Acetaminophen

(brand: Tylenol) Hani Abu-Dieh

Indication:

Fever & mild pain. Used instead of

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

Avoid ETOH

Key Points:

HESI Question
• Like in patients with Peptic Ulcer
or Hemophilia Acetaminophen
high risk client?

54 year old male who

abuses alcohol
Peptic Ulcer Hemophilia

• 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
ATI question
AIDs
NS

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

ALT and AST

ALT AST

Notes
 Acid Prevention
Antacid, H2 Blockers & PPI Hani Abu-Dieh

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
Anti –Acids
Side Effects: Can upset stomach +
Anti –MIXING with other MEDs
Liquid bowel movements
Aluminum & Calcium Magnesium ‘’mellow’’
Constipation = 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

H2 Blockers: 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

Proton Pump Inhibitor

P

stomach to reduce gastric acid

P

“-prazole”
Omeprazole
Key Terms: KEY POINTS & MEMORY TRICK
(brand: Prilosec)

Esomeprazole
(brand: Nexium)

Pantoprazole
P P P P
Stress ulcer
prophylaxis
(brand: Protonix)
Prevents holes Porous Bones Possible GI infections
Prazole
“Stress ulcer prophylaxis” “regular bone density tests” “C-Diff”
in hospitalized
/surgical
Indication: patients

Stress ulcer prevention,

GERD, heart-burn
 Adenosine Hani Abu-Dieh

Drug name: MEMORY TRICK Indication:

1st line drug to treat
- supraventricular tachycardia
AdenoSINE
Puts the HR Down 150 beats/min
in a DEN with aDENosine

MOA: SUPRAventricular tachycardia

SUPER tachy 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 TEST Question 2. Adenosine IV push “rapidly over 1-2

seconds” followed by a saline flush
Which drug does the nurse 3. Cardioversion to Convert the heart
anticipate the provider to order? rhythm - “Push the SYNCHRO-
SYNC

Adenosine #1 NIZE BUTTON” for Cardioversion

SYNC

Don’t let
THE NCLEX TRICK YOU
CARDIOVERSION DEFIBRILLATION

Cardioversion Defibrillation
C - Cardioversion D - Defibrillation - if you
C - Count a pulse D - Don't have a pulse
C - Controlled Rhythms D - Deadly rhythms (VFib & Vtach no pulse)
Synchronized button &sedation D - Don't Synch (shock away!)
PULSE NO PULSE

SYNC
SYNC

SYNC
 Uric Acid
Allopurinol & Colchicine Hani Abu-Dieh

Indication: Patient Teaching:

Given for Gout - uric acid build • Increase fluids & take with full
glass of water
up causes inflammation in the
joints • AVOID clients with Kidney & Liver Disease
• Evaluation of effectiveness?
= Normal uric acid levels
BIG KEY DIFFERENCE

AlloPurinol - Prevents gout

Colchicine - for aCute gout attacks

NOT given to reduce pain, but to

reduce uric acid HESI Question ALLOPURINOL

Allopurinol - Do not take for acute

gout attacks
Colchicine - for acute attack, DOES
KEY POINT COLCHICINE

ACute Gout Attacks

NOT provide pain relief

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

KEY POINTS: KAPLAN Question

Allopurinol
“I can use ibuprofen for pain … Gout”
IBUPROFEN

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

Needs FURTHER teaching it

Lim
when taking Allopurinol NE
VER

“I will limit my fluid intake

ALLOPURINOL
with this medication”

Notes
Antibiotics:
6 TEST TIPS OF ABX Hani Abu-Dieh

1. Finish med 2. Accidental pregnancy 3. NO alcohol

To prevent SUPER infection!
C - Child Care
ABX are hard on liver
C - “-Cillins” -Penicillin, Amoxicillin
Key Words C - “-Cycline” -Doxycycline, Tetracycline

Take until all med is finished Key Words

DO NOT stop when feeling
better Oral contraceptives ineffective
Use additional contraception
like IUD.

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

MTF “Move The Food ”
M - Macrolides - Azithromycin
T - Tetracycline – Doxycycline
F - Fluoroquinolones - Levofloxacin
Key Words
Take on EMPTY stomach
Full glass of water
AVOID “Fun The Sun” Others
F - Fluoroquinolones - Levofloxacin
T - Tetraclycine – Doxycycline Sulfonylureas (Glyburide)
S - Sulfa drugs = SUN burns Diuretics (thiazide/loops)
Trimethoprim – sulfa methox azole
(Brand: Bactrim)
Key Words
Photosensitivity
Avoid “direct sun exposure”
Sun Burns (Wear Sun Block
& Avoid Sun)

Don’t let
6. SUPER Toxic 6. SUPER Toxic NCLEX TRICK YOU
(Kidney + Ears) (Kidney + Ears)
Key Words
Vancomycin
Gentamicin REPORT: Signs of Toxicity
Ear Damage “Ototoxicity”
Neomycin - Vertigo (loss of balance)
- Tinnitus (ringing of the ears) Mycins
Key Words Kidney Damage “Nephrotoxic”
REPORT IMMEDIATELY!!
PEAK & Trough Creatinine OVER 1.3 = Bad Kidney “- Thromycin” like AziTHROmycin
Too HIGH = Kidneys DIE BUN Over 20 “-floxacin” like Cipro-flox-acin
Too Low = Infections Grows Urine output
30ml/hr or LESS = Kidney Distress
Anticholinergics &
Hani Abu-Dieh
Methylxanthines
Drug name: Drug name:

M - Methylxanthines
“-tropium”
TIOTROPIU
IPRATROPIUM M

Ipratropium “-phylline”
Tiotropium · Theophylline Aminophylline
Theophylline

· Aminophylline

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 1st Priority
· T – Tachycardia &
Memory Trick: Dysrhythmias NCLEX TIP

AIM for Acute Attack

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

‘’-phyllines’’ make you

Methy
lpredn
isolon
e

So
lu Medrol
Met
hylprednisolone

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

MOA: HESI Question

Teach pt to
Blocks secretions, anticholinergic effects: AVOID beta blockers
can’t see, pee, spit or sh* - poop that lower the heart rate
while on
Theophylline
Beta
Side Effects: Blockers
HESI & ATI Question “ALERT HCP of tachycardia
BEFORE giving next dose”
Very dry body Contraindication to
Treat the DRY mouth & throat ALL anticholinergics:
for all anticholinergics
We Never give for
· Use gum/candy patients who are Key Teaching Points
· Drink fluids
already DRY.
KEY POINT - NO swallowing NCLEX TIP
tiotropium capsules!
No giving anticholinergis CIMETIDINE CIPROFLOXACIN

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

Notes
Dabigatran
Hani Abu-Dieh
& 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
 Factor XA
Hani Abu-Dieh
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
Fondaparinux Hani Abu-Dieh

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 NO Anticoagulants
Fondaparinux can cause at least 6 hours after surgery with spinal epidural catheter
an epidural bleed!

Fondaparinux

Notes
 Anti-Coagulants
Heparin vs. Warfarin Hani Abu-Dieh

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 Sulfate (Antidote) K – Vitamin K (Antidote)
PTT – 46 – 70 Max range IN – INR 2 -3 range
Specifically with patients recovering from
An MI heart attack or those at RISK for DVT *FAST onset = Frogs are FAST *Slow onset = “Is it even WARkin?”

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

Heparin:

• Heparin works QUICKLY, or Heparin works Anti-coags DO NOT DISSOLVE CLOTS!

Hella FAST, within 20 minutes Only thrombolytics do that, like TPA or Alteplase

Key Words:

• Heparin starts in a hurry, but is gone in a hurry Both medications given TOGETHER
for several days. This gives Warfarin
• It can only be injected into the patient. IV or SQ some time to catch up.
like Enoxaparin, the lower lighter weight heparin

LABS:
LABS – BY FAR the biggest TOPIC on
Enoxaparin
Test Questions: SINCE IT’S THE MOST DEADLY!!
Warfarin: So just think if Labs:
• Warfarin has a weaker START, typically taking TOO HIGH = pt will bleed out & DIE
5 days to reach FULL effect. So warfarin takes TOO LOW = then CLOTS will GROW
a LONGER TIME to kick in, but it last LONGER
& can be taken longer
LABS

15
• So think of the WAR in Warfarin, like a
WAR that lasts a LONG TIME!

Notes
Anti-Coagulants
Heparin Hani Abu-Dieh

Key Numbers for NCLEX ATI Question

Patient on Heparin with
PTT: 46 - 70
PTT
46 - 70

Bleeding at IV SITE!!
PROTAMINE
SULFATE

Antidote: Priority action:

Protamine Sulfate
“Blood Oozing
at surgical incision”
Be careful, NCLEX, will yty & trick you!
NOT INR & NOT PTT OVER 70!

INR
<70
Priority Action:

H -HaPTT
1 STOP the Heparin – Notify HCP HEPARIN

Memory Trick:

“HePTT” the FROG

H – Heparin
2 Prepare Antidote: Protamine Sulfate PROTAMINE
SULFATE

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

HESI Question Heparin drip

aPTT 85 or 100!
NCLEX MEMORY TRICK!

HePTT
HEPARIN

Priority Action

1 STOP the Heparin

– Notify HCP 2 Prepare Antidote:
Protamine Sulfate 3 Reassess labs (1 hour)

Heparin goes FAST!!

PROTAMINE
SULFATE
HEPARIN

Notes
 Anti-Coagulants
LMW Heparin Hani Abu-Dieh

Heparin SQ Indication: Administration:

· -parin Key term 1 2
· Enoxaparin (Lovenox)
Inject at
· Dalteparin Prevention of DVT 25 G Needle ⅝ inch
90 degree angle

Less heavy and less after surgery

chances of major bleeding
90º

Common ATI question: HESI question:

3
Enoxaparin “Client on ENOXAPARIN” LOCATION
“Which statements needs Report to HCP:
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

2 inches

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
KEY Numbers
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
30%
Enoxaparin Labs

HIT is when HALF platelets Heparin

GONE in 24 hours! Low Platelets
STUDENTS WRONG
NOT aPTT or INR

?
Most commonly
HEPARIN
chosen distractor!

PRIORITY ACTION P – Parin P – Platelet

(Enoxaparin) FOCUSED
1. Alert the HCP!

HCP
Notes
Anti-Coagulants
Warfarin Hani Abu-Dieh

5.0

Key Numbers for NCLEX 4.5 Vitamin K Foods

Liver
4.0
INR 3.5
2 - 3 Therapeutic Range 3.0 Green leafy vegetables
2.5 – 3.5 (heart valve replacements)
2.5 (Broccoli, Spinach)
Antidote: Vitamin K 2.0
“K = Kills Warfarin” 1.5
Key Patient Teaching:
NCLEX KEY TERMS:
1.0 - Consistent & Moderation
Vitamin K Keep K – Consistent
- NOT! given if warfarin within - Key words:
therapeutic range
· NOT increased
- NOT! until AT LEAST 5 days of *2.5-3.5 for heart valve · NOT decreased
warfarin when switching from IV Hep!!!
replacements · NOT avoid TOTALLY

NCLEX MEMORY TRICK!

NICE to KNOW!!
W – Warfarin
WARFARIN
W – WarKIN Antibiotics INCREASE risk for Bleeding

By INCREASING INR
W K IN
Since the ABX KILL the intestinal bacteria
Warfarin Vitamin K Antidote INR (2-3 range) 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
VITAMIN K

1.5
1.0

ATI Question Common Question on EXIT EXAMS

PATIENT TEACHING
INR of 4 or 5 !!! Key Term:
· Assess for Bleeding.
· Get Vitamin K antidote
READY!!
1. Life Long Therapy
“I will increase my 2. Mechanical Valve
intake of dark green INR of 2.0 in an Replacements
leafy vegetables” ischemic CVA client 3. Frequent Blood Tests
· GIVE the Warfarin to get to 2.5!

Notes
 lOMoARcPSD|15175730

Antidysrhythmics II
Hani Abu-Dieh
ABCD’s - Atrial Rhythm drugs
Cardiac Pharmacology

MEMORY TRICK Notes

A
B SA node
Think ABCD start on the
TOP of the heart affecting C AV node
atrial rhythms affecting
the SA or AV node
D L
A
P

Drug Name Indication & Key Terms: TOP MISSED Test Question
A Atropine Symptomatic Bradycardia Atropine for a client with a heart rate of 38,
bp of 88/65, reports confusion and dizziness.
Which ECG strip would show medication
effectiveness?
Puts the heart rate really HIGH like on TOP of “a PINE” tree for
60-100
atroPINE. 1.

Given for: ‘’Symptomatic Bradycardia’’ below 60 BPM with signs 8 x 10 = 80

of low oxygenation like mental status changes (confusion, 2.
Evenly Spaced
altered, agitation) or pale blue skin signs. Goal is to get back to
NORMAL sinus rhythm! 3.

<60
0₂

0₂
0₂
0₂ 4. CORRECT

Drug Name Indication & Key Terms: 1 2 KEY Points

A Adenosine SVT (supraventricular tachycardia)
1. Give it FAST = IV push in
1-2 seconds NCLEX TIP
2. Saline Flush immediately AFTER
DEcreases the heart rate, like putting it into a DEN (for foxes) or
Downstairs.
Given for:
SVT - Supraventricular Tachycardia
* Key points:
Know how this rhythm looks! SVT = Super Fast!
Give it FAST = IV push in 2 seconds followed by flush
Super Fast = SVT

Drug Name Indication & Key Terms:

B Beta Blockers
“Propranolol”
Hypertension, SVT, Tachycardia,
A fib & A flutter
SE: LoL = Low BP, Low HR
Common Question
What drug is causing this rhythm?

