Toe Injuries — cut nails STRAIGHT
NCLEX KEY WORDS:
Daily inspection — NOT weekly
Shoes fit properly — NO sandals
SIGNS & SYMPTOMS SOFT Cotton Socks — NOT nylon
Nails trimmed–cut straight — NOT curved angles
HIGH sugar LOW sugar (70 or LESS) Non healing skin wounds — Report to HCP (Dr.)
hot and dry = sugar high cold and clammy need some candy NO callous removal
“Hyperglycemia” Hypoglycemia NO heavy Powder — light powder
(blood turns to mud) MORE SEVERE! “Hypogly Brain will Die!” NO rubbing feet hard “vigorously”
3 P’s: Polyuria • Cool, pale “pallor”, sweaty, NO HOT baths or HOT pads — warm is ok
Polydipsia clammy = candy NOT hot or flushing
Polyphagia • Trembling, Nervous, Anxious
• HIWASH = Headache, Irritable, Weakness, COMPLICATONS
Anxious, Sweaty, Shaky, Hungry KIDNEY–Nephropathy (High Creatinine OVER 1.3)
RISK FACTORS CAUSES EYE–Retinopathy (blind)
HEART–HTN & Atherosclerosis
Type ONE -None (born) HIGH sugar (115 or MORE) LOW sugar (70 or LESS) BRAIN–CVA (strokes)
Type TWO Sepsis (infection #1 cause), Exercise NERVES–Neuropathy (loss of feeling)
Stress (surgery, hospital stay), Alcohol
“MetaBOLic Syndrome”-Increased risk for diabetes, heart disease, stroke
Skip insulin Insulin PEAK times
B–BP meds or HTN (over 130 sysolic) NOTES
Steroids (predniSONE) MOST DEADLY! “Hypogly brain will DIE”
B–Blood Sugar Meds (insulin, oral diabetics) or High Blood Sugar (over 100+)
TREATMENT: Insulin 1st TREATMENT:
O–Obese (waist size: 35+ Female 45+ Male)
L–Lipids HIGH Total Cholestrol/Triglyceride/LDL 200-150-100—HDL 40 Awake? Ask to eat:
(higher LDL and lower HDL are risk factors) Juice, Soda, Crackers, Low Fat Milk
NOT high fat milk or peanut butter
*3 or MORE criteria*
Sleep? Stab them (D50 given IV/IO)
 INSULIN TYPES ORAL HYPOGLYCEMICS (Type 2 Only)
1. DIET & EXERCISE BEFORE oral meds and insulin
2. METFORMIN–Minimal chance of Low Sugar “hypoglycemia”
1. Weight GAIN
2. Lactic Acidosis: NO Alcohol + STOP 48 hours before and
after cath
IV Contrast = Kills Kidney
3. GLIPIZIDE GLYBURIDE–Heart can DIE (bad for CHF)
LOW blood sugar (Avoid alcohol “ETOH” = hypoglycemia)
TOXIC: Renal, Liver & elderly population
Sun Burns = sunscreen & protective clothing
4. THIAZOLIDINEDONE (TZD) Pioglitazone (ONE heart)
NO Heart Failure patients–new pitting edema, crackles (lungs)
NO Liver failure patients “Cirrhosis” “Liver Failure”
NOTES
NPH
PEAK TIMES=Hypoglycemia risk 70 or Less
Hypogly brain will DIE NCLEX TIP
7 INSULIN TIPS
1. Peaks + Plates = Food during PEAK times (prevent HYPOgly=brain die)
2. NO Peak NO Mix = Long acting “old guys”–Detemir & Glargine
3. IVP or IVPB ONLY = Regular insulin “ready to go IV”
4. Draw Up: Clear to Cloudy “you want CLEAR days before cloudy ones”
5. Rotate locations-Macarena-BEST on abdomen
(2 inches from: Umbilicus, Naval, “belly button”)
6. DKA - Type 1–“sick days”–YES INSULIN without food!!!
7. Hypoglycemia (70 or LESS)
Awake = Ask them to Eat (soda, juice, low fat milk)
Sleeping = Stab with IV D50 (dextrose 50)
"Unresponsive" "Responsive ONLY to pain"
 DKA HHNS
PATHO & CAUSES: PATHO & CAUSES:
TYPE 1–Faster & Younger “D comes 1st in alphabet” TYPE 2–slower & older “H comes 2nd in alphabet”
S–Sepsis (infection) NCLEX TIP Illness
FRUITY BREATH
S–Sickness "Stomach Virus & Flu" (most commom) Infections
S–Stress (surgery) Older age Harder to fix
S–Skip insulin Easier fix
SIGNS & SYMPTOMS:
SIGNS & SYMPTOMS:
D–Dry & High sugar 250—500+ H–HIGHEST SUGAR OVER—600+
K–Ketones & Kussmaul resp. (Deep/rapid/REGULAR H–HIGHER fluid loss & Extreme dehydration NCLEX TIP
respirations and fruity breath) H–Head change–LOC, Confusion, Neurological Manifestations NO FRUITY BREATH

A–Abdominal Pain N–No keytones No Acid, (NO fruity breath/ketones)

A–Acidosis Metabolic LESS than 7.35 (normal 7.35—7.45)
Hyperkalemia (Abnormally high K+) TREATMENT:
TREATMENT:
D–Dehydration FIRST! (0.9% normal saline)
K–Kill the sugar (SLOWLY) prevent low sugar
*Hourly BS checks* “land the plane slow & smooth”
Over 250: IV Regular insulin ONLY (bolus 1st)
Below 200 (or ketones resolve): SQ insulin + 1/2 NS
with D5W IV
A–Add Potassium K+ (Yes even if norm: 3.5 - 5.0)
During IV Insulin
IN-sulin = sugar & K+ IN the cell
S–Slower Onset & Stable Potassium (3.5-5.0)
H–Hydration–0.9% NS 1st, then HYPOtonic NCLEX TIP
S–Stabilize Sugars (Insulin)
CAUTION: Insulin IV = ONLY Regular Insulin
• IV bolus
• IV titration
• SQ injection & IV
• SQ only
DKA patients DIE from hypokalemia where
HHNS patients die from hypovolemia

RE-ASSESSMENT Potassium IV (Normal 3.5 - 5.0) POTASSIUM PUMPS MUSCLES NOTES

COMMON NCLEX QUESTION
Q: Child is nauseous NOT
eating—maybe vomiting—do
you still give INSULIN?
A: Yes, we give sick day insulin to
prevent DKA...because glucose
is HIGH during times of illness.
Blood Glucose Hourly • First Action = Heart monitor High Potassium (5.0+) Low Potassium (Below 3.5)
Re-Hydration Signs: Never push = DEATH High Pump Low Pump
• BP stable & Cap Refill (3 sec or less) • 10–20 mg MAX per hour IV!! (IV Pump) Peaked T waves, ST elevation Flat T wave, ST depression, U wave
• Skin color & warm temp (NOT cool/pale) • Site (central) and Slow infusion
• 30ml/hr + Urine Output
• Low spec gravity (1.005–1.030)
NOT Apical pulse NOT Lung sounds NOT Pupils
 Diabetes Drugs
- Non Sulfonylureas

How do they work? “Action” Interactions:

Metformin sensitizes the liver to circulating insulin levels • Increased risk of lactic acidosis when metformin is
and reduces hepatic glucose production. given with corticosteroids.
c s d se t rs acarbose (Precose) and • igestive en ymes may reduce the e ect of miglitol.
miglitol (Glyset) lower blood glucose levels by delaying the
digestion of carbohydrates and absorption of
carbohydrates in the intestine.
The thiazolidinediones, also called glitazones, decrease Nursing management
insulin resistance and increase insulin sensitivity by
modifying several processes, resulting in decreased • Stop metformin 48 prior to and post radiologic studies.
hepatic gluconeogenesis (formation of glucose from • Temporarily discontinue metformin before surgical
glycogen) and increased insulin-dependent muscle procedures.
glucose uptake. • Take the drug exactly as directed on the container (e.g.,
Examples of the thiazolidinediones are with food, 30 minutes before a meal).
rosiglitazone (Avandia) and pioglitazone • An antidiabetic drug is not oral insulin and cannot be
(Actos). (Ford 453) substituted for insulin.
• Never stop taking this drug or increase or decrease the
dose unless told to do so by the primary health care
Indications provider.
Oral antidiabetic drugs are used in the treatment of
• Take the drug at the same time or times each day.
patients with type 2 diabetes mellitus whose condition
• Metformin—there is a risk of lactic acidosis when using
this drug. Discontinue the drug therapy and notify the
cannot be controlled by diet alone. (Ford 452)
primary health care provider immediately if any of the
following occur: respiratory distress, muscular aches,
Adverse Reactions unusual somnolence, unexplained malaise, or
nonspeci c abdominal distress.
• GI upset (e.g., metallic taste, abdominal bloating, nausea, • When a hypoglycemic patient is taking an
cramping flatulence and diarrhea . c s d se t r e c r se r t
• Adverse effects t d ed es include upper ve t e t e t r r c se s c s
respiratory infections, sinusitis, headache, pharyngitis, c se t ets r de tr se r t er t ce e
myalgia, diarrhea, and back pain. Lactic acidosis (buildup r c d s cr se A s r t s r s c ed
of lactic acid in the blood) may also occur with the c r se r t (Ford 458)
administration of metformin.
• Metformin can also cause weight loss

Lactic Acidosis
Contraindications & Caution
• Very rare but can be fatal
• Heart failure Occurs mainly in patients with kidney disfunction
• Renal disease Symptoms: malaise (vague feeling of bodily discomfort),
• Acute or chronic metabolic acidosis abdominal pain, rapid respirations, shortness of breath,
• Ketoacidosis and muscular pain. In some patients, vitamin B12 levels
• Those over 80 are decreased. (Ford 453)
• Pregnancy Reversible with administration of B12 or discontinuation
of drug therapy.

Generic Trade Safe Dose Route

Acarbose Type 2 Diabetes as an adjunct to
• a-Glucosidase Precose sulfonylurea to improve glycemic 25-100 mg orally TID
inhibitor control
Type 2 Diabetes as an adjunct to
Metformin Glucophage, Riomet,
sulfonylurea to improve glycemic 500-3000 mg/ day orally
• Biguanide Fortamet control

Pioglitazone Type 2 diabetes in combination with

Actos 5-15 mg orally TID
• thiazolidinediones metformin for glycemic control
 Posterior Pituitary Hormones
How do they work? “Action”
Vasopressin and its derivative, desmopressin (DDAVP),
regulate the reabsorption of water by the kidneys.
Vasopressin is secreted by the pituitary when body fluids
must be conserved.
Patho
This mechanism may be activated when, for example, an
individual has severe vomiting and diarrhea with little
or no fluid intake. hen this and similar conditions are
present, the posterior pituitary releases the hormone
vasopressin, water in the kidneys is reabsorbed into the
blood (i.e., conserved), and the urine becomes
concentrated. Vasopressin exhibits its greatest activity on
the renal tubular epithelium, where it promotes water
reabsorption and smooth muscle contraction throughout
the vascular bed. Vasopressin also has some vasopressor
activity. (Ford 466)
Indications
• Diabetes insipidus
• Unlabeled Use: Management of pulseless VT/VF unre
sponsive to initial shocks, asystole, or pulseless electrical
activity E C guidelines . Vasodilatory shock.
Gastrointestinal hemorrhage ( Davis 1)
Contraindications
Vasopressin is used cautiously in patients with a history of
seizures, migraine headaches, asthma, congestive heart
failure (HF), or vascular disease (because the substance
may precipitate angina or myocardial infarction) and in
those with preoperative polyuria.
(Ford 467)
Generic Trade Use
Diabetes insipidus, hemophilia A, Von
Vasopressin None Willebrand's disease, nocturnal
enuresis
Diabetes insipidus, hemophilia A, Von
Desmopressin DDAVP Willebrand's disease, nocturnal
enuresis
Interactions:
• Norepinephrine: ecreased antidiuretic e ect
• Lithium: ecreased antidiuretic e ect
• Oral anticoagulants: ecreased antidiuretic e ect
• Carbamazepine: Increased antidiuretic e ect
• Chlorpropamide: Increased antidiuretic e ect
Adverse Reactions
• Tremor, sweating, vertigo
• Nasal congestion
• Nausea, vomiting, abdominal cramps
• Water intoxication
Nursing management
• Before administering vasopressin to relieve abdominal
distention, document the patient’s blood pressure,
pulse, and respiratory rate. Auscultate the abdomen
and record the ndings. dditionally measure and
document the patient’s abdominal girth. (Ford 467)
• Excessive dosage is manifested as water intoxication
fluid overload . ymptoms of water into ication include
drowsiness, listlessness, confusion, and headache
(which may precede convulsions and coma). If signs of
excessive dosage occur, notify the primary health care
provider before the next dose of the drug is due; a
change in the dosage the restriction of oral or IV fluids
and the administration of a diuretic may be necessary.
• onitor fluid volume status
• Monitor vitals
• Monitor intake and output closely
• Monitor weight
Dose
Diabetes insipidus: 5–10 units IM,
subcut q 3–4 hr, parenteral solution
may be used intranasally
Doses are individualized, administered
orally, intranasally, or subcut
 Diabetes Drugs
- Sulfonylureas

How do they work? “Action” Interactions:

Sulfonylureas act to lower blood glucose by stimulating cre sed ce c effects:
the cells of the pancreas to release insulin. • Anticoagulants
ulfonylureas are not e ective if the cells of the • Chloramphenicol
pancreas cannot release a su cient amount of insulin to • Clo brate
meet the individual’s needs. (Ford 452) • Fluconazole
• histamine H2 antagonists
Indications • Methyldopa
• monoamine oxidase inhibitors (MAOIs)
Oral antidiabetic drugs are used in the treatment of • nonsteroidal anti-inflammatory drugs N I s
patients with type 2 diabetes mellitus whose condition • salicylates, sulfonamides, and tricyclic antidepressants.
cannot be controlled by diet alone. (Ford 452)
ecre sed ce c effect
• blockers calcium channel blockers
Adverse Reactions • cholestyramine, corticosteroids
• estrogens, hydantoins, isoniazid
• Hypoglycemia • oral contraceptives, phenothiazines, rifampin
• Anorexia • thiazide diuretics, and thyroid agents.
• nausea, vomiting
• epigastric discomfort, weight gain
• heartburn, and various vague neurological symptoms,
such as weakness and numbness of the extremities.

Contraindications & Caution
• Known hypersensitivity
• DKA
• Severe infection
• The rst-generation sulfonylureas chlorpropa
mide, tolazamide, and tolbutamide) are
contraindicated in patients with coronary
artery disease or liver or renal dysfunction. (Ford 453)
Hypoglycemia
Methods of terminating a hypoglycemic reaction
include the administration of one or more of the
following:
• 4 ounces of orange juice or other fruit juice
• Hard candy or 1 tablespoon of honey
• Commercial glucose products such as glucose gel or
glucose tablets
• Glucagon by the subcut, IM, or IV routes
• Glucose 10% or 50% IV (Ford 458)
Nursing management
• Monitor blood glucose closely when starting or stopping
therapy.
• Monitor HbA1c number is to be lower than 6%
• Chlorpropamide, tolazamide, and tolbutamide are given
with food to prevent GI upset. However, because food
delays absorption, glipizide should be given 30
minutes before a meal. Glyburide and glimepiride are
administered with breakfast or with the rst main meal
of the day. Repaglinide can be taken immediately or up
to 30 minutes before meals. Nateglinide is taken up to
30 minutes before meals.
• Take the drug exactly as directed on the container (e.g.,
with food, 30 minutes before a meal).
• An antidiabetic drug is not oral insulin and cannot be
substituted for insulin.
• Never stop taking this drug or increase or decrease the
dose unless told to do so by the primary health care
provider.
• Take the drug at the same time or times each day.
(Ford 460)

Generic Trade Safe Dose Route

Chlorpropamide Type 2 Diabetes as an adjunct to diet
Diabense 100-250 mg orally/ day
First Generation and exercise. Diabetes insipidus

Glimepiride Type 2 Diabetes as an adjunct to diet

Amaryl 1-4 mg orally/day
2nd Generation and exercise. May be used with insulin

Nateglinide Type 2 diabetes in combination with 60-120 mg orally TID

Starlix
Meglitinide metformin for glycemic control before meals
 Thyroid Drugs

How do they work? “Action” Contraindications

These hormones increase the metabolic rate of
tissues, which results in increases in the heart and respi-
ratory rate, body temperature, cardiac output, oxygen
consumption, and the metabolism of fats, proteins, and
carbohydrates. (Ford 483)
• Hypersensitivity to the drug
• n uncorrected adrenal cortical insu ciency
• Thyrotoxicosis.
• These drugs should not be used as a treatment for
obesity or infertility.
• Thyroid hormone should not be used after a recent
myocardial infarction. (Ford 483)

Indications Nursing management

Thyroid hormones are used in the treatment or • Monitor cardiac status
prevention of hypothyroidism caused by the • Monitor thyroid labs
following:
• Replacement therapy is for life, with the exception of
• Subacute or chronic thyroiditis (Hashimoto’s
disease or viral thyroiditis) transient hypothyroidism seen in those with thyroiditis.
• Hormone supplement after hyperthyroid treatment • Do not increase, decrease, or skip a dose unless advised
• Euthyroid goiter (enlargement of a normal thyroid to do so by the primary health care provider.
gland)
• Thyroid nodules and multinodular goiter • Take this drug in the morning, preferably before
• Some types of depression breakfast, unless advised by the primary health care
• Thyroid cancer (Ford 483) provider to take it at a di erent time of day.
• Notify the primary health care provider if any of the
following occur: headache, nervousness, palpitations,
diarrhea, excessive sweating, heat intolerance, chest
pain, increased pulse rate, or any unusual physical
Adverse effects ev t r e change or event.
• Do not change from one brand of this drug to another
• Palpitations without consulting the primary health care provider.
• Tachycardia (Ford 486-487)
• Headache
• Nervousness
• Insomnia
• Diarrhea
• Vomiting
• weight loss Interactions:
• Fatigue
• Sweating • et c ers: ecreased e ectiveness of
• flushing ord cardiac drug
• Oral antidiabetics and insulin: Increased risk of
hypoglycemia
• Oral anticoagulants: Prolonged bleeding
• e ect ve ser t re t e t r
Adverse Reactions antidepressants: ecreased e ectiveness of thyroid
drug
The most common adverse reactions are signs of • All other antidepressant drug categories:
overdose and hyperthyroidism as titration of the drug is Increased e ectiveness of thyroid drug
being attempted. Adverse reactions other than symptoms (Ford 483)
of hyperthyroidism are rare. (Ford 483)

Generic Trade Dose Route

Hypothyroidism, thyroid-stimulating
Levothroid, Levoxyl, 100–125 mcg/day
Levothyroxine hormone suppression, thyrotoxicosis,
Synthroid, Unithroid orally
thyroid diagnostic testing
 Diabetes Drugs
- Insulin

How it works? “Action” Contraindications & Caution

Activates a process that allows glucose molecules to enter the cell
“ Thick of it like a Key opening a door, the cell is the door. The insulin is
the key”
Onset, peak, and duration are three important properties of
insulin:
• Onset: when insulin rst begins to act in the body
• Peak: when the insulin is exerting maximum action
• Duration: the length of time the insulin remains in e ect
peci c insulin products are contraindicated when the patient is hypoglycemic.
Insulin is used cautiously in patients with renal or hepatic impairment and during
pregnancy and lactation. The insulins are grouped in pregnancy category B
except for insulin glargine and insulin aspart, which are in pregnancy category C.
Insulin appears to inhibit milk production in lactating women and could interfere
with breastfeeding. actating women may re uire ad ustment in insulin dose and
diet. ord

Interactions:
Indications
Eucalyptus products: ay cause decreased blood sugar.
Insulin is used to: r s t cre se t e Effect ess s e
• Control type diabetes Required)
• Control type diabetes when uncontrolled by diet e ercise or • angiotensin-converting en yme CE inhibitors alcohol
weight reduction • anabolic steroids antidiabetic drugs oral -blocking drugs
• Treat severe diabetic ketoacidosis K or diabetic coma • Calcium clonidine disopyramide fluo etine brates lithium
• Treat hyperkalemia in combination with glucose • OIs mebenda ole pentamidine pento ifylline yrido ine salicylates
somatostatin analog, sulfonamides, tetracycline
e ected r s t ecre se t e Effect re s e e red
Adverse Reactions • ceta olamide albuterol antipsychotics atypical or second generation
• Asparaginase, calcitonin,contraceptives, oral corticosteroids
Hypoglycemia • Cyclophosphamide dana ol diltia em diuretics dobutamine
• The patient eats too little food. • Epinephrine estrogens glucagon human immunode ciency virus
• The insulin dose is incorrectly measured and is greater than that IV antivirals
prescribed. • Isoniazid, lithium, morphine sulfate, niacin, nicotine,
• The patient has drastically increased demands activity or illness . phenothia ines phenytoin progestogens protease inhibitors
somatropin terbutaline thia ide diuretics thyroid hormones
Hyperglycemia
• The patient eats too much food.
• Too little or no insulin is given.
• The patient experiences emotional stress, infection, surgery, Types of Insulins Names
pregnancy, or an acute illness. insulin ispro- umalog
Rapid-Acting
Insulin spart-Novolog
Regular Insulin- umulin R
Nursing management hort- cting • Regular insulin is the only one given IV
• Concentrated insulin-Insulin -
• Obtain B before administration of any insulin.
• Obtain B 3 minutes post insulin administration. Intermediate-Acting N - umulin N Novolin R
• Educate the patient how to self administer insulin and signs of
symptoms of hyper/hypoglycemia. Insulin Glargine-Lantus
• Monitor for hypoglycemia Long-Acting • Cannot mix with others Insulin
• Monitor for hyperglycemia etemir- evemir
• Monitor potassium levels
• Regular insulin is clear, whereas intermediate- and long-acting NPH/REG
insulins are cloudy. The clear insulin should be drawn up rst. hen • umulin • umulin 3 • Novolin 3
insulin lispro is mixed with a longer-acting insulin, the insulin lispro remi ed Aspart protamine/aspart • Novolog i 3
is drawn up rst. ord s r r t e s r • umalog i

Generic Trade Safe Dose Route

ispro umalog m - min - h

spart Novolog - m -3h 3- h

Regular 3 - m - h - h
umulin R IV -3 m IV -3 m IV 3 - m
N umulin N 8-12h - h None
Novolin R
Glargine antus None None h

etemir evemir 3- h None h

Mineralocorticoids

How do they work? “Action” Contraindications

Natural mineralocorticoids consist of Fludrocortisone is contraindicated in patients
aldosterone and desoxycorticosterone and with hypersensitivity to fludrocortisone and
play an important role in conserving sodium those with systemic fungal infections.
and increasing potassium excretion. Because of
these activities. Mineralocorticoids are
important in controlling salt and water balance.
Aldosterone is the more potent of these two
hormones. e ciencies of mineralocorticoids
result in a loss of sodium and water and a
retention of potassium. (Ford 474)

Indications
Mineralocorticoids are important in controlling
salt and water balance. Aldosterone is the more
potent of these two hormones. e ciencies of
mineralocorticoids result in a loss of sodium
and water and a retention of potassium.
(Ford 474)
Nursing management
• Take the drug as directed. Do not increase or
decrease the dosage except as instructed to
do so by the primary health care provider.
• Do not discontinue use of the drug abruptly.
• Inform the primary health care provider if the
following adverse reactions occur: edema,
muscle weakness, weight gain, anorexia,
swelling of the extremities, dizziness, severe
headache, or shortness of breath. (Ford 477)

Adverse Reactions
Adverse reactions may occur if the dosage is
too high or prolonged or if withdrawal is too
rapid. dministration of fludrocortisone may Interactions:
cause: • ludrocortisone decreases the e ects of
• Edema hydantoins and rifampin. There is a
• Hypertension decrease in serum levels of salicylates
• HF, enlargement of the heart when those agents are administered with
• Increased sweating, allergic skin rash fludrocortisone. ord
• Hypokalemia, muscle weakness, headache,
hypersensitivity reactions (Ford 474)

Generic Trade Use Dose

Partial replacement therapy for Addison’s 0.1 mg 3 times a week to 0.2 mg/day
Fludrocortisone None
disease, salt-losing adrenogenital syndrome orally
 Glucocorticoids
How do they work? “Action”
Glucocorticoids influence or regulate functions such as the immune
response;glucose, fat, and protein metabolism; and the
anti-inflammatory response. Glucocorticoids enter target cells and
bind to receptors, initiating many complex reactions in the body
Indications
• drenocortical insu ciency replacement therapy
• Allergic reactions
• Collagen diseases (e.g., systemic lupus erythematosus)
• Dermatologic conditions
• Rheumatic disorders
• Shock
• Multiple other conditions
Contraindications
• Tuberculosis
• fungal and antibiotic-resistant infections.
Glucocorticoids are administered with caution to patients with
renal or hepatic disease, hypothyroidism, ulcerative colitis, diverticulitis,
peptic ulcer disease inflammatory bowel disease hypertension
osteoporosis, convulsive disorders, or diabetes.
Patients taking ACTH should avoid any vaccinations with live virus. The
live virus vaccines can potentiate virus replication with ACTH, increase
any adverse reaction to the vaccine, and decreasethe patient’s antibody
response to the vaccine.
Interactions:
• Cholestyramine: E ects of hydrocortisone may be decreased.
• Oral contraceptives: E ects of corticosteroid may be increased.
• Estrogens: E ects of corticosteroid may be increased.
• Hydantoins: E ects of corticosteroid may be decreased.
• Ketoconazole: E ects of corticosteroid may be increased.
• Rifampin: E ects of corticosteroid may be decreased.
• Anticholinesterases: nticholinesterase e ects may be antagoni ed
in myasthenia gravis.
• Oral anticoagulants: Anticoagulant dose requirements may be
reduced. Corticosteroids may decrease the anticoagulant action.
• Digitalis glycosides: Coadministration may enhance the possibility of
digitalis toxicity associated with hypokalemia.
• Isoniazid: Isoniazid serum concentrations may be decreased.
• Potassium-depleting diuretics: Hypokalemia may occur.
• Salicylates: Corticosteroids will reduce serum salicylate levels and
may decrease their e ectiveness.
• Theophyllines: Alterations in the pharmacologic activity of either
agent may occur.
Generic Trade
Endocrine disorders, rheumatoid disorders,
collagen disease, dermatologic disorders,
Medrol, Depo-Medrol, allergic state, ophthalmic disorders, respiratory
Dexamethasone
Solu-Medrol disorders, hematologic disorders, neoplastic
disease, edema, GI disease, Nervous system
disorders
Prednisone None Same as dexamethasone
Adverse Reactions
• Fluid and electrolyte disturbances: odium and fluid retention
potassium loss, hypokalemic alkalosis, hypertension, hypokalemia,
hypotension or shock-like reactions
• Musculoskeletal disturbances: Muscle weakness, loss of muscle
mass, tendon rupture, osteoporosis, aseptic necrosis of femoral and
humeral heads, spontaneous fractures
• Cardiovascular disturbances: Thromboembolism or fat embolism;
thrombophlebitis; necrotizing angiitis; syncopal episodes; cardiac
arrhythmias; aggravation of hypertension; fatal cardiac arrhythmias
with rapid, high-dose IV methylprednisolone administration; HF in
susceptible patients
• GI disturbances: Pancreatitis, abdominal distention, ulcerative
esophagitis, nausea, vomiting, increased appetite and weight gain,
possible peptic ulcer or bowel perforation, hemorrhage
• Dermatologic disturbances: Impaired wound healing; thin, fragile
skin; petechiae; ecchymoses; erythema; increased sweating;
suppression of skin test reactions; subcutaneous fat atrophy; purpura;
striae; hirsutism; acneiform eruptions; urticaria; angioneurotic edema;
perianal itch
• Neurologic disturbances: Convulsions, increased intracranial
pressure with papilledema (usually after treatment is discontinued),
vertigo, headache, neuritis or paresthesia, steroid psychosis, insomnia
• Endocrine disturbances: Amenorrhea, other menstrual irregularities,
development of cushingoid state, suppression of growth in children,
secondary adrenocortical and pituitary unresponsive (particularly in
times of stress), decreased carbohydrate tolerance, manifestation of
latent diabetes mellitus, increased requirements for insulin or oral
hypoglycemic agents (in diabetic patients)
• Ophthalmic disturbances: Posterior subcapsular cataracts, increased
intraocular pressure, glaucoma, exophthalmos
• Metabolic disturbances: Negative nitrogen balance (due to protein
catabolism)
• Other disturbances: Anaphylactoid or hypersensitivity reactions,
aggravation of existing infections, malaise, increase or decrease in
sperm motility and number
Nursing management
• Never omit a dose of a glucocorticoid
• Patients with diabetes who are receiving a glucocorticoid may require
frequent adjustment of their insulin or oral antidiabetic drug dosage.
(Ford 476)
• Administration of the glucocorticoids poses the threat of adrenal gland
insu ciency ord
• Glucocorticoid therapy should never be discontinued suddenly
(Ford 476)
• Take the drug exactly as directed in the prescription container. Do not
increase, decrease, or omit a dose unless advised to do so by the
primary health care provider.
• Take single daily doses before 9:00 a.m.
• Follow the instructions for tapering the dose, because they are
extremely important.
• If the problem does not improve, contact the primary health care
provider. (Ford 477)
Use Route
Individualize dosage based on severity
of condition and response
Individualize dosage: initial dose
usually between 5 and 60 mg/day orally
 Antithyroid Drugs

d t e r Act Adverse effects

• Numbness
Antithyroid drugs or thyroid antagonists are used to treat • Headache
hyperthyroidism. In addition to the antithyroid drugs, • loss of hair
• skin rash
hyperthyroidism may be treated by the use of radioactive • nausea, vomiting
iodine or by surgical removal of some or almost all of the • agranulocytosis
thyroid gland subtotal thyroidectomy . ord
Antithyroid drugs inhibit the manufacture of thyroid
hormones. rs e e t
• Take these drugs at regular intervals around the clock
(e.g., every 8 hours) unless directed otherwise by the
dc t s primary health care provider.
• Do not take these drugs in larger doses or more
• et e e d r t r c frequently than as directed on the prescription
are used for the medical management of
hyperthyroidism. container.
• t ss d de may be given orally with methima • Notify the primary health care provider promptly if any
zole or propylthiouracil to prepare for thyroid surgery. of the following occur: sore throat, fever, cough, easy
ord
bleeding or bruising, headache, or a general feeling of
malaise.
• Record weight twice a week and notify the primary
health care provider if there is any sudden weight gain
Adverse e ct s or loss. (Note: the primary health care provider may also
• Hay fever, sore throat, skin rash, fever, headache want the patient to monitor pulse rate. If this is recom
• Nausea, vomiting, paresthesias mended, the patient needs instruction in the proper
• Agranulocytosis (decrease in the number of white blood
cells) technique and a recommendation to record the pulse
• Exfoliative dermatitis, granulocytopenia, rate and bring the record to the primary health care
hypoprothrombinemia provider’s o ce or clinic.
• rug-induced hepatitis ord
• Avoid the use of nonprescription drugs unless the
primary health care provider has approved the use of a
speci c drug. ord

tr dc t s
Mothers taking methimazole or propylthiouracil should ter ct s:
not breastfeed their children. Radioactive iodine (preg-
nancy category X) is contraindicated during pregnancy • et c ers: ecreased e ectiveness of
and lactation. Methimazole and propylthiouracil are used cardiac drug
with extreme caution during pregnancy (pregnancy • r td et cs d s : Increased risk of
category D) because they can cause hypothyroidism in hypoglycemia
the fetus. However, if an antithyroid drug is necessary
during pregnancy, propylthiouracil is the preferred • r tc ts: Prolonged bleeding
drug, because it does not cross the placenta. The • e ect ve ser t re t e t r
potential for bleeding increases when these products are t de ress ts: ecreased e ectiveness of thyroid
taken with oral anticoagulants. ord drug
• A t er t de ress t dr c te r es: Increased
e ectiveness of thyroid drug ord 3

e er c r de se te

mg day orally divided doses at

Propylthiouracil None Hyperthyroidism
8-hr intervals
 Diabetes Drugs
- Incretin Mimetics

How do they work? “Action” Contraindications & Caution

Hormone mimetic agents help control blood • Type 1 diabetes mellitus
glucose levels by maintaining cell function of • Diabetic ketoacidosis
the pancreas, enhancing insulin secretion, and • Kidney disease
suppressing glucagon, which signals the liver to • Pregnancy
decrease release of glucose. Gastric emptying is
also delayed, which slows carbohydrate
absorption. Interactions:
Sitagliptin (Januvia) lowers the blood glucose
level of those with type 2 diabetes by enhancing • May slightly increase serum digoxin levels.
the secretion of the endogenous incretin Monitoring recommended.
hormone. • Increased risk of hypoglycemia when used with
Exenatide (Byetta) mimics the action insulin, glyburide, glipizide, or glimepiride (may
of the incretin hormone. Pramlintide (Symlin) need to increase dose of insulin or
mimics the action of another secretion, amylin. sulfonylurea).

