Pharmacology For Nclex PowerPoint

PHARMACOLOGY FOR
THE NCLEX-RN
MUST KNOW DRUGS

ALTEPLASE (T-PA)
• MOA • Nursing Considerations

– thrombolytic – plasminogen – Contraindicated in active bleeding
activator – Monitor for active bleeding (q15m

x 1hr; q15-30m x 8hr)
– May cause intracranial hemorrhage
• Indications – Monitor for anaphylaxis
– MI – Use caution with uncontrolled

hypertension
– Acute ischemic stroke
– Assess neuro status during therapy
– Occluded Central lines
A patient is admitted to the emergency department with chest pain. An
electrocardiogram shows changes consistent with an evolving myocardial
infarction. The patient’s cardiac enzymes are pending. The nurse caring for
this patient will expect to:
A. administer aspirin when cardiac enzymes are completed.
B. give alteplase [Activase] within 2 hours.
C. give tenecteplase [TNKase] immediately.
D. obtain an order for an INR.
A patient is admitted to the emergency department with chest pain. An
electrocardiogram shows changes consistent with an evolving myocardial
infarction. The patient’s cardiac enzymes are pending. The nurse caring for
this patient will expect to:
A. administer aspirin when cardiac enzymes are completed.
B. give alteplase [Activase] within 2 hours.
C. give tenecteplase [TNKase] immediately.
D. obtain an order for an INR.
ATORVASTATIN (CARDIAC
STATIN) SIMVASTIN
– HMG-CoA reductase – Contraindicated in active liver
disease
inhibitor – lipid lowering
agent – May cause rhabdomyolysis
– Monitor renal function
– Monitor serum cholesterol before
• Indications treatment and 4 weeks after
starting therapy
– Management of
– Monitor LFTs
hypercholesterolemia
(primary prevention of – Instruct patient to report muscle
weakness (sign of rhabdomyolysis)
cardiovascular disease)
A patient who is recovering from a STEMI 3 months prior is in the clinic
for a follow-up evaluation. The patient is taking 81 mg of aspirin, a beta
blocker, and an ACE inhibitor daily and uses nitroglycerine as needed for
angina. The patient’s BMI is 24.5 kg/m2, and serum LDL is 150 mg/dL.
The patient has a blood pressure of 135/80 mm Hg. What will the nurse
expect the provider to order for this patient?
A. An antihypertensive medication
B. Counseling about a weight loss diet
C. Discontinuing the ACE inhibitor
D. High-dose statin therapy
A patient who is recovering from a STEMI 3 months prior is in the clinic
for a follow-up evaluation. The patient is taking 81 mg of aspirin, a beta
blocker, and an ACE inhibitor daily and uses nitroglycerine as needed for
angina. The patient’s BMI is 24.5 kg/m2, and serum LDL is 150 mg/dL.
The patient has a blood pressure of 135/80 mm Hg. What will the nurse
expect the provider to order for this patient?
A. An antihypertensive medication
B. Counseling about a weight loss diet
C. Discontinuing the ACE inhibitor
D. High-dose statin therapy
ACETAMINOPHEN (NSAID-
ANTI-PYRETIC)TYLENOL
– non-opioid analgesic – – Do not exceed 4g of
acetaminophen per day to limit risk
prostaglandin inhibitor
of renal, liver and cardiac damage
– Overdose will lead to
hepatotoxicity
• Indications
– Acetylcysteine (acetadote) is the
– Pain antidote for overdose
– Fever – May increase the risk for bleeding
with warfarin therapy
– May alter blood glucose
measurements
A patient who is taking gentamicin and a cephalosporin for a postoperative
infection requests medication for mild postsurgical pain. The nurse will
expect to administer which of the following medications?
A. Acetaminophen
B. Aspirin
C. Ibuprofen
D. Morphine
A patient who is taking gentamicin and a cephalosporin for a postoperative
infection requests medication for mild postsurgical pain. The nurse will
expect to administer which of the following medications?
A. Acetaminophen