Propranolol
Beta blockers end in “-LOL”
Memory trick: Lower the 2 L’s - Low HR & Low BP
Given for: <60
Hypertension & to put the brakes on fast rhythms like SVT, tachycardia, A fib, & A flutter. 5 x 10 = 50
Side Effects: 1 2 3 4 5
• B - Bradycardia (HR below 60 BPM) & low BP
• B - Bronchospasm (avoid asthma & COPD)
• B - Blood glucose masking s/s of low sugar
• B - Bad for clients in end stage heart failure
* Orthostatic hypotension (dizziness upon standing) - teach slow position changes!
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 lOMoARcPSD|15175730

Antidysrhythmics III
Hani Abu-Dieh
ABCD’s - Atrial Rhythm Drugs
Cardiac Pharmacology

Drug Name Indication & Key Terms:

C C
C Ca Channel Blockers
“Verapamil” “Diltiazem”
Hypertension, SVT, Tachycardia,
A fib & A flutter
Calcium Contracts the muscles

Calcium
Since calcium contracts the muscles, when calcium blocked with CCBs, it
calms the heart
Memory Trick: CCBs lower the Couple heart vitals: HR & BP
Ca
Given for:
Hypertension, tachycardia, SVT, A Fib, & A Flutter
Side Effects:
Orthostatic hypotension (dizziness upon standing) - teach slow position changes

3 Common Questions
Q1: Intended EFFECT for Q2: Priority adverse effect Q3: Most important patient
Diltiazem? to watch for when giving teaching when giving
Amlodipine? Verapamil?
Ventricular rate decreased Dizziness Slow position changes
from 160 to 70s
Q1: Intended EFFECT for Q2: Priority adverse effect
Diltiazem? KEY WORD
to watch for when giving
Q2: Priority adverse effect Q3: Most important patient Amlodipine?
to watch for when giving teaching when giving Slow position changes
Amlodipine? Verapamil? Ventricular rate decreased Dizziness

Dizziness
160 70 beats/min Slow position changes
from 160 to 70s

Diltiazem

Drug Name Indication & Key Terms: D’s for DEEP Contraction
D Digoxin A fib & Heart Failure
SE: Toxicity (NV, Vision changes)
DIGOXIN DEEP contraction

Digoxin Digoxin
Is a TOXIN so monitor levels - under 2.0 is SAFE.
It DIGs for a deeper heart contraction to help the heart contract more
forcefully & decreases the heart rate (NOT Blood pressure), so no need
for slow position changes

Main Side Effect = Toxicity Key Sign Common NCLEX Question

Max Range 2.0 Report "dizziness & lightheaded" Q1: A client on digoxin having difficulty
1st signs of toxicity: reading a book or some type of vision
Anorexia Bradycardia problem
Nausea / Vomiting
Vision changes (difficulty reading)

Max 2.0
Digoxin
Creatinine! Over 1.3 = bad kidney

Downloaded by Hani AbuDieh (Hayed88@hotmail.com)

 lOMoARcPSD|15175730

Antidysrhythmics I
Hani Abu-Dieh
Cardiac Pharmacology

Class Drug Name Mainly for Image of ECG Strip

Class 1 Procainamide V Tach &
Sodium-channel blockers & Lidocaine V Fib

Class 2 Propranolol Atrial Fibrillation

Beta blockers Atrial Flutter
HTN (hypertension)

Class 3 Amiodarone V Tach &

Potassium-channel blockers V Fib

Class 4 Verapamil Atrial Fibrillation

Calcium-channel blockers Diltiazem Atrial Flutter
Nifedipine HTN (hypertension)

Others Adenosine SVT

Digoxin A Fib
(cardiac glycoside)
Atropine Symptomatic
(anticholinergic) Bradycardia

Top Missed Question

Key Points Which drugs do we teach slow

position changes due to
orthostatic hypotension?
Select all that apply.
Dizziness
Teach SLOW position changes
1. Atenolol
2. Atropine ?
3. Amiodarone
4. Amlodipine
NORMAL

5. Digoxin
HIGH
LOW

NORMAL

Hypotension - must reassess the BP every hour 6. Diltiazem

HIGH
LOW

When BP is LOW - we got to go SLOW! 7. Furosemide

MEMORY TRICK
Think ABCD start on TOP of the heart affecting atrial rhythms.
Think LAP like in your lap, since these drugs affect ventricular rhythms.

Drug Name Indication & Key Terms:

Drug Name Indication & Key Terms:
Atropine Symptomatic Bradycardia
A Adenosine SVT (supraventricular tachycardia)
Lidocaine V Tach & V Fib

Beta Blockers Hypertension, SVT, Tachycardia,

L SE: Low BP, Low Platelets

B “Propranolol” A fib & A flutter

SE: LoL = Low BP, Low HR, bronchospasm
SA node

AV node Amiodarone V Tach & V Fib

Ca Channel Blockers Hypertension, SVT, Tachycardia, A SE: Low BP, Low HR,
Pulmonary TOXICITY!!!
C “Verapamil” “Diltiazem” A fib & A flutter
SE: Low BP, Low HR, dizziness
Procainamide V Tach
Digoxin A fib & Heart Failure P SE: Low BP, Low Platelets
D SE: Toxicity (NV, Vision changes)

Downloaded by Hani AbuDieh (Hayed88@hotmail.com)

Antiemetics
Anti-Nausea & Vomiting Hani Abu-Dieh

Drug name: Drug name:

Ondansetron Metoclopramide
(brand: Zofran) (brand: Reglan)
Ondansetron
Zofran

HESI EXIT HESI

Priority side effect: Torsades de Pointes
Contraindicated
- bleeding duodenal ulcer

Key Point:

QUESTION
KEY POINT
prescription “order”
& REPORT TO HCP
IMMEDIATELY!!
NORMAL
HIGH
LOW

Agitation Hypertension KEY WORDS

Lip smacking
Puffing of cheeks
Blinking of eyes
Tachicardia Muscle Rigidity

Serotonin Syndrome

ATI Question
Ondansetron used to decrease
Nausea & Vomiting caused by
chemo Memory Trick:
HESI Question
Question: KEY POINT
During infusion, child reports
nausea and vomits, priority M - Metoclopramide
nursing action? M – Major lip smacking
& puffing cheeks
Answer:
STOP the chemo, flush the line REPORT
and administer ondansetron

Notes
Antifungal
& Anti-viral
Hani Abu-Dieh

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 Lots of side effects!
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 C-Diff Nail Fungus Da Gut
(C Diff bacteria)
Urine 30 ml/hr or Less =
Kidney Distress

Oliguria: Low Urine

Drug name: Indication: Anti-Viral

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

herpes zoster (shingles)

KEY Points:
KEY POINTS
Taken daily

Treats oral candidiasis NO Cure! (Only slows the Virus)

Shake well - Liquid suspension AVOID sex while lesions are present
Inspect mucus membranes for
Drink extra fluids
irritation
Remove and soak client’s dentures Effective: Less frequent eruption of
lesions
Teach to swish in mouth for several T
minutes then swallow NO
DO TOP
S NYSTATIN

Continue AFTER S/S subside NYSTATIN

Notes
Antihypertensive/HF drugsHani Abu-Dieh
 Hani Abu-Dieh

----ACE Ends in APRIL

INHIBITORS:

Ends in OLOL

UM
BLOCK,E S:
,, Rx
Rx Di iozem
Veropamil (Cardizem)
(Co
Isopti ) �=--
 ACE inhibitors vs ARBS Hani Abu-Dieh

NECLEX Q
Do we give (-Prills) or (-Startans)
medication if HR is bradycardia or below
<60 ?
YES; BECAUSE
ACE inhibitors and ARBs act to lower BP
NOT HR.
SO “We only hold for low BP”.
If the BP is low DON’T give (-prills)&(-
startans)
 Hani Abu-Dieh

Teach the patient who is on

(-prills) or (-startan) to avoid potassium
rich foods like fruits ,veggies (green
leafy veggies avocado, melons , &
orangs) even salt and liver.

REMEMBER any K+ imbalance high or

low always the first action by the nurse
is cardiac monitor(ECG).
 Hani Abu-Dieh
(-Prills) & (-Sartans)
Side Effect

Remember “ACE inhibitors”

Angioedema
A (Only ACE inhibitors)
(Airway risk)
Cough
C (Only ACE inhibitors)
Persistent dry cough (harmless))

E Elevated K+
The major side
effect of ACEIs & ARBs
Angioedema Hani Abu-Dieh

Swelling of the face & tongue

resulting in a huge airway risk
(very deadly).

Remember Only this happen with ACE

inhibitors SO just think

“Prills Puff up the tongue and NOT

sartan”

“Prills- Puffy tongue”

NECLEX Note
Early sign of high K+ (+5.0)
“Muscle Spasms”.
ECG
Peaked T waves , ST elevation
 Hani Abu-Dieh
Potassium rich foods

P Plantain, Potatoes, Prunes,

Bananas
O Orange

T Tomato

A Apricot, Avocados,

S Spanish, Salt substitutes,

Soybeans
S Strawberry

I Iceberg lettuce

U Ugli fruit

M Mango, Melons
 Hani Abu-Dieh

Beta Blockers

“-olol” Atenolol
L . Low HR
L . Low BP

Think double L means

double LOWS

Beta Blockers Antidotes:

Glucagon
 Beta Blockers 4B Side Effect Hani Abu-Dieh

Bradycardia & Hypotension

DON’T give(HOLD THE DRUG) if HR <60bpm
or BP systolic <=100
Teach patient slow change position; orthostatic
hypotension.

Breathing Problems
Not for COPD , Asthma patient.
Beta blockers block B2 in the lungs causes (narrow
bronchi) bronchoconstriction “Wheezing sounds”

Bad for HF patient

Monitor the ECG to make sure that the patient DON’T
develop HF (heart block).Always watch for S&S of HF
such as(crackles from pulmonary edema, weight gain ,
peripheral edema , jugular venous distension.

Blood sugar masking

This medication is “hypoglycemic mask”
Hide the S&S of hypoglycemia especially tachycardia;
its decreased HR.
Monitor the blood sugar regularly for the patient and
educate the patient.
 Hani Abu-Dieh

BETA BLOCKER ACTIONS

Blockers Affect
(� Hea )
The Heart

Blockers Affect
( Lunge)
he Lun s
Calcium Channel Blockers Hani Abu-Dieh

Decrease BP
Decrease HR -amil
-dipine
Don’t give if -zem
SBP<100
HR<60 bpm

Nursing consideration:
REMEMBER Calcium Channel Blockers
C -Count HR & BP
Always before giving
Don’t give if SBP<100 OR HR<60
EXEPT FOR …
C – Change position slowly
(only BP meds)
Teach the patient to change position slowly ;
BP meds cause ORTHOSTATIC HYPOTENSION
(dizziness).
B –Bad headache
is normal
 Calcium Channel Blockers Hani Abu-Dieh

Question when do we hold the drug?

SBP<100
HR<60
Or (Big Drops)

Let us say 150/70 mmhg drops to 120/70 mmhg

This is a big drop.
Always slow or stop any IV drip that’s dropping BP
too quickly . Big drops can kill the patient.

NCLEX Question
Patient on IV verapamil , nifedipine , or ditiazem
the BP has quick drop or the HR<60
“Stop or slow the IV drip.

Calcium Channel Blockers Antidotes:

Calcium, Glucagon, Insulin.
 Calcium Channel Blockers Hani Abu-Dieh
Role of the nurse , Side effect ,& Education

-Monitor HR,BP “Teach” -

-Reflex tachycardia
(when the BP decrease the HR increase)

-Orthostatic hypotension
“Teach pt to change position slowly”

-Monitor ECG
-Monitor pt for S&S of HF

-Avoid grapefruit juice ; it can increase the drug

level in the body ” Teach”

-High fiber diet ; some calcium channel blockers

cause constipation.
Digoxin (Lanoxin) Hani Abu-Dieh

Cardiac Glycoside
Decreased HR

Digoxin used for

-HF
-Cardiogenic shock
-Dysrhythmias
like atrial fibrillation , or a flutter.

Digoxin contraindicated with

ventricular fibrillation.
Hold Digoxin if:
1-Apical pulse <60 bpm
2-Potassium (K+) less than 3.5
3-Digoxin toxicity (>2.5)

INTERVENTION-Hold the medication and report

for the primary provider or HCP.

ANTIDOTES: Digibind
 Nursing consideration
Hani Abu-Dieh
Hold Digoxin if:
ATP
A - Apical pulse <60bpm
BEFORE GIVING check HR (Apical pulse) for a full one
minutes if <60bpm Don’t give the dug.

T - Toxicity (>2.0) NCLEX

Normal digoxin level (0.5-2.0)
Vision change =first sign of toxicity.
(blurry vision, double vision , difficulty reading , or
color changes “yellow , greenish halos”).
GI disturbance( vomiting ,nausea , anorexia) dizziness

P - Potassium (K+) <3.5

(K+ normal value 3.5-5.5)
Checking potassium level.
“low K+ level” increase the risk for “Digoxin toxicity”

#This don’t mean that digoxin can cause wasting K+ like

diuretics-low K+ only increase the risk for digoxin toxicity#
“Digoxin does not waste K+”
Digoxin toxicity causes Hani Abu-Dieh

Electrolytes imbalance
Hypokalemia <3.5
Hypomagnesemia<1.5
Hyperkalemia>10.2

Digoxin Side effect

Fatigue
headache
diarrhea
thrombocytopenia.

Education
*S&S of digoxin toxicity
*increase K+ intake
(especially if the pt on diuretic wastes k+)
Food rich in K+ (potatoes, pork, tomatoes, oranges,
avocado , Spanish ,bananas)
*Measure HR before taking
 Digoxin Hani Abu-Dieh

A big test tip

Older patient with low kidney function are at
higher risk for toxicity.

The kidney like our washing machine that wash

the blood . broken kidney means it can’t wash
the drug out of the blood.
Remember we have 2 kidney labs for our tow
kidneys
(BUN and Creatinine)
Number one kidney lab is creatinine
(normal 0.6-1.2)

Any value over “1.3” means “No pee pee”

Or basically over 1.3 means KIDNEY INJURY.
Huge risk for toxicity for any drug.

SO you should monitor elderly and renal failure

patients very closely.
NCLEX Hani Abu-Dieh

Which patient is most at risk for

digoxin toxicity?

It’s always a patient on K+ wasting diuretics

like those ending with (-ide) furosemide or
thiazide and kidney failure patient with
creatinine >1.3.

“Elderly at risk ; they have decrease in renal

and liver function”

The patient on digoxin for HF may also be on

diuretics meds ;in HF patient the fluid is backing up
in the heart going to the lungs causing a lot of
edema so the patient will be on diuretics meds to
help remove the extra fluid.

If patient on diuretics, you have to watch those

one that waste K+ through the urine like loop &
thiazide diuretics.
Hani Abu-Dieh
 Hani Abu-Dieh

All Patient Take Medicine

Aortic
Pulmonic

Tricuspid
Mitral (Apical pulse)
Apical pulse located in the left side midclavicular
5th ICS.
Dilators (Nitroglycerine) Hani Abu-Dieh

Dilators
Decrease BP
Dilates vessels
Decrease vascular resistance

Always check BP before giving

nitro
 Hani Abu-Dieh

REMEMBER “ –afill will kill”

Early sins of decreased Bp
confusion, agitation , cold, pale, clammy
”diaphoretic or dizzy”, irritable known as
,sweating , lack of coordination

Hypotension also called “Orthostatic

hypotension”
Teach pt to slowly change position
 Hani Abu-Dieh
Nitro NO

NO Viagra with nitro

“-afil” will kill

;the 2 are vasodilators it cause vascular

collapse from decreased BP.

NCLEX NOTE
Teach chronic angina patient at home to call
911 if there is pain 5 min after the first dose.
“Pain 5 min after the first dose”
 Hani Abu-Dieh
What you can expect to see with this
drug (Normal)?