Nursing management
Indications
• Observe patient for signs and symptoms of
Oral antidiabetic drugs are used in the hypoglycemic reactions (abdominal pain,
treatment of patients with type 2 diabetes sweating, hunger, weakness, dizziness,
mellitus whose condition cannot be controlled headache, tremor, tachycardia, anxiety).
by diet alone. (Ford 452) • Monitor for signs of pancreatitis (nausea,
vomiting, anorexia, persistent severe
abdominal pain, sometimes radiating to the
Adverse Reactions back) during therapy. If pancreatitis occurs,
discontinue sitagliptin and monitor serum and
• nausea urine amylase, amylase/creatinine clearance
• vomiting ratio, electrolytes, serum calcium, glucose, and
• upset stomach lipase.
• diarrhea • Assess for rash periodically during therapy.
• constipation • Advise patient to stop taking sitagliptin and
• weight loss notify health care professional promptly if
• loss of appetite symptoms of hypersensitivity reactions (rash;
• heartburn hives; swelling of face, lips, tongue, and throat;
• dizziness di culty in breathing or swallowing or pancre
• headache atitis occur.

Generic Trade Safe Dose Route

Sitagliptin Januvia Type 2 Diabetes 100 mg orally daily

5-10 mcg sub q within

Exenatide Byetta Type 2 Diabetes
one hour of a meal

Liraglutide Victoza Type 2 diabetes 0.6-1.2 mg subq daily

Herbal Supplements

Bleed Risk:

E G G PRIORITY

Vitamin E Ginger Garlic

All Supplements LOSARTAN

Vitamin E

KEY POINTS
Assess or interactions with clients
other meds
G G O PRIORITY! Drug to drug
Ginkgo Ginseng Omega 3
Biloba intera tion 2 - 3 weeks

STOP 2 - 3 weeks before surgery

<80 JOINT Prostate

Glucosamine Saw
me o
a alme o H
WATCH for hypoglycemia
when taking anti diabeti med
SP – Saw Palme o
Benign Prostate SP – Swollen Prostate
Hypertrophy

Menopause – “HOT FLASHES”

ATI Question
Black
Cohosh Black Cohosh
Glucosamine
Bad oHOT a
Glucosamine
= Treats art riti pain

Mental -
S S S Depression & Insomnia
V - Valerian
V - Valium e e t
H H
! S - St. John Wort a e t
Heart S - Serotonin - CAUTION
- Serotonin syndrome!
Hawthorn
H - Heart Serotonin S - Stay away from
H - Hawthorn extract
Extract
Antide re ant

KEY PRIORITY
DO NOT MIX!!!
1. ntide re ant
E E Skin
2. erotonin ndrome
E - Eczema/ Mild signs
Shivering/ Diarheas
Evening
Primrose Oil s in irritations
Severe signs
E - Evening Muscle rigidity/ Fever
Primerose Seizures
Death

Notes
 Vitamins &
Electrolytes
Drug name:
Iron Indication: Kaplan &
KEY POINTS
HESI ue tion
Treat anemia r/t Dark or black stools =
Indication:
Ferrous Sulfate (oral)Iron Dextran (IV / IM)
iron de ciency Normal & Expected al ium i en it ferrou
C E so tion
ulfate
NOT GI BLEED
ran e ui e fruit ui e en an e
FERROUS
Empty stomach a or tion
IRON
SULFATE DEXTRAN 1 HOUR BEFORE Ferrous Sulfate
medi ation ea in i e ti e en t e lient
tate ill eat more fre fruit and
ole rain read

B12 (Cyanocobalamin) Key Point: Folic Acid ile ta in Pre nant atient HESI
Sulfa drugs
(Sulfa ala ine) Prevents of neural
Indication ernicious anemia atients who lack
Body lacks intrinsic factors Folic acid
tu e defe t
olic acid nemia
so can’t absorb building u lement a e efore
low blood cell count re nan
blocks to make RBCs m da
ulfa drugs decrease
iron folic acid B
folic acid absorption

SULFA
DRUGS

Pottasium K+ Indication: Memory Trick:

stin K+ Sparing
iureti Drugs
ypokalemia
low K below 3. S - S ironola tone
“-ide”
POTASSIUM S Sartan oSartan
K
Furosemide
PUMPS muscles
P Pril i inoPril
Hydrochlorothiazide
3.5

Supplement

Key Point: otassium umps the eart

Potassium IV Normal 3... - .
K
KEY POINTS
. irst ction eart monitor
SLOW infu ion rate 3 . Never push E T
if infu ion irritates client
re ort of urnin di omfort
3. ON - mE hr! IV ump
most commonly
chosen distractor 48% . low infusion if arm burns

Magnesium Indication: Key Terms: HESI Question ATI Question

Sulfate Magnesium sulfate …

Po i le ndin in a ne orn Mg
en to STOP t e infu ion
Preterm labor ild ontra tion CAUTION la id mu le tone
e irator rate elo e irator de re ion
nti on ul ant Respiratory Depression
MAGNESIUM SULFATE Decreased DTRs
Cardiac or ade de Pointe Paralysis & weak muscles
MELLOWS the muscles NCLEX TIP
= Low DTRs

Kaplan Question

STOP at i t e indi ation for

Mag Sulfate? MAGNESIUM
SULFATE

e la e for lo ma ne ium Mg

( elo )
DTR reatment for Torsades de 1.5

Pointes NCLEX TIP

Antispasmodic
- Dicyclomine

Drug name: de Effect:

Dry body: Constipation, dry mouth, urine retention

Dicyclomine
(brand: Bentyl)

Dicyclomine
Bentyl

MOA:

Relaxation of smooth muscle & dries secretions

KEY POINT
ontraindications A
- aral tic leus
or o el o tru tion
NOT - Narrow-angle glaucoma
(cataracts are ok!)
Antispasmodic Anticholinergic - ull bladder m
urinar retention

dc t :

IBS (Irritable bowel syndrome) > 400 ML

with many loose stools per day

20

MEMORY TRICK

NO pee NO see NO spit & NO sh*t

Not for full bladder Not glaucoma o el o tru tion Paral ti ileu

> 400 ML

Notes
Antiemetics
Anti-Nausea & Vomiting

Drug name: Drug name:

Ondansetron Metoclopramide
(brand: Zofran) ( rand e lan)
Ondansetron
Zofran

HESI EXIT HESI

Priorit ide e e t or ade de Pointe
ontraindi ated
leedin duodenal ul er

Key Point:

QUESTION
KEY POINT
re ri tion order
& REPORT TO HCP
IMMEDIATELY!!
NORMAL
HIGH
LOW

A itation erten ion KEY WORDS

i ma in
Pu n of ee
lin in of e e
a i ardia u le i idit

Serotonin S ndrome

ATI ue tion
Ondansetron u ed to de rea e
au ea omiting au ed
emo Memory Trick:
HESI ue tion
ue tion KEY POINT
urin infu ion ild re ort
nausea and vomits riorit M - Metoclopramide
nur in a tion M – Major lip smacking
pu ng chee s
n er
S P t e emo u t e line REPORT
and administer ondansetron

Notes
 Acid Reducers
- Proton Pump Inhibitors

How do they work? “Action” Critical Thinking

These drugs suppress gastric acid secretion by inhibition of the
hydrogen-potassium adenosine triphosphatase T ase en yme
system of the gastric parietal cells. The ATPase enzyme system is
also called the acid proton pump system. The proton pump
inhibitors suppress gastric acid secretion by blocking the nal
step in the production of gastric acid by the gastric mucosa.
Think of it as putting a cap on a volcano so it doesn't erupt!
Why are they used for? ‘’Indications’’
• Gastric and duodenal ulcers speci cally associated with .
pylori infections
• GERD and erosive esophagitis
• Pathologic hypersecretory conditions
• Prevention of bleeding in high-risk patients using antiplatelet
drugs
An important use of these drugs is combination therapy for the
treatment of . pylori infection in patients with duodenal ulcers.
One treatment regimen used to treat infection with . pylori is
a triple-drug therapy, such as one of the proton pump inhibitors
e.g. omepra ole or lansopra ole and two anti-infectives e.g.
amo icillin and clarithromycin . ord
Adverse effects
• Headache, nausea, diarrhea, and abdominal pain.
Contraindications
• Hypersensitivity
• lansopra ole rabepra ole and pantopra ole pregnancy
category B are contraindicated during pregnancy and
lactation.
Caution
• Older adults
• patients with hepatic impairment.
• Prolonged treatment may decrease the body’s ability to absorb
vitamin B12, resulting in anemia.
• Omepra ole pregnancy category C
• Menopausal Women
n increase in fractures of the hip wrist and spine have been
seen in those taking high doses of proton pump inhibitors and
undergoing treatment of osteoporosis with bisphosphonates.
Interactions:
• Sucralfate: Decreased absorption of the proton pump inhibitor
• Ketoconazole and ampicillin: Decreased absorption of the
anti-infective
• Oral anticoagulants: Increased risk of bleeding
• Digoxin: Increased absorption of digoxin
• Benzodiazepines, phenytoin: Risk for toxic level of antiseizure
drugs
• rt r c t e r e s ec c : Risk for an
increase in plasma levels of both drugs
• Bisphosphonates: Increased risk of fracture
Nursing management
• Because of the possibility of an antacid interfering with the
activity of other oral drugs, no oral drug should be adminis
tered within to hours of an antacid.
• When one of these drugs is given IV, monitor the rate of
infusion at frequent intervals. Too rapid an infusion may
induce cardiac arrhythmias.
• Keep a record of the patient’s bowel movements because
these drugs may cause constipation or diarrhea.
• Observe the patient for signs of dehydration which include
poor skin turgor, dry mucous membranes, decrease in or
absence of urinary output, concentrated urine, restlessness,
irritability, increased respiratory rate, and confusion.
• Instruct the patient to chew the tablets thoroughly before
swallowing and then drink a full glass of water or milk.
• agnesium-containing products may produce a la ative e ect
and may cause diarrhea; aluminum- or calcium-containing
antacids may cause constipation.
• Taking too much antacid may cause the stomach to secrete
e cess stomach acid. Consult the primary health care provider
or pharmacist about appropriate dose. Do not use the
ma imum dose for more than weeks e cept under the
supervision of a primary health care provider.

Generic Trade Use Dose

Erosive esophagitis, GERD, H. pylori eradication,
esomeprazole Nexium 20–40 mg/day orally
NSAID-associated gastric ulcers
Same as esomeprazole, hypersecretory
omeprazole Prilosec 20–60 mg/day orally
conditions, heartburn, reduce risk of upper GI bleeding
40 mg/day orally or IV
pantoprazole Protonix GERD, erosive esophagitis and hypersecretory conditions
Hypersecretion: 80 mg IV q 12 hr

Same as esomeprazole, hypersecretory conditions,

lansoprazole Prevacid 15–30 mg/day orally
cystic e brosis intestinal malabsorption
 Histamine H2 Agonist
- Acid Reducers

How do they work? “Action” Interactions:

Reduces the secretion of gastric acid by inhibiting the
action of histamine at H2 receptor cells of the stomach.
Why are they used for? ‘’Indications’’
• Antacids and metoclopramide: Decreased
absorption of the H2 antagonists
• Carmustine: Decreased white blood cell count
• Opioid analgesics: Increased risk of respiratory
depression
• Oral anticoagulants: Increased risk of bleeding
• Digoxin: May decrease serum digoxin levels

• Heartburn, acid indigestion, and sour stomach

(frequently sold as over-the-counter remedies)
• GERD Nursing management
• Gastric or duodenal ulcer
• Gastric hypersecretory conditions (excessive gastric • Because of the possibility of an antacid interfering with
secretion of HCl) the activity of other oral drugs, no oral drug should be
administered within 1 to 2 hours of an antacid.
• When one of these drugs is given IV, monitor the rate of
infusion at frequent intervals. Too rapid an infusion may
induce cardiac arrhythmias.
Adverse effects • Keep a record of the patient’s bowel movements,
because these drugs may cause constipation or
• Dizziness, somnolence, headache diarrhea.
• Confusion, hallucinations, diarrhea, and reversible • Observe the patient for signs of dehydration, which
impotence include poor skin turgor, dry mucous membranes,
decrease in or absence of urinary output, concentrated
urine, restlessness, irritability, increased respiratory rate,
and confusion.
• Instruct the patient to chew the tablets thoroughly
Contraindications before swallowing and then drink a full glass of water or
milk.
• Hypersensitivity • Magnesium-containing products may produce a laxative
e ect and may cause diarrhea aluminum- or
calcium-containing antacids may cause constipation.
• Taking too much antacid may cause the stomach to
secrete excess stomach acid. Consult the primary health
Caution
care provider or pharmacist about appropriate dose. Do
• Renal or hepatic impairment not use the maximum dose for more than 2 weeks,
• In severely ill, older, or debilitated patients. except under the supervision of a primary health care
• Cimetidine is used cautiously in patients with diabetes. provider.
Histamine H2 antagonists are pregnancy category B
(cimetidine, famotidine, and ranitidine) and C (nizatidine)
drugs and should be used with caution during Hint!
pregnancy and lactation.
• ook for similarities such as uses and su es
• Meds that end in * Dine are H2 antagonists

Generic Trade Use Dose

800–1600 mg/day orally; 300 mg q
Gastric/duodenal ulcers, GERD, gastric
Cimetidine Tagamet 6 hr IM or IV
hypersecretory conditions, GI bleeding, heartburn

Gastric/duodenal ulcers, GERD, gastric 20–40 mg orally; IV if unable to

Famotidine Pepcid
hypersecretory conditions, GI bleeding, heartburn take orally
150–600 mg orally in one dose or divided
Gastric/duodenal ulcers, GERD, gastric
Ranitidine Zantac doses orally; 50 mg q 6–8 hr IM, IV
hypersecretory conditions, GI bleeding, heartburn (do not exceed 400 mg/day)
 GI Stimulants
How do they work? “Action”
Increases the motility of the upper GI tract without
increasing the production of secretions. By sensitizing
tissue to the e ects of acetylcholine the tone and
amplitude of gastric contractions are increased, resulting
in faster emptying of gastric contents into the small
intestine. It also inhibits stimulation of the vomiting center
in the brain.
Why are they used for? ‘’Indications’’
• GERD
• Gastric stasis (failure to move food normally out of the
stomach) in diabetic patients, in patients with nausea
and vomiting associated with cancer chemotherapy, and
in patients in the immediate postoperative period
Adverse effects
Higher doses or prolonged administration may produce
central nervous system (CNS) symptoms, such as
restlessness drowsiness di iness e trapyramidal e ects
(tremor, involuntary movements of the limbs, muscle
rigidity), facial grimacing, and depression.
Contraindications
• Hypersensitivity to the drug
• GI obstruction, gastric perforation or hemorrhage
• Pheochromocytoma.
• Patients with Parkinson’s disease or a seizure disorder
who are taking drugs likely to cause extrapyramidal
symptoms should not take these drugs.
Caution
• Diabetes and cardiovascular disease
• Caution during pregnancy and lactation because it is
excreted in breastmilk
Generic Trade Use
Diabetic gastroparesis, GERD,
Metoclopramide Reglan
prevention of nausea and vomiting
Interactions:
• Cholinergic blocking drugs or opioid analgesics:
ecreased e ectiveness of metoclopramide
• Cimetidine: Decreased absorption of cimetidine
• Digoxin: Decreased absorption of digoxin
• Monoamine oxidase inhibitor antidepressants:
Increased risk of hypertensive episode
• Levodopa: Decreased metoclopramide and levodopa
Nursing management
• When one of these drugs is given IV, monitor the rate of
infusion at frequent intervals. Too rapid an infusion may
induce cardiac arrhythmias.
• Give on an empty stomach
• Monitor for symptoms of EPS and tardive dyskinesia
• Keep a record of the patient’s bowel movements,
because these drugs may cause constipation or
diarrhea.
• Observe the patient for signs of dehydration, which
include poor skin turgor, dry mucous membranes,
decrease in or absence of urinary output, concentrated
urine, restlessness, irritability, increased respiratory rate,
and confusion.
• Instruct the patient to chew the tablets thoroughly
before swallowing and then drink a full glass of water or
milk.
• Magnesium-containing products may produce a laxative
e ect and may cause diarrhea aluminum- or
calcium-containing antacids may cause constipation.
• Taking too much antacid may cause the stomach to
secrete excess stomach acid. Consult the primary
health care provider or pharmacist about appropriate
dose. Do not use the maximum dose for more than 2
weeks, except under the supervision of a primary health
care provider
Critical Thinking
• Tardive dyskinesia (nonreversible, involuntary muscle
spasms), which is typically associated with conventional
antipsychotics, is known to occur with long-term use (12
weeks or more) of metoclopramide. Immediately report
extrapyramidal symptoms to prevent tardive dyskinesia
from occurring.
Dose
10–15 mg orally; 10–20 mg IM, IV
 Emetics

How do they work? “Action” Contraindications

They neutralize or reduce the acidity of stomach
and duodenal contents by combining with HCl
and increasing the pH of the stomach acid. They
may increase the sphincter tone of the lower
esophagus. Examples of antacids include alumi-
num (Amphojel), magaldrate (Riopan), and mag-
nesium (Milk of Magnesia).
Why are they used for? ‘’Indications’’
Used to empty the stomach rapidly when
someone has ingested poison or for drug
overdose
Adverse effects
• Dehydration
• Nausea vomiting
• Tachycardia
• Electrolyte imbalance
• Do not use on patients who are fully
conscious
• Only use under the supervision of a licensed
healthcare provider
• Do not use if turpentine, corrosives, alkalies
(lye for soap), strong acids, petroleum
distillates kerosene cleaning fluid paint
thinner, or furniture polish.
• Do not use if patient is comatose , has altered
mental status, or is at risk for aspiration of
stomach contents
• Do not give if a patient is having seizures
• Do not give if the substance ingested can
cause altered mental status or seizures
• Do not give if the agent is caustic or corrosive
such as kerosene which brings a high risk of
pulmonary aspiration.
• Do not give if the patient has a medical
condition that can be exacerbated by vomiting;
Bradycardia severe hypertension, hemorrhagic
diathesis.
• Do not give during pregnancy or lactation
• Do not give if the patients has crohn's disease

Nursing management

• Before giving the emetic you must know:

Interactions: The chemical ingested, time ingested, and
what symptoms occur before being brought in.
• ctivated charcoal ecreases the e ects of • The primary healthcare provider should also
Ipecac call the poison control center to obtain
information on proper treatment.

Generic Trade Use Dose

To cause vomiting after suspected poisoning: 15mL
ipecac syrup followed by 1-2 glasses of water. This dose
may be repeated once in 20 minutes if vomiting does not
Induction of vomiting post poison
Ipecac n/a occur. Before using ipecac syrup to treat poisoning, call a
ingestion or drug overdose poison control hotline for advice. Ipecac syrup is available
both as a nonprescription product and as an FDA-approved
prescription product.
 Mucosal Protectant

Drug name: Drug name:

SUCRALFATE

Sucralfate SUCRALFATE
Misoprostol
(brand: Carafate)

Indication:

Indication: Protect against gastric ulcers

Given to treat and prevent both MOA:

stomach and duodenal ulcers
(small intestines) Synthetic prostaglandin that
increases protective mucous
inside the stomach
MOA:
r Adverse Effect:
Forms thick protective layer over
ulcers to provide aphysical barrier
against stomach acids & enzymes Misoprostol
Miscarriage RISK!!!
KEY Point Due to cervical ripening
AVOID
FOOD & MEDS at least
1-2 hours efore or a er
taking med

DO NOT TAKE WITH

ANY OTHER MEDS!
Patient Education:

HESI Key Term

MEMORY TRICK Cervical ripening
MUST
SucralfATE Reliable birth control
2 hours Before YOU
Do not take with
ATE!!! antacids
Taken LATE (Anti A id Anti ANTIACIDS

Mixing meds)

Notes
Pancrelipase
Enzymes

Indication: MOA:

Given to replace digestive enzymes • Enzymes help break down food

in patients with cystic fibrosis • end in ‘’-ase’’

ENZYMES
Helps break
down food
Lipase —> Fat
Protease —> Protein
Amylase —> Carb

KEY POINTS Kaplan ue tion

MUST be eaten Pancrelipase Admin:
WITH every Meal & Snack en a ule
or med i not e e ti e rin le ontent on
NOT before food it out e ing

A er

HESI ue tion
KEY TERM
Pancrelipase Admin:
edu tion in fa
tool i an e e ted
out ome

Notes
 Acid Neutralizers
How do they work? “Action”
They neutralize or reduce the acidity of stomach and duodenal
contents by combining with HCl and increasing the pH of the
stomach acid. They may increase the sphincter tone of the lower
esophagus. Examples of antacids include aluminum (Amphojel),
magaldrate (Riopan), and magnesium (Milk of Magnesia).
Why are they used for? ‘’Indications’’
• Heartburn, acid indigestion, or sour stomach
• Gastroesophageal reflux disease (GERD)
• Peptic ulcer
• Aluminum carbonate: Treats hyperphosphatemia associated
with chronic renal failure
Adverse effects
• Aluminum-containing antacids: constipation, intestinal
impaction, anorexia, weakness, tremors, and bone pain
• Magnesium: containing antacids—severe diarrhea,
dehydration, and hypermagnesemia (nausea, vomiting,
hypotension, decreased respirations)
• Calcium-containing antacids: rebound hyperacidity,
metabolic alkalosis, hypercalcemia, vomiting, confusion,
headache, renal calculi, and neurologic impairment
• Sodium bicarbonate: systemic alkalosis and rebound
hyperacidity
Contraindications
• Severe abdominal pain of unknown
• During lactation
• Sodium-containing antacids are contraindicated in patients
with cardiovascular problems, such as hypertension or heart
failure, and those on sodium-restricted diets.
• Calcium-containing antacids are contraindicated in patients
with renal calculi or hypercalcemia.
Think out of the box
Sodium bicarbonate
• Use: Symptomatic relief of peptic ulcer and stomach
hyperacidity
• Adverse effects: Electrolyte imbalance and metabolic alkalosis
Sodium bicarb is also given to someone who is in acidosis to
bind to the hydrogen ions and balance PH.
Generic Trade
Aluminum Symptomatic relief of peptic ulcer and
Basaljel
carbonate stomach hyperacidity, hyperphosphatemia
Calcium carbonate Symptomatic relief of peptic ulcer and stomach
(May cause acid rebound) Caltrate
hyperacidity, calcium deficiencies (osteoporosis)
Magnesia Milk of Symptomatic relief of peptic ulcer and
(magnesium hydroxide) Magnesia stomach hyperacidity, constipation
Caution
• Aluminum-containing antacids: gastric outlet obstruction or
those with upper GI bleeding.
• Magnesium- and aluminum-containing antacids: decreased
kidney function.
• Calcium-containing antacids: respiratory insufficiency, renal
impairment, or cardiac disease.
• Antacids are classified as pregnancy category C drugs and
should be used with caution during pregnancy
Interactions:
• Digoxin, isoniazid, phenytoin, and chlorpromazine:
Decreased absorption of the interacting drugs results in a
decreased effect of those drugs
• Tetracycline: Decreased effectiveness of anti-infective
• Corticosteroids: Decreased anti-inflammatory properties
• Salicylates: Pain reliever is excreted more rapidly in the urine
Nursing management
• Because of the possibility of an antacid interfering with the
activity of other oral drugs, no oral drug should be
administered within 1 to 2 hours of an antacid.
• When one of these drugs is given IV, monitor the rate of
infusion at frequent intervals. Too rapid an infusion may
induce cardiac arrhythmias.
• Keep a record of the patient’s bowel movements, because
these drugs may cause constipation or diarrhea.
• Observe the patient for signs of dehydration, which include
poor skin turgor, dry mucous membranes, decrease in or
absence of urinary output, concentrated urine, restlessness,
irritability, increased respiratory rate, and confusion.
• Instruct the patient to chew the tablets thoroughly before
swallowing and then drink a full glass of water or milk.
• Magnesium-containing products may produce a laxative effect
and may cause diarrhea; aluminum- or calcium-containing
antacids may cause constipation.
• Taking too much antacid may cause the stomach to secrete
excess stomach acid. Consult the primary health care provider
or pharmacist about appropriate dose. Do not use the
maximum dose for more than 2 weeks, except under the
supervision of a primary health care provider.
Use Dose
2 tablets or capsules (10 mL of
regular oral suspension) as often
as q 2 hr, up to 12 times daily
0.5–1.5 g orally
Antacid: 622–1244 mg (5–15 mL
in suspension) orally QID
Laxative: 15–60 mL orally
Antidiarrheal

How do they work? “Action” Adverse Reactions

Difenoxin (Motofen) and diphenoxylate (Lomotil) are
chemically related to opioid drugs; therefore, they
decrease intestinal peristalsis (Ford 436)
Loperamide (Imodium) acts directly on the muscle wall of
the bowel to slow motility and is not related to the
opioids. (Ford 437)
Why are they used for? ‘’Indications’’
• Loperamide: Chronic diarrhea associated with
irritable bowel syndrome
• Difenoxin & diphenoxylate: Diarrhea
• Anorexia, nausea, vomiting, and constipation
• Abdominal discomfort, pain, and distention
• Dizziness, drowsiness, and headache
• Sedation and euphoria
Interactions
• Antihistamines, opioids, sedatives, or hypnotics:
Increased risk of central nervous system (CNS)
depression
• Antihistamines and general antidepressants:
Increased cholinergic blocking adverse reactions
• Monoamine oxidase inhibitor (MAOI):
Increased risk of hypertensive crisis

Nursing management
Contraindications
• Review the patient’s chart for the course of treatment
• Known hypersensitivity and nd the reason for administration of the prescribed
• In patients whose diarrhea is associated with organisms drug
that can harm the intestinal mucosa (Escherichia coli, • Question the patient regarding the type and intensity of
Salmonella and Shigella spp.) (Ford 437) symptoms (e.g., pain, discomfort, diarrhea, or
• Pseudomembranous colitis constipation) to provide a baseline for evaluation of the
• Abdominal pain of unknown origin e ectiveness of drug therapy. ord 3
• Obstructive jaundice • Assess for relief of symptoms
• Antidiarrheal drugs are contraindicated in children • Monitor vitals
younger than 2 years of age. • Report abdominal distention , fever, or abdominal pain
• If diarrhea is chronic encourage increased fluid intake
such as , weak tea, water, bullion, or drinks that have
added electrolytes ( pedialyte, gatorade)
Caution • onitor fluid intake & output

• Severe hepatic impairment

• Pregnancy category C drugs and should be used
cautiously during pregnancy and lactation.
• Loperamide is a pregnancy category B drug but is
not recommended for use during pregnancy and
lactation.
Nclex Tip
If diarrhea persists for more than 2 days when
over-the-counter (OTC) antidiarrheal drugs are being
used, the patient should discontinue use and seek
treatment from the primary health care provider.
(Ford 437)

Generic Trade Use Dose

Pepto bismol, H. pylori infection with duodenal 2 tablets or 30 mL orally every 30 min
Bismuth ulcer, nausea, vomiting diarrhea,
bismatrol to 1 hr, up to 8 doses in 24 hr
abdominal cramps
Initial dose: 2 tablets orally, then 1
Difenoxin with Relieves symptoms of acute
Motofen tablet after each loose stool (not to
atropine diarrhea exceed 8 tablets/day)

Diphenoxylate with Relieves symptoms of acute

Lomotil, lonox 5 mg orally QID
atropine diarrhea
Initial dose 4 mg orally; then 2 mg after
Imodium, kaopectate, Relieves symptoms of acute
Loperamide each loose stool (not to exceed 16
maalox diarrhea mg/day)

Tincture of opium Paregoric Severe diarrhea 0.6 mL orally QID

 Aminosalicylates

How do they work? “Action” Nclex Tip

E ert a topical anti-inflammatory e ect in the bowel. The Hypoactive bowel sounds in severe cases of
exact mechanism of action of these drugs is unknown. obstipation (liquid stool leaked around the fecal mass,
presenting as loose stool) are evidence that the patient
is constipated which would indicate very di erent drug
Why are they used for? ‘’Indications’’ therapy. (Ford 439)
The aminosalicylates are used to treat Crohn’s disease
and ulcerative colitis as well as other inflammatory Nursing management
diseases.
• Review the patient’s chart for the course of treatment
and nd the reason for administration of the prescribed
Adverse Reactions
drug
• Abdominal pain • Question the patient regarding the type and intensity of
• Nausea symptoms (e.g., pain, discomfort, diarrhea, or
• Diarrhea. constipation) to provide a baseline for evaluation of the
• Headache e ectiveness of drug therapy. ord 3
• Dizziness • Assess for relief of symptoms
• Fever • Monitor vitals
• Weakness. • Report abdominal distention , fever, or abdominal pain
• If diarrhea is chronic encourage increased fluid intake
such as , weak tea, water, bullion, or drinks that have
Contraindications added electrolytes (pedialyte, gatorade)
• onitor fluid intake & output
• Known hypersensitivity
• hypersensitivity to sulfonamides and sul tes
• Intestinal obstruction Herbal Considerations
• Children younger than 2 years.
Chamomile has several uses in traditional herbal therapy,
including as a mild sedative and for treatment of
Caution digestive upsets, menstrual cramps, and stomach ulcers.
It has been used topically for skin irritation and inflamma-
Aminosalicylates are pregnancy category B drugs (except
tion. Chamomile is on the U.S. Food and Drug
olsalazine, which is in pregnancy category C); all are used
Administration (FDA) list of herbs generally recognized as
with caution during pregnancy and lactation
safe. It is one of the most popular teas in Europe. When
(safety has not been established).
used as an infusion, it appears to produce an
(Ford 436)
antispasmodic e ect on the smooth muscle of the GI
tract and to protect against the development of stomach
Interactions ulcers. Although the herb is generally safe and nontoxic,
the infusion is prepared from the pollen- lled flower
• Digoxin: Reduced absorption of digoxin heads and has resulted in mild symptoms of contact
• Methotrexate: Increased risk of immunosuppression dermatitis to severe anaphylactic reactions in individuals
• Oral hypoglycemic drugs: Increased blood glucose hypersensitive to ragweed, asters, and chrysanthemums
level (DerMarderosian, 2003). (Ford 436)
• Warfarin: Increased risk of bleeding

Generic Trade Use Dose

Balsalazide Colazal Treats active ulcerative colitis 2250 mg orally TID for 8 wk

Treats active ulcerative colitis, 800–1000 mg orally TID or QID

Mesalamine Asacol, Pentasa,
proctosigmoiditis, proctitis Suspension enema: 4 g daily

Maintenance and remission of

Olsalazine Dipentum 1 g/day orally in two divided doses
ulcerative colitis

Ulcerative colitis, rheumatoid Initial: 3–4 g/day orally in divided

Sulfasalazine ul dine
arthritis doses Maintenance: 2 g orally QID
 Laxatives
How do they work? “Action”
There are many forms of laxatives,but the main goal is to relieve
constipation.
Why are they used for? ‘’Indications’’
• Stimulant, emollient, and saline laxatives—evacuate the colon
for rectal and bowel examinations
• Stool softeners or mineral oil—prevention of strain during
defecation (after anorectal surgery or a myocardial infarction)
• Psyllium and polycarbophil—irritable bowel syndrome and
diverticular disease
• yperosmotic lactulose agents reduction of blood ammonia
levels in hepatic encephalopathy
Adverse Reactions
• Constipation
• Diarrhea and a loss of water and electrolytes
• Abdominal pain or discomfort, nausea, vomiting, perianal
irritation fainting bloating flatulence cramps and weakness.
• Prolonged use of a laxative can result in serious electrolyte
imbalances, as well as the “laxative habit”, that is, dependence
on a la ative to have a bowel movement.
• Some of these products contain tartrazine (a yellow food dye),
which may cause allergic-type reactions (including bronchial
asthma in susceptible individuals. Obstruction of the
esophagus, stomach, small intestine, and colon has occurred
when bulk-forming la atives are administered without
ade uate fluid intake or in patients with intestinal stenosis.
Interactions
• Mineral oil may impair the GI absorption of fat-soluble
vitamins E and K .
• Laxatives may reduce absorption of other drugs present in the
GI tract by combining with them chemically or hastening their
passage through the intestinal tract.
• When surfactants are administered with mineral oil, they may
increase mineral oil absorption.
• ilk antacids histamine antagonists and proton pump
inhibitors should not be administered to hours before
bisacodyl tablets because the enteric coating may dissolve
early (before reaching the intestinal tract), resulting in gastric
lining irritation or dyspepsia and decreasing the la ative e ect
of the drug.
Contraindications
• Known hypersensitivity
• Persistent abdominal pain
• Nausea or vomiting of unknown cause
• Signs of acute appendicitis
Caution
Magnesium: Used cautiously in any degree of renal impairment
Nursing management
• Avoid long-term use of these products unless use of the
product has been recommended by the primary health care
provider. ong-term use may result in the la ative habit
which is dependence on a laxative to have a normal bowel
movement. Constipation may also occur with overuse of these
drugs. a atives are not to be used for weight loss. Read and
follow the directions on the label.
• Do not use these products in the presence of abdominal
pain nausea or vomiting.
• Notify the primary health care provider if constipation is not
relieved or if rectal bleeding or other symptoms occur.
• To avoid constipation drink plenty of fluids get e ercise and
eat foods high in bulk or roughage. Cascara sagrada or
senna ink-red red-violet red-brown yellow-brown or black
discoloration of urine may occur. ord
Types
• Bulk-producing la atives are not digested by the body and
therefore add bulk and water to the contents of the intestines.
The added bulk in the intestines stimulates peristalsis moves
the products of digestion through the intestine, and
encourages evacuation of the stool. ometimes these la atives
are used with severe diarrhea to add bulk to the watery bowel
contents and slow transit through the bowel.
Psyllium “Metamucil”
• Emollient laxatives lubricate the intestinal walls and soften the
stool thereby enhancing passage of fecal material. ineral oil
• Stool softeners promote water retention in the fecal mass and
soften the stool. One di erence between emollient la atives
and stool softeners is that the emollient laxatives do not
promote the retention of water in the stool. ocusate
• yperosmolar drugs dehydrate local tissues which causes
irritation and increased peristalsis, with consequent
evacuation of the fecal mass. Glycerine or lactulose
• Irritant or stimulant laxatives increase peristalsis by direct
action on the intestine. Cascara sagrada
• Saline laxatives attract or pull water into the intestine, thereby
increasing pressure in the intestine, followed by an increase in
peristalsis. agnesium preparations
 Acid Prevention
Antacid, H2 Blockers & PPI

Antacid: MOA:
IT DOESN’T
S Sodium Bicarbonate (brand: Alka-selzer) Immediately neutralizes stomach acid, LAST LONG
but ONLY temporary (NOT long lasting)
C Calcium Carbonate (brand: Tums, Rolaids)

A Aluminum Hydroxide
HESI Question KEY POINTS & MEMORY TRICK
M Magnesium Hydroxide (brand: Milk of Mag)
Magnesium hydroxide
nti –Acids
de Effects: Can upset stomach +
nti –MIXING with other MEDs
Liquid bowel movements
Aluminum & Calcium Magnesium ‘’mellow’’
Consti tion = Diarrhea 1 hour BEFORE or AFTER
OTHER MEDs !