B. Aspirin
C. Ibuprofen
D. Morphine
ACYCLOVIR(ZOVIRAX)
ANTIVIRAL
– antiviral – purine analogue – May cause seizures, renal failure,
Stevens-Johnson syndrome,
thrombotic thrombocytopenic
purpura syndrome, diarrhea,
• Indications dizziness, nausea
– Genital herpes – Monitor renal panel during
– Herpes zoster administration
– Assess lesions during therapy
– Chicken pox
– Instruct patient to use proper
protection during sexual
intercourse
The nurse is caring for a patient receiving intravenous acyclovir. To
prevent nephrotoxicity associated with intravenous acyclovir, the nurse
will:
A. hydrate the patient during the infusion and for 2 hours after the
infusion.
B. increase the patient’s intake of foods rich in vitamin C.
C. monitor urinary output every 30 minutes.
D. provide a low-protein diet for 1 day before and 2 days after the
acyclovir infusion.
The nurse is caring for a patient receiving intravenous acyclovir. To
prevent nephrotoxicity associated with intravenous acyclovir, the nurse
will:
A. hydrate the patient during the infusion and for 2 hours after
the infusion.
B. increase the patient’s intake of foods rich in vitamin C.
C. monitor urinary output every 30 minutes.
D. provide a low-protein diet for 1 day before and 2 days after the
acyclovir infusion.
ALBUTEROL (V0SPIRE) BETA
2 ADRENERGIC
– bronchodilator – binds to Beta2 – May decrease effectiveness of
adrenergic receptors in airway beta blockers
leading to relaxation of the – Use with caution: heart disease,
smooth airway muscles diabetes, glaucoma, seizure
disorder
– Overuse of inhaler can lead to
• Indications
bronchospasm
– Airway obstruction
– Monitor for chest pain and
– COPD palpitations
– Asthma – Can increase digoxin levels
A patient is using a metered-dose inhaler containing albuterol for asthma.
The medication label instructs the patient to administer “2 puffs every 4
hours as needed for coughing or wheezing.” The patient reports feeling
jittery sometimes when taking the medication, and she doesn’t feel that the
medication is always effective. Which action is outside the nurse’s scope of
practice?
A. Asking the patient to demonstrate use of the inhaler
B. Assessing the patient’s exposure to tobacco smoke
C. Auscultating lung sounds and obtaining vital signs
D. Suggesting that the patient use one puff to reduce side effects
A patient is using a metered-dose inhaler containing albuterol for asthma.
The medication label instructs the patient to administer “2 puffs every 4
hours as needed for coughing or wheezing.” The patient reports feeling
jittery sometimes when taking the medication, and she doesn’t feel that the
medication is always effective. Which action is outside the nurse’s scope of
practice?
A. Asking the patient to demonstrate use of the inhaler
B. Assessing the patient’s exposure to tobacco smoke
C. Auscultating lung sounds and obtaining vital signs
D. Suggesting that the patient use one puff to reduce side effects
ALEDRONATE (FOSOMAX)
BIPHOSPHANATES
– biphosphnate – inhibits – Take first thing in the
osteoclast activity leading to morning with full glass of
inhibition of resorption of water 30 mins prior to eating
bone – Assess serum calcium and
vitamin D
• Indications – May lead to muscle pain
– Osteoporosis (aging,
menopause, corticosteroid
induced)
ALPRAZOLAM (XANAX)
BENDZODIAZAPINE
– Use caution with existing CNS
– benzodiazepine – works in
depression, sleep apnea, renal
CNS to produce anxiolytic dysfunction, hepatic dysfunction
effect causing CNS – May cause CNS depression,
depression drowsiness, lethargy
– May lead to physical dependence,
may experience tolerance effect
• Indications – Assess anxiety and mental status
– Anxiety, panic disorder, – Flumazenil is antidote for overdose