-Facial flushing
-Burning or tingling under the tongue
-Headache
-Dizzy
-Hypotension

Things to consider before giving Nitro:

1-Confirm no known allergy to Nitroglycerine.

2-Confirm the patient hasn’t recently taken a

phosphodiesterase inhibitors like sildenafil
(Viagra) or Tadalafil (Cialis), which could lead
to severe hypotension.

3-NOT for increased intracranial pressure

patient.
During taking medication Hani Abu-Dieh

-Have the patient sit down

-Obtain baseline vital signs

Medication will lower BP (Make sure your

patient’s SBP is within parameters)

You preferably want the patient on cardiac

monitor (To look for ST segment
abnormalities …ST elevation or depression)
-Ask patient about chest pain rating
-If SBP is within parameters , you can give a
2nd dose in 5 min if chest pain still present.

-If chest pain is still present AFTER 2nd dose

and SBP is within parameters you can give a
3rd dose in 5 minutes.

DON’T give more than 3 doses

Contact MD for further orders if chest pain
persists.
Diuretics Hani Abu-Dieh

“is the number one drug we use for acute

or worsening heart failure” decreased BP

Diuretics D
D-Decrease BP
D-Drain fluid (urinate)
D-Dehydrate (Dried body)
Explanation “Decrease BP by draining the
fluid to dehydrate HF patient with heavy
fluids.

Diuretics increase urine output by affecting

Na+ reabsorption or blocking Na+
reabsorption within the nephron (kidney) So
with less sodium retained we have less
swelling retained.

NCLEX
Drain the fluid from the body and into the body.
Diuretics Types Hani Abu-Dieh

K+ Wasting diuretics
-Loop diuretics (Furosemide)
(-mide)
Used to treat: (-nide)
-Edema “Pulmonary edema”
-HTN ; lowering
the fluid volume lead to decrease BP
-Hypercalcemia
-Liver impairment (ascites)
a lot of swelling in the abdomen.

-Thiazide diuretics
(Hydrochlorothiazide)

Used for:
-HTN
-HF -
-Renal calculi (calcium)(renal stones) -
K+ sparing diuretics (Spironolactone)
Hani Abu-Dieh

Side-Effect: Increase K+

Used to treat:
-Hypokalemia
-Hyperaldosteronism
Seen in patients with liver cirrhosis and
nephrotic
syndrome.

Osmotic diuretics (Mannitol)

Used to treat oliguria or anuria and to prevent
ARF during a prolonged surgery or trauma.

Carbonic anhydrase inhibitors

(Acetazolamide/Methazolamide)
Used to treat: Glaucoma
 Loop & Thiazide Diuretics
Hani Abu-Dieh

Only give K+
wasters if K+
is normal
(3.5-5.0)
if K+ <3.5 we DON’T
give the drug.

REMEMBER
“we give (–ide) to make the body dried”

increase K+ intake
melons , bananas , green leafy veggies and liver.
Avoid licorice root ; lowers K+.
“ Licoric lowers K+”
Note about furosemide Hani Abu-Dieh

It’s the number one drug for worsening HF .

Caution if given too fast it can cause

-Ototoxicity
Meaning ear pain or ringing in the ears called tinnitus.
-Hypotension
Low BP NOT HR Never low HR.

IF given too much over the long term it can

cause
-Nephrotoxicity (kidney toxic)
With high BUN and high creatinine always check these 2
labs.
-Hypokalemia.

If it’s necessary to remove edema quickly use

(Furosemide)
May be given by slow IV push
Given IV for ARF and HTN Crisis.
 Hani Abu-Dieh

Just think S for spares (increase) the K+

Teach patient to avoid K+ rich foods (malins,
avocado , salt substitute)

REMEMBER Any K+ abnormality

The first nursing action (priority intervention) is to
place the patient on a cardiac monitor.
 Hani Abu-Dieh
Diuretics killer nursing considerations

“Before giving diuretics always check

BP”

BP
(hold the medication for low SBP<100)
B BUN & Creatinine (Kidney labs)
Always check before giving ; it can hurt
the kidneys by giving too much or too
quickly (renal failure).

P Potassium imbalance
(3.5-5.0)
; “Potassium pumps the heart “
Always put the patient on cardiac
monitored watch for muscle spasms or
cramps ,weakness and paresthesia .
NCLEX
“Potassium pumps the muscle” Hani Abu-Dieh

Muscle spasm or muscle cramps

This indicate a K+ problem

K+ wasters lower K+ levels in the

blood
Low K+ =low pumps means low pumps in the
heart
(Flat T wave , ST depression , U wave)
NOTE
We never push potassium IV (this mean instant death)
We always give it iv bag over an hour or more . Never
30 min or 45 min one hour or more “typically 4 hours”

K+ sparing (spironolactone)
Spare potassium
High K+ means high pumps
(Peaked T waves , ST elevation) in severe
hyperkalemia.
 Diuretics Side-Effect Hani Abu-Dieh

Loop Thiazide K-Sparing

Diuretics Diuretics Diuretics

Hypo-K Hypo-K Hyper-K

Hypo-Mg Hypo-Na Metabolic

Acidosis

Hypovolemia Hypovolemia Gynecomastia

Hypotension Hypotension

Hyperuricemia Hyperuricemia
Leads to gout Leads to gout

Ototoxicity Hyperglycemia

Metabolic Azotemia
Alkalosis

Metabolic
Alkalosis
Nursing consideration (responsibilities)
Hani Abu-Dieh

Monitor
-BP

-K+

-Intake & Output

-S&S of dehydration
Tachycardia , hypotension, excessive thirst(lethargic) ,
decrease skin turgor.

-Gout symptoms

-Weight
Daily weight at the same time at the same scale.
If pt gain 3 pounds in 24 hrs that mean they're retaining
too much fluid (increase the dose)
-Labs Hani Abu-Dieh

(K+, Na+ ,BUN & Creatinine, Uric acid levels).

REMEMBER
Hypokalemia increase the risk for digoxin
toxicity
Hyponatremia increase the risk for lithium
toxicity.

-Drug effectiveness
By monitoring weight
(weight loss means water loss), output , listen to
the lung sounds (clear or crackles), Edema.

-For hearing ; (ototoxicity)

loss, impairment , tinnitus , dizziness
(loop diuretics)

-Blood sugar level

for diabetic pt (thiazide diuretics)
 Education Hani Abu-Dieh

Teach pt to
-Take medication early in the day ;to reduce the -
chance of nocturia. to avoid
urination at night -

-Report hearing loss or gout symptoms

-Change position slowly (any BP meds)

-Increase K+ intake or taking K+

supplements
(K+ Wasting diuretics “loop & thiazide”)

-Avoid K+ rich foods (K+ sparing

diuretics)
Teach diabetic patient to monitor their
blood sugar (thiazide diuretics)
 Hani Abu-Dieh

Drugs increase the effect of

diuretics
-Aminoglycoside antibiotics
-Antihypertensive drugs
-Corticosteroids

Drugs decrease the effect of

diuretics
-NSAIDs (Ibuprofen, Aspirin)
-Oral contraceptive
-Vasopressors (Epinephrine ,Norepinephrine)
NCLEX Tip Diuretics
Hani Abu-Dieh
-Morning NOT at night
;to reduce chance of nocturia.

-Slow position changes (any BP med)

To avoid feigning
;this meds cause dizziness (orthostatic
hypotension/postural hypotension)

-Daily weights (report 2-3 Ibs)

NOT weakly but daily
REMEMBER weight gain usually means water gain So may
be we need to increase the dose.

-Low Na+ diet (Sodium swells)

No chips , fried foods(fried chicken , fried ice cream ,
French fries),canned foods ,packaged foods like cheese
,meats, fast foods.

-Avoid OTC meds

CAAN , Acetaminophen (like-Tylenol)
all these contain high amounts of Na+ which swells the
body.
 lOMoARcPSD|15175730

Antihypertensives
Hani Abu-Dieh
Ace Inhibitors

How it works? “Action” Nursing management

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.
Why do we give it? ‘’Reason’’
• Instruct your clients to get up slowly and avoid salt
• Treatment of hypertension substitutes.

Adverse effects Interactions:

CV: Orthostatic hypotension, syncope • NSAIDS: Reduced hypotensive effects
tachycardia, hypotension, chest pain • Rifampin: Decreased ace1 effects
CNS: Dizziness, fatigue, headache, weakness. • Allopurinol: Increased risk of hypersensitivity
GI: Abdominal pain, diarrhea, nausea, vomiting • Digoxin: Decreased dig levels
GU: Erectile dysfunction, impaired renal • Loop diuretics: Decrease diuretic effects
• Lithium: Possible lithium toxicity
function.proteinuria • Hypoglycemics(insulin): Increase risk of
Derm: Rashes. F and E: hyperkalemia. hypoglycemia
Misc: ANGIOEDEMA • Potassium sparing diuretics: Elevated potassium
RESP: Upper respiratory infections and cough, levels ( hyperkalemia )
HEMAT: Neutropenia

Simple Nursing Brain bits

• Be mindful of suffixes! All ACE inhibitors end in

Contraindications
• ACE1/Angiotensin receptor blockers: HF, salt or
volume depletion, bilateral stenosis, angioedema,
pregnancy 2nd/3rd trimester due to neonatal
death.
‘’april’’ Use caution with African American population
as drugs may not be effective and/or may cause
extremely uncomfortable side effects

Generic Trade with/without food Safe dose Route

Captopril Capoten Without food 12.5– 25 mg 2– 3 PO

times daily

Lisinopril Prinivil With food 10 mg once daily PO

Enalapril Vasotec with/ without 2.5– 5 mg once PO , IV

daily

Ramipril Altace with/without 2.5 mg once daily PO

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 lOMoARcPSD|15175730

Antihypertensives
Hani Abu-Dieh
Angiotension Receptor Blockers

How it works? “Action” Nursing management

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
effects 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).
Why do we give it? ‘’Reason’’ • May cause hyperkalemia.
• Instruct your clients to get up slowly and avoid salt
• Treatment of hypertension substitutes.

Adverse effects
Interactions:
CNS: dizziness, fatigue, headache, insomnia,
weakness. • NSAIDS: Reduced hypotensive effects
• Rifampin: Decreased ace1 effects
CV: chest pain, edema, hypotension. • Allopurinol: Increased risk of hypersensitivity
EENT: nasal congestion. • Digoxin: Decreased dig levels
Endo: hypoglycemia, weight gain. • Loop diuretics: Decrease diuretic effects
• Lithium: Possible lithium toxicity
GI: diarrhea, abdominal pain, dyspepsia, nausea. • Hypoglycemics(insulin): Increase risk of
GU: impaired renal function. hypoglycemia
F and E: hyperkalemia. • Potassium sparing diuretics: Elevated potassium
levels ( hyperkalemia )
MS: back pain, myalgia.
Misc: ANGIOEDEMA, fever.

Simple Nursing Brain bits

• Be mindful of suffixes! All ARBS end in ‘’TAN’’

Contraindications These replace ACE in african american population
and when the side effects 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 Safe Dose Route

Irbesartan Apravo 150 mg once daily PO

Losartan Cozaar 50 mg once daily PO

80 mg or 160 mg once
Valsartan Diovan PO
daily
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 lOMoARcPSD|15175730

Antihypertensives
Hani Abu-Dieh
Beta Blockers

How it works? “Action” Nursing management

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 stabilizing effects. Timolol • Abrupt withdrawal of propranolol may precipitate
treats glaucoma. life-threatening arrhythmias, hypertension, or
myocardial ischemia
• Take HR and BP immediately prior to administering
Why do we give it? ‘’Reason’’ 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, difficulty breathing, wheezing, 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, Interactions:

PULMONARY EDEMA, • Antidepressants: bradycardia and increase beta
ENDO: May cause ^ BUN, serum lipoprotein, blocker effects
potassium, triglyceride, and uric acid levels. • NSAID: decrease beta blocker effects
May cause ^ blood glucose levels. In labile • Diuretics: increase beta blocker
effects/hypotension
diabetic patients, hypoglycemia may be • Clonidine: paradoxical hypertensive effects
accompanied by precipitous ^ of BP. • Cimetidine: beta blocker toxicity
RESP: bronchospasm (hx of asthma) • Lidocaine: beta blocker toxicity

Simple Nursing Brain bits

Contraindications
• 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

Generic Trade Safe Dose Route

Inderal, Inderal LA, 80– 320 mg/day in 2– 4 divided
Propranolol PO, IV , PO-ER
InnoPran XL doses

Metoprolol:
lopressor 25– 100 mg/day as a single dose PO, IV , PO-ER
lopressor

Sotalol
Betapace, Betapace
Give on an 80 mg twice daily PO
AF
empty stomach
One drop of 0.25% eye drops into
Timolol
Novo-Timol each affected eye(s) twice daily, Ophthalmic
Ophthalmic
approximately 12 hours apart.
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 lOMoARcPSD|15175730

Calcium Channel Blockers Hani Abu-Dieh

How it works? “Action” Contraindications

Systemic 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

Nursing management

• Monitor BP and pulse frequently

• Monitor intake and output ratios and daily weight.
Why do we give it? ‘’Reason’’ 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. Interactions:
Derm: flushing • Cimetidine: increase effects of CCB
• Theophylline: toxic effects of theophylline
• Digoxin: Dig toxicity
• Rifampin: decreased CCB effects

Generic Trade Safe Dose Route

Amlodipine Norvasc 5– 10 mg once daily PO

30– 120 mg 3– 4
Diltiazem Cardizem PO
times daily o

80– 120 mg 3
Verapamil Calan PO, IV
times daily
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Anti-inflammatory
SULFasalazine Hani Abu-Dieh

MOA:
INDICATION Kaplan
Decreases colon inflammation by
stopping prostaglandins Continue medication
Inflammatory bowel (which cause inflammation) even after symptoms
disease (IBD)
subside
Crohn disease
Ulcerative Colitis NO
DO OP
T

ST

Side Effects:
HESI
NORMAL Contraindicated in
patient with SULFA
• Yellow-orange discoloration allergy.
of the client’s skin and urine

• No need for follow-up! TAKING

DO NOT stop taking med MED SULFASALAZINE

Major 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

Photosensitivity Dehydration
• DRINK 8 glasses of water daily
• Wear sunblock • Elevated urine Specific Gravity
• TAKE Folic acid - 1mg/day
• Avoid “direct” sun exposure • High & DRY!!! (norm: 1.003-1.030)

Notes
Anti Inflammatory
Agents
Hani Abu-Dieh

Drug names: Side 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
Salmeterol for first sign of