Al Gi
MILK OF
NOT for heart failure!
Mg
MAGNESIA
· Nothing OTC “over the counter”
Ca · Sodium = Swells

c ers: Indication: MOA:

GERD & Ulcers Reduces gastric secretions by

tidine
(duodenal & gastric) prevention BLOCKING H20 receptors in H2
Ranitidine
(brand: Zantac)
the stomach
Famotidine Patient Education:
(brand: Pepcid)
KEY POINTS & MEMORY TRICK
• No over eating
• No stress/smoking 30 MIN BEFORE MEALS
• No NSAIDS + Asa - GI bleeds

RANITIDINE

NSAIDS
ASA

PPI: MOA:
P
P

Inhibits proton pump in the parietal cells of the P

o on um In o stomach to reduce gastric acid

P P

oe
Ome oe
e er s: KEY POINTS & MEMORY TRICK
(brand: Prilosec)

Esome oe
(brand: Nexium)

P P P P
Panto oe Stress ulcer
prophylaxis
(brand: Protonix)
Prevents holes Porous Bones Po i le infe tion
Prazole
S ess u e o s e u one ens es s C
in hospitalized
/surgical
Indication: patients

Stress ulcer prevention,

GERD, heart-burn
Anti-inflammatory
SULFasalazine

A:
INDICATION Kaplan
ecreases colon inflammation by
stopping prostaglandins Continue medication
nflammator bowel which cause inflammation even after symptoms
disease B
subside
rohn disease
lcerative olitis NO
DO OP
T

ST

de Effects:
HESI
NORMAL Contraindicated in
atient it SULFA
• Yellow-orange discoloration allergy.
of the client’s skin and urine

• No need for follow-up! I

DO NOT stop taking med MED SULFASALAZINE

r Adverse Effects:

S U L F
Sun Dried! Urine Crystals Low Urine Output Fluid & Folic Acid
(sunblock & dry body!) (Kidney Stones) (SG HIGH = Dry)

FOLIC ACID

o osens ti e tion
• DRINK 8 glasses of water daily
• Wear sunblock •Ee e u ne S e
• TAKE Folic acid - 1mg/day
• Avoid “direct” sun exposure • High & DRY!!! (norm: 1.003-1.030)

Notes
Lactulose &
Sodium Polystyrene Sulfonate

Lactulose Sodium Polystyene Sulfonate

Given to decrease HIGH pottasium (over 5.0)
LAC
L - Laxative for Memory Trick:
A - Ammonia levels-decrease
C - Cognition returns
“improved mental status” Kayexalate - helps K+ to Exit the body

Given to decrease ammonia levels in Cirrhosis EXIT

patients, to treat hepatic encephalopathy
(cloudy brain) K

Memory Trick:
Ammonia

Lacto - LOSE K KEY WORDS

Helps the large intestine to
remove excess K+ within
K the body
K
K

‘’Lose ammonia via Loose bowels’’ K

Key Points: Key Points:

KEY POINTS: Ammonia

2 - 3 soft stools per day
Ammonia levels decrease
Cognition improved
“Improved mental status”
NOT a Diuretic
KEY POINTS
Assess the Abdomen
Recent bowel patterns
NCLEX TIP & frequency of stools
Bowel Function
Potassium (K+) within normal
limits (3.5-5.0 mEq/L)

NO NO NO
renal excretion of
ammonia
it does not decrease
portal HTN
Abdominal distention
will not improve with HESI Question
lactulose

Sodium Polystyrene
Encourage patient to
drink fluids after administration

Notes
Antiflatulents

How do they work? “Action” Caution

Work by reducing flatus in the GI tract via • Pregnancy category C
expulsion such as:
• Belching or passing gas.
• Simethicone also has a defoaming
• Agent that disperses and prevents
• The formation of gas pockets.
Interactions
• Decreases the effectiveness of other drugs

Why are they used for? ‘’Indications’’

• Post op gas distention & air swallowing
• Dyspepsia
• Peptic ulcer
Nursing management
• Irritable bowel syndrome
• Diverticulosis • Assess patient for abdominal pain, distention,
• Charcoal may be used to prevent pruritus and bowel sounds prior to and periodically
associated with kidney dialysis treatment & as throughout course of therapy. Frequency of
an antidote in poisoning belching and passage of flatus should also be
assessed.
• PO: Administered after meals and at bedtime
for best results. Shake liquid preparations well
prior to administration. Chewable tablets
Adverse Reactions should be chewed thoroughly before
No adverse reactions have been reported. swallowing, for faster and more complete
results.
• Drops can be mixed with 30 mL of cool water,
infant formula, or other liquid as directed.
Shake well before using.
Contraindications • Explain to patient the importance of diet and
exercise in the prevention of gas. Also explain
• Known hypersensitivity
that this medication does not prevent the
formation of gas.
• Advise patient to notify health care
professional if symptoms are persistent.

Generic Trade Use Dose

Intestinal gas, Diarrhea,
Charcoal Charcocaps, Flatulex 520 mg orally after meals
poisoning antidote

Gas-x , mylicon, Post op gas distention, dyspepsia, 40-125 mg QID after

Simethicone
maalox, mylanta IBS, peptic ulcer meals and at bedtime
 Eye & Ear

Eye Administration: Ear Administration:

1. 2. 3. 4. 1. Affected ear up tilt head or lay down

Dro medication into entl close rotate Apply GENTLE ait minutes
on uncti al ac t e e es around a er ressure to t e corner
administration of t e cant us
2. Straighten ear canal
Adults pull up out
Child pull down back

3. N occlude ear with dropper

Drug name: 4. Warm med at room temperature

Acetazolamide

Acetazolamide Acetazolamide
4 KEY POINTS

Indication:
1. 2.
A ected A trai ten t e ar
Canal
Chronic glaucoma to decrease
ESSURE

pressure inside the eye

PR

ATI uestion KAPLAN uestion

ndication Chronic Acetazolamide =
open angle glaucoma contraindicated for
atient Teac in sulfa allergy
Report arest esia
(facial regions) to
HCP immediately
ontraindications
allergy to sulfa drugs. SULFA

3. 4.
DRUGS

Do not occlude t e ear Keep med warm or

Side Note: it a dro er room temp
ATROPINE

ATROPINE

Avoid AntiCholinergics IPRATROPIUM

Acetazolamide

Anti Cholinergics = Glaucoma Acetazolamide

Ipratropium

NO - Atropine
NO - Ben tropine
ESSURE

BENZTROPINE

NO - Ipratropium
PR

Glaucoma
NO - xybutynin
IN
UTYN
OXYB

Notes
Tumor Necrosis Factor Inhibitors
Etanercept, Infliximab, Adalimumab

Drug name:
ETANERCEPT Flu
Vaccine

Etanercept Ne ati e Tuberculosis s in test

In iximab n iximab

PATIENT EDUCATION
Adalimumab Tuberculosis ( B) Reactivation
Adalimumab Neg. TB skin test needed to start therapy
accines
early u vaccine
MEMORY TRICK Live vaccines
(herpes oster or shingles)
INTERCEPT
Contraindication
ETANERCEPT
ADALIMUMAD Cannot ta e med Chronic
INFLIXIMAD reoccurring or recent infections

- Etanercept - Intercepts immune response

- causing immune suppression AVOID Chronic

- MAB ending think MAD immune suppression Reoccurring

adalimumab infliximab ecent

KEY POINT
LABs
REPORT ! Elevated BCs
Priority to Report to HCP! Elevated CRP
Elevated BC NOT “the most important” lab
Fever (over 00.3 F 3 C)
NCLEX TIP

(CRP is the most commonly chosen wrong answer

nearly of the time levated C is expected
with these patients since there is inflammation
all over the body

m ortant

CRP

> 100.3 F/ 38 C most commonly CRP

chosen wrong answer

Notes
 Immunosuppressants
NCLEX Questions
Indication:
Given to help the body STOP attacking
itself - like in clients with autoimmune dieases
Common
A patient is prescribed
methotrexate for treatment of an
autoimmune disorder. hich
patient report requires immediate
assessment and intervention by the
nurse
A. “I will consult with my
provider before discontinuing
birth control.”
noticed t at a e
de elo ed tin reddis ur le
lesions all o er m arms
C. “I have not had a normal
bowel movement in two days.”
. “I seem to be losing an
excessive amount of hair since
starting this medication.”
he nurse is instructing a patient with a
severe allergy to wasp stings on the
proper use of the e ine rine
auto in ector. hich patient statement
best demonstrates that teaching has been
e ective
. “I will eep my epi-pen stored
90o
EPIPE
in my refrigerator at all times.”
ill in ect t e medication
1 into m outer t i at t e rst
EPIPE
si n of an aller ic reaction
EPINEPHRINE
3. “I will see follow-up treatment
i erine
within 2 hours of in ecting the
medication.”
.“I will hold the epi-pen rmly in
place for at least 5 seconds to
ensure full delivery of the
medication.”
Notes
Bad News: NCLEX TIPS
Bone marrow suppression =
1. Low WBC = Infection Risk
2. Low Plt = Bleed Risk nfections leedin
E Question
hat should the nurse include in
teaching for a patient newly
prescribed drox c loro uine for
the treatment of systemic lupus
erythematosus elect all t at a l
. Ensure to see your optometrist
at least every 2 years.
e ort an ne isual c an es
to our ro ider
3. his medication is li ely to
increase feelings of fatigue
associated with lupus.
. otify your provider if no
improvement in symptoms is
noticed within one wee of
beginning this medication.
hich lab results should the nurse review
prior to administration of etanerce t to a
patient with psoriatic arthritis elect all
t at a l
Ne ati e Tuberculosis s in test
Tuberculin s in test T s in
test
2. aP (partial thromboplastin
time)
ite blood cell count
. otal cholesterol panel
ed blood cell count
Immunosuppressants

Drug name: Drug name:

OQUINE
YCHLOR
HYDROX

Hydroxychloroquine Cyclosporine / Azathioprine CYCLOSPORINE

Indication: Indication:
Treat autoimmune diseases where Prevent organ transplant
the body is attacking itself rejection
Lupus

MEMORY TRICK
MOA:
yclo-S orine ycloSPARIN
Sparing the organ
INcreased energy levels CYCLOSPORINE from rejection
NOT decreased

KEY POINT ADVERSE EFFECT

KEY POINT KEY POINT
E E ivin
- Check WBC + Plts
a or dverse E ects Common ide E ect
REPORT leu o enia Cyclosporine
etinal dama e vision ro lems
Low WBC < 4000 Gingival hyperplasia
Teach: Regular eye appt. onitor for leedin
Every - mont s No pregnant patients -
se Contraception

- mont s

MEMORY TRICK
ATI HESI
Hyyy-dddroxy Chloroquine Teaching - Cyclosporine &
otify provider for
“Eyyye Damage Clorine” Azathioprine
an si n o in e tion
Avoid crowds
No live vaccines
1
(Herpes Zoster + Shingles)
CHLORINE
oft bristled toothbrush
se contraception

KAPLAN
HESI Question atient statement t at re uires CYCLOSPORINE

urt er tea in
eaching is e ective when the “I will mix cyclosporine with
grapefruit uice”
client states
Cyclosporine teaching: Organ
transplant
“I need to see my o tometrist a e med for life
HCP will eval blood wor
at least once a year” regularly
a e med at same time everyday

Notes
Epinephrine
Epi auto-injectors ‘’Epi-Pen’’

Indication: KAPLAN
Anaphylaxis (severe allergic reaction) Patient scenario
Administration of ampicillin & client
reports itchiness and di u t
reat in .
EPIPEN

Priority actions
EPINEPHRINE

1. Stop infusion
2. Auscultate lungs
WHO

SYS
mmHg

DIA

3. Prepare to administer epinephrine

mmHg

MOA:
1st
- Vasopressor that presses the vital signs up! E ective management of shoc
BP 130/67
- Increased BP, RR, HR Apical HR 99
Cap re ll less than 2 seconds 99

KEY POINT
Epi is the 1st drug
HESI orma
to use for anaphylaxis. ide e ts
First signs of
ATI Tachycardia (HR over 100)
Palpitations
anaphylaxis (hives, dyspnea,
Dizziness
hypotension) give Epi Pen
Repeat every 5 -15 minutes if
s/s continue NCLEX TIP
e eat E i until signs & o to use i en
symptoms resolve NCLEX TIP KEY POINTS

1. n e t into outer at
de ree an e at onset o s s
HESI “Stab pen into outer thigh”

1 2 3 Hold in place for

2. eek immediate medi a
se onds

a ention after use

Go to the hospital!
Albuterol
3. tore e i ens in dark a e at
EPIPEN
room tem erature
Steroids (not too cold/ not too hot)
EPINEPHRINE

Diphenhydramine

Albuterol
Epinephrine Diphenhydramine
Steroids 90o
EPIPEN

EPIPEN
EPINEPHRINE

Notes
Immunosuppressants
Methotrexate

Drug name: MEMORY TRICK

Meth NOOO trexate

Methotrexate

Methotrexate
NO NO NO

Indication:
Kaplan

Mainly for Rheumatoid Arthritis

(Autoimmune disease) body is
attacking it’s own joints

• NO pregnant clients
MOA:
• NO crowds or LIVE vaccines
Stops folic acid metabolism, which Folic Acid
• NO razors or brushing teeth hard
stops cell reproduction

KEY POINT AVOID

Adverse Effects:
Infection leedin
Infection is
• Low immunity = Infections Report Fever (over 100.3º F, 38ºC)
AVOID
Avoid crowds & sick people
• Low Platelets = serious bleeding Avoid fresh fruit & owers

• Fetal death in pregnancy rom ocyto enia (platelets under 100,000)

Report bleeding:
Petechiae (bleeding under s in)
< 100,000
Purpura (purple spots on s in)
Melena (black tarry stool)
Hematemesis (vomitin blood)
Bleeding Gums Thrombocytopenia

HESI Question KEY POINT

Pre nancy - NOT BABY SAFE
et otrexate S use irt ontrol
Suppresses B and T lymphocytes
“No pregnancy until one menstrual
cycle after treatment is resolved”

“No pregnancy until 3 months after

treatment is nished” January

“ en no trying for a baby until 3

months after treatment with
Methotrexate

B lymphocyte T lymphocyte methotrexate is complete”

Notes
Immunologic Agents
- IG & Antivenin
What do they do?
Immune globulins are solutions obtained
from human or animal blood containing
antibodies that have been formed by the
body to speci c antigens. ecause they
contain ready-made antibodies, they are
given for passive immunity against disease.
Antivenins are used for passive, transient
protection from the toxic effects of bites by
spiders (black widow and similar spiders)
and snakes (rattlesnakes, copperhead and
cottonmouth and coral . he most effective
response is obtained when the drug is
administered within hours after exposure.
Interactions
Antibodies in the immune globulin
preparations may interfere with the immune
response to live virus vaccines, particularly
measles, but including others such as
mumps and rubella. It is recommended that
the live virus vaccines be administered 14 to
30 days before or 6 to 12 weeks after
administration of immune globulins.
No known interactions have been reported
with antivenins.
Notes
Contraindications
he immune globulins are contraindicated in
patients with a history of allergic reactions after
administration of human immunoglobulin
preparations and in individuals with isolated
immunoglobulin A IgA de ciency individuals
could have an anaphylactic reaction to
subsequent administration of blood products
that contain IgA .
uman immune globulin intravenous IGI
products have been associated with renal
impairment, acute renal failure, osmotic nephro-
sis and death. Individuals with a predisposition
to acute renal failure e.g. those with
pre-existing renal disease), those with diabetes
mellitus, individuals older than 65 years of age,
or patients receiving nephrotoxic drugs should
not be given human IGI products.
 Immunologic Agents
- Vaccines & Toxoids
What do they do?
The weakened or killed antigens contained in the vaccine
do not have su cient strength to cause disease. Although
it is a rare occurrence, vaccination with any vaccine may
not result in a protective antibody response in all
individuals given the vaccine.
A toxin that is attenuated or weakened but still capable
of stimulating the formation of
antitoxins is called a toxoid.
Indications
• Routine immunization of infants and children
• Immunization of adults against tetanus
• Immunization of adults at high risk for certain diseases
e.g. pneumococcal and influen a vaccines
• Immuni ation of children or adults at risk for exposure
to a particular disease e.g. hepatitis A for those going
to endemic areas
• Immunization of prepubertal girls or nonpregnant
women of childbearing age against rubella Routine
immunization of infants and children
• Immunization of adults against tetanus
• Immunization of adults at high risk for certain diseases
e.g. pneumococcal and influen a vaccines
• Immuni ation of children or adults at risk for exposure
to a particular disease e.g. hepatitis A for those going
to endemic areas
• Immunization of prepubertal girls or nonpregnant
women of childbearing age against rubella
Adverse Reactions
• Chills, fever
• muscular aches and pains
• Rash
• lethargy
Contraindications
• Immunologic agents are contraindicated inpatients with
known hypersensitivity to the agent or any component
of it. Allergy to eggs is a concern with some vaccines.
• The measles, mumps, rubella, and varicella vaccines are
contraindicated in patients who have had an allergic
reaction to gelatin, neomycin, or a previous dose of one
of the vaccines
• accines and toxoids are contraindicated during acute
febrile illnesses, leukemia, lymphoma,
immunosuppressive illness or drug therapy, and non
locali ed cancer. Always ask about allergy history before
preparing a vaccine for administration.
Interactions
Vaccinations containing live organisms are not •dminis-
tered within 3 months of immune globulin administration,
because antibodies in the globulin preparation may
interfere with the immune response to the vaccination.
Corticosteroids, antineoplastic drugs, and radiation
therapy depress the immune system to such a degree
that insu cient numbers of antibodies are produced to
prevent the disease. When the salicylates are
administered with the varicella vaccination, there is an
increased risk of eye s syndrome developing.
Nursing management
• ost vaccine preparations re uire refrigeration. Always
have a backup plan for storage of the vaccine should the
health care facility lose power. emperature fluctuations
can harm the vaccines.
• Monitor the patient before allowing them to leave after
administering any vaccine.
• State agencies, drug companies, and immunization
organizations all provide standardized forms for parents
or caregivers that document immuni ation history. In
addition to your facility documentation, provide or
record on the document presented by the parent or
caregiver the following information:
• Date of vaccination
• Route and site, vaccine type, manufacturer
• ot number and expiration date
• Name, address, and title of individual administering
vaccine
 Antineoplastics ‘’Cell Cycle Nonspecific’’
- Alkylating Agents

What do they do? Herbal Consideration

Alkylating agents make the cell a more alkaline environment, which in
turn damages the cell. Malignant cells appear to be more susceptible to
the effects of alkylating drugs than normal cells.
Indications
• Treatment of cancer
The shiitake mushroom, an edible variety of mushroom, is associated
with general health maintenance but not with any severe adverse
reactions. ild side effects such as skin rashes and GI upset have been
reported. Lentinan, a derivative of the shiitake mushroom, is proving to
be valuable in boosting the body’s immune system and may prolong the
survival time of patients with cancer by supporting immunity. In Japan,
lentinan is commonly used to treat cancer. Additional possible bene ts
of this herb include lowering cholesterol levels by increasing the rate at
which cholesterol is excreted from the body. Under no circumstances
should shiitake or lentinan be used for cancer or any serious illness
without consulting a primary health care provider (DerMarderosian,
2003).

Adverse Reactions
• Bone marrow suppression (anemia, leukopenia, thrombocytopenia )
• Stomatitis
• Diarrhea
• and hair loss.
• The most common reactions are leukopenia and thrombocytopenia
Nursing Alert
Radiation recall is a skin reaction in which an area that was previously
irradiated becomes reddened when a patient is administered certain
speci c chemotherapy drugs. his is well differentiated from a reaction
exclusive to the drugs because of the de ned outline of the previous
radiation treatment eld on the body.
Contraindications
Antineoplastic drugs are contraindicated in patients with
leukopenia, thrombocytopenia, anemia, serious infections, serious renal
disease, or known hypersensitivity to the drug, and during pregnancy
Interactions:
• Phenytoin: Increased risk of seizures
• Aminoglycosides: Increased risk of nephrotoxicity and ototoxicity
• Loop diuretics: Increased risk of ototoxicity
Nursing management
• Wear personal protective equipment when preparing any of these
drugs for parenteral administration.
• Administer any prophylactic medications or fluids in a timely manner to
prevent reactions.
• Observe the patient closely before, during, and after the administration
of an antineoplastic drug.
• Observe the IV site closely to detect any signs of extravasation
(leakage into the surrounding tissues). Tissue necrosis can be a
serious complication. Discontinue the infusion and notify the oncology
health care provider if discomfort, redness along the pathway of the
vein or in ltration occurs.
• Continually update nursing assessments, nursing diagnoses, and
nursing care plans to meet the changing needs of the patient.
• Notify the oncology health care provider of all changes in the patient’s
general condition, the appearance of adverse reactions, and changes in
laboratory test results.
• Provide the patient and family with both physical and emotional
support during treatment.
• Institute neutropenic precautions to prevent infections.
• Immediately report a temp higher than 100.4 or higher, cough, sore
throat, chills, frequent urination, or a white blood cell count of less than
2500/mm3.
• Immediately before administering the rst dose of an antineoplastic
drug, take the patient’s vital signs and obtain a current weight
• Get a baseline C C before rst dose
• Monitor ongoing blood results
• You may need to hydrate the patient before administration of cisplatin.
• You may need to administer antiemetics prior to administration.
• ducate the patient on side effects including weight loss and alopecia.
• Provide support and comfort.
• Teach the patient to report to you or to the health care provider
immediately any of the following: bleeding gums, easy bruising,
petechiae (pinpoint hemorrhages), increased menstrual bleeding, tarry
stools bloody urine or coffee ground emesis.

Generic de Effects Route

Immediate: nausea, vomiting
During therapy cycles: leukopenia,
Cyclophosphamide
hemorrhagic cystitis, thrombocytopenia
Long term: fertility problems, secondary cancers
Leukemia/lymphomas: ALL, AML, CLL, advanced
lymphomas, Hodgkin’s disease
Solid tumors: breast, ovary, neuroblastoma,
retinoblastoma
Nonmalignant: mycosis fungoides, nephrotic
syndrome (children), rheumatoid arthritis,
systemic lupus erythematosus, multiple sclerosis

During therapy cycles: anemia, leukopenia,

Leukemia/lymphomas: chronic lymphocytic
Chlorambucil thrombocytopenia
leukemia (CLL), lymphomas, Hodgkin’s disease
Long term: fertility problems
 Muscle Relaxers

Top 3 issed uestions

3 BIG TEST TIPS
hich teaching should the nurse
provide for a patient who is
1. Dizziness upon prescribed calcium carbonate for a
new diagnosis of osteoporosis
hat teaching should the nurse
include for a patient newly prescribed
allopurinol for the treatment of gout
Select all that apply.
hen providing education to a
patient who is newly prescribed
cyclobenzaprine, which
instructions should be included

c an in ositions Select all that apply.

1. Report the development of any
Select all that apply.

. otify the provider of a

is expected
1. Always take calcium new rash to your provider
carbonate in divided doses less immediately. temperature greater than .5 F
than 500 mg per dose. 2. a e your allopurinol at the rst 2. Report any drowsiness to the

2. NO alcohol 2. a e calcium carbonate 2

hours before or after meals.
3. top ta ing calcium carbonate
sign of an acute attac .
3. ou ma continue to treat ain
health care provider.
3. Do not sto ta in t is
associated it acute a ac s medicationa abru tl

3. DO NOT Abruptly Stop if constipation develops

4. chedule wee ly blood draws
to monitor serum calcium levels.
ontinue ta in itamin D
supplements while taking
calcium carbonate.
with ibuprofen.
4. Report any symptoms of nausea
to your provider immediately.
5. Allopurinol helps prevent the
build up of uric acid which leads
to acute a ac s
4. Limit wine consumption to
3- glasses per day while ta ing
this medication.
5. Avoid ta ing ibuprofen while
ta ing this medication.

Drug name: Indication: D T KAPLAN

Dantrolene
Dantrolene • Spinal Cord injury
uscle relaxant
• Cerebral Palsy
DANT O N
• Multiple Sclerosis HESI
LIVER TOXIC SEDATION
“DROWSINESS”
Dantrolene
MOA: Contraindicated in client with
MEMORY TRICK and Cirrhosis
Acts directly on the muscle to
prevent the release of calcium Calcium Contracts muscles
Less calcium = Less Contraction

Drug name: Indication: ide ects

HESI uestion
CycloBENzaprine Reduces muscle spasms after
Carisoprodol
& Carisoprodol CYCLOBENZAPRINE
A O ODO

surgery on open fractures Ris of dependence

rowsiness & sedation

MEMORY TRICK Pt teaching

CycloBENZaprine CycloBACKzzaprine
ATI uestion
aper o medication -
CYCLOBENZAPRINE

DO NOT stop abruptly

Drug name: MOA: HESI uestion

KEY POINTS
Enhances GABA to make Gaba i iness upon changing ide e ects of Baclofen:
• Baclofen A O N
A O N

everything low & slow positions rtho-hypotension

i iness ausea
NOT a contraindication
de Effects: to giving this med otential Deadl ects
Indication: Rhabdomyolysis
N Abruptly top
(any muscle relaxant) ultiple organ failure
Decrease in flexor and extensor - Constipation
spasticity with spinal cord - Low BP & orthostatic
injury, MS & cerebral palsy hypotension Memory Trick

Baclofen
Bac o slowly (do
not abruptly stop)
 Bones

Drug name: Drug name:

Calcium Carbonate CALCIUM

End in ‘’-dronate’’
alendronate
CARBONATE
ALENDRONATE
SODIUM

risedronate
Indication:

Osteoporosis & bone health to Indication:

help make bones stronger
Osteoporosis

KEY POINTS MOA:

EI I I E SES- Inhibits bone reabsorption by

m
Less than 500 mg reducing osteoclast activity, OSTEOCLAST

which breaks down the bone

CALCIU ATE
M

CARBON

Doses E m
at one time are a sor ed
KEY POINT
need for frequent blood
tests or routine labs
Monitor bone density

Take on Empty Stomach

COMMON SIDE EFFECT
Esophagitis = Sit up

30 minutes NCLEX TIP

NORMAL
HESI uestion

• Constipation which is normal & to be expected. Treats Osteoporosis 8OZ

• ust add fluids ambulation

Drink full o with
MEMORY TRICK medication

Since calcium makes bones

hard, just think Calcium
Ca makes bowels hard too!
KAPLAN uestion
• High CAL = Hard Bowel
each patient to sit upright
Ca • Low CAL = Loose Bowel for at least minutes

Notes
 Uric Acid
Allopurinol & Colchicine

Indication: Patient Teaching:

Given for Gout - uric acid build • Increase fluids take with full
glass of water
up causes inflammation in the
joints •A ID clients with Kidney iver Disease

• valuation of effectiveness
Normal uric acid levels
BIG KEY DIFFERENCE

AlloPurinol - Prevents gout

Colchicine - for aCute gout attac s

NOT given to reduce pain, but to

reduce uric acid HESI uestion ALLOPURINOL

Allopurinol - o not ta e for acute

gout attac s
Colchicine - for acute attac E
KEY POINT COLCHICINE

ACute out Attac s

provide pain relief

Naproxen (NSAID) - used for PAIN
ric cid Pain Uric Acid nflammation relief with gout. NSAIDS

KEY POINTS: KAPLAN uestion

Allopurinol IBUPROFEN

“I can use ibuprofen for pain … Gout”

NCLEX TIP
MEMORY TRICK
Rash ALL Over HESI uestion
ALLopurinol = Deadly

Needs FURTHER teaching it

Lim
when ta ing Allopurinol NE
VER

“I will limit my uid inta e

ALLOPURINOL
with this medication”

Notes
 Skeletal Muscle Drugs
- Uric Acid Inhibitors
How do they work? “Action”
Allopurinol (Zyloprim) reduces the production
of uric acid, thereby decreasing serum uric acid
levels and the deposit of urate crystals in joints.
This probably accounts for its ability to relieve
the severe pain of acute gout. Febuxostat
(Uloric), a newer drug, is used to reduce serum
uric acid levels, preventing gout attacks.
Indications
Drugs indicated for treatment of gout may be
used to manage acute attacks of gout or in
preventing acute attacks of gout (prophylaxis).
Adverse Reactions
• Headache
• Urinary frequency
• One adverse reaction associated with
allopurinol is skin rash, which in some cases
has been followed by serious hypersensitivity
reactions, such as exfoliative dermatitis and
Stevens-Johnson syndrome. Colchicine admin
istration may result in severe nausea, vomiting,
and bone marrow depression; therefore, it is
used as a second line of treatment when other
drugs fail.
Contraindications
• Colchicine is contraindicated in patients with
serious GI, renal, hepatic, or cardiac disorders
and those with blood dyscrasias
• Probenecid is contraindicated in patients with
blood dyscrasias or uric acid kidney stones,
and in children younger than 2 years. If
patients are taking azathioprine (Imuran),
mercaptopurine, or theophylline they should
not be prescribed febuxostat.
Generic Trade Use
Allopurinol Zyloprim Management of symptoms of gout
Relief of acute attacks of gout,
Colchicine NA
prevention of gout attack
Interactions
Allopurinol and febuxostat
• Ampicillin: Increased risk of rash
• Theophylline: Increased risk of theophylline
toxicity
• Aluminum-based antacids:
• Decreased effectiveness of allopurinol
Probenecid
• Penicillins, cephalosporins, acyclovir,
rifampin, and the sulfonamides: Increased
serum level of anti-infective
• Barbiturates and benzodiazepines:
Increased serum level of sedative
• NSAIDs: Increased serum level of NSAID
• Salicylates: Decreased effectiveness of
probenecid
Nursing management
• Drink at least 10 glasses of water a day until the
acute attack has subsided.
• Take this drug with food to minimize GI upset.
• If drowsiness occurs, avoid driving or
performing other hazardous tasks.
• Acute gout—notify the primary health care
provider if pain is not relieved in a few days.
• Notify the primary health care provider if a skin
rash occurs.
• When using drugs for muscle spasm and
cramping:
• This drug may cause drowsiness. Do not drive
or perform other hazardous tasks if
drowsiness occurs.
• This drug is for short-term use. Do not use the
drug for longer than 2 to 3 weeks.
• Avoid alcohol or other CNS depressants while
taking this drug.
Dose
100–800 mg/day orally
Prophylaxis:
0.5–0.6 mg/day orally
Acute attack: initial dose 0.5–1.2 mg orally or 2
mg IV, then 0.5–1.2 mg orally q 1–2 hr or 0.5
mg IV q 6 hr until attack is aborted or adverse
effects occur
 Skeletal Muscle Drugs
- Bisphosphonates
How do they work? “Action”
Bisphosphonates act primarily on the bone by inhibiting
normal and abnormal bone resorption. This results in
increased bone mineral density, reversing the progression
of osteoporosis.
Indications
• Osteoporosis in postmenopausal women and men
(caused by glucocorticoid use)
• Hypercalcemia (increased serum calcium) of malignant
diseases and bony metastasis of some solid tumors
• Paget’s disease of the bone
Adverse Reactions
• Increased or recurrent bone pain
• Headache
• Dyspepsia (GI discomfort), acid regurgitation, dysphagia
• Abdominal pain
Contraindications
• Alendronate (Fosamax) and risedronate (Actonel) are
contraindicated in patients with hypocalcemia.
Alendronate is a pregnancy category C drug and is
contraindicated during pregnancy.
• Delayed esophageal emptying or renal impairment.
Concurrent use of these drugs with hormone replace
ment therapy is not recommended.
Interactions
• Calcium supplements or antacids with magnesium and
aluminum: Decreased effectiveness of bisphosphonates
• Aspirin: Increased risk of GI bleeding
• Theophylline: Increased risk of theophylline toxicity
Generic Trade Use
Treatment and prevention of
postmenopausal osteoporosis,
Alendronate Fosamax
glucocorticoid-induced osteoporosis,
osteoporosis in men, Paget’s disease
Hypercalcemia of malignancy, Paget’s
Pamidronate Aredia
disease
Nursing management
• When bisphosphonates are administered, serum calcium
levels are monitored before, during, and after therapy.
• When to treat. Diagnosis for osteoporosis treatment is
made by your T-score (from the bone mineral density
scan). You may not be a candidate for treatment if you
have gastroesophageal problems, kidney disease, or
severe vitamin D de ciency. ome preparations are
taken daily and others as infrequently as monthly.
Research shows good results when taken for 5 to 10
years—so correct administration is important.
• upplements. hese drugs work by using the building
blocks of bone formation. You need an intake of 1500
mg of calcium and 400 to 800 units of vitamin D daily.
The drug you take may or may not have this supplement
in the preparation. Check with your primary health care
provider and follow the vitamin supplement
recommended.
• peci c drug administration routine. hese drugs are
absorbed slowly from the stomach and can cause severe
irritation of the esophagus. You must take the pill with 6
to 8 ounces of plain water and cannot eat or drink for 30
minutes after taking the drug, and you must be in
an upright position during that time. Here are
suggestions to make taking this drug easier and build it
into your weekly routine:
• Use a calendar or cell phone alert to remember your
monthly dose.
• Put the medication out the night before in a place you
will see it when you rst get up out of bed.
• Take your medication and then do a distracting activity,
such as taking your morning shower or sitting in a chair
and watching the morning news on television, listening
to music on the radio, or looking at or answering email.
• Make this morning’s breakfast special with foods you
especially like to eat; use breakfast as a reward for
having taken your medication correctly!
• Make a habit of calling your primary health care provider
at least every 6 months (if taking monthly) to talk about
whether you are or are not having any GI changes
(belching, pressure, heartburn)—it could be from the
medication.
Dose
5–10 mg orally, in daily or (70-mg) weekly
doses
60–90 mg in a single IV dose infused over
2–24 hr
 Skeletal Muscle Drugs
- Skeletal Muscle Relaxants

How do they work? “Action” Interactions

Many of these drugs do not directly relax • Central nervous system (CNS) depressants,
skeletal muscles, but their ability to relieve such as alcohol, antihistamines, opiates,
acute painful musculoskeletal conditions may and sedatives: Increased CNS depressant
be due to their sedative action. effect
Cycloben aprine appears to have an effect on Cyclobenzaprine
muscle tone, thereby reducing muscle spasm • MAOIs: Risk for high fever and convulsions
Orphenadrine
• Haloperidol: Increased psychosis
Tizanidine:
Indications • 11.3445
Antihypertensives:
pt Increased risk of
hypotension
• Skeletal muscle relaxants are used in various
acute painful musculoskeletal conditions, such
as muscle strains and back pain.