manage symptoms of PMS, – Grapefruit juice may increase blood
insomnia, mania, psychosis levels
AMIODARONE(ACLS)CORDA
RONE (ANTIARRYTHMIC • Nursing Considerations
– May lead to ARDS, pulmonary toxicity,
CHF, bradycardia, hypotension
– Increases risk for QT prolongation
• MOA
– Increases digoxin levels
– potassium channel blocker – class III
– Increases activity of warfarin
antiarrhythmic – prolongs action
potential, inhibits adrenergic – Monitor EKG continuously while on
stimulation, slows rate, decreases therapy
peripheral vascular resistance – Assess for signs and symptoms of ARDS
causing vasodilation – Monitor LFTs
– Check dosage with another RN
• Indications – Teach pt to monitor pulse daily and report
abnormalities
– Ventricular arrhythmias, SVT
– Avoid drinking grapefruit juice
– ACLS protocol for V-Fib and V-Tach
A nurse is providing teaching to a patient who is admitted to the hospital for
initiation of treatment with amiodarone [Cordarone] for atrial fibrillation
that has been refractory to other medications. Which statement by the
patient indicates a need for further teaching?
A. “I may have itching, malaise, and jaundice, but these symptoms
will subside.”
B. “I need to use sunblock to help keep my skin from turning
bluish gray.”
C. “I should not drink grapefruit juice while taking this medication.”
D. “I should report shortness of breath and cough and stop taking
the drug immediately.”
A nurse is providing teaching to a patient who is admitted to the hospital for
initiation of treatment with amiodarone [Cordarone] for atrial fibrillation
that has been refractory to other medications. Which statement by the
A. “I may have itching, malaise, and jaundice, but these
symptoms will subside.”
B. “I need to use sunblock to help keep my skin from turning
bluish gray.”
C. “I should not drink grapefruit juice while taking this medication.”
D. “I should report shortness of breath and cough and stop taking
the drug immediately.”
AMITRYPTILINE (ELAVIL)
TRICYCLIC • Nursing Considerations
– Contraindicated in MI, heart failure, QT
prolongation, glaucoma
– May increase risk for suicidal ideation
• MOA – May lead to photosensitivity, instruct pt to
use sunscreen
– tricyclic antidepressant –
– May turn urine blue/green color
increases effect of serotonin
– May cause arrhythmias, hypotension, EKG
and norepinephrine in the changes
CNS, exhibits anticholinergic – May cause alterations in blood glucose levels
effects – May lead to general sedation and lethargy
– Do not use within 2 weeks of MAOIs
– Instruct pt to take exactly as instructed
• Indications – Monitor for orthostatic hypotension
– Depression, anxiety, insomnia
AMLODIPINE
(NORVASC)CALCIUM CHANNEL
– Calcium channel blocker – – May cause gingival hyperplasia
antihypertensive – blocks – Grapefruit juice may increase
transport of calcium into drug level
muscle cells inhibiting – Monitor BP and pulse prior to
excitation and contraction and during therapy
– Monitor for signs of CHF
– Assess characteristics of angina
• Indications
– Instruct patient of interventions
– Hypertension
for hypertension and how to take
– Angina BP
AMOXICILLIN (PCN
ANTIBIOTIC) AMOXIL
– anti-infective/antiulcer agent – – Contraindicated with
aminopenicillins - inhibits penicillin allergy
synthesis of bacterial cell wall
leading to cell death – May cause seizures
– Assess for rash, anaphylaxis
– Excreted by kidneys –
• Indications
monitor renal function
– Skin infections, respiratory
infections, sinusitis, endocarditis – Monitor patient for diarrhea
prophylaxis, lyme disease – bloody stool should be
reported immediately
AMPICILLIN ANITINFECTIVE
• Nursing Considerations
• MOA – Contraindicated in penicillin allergy
– Anti-infective – aminopenicillin – Use caution in renal insufficiency