GH
LO
L

E
Beclomethasone water !!
acute asthma attack!
Fluticasone
Methylprednisolone AIM for Acute Attack
A – Albuterol 1st
I – Ipratropium 2nd Sores in MOUTH
(infection)

Indication: M – Methylprednisolone
(brand: Solu Medrol)

Swelling & inflammation

Drug names: Memory Trick NCLEX Key Points

L - Leukotriene Inhibitor 3 L’s NOT during acute

“-Lukast” Luke likes to SING (airway attacks
open) NOT a RESCUE
Montelukast
(Brand: singulair) DRUG
Zafirlukast This med will prevent
inflammation that
causes asthma attacks
SINGUILAIR
Monteukast ZAFIRLUKAST

ZA
FI
RLU
KA
SINGU ST
Mon
teuk
ILAIR
ast

Drug name: Indication:

Key Point
M - Mast cell stabilizers Blocks massive swelling
PREVENTS activity
Cromolyn induced asthma
N NH2

N
Take 15 minutes before
exertion for maximum
H

CROMOLYN effects HESI

Use 10-15 minutes before
Cromolyn physical activity ATI

Notes
Antiplatelets
Abciximab Hani Abu-Dieh

Drug name: Nursing care:

KEY TERM:
1. Assess
Glycoprotein (GP)
receptor inhibitors HEMOGLOBIN PLATELETS PLATELETS
<7 <150,000 <50,000
Abciximab
Eptifibatide
Tirofiban
!
Indication:
2. Assess for bleeding
Mainly used after cardiac procedures
like heart cath - Coronary Stent Placement REPORT TO HCP!
to prevent reocclusion
Red tinged urine “hematuria”
“Dark” tarry stools /
Black or bloody stools
Monitor groin (insertion site)
for s/s bleeding

Adverse Effects:

3. Place client on
Adverse Effects cardiac monitor
Thrombocytopenia
Bleeding ECG changes!

4. NO needles!
(no new IV or IM)

Notes
Antiplatelets
Acetylsalicylic & Clopidogrel Hani Abu-Dieh

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 2. 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: Treatment:
Tinnitus
Activated Charcoal
Hyperventilation
Mainly for Clot prophylaxis KEY TERM:
Notify the HCP
Initial treatment of salicylate
(Aspirin) toxicity
• Heart: MI / CVA prevention
• Narrowed arteries
- ACS (heart)
- TIA (brain)
- PAD (extremities) Activated
Charcoal

• Prevention of stent/bypass re-occlusion

ATI Question
Long term aspirin
“Assess for tinnitus”
ASPIRIN

ACS TIA PAD

Notes
Antispasmodic
- Dicyclomine Hani Abu-Dieh

Drug name: Side Effect:

Dry body: Constipation, dry mouth, urine retention

Dicyclomine
(brand: Bentyl)

Dicyclomine
Bentyl

MOA:

Relaxation of smooth muscle & dries secretions

KEY POINT
Contraindications AVOID
NOT - Paralytic Ileus
or bowel obstruction
NOT - Narrow-angle glaucoma
(cataracts are ok!)
Antispasmodic Anticholinergic NOT - Full bladder ( > 400 mL)
“urinary retention”

Indication:

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 Bowel obstruction & Paralytic ileus

> 400 ML

Notes
 Hani Abu-Dieh

HYPERthyroidism HYPOthyroidism
Graves = GAINS "HIGH" HashimOtos | LOW & SLOW

EMERGENCY CONDITION: EMERGENCY CONDITION:

Thyroid Storm​ “thyrotoxicosis” Myxedema​ ​Coma​ (​M​ini hypothyroid)
VERY HIGH = “Agitation/Confusion” + HTN crisis! VERY Low/Slow:
Airway, Breathing, Low BP = D​ EATH!

PATHO & CAUSES PATHO & CAUSES

HIGH T3 & T4​ ​Thyroid Hormones LOw T3 & T4​​ ​Thyroid hormones
Too much Iodine Low Iodine, Antithyroid Treatments
Too much Thyroid Meds. (​Levo​thyroxine) Pituitary Tumor ​
Autoimmune: ​G​raves = ​G​AINS “​HIGH​”
AUTOIMMUNE: HashimOtos | LOW & SLOW
AUTOIMMUNE: ​G​raves = ​G
​ AINS “​HIGH​”

SIGNS & SYMPTOMS SIGNS & SYMPTOMS

PRIORITY: ​EXTREME HIGH = Thyroid Storm PRIORITY: ​EXTREME LOW = Myxedema Coma
”​Agitation​ & ​confusion​” early sign Low RR—​Respiratory FAILURE

PRIORITY: Place “Tracheostom Kit” by bedside

HIGH & HOT! KEY WORD: “Endotracheal Intubation set up”
Low BP & HR “hypotension” “bradycardia” (below 60)
CLASSIC SIGNS–NCLEX KEY WORDS Low Temp. “cold intolerance” ​NO​ electric blankets
G GRAPE EYE “Exopthalamos”
(Use Eye patch/Tape Eyelids down) LOW & SLOW = HYPO
G GOLF BALLS in throat “Goiter”
HIGH BP–HTN Crisis 180/100+ CLASSIC SIGNS
(MI, CVA, Aneurysms) LOW energy “fatigue, weakness, muscle pains, aches”
HIGH HR–Tachycardia 100+ (normal 60–100) LOW metabolism–Weight GAIN/Water Gain (Edema eyes)
HEART PALPITATIONS + Atrial Fibrillation LOW digestion “Constipation” NOT diarrhea
HIGH TEMP. = NOT DRY! LOW HAIR LOSS “alopecia” NOT hirsutism
HOT & Sweaty Skin “diaphoresis” LOW mental–forgetful, ALOC (altered)
Heat Intolerance LOW mood–depression, “apathy, confusion”
HIGH GI “Diarrhea” LOW Libido–Low sex drive, infertile
SLOW DRY skin turgor
LOW & SLOW–menstruation “irregular”
LABS NO period “missed”–Amenorrhea “AMEN no period!”
SLOW heavy period–Hypermenorrhea (Hyper Menstruation)
HIGH​​T3 & T4 ​HYPER
Low—TSH
(look at T3 & T4 levels FIRST)
LABS
DIET LOw ​T3 & T4 ​hypO
HIGH METABOLISM - HIGH TSH
HIGH calories (4,000–5,000 per day) “TSH always opposite of T3 & T4”
HIGH protein & Carbs (meals & snacks)
NOT​high fiber = LOW FIBER! (unless constipated) DIET
NO​caffeine (coffee, soda, Tea) LOW Metabolism
NO​spicy food LOW Calories
LOW energy “Frequent rest periods”

NOTES
 Hani Abu-Dieh

HYPERthyroidism HYPOthyroidism
Graves = GAINS "HIGH" HashimOtos | LOW & SLOW

PHARMACOLOGY PHARMACOLOGY
SSKI (​Potassium Iodide) L–L​ev​o​thyroxine​ (​Lev​O​= HYPO​)
S–S​hrinks the Thyroid “​Le​ aves” ​T3 & T4 ​in the body MEMORY
​​ TRICK
S–Stains Teeth (use straw + juice)
K–Keep 1 hour apart of other meds L–Life Long + Long slow onset (3-4 weeks till relief)
METHIMAZOLE E–Early morning /​E​mpty stomach x 1 daily (​NOT​at night)
NOT baby safe V–Very active (HIGH HR & BP) R​ eport​ “agitation/confusion”
PTU-P​ropylthiouracil O–Oh the baby is fine! (pregnancy safe)
“Pu​ts Th​yroid Un​derground” M
​ EMORY TRICK NO FOOD–take 1 hour BEFORE breakfast
Baby safe NO Cure–med will NOT cure, only treat
REPORT: ​Fever/Sore Throat NO ​Doubling doses (missed dose? Take it!)
NEVER “abruptly” STOP = Myxedema ​Coma
BETA BLOCKERS ​ “​-​lol​”​ Proprano​lol
L–Low BP
L–Low HR
NOTES

TREATMENTS
RAIU–Radioactive​Iodine Uptake (Destroys the Thyroid)
BEFORE:
Pregnancy test before
REMOVE neck jewelry & dentures
5–7 days​ b​ efore​ Hold antithyroid Meds
AWAKE–NO​anesthesia or Conscious Sedation
Diet: Before–NPO 2–4 hrs
After–NPO 1–2 hrs
AFTER: AVOID EVERYONE!
NO​pregnant people NO​ crowds
NOT​same restroom (Flush 3 x) NOT​same food utensils
NOT​same laundry as your f​amily

PATIENT EDUCATION
 E–Exophthalamos” (grape eyes)
 Eye Exercise “full range of motion” (​YES​MOVE EYES)
 Eye Drops “artificial tears in conjunctiva” (​NO​dry eye)
​ Dark​Sunglasses (avoid irritation) NO​​ Massaging
 T–Tape the eyelids closed or use Eye Patch
AVOID 5 S’s
Can Trigger T​ HYROID STORM!
NO​Sodium (eye swelling) + HOB Up (drain the eyes)
NO​Stimulants (Cluster care/ Dim Lights)
NO​Smoking, Stress, Sepsis “sickness” (infection)
*Don’t Touch Neck... release MORE T3 & T4*

THYROIDECTOMY​ SURGERY
Risk for THYROID STORM!
Priority: S
​ tridor/Noisy breathing
 A–Airway–Endotracheal Tube​ bedside ​#1 Priority
​ Trach​eostomy Set
 B–Breathing–Laryngeal ​Stridor​ “Noisy breathing”
Keywords: “Monitor Voice strength & Quality”
 C–Circulation–bleeding around pillow & I​ncision site
Neutral​head & neck alignment ​
- NOT ​SUPINE​! HOB 30–45 degree
- NO​​ FLEXING or Extending Neck
 C–Calcium ​LOW​ ​below 8.6​ (normal: 8.6–10.2)
 Chvostek (​ Cheek Twitch when touched) ​
Trousseau (“Twerk arm” with BP cuff x 3 min.)
Tingling around mouth/Muscle Twitching
MEMORY TRICK: “Remove the ​T (thyroid) Check the C
​ ​ (calcium)”
 Atropine
Symptomatic Bradycardia Hani Abu-Dieh

Drug name: Memory tricks Side Note

AtroPINE ATROPINE

Symptomatic bradycardia
ATROPINE

If drugs do not work to fix the problem, then we

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

Key word 1st 2ⁿd

Correct sequence:
1. Atropine
Symptomatic ATROPINE
2. External pacing

bradycardia

MOA:
Atropine acts to increase the heart rate by blocking the
action of the vagus nerve to block the PNS (parasympathetic
Signs: Symptomatic bradycardia nervous system) REST & DIGEST, and turns ON the SNS
?
? (fight & flight) in the heart like flicking a light switch.
Mental Status changes
?
? ?
?
1. Confusion
2. Irrritability
3. Agitation
SNS
ATROPINE

PNS
Parasympathetic nervous system

Key points
Atropine is effective when we see normal Sinus
rhythm and reversal of the sympoms. They will
show you normal sinus rhythm like this & no
more hypoxic symptoms, like confusion, agitation,
hypotension or synocope.
Common NCLEX Question
Atropine for a client with a heart rate of 38,
bp of 88/65, reports confusion and dizziness.
Which ECG strip would show medication
effectiveness?

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

3.

ATROPINE

4. CORRECT
Macrolides
Azithromycin Hani Abu-Dieh

Drug name: Key NCLEX Tips:

Macrolides end in ‘’-thromycin’’
They are also: Hepatotoxic or LIVER TOXIC.
So monitor Liver Labs (ALT/AST):
YES it’s TRUE, they sound
Report 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.

Side 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
Beta 2 Agonist Hani Abu-Dieh

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

B - Buterol
B - Brutal Asthma Attacks

Indication:

1st drug used during

SEVERE asthma attacks

NCLEX TIPS
NCLEX TIP
STEROID
THE ONLY “rescue inhaler”
BEFORE steroid inhaler!!!!
AVOID
Beta
Blockers

· S - Salmeterol
· S - Slower Acting
(NOT rescue inhaler)
Beta Blockers – Atenolol
NSAIDS – Naproxen,
NSAIDS
Ibuprofen
Common NCLEX Question

DO NOT use fluticasone SALMETEROL

or salmeterol for first sign

FLUTICASONE KEY POINTS
of acute asthma attack!

SHAKE IT WELL!

MEMORY TRICK

AIM for Acute Asthma Attack ALBUTEROL

Shake IT Before you take IT

Solu M
edrol
A – Albuterol 1st Methy
lpredni
solone

I – Ipratropium 2nd Sol

M u Medrol
ethylprednisolone

M – Methyl-predniso-lone
(brand: Solu Medrol)

HCP
1

KEY POINTS
24

RR
Expected SE: AlbuTerol
If Not working after 3 doses?
T T T · NOTIFY HCP!!!
Tachycardia & palpitations Tremor Toss & Turning at Night

Effective:
· Decrease in RR (example: HCP
1

34 to 24) 90 %
· Oxygen Sat. at least 90% or Oxygen
higher
Insomnia & difficulty sleeping TEST TIP!!

Notes
 Blood Thinners Hani Abu-Dieh

Aspirin Warfarin TBA

& & &
Clopidogrel Heparin Alteplase

Blood thinners generally they come in 3 sizes

small , medium, & large.

Thrombolytic clot busters

These are the atomic pumps
The deadliest since they have the highest
bleeding risk.
 Antiplatelets Hani Abu-Dieh

“AC for Aspirin & Clopidogrel =AC

Anti clot”

Preventing platelets from forming

clots (Clot Prevention)

Indication for clot prevention

“USED FOR”

-Heart & Brain clots (MI,CVA ).

-Narrowed arteries like (ACS,TIA,PAD).
-Prevention after a stent or bypass.
-Post PCI “percutaneous coronary
intervention”
 Hani Abu-Dieh

BEFORE giving always assess (Hgb,

Platelets)

This is known as “Thrombocytopenia”=Huge

risk for bleeding
 Hani Abu-Dieh

Aspirin contra indicated for patient with

hypoprothrombinemia (low clotting factors)
Aspirin (Salicylate )Toxicity

The number 1 drug for aspirin (Salicylate) toxicity is

Activated Charcoal
it’s bind with aspirin to block the absorption by the
small intestine.
 Hani Abu-Dieh

For long term aspirin administration

Priority assessment is
“Assess for tinnitus”

NOTE
Tachycardia & Hypotension are NOT
signs of toxicity.
Tachycardia & Hypotension indicates
a bleed.
 Antiplatelets “Abciximab”
Hani Abu-Dieh

Also an antiplatelets given for prevention of

platelet aggregation.

# It’s mainly used after cardiac procedures

like a heart cath or coronary stent placement
to prevent vessel reclusion.