Adverse Reactions

• Drowsiness
• Sedation
• sleepiness, lethargy, constipation
• Diarrhea
• bradycardia or tachycardia, and rash. Nursing management
• This drug may cause drowsiness. Do not drive
or perform other hazardous tasks if
drowsiness occurs.
Contraindications • This drug is for short-term use. Do not use the
drug for longer than 2 to 3 weeks.
• Baclofen is contraindicated in skeletal muscle
• Avoid alcohol or other CNS depressants while
spasms caused by rheumatic disorders.
taking this drug.
• Carisoprodol is contraindicated in patients
with a known hypersensitivity to
meprobamate.
• Cyclobenzaprine is contraindicated in patients
with a recent myocardial infarction, cardiac
conduction disorders, and hyperthyroidism.
• Cyclobenzaprine is contraindicated within 14
days of the administration of a monoamine
oxidase inhibitor (MAOI).
• Oral dantrolene is contraindicated during
lactation and in patients with active hepatic
disease and muscle spasm caused by
rheumatic disorders.
 Skeletal Muscle Drugs
- Dmards

How do they work? “Action” Interactions

When the immobility and pain of RA can no longer be
controlled by pain relief agents and anti inflammato-
ry drugs, DMARDs are used. These drugs have prop-
erties to produce immunosuppression, which in turn
decreases the body’s immune response. Therefore,
in RA treatment, DMARDs are useful for their
immunosuppressive ability.
Indications
• Rheumatoid arthritis
• Crohn's disease
• Fibromyalgia
Adverse Reactions
• Nausea
• Stomatitis
• Alopecia (hair loss)
• The adverse reactions to sulfa-based drugs, such as
sulfasalazine, include ocular changes,
gastrointestinal (GI) upset, and mild pancytopenia.
Contraindications
atients with renal insu ciency liver disease alcohol
abuse pancytopenia or folate de ciency should not
take methotrexate. Etanercept (Enbrel), adalimumab
umira and infliximab emicade should not be
used in patients with congestive heart failure or
neurological demyelinating diseases. Anakinra
(Kineret) should not be used in combination with
etanercept adalimumab or infliximab.
• Sulfa antibiotics: Increased risk of methotrexate
toxicity
Nursing management
• Because DMARDs are designed to produce
immunosuppression, patients need to be
monitored routinely for infections. Instruct patients
to report any problem, no matter how minor, such
as a cold or open sore—even these can become
life-threatening.
• Explain carefully that treatment for the disorder
includes drug therapy, as well as other medical
management, such as diet, exercise, limitations or
speci cations of activity and periodic physical
therapy treatments.
• Teach the importance of asking the primary health
care provider before taking any nonprescription
drugs or supplements.
• Some drugs used for RA require self-administered
subcutaneous injections. Teach the patient and
family proper injection and disposal techniques.
• Teach about site rotation, and have the patient
demonstrate proper injection technique before this
becomes a self-administered procedure.
• Patients need to be taught how to manage the
discomfort to the site of injection and to report
redness, pain, and swelling to the primary health
care provider.
• When using drugs to treat RA:
• When taking methotrexate, use a calendar or some
other memory device to remember to take the drug
on the same day each week.
• Notify the primary health care provider immediately
if any of the following occur: sore mouth or sores in
the mouth, diarrhea, fever, sore throat, easy
bruising, rash, itching, or nausea and vomiting.
• Women of childbearing age should use an effective
contraceptive during therapy with methotrexate
and for 8 weeks after therapy.

Generic Trade Use Dose

RA; other autoimmune
Adalimumab Humira 40 mg subq every other week
disorders (e.g., Crohn’s disease)

25 mg subcut twice weekly, or 50 mg

Etanercept Enbrel RA
subcut weekly

Hydroxychloroquine Plaquenil RA, antimalarial 400–600 mg/day orally

Anxiolytics

ss: Indication:
MEMORY TRICK
KEY POINT:
Benzodiazepines Anxiety, seizures
a e at edtime NCLEX TIP
r es: MOA:
Don’t skip doses NCLEX TIP
Increases GABA Stop drinking alcohol (wine)
Do not operate dangerous
“-lam” Neuron acti it

machines
AlprazoLAM MEMORY TRICK
MEMORY TRICK

MidazoLAM Antidote Benzos: Flumazenil

Antidote Opioids: Naloxone
FAST LANE

“-pam” BENZ
de Effects: (brand: Narcan)
TemazePAM
FAST FAST FAST

HIGHLY
ddictive DANGEROUS

ClonazePAM Low & slow vitals

& brain

ss: GOOD NEWS HESI uestion

Lasts LONGER
Barbiturates
in the body Is a scenario of a patient
Drug name: on phenobarbital with
low blood pressure &
PHENOBARBITAL PHENOBARBITAL

increased sedation
Phenobarbital
BAD NEWS
Memory Trick:
Take LONGER
to get out of the body BARBITAL

PHENOBARBITAL
Sedation like at a bar &
Higher risk for Toxicity lasts a long time,
leading to hypotension, like stuck behind bars
Respiratory depression

Drug name: Memory Trick:

BAD NEWS
Buspirone Takes a LONG TIME 2 Common est questions for Anxiolytics
PIRONE to kick in
Patient teaching for ia epam Client on phenobarbital which of the
elect All T at A l follow should the nurse do SATA

KEY POINT 1. A oid alerian root

Patient Teaching: 2. Avoid in go and inseng
3. A oid muscle relaxants

- OK to drive 4. e ort istor of reaction to

mida olam
- ‘’drive the BUSpirone’’ 5. aloxone is the antidote for

- NOT used for acute attacks this med.

. ecrease alcohol consumption

Notes
 Antipsychotics

Drug name: r de Effects:

No need to report to HCP Key Signs riorit Action
1 generation ypical
st - EPS ‘’extrapyramidal symptoms’’
High
High Fever
Fever &&Diaphoresis
iaphoresis 1. HOLD Haloperidol
Dystonia (spasm of neck, face &
HALOPERIDOL

HALOPERIDOL Change inMental

Change in ental tatus
Status 2. Assess patient
tongue) uscle Rigidity
Muscle Rigidity 3. NOTIFY HCP
remors
Tremors immediately

Indication:
HALOPERIDOL

1. Schizophrenia
2. Tourettes - to control Key point
motor movement
NEUROLEPTIC MALIGNANT
SYNDROME

LIFE threatening!

Drug name: r de Effects: Memory Trick

riorit Action
No need to report:
CloZAPine
1

2nd generation A-typical Weight gain, drooling & sedation Immediately report
CLOZAPINE CLOZAPINE
RISPERIDONE
aps BC to HCP
RISPERIDONE
Z
Z
Z

Key Points
Indication: uestion
er de Effects: ore hroat
chi ophrenia chi oaffective Fever
who are NOT responding to Report To Provider Flu li e symptoms hich med order for
dementia patient
other antipsychotics Leukopenia - Low WBC Requires intervention by
High Risk for Infection the NURSE?
a or Ad erse ects

Risperidone

Drug name: Indication:

KEY POINT
Bipolar mania, acute psychosis MEMORY TRICK
Hypotension
& agitation onitor for Widened QT intervals
Ziprasidone hydrochloride
(brand eodon) ZiprasiDONE
T NORMAL
HIGH
LOW

NORMAL
Q
HIGH
LOW

Ziprasidone Bipolar Mania Acute Psychosis

hydrochloride
Geodon
T Done prolonged your QT
Q interval & dropped the BP
T

Q
itation

Notes
Bipolar Meds
- Lithium

Drug name:
L LEVELS OVER 1.5 MEQ/L
= TOXIC!
1.5mEq/L
ommon est Question

Lithium Is it lithium at herapeutic level

es - continue at C RRE dose

Indication:
I INCREASE FLUID &
OD NA

KEY POINT Contraindicated

Na+
e ydration
Treatment: Low sodium “Hyponatremia”
below 35 mEq/L
Bipolar Do NOT limit sodium
chi oa ective disorder or water intake
HIGH RISK Toxicity
Stomac lu diarr ea vomitin
iven for long term treatment

T TOXIC SIGNS
Lithium Battery ‘’B’’ Bipolar
Since Lithium lasts a Long time REPORT to HCP!
MEMORY TRICK Report excessive urination
and extreme thirst
omiting & diarrhea
euro uscular excitability
- Lithium + (tremors / myoclonic er s)

KEY POINT
H HOLD NSAIDS
Urine Output < 30ml/hr

(Ibuprofen, Naproxen)
1.5mEq/L
Toxicity ver 1.5
Key Kidney signs:
KEY POINT
Creatinine reatinine > 1.3

OVER 1.3 = BAD kidney! NSAIDS (ibuprofen)

decrease renal blood ow NAPROXEN

rine 30 ml / hr or LESS increasing r/t toxicity

= kidneys DISTRESS! AVOID!! NEED
S/S innitus (ringing of FURTHER TEACHING!
the ears)

Notes
Bipolar Meds
Carbamazepine vs. Valproic Acid

Drug name: Drug name:

Carbamazepine Valproic Acid

Carbamazepine

Indication: de Effects e r rc :

• Bipolar & Seizures

VALLLLLLLL
• Trigeminal neuralgia
(neuropathic pain) Think of L’s for vaLLproic Acid

de Effects:
• L - Liver toxic
Jaundice & Liver labs (ALT & AST)
• Leukopenia - LOW WBC

• Increased risk for BIG infection

ALT AST

KEY WORD
Report fever / sore throat!! • L - Low Platelets
AKA - Thrombocytopenia
Accidental Pregnancy!! BIG bleed risk
ral contraceptives ine ective
ill need alternative birth
control methods
Thrombocytopenia

Not Pregnancy Safe!

Teach client not to discontinue abruptly

Carbamazepine

Notes
Withdrawal Meds

Drug name: Drug name:

Methadone Disul ram

(opioid withdrawal) (brand: Antabuse)

aution
Indication: alcohol based products
with ARTS & CRAFTS
Opioid withdrawal
Methadone

Indication:
Key Points:
Alcohol withdrawal

LONG half life E ected Effects:

Early signs of Toxicity:
Including patient teaching to be caution
N & V and lethargy
with working with rubbing alcohol, or
Frequent emesis
alcohol based products with ARTS &
Monitor: CRAFTS could cause a reaction
Prolonged QT interval (ECG)
O2 Sat less than 90%
(95-100% in healthy adults)
Client falls asleep easily
Rubbing
Alcohol
<90 %

O 2
Z
Z
Z

95-100%
in healthy adults

Notes
ADHD Meds

Drug names: Indication:

Methylphenidate
Ritalin Given to treat:
Methylphenidate
(brand: Ritalin)
ADHD in children & adolescents
Amphetamine mixture AMPHETAMINE
MIXTURE
ADRENAL
& even narcolepsy
(brand: Adrenal)

Dextroamphetamine
timulants DEXTROAMPHETAMINE

KEY POINT
F- A

Loss of Appetite & eight

Loss of Sleep
Restlessness
ive last dose LA ER than
6 PM
Improvements in school wor
PRI RI nursing assessments
6 p.m
Monitor BP
I R and report height
weight trends with HCP
O T nursin asssessment

Reversal Agent: Alprazolam

MOA:
Norepinephrine

nhance effects of dopamine

and norepinephrine in brain
Dopamine

Notes
Antidepressants
- 4 Rules

1. Increased risk of suicide lo Onset O ta er o

Antidepressants can increase NEVER STOP abruptly
suicidal thoughts in first few
weeks of Treatment SSRI

NOTIFY provider of any suicidal 3. NEVER Mix

thoughts! SSRI + St John’s Wart or
St John’s Wart

CLARIFY any new prescription MAOI + Antidepressant MAOI

MONITOR for: (TCA, SSRI, SNRI) Antide ressant

- New thoughts of suicide

- Unusual behavior Decrease BP

- Worsening depression 4. ALL psych drugs

NORMAL

HIGH
LOW
Decrease BP (slow position
changes)
Cause weight changes 40.0
0

SSRI SNRI TCA MAOI

TOP 3 MISSED uestions
hich medication have the hich combination of drugs ost potential for in ury
most potential ris should the nurse question elect all that apply
for in ury elect all that apply
elect all that apply SSRI
oo in for sedatin meds ertraline Amitri t line to treat brom al ia ain
Escitalopram
Citalopram 2. Headache while on Phenelzine
1. Amitriptyline MAOI 3. Taking St Johns wart with Sertraline
2. Diphenhydramine Phenel ine Discontinuin escitalopram the day
3. Colace elegiline before ta in socarboxa id
4. Alprazolam 5. Peanut butter and elly sandwhich
1. Sertraline with Selegiline
5. Buspirone while on elegiline
2. Alpra olam with citalopram
3. Buspirone with Phenel ine e ortin sore t roat fati ue and lo

4. Lithium with Ketorolac grade fever while on clozapine

5. t ohn s ort with

Buspirone

Notes
Antidepressants
SNRI vs. TCA

Drug name: Drug name:

DULOXETINE IMIPRAMINE

AMITRIPTYLINE
SLOW position changes

Indication:
IMIPRAMINE AMITRIPTYLINE

1. Depression Indication:

1. Depression, Anxiety
2. Pain: Neuro pathic pain
= Diabetics & Fibromyalgia
2. Neuro pathic pain =
Diabetics & Fibromyaliga
Memory Trick:
de Effects:
D A OXETINE
Dry body can t see pee spit or shh poop
DOUBLE PURPOSE
D ON PAIN
Patient Education:
NCLEX TIP
If a bromyalgia patient is prescribed this
they re not depressed they need education
on the purpose that it is to help with their
pain ‘’ KEY POINT
Ort ostatic otension
- low position changes esp
u o etine

MEMORY TRICK

mitri t ine Amy trips on

things SLOW position
changes
KEY POINT rinar etention MAOI Anti
depressant

MEMORY TRICK

mi ramine - Inhibit my PEEI

NEVER take with MAOI
Helps with chronic pain & 2 wee wash-out period
improves sleep in patients NO MAOI + Antidepressants
with bromyalgia (TCA, SSRI, SNRI)

Notes
Antidepressants
- SSRI

Drug names: dc t : ANXIETY

DEPRESSION PTSD

Depression, Anxiety, PTSD

SERTRALINE
CITALOPRAM MOA:
ESCITALOPRAM Inhibits the REuptake of Serotonin
PAROXETINE keeping MORE around. So Serotonin
FLUOXETINE levels are INCREASED

E
SELECTIVE
LIN
TRA

SEROTONIN
SER

CIT
ALO
PRA
M
FLUOXETINE

ESCITALOPRAM
PAROXETINE
REUPTAKE
INHIBITORS SEROTONIN

de Effects:

1. Sexual dysfunction 2. Weight Gain 3. Insomnia, NOT sleepiness

or sedation, don’t get tricked

erotonin ndrome

SUICIDE Risk SLOW Onset & SWEATY & HOT RIGID muscles INCREASED
INCREASED lo Ta er o + FEVER + Restlessness Heart Rate
A itation “Tachycardia”

2-4 ee s

Notes
Antidepressants
- MAOI

Drug names:

NARDIL
PHENELZINE KEY Words
PHENELZINE Brand: Nardil
SELEGILINE Pt States: “This med is not
ISOCARBOXAZID
SELEGILINE
or in a er ee s
TRANYLCYPROMINE ASSESS 1
ISOCARBOXAZID

Further expressions of:

1. Hopelessness
Indication:
2. Despair
3. Suicidal thoughts
Very powerful antidepressants:
4. Thoughts of self-harm
Depression, Panic disorder & Social
phobia. Used for depression that is
ANTIDEPRESSANTS

resistant to other meds

MOA:

Increase availability of norepinephrine,

serotonin, and dopamine in brain

NOREPINEPHRINE SEROTONIN DOPAMINE

M A O O I
Massive A VOID O
TC drugs O
ther I
ncreased
HTN crisis Risk TYRAMINE = HTN CRISIS!!! Antidepressants Suicide risk
SSRIs MAOIs TCAs

NORMAL NH
HIGH
LOW

HO

Tyramine

NCLEX Key terms: 1. Wine & Cheese C – Calcium Serotonin Syndrome NCLEX Key terms:
Headache ( wine tasting) A – Anti acids 2 week wash-out hen starting med.
Increased Agitation 2. Beer & Sausage, Salami A – Acetaminophen KEY DRUGS: Increasing Dose
( beer fest) N – NSAIDS Escitalopram ( RI)
3. Chocolate ( aproxen Ibuprofen) Imipramine ( CA)

Notes
 Atypical
Antidepressant

r e: r e:

Z
Trazodone Z
Z
u ro ion
Brand: Wellbutrin
KEY WORD

Avoid ETOH
& other sedatives
Indication:

Depression & aid to stop smoking

Indication:

Depression & Sleep aid

de Effects e r rc :

de Effects:
Sleepy and sedated
Insomnia, HA, weight loss

TraZZZadone TRANCEadone

Z
Z Z

te t e c :
• Avoid ETOH & other sedatives
(benzos, antihistamines)
Anti istamines

KEY POINT

XL, SR pill
• Take at night NEVER crush, chew, cut

• Orthostatic hypotension =
Teach: Slow position changes
NORMAL

• Never ‘’double up’’ on missed

HIGH
LOW

dose
• Rare: Priapism (erection)
Teach: Erection that lasts for hours - • Do not crush XR - extended
go to hospital! release or SR - Sustained release

Notes
Osmotic Diuretic
Mannitol

Drug name:
ATI
Mannitol MANNITOL
Give Mannitol for
increased ICP
Assess LOC every
hour
Indication:

Decreases cerebral edema resulting in

increased ICP: head injury, brain swelling,
etc. HESI
Decreases intraocular pressure - glaucoma
emergencies Mannitol: Used to
decrease ICP
IV admin - cannot be
given PO
ESSURE

ide e ect - Edema

PR

Begins 30 - 60 minutes
Memory Trick: after administration.

- Mannitol

- Man ICP hurts or Man Eyes hurt ATI

MANNITOL
Mannitol
Monitor for s/s heart failure:
Bibasilar crackles,
pulmonary edema

MOA:
de Effect:
Drains fluid out of brain cells into vascular
space IG I K for fluid volume overload
too much fluid in the body

Heart Failure Heavy Fluid

eart failure
HF =
eavy luid all over the body

Notes
Parkinson’s
Carbidopa + Levodopa

Pathophysiology:
uestion
NH
A Is (antidepressant)
HO
OH Parkinson’s Disease en ance e cacy
Dopamine
LOW Dopamine Selegiline ( A Is) used as
CH O
HIGH acetylcholine ad unct treatment
HC N with carbidopa-levodopa
O CH
HC
Acetylcholine

pa
Levodo

Memory Trick: Selegiline

MAOI Carbi
dopa

Levodopa - Leaves more dopamine in the brain

Carbidopa - Conserves the dopamine

KEY POINT

pa Carbid
opa Improvement in spontaneous
Levodo
movement
Dopamine (e ective for brady inesia)
Bradykinesia

uestion
Memory Trick:
Levodopa - If you want to Jump Rope
- You need more DOP-amine
ain drug of Par inson treatment NH

opamine precursor HO
OH

Dopamine

a lan uestion

KEY POINT Carbidopa - Levodopa

Patient eaching NORMAL
edication e ective y us and
is a le to al around t e yard
NO NEED TO REPORT

Slow onset 2 - 6 weeks

E ectiveness Client is more am ulatory
to become e ective
on t let t e E tric you
Slow position changes
NO - it does not el it memory
Red, brown urine sweat saliva
R AL NCLEX TIP
NO high protein meals NCLEX TIP limination
NOT “elimination” of tremors or rigidity
- nly ecreases NCLEX TIP
NEVER stop abruptly

Notes
 Neuromuscular Drugs
- Compt Receptor
How do they work? “Action”
hought to prolong the effect of levodopa by
blocking an enzyme, COMT, which eliminates
dopamine. When given with levodopa, the COMT
inhibitors increase the plasma concentrations
and duration of action of levodopa.
Indications
Used as adjuncts to levodopa/carbidopa in
treating Parkinson’s disease. Entacapone is a
mild COMT inhibitor and is used to help manage
fluctuations in the response to levodopa in
individuals with Parkinson’s disease. Tolcapone
is a potent COMT inhibitor that easily crosses the
blood–brain barrier. However, the drug is
associated with liver damage and liver failure.
Because of the danger to the liver, tolcapone is
reserved for people who are not responding to
other therapies.
Adverse Reactions
• Dizziness
• Dyskinesias, hyperkinesia, akathisia
• Nausea, anorexia, and diarrhea
• Orthostatic hypotension, sleep disorders,
excessive dreaming
• Somnolence and muscle cramps
Interactions
• MAOI antidepressants:
• Increased risk of toxicity of both drugs
• Adrenergic drugs: Increased risk of cardiac
symptoms
Generic Trade
As adjunct to levodopa/carbidopa in
Entacapone Comtan
Parkinson’s disease
Parkinson’s disease when refractory to
Tolcapone Tasmar
levodopa/carbidopa
Contraindications
These drugs are contraindicated in patients with
hypersensitivity to the drugs and during
pregnancy and lactation (pregnancy category C).
Tolcapone is contraindicated in patients with
liver dysfunction. The COMT inhibitors are used
with caution in patients with hypertension,
hypotension, and decreased hepatic or renal
function.
Nursing management
• If dizziness, drowsiness, or blurred vision
occurs, avoid driving or performing other tasks
that require alertness.
• Avoid the use of alcohol unless use has been
approved by the primary health care provider.
• Relieve dry mouth by sucking on hard candy
(unless the patient has diabetes) or taking
frequent sips of water. Consult a dentist if
dryness of the mouth interferes with wearing,
inserting, or removing dentures or causes
other dental problems.
• Keep all appointments with the primary health
care provider or clinic personnel because close
monitoring of therapy is necessary.
• Ask your primary health care provider before
buying vitamin supplements when taking
levodopa. Vitamin B6 (pyridoxine)
may interfere with the action of levodopa.
Dose Use
200–1600 mg/day orally
100–200 mg orally TID
Cholinergics
Neostigmine, Pyridostigmine

Drug name: Antidote:

Atropine (Anticholinergic)
Neosti mine NEOSTIGMINE
- Ending in Tropine ATROPINE

Pyridosti mine - NO pee with tropine

Dry body

Indication: uestion
nti i ate dru to treat m ast enia
• MG - Myasthenia Gravis ra is
eosti mine

• Dry body & lack of mobility atient ein mana ed or m ast enic
crisis de e o s ast ma
is ontinue ridosti mine
atient it anti o iner i to i it
MOA: sosti mine
Helps lube up the body with secretions by ed e ti eness ti mine
increasing acetylcholine sen e o muscle cram s and
ade uate ision it out di lo ia

AT uestion
NEOSTIGMINE

Memory Trick: Pupil constriction

i culty with visual

sti mine accommodation
ecretions I E Atropine given for
c oliner ic crisis caused
b excess amount of
neosti mine
Adverse Effects:

CCC oliner ic risis

is a eCCCretion crisis
A AN uestion
1

HCP
u il
constriction
Tears
lacrimation
ali a
Droolin
eatin
Dia oresis
Diarr ea N Client on ridosti mine
having salivation
lacrimation and urination
- notify the HCP

Notes
 Neuromuscular Drugs
- Dopaminergics
How do they work? “Action”
Drugs that work to stimulate the dopamine
receptors are called agonists. An example of
this drug category includes bromocriptine.
The action of amantadine is to make more of
the dopamine available at the receptor site.
asagiline A ilect and selegiline inhibit
monoamine oxidase type B, again making
more dopamine available.
(Ford 282)
Indications
• Parkinson’s disease
• Parkinson-like symptoms (extrapyramidal) as a
result of injury, drug therapy, or encephalitis
• Restless leg syndrome (RLS)
• Viral infections (amantadine)
(Ford 282-283)
Adverse Reactions
• Dry mouth and di culty in swallowing
• Anorexia, nausea, and vomiting
• Abdominal pain and constipation
• Increased hand tremor
• eadache and di iness ord
• The most serious adverse reactions seen with
levodopa include choreiform movements
(involuntary muscular twitching of the limbs or
facialmuscles) and dystonic movements
muscular spasms most often affecting the
tongue, jaw, eyes, and neck). (Ford 283)
Contraindications
Levodopa is contraindicated in patients with
narrow-angle glaucoma and those receiving
MAOI antidepressants.
Generic Trade
Parkinson’s disease/drug-induced
extrapyramidal symptoms,
Amantadine N/A
prevention and treatment of
infection with influen a A virus
Carbidopa/
Sinemet, Sinemet CR,
Parkinson’s disease
Levodopa Parcopa
Interactions
• Tricyclic antidepressants: Increased risk of
hypertension and dyskinesia
• Antacids: Increased effect of levodopa
• Anticonvulsants: Decreased effect of levodopa
• Foods high in pyridoxine (vitamin B6) or
vitamin preparations reduce the effect of
levodopa.
Nursing management
• The patient should be screened for unusual skin
lesions, because levodopa can activate malignant
melanoma
• The dopamine agonists selegiline and rasagiline
should not be used with the opioid meperidine
(Demerol) because of antimetabolite conversion.
Caution should be taken with any other opioid
used with these antiparkinson drugs.
• Hallucinations occur more often in the older adult
than in the younger adult receiving antiparkinson
drugs. This is especially likely when taking
dopamine receptor agonists.
• If di iness drowsiness or blurred vision occurs
avoid driving or performing other tasks that require
alertness.
• Avoid the use of alcohol unless use has been
approved by the primary health care provider.
• Relieve dry mouth by sucking on hard candy
(unless the patient has diabetes) or taking frequent
sips of water. Consult a dentist if dryness of the
mouth interferes with wearing, inserting, or
removing dentures or causes other dental
problems.
• Keep all appointments with the primary health care
provider or clinic personnel because close
monitoring of therapy is necessary.
• Ask your primary health care provider before
buying vitamin supplements when taking levodopa.
Vitamin B6 (pyridoxine) may interfere with the
action of levodopa.
Dose Use
200–400 mg/day orally in
divided doses
Begin with 10 mg/100 mg tablet
orally TID, titrated dose
combination to minimi e symptoms
 Neuromuscular Drugs
- Cholinergic Blocking Drug

How do they work? “Action” Drugs with Parkinson-like Adverse Reactions

Drugs with cholinergic blocking activity block ACh in the
CNS, enhancing dopamine transmission.
Indications
Adjunctive therapy in all forms of Parkinson-like
symptoms and in the control of drug-induced extrapyra-
midal disorders
Adverse Reactions
• Dry mouth
• Blurred vision
• Dizziness, mild nausea, and nervousness
• Skin rash, urticaria (hives)
• Urinary retention, dysuria
• Tachycardia, muscle weakness
• Disorientation and confusion
Contraindications
• Glaucoma (angle-closure glaucoma)
• Pyloric or duodenal obstruction
• Peptic ulcers, prostatic hypertrophy, achalasia (failure of
the muscles of the lower esophagus to relax, causing
di culty swallowing myasthenia gravis and megacolon.
Interactions
• Amantadine: Increased anticholinergic effects
• Digoxin: Increased digoxin serum levels
• Haloperidol: Increased psychotic behavior
• Phenothiazines: Increased anticholinergic effects
The following drugs can produce symptoms similar
to Parkinson’s disease, also known as extrapyramidal
symptoms (EPS), which may be treated with
similar drugs to reduce the adverse reactions:
• Antidepressants
• Antiemetics
• Antipsychotics rst generation
• Lithium
• Stimulants
• Individuals older than 60 years frequently develop
increased sensitivity to anticholinergic drugs and
require careful monitoring. Confusion and
disorientation may occur. Lower doses may be
required.
Nursing management
• If dizziness, drowsiness, or blurred vision occurs,
avoid driving or performing other tasks that require
alertness.
• Avoid the use of alcohol unless use has been
approved by the primary health care provider.
• Relieve dry mouth by sucking on hard candy (unless
the patient has diabetes) or taking frequent sips of
water. Consult a dentist if dryness of the mouth
interferes with wearing, inserting, or removing
dentures or causes other dental problems.
• Keep all appointments with the primary health care
provider or clinic personnel because close
monitoring of therapy is necessary.
• Ask your primary health care provider before
buying vitamin supplements when taking levodopa.
Vitamin B6 (pyridoxine) may interfere with the
action of levodopa.