– bactericidal, broader spectrum – May lead to seizures, diarrhea,
that penicillin, binds to cell wall anaphylaxes, super infection
leading to bacterial cell death – Monitor LFTs
– Instruct patient on signs of super
infection: furry overgrowth on tongue,
• Indications vaginal itching, loose and foul smelling
stool
– Skin infections, soft tissue
infections, otitis media, sinusitis, – Pt should not use with oral contraceptive
use
respiratory infections, GU
infections, meningitis, septicemia
ASPIRIN

– non-opioid analgesic and antipyretic – Use caution with bleeding disorders
– salicylates – inhibits the and chronic alcohol use
production of prostaglandins which – May lead to Stevens-Johnson
leads to a reduction of fever and syndrome, laryngeal edema, and
inflammation, decreases platelet anaphylaxis
aggregation leading to a decrease in – Increases risk for bleeding with
ischemic diseases warfarin, heparin, and clopidogrel
– Increased risk for GI bleeding with
NSAID use
• Indications – Monitor LFTs
– Rheumatoid arthritis, osteoarthritis, – Concurrent use with alcohol may
ischemic stroke, MI prophylaxis increase risk for GI bleeding
ATENOLOL (BETA
BLOCKER)TENORMIN
– beta blocker – – Contraindicated in CHF,
antianginal/antihypertensive – pulmonary edema, cardiogenic
blocks the stimulation of beta 1 shock, bradycardia, heart block
receptors in the SNS with – Monitor HR/BP
minimal effects on beta 2 – May cause bradycardia, CHF,
receptors pulmonary edema
– Masks symptoms associated with
DM
• Indications
– Advise to change positions slowly
– Hypertension, angina,
prevention of MI – Instruct pt how to take BP
ATROPINE
• MOA
– antiarrhythmic/anticholinergic – inhibits • Nursing Considerations
effects of the parasympathetic nervous
– Avoid in acute hemorrhage,
system, specifically acetylcholine –
increases HR, bronchodilation,
tachycardia, and closed-angle
decreased GI and respiratory secretions glaucoma
– Monitor pt for tachycardia and
palpitations
• Indications
– May cause urinary retention in
– Decreases oral and respiratory
secretions, treats sinus bradycardia and elderly patients
heart block, treatment of bronchospasm – Patients may experience
constipation due to slowed GI
motility
A patient is brought to the emergency department after ingesting a handful
of diphenhydramine tablets. The patient has dilated pupils, a flushed face,
and tremors. The patient is agitated and has a heart rate of 110 beats per
minute. The nurse may anticipate administering which agents? (Select all
that apply.)
A. Activated charcoal
B. Atropine
C. Cathartics
D. Lorazepam
E. Second-generation H1 antagonists
A patient is brought to the emergency department after ingesting a handful
of diphenhydramine tablets. The patient has dilated pupils, a flushed face,
and tremors. The patient is agitated and has a heart rate of 110 beats per
minute. The nurse may anticipate administering which agents? (Select all
that apply.)
A. Activated charcoal
B. Atropine
C. Cathartics
D. Lorazepam
E. Second-generation H1 antagonists
AZITHROMYCIN
(ANTIINFECTIVE ZPAK
• MOA
– macrolide – anti-infective for atypical
mycobacterium – inhibits bacterial – May lead to pseudomembranous
protein synthesis colitis, pain diarrhea, nausea,
angioedema
• Indications – May increase risks for warfarin
– URI, chronic bronchitis, lower toxicity
respiratory infections, otitis media,
– Monitor for anaphylaxis
skin infections, STIs, prevention of
bacterial endocarditis, treatment of – Notify PCP for diarrhea or blood
cystic fibrosis or pus in stool
– Instruct pt to take as prescribed
BENZOTROPINE (COGENTIN)

– Anti-Parkinson agent – – May lead to arrhythmias,
anticholinergic – hypotension, palpitations, and
anticholinergic properties tachycardia
reduce tremors and rigidity – Anticholinergic effects like
constipation, dry mouth
– Assess for extrapyramidal
• Indications symptoms
– Treatment for Parkinson’s – Instruct pt to take as directed
Disease – Instruct pt to maintain good oral
hygiene
BISCODYL (SENEKOT)