Adverse Effect just like

aspirin but more
severe.
 Nursing Intervention Hani Abu-Dieh
“actions the nurse should implement”
 Hani Abu-Dieh

Monitor groin
insertion site
for S&S of
bleeding after
PCI.

NO IV or MI during or
after administration
 Anticoagulant
Heparin vs Warfarin Hani Abu-Dieh

For patient
*recovering from MI ” Heart Attack”
*at risk for DVT “after hip or knee surgery”

Don’t let NCLEX trick you

Anticoagulants DON’T dissolve clots Only
thrombolytics do that like “TPA & Alteplase”

“Anticoagulant are Anti coagulation”

Block the formation of fibrin that seals on
the clot.
 Heparin Warfarin (Coumadin)
Hani Abu-Dieh

Indirect thrombin Vit K antagonist

inhibitors
Injections only (IV,SC) Orally only

Used for short term Used for long term

Treatment fast Treatment slow(3-5 days)

√ Pregnancy ;(don’t X Pregnancy ;(cross the

cross the placenta) placenta)
Enter breast milk Don’t enter breast
milk
Monitor aPTT Monitor PT/INR
Normal (30-40s) Normal (0.75-1.25)
Therapeutic : (1.5-2.5 Therapeutic (2-3)
times the normal)
(60-80s)
Antidote : Protamine Antidote : Vitamine K
sulphate
Hani Abu-Dieh

INR
 Heparin Warfarin
Hani Abu-Dieh

Therapeutic Range Therapeutic Range

46-70PTT 2- 3 INR
�
Memory Trick: .J
Memory Trick:
"HePTT" the FROG "War-K-IN"
H - Heparin W-Warfarin
P - Protamine Sulfate (Antidote) K - Vitamin K (Antidote)
PTT - 46 - 70 Max range IN - INR 2 -3 range
*FAST onset= Frogs are FAST *Slow onset= "Is it even WARkin?"
 150.000-400.000 Platelets Hani Abu-Dieh

NORMAL

Look for the P’s

(asPirin , clopidogrel, enoxaparin)

Thrombocytopenia is 50.000 or
less so we hold any type of heparin.
 Heparin Hani Abu-Dieh

Priority Action
Question
A patient on heparin with bleeding at the
IV site what’s the priority action?
“Blood oozing at surgical incision or at the
IV site “
Hani Abu-Dieh
Warfarin Hani Abu-Dieh
Client on Warfarin which statement
Hani Abu-Dieh

requires intervention:

I will increase my intake of dark green

leafy vegetables.

Antibiotics increase the risk for

bleeding by increasing INR;

because antibiotics kill the intestinal bacteria

that produce vit K & we end up with vit K
deficiency which increase the risk for
bleeding.
NCLEX think “Warfarin ,WarKIN”
Hani Abu-Dieh
since warfarin take so long to
work
Patient Education
Hani Abu-Dieh
Warfarin given life long to prevent
clots like patient with:
*Atrial Fibrillation
*Artificial heart valve replacement
“Mechanical valve replacement”

Always do frequent blood test to check therapeutic

range.
Heparin is different
Only given for a few days or weeks.
Heparin IV :
Given after MI ” Heart Attack” or PE
To prevent the clot from growing.

Given for prevention of

DVT (clots) after
surgery.
 ANTI-COAGULANTS LMW HEPARIN Hani Abu-Dieh

Inject at
25 G Needle, 5/8 inch
90 degree angle

NCLEX KEYWORD

2 inches from Umbilicus NOT thigh NOT IV route

2inches
 Hani Abu-Dieh

Never aspirate SQ NEVER RUB site!

HESI KEY POINT:

Normal to have mild
"pain, bruising, irritation, redness at site"
 Enoxaparin (LMW heparin) Hani Abu-Dieh

Which statements needs further

teaching?

1-I will inject the med into my thigh.

“NO in the umbilicus (Pelly Potton) “

2-I will need frequent blood test.

“NO this for warfarin”
special consideration for LMW ”low
Hani Abu-Dieh
molecular weight heparin” Enoxaparin

Always assess H&H before giving a client

with open fractures.
Assess the BP.
Monitor for low platelets.

NCLEX
Always notify HCP & clarify order for
enoxaparin if H/H slightly low!
DON’T give Enoxaparin

Question
Patient on Enoxaparin what should the nurse
report to the HCP?
Decrease H&H
Decrease BP “drops by 20 points”
This usually means blood loss.
Enoxaparin labs (LMW Heparin) monitor for
low platelets. Hani Abu-Dieh

Think “ P in –Parin = P for Platelet

monitoring”

Platelet should be 150K-400K.

Hold the drug if platelet less than 50.000

Risk Factor “Side Effect”

HIT “heparin induced
thrombocytopenia”
This happens if platelets are decrease by half
within 24 hours after starting heparin of any
type. “very deadly”
PRIORITY ACTION Report to the HCP.
 Anticoagulants Hani Abu-Dieh
“Fondaparinux”

NO risk for HIT

Disadvantages
Can cause epidural bleeding.

DON’T give it for a patient with

-Severe back pain
-Decrease LOC
-Paralysis
HOLD THE DRUG & REPORT TO HCP.

NO fondaparinux for at least 6 hours after

surgery.

NO anticoagulants with spinal epidural

catheter “risk for epidural bleeding”
 Thrombolytics “Clot Hani Abu-Dieh

busters”

The atomic pumps ,The most powerful

ONE TIME ONLY PUSH DRUGS

These are the only drug that dissolve
clots.
Only be given between 3-4.5 hour from
the onset of S&S.
 Hani Abu-Dieh

NO INJECTIONS AT ALL
NEVER give clot busters through a central
line where you can’t hold a pressure.
Hani Abu-Dieh

ONLY through PERIPHERAL IV where you

can be compressed (hold pressure).
 Hani Abu-Dieh

NCLEX Key Contraindications:

AVOID giving to:

1. Active bleeding
KEY TERM: Peptic ULCER
2. Uncontrolled HTN 180/110 +
3. Recent surgery within 2 weeks

Clarify Prescription with Provider !

-�
u NCLEXT1P
· A - Accidents "Recent Trauma
• A - Aneurysm - Hx of hemorrhagic CVA
• A - AV malformation NCLEXr1P Net
 Hani Abu-Dieh

OW
(IV MA )
rI
Fibrinolytics (Clot Buster’s)
Hani Abu-Dieh
TPA or Streptokinase (allergy risk)

clot busters like TPA to dissolve the

clot.

These are like the atomic bomb.

They are one-time push drugs.
These drugs have HUG bleeding risk; it has
an 8 hours or less duration . this means
we’re most at risk to bleed during that 8
hours.
SO NO injections at ALL NO (IV,SQ,IM,ABG)
No new iv or SQ injection even for diabetics.

These drugs can only be given through a

compressible site like an iv.

NEVER given through a central lines ;we can’t

hold pressure on that central line only
peripheral lines.
 Contraindication for any Blood
Thinners Hani Abu-Dieh

& Patient education

“ACTIVE BLEED” like peptic ulcer disease
NCLEX

*Always Avoid any patient with liver

problem since the liver makes coagulation
factors.
*Avoid EGGGOS (Supplements)
AVOID
CHANT & EGGGOS

Tylenol overdose leading to liver damage.

Monitor signs of bleeding
Hani Abu-Dieh

(Educate pt) REPORT

Hani Abu-Dieh
Blood Thinners Hani Abu-Dieh

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
 Bones Hani Abu-Dieh

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:

▪ TAKE IN DIVIDED DOSES- Inhibits bone reabsorption by

> 500 mg
Less than 500 mg reducing osteoclast activity, OSTEOCLAST

which breaks down the bone

CALCIU ATE
M

CARBON

▪ Doses OVER 500 mg

at one time are NOT absorbed
KEY POINT
NO 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 Question

Treats Osteoporosis 8OZ

• Constipation which is normal & to be expected.
• Just add fluids & ambulation
Drink full 8 oz with
MEMORY TRICK medication

Since calcium makes bones

hard, just think Calcium
Ca makes bowels hard too!
KAPLAN Question
• High CAL = Hard Bowel
Teach patient to sit upright
Ca • Low CAL = Loose Bowel for at least 30 minutes

Notes
 lOMoARcPSD|15175730

Cardiotonic Drugs Hani Abu-Dieh

How it works? “Action” Nursing management

Cardiotonics such as digoxin increase cardiac output
through positive inotropic activity (an increase in the
force of the contraction). They slow the conduction
velocity through the atrioventricular (AV) node in the
heart and decrease the heart rate through a
negative chronotropic effect.
Milrinone has inotropic action and is used in the
short-term management of severe heart failure
that is not controlled by the digitalis preparation.
(Ford 403)
Why do we give it? ‘’Reason’’
• Heart failure
• Atrial fibrillation
Contraindications
• Digitalis toxicity
• known hypersensitivity
• ventricular failure, ventricular tachycardia, cardiac
tamponade, restrictive cardiomyopathy, or AV block.
(Ford 404)
Digoxin toxicity & electrolyte imbalances
The physical assessment should include the following:
• Taking blood pressure, apical-radial pulse rate,
respiratory rate
• Auscultating the lungs, noting any unusual sounds
during inspiration and expiration
• Examining the extremities for edema
• Checking the jugular veins for distention
• Measuring weight
• Inspecting sputum raised (if any) and noting the
appearance (e.g., frothy, pink tinged, clear, yellow)
• Looking for evidence of other problems such as cyanosis,
shortness of breath on exertion (if the patient is allowed
out of bed) or when lying flat, and mental changes
(Ford 405)
• Pediatric
• The drug is withheld and the primary health care
provider notified before administration of the drug if
the apical pulse rate in a child is below 70 bpm, or
below 90 bpm in an infant.
• Daily weights
Interactions:
• Thyroid hormone: Decreased effects of digoxin
• Thiazide and loop diuretics: Increased diuretic
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
atrial fibrillation 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
Downloaded by Hani AbuDieh (Hayed88@hotmail.com)
Chemotherapy Hani Abu-Dieh

Drug names: Adverse Effects: Key Points:

• Doxorubicin All fast growing Low RBC & LOW CBC -“Anemia”
• Cisplatin cells die Normal: 4.5 - 6 million RBC
• Cyclophosphamide
DOXORUBICIN CISPLATIN
4.5 - 6 million
Low Platelets
• 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: “Immunodeficiency”
“Immune compromised” KAPLAN
Directly inhibiting growing FEVER is a priority
Doxorubicin- Temperature is highest
> 100.3 F/ 38oC

cells in the body OVER 100.3 F (38 C)!!!

priority Over 100.5 F (38 C)
NCLEX TIP

Cisplatin: Creatinine > 1.3

MEMORY TRICK
KEY POINT BUN/Creatinine

Renal toxicity CISplatin PISSplatin

Monitor Urine- Input & Output BUN > 20
Creatinine
OVER 1.3 = Bad kidney BUN/Creatinine

BUN OVER 20 CISPLATIN

Urine Output < 30ml/hr

Urine ouput 30ml/hr

or LESS = Kidney Distress

Drug name:
VINCRISTINE
Common NCLEX Question
Vincristine Vincristine
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!
1. Partial thromboplastin time 55.
Memory Trick:
2. Platelet count of 48,000. > 100.3 F/ 38oC

Very Cool CHRISTIAN 3. Red blood cell count 5 x 10^6.

4. Temperature of 100.7 (38.2 C).
Just a gentle Saintly soul, 5. White blood cells 3,600.
does not harm the bone
< 4,000
marrow Normal 5,000- 10,000

Notes
 CHOLESTEROLLOWERI
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Hani Abu-Dieh
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Epinephrine
Epi auto-injectors ‘’Epi-Pen’’ Hani Abu-Dieh

Indication: KAPLAN
Anaphylaxis (severe allergic reaction) Patient scenario:
Administration of ampicillin & client
reports itchiness and difficulty
breathing.
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! Effective management of shock
BP 130/67
- Increased BP, RR, HR Apical HR 99
Cap refill less than 2 seconds 99

KEY POINT
Epi is the 1st drug
HESI Normal EXPECTED
to use for anaphylaxis. Side Effects HR > 100

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
Repeat Epi until signs & How to use Epi-Pen
symptoms resolve! NCLEX TIP KEY POINTS

1. Inject into outer THIGH at 90

degree angle at onset of s/s
HESI “Stab pen into outer thigh”

1st 2ⁿd 3rd Hold in place for 10 seconds

2. Seek immediate medical
attention after use!
Go to the hospital!
Albuterol
3. Store epi pens in dark place at
EPIPEN
room temperature
Steroids (not too cold/ not too hot)
EPINEPHRINE

Diphenhydramine

Albuterol
Epinephrine Diphenhydramine
Steroids 90o
EPIPEN

EPIPEN
EPINEPHRINE

Notes
 Eye & Ear Hani Abu-Dieh

Eye Administration: Ear Administration:

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

Drop medication into Gently close & rotate Apply GENTLE Wait 5 minutes
Conjunctival Sac the eyes around after pressure to the corner
administration. of the canthus
2. Straighten ear canal
Adults - pull up & out
Child - pull down & back

3. NEVER occlude ear with dropper

Drug name: 4. Warm med at room temperature

Acetazolamide

Acetazolamide Acetazolamide
4 KEY POINTS

Indication:
1. 2.
Affected EAR UP !! Straighten the Ear
Canal
Chronic glaucoma to decrease
ESSURE

pressure inside the eye

PR

ATI Question KAPLAN Question

Indication: Chronic, Acetazolamide =
open angle glaucoma contraindicated for
Patient Teaching: sulfa allergy
Report paresthesia
(facial regions) to
HCP immediately
Contraindications
allergy to sulfa drugs. SULFA

3. 4.
DRUGS

Do not occlude the ear Keep med warm or

Side Note: with a dropper! room temp
ATROPINE

ATROPINE

Avoid AntiCholinergics! Acetazolamide

Anti Cholinergics = Glaucoma

IPRATROPIUM

Acetazolamide

Ipratropium

▪ NO - Atropine
▪ NO - Benztropine
ESSURE

BENZTROPINE

▪ NO - Ipratropium
PR

Glaucoma
▪ NO - Oxybutynin
IN
UTYN
OXYB

Notes
Herbal Supplements Hani Abu-Dieh

Bleed Risk:

E G G PRIORITY

Vitamin E Ginger Garlic

All Supplements LOSARTAN

Vitamin E

KEY POINTS
Assess for interactions with clients

G G O other meds
PRIORITY! Drug to drug
Ginkgo Ginseng Omega 3
Biloba interactions 2 - 3 weeks

STOP 2 - 3 weeks before surgery

<80 JOINT Prostate

Glucosamine Saw
Palmetto
Saw Palmetto: TREATs BPH
WATCH for hypoglycemia
when taking anti-diabetic meds
SP – Saw Palmetto
Benign Prostate SP – Swollen Prostate
Hypertrophy

Menopause – “HOT FLASHES”

ATI Question
Black
Cohosh Black Cohosh
Glucosamine
Bad CoHOT flash
Glucosamine
= Treats arthritic pain

Mental -
S S S Depression & Insomnia
V - Valerian
V - Valium effects
H H
! S - St. John Wort affects
Heart S - Serotonin - CAUTION
- Serotonin syndrome!
Hawthorn
H - Heart Serotonin S - Stay away from
H - Hawthorn extract
Extract
Antidepressants !!