Generic Trade Use Dose

Parkinson’s disease, 0.5–6 mg/day orally

Benztropine Cogentin
drug-induced EPS Acute dystonia: 1–2 mL IM or IV

Diphenhydramine Benadryl Drug-induced EPS, allergies 25–50 mg orally TID or QID

 Anticonvulsants
- Misc
How do they work? “Action”
Miscellaneous drugs have differing properties for example
gabapentin is a GABA agonist, and topiramate blocks the seizure
activity rather than raising the threshold.
Indications
• Seizures of all types
• Neuropathic pain
• Bipolar disorders
• Anxiety disorders
Adverse Reactions
• Nystagmus (constant, involuntary movement of the eyeball)
• Ataxia (loss of control of voluntary movements, especially gait)
• Slurred speech
• Gingival hyperplasia (overgrowth of gum tissue)
Contraindications
All categories of anticonvulsants are contraindicated in patients
with known hypersensitivity to the drugs. Carbamazepine should
not be given within 14 days of monoamine oxidase inhibitor
(MAOI) antidepressants. Carbamazepine is contraindicated in
patients with bone marrow depression or hepatic or renal
impairment and during pregnancy (pregnancy category D).
Interactions
• Antibiotics/antifungals: Increased effect of the anticonvulsant
• Tricyclic antidepressants: Increased effect of the
anticonvulsant
• Salicylates: Increased effect of the anticonvulsant
• Cimetidine: Increased effect of the anticonvulsant
• Theophylline: Decreased serum levels of the anticonvulsant
• Antiseizure medications: May increase seizure activity
• Protease inhibitors: Increased carbamazepine levels, resulting
in toxicity
• Oral contraceptives: Decreased effectiveness of birth control
resulting in breakthrough bleeding or pregnancy
• Analgesics or alcohol: Increased depressant effect
• Antidiabetic medications: Increased blood glucose levels
Generic Trade
Tegretol,
Epilepsy, bipolar disorder,
Carbamazepine Carbatrol,
trigeminal/postherpetic neuralgia
Epitol, Equetro
Fun Fact
• Research suggests an association between the use of
anticonvulsants by pregnant women with epilepsy and
an increased incidence of birth defects. The use of
anticonvulsants is not discontinued in pregnant women
with a history of major seizures because of the danger of
precipitating status epilepticus. However, when seizure
activity poses no serious threat to the pregnant woman,
the primary health care provider may consider
discontinuing use of the drug during pregnancy.
• Recurrence of seizure activity may result from abrupt
discontinuation of the drug, even when the
anticonvulsant is being administered in small daily doses
• Hematologic changes (e.g., aplastic anemia, leukopenia,
and thrombocytopenia) need to be reported
immediately. Teach the patient how to identify signs of
thrombocytopenia (bleeding gums, easy bruising,
increased menstrual bleeding, tarry stools) or leukopenia
(sore throat, chills, swollen glands, excessive fatigue, or
shortness of breath) and to contact the primary health
care provider..
Nursing management
• Do not omit, increase, or decrease the prescribed dose.
• Anticonvulsant blood levels must be monitored at
regular intervals, even if the seizures are well controlled.
• This drug should never be abruptly discontinued,
except when recommended by the primary health care
provider.
• Do not attempt to put anything in the mouth of a
person having a seizure.
• If the primary health care provider nds it necessary to
stop the drug, another drug usually is prescribed. Start
taking this drug immediately (at the time the next dose
of the previously used drug was due).
• Anticonvulsant drugs may cause drowsiness or dizziness.
Observe caution when performing hazardous tasks. Do
not drive unless the adverse reactions of drowsiness,
di iness or blurred vision are not signi cant. Driving
privileges will be approved or reinstated by the primary
health care provider based on seizure control.
• Avoid the use of alcohol unless use has been approved
by the primary health care provider.
• Wear medical identi cation such as a edic Alert tag
or bracelet, indicating drug use and the type of seizure
disorder.
Use Route
Dose
Maintenance: 800–1200 mg/day
orally in divided doses
Neurological
Top Missed Questions

hich nursing action(s) are hich adverse e ects of

appropriate for a nurse preparing to phenytoin should the nurse
administer phenytoin via a immediately report to the
nasogastric ( ) tube Select all provider Select all that
that apply. apply

1. Hold tube feedings for at

least one hour prior to 1. New reports of
administration feeling “unsteady”
Flush with 30 - 50 mL tap water

2. Flush the nasogastric tube en ambulatin

with 30 mL tap water before 2. The appearance of
before a er
and a er administration a new rash on the
3. onitor blood pressure and atient s c est
heart rate every 5 minutes 3. Reports of feeling
for two hours after hopeless and
administration. a at etic 20 mcg/dl
1

onitor li er function tests 4. A morning

HPC

KEY POINTS
on a re ular basis for atients phenytoin level of 26
10-20 mcg/dl T era eutic an e

taking phenytoin. Below 10 - Seizure Risk -

REP R HCP mg/ dL.
OVER 20 - Toxic Risk -
5. Administer phenytoin at the H L E & notify HCP
Di cult formin
outine lood Tests “blood

onset of new sei ure activity. levels monitored routinely”

words and sentences.

he health care provider has hich instruction(s) should the nurse LEAVEodopa
prescribed mg succinylcholine nurse include in the plan of care for a
to be administered I push patient newly prescribed
during a rapid sequence carbidopa-levodopa for the treatment of
intubation. hich is the nurse s Par inson isease elect all that apply.
Succinylcholine

riorit action when preparing

to administer this medication . “If you don t notice improvement
. Chec the patient s in your symptoms within one wee
core body notify your provider.”
temperature. en oin from a si n to a
As t e atient standin osition be sure to
about a history of c an e our osition slo l
alcohol abuse. 3. “It is a good idea to remove any
3. Prepare a dose of extra clu er from our ome t at
mida olam as could cause you to trip and fall.”
prescribed for KEY POINT . “Call your provider if you notice
creen for HIGH RISK - MH
sedation. that your urine changes to a slightly
1. Prior reaction to
. Ensure that a general anesthesia S
reddish color.”
CRITICAL Levod
opa

non-rebreather mas 2. Blood relatives with

A oid eatin meals t at contain
signi cant reaction to
is at the bedside prior general anesthesia large amounts of protein while opa
3. Alcoholics HESI Carbid
to administration. ta in t is medication
 Anticonvulsants
- Oxazolidinedione

How do they work? “Action” Fun Fact

Oxazolidinones decrease repetitive synaptic • Research suggests an association between the use of
transmissions of nerve impulses. anticonvulsants by pregnant women with epilepsy and
an increased incidence of birth defects. The use of
anticonvulsants is not discontinued in pregnant women
Indications with a history of major seizures because of the danger of
• Seizures of all types precipitating status epilepticus. However, when seizure
• Neuropathic pain activity poses no serious threat to the pregnant woman,
• Bipolar disorders the primary health care provider may consider
• Anxiety disorders discontinuing use of the drug during pregnancy.
• Recurrence of seizure activity may result from abrupt
discontinuation of the drug, even when the
Adverse Reactions anticonvulsant is being administered in small daily doses
• Hematologic changes (e.g., aplastic anemia, leukopenia,
• Nystagmus (constant, involuntary movement of the
and thrombocytopenia) need to be reported
eyeball)
• Ataxia (loss of control of voluntary movements, immediately. Teach the patient how to identify signs of
especially gait) thrombocytopenia (bleeding gums, easy bruising,
• Slurred speech increased menstrual bleeding, tarry stools) or leukopenia
• Gingival hyperplasia (overgrowth of gum tissue) (sore throat, chills, swollen glands, excessive fatigue, or
shortness of breath) and to contact the primary health
care provider..
Contraindications
Oxazolidinones have been associated with serious adverse
reactions and fetal malformations. They should be used
only when other less toxic drugs are not effective in
controlling seizures.

Interactions Nursing management

• Antibiotics/antifungals: Increased effect of the
anticonvulsant
• Tricyclic antidepressants: Increased effect of the
anticonvulsant
• Salicylates: Increased effect of the anticonvulsant
• Cimetidine: Increased effect of the anticonvulsant
• Theophylline: Decreased serum levels of the
anticonvulsant
• Antiseizure medications: May increase seizure activity
• Protease inhibitors: Increased carbamazepine levels,
resulting in toxicity
• Oral contraceptives: Decreased effectiveness of birth
control, resulting in breakthrough bleeding or pregnancy
• Analgesics or alcohol: Increased depressant effect
• Antidiabetic medications: Increased blood glucose
levels
• his drug may cause photosensitivity. Take protective
measures (e.g., wear sunscreens and protective clothing)
when exposed to ultraviolet light or sunlight until
tolerance is determined.
• Notify the primary health care provider if the following
reactions occur: visual disturbances, excessive
drowsiness or dizziness, sore throat, fever, skin rash,
pregnancy, malaise, easy bruising, epistaxis, or bleeding
tendencies.
• Avoid pregnancy while taking trimethadione; the drug
has caused serious birth defects.

Generic Trade Dose Use

900 mg–2.4 g/day orally in
Trimethadione Tridione Epilepsy
equally divided doses
Anticonvulsant
Phenytoin

Indication: atient Teac in

Epilepsy (long term protection NO oral

contraceptives FOLIC VIT D

against seizures)
ACID

NO stopping
abruptly
CALCIUM

Take Folic acid,

KEY POINTS
Phenytoin = mc dl

phenyTOXIC 10-20 mcg/dl T era eutic an e

1

HCP

Below 10 - Seizure Risk

REPORT TO HCP!
Administration
OVER 20 - Toxic Risk
Phenytoin H L E & notify HCP STOP Tube eedin
outine lood Tests
Phenytoin for 1-2 hours before and
“blood levels monitored routinely”
after admin.

entioned multi le
times as a riorit

Toxicity: NCLEX TIPs

uestion ATI uestion
EARLY i ns to e ort to HCP
EACH pt. to inform dentist
Hold med for level that they are taking phenytoin
Ataxia (*unsteady gait i er t an
or gait disturbance)
Hand Tremor a e at same time HESI uestion
Slurred speech daily - narrow Perform or assist with oral
t era eutic index care every shift.
in rash fatigue &
dyspnea - priority

Other Adverse E ects

KAPLAN uestion
e ord
Statements requiring
immediate intervention
uicidal Ideations
1

HPC
“I noticed a rash on my
Skin Rash - “new” stomach last wee ”
“painful” PRI RI “Lately I nd myself
thinking about dri in
o a cli ”

x ected ide ect KAPLAN uestion

Bradycardia & Hypotension
Encourage foods such as
Gingival hyperplasia milk, cantaloupe and kale
NCLEX TIP foods i in folate
Vitamin D)
T
NO
DO P
TEACH: e uires furt er teac in STO TLY
UP
ABR
Good dental hygiene with “If I start having adverse
e ects ill sto ta in
Phenytoin
soft toothbrush
this med immediately” Phenytoin

Notes
 Neuromuscular
Blocking Agent
Drug names:
d erse e t

Succinylcholine a i nant ert ermia

M - Muscle rigidity
Pancuronium Succinylcholine Pancuronium
Cisatracurium
- HOT
Cisatracurium

Indication: 1 2 3
1

Given before intubation & mechanical ventilation.

Like before surgery & in emergency settings
DANTROLENE

1. Notify HCP 2. IV dantrolene 3. Oxygen

HESI
After admin su in o ine …
HESI high e er and mus e ri idit
Used to facilitate Prepare to give DANTROLENE

mec anical ventilation

Produces deep muscle
relaxation NCLEX

HESI KEY POINT

MUST give sedation
Primary result is fla id Screen for
ara sis - NOT loss of
consciousness
1. Prior reaction to
general anesthesia MOST
CRITICAL
1 2 3 2. Blood relatives with
signi cant reaction to
general anesthesia
3. Alcoholics HESI
ida o am
Succinylcholine

Notes
 Anticonvulsants
- Benzodiazepines

How do they work? “Action” Fun Fact

Benzodiazepines elevate the seizure threshold by • Research suggests an association between the use of
decreasing postsynaptic excitation. en os are speci c to anticonvul sants by pregnant women with epilepsy and
treatment of status epilepticus. an increased incidence of birth defects. The use of
anticonvulsants is not discontinued in pregnant women
with a history of major seizures because of the danger of
Indications precipitating status epilepticus. However, when seizure
activity poses no serious threat to the pregnant woman,
• Seizures of all types
the primary health care provider may consider
• Neuropathic pain
discontinuing use of the drug during pregnancy.
• Bipolar disorders
• Recurrence of seizure activity may result from abrupt
• Anxiety disorders
discontinuation of the drug, even when the
anticonvulsant is being administered in small daily doses
Adverse Reactions • Hematologic changes (e.g., aplastic anemia, leukopenia,
and thrombocytopenia) need to be reported
• Nystagmus (constant, involuntary movement of the immediately. Teach the patient how to identify signs of
eyeball) thrombocytopenia (bleeding gums, easy bruising,
• Ataxia (loss of control of voluntary movements, especially increased menstrual bleeding, tarry stools) or leukopenia
gait) (sore throat, chills, swollen glands, excessive fatigue, or
• Slurred speech shortness of breath) and to contact the primary health
• Gingival hyperplasia (overgrowth of gum tissue) care provider..

Contraindications
All categories of anticonvulsants are contraindicated in
patients with known hypersensitivity to the drugs.Benzodi-
azepines are used cautiously during pregnancy (pregnancy
category D) and in patients with psychoses, patients with
acute narrow-angle glaucoma, and older or debilitated
patients.
Interactions
• Antibiotics antifungals Increased effect of the
anticonvulsant
• ricyclic antidepressants Increased effect of the
anticonvulsant
• alicylates Increased effect of the anticonvulsant
• Cimetidine Increased effect of the anticonvulsant
• Theophylline:Decreased serum levels of the
anticonvulsant
• Antisei ure medications ay increase sei ure activity
• Protease inhibitors: Increased carbamazepine levels,
resulting in toxicity
• ral contraceptives Decreased effectiveness of birth
control, resulting in breakthrough bleeding or pregnancy
• Analgesics or alcohol Increased depressant effect
• Antidiabetic medications: Increased blood glucose levels
Nursing management
• Do not omit, increase, or decrease the prescribed dose.
• Anticonvulsant blood levels must be monitored at regular
intervals, even if the seizures are well controlled.
• This drug should never be abruptly discontinued, except
when recommended by the primary health care provider.
• Do not attempt to put anything in the mouth of a person
having a seizure.
• If the primary health care provider nds it necessary to
stop the drug, another drug usually is prescribed. Start
taking this drug immediately (at the time the next dose of
the previously used drug was due).
• Anticonvulsant drugs may cause drowsiness or dizziness.
Observe caution when performing hazardous tasks. Do
not drive unless the adverse reactions of drowsiness,
di iness or blurred vision are not signi cant. Driving
privileges will be approved or reinstated by the primary
health care provider based on seizure control.
• Avoid the use of alcohol unless use has been approved
by the primary health care provider.
• Wear medical identi cation such as a edic Alert tag or
bracelet, indicating drug use and the type of seizure
disorder.

Generic Trade Use Dose

Seizure control: 2–10 mg/day orally
Status epilepticus, seizure disorders BID to QID
Diazepam Valium (all forms), anxiety disorders, Status epilepticus: 5–10 mg IV initially,
alcohol withdrawal maximum dose 30 mg
Rectally: 0.2–0.5 mg/kg
 Neuromuscular Drugs
- Dopamine Receptor Agonist
How do they work? “Action”
It is thought that non ergot dopamine receptors
act directly on postsynaptic dopamine receptors
of nerve cells in the brain mimicking the effects
of dopamine in the brain.
Indications
Treatment of the signs and symptoms of
Parkinson’s disease. It is also used in the
treatment of RLS. apomorphine (Apokyn) is used
for the on off phenomena of arkinson s
disease. Antiemetic therapy must be initiated
with this drug.
Adverse Reactions
• Nausea, dizziness, vomiting
• Somnolence, hallucinations, confusion, visual
disturbances
• Postural hypotension, abnormal involuntary
movements
• Headache
Contraindications
Dopamine receptor agonists are used with
caution in patients with dyskinesia, orthostatic
hypotension, hepatic or renal impairment,
cardiovascular disease, and a history of
hallucinations or psychosis. Both ropinirole and
pramipexole are pregnancy category C drugs,
and safety during pregnancy has not been
established.
Generic Trade
Apomorphine Apokyn
Pramipexole Mirapex
Ropinirole Requip
Interactions
• Cimetidine, ranitidine: Increased dopamine
agonist effectiveness
• verapamil, quinidine: Increased dopamine
agonist effectiveness
• Estrogen: Increased dopamine agonist
effectiveness
• Phenothiazines: Decreased dopamine agonist
effectiveness
Nursing management
• Hallucinations occur more often in the older
adult than in the younger adult receiving anti
parkinson drugs. This is especially likely when
taking dopamine receptor agonists.
• If dizziness, drowsiness, or blurred vision
occurs, avoid driving or performing other tasks
that require alertness.
• Avoid the use of alcohol unless use has been
approved by the primary health care provider.
• Relieve dry mouth by sucking on hard candy
(unless the patient has diabetes) or taking
frequent sips of water. Consult a dentist if
dryness of the mouth interferes with wearing,
inserting, or removing dentures or causes
other dental problems.
• Keep all appointments with the primary health
care provider or clinic personnel because close
monitoring of therapy is necessary.
• Ask your primary health care provider before
buying vitamin supplements when taking
levodopa. Vitamin B6 (pyridoxine) may
interfere with the action of levodopa.
Use Dose
arkinson s disease off . m as needed for off
episode episode
Parkinson’s disease, RLS 0.125–1.5 mg orally TID
Parkinson’s disease, RLS 0.25–1 mg orally TID
Migraine

Drug name: Drug name:

RIPTAN
SUMAT

Sumatriptan
Ergotamine SL Ergotamine SL

Indication:

Given to treat migraines & MOA:

cluster headaches

Vasoconstriction of brain vessels

MOA:

Vasoconstriction of brain vessels

AT uestion
Contraindication:

• CAD - coronary artery disease

Indication Migraine Headaches

• Uncontrolled Hypertension eac Take one tablet

Risk for HTN crisis, angina & MI immediately at onset of headaches

NORMAL
HIGH
LOW

REPORT
uestion
KEY POINT NORMAL
HIGH
LOW

Screen for history of

uncontrolled HTN
Er otamine
& REPORT it! Priority nding Pale extremities
ATI Teach: Report angina
(coronary vasospasms)
with Sumatriptan
Ergotamine SL

Notes
Anticholinergics
Benztropine, Atropine

Drug names: Memory Trick:

E
ATROPIN

Benztro ine T O ropines

Atro ine ATROPINE

aTropines reat remors arkinsons

Indication:
KEY POINTS
1. Speeds up heart rate in symptomatic
bradycardia CONTRAINDICATIONS
No o el obstruction
2. Antidote for cholinergic crisis No laucoma

3. Treats tremors in Parkinsons NCLEX

Atro ine ma reci itate acute
laucoma
Clients with glaucoma - otify
HCP
No or urinary
MOA: retention
urns off the N parasympathetic rest digest 1

by blocking the vagus nerve. This allows the SNS

sympathetic ght or flight to be N IN C .
ESSURE

Which activates the vital organs ING

PR

the heart rate making the body dry

uestion
PNS SNS atient Teac in
Teac in otify the HCP
if you develop urinar
retention.

KEY POINTS This med can reduce t e

abilit to s eat so do not
Treat Extrapyramidal s/s overheat
(Dystonia) Sit or stand up slowly to
Parkinson's Tremors prevent lightheadedness
(Bradykinesia)
uscle ri idit
1

u in ait

Notes
 Anticonvulsants
- Carboxylic Acid

How do they work? “Action” Interactions

Carboxylic acid derivatives increase levels of gamma • Antibiotics antifungals Increased effect of the anticonvulsant
aminobutyric acid GA A which stabili es cell mem • ricyclic antidepressants Increased effect of the anticonvulsant
branes. • alicylates Increased effect of the anticonvulsant
• Cimetidine Increased effect of the anticonvulsant
• heophylline Decreased serum levels of the anticonvulsant
• Antisei ure medications ay increase sei ure activity
• rotease inhibitors Increased carbama epine levels resulting in
toxicity
• ral contraceptives Decreased effectiveness of birth control
resulting in breakthrough bleeding or pregnancy
Indications
• Analgesics or alcohol Increased depressant effect
• ei ures of all types • Antidiabetic medications Increased blood glucose levels
• Neuropathic pain
• ipolar disorders
• Anxiety disorders

Adverse Reactions
• Nystagmus constant involuntary movement of the
eyeball
• Ataxia loss of control of voluntary movements especially
gait
• lurred speech
• Gingival hyperplasia overgrowth of gum tissue
Contraindications
Carbama epine should not be given within days of
monoamine oxidase inhibitor A I antidepressants.
Carbama epine is contraindicated in patients with bone
marrow depression or hepatic or renal impairment and
during pregnancy pregnancy category D . alproic acid
Depakote is not administered to patients with renal
impairment or during pregnancy pregnancy category D .
xcarba epine rileptal a miscellaneous anticonvulsant
may exacerbate dementia.
Nursing management
• Do not omit increase or decrease the prescribed dose.
• Anticonvulsant blood levels must be monitored at regular
intervals even if the sei ures are well controlled.
• his drug should never be abruptly discontinued except when
recommended by the primary health care provider.
• Do not attempt to put anything in the mouth of a person having
a sei ure.
• If the primary health care provider nds it necessary to stop the
drug another drug usually is prescribed. tart taking this drug
immediately at the time the next dose of the previously used
drug was due .
• Anticonvulsant drugs may cause drowsiness or di iness.
bserve caution when performing ha ardous tasks. Do not
drive unless the adverse reactions of drowsiness di iness or
blurred vision are not signi cant. Driving privileges will be
approved or reinstated by the primary health care provider
based on sei ure control.
• Avoid the use of alcohol unless use has been approved by the
primary health care provider.
• Wear medical identi cation such as a edic Alert tag or
bracelet indicating drug use and the type of sei ure disorder.
• Do not use any nonprescription drug unless the preparation has
been approved by the primary health care provider.
• Keep a record of all sei ures date time length as well as any
minor problems e.g. drowsiness di iness lethargy and take
the record to each clinic or o ce visit.
• Contact the local branches of agencies such as the pilepsy
oundation of America for information and assistance with
problems such as legal matters insurance driver s license
low cost prescription services and ob training or retraining.

Generic Trade Dose Use

Epilepsy, migraine headache, 10–60 mg/kg/day orally; if dosage is more
Valproic acid DEPAKOTE
mania than 250 mg/day, give in divided doses
 Anticonvulsants
- Hydantoins

How do they work? “Action” Fun Fact

Hydantoins stabilize the hyperexcitability postsynaptically in the
motor cortex of the brain.
Indications
• Seizures of all types
• Neuropathic pain
• Bipolar disorders
• Anxiety disorders
Adverse Reactions
• Nystagmus (constant, involuntary movement of the eyeball)
• Ataxia (loss of control of voluntary movements, especially gait)
• Slurred speech
• Gingival hyperplasia (overgrowth of gum tissue)
Contraindications
Phenytoin is contraindicated in patients with sinus bradycardia,
sinoatrial block, Adams-Stokes syndrome, and second- and
third-degree atrioventricular (AV) block; it also is contraindicated
during pregnancy and lactation(ethotoin and phenytoin are
pregnancy category D drugs).
Interactions
• Antibiotics/antifungals: Increased effect of the anticonvulsant
• Tricyclic antidepressants: Increased effect of the
anticonvulsant
• Salicylates: Increased effect of the anticonvulsant
• Cimetidine: Increased effect of the anticonvulsant
• Theophylline: Decreased serum levels of the anticonvulsant
• Antiseizure medications: May increase seizure activity
• Protease inhibitors: Increased carbamazepine levels, resulting
in toxicity
• Oral contraceptives: Decreased effectiveness of birth control
resulting in breakthrough bleeding or pregnancy
• Analgesics or alcohol: Increased depressant effect
• Antidiabetic medications: Increased blood glucose levels
• Research suggests an association between the use of
anticonvulsants by pregnant women with epilepsy and
an increased incidence of birth defects. The use of
anticonvulsants is not discontinued in pregnant women
with a history of major seizures because of the danger of
precipitating status epilepticus. However, when seizure
activity poses no serious threat to the pregnant woman,
the primary health care provider may consider
discontinuing use of the drug during pregnancy.
• Recurrence of seizure activity may result from abrupt
discontinuation of the drug, even when the
anticonvulsant is being administered in small daily doses
• Hematologic changes (e.g., aplastic anemia, leukopenia,
and thrombocytopenia) need to be reported
immediately. Teach the patient how to identify signs of
thrombocytopenia (bleeding gums, easy bruising,
increased menstrual bleeding, tarry stools) or leukopenia
(sore throat, chills, swollen glands, excessive fatigue, or
shortness of breath) and to contact the primary health
care provider..
Nursing management
• Inform the dentist and other primary health care
providers of use of this drug.
• rush and floss the teeth after each meal and make
periodic dental appointments for oral examination and
care.
• Take the medication with food to reduce GI upset.
• Thoroughly shake a phenytoin suspension
immediately before use.
• Do not take capsules that are discolored.
• Notify the primary health care provider if any of the
following occurs: skin rash, bleeding, swollen or tender
gums, yellowish discoloration of the skin or eyes, unex
plained fever, sore throat, unusual bleeding or bruising,
persistent headache, malaise, or pregnancy

Generic Trade Use Dose

Loading dose: 15–20 mg/kg IV
Fosphenytoin N/A Status epilepticus
Maintenance dose: 4–6 mg/kg/day IV
Oral: loading dose: 1 g divided into three
doses prevention (400 mg, 300 mg, 300 mg)
Tonic-clonic seizures, status
orally q 2 hr
Phenytoin Dilantin epilepticus, prophylactic
Maintenance dose: started 24 hr after
seizure prevention
loading dose, 300–400 mg/day
Parenteral: 10–15 mg/kg IV
 Anticonvulsants
- Succinimides

How do they work? “Action” Fun Fact

Succinimides depress the motor cortex, creating a higher
threshold before nerves react to the convulsive stimuli.
Indications
• Seizures of all types
• Neuropathic pain
• Bipolar disorders
• Anxiety disorders
Adverse Reactions
• Nystagmus (constant, involuntary movement of the eyeball)
• Ataxia (loss of control of voluntary movements, especially gait)
• Slurred speech
• Gingival hyperplasia (overgrowth of gum tissue)
Contraindications
Succinimides are contraindicated in patients with bone marrow
depression or hepatic or renal impairment. A higher incidence of
systemic lupus erythematosus has been found in patients taking
succinimides.
Interactions
• Antibiotics/antifungals: Increased effect of the anticonvulsant
• Tricyclic antidepressants: Increased effect of the
anticonvulsant
• Salicylates: Increased effect of the anticonvulsant
• Cimetidine: Increased effect of the anticonvulsant
• Theophylline: Decreased serum levels of the anticonvulsant
• Antiseizure medications: May increase seizure activity
• Protease inhibitors: Increased carbamazepine levels, resulting
in toxicity
• Oral contraceptives: Decreased effectiveness of birth control
resulting in breakthrough bleeding or pregnancy
• Analgesics or alcohol: Increased depressant effect
• Antidiabetic medications: Increased blood glucose levels
• Research suggests an association between the use of
anticonvulsants by pregnant women with epilepsy and
an increased incidence of birth defects. The use of
anticonvulsants is not discontinued in pregnant women
with a history of major seizures because of the danger of
precipitating status epilepticus. However, when seizure
activity poses no serious threat to the pregnant woman,
the primary health care provider may consider
discontinuing use of the drug during pregnancy.
• Recurrence of seizure activity may result from abrupt
discontinuation of the drug, even when the
anticonvulsant is being administered in small daily doses
• Hematologic changes (e.g., aplastic anemia, leukopenia,
and thrombocytopenia) need to be reported
immediately. Teach the patient how to identify signs of
thrombocytopenia (bleeding gums, easy bruising,
increased menstrual bleeding, tarry stools) or leukopenia
(sore throat, chills, swollen glands, excessive fatigue, or
shortness of breath) and to contact the primary health
care provider..
Nursing management
• If GI upset occurs, take the drug with food or milk.
• Notify the primary health care provider if any of the
following occurs: skin rash, joint pain, unexplained fever,
sore throat, unusual bleeding or bruising, drowsiness,
dizziness, blurred vision, or pregnancy.

Generic Trade Use Dose

Up to 1.5 g/day orally in divided
Ethosuximide Zarontin Partial seizures
doses; children, 250 mg/day orally

Methsuximide Celontin Partial seizures 300–1200 mg/day orally

Anticonvulsant
Levetiracetam

Drug name:

e etiracetam e etiracetam
A O AD
T
e etiracetam

Just like Phenytoin -

Indication:
Suicidal thoughts
• Prevent & treat seizures Stevens-Johnson

• Report: New anxiety, agitation,

depression, mood changes
• Report: Rash, blistering, muscle/joint pain

• Often preferred over phenytoin

due to minimal drug to drug
interactions
O T

O er en toin

en toin

O NT
e etiracetam

e etiracetam
en toin

atient teac in
Dri in = Get
de Effets:
permission from HCP &
CNS depressant - LOW & SLOW body follow transportation
- drowsiness & fatigue dept. guidelines.

Trans ortation de t uidelines

S M T W T F S

1 2 3 4 5

6 7 8 9 10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30

Notes
 PNS Drugs
- Cholinergics

How do they work? “Action” Interactions

• Cholinergic drugs that act like the neurotrans
mitter ACh are called direct-acting cholinergics.
Cholinergic drugs causes contraction of the
bladder smooth muscles and passage of urine.
(Ford 266)
• Cholinergic drugs that prolong the activity of
ACh by inhibiting the release of AChE are called
indirect-acting cholinergics or
anticholinesterase muscle stimulants.
Indications
• Urinary retention
• Myasthenia gravis
Adverse Reactions
• Aminoglycoside: Anti-infective agent
Increased neuromuscular blocking effect
• Corticosteroids: Decreased effect of the
cholinergic drug
Nursing Alert
Cholinergic crisis (cholinergic drug toxicity)
symptoms include severe abdominal cramping,
diarrhea, excessive salivation, muscle weakness,
rigidity and spasm, and clenching of the jaw.
Patients exhibiting these symptoms require
immediate medical treatment. In the case of
drug overdose, an antidote such as atropine (0.4
to 0.6 mg intravenously [IV]) is administered.
(Ford 267)

• Nausea, diarrhea, abdominal cramping

• Salivation
• Flushing of the skin
• Cardiac arrhythmias and muscle weakness
Contraindications
Hypersensitivity to the drugs, asthma, peptic
ulcer disease, coronary artery disease, and
hyperthyroidism. Bethanechol is contraindicated
in those with mechanical obstruction of the GI or
genitourinary tracts. Patients with secondary
glaucoma, iritis, corneal abrasion, or any acute
inflammatory disease of the eye should not use
the ophthalmic cholinergic preparations.
(Ford 267)
Nursing management
Because of the need to make frequent dosage
adjustments, observe the patient closely for
symptoms of drug overdose or underdose. Signs
of drug overdose include muscle rigidity and
spasm, salivation, and clenching of the jaw. Signs
of drug underdosage are signs of the disease
itself, namely, rapid fatigability of the muscles,
drooping of the eyelids and di culty breathing.
If symptoms of drug overdose or underdose
develop, contact the primary health care
provider immediately.

Generic Trade Use Dose

Acute non obstructive urinary
Duvoid, 10–50 mg orally BID to QID; 2.5–5
Bethanechol retention, neurogenic atony of urinary
Urecholine mg subcutaneously TID to QID
bladder with urinary retention

Ambenonium Mytelase Myasthenia gravis 5–75 mg orally TID, QID

 PNS Drugs
- A/B Blocking Drugs

How do they work? “Action” Nursing Alert

Adrenergic blocking drugs block the stimulation
of both the and adrenergic receptors resulting
in peripheral vasodilation. The two drugs in this
category are carvedilol (Coreg) and labetalol
randate . ord
Indications
• Carvedilol is used to treat essential hypertension
and in HF to reduce progression of the disease.
• Labetalol is used in the treatment of hypertension,
either alone or in combination with another drug,
such as a diuretic. ord
Adverse Reactions
General body system adverse reactions include
fatigue, dizziness, hypotension, drowsiness,
insomnia, weakness, diarrhea, dyspnea, chest, pain,
bradycardia and skin rash. ord
Contraindications
• Hypersensitivity to the drugs bronchial asthma
• Decompensated HF
• Severe bradycardia
Interactions
• Antidepressants (tricyclics and SSRIs):
Increased risk of tremors
• Cimetidine: Increased effect of the adrenergic
blocker
• Clonidine: Increased effect of the clonidine
• Digoxin: Increased serum level of the digoxin and
higher risk of digoxin toxicity ord
When administering a sympatholytic drug, such as
propranolol (Inderal), take an apical pulse rate and
blood pressure before giving the drug. If the pulse is
below beats min or if there is any irregularity in
the patient’s heart rate or rhythm, or if systolic blood
pressure is less than mm g withhold the drug
and contact the primary health care provider.
(Ford 258)
Nursing management
• Do not stop taking the drug abruptly, except on the
advice of the primary health care provider. Most of
these drugs require that the dosage be gradually
decreased to prevent precipitation or worsening of
adverse effects.
• Notify the primary health care provider promptly if
adverse drug reactions occur.
• Observe caution while driving or performing other
ha ardous tasks because these drugs adrenergic
blockers) may cause drowsiness, dizziness, or
lightheadedness.
• Immediately report any signs of HF (weight gain,
di culty breathing or edema of the extremities .
• Do not use any nonprescription drug (e.g., cold or
flu preparations or nasal decongestants unless you
have discussed use of a speci c drug with the
primary health care provider.
• Inform dentists and other primary health care
providers of therapy with this drug.
• Keep all primary health care provider appointments
because close monitoring of therapy is essential.
• Check with a primary health care provider or
clinical pharmacist to determine if the drug is to be
taken with food or on an empty stomach.
ord

Generic Trade Use Dose

Hypertension, HF, left ventricular
Carvedilol Coreg . mg orally ID
dysfunction
mg day orally in divided
doses I mg over min with
Labetalol Trandate Hypertension
blood pressure monitoring, may
repeat
 CNS Stimulants
- Anorexiants
How do they work? “Action”
Anorexiants are drugs pharmacologically similar to the amphet-
amines. Their ability to suppress the appetite is thought to be
due to their action on the appetite center in the hypothalamus.
(Ford 190)
Indications
Treatment of obesity via appetite suppression
Adverse Reactions
• xcessive CN stimulation headache di iness
• Apprehension, disorientation, hyperactivity
• Nausea vomiting cough dyspnea
• Urinary retention, tachycardia, palpitations
Education
• These drugs are intended for patients with chronic weight
management issues when used with an approved diet and
physical activity program.
• These drugs should only be used for obesity (body mass index
[BMI] of 30 or greater) or overweight (BMI of 27) when comor
bid conditions exist, such as hypertension, type 2 diabetes, or
dyslipidemia.
• Never take over the counter weight loss preparations with
these drugs.
• If you have not achieved 5% weight loss in 12 weeks, contact
your primary health care provider; never increase the dose to
speed up or increase weight loss.
• Call your primary health care provider immediately if you
experience mental changes (agitation or hallucinations), rapid
heartbeat di iness lack of coordination or feelings of
warmth. This may be a condition called neuroleptic malignant
syndrome, which needs emergent treatment.
• Be aware of possible impairment in the ability to drive or
perform ha ardous tasks.
• Avoid other stimulants including those containing caffeine such
as coffee tea and cola drinks
• Read labels of foods and nonprescription drugs for possible
stimulant content.
• Women: Use pregnancy protection and do not breastfeed when
using these drugs.
• Men: Seek immediate medical treatment if you have an
erection lasting more than 4 hours. (Ford 192)
Generic Trade
Benzphetamine Didrex
Phendimetrazine Bontril
Contraindications
• Known hypersensitivity
• Convulsive disorders
• entilation disorders C D
• Cardiac problems
• Hypertension
• Hyperthyroidism
• Glaucoma
• Pregnancy
Interactions
• Anesthetics: Increased risk of cardiac arrhythmias
• Theophylline: Increased risk of hyperactive behaviors
• Oral contraceptives: Decreased effectiveness of oral
contraceptive when taken with moda nil
Nursing management
• An increased risk of suicidal ideation in children and
adolescents has been found when using the drug atomoxetine
(Strattera). Patients with ADHD started on atomoxetine should
be monitored carefully for suicidal thoughts or behaviors.
• Stimulants enhance dopamine transmission to areas of the
brain that interpret well-being. To maintain pleasur able
feelings, people continue the use of stimulants, which leads to
their abuse and the potential for addiction.
• lder adults are especially sensitive to the effects of the CN
stimulants and may exhibit excessive anxiety, nervousness,
insomnia and mental confusion. Cardiovascular disorders
common in the older adult may be worsened by the CN
stimulants. Careful monitoring is important because these
reactions may result in the need to discontinue use of the drug.
• ADHD: Give the drug in the morning 30 to 45 minutes before
breakfast and before lunch. Do not give the drug in the late
afternoon.
• Narcolepsy: Keep a record of the number of times per day that
periods of sleepiness occur, and bring this record to each visit
to the primary health care provider or clinic.
• Amphetamines and anorexiants: These drugs are taken early
in the day to avoid insomnia. Do not increase the dose or take
the drug more frequently, except on the advice of the primary
health care provider.
• ffe e r rescr t : ver the counter caffeine
preparations should be avoided if the individual has a history
of heart disease, high blood pressure, or stomach ulcers.
Use Dose
Obesity 25–50 mg orally 1–3 times/day
Obesity 35 mg orally 2–3 times/day
 CNS Stimulants
- Analeptics

How do they work? “Action” Facts

Drugs that stimulate the respiratory center of the
brain and cardiovascular system, used with
narcolepsy and as an adjuvant treatment for
obstructive sleep apnea
Stimulants enhance dopamine transmission to areas
of the brain that interpret well-being. To maintain
pleasurable feelings, people continue the use of
stimulants, which leads to their abuse and the poten-
tial for addiction. (Ford 190)

Indications
Nursing management
• Narcolepsy • An increased risk of suicidal ideation in children and
• Obstructive sleep apnea adolescents has been found when using the drug
atomoxetine (Strattera). Patients with ADHD started on
atomoxetine should be monitored carefully for suicidal
Adverse Reactions thoughts or behaviors.
• Stimulants enhance dopamine transmission to areas of
• Excessive CNS stimulation, headache, dizziness the brain that interpret well-being. To maintain
• Apprehension, disorientation, hyperactivity pleasurable feelings, people continue the use of
• Nausea, vomiting, cough, dyspnea stimulants, which leads to their abuse and the potential
• Urinary retention, tachycardia, palpitations for addiction.
• lder adults are especially sensitive to the effects of the
CNS stimulants and may exhibit excessive anxiety,
nervousness, insomnia, and mental confusion.
Contraindications Cardiovascular disorders, common in the older adult,
• Known hypersensitivity may be worsened by the CNS stimulants. Careful
• Convulsive disorders monitoring is important because these reactions may
result in the need to discontinue use of the drug.
• Ventilation disorders ( COPD)
• ADHD: Give the drug in the morning 30 to 45 minutes
• Cardiac problems before breakfast and before lunch. Do not give the drug
• Hypertension in the late afternoon.
• Hyperthyroidism • Narcolepsy: Keep a record of the number of times per
• Glaucoma day that periods of sleepiness occur, and bring this
• Pregnancy record to each visit to the primary health care provider
or clinic.
• Amphetamines and anorexiants: These drugs are
Interactions taken early in the day to avoid insomnia. Do not increase
the dose or take the drug more frequently, except on the
• Anesthetics: Increased risk of cardiac arrhythmias advice of the primary health care provider.
• Theophylline: Increased risk of hyperactive • ffe e r rescr t : Over-the-counter
behaviors caffeine preparations should be avoided if the individual
• Oral contraceptives: Decreased effectiveness of has a history of heart disease, high blood pressure,
oral contraceptive when taken with moda nil or stomach ulcers.

Generic Trade Use Dose

Narcolepsy, obstructive sleep apnea, 150–250 mg/day orally in a
Ar d Nuvigil
sleepiness due to shift work single morning dose
Respiratory depression: postanesthesia,
Doxapram Dopram drug-induced, acute respiratory 0.5–1 mg/kg IV
insu ciency superimposed on C D

d Provigil Narcolepsy, obstructive sleep apnea 200–400 mg/day orally

 CNS Drugs
- Cholinesterase Inhibitors

d t e r Act Nursing management

he cholinesterase inhibitors act to increase the level of • Should cholinesterase inhibitor therapy be discontinued,
acetylcholine in the central nervous system CN by inhibiting its individuals lose any bene t they have received from the drugs
breakdown and slowing neural destruction. ord within 6 weeks.
• Keep all appointments with the primary care provider or clinic
because close monitoring of therapy is essential. Dose changes
Indications may be needed to achieve the best results.
• eport any unusual changes or physical effects to the primary
Cholinesterase inhibitors are used to treat early and moderate health care provider.
stages of dementia associated with AD. heir use for severe • ake the drug exactly as directed. Do not increase decrease or
cognitive decline as well as other dementias such as vascular or omit a dose or discontinue use of this drug unless directed to
arkinson s dementia is being studied. ord do so by the primary health care provider.
• Do not drive or perform other ha ardous tasks if drowsiness
occurs. Discuss with your primary health care provider when
patients should be evaluated for their continued ability to
Adverse Reactions drive.
• Do not take any nonprescription drug before talking to your
• Anorexia nausea vomiting diarrhea
primary health care provider.
• Di iness and headache
• Keep track of when the drug is taken. arking the calendar cell
phone alarms or a pill counter that holds the medicine for
each day of the week may be helpful tools to remind the
Interactions patient to take the medication or determine whether the
medication has been taken for the day.
• Anticholinergics: Decreased effectiveness of anticholinergics • Notify the primary care provider if the following adverse
• ster d t t r dr s: Increased risk of GI reactions are experienced for more than a few days
bleeding nausea diarrhea di culty sleeping vomiting or loss of
• e e: Increased risk of theophylline toxicity appetite.
• Immediately report the occurrence of the following adverse
reactions severe vomiting dehydration or changes in neuro
logic functioning.
Dementia Vs. • Notify the primary health care provider if the patient has a
Delirium Dementia
Delirium history of ulcers feels faint experiences severe stomach
pains vomits blood or material that resembles coffee
grounds or has bloody or black stools.
rogressive
Onset udden change
change
• emember that these drugs do not cure AD but slow the
mental and physical degeneration associated with the
disease. he drug must be taken routinely to slow the
progression.
Affects memory
Presentation Affects senses
and udgment
Herbal Consideration
Ginkgo one of the oldest herbs in the world has many bene cial
Yes, when cause No, can slow
effects. It is thought to improve memory and brain function and
such as oxygen progression with enhance circulation to the brain heart limbs and eyes.
or chemical drugs need to However, research is inconclusive as to whether or not his is
evers t imbalances or change true. Ginkgo is contraindicated in patients taking selective
infections environment for serotonin reuptake inhibitor I or monoamine oxidase
found and patient to inhibitor A I antidepressants because of the risk of a toxic
treated remain safe reaction.

Generic Trade Use Dose

ild to severe dementia due to AD
memory improvement in dementia due
Donepezil Aricept mg day orally
to stroke vascular disease multiple
sclerosis

Galantamine a adyne ild to moderate AD dementia mg ID orally

 PNS Drugs
- B-Adrenergic Blockers

How do they work? “Action” Interactions

These drugs decrease the heart’s excitability, decrease cardiac
workload and oxygen consumption, and provide
membrane stabili ing effects that contribute to the antiarrhyth
mic activity of the adrenergic blocking drugs. xamples of
adrenergic blocking drugs used for cardiac purposes are
esmolol revibloc and propranolol Inderal . ord
Indications
• Antidepressants (monoamine oxidase inhibitors
[MAOIs], selective serotonin reuptake inhibitors
[SSRIs]) Increased effect of the blocker bradycardia
• ster d t t r dr s A s
salicylates: Decreased effect of the blocker
• Loop diuretics: Increased risk of hypotension
• Clonidine: Increased risk of paradoxical hypertensive effect
• Cimetidine: Increased serum level of the blocker and higher
risk of blocker toxicity
• Lidocaine: Increased serum level of the blocker and higher
risk of blocker toxicity

• ypertension rst choice drug for patients with stable angina

• Cardiac arrhythmia abnormal rhythm of the heart such as Nursing Alert
ventricular or supraventricular tachycardia
• Migraine headaches Hypertension research studies demonstrate better patient
• eart failure outcomes for African Americans when blockers are used in
• Angina pectoris combination with diuretics than other drugs alone to treat
• Glaucoma topical ophthalmic eye drops hypertension such as angiotensin converting en yme AC
ord inhibitors erdinand . ord

Adverse Reactions
Cardiac reactions that affect the body in a generali ed manner
include orthostatic hypotension, bradycardia, dizziness, vertigo,
and headache. Gastrointestinal GI reactions include hyperglyce
mia, nausea, vomiting, and diarrhea. Another bodily system
reaction is bronchospasm (especially in those with a history of
asthma . ord
Contraindications
hese drugs are contraindicated in patients with an allergy to
blockers in patients with sinus bradycardia secondor third de
gree heart block, or HF; and in those with asthma, emphysema,
and hypotension. The drugs are used cautiously in patients with
diabetes thyrotoxicosis or peptic ulcer. ord
Nursing management
• Do not stop taking the drug abruptly, except on the advice of
the primary health care provider. Most of these drugs
require that the dosage be gradually decreased to prevent
precipitation or worsening of adverse effects.
• Notify the primary health care provider promptly if adverse
drug reactions occur.
• Observe caution while driving or performing other hazardous
tasks because these drugs adrenergic blockers may cause
drowsiness, dizziness, or lightheadedness.
• Immediately report any signs of weight gain di culty
breathing or edema of the extremities .
• Do not use any nonprescription drug e.g. cold or flu
preparations or nasal decongestants unless you have
discussed use of a speci c drug with the primary health care
provider.
• Inform dentists and other primary health care providers of
therapy with this drug.
• Keep all primary health care provider appointments because
close monitoring of therapy is essential.
• Check with a primary health care provider or clinical pharmacist
to determine if the drug is to be taken with food or on an
empty stomach. ord

Generic Trade Use se

ypertension mg orally in doses
Hypertension, ventricular
Acebutolol Sectral Arrhythmias mg day orally in
arrhythmias H
divided doses

Cardiac arrhythmias, MI, angina, Arrhythmias mg orally ID ID

hypertension, migraine prophylaxis, ypertension mg day orally in
Propranolol Inderal hypertrophic subaortic stenosis, divided doses Angina mg day
pheochromocytoma, essential tremor orally in divided doses igraine
mg day orally in divided doses
 CNS Stimulants
- Amphetamines

How do they work? “Action” Interactions

Amphetamines are sympathomimetic adrenergic . • Anesthetics: Increased risk of cardiac arrhythmias
Which means that they mimicking a response from • Theophylline: Increased risk of hyperactive
the sympathetic nervous system, causing the CNS to behaviors
speed up, resulting in : • Oral contraceptives: Decreased effectiveness of
• Elevated blood pressure oral contraceptive when taken with moda nil
• Wakefulness
• Increased or decreased pulse rate
Nursing management
• An increased risk of suicidal ideation in children and
Indications adolescents has been found when using the drug
atomoxetine trattera . atients with AD D started on
• ADHD atomoxetine should be monitored carefully for suicidal
• Drug-induced respiratory depression thoughts or behaviors.
• ost Anesthesia respiratory depression without • Stimulants enhance dopamine transmission to areas of
reduction of analgesia the brain that interpret well being. o maintain pleasur
• Narcolepsy able feelings, people continue the use of stimulants,
• Obstructive sleep apnea which leads to their abuse and the potential for
• Exogenous obesity addiction.
• atigue caffeine • lder adults are especially sensitive to the effects of the
CNS stimulants and may exhibit excessive anxiety,
nervousness insomnia and mental confusion.
Adverse Reactions Cardiovascular disorders, common in the older adult,
may be worsened by the CN stimulants. Careful
• Excessive CNS stimulation, headache, dizziness monitoring is important because these reactions may
• Apprehension, disorientation, hyperactivity result in the need to discontinue use of the drug.
• Nausea, vomiting, cough, dyspnea • ADHD: Give the drug in the morning 30 to 45 minutes
• Urinary retention, tachycardia, palpitations before breakfast and before lunch. Do not give the drug
in the late afternoon.
• Narcolepsy: Keep a record of the number of times per
day that periods of sleepiness occur, and bring this
Contraindications record to each visit to the primary health care provider
or clinic.
• Known hypersensitivity • Amphetamines and anorexiants: hese drugs are
• Convulsive disorders taken early in the day to avoid insomnia. Do not increase
• entilation disorders C D the dose or take the drug more frequently, except on the
• Cardiac problems advice of the primary health care provider.
• Hypertension • ffe e r rescr t : Over-the-counter
• Hyperthyroidism caffeine preparations should be avoided if the individual
• Glaucoma has a history of heart disease, high blood pressure, or
• regnancy stomach ulcers.

Generic Trade Use Dose

Narcolepsy: 5–60 mg/day orally in divided
Narcolepsy, ADHD,
Amphetamine N/A doses ADHD: 5 mg BID, increase by 10
exogenous obesity N
mg wk until desired effect.
. mg orally ID maximum dosage
Dexmethylphenidate Focalin ADHD
mg/day

ADHD: up to 25 mg/day orally

Methamphetamine Desoxyn ADHD, exogenous obesity
Obesity: 5 mg orally 30 min before meals
 PNS Drugs
- Alpha Adrenergic Blockers

How do they work? “Action” Nursing management

timulation of adrenergic nerves results in
vasoconstriction. If stimulation of adrenergic
nerves is interrupted or blocked, the result is
vasodilation.
Indications
• Hypertension caused by pheochromocytoma (a
tumor of the adrenal gland that produces
excessive amounts of epinephrine and
norepinephrine
• Hypertension during preoperative preparation
• They are also used to prevent or treat
tissue damage caused by extravasation of
dopamine.
Adverse Reactions
• weakness, orthostatic hypotension
• cardiac arrhythmias, hypotension, and
tachycardia.
Contraindications
• Hypersensitivity
• Coronary artery disease
• Do not stop taking the drug abruptly, except on
the advice of the primary health care provider.
Most of these drugs require that the dosage be
gradually decreased to prevent precipitation or
worsening of adverse effects.
• Notify the primary health care provider
promptly if adverse drug reactions occur.
• Observe caution while driving or performing
other hazardous tasks because these drugs
adrenergic blockers may cause drowsiness
dizziness, or lightheadedness.
• Immediately report any signs of HF (weight
gain di culty breathing or edema of the
extremities .
• Do not use any nonprescription drug (e.g., cold
or flu preparations or nasal decongestants
unless you have discussed use of a speci c
drug with the primary health care provider.
• Inform dentists and other primary health care
providers of therapy with this drug.
• Keep all primary health care provider
appointments because close monitoring of
therapy is essential.
• Check with a primary health care provider or
clinical pharmacist to determine if the drug is
to be taken with food or on an empty stomach.
ord
Interactions
None listed.

Generic Trade Use Dose

Diagnosis of pheochromocytoma,
hypertensive episodes before and 5 mg IV, IM
during surgery, issue necrosis mg in m
Phentolamine Regitine
prevention/treatment of dermal saline solution in ltrated into
necrosis after IV administration of affected area
norepinephrine or dopamine
Anticholinergics &
Methylxanthines
Drug name: Drug name:

TIOTROPIU et lxant ines

“-tropium” IPRATROPIUM M

Ipratropium “-phylline”
Tiotropium · Theo lline Amino lline
T eo lline

· Amino lline

Indication:
Moderate to severe asthma & COPD, longer KEY POINTS
> 20mcg/ml

acting bronchodilator used 2nd during asthma

attacks 3 T’s NCLEX TIP
T––Toxic!
· T Toxic!Over
Over20
20(mcg/mL)
(mcg/mL)
“Frequent blood draws”
· T – Tonic Clonic Seizures
Severe Toxicit st riorit
· T – Tac cardia &
Memory Trick: Dysrhythmias NCLEX TIP

AIM for Acute Attac

A – Albuterol 1st Memory Trick:
1st ALBUTEROL
2 nd
Solu Med

I – Ipratropium 2nd
rol

‘’- es’’ make you

Methy
lpredn
isolon
e

So
lu Medrol
Met
hylprednisolone

M – Methylprednisolone
(brand: Solu Medrol) feeling caffeinated toxic

MOA: HESI uestion

Teach pt to
locks secretions anticholinergic effects A O D beta bloc ers
can’t see, pee, spit or sh* - poop that lower the heart rate
while on
T eo lline
Beta
de Effects: Blockers
HESI & ATI uestion “ALERT HCP of tachycardia
BEFORE giving next dose”
Very dry body ontraindication to
Treat the DRY mouth & throat A antic oliner ics
for all anticholinergics
e ever give for
se gum/candy patients who are e Teac in oints
· Drin uids
already DRY.
KEY POINT - NO swallowing NCLEX TIP
tiotro ium ca sules
No giving anticholinergis CIMETIDINE CIPROFLOXACIN

to
• Glaucoma
• Urinary retention (BPH)
• Bowel obstruction

Notes
Upper Respiratory
Drugs

Cough Expectorants

Drug name: Indication: Drug name: Memory Trick:

Helps patient to cough A - Acetylcysteine

Guaifenesin out excess secretions Acetylcysteine
(brand: mucinex) (brand mucomyst) A - AVOID asthma patients
KEY POINTS
MOA: ntidote Acetaminophen
( ylenol) poisoning
Increase uid inta e Thins the mucus
rin at least 2 L / day KEY POINT
Asthma Safe NOT SAFE
Cause or orsen bronchospasm

Cough Suppressant ‘’Antitussive’’

DON’T LET NCLEX TRICK YOU

Codeine NOT NOT NOT

otosensiti it eart a itations nsomnia or n iet
KEY POINT
CODEINE
. low position changes
2. for C P
3. a e with food
. Increase uid inta e
5. full glasses of water (minimum)

Antihistamine ‘’allergy meds’’

Drug name: Drug name: Drug name:

Diphenhydramine
(Brand Benadryl)
Loratadine Fexofenadine
(brand Claritin)
Z

(brand Allegra)
Z
Z

ontraindicated e er sedation e ects KEY POINT

Closed angle glaucoma for laucoma
rinary retention ue to anticholinergic e ects
Peptic ulcer that increase intraocular pressure
mall bowel obstruction Loratadine
laritin

Indication:
inusitis
For anaphylaxis (big allergic reactions)
Z

MOA: Z
Z

locks histamine which creates inflammation Allergies Hives

Anti Inflammatory
Agents

r es: de Effects: KEY POINT

Slow onset ! Use Spacers to Prevent
oral THRUSH (Candida)
S - Steroids NCLEX KEY WORD
Sugar INCREASE RINSE MOUTH AFTER
EACH USE
“-Sone” DO NOT USE Fluticasone or MODERATE

UCOS
DON’T SWALLOW

HI
W
GL EVEL
almeterol for rst sign of

GH
LO
L

E
Beclomethasone water !!
a ute ast ma a a k
Fluticasone
Methylprednisolone AIM for Acute Attac
A – Albuterol 1st
I – Ipratropium 2nd Sores in MOUTH
infection

Indication: M – Methylprednisolone
(brand: Solu Medrol)

welling inflammation

r es: Memory Trick NCLEX Key Points

L - Leukotriene n i itor 3 L’s NOT during acute

attac s
“-Lu ast” Lu e li es to SING (airway
open) NOT a RESCUE
Montelu ast
(Brand: singulair) DRUG
a rlu ast This med will prevent
in ammation that
causes asthma attac s
SINGUILAIR
Monteukast ZAFIRLUKAST

ZA
FI
RLU
KA
SINGU ST
Mon
teuk
ILAIR
ast

Drug name: Indication:

Key Point
M - Mast e sta i i ers locks massive swelling
PREVENTS activity
Cromolyn induced asthma
N NH2

N
a e 15 minutes before
exertion for maximum
H

CROMOLYN e ects HESI

Use 10-15 minutes before
Cromolyn physical activity ATI

Notes
Beta 2 Agonist

Drug name:
HESI uestion
B - Beta 2 Agonist ALBUTEROL
“-buterol”
Albuterol
Levalbuterol

B - Buterol
B - Brutal Asthma Attac s

Indication:

st drug used during

E ERE asthma attac s

NCLEX TIPS
NCLEX TIP
STEROID
HE L “rescue inhaler”
BEFORE steroid inhaler!!!!
AVOID
Beta
Blockers

· S - Salmeterol
· S - lower Acting
( rescue inhaler)
Beta Bloc ers Atenolol
AI aproxen
NSAIDS
Ibuprofen
ommon N uestion

use uticasone SALMETEROL

or salmeterol for rst sign

FLUTICASONE KEY POINTS
of acute asthma attac

SHAKE IT WELL!

MEMORY TRICK

AIM for Acute Asthma Attac ALBUTEROL

Shake IT efore you take IT

Solu M
edrol
A – Albuterol 1st Methy
lpredni
solone

I – Ipratropium 2nd Sol

M u Medrol
ethylprednisolone

M ethyl-predniso-lone
(brand olu edrol)

HCP
1

KEY POINTS
Expected E AlbuTerol 24

RR
If ot wor ing after 3 doses?
T T T · IF HCP
Tachycardia & palpitations Tremor Toss & Turning at ight

E ective
· Decrease in RR (example HCP
1

3 to 2 ) 90 %
· Oxygen Sat. at least 90% or Oxygen
higher
Insomnia di culty sleeping TEST TIP!!

Notes
Lower Respiratory Drugs

ost Commonly issed uestion

NCLEX NOTES Patient with evere asthma hich medication would you give
elect All t at a l
· achycardia ( 20 BP )
· achypnea ( 30 BP ) . Inhaled salmeterol
· 2 sat 0 on RA Albuterol in aler

BRONCHOdilators ANT N A ATO Agents Pea exp. Flow 0 Nebuli er ratropium

predicted or best . I methamphetamines
B Beta 2 Agonist
Albuterol
S teroids
Beclomethasone
50L/min)
et l rednisolone

A Antic oliner ics

Ipratropium
L eu otriene n ibitor
Montelukast

ALBUTEROL
et lxant ines ast ell tabili ers Solu
edrol
Methylpre
dnisolone

heophylline Cromyolyn
So
Me
lu edrol
thylpredn
isolone

Common Exam uestions

A client is receiving discharge instructions for a hich statement by the patient requires further
inhaled corticosteroid metered dose inhaler. teaching?
Which teaching should the nurse include?

. iscard the use uticasone if albuterol . I will use cromolyn to prevent activity induced
provides relief. asthma
2. Do not swallow the water as you wash 2. I will use montelu ast to prevent asthma
our mout a er eac use attac s.
3. If ta ing albuterol be sure to use after the 3. I will use spacers to prevent oral thrush while
steroid. using beclomethasone.
. teroid inhalers should be used before ill ta e cromol n minutes before
O O N

beta 2 agonists. sical acti it Cromolyn

3 Common CLE & Exit uestions

hich of the follow hat patient teaching should be hich medication
prescriptions should the nurse included with a new prescription of prescribed for asthma
question albuterol ibuprofen tiotropium and causes of tachycardia &
beclomethasone? dysrhythmias?
. Na roxen for an elect All T at A l
ast matic atient . innitus is an expected . Phenobarbital
2. ratro ium for a atient side e ect. 2. Aminophylline
Aminophylline
it laucoma 2. Tac cardia is ex ected 3. almeterol
3. Losartan for a patient a er albuterol . Albuterol
with diabetes. 3. e ort dar stool to t e
. T eo lline for a ro ider
atient ta in cimetidine . Drin uids to re ent dr
Theophylline
5. Atenolol for a atient mout and t roat
with asthma 5. Ipratropium is used rst
during an attac .
Urinary

Drug name: Memory Trick: MOA:

KAPLAN
ethan echol timulated cholinergic
Bethanechol - sed to treat functional
• Bethanechol Bethanechol - Bladder Control receptors urinary retention (neurogenic bladder)
more secretions
HESI
Indication:
Bethanechol - Used for urinary atony
TCAs plus bethanechol used to
Non obstructive urinary retention re ent bladder d sfunction
speci cally neurogenic bladder where Expected outcome: Non-distended
clients with Neuro issues get loss of bladder
strength in the urinary muscles

Drug name: Memory Trick: KEY POINTS de Effects:

- BPH atient teac in
• Terazosin •TeraGOOOsin -
elps w urination
- Big Prostate Holds
• Tamsulosin
back urine Grapefruit juice is actually
OK with this drug • TeraSLOWsin low
position changes
orthostatic hypotension
Indication: MOA:
• TeraLOW sin Avoid blood
rinary retention with enlarged elaxes smooth muscles in the pressure lowering drugs
prostate benign prostatic bladder prostate periphery
hyperplasia to help release urine

Drug name: Memory Trick:

If you want a N ride on a Top Missed Questions

• Finasteride horse take FINasterRIDE
he nurse is conducting teaching with an elderly
un ride patient newly prescribed terazosin. Which
instruction(s) should be included in the teaching
plan? Select all that apply.

1. It is not necessary to avoid foods that contain

Indication: HESI
ra efruit
a e sure to c an e ositions slo l ile on
hrinks the prostate
What med will shrink the t is medication
prostate = Finasteride ill not ta e t is medication it antacids
Do not ta e sildena l ile on t is medication
5. If you forget a dose of this medication ta e two pills
as soon as you remember.

Notes
 Urinary System Drugs
- BPH Drugs

d t e r Act
Peripherally acting a adrenergic blockers that
exert their action primarily on the smooth muscle of
the prostate and the bladder neck. y blocking
norepinephrine the muscles relax and this allows
urine to flow from the bladder. Adrenergic blockers
can be uroselective therefore the a adrenergic
blockers exert their action on the bladder with mini-
mal action on the vascular system.
Androgen hormone inhibitors prevent the
conversion of testosterone into the androgen di-
hydrotestosterone D . he growth of the prostate
gland depends on D . he lowering of serum levels
of D reduces the effect of this hormone on the
prostate gland resulting in a decrease in the si e of
the gland and the symptoms associated with
prostatic gland enlargement. ord
Indications
reatment and symptom control of
Adverse Reactions
A dre er c c ers:
• weight gain fatigue di iness and transient
orthostatic hypotension.
Androgen hormone inhibitors
• impotence decreased libido
• decreased volume of e aculate. Changes to breast
tissue pain or tenderness nipple discharge or
enlargement ord
Interactions
• Antibiotics/antifungals:
Decreased effectiveness of anti infective drug
• c ers: Increased hypotension
• Phosphodiesterase type 5 inhibitors:
Increased hypotension
Contraindications
• Uncontrolled angle-closure glaucoma
• Intestinal obstruction or atony
• Urinary retention.
• oth adrenergic blockers and A I drugs should be
used with caution in patients with hepatic or
renal disease. Caution the patient with
hypertension when using both beta and
blockers that hypotensive symptoms may be
increased. ord
Nursing management
• onitor voiding pattern and intake and output
ratios
• Assess abdomen for bladder distention prior to and
periodically during therapy.
• Catheteri ation may be used to assess postvoid
residual.
• Cystometry is usually performed to diagnose type of
bladder dysfunction prior to prescription of
oxybutynin.
• Geri: Assess geriatric patients for anticholinergic
effects sedation and weakness .
Herbal Consideration
aw palmetto is used to relieve the symptoms of
urinary fre uency decreased flow of urine and
nocturia . he herb is believed to reduce
inflammation and the hormone D responsible
for prostate enlargement . aw palmetto does not
cause impotence yet it can aggravate GI disorders
such as peptic ulcer disease. Men report reduction in
urinary symptoms in 1 to 3 months when 160 mg
twice daily is taken. It is not recommended as a tea
because the active constituents are not water soluble.
It is usually recommended that the herb be taken for
months followed by evaluation by a primary health
care provider ent . ord

Generic Trade Use Dose

Finasteride
• Androgen hormone ropecia roscar ale pattern baldness 1–5 mg/day orally
inhibitor

Doxazosin ypertension mg orally daily

Cardura ypertension
• Peripheral adrenergic mg orally daily

Tamsulosin
• Peripheral adrenergic
Flomax 0.4 mg orally daily
 Urinary
Oxybutynin & Tolterodine

Drug name: MOA:

Anticholinergic to dry the body, think

t secret s for anti-cholinergic
• Oxybutynin
OXYBUTYNIN

• Tolterodine de Effects:
Dry body, avoid Glaucoma & BPH
(all anticholinergics)
Indication:
ATI
• Overactive bladder
• Decreases urgency, frequency & nighttime Blurred vision
bathroom visits (nocturia)
Dry eyes
Avoid Glaucoma
AVOID

ESS URE
Dry mouth NCLEX TIP

PR
Memory Trick:
KEY POINTS

Don’t get tricked with sound MAJOR ADVERSE EFFECT

1. rinar retention
No urination all da
• Oxy-Buty-nin - B for Bladder REPORT TO HCP! NCLEX TIP
Ox is on your Bladder! Given for urinary PATIENT TEACHING
frequency 2. lo osition c an es prevent
B rthostatic hypotension
OxyButynin AVOID
3. A oid ert ermia too much
OXYBUTYNIN sun exposure

Don’t get tricked with sound alike drug names:

Common E Question
• Oxy-codone - is a opioid pain med
Codone sounds like codeine hich are expected side e ects of oxybut nin?
OXYCODONE
elect all t at a l
Opioid pain med, or just look for the
O’s in cOdOne - O for opioid 1. Hypertension.
Dr e es
• Oxy-tocin - is for labor Dr mout
To contract - given for contractions to induce 4. Diarrhea.