KEY PRIORITY
DO NOT MIX!!!
1. Antidepressants SSRI’s,
E E Skin MAOIs, TCAs
2. Serotonin Syndrome
E - Eczema/ Mild signs
Shivering/ Diarheas
Evening
Primrose Oil skin irritations
Severe signs
E - Evening Muscle rigidity/ Fever
Primerose Seizures
Death

Notes
Immunosuppressants Hani Abu-Dieh

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:
Cyclo-Sporine CycloSPARIN
Sparing the organ
INcreased energy levels CYCLOSPORINE from rejection
NOT decreased

KEY POINT ADVERSE EFFECT

KEY POINT KEY POINT
BEFORE giving
Major Adverse Effects: - Check WBC + Plts Common Side Effect
REPORT leukopenia Cyclosporine
Retinal damage & vision problems
Low WBC < 4000 Gingival hyperplasia
Teach: Regular eye appt. Monitor for bleeding
Every 6 -12 months No pregnant patients -
Use Contraception

6 - 12 months

MEMORY TRICK
ATI HESI
Hyyy-dddroxy Chloroquine Teaching - Cyclosporine &
Notify provider for
“Eyyye Damage Clorine” Azathioprine
any sign of infection
Avoid crowds
No live vaccines
1
(Herpes Zoster + Shingles)
CHLORINE
Soft bristled toothbrush
Use contraception

KAPLAN
HESI Question Patient statement that requires CYCLOSPORINE

further teaching
Teaching is effective when the “I will mix cyclosporine with
grapefruit juice”
client states
Cyclosporine teaching: Organ
transplant
“I need to see my optometrist Take med for life
at least once a year” HCP will eval blood work
regularly
Take med at same time everyday

Notes
Immunosuppressants
Methotrexate Hani Abu-Dieh

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 & Bleeding
Infection Risk
• Low immunity = Infections ▪ Report Fever (over 100.3º F, 38ºC)
AVOID
▪ Avoid crowds & sick people
• Low Platelets = serious bleeding ▪ Avoid fresh fruit & flowers
Thrombocytopenia (platelets under 100,000)
• Fetal death in pregnancy ▪ Report bleeding:
▪ Petechiae (bleeding under skin)
< 100,000
▪ Purpura (purple spots on skin)
▪ Melena (black tarry stool)
▪ Hematemesis (vomiting blood)
▪ Bleeding Gums Thrombocytopenia

HESI Question KEY POINT

NO Pregnancy - NOT BABY SAFE
Methotrexate: MUST use Birth Control
Suppresses B and T lymphocytes
▪ “No pregnancy until one menstrual
cycle after treatment is resolved”

▪ “No pregnancy until 3 months after

treatment is finished” January

▪ “Men … no trying for a baby until 3

months after treatment with
Methotrexate

B lymphocyte T lymphocyte methotrexate is complete”

Notes
 Immunosuppressants
Hani Abu-Dieh
NCLEX Questions
Indication: Bad News: NCLEX TIPS

Given to help the body STOP attacking Bone marrow suppression =

itself - like in clients with autoimmune dieases 1. Low WBC = Infection Risk
2. Low Plt = Bleed Risk Infections Bleeding

Common NCLEX Question

A patient is prescribed What should the nurse include in

methotrexate for treatment of an
autoimmune disorder. Which
patient report requires immediate
assessment and intervention by the
nurse?
A. “I will consult with my
provider before discontinuing
birth control.”
B. “I noticed that I have
developed tiny reddish-purple
lesions all over my arms.”
C. “I have not had a normal
bowel movement in two days.”
D. “I seem to be losing an
excessive amount of hair since
starting this medication.”
teaching for a patient newly
prescribed hydroxychloroquine for
the treatment of systemic lupus
erythematosus? Select all that apply.
1. Ensure to see your optometrist
at least every 2 years.
2. Report any new visual changes
to your provider.
3. This medication is likely to
increase feelings of fatigue
associated with lupus.
4. Notify your provider if no
improvement in symptoms is
noticed within one week of
beginning this medication.

The nurse is instructing a patient with a
severe allergy to wasp stings on the
proper use of the epinephrine
auto-injector. Which patient statement
best demonstrates that teaching has been
Which lab results should the nurse review
prior to administration of etanercept to a
patient with psoriatic arthritis? Select all
that apply
Negative Tuberculosis skin test

1.Tuberculin skin test (TB skin

effective?
test)
1. “I will keep my epi-pen stored
90o

2. aPTT (partial thromboplastin

EPIPEN

in my refrigerator at all times.”

time)
2. “I will inject the medication
3. White blood cell count
1st into my outer thigh at the first
4. Total cholesterol panel
sign of an allergic reaction.”
5. Red blood cell count
EPIPEN
EPINEPHRINE

3. “I will seek follow-up treatment

Epipherine
within 24 hours of injecting the
medication.”
4.“I will hold the epi-pen firmly in
place for at least 5 seconds to
ensure full delivery of the
medication.”

Notes
 lOMoARcPSD|15175730

Inotropic, Chronotropic,
Hani Abu-Dieh
Dromotropic

D D D INOtropic
Digoxin Dopamine Dobutamine “INcreased cardiac contractility”
“INcreased forceful contraction”
3 Ds for DEEP contraction
Digoxin
DOPAMINE Dobutamine D - Digoxin
2.0 +
D - Dopamine
D - Dobutamine

Chronos
Clock
HR<60 Neg. Chronos - Neg time
Positive Chronos - Positive time
Faster HR - Positive Chronotropic
Lower HR - Negative Chronotropic

Dromo
Drums
Neg. Dromotropic -
stable heart rhythm

Inotropic Chronotropic Dromotropic

Drug Force of Heartbeat Rate of Heartbeat Rhythm of Heartbeat

A amiodarone + Pos. - Neg. - Neg.

B beta blockers
Atenolol - Neg. - Neg. - Neg.
C calcium CB - Neg. - Neg. - Neg.
C cardiac glycosides
+ Pos. - Neg. - Neg.
Digoxin

D dobutamine + Pos. X X
D dopamine + Pos. + Pos. X
E epinephrine + Pos. + Pos. X
Downloaded by Hani AbuDieh (Hayed88@hotmail.com)
 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)

PATHO & CAUSES DIAGNOSTIC LABS

“whole wheat/grain/milk” Hani Abu-Dieh
• 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) 7 INSULIN TIPS
1. DIET & EXERCISE BEFORE oral meds and insulin 1. Peaks + Plates = Food during PEAK times (prevent HYPOgly=brain die)
2. METFORMIN–Minimal chance of Low Sugar “hypoglycemia”
1. Weight GAIN
Hani Abu-Dieh
2. NO Peak NO Mix = Long acting “old guys”–Detemir & Glargine
3. IVP or IVPB ONLY = Regular insulin “ready to go IV”
2. Lactic Acidosis: NO Alcohol + STOP 48 hours before and 4. Draw Up: Clear to Cloudy “you want CLEAR days before cloudy ones”
after cath 5. Rotate locations-Macarena-BEST on abdomen
IV Contrast = Kills Kidney
(2 inches from: Umbilicus, Naval, “belly button”)
3. GLIPIZIDE GLYBURIDE–Heart can DIE (bad for CHF)
6. DKA - Type 1–“sick days”–YES INSULIN without food!!!
LOW blood sugar (Avoid alcohol “ETOH” = hypoglycemia)
TOXIC: Renal, Liver & elderly population 7. Hypoglycemia (70 or LESS)
Sun Burns = sunscreen & protective clothing Awake = Ask them to Eat (soda, juice, low fat milk)
4. THIAZOLIDINEDONE (TZD) Pioglitazone (ONE heart) Sleeping = Stab with IV D50 (dextrose 50)
NO Heart Failure patients–new pitting edema, crackles (lungs) "Unresponsive" "Responsive ONLY to pain"
NO Liver failure patients “Cirrhosis” “Liver Failure”

NOTES

NPH

PEAK TIMES=Hypoglycemia risk 70 or Less

Hypogly brain will DIE NCLEX TIP
 DKA HHNS
PATHO & CAUSES: PATHO & CAUSES:
TYPE 1–Faster & Younger “D comes 1st in alphabet”
S–Sepsis (infection) NCLEX TIP
TYPE 2–slower & older “H comes 2nd in alphabet”
Illness
Hani Abu-Dieh
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

Blood Glucose Hourly • First Action = Heart monitor High Potassium (5.0+) Low Potassium (Below 3.5)
COMMON NCLEX QUESTION Re-Hydration Signs: Never push = DEATH High Pump Low Pump
Q: Child is nauseous NOT • 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
eating—maybe vomiting—do • Skin color & warm temp (NOT cool/pale) • Site (central) and Slow infusion
you still give INSULIN? • 30ml/hr + Urine Output
• Low spec gravity (1.005–1.030)
A: Yes, we give sick day insulin to NOT Apical pulse NOT Lung sounds NOT Pupils
prevent DKA...because glucose
is HIGH during times of illness.
 Hani Abu-Dieh

Insulin Cheatsheet
Short Acting Insulins:

Insulin Type of Onset Onset Peak Duration

Insulin lispro (Humalog) Rapid onset 15-30 mins 0.5-2.5 hrs 3-6 hrs
Regular insulin Slower onset 30-60 mins 1-5 hrs 6-10 hrs
(Humulin R)

Intermediate Insulins:

Insulin Type of Onset Onset Peak Duration

NPH (Humulin N, Intermediate 1-2 hrs 6-14 hrs 16-24 hrs
Novolog N)

Premixed Insulins:

Insulin Type of Onset Onset Peak Duration

70% NPH/30% regular Mixed 30-60 mins 1.5-16 hrs 10-16 hrs
insulin

Long Acting Insulins:

Insulin Type of Onset Onset Peak Duration

Insulin glargine (Lantus) Longer onset 70 mins None 18-24 hrs
Insulin detemir Longer onset 1-2 hrs 12-24 hrs 16-24 hrs
(Levemir)

Quick Insulin Rules

• Never mix insulin glargine (Lantus) with another type of insulin
• NPH is a suspension and there is cloudy. You must wash your hands and then roll the NPH insulin in between
your palms until it is uniformly cloudy to ensure it is mixed well. Do not shake to avoid bubbles in the syringe. All
other insulin is clear.
• When drawing up insulin, draw up the shorter acting insulin first then the longer.
• After mixing insulins give within 10-15 mins to avoid the short acting insulin from binding with the NPH insulin
and losing its effectiveness

Storing Insulin
YES NO!
-Room temperature: If will be used up in 1 month -Extreme temperatures
-Refrigerator: If the vial will not be used up in 1 month -Direct sunlight
-Freezing
-Inside a car
 Hani Abu-Dieh
Preparing to Administer Insulin
Clear = Regular Insulin (short acting)

Cloudy = NPH (intermediate acting)

 Hani Abu-Dieh
Administering Insulin
• Given as a subcutaneous injection in the
o Thigh
o Back of upper arm
o Abdomen (2 fingerbreaths away from umbilicus): Absorbed more evenly here
o Hips

• To give a subcutaneous injection you:

o Cleanse the site with an alcohol wipe
o Allow it to air dry: do not blow on it or fan it
o Gently pinch the skin together
o Inject the needle at a 45-90 degree angle or 45-60 degree if they are very thin
o For a subcutaneous injection you do not aspirate
o Rotate sites
Lactulose &
Sodium Polystyrene Sulfonate Hani Abu-Dieh

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
 lOMoARcPSD|15175730

Need to know
Hani Abu-Dieh
medications for NCLEX I

ANALGESICS ANTICONVULSANTS

• Opioids ↑ interval between seizures

• ↑ pain threshold by altering pain
perception Common Brand Name Generic Name

Dilantin Phenytoin
Common Brand Names Generic Names
Neurontin Gabapentin
Demerol Meperidine HCL
Tegretol Carbamazepine
Dilaudid Hydromorphone
Depakote Valproic Acid
Duragesic, Sublimaze Fentanyl

Morphine Sulfate Morphine Sulfate *Neurontin is sometimes prescribed for

chronic pain neuropathy
Vicodin, Norco Hydrocodone *Monitor blood levels: Dilantin, Tegretol,
and Depakote

BENZODIAZEPINES (Pam & Lam) ANTIDEPRESSANTS

• SSRIs
• Enhance/facilitate GABA, an inhibitory
neurotransmitter • Act by inhibiting serotonin reuptake in CNS

Common Brand Names Generic Names

Common Brand Name Generic Name Celexa Citalopram

Xanax Alprazolam Effexor Venlafaxine

Valium Diazepam Lexapro Escitalopram Oxalate

Ativan Lorazepam Paxil Paroxetine

Versed Midazolam 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

Buspar Buspirone Hydrochloride Elavil Amitriptyline

Downloaded by Hani AbuDieh (Hayed88@hotmail.com)

Metronidazole Hani Abu-Dieh

Indication:
Normal Side effect
Metronidazole NO need to report!
(brand: Flagyl)
Dark urine “Discoloration”
#1 Drug to treat C-diff (brown & rusty)
infection Metallic taste
STI (Trichomoniasis) HESI TIP
(Metro-Metallic Taste)

KEY POINT: DEADLY Side effect

Avoid ETOH (alcohol)
Report any new rash or
During & 3 days after skin peeling!
treatment
Patients will have violent Stevens-Johnson Syndrome,
vomiting & cramping if which is NECROSIS of skin
and mucous membranes!
alcohol is consumed Always TEACH patients
during and after treatment to REPORT immediately
Stevens-Johnson Syndrome

Memory Trick:

METALLIC ETOH TREATS RASH OH NOT

Taste & Dark Avoid C Diff & STI or Skin Peeling “Dazole”ing
Urine (Trichomoniasis)

NORMAL REPORT

Notes
 Mucosal Protectant Hani Abu-Dieh

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:
Major 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 before or after
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-Acids = Anti ANTIACIDS

Mixing meds)

Notes
 Muscle Relaxers Hani Abu-Dieh

Top 3 Missed Questions

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

changing positions Select all that apply.

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

is expected
1. Always take calcium new rash to your provider 1. Notify the provider of a
carbonate in divided doses less immediately. temperature greater than 99.5 F
than 500 mg per dose. 2. Take your allopurinol at the first 2. Report any drowsiness to the

2. NO alcohol 2. Take calcium carbonate 2

hours before or after meals.
3. Stop taking calcium carbonate
sign of an acute attack.
3. You may continue to treat pain
health care provider.
3. Do not stop taking this
associated with acute attacks medicationa abruptly.

3. DO NOT Abruptly Stop if constipation develops

4. Schedule weekly blood draws
to monitor serum calcium levels.
5. Continue taking Vitamin 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 attacks.
4. Limit wine consumption to
3-4 glasses per day while taking
this medication.
5. Avoid taking ibuprofen while
taking this medication.

Drug name: Indication: SIDE EFFECT KAPLAN

Dantrolene
Dantrolene • Spinal Cord injury
Muscle relaxant
• Cerebral Palsy
DANTROLENE
• Multiple Sclerosis HESI
LIVER TOXIC SEDATION
“DROWSINESS”
Dantrolene
MOA: Contraindicated in client with MS
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: Side Effects

HESI Question
CycloBENzaprine Reduces muscle spasms after
Carisoprodol
& Carisoprodol CYCLOBENZAPRINE
CARISOPRODOL

surgery on open fractures Risk of dependence

Drowsiness & sedation

MEMORY TRICK Pt teaching

CycloBENZaprine CycloBACKzzaprine
ATI Question
Taper off medication -
CYCLOBENZAPRINE

DO NOT stop abruptly!

Drug name: MOA: HESI Question

KEY POINTS
Enhances GABA to make Gaba Side effects of Baclofen:
• Baclofen BACLOF
EN BACLOFEN

everything low & slow

Dizziness upon changing
positions Ortho-hypotension,
Dizziness, Nausea
NOT a contraindication
Side Effects: to giving this med Potential Deadly Effects:
Indication: Rhabdomyolysis
NEVER Abruptly Stop
(any muscle relaxant) Multiple organ failure
Decrease in flexor and extensor - Constipation
spasticity with spinal cord - Low BP & orthostatic
injury, MS & cerebral palsy hypotension Memory Trick

Baclofen
Back off slowly (do
not abruptly stop)
NSAIDS Hani Abu-Dieh

Drug name: Aspirin Pt Education:

N Naproxen NCLEX TIP A – Aspirin

A – Avoid Kids NCLEX TIPS
S Salicylate acid (Aspirin) = possible Reye’s Syndrome

A
Early sign of toxicity is Tinnitus
Acetylsalicylic acid (Aspirin) - report to HCP

I Ibuprofen & Indomethacin

K Ketorolac (brand: Toradol) NCLEX TIP

NCLEX Question ACETAMINOPHEN

Indication:

Anti-inflammatory & Antipyretic (Fever reducer)

MOA:
Decrease prostaglandin response to KEY Words
decrease pain & inflammation

HESI Question
Gout teaching effective
“I can use ibuprofen or
naproxen for pain”

Kaplan Question
ATI Question
Patient with rheumatoid
arthritis, NSAIDS relieve
the symptoms
HESI Question
Ibuprofen

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

(Kidneys, Heart Failure, Asthma, GI, clots ect) stomach. – YES
- Patient with Acid reflux on

S
RANITIDINE
STICKY BLOOD “CLOTS” Ranitidine (PPI) & NSAID -
Increased risk for thrombosis YES ok
- “I take occasional ibuprofen

A
for my knees” - YES
ASTHMA WORSENING

I INCREASED BLEED RISK! HESI Question

Patient with HTN or CHF

D
DYSFUNCTIONAL KIDNEYS
Renal Injury (long term use)
IBUPROFEN
Creatinine over 1.3, Urine output 30ml/hr or Less “I will call my HCP

S
before taking ibuprofen”
SWELLING HEART
CHF (heart failure) & HTN worsening

Notes
Opioids Hani Abu-Dieh

Drug name:
OXycodone

Opioids – O’s Memory Trick KEY WORDS

mOrphine Sulfate
Opioids
OXYCODONE

HydrOmOrphOne
cOdeine
Oxycontin
OxycOdOne
LOW & SLOW
Fentanyl

Antidote:
Indication:

Severe pain (not anti Naloxone

inflammatory/antipyretic) (brand: Narcan)

Reversal agent for opioid

& heroin overdose
Killer Adverse Effects Atelectasis

Pneumonia
Low RR - respiratory depression
KEY Number:
Hold dose for RR below 12
KEY POINT Key terms
Low BP – Hypotension
“orthostatic Hypotension” 1-2 hours Half Life RR below 12
KEY Terms:
If client becomes dizzy/ light Reassess Every 60 Unarousable
headed minutes Falling asleep while talking
Assist to a seated position! to you
DO NOT get up unassisted
Prepare for second dose
Low Brain - CNS sedation of Narcan!
KEY Terms:
Notify HCP
Easily falls asleep when talking
Unarousable

A I M S
Long term Side Effects
Assess ABCs Intervention: Oxygen Make HCP aware Second dose of naloxone
CONSTIPATION 1st 2nd 3rd 4th

KEY TERM

ABC
PRN stool softeners
Oxygen
HPC
TEACH preventative NARCAN
measures!

Greatest Risk DEATH

IV ADMINISTRATION
“Advanced Age”
(70 and older)
2 - 3 Minutes IV Push Reassess after
Underlying pulmonary 15 - 30 minutes
disease (COPD, Asthma) NOT over 5 - 10
seconds!! NOT after 1 hour
Post Surgery (24 hours)

Notes
Pancrelipase
Enzymes Hani Abu-Dieh

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 Question

MUST be eaten Pancrelipase Admin:
WITH every Meal & Snack Open capule &
or med is not effective sprinkle contents on
NOT before food without chewing

NOT After

HESI Question
KEY TERM
Pancrelipase Admin:
Reduction in fatty
stools is an expected
outcome

Notes
PCA Pump vs.
Hani Abu-Dieh
Fentanyl
Drug name: Drug name:
Fentanyl

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

Can take up to 17 hours for full effect

Key Points KEY Words

Not “Acute” Pain:
Client ONLY NOT Post-op pain NCLEX TIP
NOT family NOT Intermittent pain NCLEX TIP

NOT nurse Clarify order with HCP!

NOT Dr. Appropriate for allergy to codeine
CODEINE

Kaplan Question
NCLEX TIPS Fentanyl Patch
“constipation
= use stool softeners”
Nursing Care
Twice the dose of Meds given ATI Question
If patient still reports pain Fentanyl Patch
1 st action = pain ASSESSMENT “Tolerance
= need increase doses
for pain relief”

HESI Question
A I R AIR Fentanyl Patch
A - Assessment before 1st! “REMOVE old patch
I – Intervention BEFORE new one”
R – Re-assessment Clean area
Dry skin

Notes
Penicillin &
Hani Abu-Dieh
Cephalosporins

Drug name: COMMON SIDE EFFECTS

Penicillin -Ceph = Diarrhea -Cillins = Bleeding

Amoxicillin (monitor platelet count)
Ampicillin
Piperacillin Tazobactam

Cephalosporins
Cephalexin (brand: Keflex) NCLEX TIP
Cefazolin
Ceftriaxone (brand: Rocephin)

Penicillin end in CILLIN KEY POINT & MEMORY TRICK

Cephalosporins start with CEPH

C C C
MOA: CROSS SENSITIVITY CEPH / CEF CILLIN
(ALLERGY) (CEPHALEXIN, CEFAZOLIN) (AMOXACILLIN)

Weakens bacteria cell wall

Patient teaching:
AMOXACILLIN
CEFAZOLIN

Key Words DURING A REACTION

Oral contraceptives are

STOP ASSESS EPINEPHRINE
ineffective (“HOLD”) MEDICATION
the type of reaction
(prepare to admin)
Use additional contraception • Auscultate Lungs

Penicillin cause accidental pregnancy

EPINEPHRINE

CEPHALEX

since it BUMPs the PILL

Anaphylaxis allergy:
Common NCLEX Question
“-Cillins” & “Cephs”
Nurse should What is the best action for the
CLARIFY PRESCRIPTION nurse to take before
administering amoxicillin to a
Both are PREGNANCY SAFE and patient with allergies to
levofloxacin & ceftriaxone.
BREASTFEEDING SAFE
CEFAZOLIN
1. Clarify the order with pharmacy
Administration 2. Ask the patient about the type of
reaction they have to ceftriaxone.
“-Cillin”
3. Notify the HCP of the allergy to
KEY Terms:
· Take with food if GI upset ceftriaxone.
(nausea/ vomiting/diarrhea) 4. Administer meds separately with
· Shake well before use normal saline in between.

Notes
 lOMoARcPSD|15175730

Pharm Quick Glance Hani Abu-Dieh

Medication Classifications Pregnancy Categories

• 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)
• 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.
• Pregnancy Category N—Not 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
ADHD. Assess 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.

Downloaded by Hani AbuDieh (Hayed88@hotmail.com)

Upper Respiratory
Hani Abu-Dieh
Drugs

Cough Expectorants

Drug name: Indication: Drug name: Memory Trick:

Helps patient to cough A - Acetylcysteine

Guaifenesin Acetylcysteine
(brand: mucinex)
out excess secretions
(brand: mucomyst) A - AVOID asthma patients
KEY POINTS
MOA: Antidote: Acetaminophen
(Tylenol) poisoning
Increase fluid intake Thins the mucus
Drink at least 2 L / day KEY POINT
Asthma Safe NOT SAFE
Cause or Worsen bronchospasm!

Cough Suppressant ‘’Antitussive’’

DON’T LET NCLEX TRICK YOU

Codeine NOT NOT NOT

Photosensitivity Heart Palpitations Insomnia or Anxiety
KEY POINT
1. Slow position changes!!! CODEINE

2. NOT for COPD

3. Take with food!!!
4. Increase fluid intake!
5. 8 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

Contraindicated: Fewer sedation effects KEY POINT

Closed angle glaucoma NOT for Glaucoma
Urinary retention Due to anticholinergic effects
Peptic ulcer that increase intraocular pressure
Small bowel obstruction Loratadine
Claritin

Indication:
Sinusitis
For anaphylaxis (big allergic reactions)
Z

MOA: Z
Z

Allergies Hives
Blocks histamine which creates inflammation
Lower Respiratory Drugs Hani Abu-Dieh

Most Commonly Missed Question

NCLEX NOTES Patient with Severe asthma:
· Tachycardia (>120 BPM)
· Tachypnea (> 30 BPM)
· O2 sat < 90% on RA
Which medication would you give?
Select All that apply
1. Inhaled salmeterol
2. Albuterol inhaler

BRONCHOdilators ANTI-INFLAMMATORY Agents · Peak exp. Flow < 40% 3. Nebulizer Ipratropium
predicted or best 4. IV methamphetamines
B Beta 2 Agonist
Albuterol
S Steroids
Beclomethasone
< 150L/min)
5. IV Methylprednisolone

A Anticholinergics
Ipratropium
L Leukotriene Inhibitor
Montelukast

M
ALBUTEROL
Methylxanthines
Theophylline
M Mast Cell Stabilizers
Cromyolyn
Solu Me
drol
Methylpre
dnisolone

So
Me
lu Medrol
thylpredn
isolone

Common Exam Questions:

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

1. Discard the use fluticasone if albuterol 1. I will use cromolyn to prevent activity induced
provides relief. asthma
2. Do not swallow the water as you wash 2. I will use montelukast to prevent asthma
your mouth after each use. attacks.
3. If taking albuterol, be sure to use after the 3. I will use spacers to prevent oral thrush while
steroid. using beclomethasone.
4. Steroid inhalers should be used before 4. I will take cromolyn 45 minutes before
CROMOLYN

beta 2 agonists. physical activity Cromolyn

3 Common NCLEX & Exit Questions

Which of the follow What patient teaching should be Which medication
prescriptions should the nurse included with a new prescription of prescribed for asthma
question? albuterol, ibuprofen, tiotropium and causes of tachycardia &
beclomethasone? dysrhythmias?
1. Naproxen for an Select All That Apply
asthmatic patient 1. Tinnitus is an expected 1. Phenobarbital
2. Ipratropium for a patient side effect. 2. Aminophylline
Aminophylline
with glaucoma 2. Tachycardia is expected 3. Salmeterol
3. Losartan for a patient after albuterol. 4. Albuterol
with diabetes. 3. Report dark stool to the
4. Theophylline for a provider.
patient taking cimetidine. 4. Drink fluids to prevent dry
Theophylline
5. Atenolol for a patient mouth and throat.
with asthma 5. Ipratropium is used first
during an attack.
Skin Isotretinoin
Vitamin A derivative Hani Abu-Dieh

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
Steroids Hani Abu-Dieh

Drug name: ADDISON vs. CUSHING TREATMENTS:

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

STEROIDS

s SWOLLEN (Water gain = Weight gain)

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

s
“-Sone”
- Prednisone SUGAR INCREASED
- Dexamethasone Fludrocortisone
‘’Hyperglycemia’’ NCLEX TIP

s
- Hydrocortisone Hydrocortisone

- Fludrocortisone
SKINNY
Muscle & Bones ‘’Osteoporosis’’ (R/F Fx)
Indication:

Given to help the body respond to

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

COPD
PREVENT CRISIS:
s
• Inflamed Lung like COPD
• Inflamed joints like Rheumatoid Arthritis SLOWLY taper off
• Inflamed SKIN like Psoriasis (NEVER abruptly stop) NCLEX TIP

s
• Inflamed body - like Lupus where the body
attacks itself STRESS or Surgery
• Allergic reaction where EVERYTHING swells UP (increase dose)

TOP 3 MISSED Questions:

The nurse should be concerned Which priority teaching is Which of the follow is an
when the client states: required for a patient prescribed indication that the client needs
“I have a sore on my leg that prednisone for Lupus? additional teaching,
won’t go away”. while taking fludrocortisone?
Which medication should be 1. Report slight increases in blood
reviewed with HCP.
sugar to HCP immediately. 1. I will not discontinue this
Select all that apply
2. Increase dose before surgery medication abruptly
or during times of stress. 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 &
5. Hydrocortisone
symptoms of infection

Notes
Sulfonamides
Hani Abu-Dieh
& Fluoroquinolones

Sulfonamides MOA: KEY POINT

Stops bacteria folic Rash while on Glyburide?

Potential allergy to sulfa drugs!!!!
NOT Pregnancy Safe

Trimethoprim acid synthesis

sulfamethoxazole SULFA
-METHO-XAZOLE !
(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) Crystals & Specific Gravity water!! 2-3L per day (take daily)
HIGH = DRY!