labor 5. Hypokalemia

Notes
 Urinary Drugs
- Antispasmodics
d t e r Act
Antispasmodics are cholinergic blocking drugs that
inhibit bladder contractions and delay the urge to
void. These drugs counteract the smooth muscle
spasm of the urinary tract by relaxing the detrusor
and other muscles through action at the
parasympathetic nerve receptors (Ford 518)
Indications
• Flavoxate (Urispas) is used to relieve symptoms of
dysuria painful or di cult urination urinary
urgency, nocturia (excessive urination during the
night), suprapubic pain and frequency, and urge
incontinence.
• t er ts s d c drugs are also used to treat
bladder instability (i.e., urgency, frequency, leakage,
incontinence and painful or di cult urination
caused by a neurogenic bladder (impaired bladder
function caused by nervous system abnormality,
typically an injury to the spinal cord). (Ford 518)
Adverse Reactions
• t see c t ee c t s t c t s
• Dry mouth, drowsiness, constipation or diarrhea,
decreased production of tears, decreased sweating,
gastrointestinal (GI) disturbances, dim vision, and
urinary hesitancy
• Nausea and vomiting, nervousness, vertigo,
headache, rash, and mental confusion (particularly
in older adults)
• These drugs can also cause the urine to take on a
dark brown color
Generic Trade
Oxybutynin Ditropan
Solifenacin Vesicare
r s Sanctura
Contraindications
Antispasmodics are cholinergic blocking drugs that
inhibit bladder contractions and delay the urge to
void. These drugs counteract the smooth muscle
spasm of the urinary tract by relaxing the detrusor
and other muscles through action at the parasympa-
thetic nerve receptors (Ford 518)
Interactions
• Antibiotics/antifungals: Decreased effectiveness
of anti-infective drug
• e er d e r e e t es:
Increased effect of the antispasmodic
• Tricyclic antidepressants: Increased effect of the
antispasmodic
• Haloperidol (Haldol): Decreased effectiveness of
the antipsychotic drug (Ford 519)
rs e e t
• Flavoxate: Take this drug three to four times daily
as prescribed. This drug is used to treat symptoms;
other drugs are given to treat the cause.
• Oxybutynin: Take this drug with or without food.
Oxybutynin (Ditropan XL) contains an outer coating
that may not disintegrate and sometimes may be
observed in the stool. This is not a cause for
concern. If using the transdermal form (patch) of
the drug, be sure to apply to a clean, dry area of the
hip, abdomen, or buttocks. Remove the old patch
and rotate sites of new application every 7 days.
• Antispasmodic drugs can cause heat prostration
(fever and heat stroke caused by decreased
sweating) in high temperatures. If you live in hot
climates or will be exposed to high temperatures,
take appropriate precautions. (Ford 523)
Use Dose
Overactive bladder,
5 mg orally BID or TID
neurogenic bladder
Overactive bladder
5 mg/day orally
Overactive bladder 20 mg orally TID
 Urinary Drugs
- Urinary Anti Infectives
How do they work? “Action”
Treat UTIs by either slowing the growth of more bacteria or killing
the bacteria. Phenazopyridine is a dye that exerts a topical
analgesic effect on the lining of the urinary tract. It does not have
anti-infective activity. Phenazopyridine is available as a separate
drug but is also included in some urinary tract anti-infective
combination drugs. (Ford 531)
Indications
• Relieves pain associated with UTI
• Retards or halts the growth of bacteria in the urinary tract
Adverse Reactions
Adverse reactions are primarily gastrointestinal (GI)
disturbances and include the following:
• Anorexia, nausea, vomiting, and diarrhea
• Abdominal pain or stomatitis
Other generalized body system reactions include:
• Drowsiness, dizziness, headache, blurred vision, weakness, and
peripheral neuropathy
• Rash, pruritus, photosensitivity reactions, and leg cramps
Contraindications
• hypersensitivity to the drugs and during pregnancy (pregnancy
category C) and lactation (Ford 531)
Herbal Consideration
Cranberry juice has long been recommended for use in treating
and preventing Is. Clinical studies have con rmed that
cranberry uice is bene cial to individuals with fre uent Is.
Cranberry juice inhibits bacteria from attaching to the walls of the
urinary tract and prevents certain bacteria from forming dental
plaque in the mouth. Cranberry juice is safe for use as a food and
for urinary tract health.
Cranberry juice and capsules have no contraindications, no
known adverse reactions, and no drug interactions. The
recommended dosage is 9 to 15 capsules a day (400 to 500
mg/day) or 4 to 8 ounces of juice daily (Brown, 2012). (Ford 532)
Generic/Class Trade
Fosfomycin Monurol Acute bacterial UTIs
Methenamine Hiprex, Urex Chronic bacterial UTIs
Relief of pain associated with irritation
Phenazopyridine Pyridium of the lower genitourinary tract
Interactions
Sulfamethoxazole
• oral anticoagulants: Increased risk for bleeding
Nitrofurantoin
• magnesium trisilicate or magaldrate: Decreased absorption
of anti-infective
• Anticholinergics: Delay in gastric emptying, thereby increasing
the absorption of nitrofurantoin
Fosfomycin (Monurol)
• metoclopramide (Reglan): Lowers plasma
concentration and urinary tract excretion (Ford 532)
Nursing management
• Check laboratory culture and sensitivity results before giving any
antibiotic.
• Phenazopyridine is not administered for more than 2 days when used in
combination with an antibacterial drug to treat a UTI. When used for
more than 2 days, the drug may mask the symptoms of a more serious
disorder.
• Take the drug with food or meals (nitrofurantoin must be taken with
food or milk). If GI upset occurs despite taking the drug with food,
contact the primary health care provider.
• Take the drug at the prescribed intervals and complete the full course of
therapy. Do not discontinue taking the drug even though the symptoms
have disappeared, unless directed to do so by the primary health care
provider.
• If drowsiness or dizziness occurs, avoid driving and performing tasks
that require alertness.
• Avoid alcoholic beverages and do not take any nonprescription drug
unless its use has been approved by the primary health care provider.
• Notify the primary health care provider immediately if symptoms do not
improve after 3 or 4 days.
• Nitrofurantoin: Take this drug with food or milk to improve absorption.
Continue therapy for at least 1 week or for 3 days after the urine shows
no signs of infection. Notify the primary health care provider
immediately if any of the following occur: fever, chills, cough, shortness
of breath chest pain or di culty breathing. Do not take the next dose
of the drug until the primary health care provider has been contacted.
The urine may appear brown during therapy with this drug; this is not
abnormal.
• Methenamine: Avoid excessive intake of citrus products, milk, and milk
products.
• Fosfomycin comes in dry form as a one-dose packet to be dissolved in
90 to 120 mL of water (not hot water). Drink immediately after mixing
and take with food to prevent gastric upset.
• Phenazopyridine: This drug may cause a reddish-orange discoloration
of the urine and tears and may stain fabrics or contact lenses. This is
normal. Take the drug after meals. Do not take this drug for more than
2 days if you are also taking an antibiotic for the treatment of a UTI.
(Ford 533-534)
Use Dose
3-g packet orally, provided in powder
that must be mixed with fluid
1 g orally BID
200 mg orally TID
 Urinary System Drugs
- Estrogens
How do they work? “Action”
In addition to contraception, estrogen is most commonly
used in HRT (or estrogen replacement therapy [ERT]) in
postmenopausal women.
Indications
Changes to aging tissues can be lessened when estro-
gens are used for the following:
• Relief of moderate to severe vasomotor symptoms of
menopause flushing sweating
• Treatment of atrophic vaginitis
• Treatment of osteoporosis in women past menopause
• Palliative treatment of advanced prostatic carcinoma
(in men)
• Selected cases of advanced breast carcinoma (Ford 516)
Adverse Reactions
• Headache, migraine
• Dizziness, mental depression
• Dermatitis, pruritus
• Chloasma (pigmentation of the skin) or melasma
(discoloration of the skin), which may continue when use
of the drug is discontinued
• Nausea, vomiting
• Abdominal bloating and cramps
• Breakthrough bleeding, withdrawal bleeding, spotting,
changes in menstrual flow
• Dysmenorrhea, premenstrual-like syndrome,
amenorrhea
• Vaginal candidiasis, cervical erosion, vaginitis
• Steepening of corneal curvature
• Intolerance to contact lenses
• Edema, rhinitis, changes in libido
• Breast pain, enlargement, and tenderness
• Reduced carbohydrate tolerance
• Venous thromboembolism, pulmonary embolism
• Weight gain or loss
• Generalized and skeletal pain
• Increased risk of endometrial cancer, gallbladder disease,
hypertension, liver adenoma, thromboembolic disease,
hypercalcemia
Contraindications
• breast cancer (except for metastatic disease),
• estrogen-dependent neoplasms
• undiagnosed abnormal genital bleeding
• and thromboembolic disorders. T
• he progestins also are contraindicated in patients with
cerebral hemorrhage or impaired liver function.
• oth the estrogens and progestins are classi ed as
pregnancy category X drugs and are contraindicated
during pregnancy.
(Ford 518)
Interactions
• Oral anticoagulants: Decreased anticoagulant effect
• Tricyclic antidepressants: Increased effectiveness of
antidepressant
• Rifampin: Increased risk of breakthrough bleeding
• Hydantoins: Increased risk of breakthrough bleeding
and pregnancy
Nursing management
lack cohosh an herb reported to be bene cial in
managing symptoms of menopause, is generally regarded
as safe when used as directed. Black cohosh is a member
of the buttercup family. Black cohosh tea is not considered
as effective as other forms. oiling the root releases only a
portion of the therapeutic constituents. he bene ts of
black cohosh (not to be confused with blue cohosh)
include:
Reduction in physical symptoms of menopause:
• hot flashes night sweats headache
• heart palpitations, dizziness, vaginal atrophy, and
tinnitus (ringing in the ears)
Decrease in psychological symptoms of menopause:
• insomnia, nervousness, irritability, and depression
• Improvement in menstrual cycle regularity by balancing
the hormones and reducing uterine spasms. Black
cohosh is contraindicated during pregnancy. Toxic
effects include di iness headache nausea
• impaired vision, and vomiting.
This herb is purported to be an alternative to HRT.
(Ford 518)
 Urinary System Drugs
- Erectile Dysfunction Drugs
How do they work? “Action”
Phosphodiesterase type 5 inhibitors are oral
drugs that facilitate the enzyme that allows blood
flow into the penis resulting in an erection.
Indications
• Allows blood flow into the penis resulting in an
erection.
Adverse Reactions
• eadache flushing GI upset nausea and
runny nose or congestion
Contraindications
• Drugs for ED should not be taken by men who
use nitrates (e.g., for anginal pain). Because
these drugs affect smooth muscle patients
with pre-existing cardiac problems, especially
those using drugs to lower blood pressures
• Medical attention should be sought for
erections sustained for more than 4 hours.
• Pulmonary veno-occlusive disease
• Chronic use not recommended for pulmonary
hypertension due to lack of e cacy INC A D
risk of death.
Interactions
• Antiretrovirals; Increased effectiveness of D drug
• Antihypertensives: Increased effectiveness of
antihypertensive
Generic Trade
de Viagra Erectile dysfunction
d Cialis Erectile dysfunction, BPH
rde evitra taxyn Erectile dysfunction
Nursing management
• Viagra: Determine erectile dysfunction before
administration. ildena l has no effect in the
absence of sexual stimulation.
• evatio onitor hemodynamic parameters and
exercise tolerance prior to and periodically
during therapy.
• Instruct patient to take sildena l as directed.
For erectile dysfunction, take approximately 1
hour before sexual activity and not more than
once per day. If taking sildena l for pulmonary
arterial hypertension, take missed doses as
soon as remembered unless almost time for
next dose; do not double doses.
• Advise patient that iagra is not indicated for
use in women.
• Caution patient not to take sildena l
concurrently with alpha-adrenergic blockers
unless on a stable dose or nitrates. If chest
pain occurs after taking sildena l instruct
patient to seek immediate medical attention.
Advise patient taking sildena l for pulmonary
arterial hypertension to notify health care
professional of all x or C medications
vitamins, or herbal products being taken and
to consult with health care professional before
taking other medications.
• Instruct patient to notify health care
professional promptly if erection lasts longer
than 4 hr or if experience sudden or decreased
vision loss in one or both eyes or loss or
decrease in hearing, ringing in the ears, or
dizziness.
• Inform patient that sildena l offers no
protection against sexually transmitted
diseases. Counsel patient that protection
against sexually transmitted diseases and I
infection should be considered.
Use Dose
25–50 mg orally 30–60 min before
sexual activity
5–20 mg orally, take daily for BPH, as
needed for sexual activity
Up to 36 hours before sexual activity
5–20 mg orally 60 min before sexual
activity 4 hours before sexual activity
 Uterine Drugs
Tocolytics

How do they work? “Action” Critical Thinking

These drugs are used to manage premature Incase of emergency, when administering magnesium
labor.Indomethacin is an NSAIDS that inhibits the sulfate have calcium gluconate and reflex hammer ready
production of prostaglandins which contribute to uterine in case of overdose.
contractions.. eta adrenergic and calcium channel
blockers are used to delay the delivery process for 24 to 48
hours. These drugs block the contractions of the smooth
muscle of the uterus. Magnesium is used drugs to
decrease uterine muscle contractions, and is used for
seizure control with eclampsia. Magnesium is a calcium
antagonist that works to decrease the force of uterine Nursing management
contractions.
During the ongoing assessment of a patient receiving a
tocolytic drug, nursing activities include the following at
15- to 30-minute intervals:
Indications • Obtaining blood pressure, pulse, and respiratory rate
• Monitoring FHR
• Used to stop or decrease uterine contractions in preterm • Checking the IV infusion rate
labor • xamining the area around the I needle insertion site
for signs of in ltration
• Monitoring uterine contractions (frequency, intensity,
length)
Adverse Reactions • Measuring maternal intake and output
• aternal reflexes if using magnesium ord
• atigue flushing headache di iness diplopia
• Nausea, vomiting, stomach upset, heartburn
• Prolonged vaginal bleeding
• weating hypotension depressed reflexes and flaccid
paralysis are other adverse reactions associated with IV
administration. They are related to hypocalcemia
induced by the therapy. Interactions
• Increase CN depressant effects of opioid analgesics
when given with magnesium
Contraindications
Magnesium and calcium channel blockers are
contraindicated in patients with known hypersensitivity to
these drugs, in patients with heart block or myocardial
damage, and when the woman is within 2 hours of deliv-
ery. ord

Generic Trade Dose Use

Preterm labor before 100 mg rectally, then 50 mg orally q 6
Indomethacin Indocin
31 weeks’ gestation hr for a total of 8 doses

Preterm labor, 4–6 g IV over 2 min, then

Magnesium n/a
seizure control infuse 1–4 g/hr

Subcut: 250 mcg hourly until contractions stop

Terbutaline Brethine Preterm labor
Orally: 2.5 mg q 4–6 hr until delivery (Ford 511)
 Uterine Drugs
- Oxytocics
How do they work? “Action”
Uterine stimulants increase the strength, duration, and frequen-
cy of uterine contractions and decrease the incidence of uterine
bleeding. They are given after the delivery of the placenta and
are used to prevent postpartum and postabortal hemorrhage
caused by uterine atony (marked relaxation of the uterine
muscle). These drugs include carboprost, methylergonovine, and
misoprostol. ord
Oxytocin is an endogenous hormone produced by the posterior
pituitary gland. This hormone has uterus-stimulating properties,
acting on the smooth muscle of the uterus, especially on the
pregnant uterus.
Adverse Reactions
Administration of oxytocin may result in the following:
• etal bradycardia uterine rupture uterine hypertonicity
• Nausea, vomiting, cardiac arrhythmias, anaphylactic reactions
• Oxytocin is similar to the hormone vasopressin and because of
its antidiuretic effect serious water intoxication fluid
overload fluid volume excess may occur.
Adverse reactions associated with other uterine stimulants
include the following:
• Nausea, vomiting, diarrhea
• Elevated blood pressure, temporary chest pain
• Dizziness, water intoxication, headache
• Allergic reactions may also occur. In some instances
hypertension associated with seizure or headache may occur.
ord
Contraindications
Oxytocin
• Cephalopelvic disproportion
• Unfavorable fetal position or presentation.
• Also contraindicated in obstetric emergencies, situations of
fetal distress when delivery is not imminent
• Severe preeclampsia, eclampsia, and hypertonic uterus,
• During pregnancy when there is total placenta previa.
• It is contraindicated as an agent to induce labor when vaginal
delivery is contraindicated
Other uterine stimulants
• Methylergonovine is not used before delivery of the placenta.
• It is contraindicated in those with known hypersensitivity to
the drug or hypertension. ord
Generic Trade Dose
Control of postpartum bleeding
Methylergonovine Methergine
and hemorrhage, uterine atony
Postpartum hemorrhage,
Misoprostol Cytotec
cervical ripening
Antepartum: to initiate or
improve uterine contractions
Oxytocin Pitocin Postpartum: control of
postpartum bleeding and
hemorrhage
Indications
• Prevent postpartum and postabortal hemorrhage caused by
uterine atony
• Induce an early vaginal delivery when there are fetal or
maternal problems, such as a woman with diabetes and a large
fetus h problems premature rupture of the membranes
uterine inertia, and preeclampsia
• Managing inevitable or incomplete abortion
Nursing management
When oxytocin is administered with vasopressors,
however, severe maternal hypertension may occur.
• Obtain an obstetric history (e.g., parity, gravidity, previous
obstetric problems, type of labor, stillbirths, abortions,
live-birth infant abnormalities) and a general health history.
• Keep a record of the activity of the uterus (strength, duration,
and frequency of contractions, if any).
• All patients receiving IV oxytocin must be under constant
observation to identify complications. In addition, the health
care provider attending the delivery should be immediately
available at all times.
When monitoring uterine contractions, immediately stop the
oxytocin infusion and notify the health care provider attend-
ing the delivery immediately if any of the following occurs:
• A signi cant change in the or rhythm
• A marked change in the frequency, rate, or rhythm of uterine
contractions; uterine contractions lasting more than 60
seconds; or contractions occurring more frequently than every
2 to 3 minutes, or no palpable relaxation of the uterus
• A marked increase or decrease in the patient’s blood pressure
or pulse or any signi cant change in the patient s general
condition (vital signs are typically obtained every 15 to 30
minutes in active labor)
Other uterine stimulants
• When the patient is to receive any of these drugs after
delivery, it is important to take the blood pressure, pulse, and
respiratory rate before administration. ord
• Methylergonovine is administered for uterine atony and
hemorrhage, abdominal cramping can occur and is usually an
indication of drug effectiveness. he uterus is palpated in the
lower abdomen as small rm and round. owever report
persistent or severe cramping to the primary health care
provider. ord
Use
0.2 mg IM, IV after delivery of the placenta;
0.2 mg orally TID, QID
100-mcg tablet vaginally administered
Induction of labor: individualize dose not to
exceed 10 units/min
Postpartum bleeding: IV infusion of 10–40 units
in 1000-mL IV solution or 10 units IM after
placenta delivery
Prenatal
Folic Acid & Betamethasone

Vitamin name: Drug name:

Celestone
Soluspan

Folic Acid FOLIC Betamethasone

ACID Celestone
Soluspan

Indication: Indication:

Helps lung development

with preterm babies

MOA:

Increases surfactant production

which helps lungs to expand

iven to prevent spina bi da

Prevention of neural
tube defects
Begin ta ing before
pregnancy
ATI uestion
aluation of e ecti eness
ormal respiratory
pattern in newborn
FOLIC FOLIC
ACID ACID

Notes
 Contraception

Drug names: Drug names:

t es
Estrogen & Progesterone ESTROGEN
PROGESTERONE

Copper
Intrauterine evice
MIRENA
Levonorgestrel

a or Ad erse ects
That’s why it’s not given to
Increased ris for
patients with:
blood clots

MI DVT PE A stro e

KEY POINTS
Copper Intrauterine evice
ild discomfort upon insertion
(spo ng/ cram in )
Heavier bleedin and increased
KEY POINTS emor Tric cram in during menses
atient teac in
DO NOT smo e HESI Both I s TEACH
E - strogen & Pro esterone
REP R 1. ec strin s ONT after
evere leg pain E - Emboli
swelling vision loss menses to ensure I still in place
(Could be / C A)
2. Longer shorter missing string
O T to t e

HESI uestion KAPLAN uestion 1

HCP
strogen & mo ing Priority nding
increases ris for blood clots Client ta ing estro en with report ?
stro en contraindication of le le ain behind the nee
for a patient with Thrombophlebitis ossible D T

Don t let

NCLEX TRICK YOU

ATI uestion QUESTION BANK I s are NOT
o not ta e with
a ected by
edroxy ro sterone acetate
carbama e ine... lubricants
ma es oral Instruct client that ovulation may issed periods randomly - NOT normal

contraceptives
not occur for a few months after
using this med.
- COULD MEAN PREGNANCY!
NOT a ected
ine ective b ei t ain
or loss

Notes
Labor Drugs

Drug name: Drug name:

Terbutaline Terbutaline
xytocin

Indication: Indication:

Induces labor & stimulates

Delays labor momentarily by
contractions
suppressing contractions

Nursing Care:
Memory Trick

TurbutaLINE HESI uestion

Wait in LINE for the baby &
Terbutaline slows down Oxytocin
Turbulent contractions sed to stimulate
uterine contractions
Administered 6 - 12
ours a er last dose
MOA: of dinoprostone

Activated beta 2 receptors to activate

the sympathetic nervous system,
which suppresses labor
HESI uestion 00:60

Beta 2 iscontinue if contractions last longer than

60 seconds Oxytocin

aintain one on one care

Piggyback the oxytocin into the main I uids

HESI uestion KAPLAN uestion 02:00

top oxytocin infusion for contractions

Terbutaline 48h sustained over 2minutes
riorit action for 3 consecutive late Oxytocin

decelerations urn o xytocin

ay be used for
48 hours to suppress
preterm labor
ATI uestion
urn the client to the side if late decelerations
are noted.

Notes
 Progestins

How do they work? “Action” Interactions

Progesterone is secreted by the corpus luteum, placenta, • Anticonvulsants or rifampin:
and (in small amounts) adrenal cortex. They transform the Decreased effectiveness of progestin
proliferative endometrium into a secretory endometrium. • Penicillins or tetracyclines:
Progestins are necessary for the development of the Decreased effectiveness of oral contraceptive
placenta and inhibit the secretion of pituitary
gonadotropins, which in turn prevents maturation of the
ovarian follicle and ovulation. (Ford 494)

Indications
• Treatment of amenorrhea,
• Endometriosis
• Functional uterine bleeding
• Progestins are also used as oral contraceptives, either
alone or in combination with an estrogen (Ford 494)
Adverse Reactions
• Breakthrough bleeding, spotting, change in menstrual
flow amenorrhea
• Breast tenderness, edema, weight increase or decrease
• Acne, chloasma or melasma, insomnia, mental
depression (Ford 496)
Contraindications
Estrogen and progestin therapy is contraindicated in
patients with known hypersensitivity to the drugs, breast
cancer (except for metastatic disease),
estrogen-dependent neoplasms, undiagnosed abnormal
genital bleeding, and thromboembolic disorders. The
progestins also are contraindicated in patients with
cerebral hemorrhage or impaired liver function. Both the
estrogens and progestins are classi ed as pregnancy
category X drugs and are contraindicated during
pregnancy. (Ford 497)
Nursing management
• Monitor blood pressure, pulse, respiratory rate, and
weight
• Estrogens may be administered orally, IM, intravenously
(IV), transdermally, or intravaginally.
• onitor for excess fluid volume and sodium retention
• Teach the patient how to monitor for signs of
thromboembolic effects such as pain swelling and
tenderness in the extremities, headache, chest pain, and
blurred vision. hese adverse effects are reported
immediately to the primary health care provider
• Carefully read the patient package insert available with
the drug. If there are any questions about this
information, discuss them with the primary health care
provider.
• If GI upset occurs, take the drug with food.
• Notify the primary health care provider if any of the
following occurs: pain in the legs or groin area;
sharp chest pain or sudden shortness of breath;
lumps in the breast; sudden severe headache;
dizziness or fainting; vision or speech disturbances;
weakness or numbness in the arms, face, or legs;
severe abdominal pain; depression; or yellowing of the
skin or eyes.
• If pregnancy is suspected or abnormal vaginal bleeding
occurs, stop taking the drug and contact the primary
health care provider immediately.
• Patient with diabetes: Check the blood glucose daily, or
more often. Contact the primary health care provider if
the blood glucose is elevated. An elevated blood glucose
level may require a change in diabetic therapy (insulin,
oral antidiabetic drug) or diet; these changes must be
made by the primary health care provider. (Ford 500)

Generic Trade Use Dose

Endometrial hyperplasia (oral), Orally: 200 mg for 12 days of cycle
Progesterone prometrium amenorrhea, abnormal uterine bleeding IM: 5–10 mg/day for 6–8 days
(injection), infertility (gel) Gel: 90 mg/day

Amenorrhea, abnormal uterine bleeding,

Medroxyprogesterone Provera 5–10 mg/day orally
endometrial hyperplasia

Amenorrhea, abnormal uterine bleeding,

Norethindrone aygestin 2.5–10 mg/day for 5–10 days of cycle
endometriosis
 Estrogens

How do they work? “Action” Contraindications

Estrogens are secreted by the ovarian follicle and in smaller amounts by
the adrenal cortex. They are important in the development and mainte-
nance of the female reproductive system and the
primary and secondary sex characteristics they
• promote growth and development of the vagina, uterus, fallopian tubes,
and breasts.
• affect the release of pituitary gonadotropin
• fluid retention protein anabolism thinning of the cervical mucus and
inhibition or facilitation of ovulation.
• contribute to the conservation of calcium and phosphorus, the growth
of pubic and axillary hair, and pigmentation of the breast areola and
genitals.
Estrogen and progestin therapy is contraindicated in patients with known
hypersensitivity to the drugs, breast cancer (except for metastatic
disease), estrogen-dependent neoplasms, undiagnosed abnormal genital
bleeding, and thromboembolic disorders. The progestins also are
contraindicated in patients with cerebral hemorrhage or impaired liver
function. oth the estrogens and progestins are classi ed as pregnancy
category X drugs and are contraindicated during pregnancy. (Ford 497)
Estrogens are used cautiously in patients with gallbladder disease,
hypercalcemia (may lead to severe hypercalcemia in patients with breast
cancer and bone metastasis),

Indications Interactions
• combination with progesterones as a contraceptive agent • Oral anticoagulants: Decreased anticoagulant effect
• as estrogen replacement therapy (ERT) in postmenopausal women • Tricyclic antidepressants: Increased effectiveness of antidepressant
• Rifampin: Increased risk of breakthrough bleeding
• Hydantoins: Increased risk of breakthrough bleeding and pregnancy
Adverse Reactions
C N S:
• Headache, migraine
• Dizziness, mental depression
Nursing management
Dermatologic
• Dermatitis, pruritus • Monitor blood pressure, pulse, respiratory rate, and weight
• Chloasma (pigmentation of the skin) or melasma (discoloration of the • Estrogens may be administered orally, IM, intravenously (IV),
skin), which may continue when use of the drug is discontinued transdermally, or intravaginally.
• onitor for excess fluid volume and sodium retention
Gastrointestinal
• each the patient how to monitor for signs of thromboembolic effects
• Nausea, vomiting
such as pain, swelling, and tenderness in the extremities, headache,
• Abdominal bloating and cramps
chest pain and blurred vision. hese adverse effects are reported
Genitourinary
immediately to the primary health care provider
• Breakthrough bleeding, withdrawal bleeding, spotting, change in
• Carefully read the patient package insert available with the drug. If there
menstrual flow
are any questions about this information, discuss them with the primary
• Dysmenorrhea, premenstrual-like syndrome, amenorrhea
health care provider.
• Vaginal candidiasis, cervical erosion, vaginitis
• If GI upset occurs, take the drug with food.
Local • Notify the primary health care provider if any of the following occurs:
• Pain at injection site or sterile abscess with parenteral form of the pain in the legs or groin area; sharp chest pain or sudden shortness of
drug breath; lumps in the breast; sudden severe headache; dizziness or
• Redness and irritation at the application site with transdermal system fainting; vision or speech disturbances; weakness or numbness in the
Ophthalmic arms, face, or legs; severe abdominal pain; depression; or yellowing of
• Steepening of corneal curvature the skin or eyes.
• Intolerance to contact lenses • If pregnancy is suspected or abnormal vaginal bleeding occurs, stop
Miscellaneous taking the drug and contact the primary health care provider
• Edema, rhinitis, changes in libido immediately.
• Breast pain, enlargement, and tenderness • Patient with diabetes: Check the blood glucose daily, or more often.
• Reduced carbohydrate tolerance Contact the primary health care provider if the blood glucose is
• Venous thromboembolism, pulmonary embolism elevated. An elevated blood glucose level may require a change in
• Weight gain or loss diabetic therapy (insulin, oral antidiabetic drug) or diet; these changes
• Generalized and skeletal pain (Ford 496) must be made by the primary health care provider. (Ford 500)

Generic Trade Use Dose

Estrogen conjugated
Oral: hypogonadism, primary ovarian failure
0.3–2.5 mg/day orally
premarin Parenteral: abnormal uterine bleeding from
IM: 25 mg/injection
hormonal imbalance

Oral: hypogonadism, primary ovarian failure

Estr e s ester ed menest Parenteral: abnormal uterine bleeding from 1–5 mg IM every 3–4 wk
hormonal imbalance

0.3–2.5 mg/day orally

Estropipate Ogden, ortho est Female hypogonadism, ovarian failure 0
IM: 25 mg/injection
 Contraceptives
How do they work? “Action”
Most contraceptives are formed from estrogen and
progesterone. These two hormones act together to block the
release of an egg during ovulation, thus preventing pregnancy.
Indications
• Regulation of menstrual cycle
• Prevention of unintended pregnancy
• Decrease menstrual bleeding
• Decreasing the ris of iron deficits during menstruation
• Decrease risk of ovarian cysts
• Decrease in fibrocystic breast disease
• Decrease in pelvic inflammatory disease
• Decrease risk of endometrial cancer
• Decrease risk of cervical cancer
• Decrease in acne
Adverse Reactions
Estrogen
• Excess: Nausea, bloating, cervical mucorrhea (increased
cervical discharge), polyposis (numerous polyps),
hypertension, migraine headache, breast fullness or
tenderness, edema
• efi it Early or mid cycle breakthrough bleeding,
increased spotting, hypomenorrhea, melasma
(discoloration of the skin)
Progestin
• Excess: Increased appetite, weight gain, tiredness,
fatigue, hypomenorrhea, acne, oily scalp, hair loss,
hirsutism (excessive growth of hair), depression, monilial
vaginitis, breast regression
• efi it Late breakthrough bleeding, amenorrhea,
hypomenorrhea
Contraindications
The warnings associated with the use of oral contraceptives,
notably the combined drug contraceptives, are the same as those
for the estrogens and progestins and include cigarette smoking
(especially those older than 35 years of age), which increases the
ris of cardiovascular side effects, such as venous and arterial
thromboembolism, myocardial infarction, and thrombotic and
hemorrhagic stroke. Also reported with oral contraceptive use
are hepatic adenomas and other tumors, visual disturbances,
gallbladder disease, hypertension, and fetal abnormalities.
(Ford 497)
Interactions
• Oral anticoagulants: Decreased anticoagulant effect
• Tricyclic antidepressants: Increased effectiveness of
antidepressant
• Rifampin: Increased risk of breakthrough bleeding
• Hydantoins: Increased risk of breakthrough bleeding and
pregnancy
Critical Thinking
• If the interval is greater than 14 weeks between the IM
injections of medroxyprogesterone, be certain that the patient
is not pregnant before administering the next injection.
(Ford 498)
• There is an increased risk of postoperative thromboembolic
complications in women taking oral contraceptives. If possible,
use of the drug is discontinued at least 4 weeks before a
surgical procedure associated with thromboembolism or during
prolonged immobilization. (Ford 498)
Nursing management
• Assess likelihood of current pregnancy
• Administer pregnancy test
• Document the patient’s sexual history and reason for
contraception.
• Evaluate the patient’s understanding of safe sexual
practices and understanding that hormonal
contraceptives do not protect against sexually
transmitted infections (STIs).
• Inquire about a history of thrombophlebitis or other
vascular disorders, a smoking history, and a history of
liver diseases. Assess Blood pressure, pulse, and
respiratory rate
• Monophasic oral contraceptives are administered on a
day regimen, with the first tablet ta en on the first
Sunday after the menses begin or on the day the menses
begin if the menses begin on Sunday. After the 21-day
regimen, the next 7 days are skipped,
• Levonorgestrel, a progestin, is available as an implant
contraceptive system (Norplant System). Six capsules,
each containing levonorgestrel, are implanted using local
anesthesia in the subdermal (below the skin) tissues of
the midportion of the upper arm. The capsules provide
contraceptive protection for 5 years but may be removed
at any time at the request of the patient.
• Medroxyprogesterone (Depo-Provera), a synthetic
progestin used in the treatment of abnormal uterine
bleeding and secondary amenorrhea, is also used as a
contraceptive. This drug is given IM every 3 months, and
the initial dosage is given within the first days of
menstruation or within 5 days postpartum. (Ford 498)
 Gonadotropins

How do they work? “Action” Contraindications

and influence the secretion of sex hormones, the
development of secondary sex characteristics, and
the reproductive cycle in both men and women.
Indications
• Gonadotropins are used to induce ovulation and
pregnancy in anovulatory women (women whose
bodies fail to produce an ovum or fail to ovulate).
• Human chorionic gonadotropin (HCG) is extracted from
human placentas. This drug is also used in boys to treat
prepubertal cryptorchidism and in men to treat selected
cases of hypogonadotropic hypogonadism. (Ford 469)
• Follistim AQ is used to induce sperm production
(spermatogenesis). (Ford 469)
• Clomiphene and ganirelix are synthetic nonsteroidal
compounds that bind to estrogen receptors. These drugs
are used to induce ovulation in anovulatory (non
ovulating) women. (Ford 469)
Adverse Reactions
Hormone-Associated Reactions
• asomotor flushes which are li e the hot flashes of
menopause)
• Breast tenderness
• Abdominal discomfort, ovarian enlargement
• Hemoperitoneum (blood in the peritoneal cavity)
Generalized Reactions
• Nausea, vomiting
• Headache, irritability, restlessness, fatigue
• Edema and irritation at the injection site (Ford 469)
Interactions
• None listed
• high gonadotropin levels
• thyroid dysfunction
• adrenal dysfunction
• liver disease
• abnormal bleeding, ovarian cysts, or sex
hormone–dependent tumors,
• organic intracranial lesion (pituitary tumor).
Gonadotropins are contraindicated during pregnancy
(pregnancy category X). (Ford 469)
Nursing management
• If the patient complains of visual disturbances, the drug
therapy is discontinued and the primary health care
provider notified. n examination by an ophthalmolo
gist is usually indicated. (Ford 470)
• The patient is chec ed for signs of excessive ovarian
enlargement (abdominal distention, pain, ascites [with
serious cases . The drug is discontinued at the first
sign of ovarian stimulation or enlargement. The patient
is usually admitted to the hospital for supportive
measures. (Ford 470)
HORMONAL OVARIAN STIMULANTS
• Before beginning therapy, be aware of the possibility of
multiple births and birth defects.
• It is a good idea to use a calendar to trac the
treatment schedule and ovulation.
• eport bloating, abdominal pain, flushing, breast
tenderness, and pain at the injection site.
NON HORMONAL OVARIAN STIMULANTS
• Ta e the drug as prescribed days and do not stop
ta ing the drug before the course of therapy is finished
unless told to do so by the primary health care provider.
• Notify the primary health care provider if bloating,
stomach or pelvic pain, jaundice, blurred vision, hot
flashes, breast discomfort, headache, nausea, or
vomiting occurs.
• Keep in mind that if ovulation does not occur after the
first course of therapy, a second or third course may be
used. If therapy does not succeed after three courses,
the drug is considered unsuccessful and is
discontinued.