1
SULFA GLYBURIDE
FOLIC ACID -METHO-XAZOLE

Gravity HIGH

Fluoroquinolones Indication:

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

Contraindication: Tendonitis 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
Look at the entire suffix so you don’t end tricked.
FLEX-ACIN
!
DON’T
GET TRICKED FLOXACIN MYCIN !
VancoMYCIN
GentaMICIN

Notes
Tetracyclines Hani Abu-Dieh

Drug name: Indication:

Mainly used for SKIN ACNE

Tetracyclines
Doxycycline MOA:

It blocks protein synthesis to STOP

KEY Points: bacterial growth.

Patient Teaching:

Key Terms:
Memory Trick:

Use additional contraception

• Cycling is DANGEROUS - Not safe for a
pregnant mothers! Take on empty stomach
Sit Up 30 minutes after taking…
DO NOT LAY DOWN!!!
• You can get BUGS in your teeth while AVOID - Calcium products:
cycling on a bike leading to tooth
discoloration 1. NO Dairy (milk, cheese)

2. NO Antacids (tums, Milk of Mg)

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

Notes
 Thrombolytics
tPA & Alteplase Hani Abu-Dieh

Drug name:
NCLEX Key Contraindications:
tPA
AVOID giving to:
“-Ase” 1. Active bleeding
Alteplase KEY TERM: Peptic ULCER
Reteplase 2. Uncontrolled HTN 180/110 +
3. Recent surgery within 2 weeks
Streptokinase
Clarify Prescription with Provider !
· A – Accidents “Recent Trauma” NCLEX TIP
· A – Aneurysm - Hx of hemorrhagic CVA
· A - AV malformation NCLEX TIP NCLEX TIP

Key Point:

• Clot Busters - our ATOMIC BOMB! KEY TERMS

The MOST powerful 1 time push drugs!
3 – 4.5 hour from
ONSET of symptoms
• These are the ONLY ones that dissolve clots!

• Aspirin & Clopidogrel - NOT clot busters,

they are Anti-Platelets
KEY TERMS

• Heparin & Warfarin - NOT clot busters, THE BIG caution here is
HEPARIN WARFARIN they prevent new clots & existing clots the MASSIVE - BLEEDING
from getting bigger. RISK !!!!!

• The big caution here is the MASSIVE -

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

These drugs can only be given

in a compressible site like an
• NO injections at all! peripheral IV.
Yes “Existing” peripheral IV
• NO NEW: NOT Central Line

NO IV’S NO SUB Q NO IMS NO ABG

Notes
 lOMoARcPSD|15175730

Top 5 Toxic Drug Levels Hani Abu-Dieh

1. Lithium 1.5 +
NCLEX TIP
2. Digoxin 2.0 +
HIGHEST risk for toxicity
3. Theophylline 20 +
Decreased renal function
4. Phenytoin 20 +
Creatinine Over 1.3 = Bad Kidney
(brand: Dilantin)
• Renal Failure
5. Kidney Killers: • Older Age
Creatinine Over 1.3 = dead kidney
� CT contrast Creatinine > 1.3
� Antibiotics: Vancomycin
& Gentamicin

CREATININE
Digoxin 2.0 +
Lithium: 1.5 + Top Signs of toxicity
Theophylline 2.0 +
Top Signs leading to toxicity • Nausea & Vomiting Top Signs of toxicity
1. Extreme thirst • Vision changes • Seizures
2. Excessive urination “difficulty reading” T - Theophylline
3. Vomiting / diarrhea D - Digoxin T - Tonic Clonic seizures
D - Difficulty reading

D D T T
Digoxin Difficulty reading Theophylline Tonic Clonic seizures

A WB I

DIGOXIN
Theophylline
20+

Phenytoin 2.0 + Kidney Killers

Top Signs of toxicity (creatinine over 1.3 = bad kidney)
1. Ataxia - unsteady gait • CT Contrast Vancomycin

2. Hand tremors • Mycin Antibiotics

Gentamicin

3. Slurred speech

Notes

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Tumor Necrosis Factor Inhibitors
Etanercept, Infliximab, Adalimumab Hani Abu-Dieh

Drug name:
ETANERCEPT Flu
Vaccine

Etanercept Negative Tuberculosis skin test

Infliximab Infliximab

PATIENT EDUCATION
Adalimumab ▪ Tuberculosis (TB) Reactivation
Adalimumab ▪ Neg. TB skin test needed to start therapy
▪ Vaccines:
▪ Yearly flu vaccine
MEMORY TRICK ▪ NO Live vaccines
(herpes zoster or shingles)
INTERCEPT
▪ Contraindication:
ETANERCEPT
ADALIMUMAD Cannot take 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 Recent

KEY POINT
LABs
▪ REPORT ! Elevated WBCs
Priority to Report to HCP! ▪ Elevated CRP
▪ Elevated WBC = NOT “the most important” lab
▪ Fever (over 100.3 F, 38 C)
NCLEX TIP

(CRP is the most commonly chosen wrong answer

nearly 50% of the time) Elevated CRP is expected
with these patients, since there is inflammation
all over the body

Important!

CRP

> 100.3o F/ 38oC most commonly CRP

chosen wrong answer

Notes
 Vancomycin
Hani Abu-Dieh
GLYCOPEPTIDES CLASS &
AMINOGLYCOSIDE CLASS

Glycopeptides Class Key NCLEX Tips: Aminoglycosides Class

Vancomycin Tobramycin
KEY Words: Gentamicin Cystic Fibrosis

Indication: REPORT Signs of Toxicity

Neomycin
MRSA C DIFF

Given for serious infections like: Ear Damage “Ototoxicity”

MRSA & C Diff in the gut NCLEX TIP - Vertigo (loss of balance) Indication:
NCLEX TIP - Tinnitus (ringing of the ears)

Treat infections in cystic fibrosis

MOA: Kidney Damage “Nephrotoxic”

MOA:
Inhibits cell wall synthesis REPORT / NOTIFY HCP

Creatinine Blocks protein synthesis of the

OVER 1.3 = Bad Kidney
bacteria to STOP bacterial
KEY Words: growth but the NCLEX
BUN Over 20
PEAK & Trough does not focus on this, but
Urine output 30ml/hr rather on the way this drug
Check 15 – 30 minutes BEFORE
“next dose” or “administration”
or LESS = Kidney Distress can HARM THE PATIENT
Draw & review levels

REPORT and HOLD NCLEX

Over 20 = Vancomycin
KEY POINT:
Draw & Review levels
Assess site every 30 minutes for: KEY POINT:
pain, redness & swelling BUN/Creatinine

Very Toxic in combo with

Red mans Syndrome Vancomycin
KEY Words:
Rapid infusion
***Notify HCP of Increas-
Sudden onset of severe: Monitor BP
ing
Infuse SLOWLY at least BUN/Creatinine!
Hypotension
over 60 minutes
Flushing & pruritis “itching” (<10mg/min)

Red rash on face, neck,

chest & extremities Common NCLEX Question
120/80 A patient in sepsis is prescribed
90/60
several antibiotics during their
80/50
hospital stay. What patient teaching
should be included?
(see exhibit for list of meds)
Levofloxacin
Doxycycline
ANAPHYLAXIS Vancomycin
Azithromycin

Hive 1. Avoid direct sun exposure

Wheezing 2. Oral birth control ineffective

IMMEDIATELY 3. Take until symptoms subside

STOP infusion & administer 4. Monitor QT interval
Epinephrine!
5. Suppliment with vitamin B6
E – Edema “Angioedema”
P – Pruritis & Hives 6. Monitor creatinine and BUN
I – Insp. / Exp. “Wheezes”

Notes
 lOMoARcPSD|15175730

Vasopressors
Hani Abu-Dieh
Alpha & Beta Physiology
Cardiac Pharmacology

VasoPRESSors - PRESS on the vessels

VasoPRESSors - PRESS on the blood vessels,
Goes back to the heart
Main Vasopressors
increasing blood pressure in order to squeeze
• Epinephrine
• Norepinephrine
oxygen rich blood back to the CORE of the body
• Vasopressin to perfuse the vital organs (sort of like
• Dobutamine squeezing a toothpaste bottle).
• Dopamine

Indication
Key Receptors: Alpha & Betas
Increase BP Cardiac Arrest Shock Mode of Action
NORMAL

HIGH
LOW
NORMAL

NORMAL They work by activating

HIGH
LOW

HIGH
LOW

ACLS
Alpha & Beta receptors
Dobutamine
inside the heart & blood
Norepinephrine

vessels
EPINEPHRINE
EPINEPHRINE

Vasopressin

Alpha 1 - Constriction of Vessels

Alpha 1 - Anaconda (memory trick)
• Squeezing down the blood vessels so blood is pushed back to the heart.

Alpha Agonist
• Think AGonists ADD to the BP to increase it (example: vasopressors)
Alpha Antagonists
• Are ANTI constriction - less constriction = less pressure to lower BP (example: clonidine)

Beta 1 = 1 Heart
Beta Agonists - think AGonists ADD - Faster heart rate. (example: Vasopressors)
• Positive Chronotropic (chronos = time) more beats per minute.
• Positive INOtropic = more FORCEFUL beats, which increased Cardiac OUTPUT (increased
blood coming OUT of the heart to perfuse the body)

Beta Antagonists - are ANTI heart, used to decrease the HR & BP (example: beta blockers) NORMAL

• Negative Chronotropic - Less Beats

HIGH
LOW

• Negative Inotropic - Less force

Beta 2 = 2 Lungs Indication Alpha 1 Beta 1 Beta 2

Beta 2 Agonist Anaconda 1 heart 2 Lungs & Dilation
Constriction • Chrono - High HR Big Lungs
• Think they ADD to the lungs - dilating • Inotropic - C.O. & Vessels
both the vessels & bronchi - like a big Septic shock &
balloon or beach ball Epinephrine Cardiac arrest BIG Medium Small

(example: Vasopressors & Albuterol)

Norepinephrine Septic shock BIG Medium Small

Vasopressin
Desmopressin
Hypovolemic shock - - -
Dopamine Cardiogenic shock Med.
BIG Small

Dobutamine Cardiogenic shock Small BIG Medium

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 lOMoARcPSD|15175730

Vasopressors
Hani Abu-Dieh
Top Tested Drugs
Cardiac Pharmacology

Epinephrine & Norepinephrine Kaplan Question

1st line drug Epinephrine
Epinephrine treatment is effective if ….
(Brand: Adrenaline) Answer: BP 130/67,
Apical HR 99, Cap refill
Norepinephrine HESI Question less than 2 seconds
(Brand: Levophed)
Epinephrine Less than 2s
Key difference
Initiates heart contraction

EPINEPHRINE
EPINEPHRINE
Epinephrine

Adrenaline
Cardiac Arrest during cardiac arrest
130/67 HR 99
• Asystole
• PEA (pulseless electrical Activity)
NORMAL

Vasopressin & Desmopressin (ADH)
Vasopressin
Vasopressin - synthetic ADH
(AntiDiuretic Hormone)
• ADH - Adds Da H20
Pressin - PRESSes that BP UP
HIGH
LOW
DI - Diabetes Insipidus
Indication DI - end up DIuresing or DraIning a lot of fluid
Given for Diabetes Insipidus (DI)
where clients Drain a lot of fluid!
ADH is given to “Add Da H20” to
the body, adding fluid volume &
not affecting the constriction of
vessels.

Dobutamine & Dopamine

Indication
INOtropic
D’s for DEEP Contraction Given to treat cardiogenic shock - “INcreased cardiac contractility”
DEEP contraction Dopamine & Dobutamine
where the heart FAILS to pump! “INcreased forceful contraction”
These guys give a DEEPER heart
Dobutamine
DOPAMINE contraction, to increase that blood
out of the heart & to the body
(increasing cardiac output & BP)

HESI Question Kaplan Question

Dopamine Dopamine
Activates alpha 1 and beta 1 receptors Given for a patient with
hypotension, what indicates
Therapeutic Effects: effectiveness?
• Low doses act on dopamine
Answer: Increased cardiac output
receptors 1 1
• Moderate doses acts on beta 1
receptors
• High doses acts on alpha 1 and
ATI Question
beta 1 receptors
Dobutamine, Dopamine
Assess IV site hourly for s/s infiltration • Assess BP hourly
• Monitor vital signs

Notes

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 Vitamins &
Hani Abu-Dieh
Electrolytes
Drug name:
Iron Indication: Kaplan &
KEY POINTS
HESI Question
Treat anemia r/t Dark or black stools =
Indication:
Ferrous Sulfate (oral)Iron Dextran (IV / IM)
iron deficiency Normal & Expected Calcium given with ferrous sulfate
BLOCKED Absorption
NOT GI BLEED
Orange juice/ fruit juice = enhance
FERROUS
Empty stomach absorption
IRON
SULFATE DEXTRAN 1 HOUR BEFORE Ferrous Sulfate
medications Teaching is Effective when the Client
states: “I will eat more fresh fruits and
whole grain bread”

B12 (Cyanocobalamin) Key Point: Folic Acid While taking Pregnant patients HESI
Sulfa drugs
(Sulfasalazine) Prevents of neural
Indication: Pernicious anemia Patients who lack tube defects
Body lacks intrinsic factors Folic acid
Folic acid: Anemia
so can’t absorb building supplement Take before
(low blood cell count), - 1 mg/day pregnancy
blocks to make RBCs
Sulfa drugs decrease
(iron, folic acid, B12)
folic acid absorption

SULFA
DRUGS

Pottasium K+ Indication: Memory Trick:

K+ Wasting K+ Sparing
Diuretics Drugs
Hypokalemia
(low K+ below 3.5) S - Spironolactone
“-ide”
POTASSIUM S - “-Sartans” LoSartan
K
Furosemide
PUMPS muscles
P - “-Prils” LisinoPril
Hydrochlorothiazide
3.5

Supplement

Key Point: Potassium Pumps the Heart

Potassium IV (Normal 3...5-5.0)
K
KEY POINTS
1. First Action = Heart monitor
SLOW infusion rate 3 2. Never push = DEATH
if infusion irritates client
reports of burning/ discomfort
3. ONLY 10-20 mEq/hr! (IV Pump)
most commonly
chosen distractor 48% 4. Slow infusion (if arm burns)

Magnesium Indication: Key Terms: HESI Question ATI Question

Sulfate Magnesium sulfate …

Possible findings in a newborn? Mg
When to STOP the infusion?
Preterm labor = wild contractions CAUTION ○ Flaccid muscle tone
○ Respiratory rate below 12 ○ Respiratory depression
Anticonvulsant Respiratory Depression
MAGNESIUM SULFATE ○ Decreased DTRs
Cardiac = Torsades de Pointes Paralysis & weak muscles
MELLOWS the muscles NCLEX TIP
= Low DTRs

Kaplan Question

STOP What is the indication for

Mag Sulfate? MAGNESIUM
SULFATE

○ Replace for low magnesium Mg

(below 1.5)
DTR ○ Treatment for Torsades de 1.5

Pointes NCLEX TIP