Generic Trade Use Dose

Gonadotropin Bravelle, Follistim AQ, Gonal-f, Ovulation induction, multifollicular Individualized dosing dependent on
• Gonadotropin ovarian Gonal-f RFF, Menopur, Repronex development, male infertility patient outcome
stimulant
Nafarelin
• Gonadotropin-releasing Synarel Endometriosis, precocious puberty 400 mcg/day intranasally in 2 doses
hormone/ synthetic
Cetrorelix
• Gonadotropin-Releasing Cetrotide Infertility Does individualized during cycle
Hormone Antagonists
Clomiphene
mg day orally for days, may be
• Nonsteroidal Ovarian Clomid, Serophene Ovulatory failure
repeated
Stimulant
Common Drug Antidotes
& Therapeutic Ranges

Drug Antidote
Opioid Analgesics Nalaxone

Heparin Protamine sulfate

Coumadin Vitamin K

Benzodiazepines Fluzmazenil

Acetominophen Acetylcysteine

Magnesium sulfate Calcium gluconate

Cholinergics Atropine

Digoxin Digiband

Beta blockers Glucagon

Aspirin Sodium bicarbonate

Cyanide Sodium thiosulfate

Drug Therapeutic range

Digoxin 0.5-2.0 mg/ml

Lithium 0.8-1.5 mEq/ L

Dilantin 10-20 mcg/ dL

Theophylline 10-20 mcg/dL

5—10 mcg/ml (peak), <2.0 mcg/ml

Gentamycin (valley)

20—40 mcg/ml (peak), 5 to 15 mcg/ml

Vancomycin (trough)

Carbamazepine 4—10 mcg/ml

Phenobarbital 15—40 mcg/mL

Phenytoin 10—20 mcg/dL

Tobramycin 5—10 mcg/mL (peak),

0.5—2.0 mcg/mL (valley)

Valproic Acid 50—100 mcg/ml

Drug Activity in the body
r e ti se
During this phase the drug is
dissolved in the body. Liquid
medications and I medications are
already dissolved therefore they
absorb much faster in the body.
tablet or capsule must pass through
the I tract to become dissolved.
nteric coated medications are time
released capsules or tablets that must
meet the al aline environment of the
small intestine before it dissolves.
r o ineti se
This phase refers to how the drug is
transported and distributed. The drug
canbe distributed or transported via
absorption, distribution, metabolism,
and excretion.
• sor tion moves the drug
from the point of administration
to the body fluids via active
transport, passive transport,
pinocytosis.
• istri tion The systemic
circulation distributes drugs to
various body tissues. Distribution
depends on protein binding,
blood flow, and solubility. The
drug comes into contact with
albumin or remain free, only free
circulating particles can produce
a therapeutic effect.
• et o is r biotransformation,
the body changes the drug to be
more or less active and excretable.
Most are metaboli ed by the liver
or idneys, lungs, plasma, and
intestinal mucosa.
• E retion limination of the
drug from the body after the
liver renders it in active it is then
excreted by the idneys via
urine.
r od n i se
Deals with the drugs action and effect
on the body.
• ri r e e t The desired
therapeutic effect.
• e ond r e e t ny other
effect the drug has on the
body. or example, sildenafil
was made for treatment of
hypertension. It was also
found to help with rectile
dysfunction which is its
secondary effect.
drug exerts its action by two
main mechanisms.
• ter tion in e r n tion
• ter tion in e r en iron ent
ses ti it
• harmaceutic phase
• harmaco inetic phase
• harmacodynamic phase.
n en es n sor tion
• oute I IM are the fastest to be
absorbed.
• Solubility
• ondition of body tissues
n en e n et o is
• Age
• Weight
• Sex
• Disease
• Route
nter tions
• dditi e dr g inter tion The
combined effect of two drugs has
an e ual effect if the drug was
given alone.
• nergisti inter tion When
drugs interact and create an
increased effect example
ypnotics and alcohol when ta en
together will cause increased
depression.
• nt gonisti inter tion One
drug interferes with the action of
another for example aloxone
reverses the effects of opioids.
• ood inter tion ome food and
decrease or increase the metabolism
of a drug.
E e ts n e er o s
• t o i eti physiological
effects characteristic of the
sympathetic nervous system by
promoting the stimulation of
sympathetic nerves.
• t o ti antagonistic to or
inhibiting the transmission of nerve
impulses in the sympathetic nervous
system.
• r s t o i eti stimulates the
parasympathetic nervous system
These chemicals are also called
cholinergic drugs because acetylcholine.
h is the neurotransmitter used by
the .
• r s t o ti reduces the activity
of the parasympathetic nervous system.
e er s
• irst ss e e t The concentration
of a drug is greatly reduced before it
reaches the systemic circulation
• i e Time is ta es for the body
to eliminate of the drug.
• nset o tion Time it ta es for the
drug reach therapeutic effect after
administration.
• e on entr tion When the
absorption rate e uals the elimination
rate.
• r tion ow long the drug
produces a therapeutic effect.
• harmacogenomics eople s
response to medication are variable.
enetic ma eup can alter how a drug
wor s.
• er togen Any substance that
causes abnormal development of a
fetus.
• dios n r s unusual or abnormal
reaction to a drug.
• r g to er n e Decreased response
to a drug that re uires an increase in
dosage.
• ti e dr g e e t Seen in
people with liver or idney disease,
the body is unable to excrete one
dose of the drug before the next dose
is given causing an accumulation of
the drug in the system.
e tions
• d erse dr g re tions
ndesirable drug effects. They may
be mild, severe or life threatening.
May occur at the first dose or after
subsequent doses.
• ergi dr g re tions
Immediate hypersensitivity reaction.
ccurs because the individual s
immune system responds to the
ste drug as a foreign substance. ome
reactions occur immediately or they
can ta e time. They can be mild,
severe or life threatening.
• n ti s o xtremely
serious reaction that usually occurs
immediately after drug
administration. This re uires
immediate medical intervention to
raise the B and improve breathing.
an be fatal if not treated immediately.
• ngioede llergic reaction
.
manifested by collection of fluid in
the subcutaneous tissue. Most
commonly affects the eyes, lips,
mouth and throat.
• o i re tion Toxic levels build
up in the body when the body
cannot excrete the drug.
Need to know
medications for NCLEX VIII
INSULINS
Types of Insulins Names
• blood glucose by transporting glucose into cells
• promoting conversion of glucose to glycogen Insulin Lispro-Humalog
• inhibiting the liver from changing glycogen to glucose Rapid-Acting
Insulin Aspart-Novolog

Regular Insulin-Humulin R
• Regular insulin is the
LONG ACTING NPH REGULAR RAPID
Short-Acting only one given IV
• Concentrated
NO Peak iNtermediate Ready to go IV Aspart/Lispro/
NO Mix NEVER IV DRIP Regular goes Glulisine insulin-Insulin U-500
• Detemir or IV Bag right into the
• Glargine Mix clear to vein
• Levemir = cloudy ONLY IV insulin Intermediate-Acting NPH-Humulin N, Novolin R
Long acting Give 2x per day

Insulin Glargine-Lantus
• Cannot mix with
PEAK Long-Acting
30-9- minute
others
PEAK 15 minute Insulin Detemir-Levemir
2-4 hour ONSET
PEAK
4-12 hour MOST DEADLY NPH/REG
NO PEAK
• Humulin 50/50
• Humulin 70/30
Premixed • Novolin 70/30
Aspart
protamine/aspart
• Novolog Mix 70/30
Lispro protamine/lispro
• Humalog Mix 75/25

Names Onset Peak Duration

Lispro
5m 60-90min 4-6h
(Humalog)
Aspart
10-20m 1-3h 3-5h
(Novolog)
Regular SQ: 30-60m SQ: 2-4h SQ: 5-7h
(Humulin R) IV: 10-30m IV: 15-30m IV: 30-60m

U-500 2-3h 5-7h

NPH
(Humulin N, Novolin R)
8-12h 18-24h

Glargine
None 24h
(Lantus)
Detemir
3-14h 24h
(Levemir)

NPH
(Humulin 50/50,
4-8h 24h
Humulin 70/30,
Novolin 70/30)

Apart
Protamine/aspart 1-4h 24h
(Novolog mix 70/30)

Lispro
Protamine/lispro 2.8h 24h
(Humalog mix 75/25)
Need to know
medications for NCLEX VI

STOOL SOFTENERS CORTICOSTEROIDS

• surface tension of interfacing liquid • inflammation, produce intentional
contents of the bowel-promoting additional immunosuppression, and treat adrenocortical
liquid into stools=softer mass. insufficiency

Brand Names Generic Name Brand Names Generic Names

Colace Docusate Sodium Celestone Betamethasone

Surfak Docusate Calcium Decadron Dexamethasone

Deltasone Prednisone

Solu-Cortef Hydrocortisone

ANTI-INFECTIVES Solu-Medrol Methylprednisolone

• Aminoglycosides • *Monitor WBC and Blood Glucose levels

Brand Names Generic Name

ANTIPROTOZOAL

Gentamicin Gentamicin Sulfate Brand Names Generic Names

Streptomycin Streptomycin Sulfate Flagyl Metronidazole

Tobramycin Tobramycin Sulfate
• *No alcohol products, including mouthwash,
aftershave, deodorant, bath splashes.
• Disulfiram- type reaction may occur (flushing,
RESPIRATORY MEDICATIONS nausea, vomiting, palpitations).
• ß-LACTAMs
• ß-Lactam antibiotics include:
PCNs, cephalosporins, monobactams,
• Bronchodilators carbapenems
• Relax bronchial smooth muscle • *Assess for allergies to any ß-Lactam antibiotic

Brand Names Generic Names

Proventil, Ventolin Albuterol Sulfate

CEPHALOSPORINS
Brovana Arformoterol Tartrate

Foradil Formoterol Fumarate Brand Name Generic Name

Xopenex Levalbuterol Rocephin Ceftriaxone
Spiriva Tiotropium Maxipime Cefepime

Fluticasone/Salmeterol Mefoxin Cefoxitin

• *combo drug
Advair (flut-potent Ancef Cefazolin
Advair Diskus anti-inflam
effects/Salm-bronch
odilator)
Need to know
medications for NCLEX VII

PENICILLINS CARBAPENEMS

Brand Names Generic Names Brand Names Generic Name

Amoxil Amoxicillin Invanz ErtapenemSulfate

Omnipen Ampicillin Merrem MeropenemSulfate

Unipen Nafcillin Primaxin ImipenemSulfate

Pipracil Piperacillin

Zosyn Piperacillin/Tazobactam

FLUOROQUINOLONES (oxacin)
SULFONAMIDES

Brand Names Generic Names Brand Names Generic Name

Bactrim SMZ-TMP Cipro i ro o in

Bactrim DS Trimethoprim-Sulfa
Septra methoxazole Levaquin e o o in

*Avoid or use with extreme caution if allergic to • *Tendon rupture.

sulfa rythromycin ulfisoxa ole, ulfasala ine, • *Adjust dosage for renal patients.
Dapsone, ulfonamides, elebrex, Imitrex, asix,
ydrochlorothia ide T

VANCOMYCIN TETRACYCLINES

Brand Names Generic Names Brand Names Generic Name

Vancomycin Tetracycline Tetracycline

Vancocin
Hydrochloride
Vibramycin Doxycycline

• ephrotoxicity, totoxicity, ed Man yndrome

• *Peak: 30 minutes to 1 hour after administration.
• Trough minutes before the next dose.
Need to know
medications for NCLEX V

PROTON PUMP INHIBITORS (PPI) H2-HISTAMINE RECEPTOR ANTAGONISTS

• Inhibit histamine at histamine receptor
• Bloc final step of gastric acid production sites, gastric acid secretion
• lcer reducing
Brand Names Generic Name
Brand Names Generic Name
Pepcid Famotidine
Nexium Esomeprazole
Zantac Ranitidine
Prilosec Omeprazole

Protonix Pantoprazole

ANTILIPIDEMICS
• T TI M D T I IBIT
ANTIEMETICS • Inhibits M o reductase, an early step in
cholesterol production

• ct by ↓ preventing nausea vomiting Brand Names Generic Name

Brand Names Generic Name Crestor Rosuvastatin

Phenergan Promethazine Lipitor Atorvastatin

Zofran Ondansetron Zocor Simvastatin

• habdomyolysis, epatotoxicity

GI MEDS
MISCELLANEOUS ANTILIPIDEMICS
• on absorbable medications used
prophylactically to treat prevent
ulcers and D
Brand Name Generic Name • I rotectant
• Mixes with gastric acid to form a
Zetia Ezetimibe protective coating of gastric mucosa
Inhibits absorption of
Selective cholesterol cholesterol by small
absorption inhibitor Brand Names Generic Names
intestine
Carafate Sucralfate
TriCor enofi r te
↓ triglyceride
Fibric Acid Derivative synthesis in liver
GI STIMULANT
Lopid e fi ro i
↓ triglyceride • ct by ↑ resting tone of esophageal sphincter
Fibric Acid Derivative synthesis in liver • romotes gastric emptying intestinal transit
Brand Names Generic Names
Questran Cholestyramine
Bile acid sequestrant Binds bile acids, Reglan Metoclopramide
(food additive improving impeding absorption
quality) (elimination in feces)
• ometimes used with diabetic gastroparesis
Need to know
medications for NCLEX IV
ARBS-(SARTAN) NITRATES
• Block binding of angiotensin II at the receptor • eripheral and coronary vasodilators.
site, preventing vasoconstriction & aldosterone • Treat/prevent angina, ↓ BP ↓, preload/afterload,
secreting effect usually caused by angiotensin II ↓ myocardial demand.
• I rotate transdermal patches remove after
Brand Names Generic Name
hours patch free interval of hours daily
Atacand Candesartan
Common Brand Names Generic Name
Cozaar Losartan
Nitro BID
Tridil
Diovan Valsartan Nitroglycerin
Transderm Nitro
Nitrostat
CARDIAC GLYCOSIDES Imdur Isosorbide Mononitrate

• ositive inotropes improve contractility Isorbid

and cardiac output Isordil Isosorbide Dinitrate
• Negative dromotropic slow AV Sorbitrate
conduction rate.
• hec otassium evel
• Negative chronotropes ↓ HR & improve
cardiac output.
• ct as antiarrhythmic via tropic effect.
• I Monitor level, toxicity ANTI-DIABETICS
Brand Names Generic Names
• ulfonylureas
Lanoxin Digoxin • romotes insulin secretion by the
pancreas; ↑ tissue response to insulin

• Monitor Dig level, toxicity

Brand Names Generic Name
BIGUANIDES
Amaryl Glimepiride
• ↓ hepatic glucose production
Diabeta
intestinal absorption of glucose
Glynase Glyburide
• improves insulin sensitivity
Micronase
tissue response to insulin
Glucotrol (XL) Glipizide
Brand Names Generic Names

Glucophage Metformin

• Initial drug therapy for newly D T DM. GLITAZONES-(GLITAZONE)

• Most common side effect I.
• are side effect actic acidosis • Decrease insulin resistance

Common Brand Names Generic Name

Brand Names Generic Names
Actos Pioglitazone
Januvia Sitagliptin
Avandia Rosiglitazone
GLIPTINS (DPP-4 Enzyme Inhibitors)
dema secondary to renal retention of fluid
• ↑ levels of incretins naturally occurring substances
control blood sugar by ↑ insulin release,
especially after a meal.
Pharm Quick Glance
edi tion ssifi tions
• Antacids - reduces hydrochloric acid in
the stomach.
• Antianemics - increases blood cell
production.
• Anticholinergics - decreases oral
secretions.
• Anticoagulants - prevents clot formation,
• Anticonvulsants - used for management
of seizures and/or bipolar disorders.
• Antidiarrheals - decreases gastric motility
and reduce water in bowel.
• Antihistamines - block the release of
histamine.
• Antihypertensives - lower blood pressure
and increases blood flow.
• Anti-infectives - used for the treatment of
infections
• Bronchodilators - dilates large air passages
in asthma or lung diseases (e.g.,COPD).
• Diuretics - decreases water/sodium from
the Loop of Henle.
• Laxatives - promotes the passage of
stool.
• Miotics - constricts the pupils.
• Mydriatics - dilates the pupils.
• Narcotics/analgesics - relieves moderate
to severe pain.
Drug Schedules
Drug Schedules
• Schedule I - no currently accepted medical use
and for research use only (e.g., heroin, LSD,
MDMA).
• Schedule II - drugs with high potential for abuse
and requires written prescription (e.g., Ritalin,
hydromorphone (Dilaudid), meperidine (Demerol),
and fentanyl).
• Schedule III - requires new prescription after six
months or five refills e.g., codeine, testosterone,
ketamine).
• Schedule IV - requires new prescription after six
months (e.g., Darvon, Xanax, Soma, and Valium).
• Schedule V - dispensed as any other prescription
• • Isoniazid - can cause peripheral neuritis, take
or without prescription (e.g., cough preparations,
Lomotil, Motofen)
Pregnancy Categories
• Category A—No risk in controlled human studies
• Category B—No risk in other studies.
Examples: Amoxicillin, Cefotaxime.
• Category C—Risk not ruled out.
Examples: Rifampicin (Rifampin), Theophylline
(Theolair).
• Category D—Positive evidence of risk.
Examples: Phenytoin, Tetracycline.
• Category X—Contraindicated in Pregnancy.
Examples: Isotretinoin (Accutane), Thalidomide
(Immunoprin), etc.
• regnancy ategory ot yet classified
Nursing Considerations
• Digoxin (Lanoxin) - Assess pulses for a full
minute, if less than 60 bpm hold dose. Check
digitalis and potassium levels.
• Aluminum Hydroxide (Amphojel) - Treatment
of GERD and kidney stones. Monitor constipation.
• Hydroxyzine (Vistaril) - Treatment of anxiety
and itching. WOF dry mouth.
• Midazolam (Versed) - given for conscious
sedation. Watch out for respiratory depression
and hypotension.
• Amiodarone (Cordarone) - diaphoresis,
dyspnea, lethargy. Take missed dose any time
in the day or to skip it entirely. Do not take
double dose.
• Warfarin (Coumadin) - Watch for signs of
bleeding, diarrhea, fever, or rash. Stress
importance of complying with prescribed
dosage and follow-up appointments.
• Methylphenidate (Ritalin) - Treatment of
D D. ssess for heart related side effects
and reported immediately. Child may need a
drug holiday because the drug stunts growth.
• Dopamine - Treatment of hypotension, shock,
and low cardiac output. Monitor ECG for
arrhythmias and blood pressure.
• Rifampicin - causes red-orange tears and
urine.
• Ethambutol - causes problems with vision,
liver problem.
vitamin B6 to counter.
 Need to know
medications for NCLEX III

ANTIHYPERTENSIVES –(PRIL) ALPHA 1 ADRENERGIC BLOCKERS-(ZOSYN)

• ACE Inhibitors • Dilate blood vessels and ↓ (PVR)

• Block the conversion of angiotensin I to angiotensin II
(potent vasoconstrictor)-Causing vasodilation and
PVR (peripheral vascular resistance) without ↓ cardiac Common Brand Names Generic Name
output/rate/contractility-Aldosterone is also blocked,
causing a ↓ in a and retention. ide effect Hytrin Terazosin
Nagging, nonproductive cough, angioedema
Minipress Prazosin
Common Brand Name Generic Name

Altace Ramipril
ALPHA & BETA ADRENERGIC BLOCKERS-(LOL)
Capoten Captopril
• Alpha blockers-block alpha 1 receptors
Prinivil, Zestril Lisinopril
vasodilation. Beta blockers-block beta 1
Vasotec Enalapril beta receptors
• reduce HR, myocardial irritability, force of
*check potassium level contraction
• depress automaticity of SA node,
ALPHA 2 ANTAGONISTS ↓ speed of AV & intraventricular conduction
suppress release of renin from the kidneys
• centrally-acting anti-hypes causing
↓ amounts of norepinephrine to be
released, ↓ sympathetic activity Common Brand Names Generic Name

Coreg Carvedilol
Common Brand Names Generic Names
Trandate, Normodyne Labetalol
Catapres Clonidine

CALCIUM CHANNEL BLOCKERS

BETA BLOCKERS-(OLOL)
• Prevent sympathetic stimulation of the heart,
thus ↓ HR and contractility.
• ↓ myocardial irritability, depress
automaticity of SA node,↓ speed of AV &
intraventricular conduction
• suppress release of renin from the kidneys.
• Bloc a influx into the beta receptors
• ↓ force of myocardial contraction/conductivity
• ↓ HR, ↓ PVR.
• roduce relaxation of coronary vascular
smooth muscle; dilates coronary arteries;
↑ myocardial O2 delivery, ↓ O2 demand.
• ide effect edema, dysrhythmias

Common Brand Name Generic Name

Common Brand Name Generic Name
Inderal Propranolol
Cardizem Diltiazem
Lopressor Metoprolol Tartrate
Norvasc Amlodipine
Toprol-XL Metoprolol Succinate
Procardia Nifedipine
Tenormin Atenolol
Verelan, Isoptin, Calan Verapamil
• *May cause bronchoconstriction.
Need to know
medications for NCLEX II

SEDATIVES/HYPNOTICS
Common Brand Names
Ambien
DIURETICS
• ↓ fluid volume in the body
Generic Name I monitor daily weight under standard
conditions, assess B , I , presence of edema
Zolpidem Tartrate

Lunesta Eszopiclone LOOP DIURETICS

• Inhibit reabsorption of a , , and
in loop of enle , but also in proximal and
distal renal tubules

Common Brand Names Generic Name

Bumex Bumetanide

Demadex Torsemide

ANTICOAGULANTS Lasix Furosemide

• Interferes with blood clotting processes.

sed to prevent thrombus and embolus

Common Brand Names Generic Name

Thiazide Diuretics
Coumadin Warfarin Generic
• ↑ excretion of a , l , , in distalName
tube
Lovenox Enoxaparin and ascending loop of enle

Heparin Sodium-from
Heparin Common Brand Names Generic Name
beef/pork
Diuril Chlorothiazide Sodium

Hydrodiuril, HCTZ Hydrochlorothiazide

Zaroxolyn Metolazone
ANTIPLATELETS

• Interferes with the T step in the clotting

process platelet aggregation

Common Brand Names Generic Name POTASSIUM-SPARING DIURETICS

Generic Name
ASA - aspirin Acetylsalicylic Acid
• ontains aldosterone at receptor sites in
Plavix Clopidogrel distal tubule excrete a , l , , not

• epto Bismol contains aspirin Common Brand Names Generic Name

Aldactone Triamterene

Dyrenium Spironolactone
Need to know
medications for NCLEX I

ANALGESICS ANTICONVULSANTS
• Opioids ↑ interval between seizures
• ↑ pain threshold by altering pain
perception
Common Brand Name Generic Name
Common Brand Names Generic Names Dilantin Phenytoin
Demerol Meperidine HCL Neurontin Gabapentin
Dilaudid Hydromorphone Tegretol Carbamazepine
Duragesic, Sublimaze Fentanyl Depakote Valproic Acid
Morphine Sulfate Morphine Sulfate
*Neurontin is sometimes prescribed for
Vicodin, Norco Hydrocodone chronic pain neuropathy
*Monitor blood levels: Dilantin, Tegretol,
and Depakote

BENZODIAZEPINES ( Pam & Lam) ANTIDEPRESSANTS

• Enhance/facilitate GABA, an inhibitory • SSRIs

neurotransmitter • Act by inhibiting serotonin reuptake in CNS

Common Brand Name Generic Name Common Brand Names Generic Names

Dilantin Phenytoin Celexa Citalopram

Neurontin Gabapentin E e or Venlafaxine

Tegretol Carbamazepine Lexapro Escitalopram Oxalate

Depakote Valproic Acid Paxil Paroxetine

Prozac Fluoxetine

Zoloft Sertraline

ANXIOLYTICS TRICYCLICS
• Azaspirodecanedione derivatives • Act by blocking reuptake of norepinephrine
• ↓ anxiety. Action unknown, thought to act by and serotonin at nerve endings
↓ the amount/action of serotonin in certain parts
of the brain.
Common Brand Names Generic Names
Common Brand Names Generic Names
Elavil Amitriptyline
Buspar Buspirone Hydrochloride
Common Drug Suffixes

CNS Neuromuscular Infectious Disease

Family Drug Example Family Drug Example
-chol Muscarinic agonist carbachol Cell wall inhibitor “Broad Imipenem
-penam
spectrum” Meropenem
-trop Atropine
Muscarinic blocker
scop- Scopolamine iprofloxacin
o in Fluoroquinolone
-stigmine Achase inhibitor Neostigmine evofloxacin

-curium Nondepolarizing Atracurium -conazole Ketoconazole

Antifungal
-curonium neuromuscular blocker
Mivacurium ‘’Azole’’ Fluconazole
Pancuronium

-ane Inhailed anasthetic Halothane Chloroquine

-quine Antimalarial
Primaquine
-caine Local anaesthetic Lidocaine
Acyclovir
Antiviral “ DNA polymerase
-pam Diapam -ovir Ganciclovir
Benzodiazepine inhibitors” treats herpes
-lam Lorazopam Valacyclovir

-tal Barbiturate Phenobarbital Neuraminidase inhibitor “

-ivir Zanamivir
treats influen a
Typical antipsychotic Chlorpromazine
-zine Antiviral protease Indinavir
or antihistamine Thoridazine -avir
inhibitor “treats HIV/AIDS” Ritonavir
-apine Clozapine
Atypical antipsychotic
-idone Risperidone

COMT inhibitor for Tolcapone

-capone
parkinson's disease Entacapone

Cardiovascular GI
Family Drug Example Family Drug Example

-olol Beta blocker metoprolol -tidine H2 blocker Cimetidine

-alol Sotalol -prazole PPI Pantoprazole

Alpha-Beta blockers
-ilol cardviolol

Vascular Calcium -setron 5HT3 blocker ‘’Anti Emetic’’ Ondansetron

-dipine ifidipine
channel blocker

Terazosin
-zosin Alpha -1 blocker
Doxa osin

-pril Ace inhibitor Lisinopril Oncology

-sartan ARB Losartan Family Drug Example
-darone Antiarrhythmic Amiodarone Vincristine
vin- Microtubule inhibitor
Vinblastine
Anti hyperlipidemic Hmg
-statin Rosuvastatin -rubicin Cancer drug Doxorubicin
coa reductase inhibitor
-mab Monoclonal antibody drug ituximab
Carbonic anhydrase
-zolamide Acetazolamide
inhibitor -tinib Tyrosine kinase inhibitor Imatinib
-semide Loop diuretic Furosemide

Low molecular weight

-parin noxaparin
heparin

-rudin Direct thrombin inhibitor Lepirudin

Breast Cancer
& Immunotherapy

Drug name: KEY WORDS NCLEX Question

▪ Clots Risk! When preparing to administer tamoxifen to a
Tamofixen patient with breast cancer, the nurse is most
▪ E - Estrogen concerned by which patient report?
▪ E - Emboli (clot risk)
A. “I have been experiencing really heavy menstrual
Contraindication:
MOA: cycles recently.”
History of DVT or PE CLARIFY
B. “My hot flashes seem to be decreasing in frequency.”
Blocks estrogen receptors in order with provider! C. “I feel like I may be developing a sinus infection.”

the breast to stop estrogen D. “I just don’t have the energy for sex the way that I

dependent cancer used to.”

SIDE EFFECT
NORMAL KAPLAN
HESI Question
DON’T Endometrial cancer
GET TRICKED Tamoxifen - Treats breast cancer Report “heavy periods” “excessive
Bleeding”

Drug names: Indication: Key Point:

Stimulates WBC
(neutrophil) production
Filgrastim NEUPOGEN

Expected = INCREASE neutrophil count

Pegfilgrastim Neupogen
PEGFILGRASTIM

WBC- neutrophil

Drug name: Indication: ATI HESI

Increases platelet production, Patient Scenario: Adverse Effects

Stimulates growth of hematopoietic Fluid retention
Oprelvekin for patients in chemo who have stem cells
Oprelvekin effectiveness =
A fib
Anaphylaxis
high risk for thrombocytopenia Increased platelets

(low platelet)
OPREL-
OPREL- VENKIN
VENKIN

Drug name: Indication: ide E e ts

HESI
Stimulates the body’s Flu like symptoms:
Interferon immune system to Fever, muscles aches, Interferon beta
detect & kill cancer chills are NORMAL ● Apply warm compress before
cells & viruses Memory Trick:
giving injection to reduce risk of
pain at site
INTERFERON ● Administer med late in the
day so flu like symptoms occur
during sleep
Interferon

NORMAL

Notes
Cancer Treatment
Radiation & Brachytherapy

Name: Name:

Radiation (outside of the body) Brachytherapy (radiation inside the body)

Indication: Indication:

Typical radiation outside of the body is used • Endometrial cancer Endometrial cancer

in combo with chemotherapy to help shrink • Cervical cancer

Cervical cancer

cancerous tumors before surgery

24-72H

NCLEX #1 goal is safety

A radioactive implant is placed
directly inside the tumor for
o rs ing t is tient
ide E e ts i e r dio ti e rd

Very hard on the skin: red, dry & itchy

KEY POINTS
• NO hard scrubbing of skin
1. Time:
• NO tape or deodorants ● Cluster care 30 minutes
• NO shaving ●
• NO lotions, creams, perfumes, powders,
makeup cosmetics 2. Distance:
●

NO
●
●
● Private
●
●

ATI
Use DIRECT CONTACT

Client with cancer undergoing

radiation therapy
I will use my hands rather than
a washcloth to clean the
radiation area
CAUTION RADIOACTIVE

Notes
Chemotherapy

Drug names: d erse E e ts Key Points:

• Doxorubicin All fast growing Low RBC & LOW CBC -“Anemia”
• DOXORUBICIN CISPLATIN
cells die Normal: 4.5 - 6 million RBC
• Cyclophosphamide Low Platelets
4.5 - 6 million

• Bone cells DIE Normal plt 150 - 400,000

Indication: • Blood cells DIE Less than 100,000 =

• Low immunity Thrombocytopenia 150,000 - 400,000

Slow & stop the growth Low WBC - leukopenia < 4,000
of tumors Normal: 5,000 - 10,000
< 4000
KEY WORDS
MOA: Immunode ciency
“Immune compromised” KAPLAN
Directly inhibiting growing FEVER is a priority > 100.3 F/ 38 C

Doxorubicin- Temperature is highest

cells in the body OVER 100.3 F (38 C)!!!
priority Over 100.5 F (38 C)
NCLEX TIP

Cisplatin: > 1.3

MEMORY TRICK
KEY POINT

Renal toxicity CISplatin PISSplatin

Monitor Urine- Input & Output BUN > 20
Creatinine
OVER 1.3 = Bad kidney
BUN OVER 20 CISPLATIN
Urine Output < 30ml/hr

Urine ouput 30ml/hr

or LESS = Kidney Distress

Drug name:
VINCRISTINE
Common NCLEX Question
Vin incristine
The nurse is caring for a client with ovarian
cancer taking doxorubicin, which assessment <50,000
Normal 150,000- 400,000
finding should the nurse report to the health
Only chemo drug that does NOT care provider? Select All That Apply
cause bone marrow suppression!
. Partial thromboplastin time .
Memory Trick:
. Platelet count of . > 100.3 F/ 38 C

Very Cool CHRISTIAN . Red blood cell count x .

. Temperature of . . .
Just a gentle Saintly soul, . hite blood cells .
does not harm the bone
< 4,000
marrow Normal 5,000- 10,000

Notes