– stimulant laxative – – May lead to hypokalemia
stimulates peristalsis leads to – May cause abdominal pain and
fluid accumulation in the cramps
colon – Use caution with milk
– Assess for abdominal distension
and bowel function
• Indications – Instruct pt to drink 1500-2000
– Treatment of constipation mL/day during therapy
– Bowel regimen – Monitor fluid and electrolyte

levels
BISMUTH
SUBSALICYLATE(PEPTOBISMO
• MOA • Nursing Considerations:
– adsorbent antidiarrheal/antiulcer – Contraindicated in aspirin
– stimulates the absorption of hypersensitivity
fluids and electrolytes in the
intestinal wall, reduction in – Increased risk for impaction
hypermotility of the stomach, with geriatric and pediatric
and binds to toxins patients
– Monitor LFTs
• Indications – Bismuth may interfere with
– Diarrhea, heartburn, indigestion, radiologic exams
H. pylori-associated ulcers
A patient is taking bismuth subsalicylate to prevent diarrhea. The nurse
performing an assessment notes that the patient’s tongue is black. What
will the nurse do?
A. Assess further for signs of gastrointestinal (GI) bleeding.
B. Reassure the patient that this is an expected side effect of this
drug.
C. Request an order for liver function tests to evaluate for
hepatotoxicity.
D. Withhold the drug, because this is a sign of bismuth overdose.
A patient is taking bismuth subsalicylate to prevent diarrhea. The nurse
performing an assessment notes that the patient’s tongue is black. What
will the nurse do?
A. Assess further for signs of gastrointestinal (GI) bleeding.
B. Reassure the patient that this is an expected side effect of
this drug.
C. Request an order for liver function tests to evaluate for
hepatotoxicity.
D. Withhold the drug, because this is a sign of bismuth overdose.
BUPROPION (WELLBUTRIN)ATYPICAL
ANTIDEPRESSANT • Nursing Considerations
– May lead to seizures, suicidal thoughts
– Do not administer if pt is taking
MAOIs or with grapefruit juice
• MOA
– Use caution with renal and liver
– aminoketones – impairment
antidepressant/smoking deterrent – Assess mental status
– relieves anxiety by binding to
– Instruct pt to avoid alcohol and CNS
dopamine and serotonin
depressants while taking bupropion
receptors
– May lead to dizziness, drowsiness,
fatigue, and weakness
• Indications – Pt may experience chest pain,
– Depression, smoking cessation, palpitations, tachycardia
treat ADHD in adults
– Management of anxiety
A patient who has been taking an SSRI tells the nurse that the drug has
caused reduced sexual performance, weight gain, and sedation. The nurse
will suggest that the patient ask the provider about using which drug?
A. Bupropion
B. Imipramine
C. Isocarboxazid
D. Trazodone
A patient who has been taking an SSRI tells the nurse that the drug has
caused reduced sexual performance, weight gain, and sedation. The nurse
will suggest that the patient ask the provider about using which drug?
A. Bupropion
B. Imipramine
C. Isocarboxazid
D. Trazodone
BUTORPHANOL(STADOL)

– opioid analgesic – alters – Use caution with concurrent
perception and response to use of MAOIs
pain by binding to opiate – May cause confusion,
receptors in CNS hallucinations, sedations
– Monitor for CNS depression
• Indications – Assess BP/HR/RR during
– Moderate to severe pain, administration
labor pain, sedation – Administer slowly through
IV line
CALCIUM ACETATE
(PHOSLO)
– (antacids – essential for nervous – May cause cardiac arrest and
muscular and skeletal systems, helps
arrhythmias
maintain cell membranes, aids in nerve
impulses and muscle contraction, aids – Phlebitis at site of insertion
in blood formation and coagulation – May cause hypotension,
bradycardia, and arrhythmias
• Indications – Administer slowly
– Treatment of hypocalcemia, prevention – Instruct pt on foods that contain

of postmenopausal osteoporosis, Vit D and encourage adequate
adjunct in cardiac arrest, control of intake
hyperphosphatemia with ESRD – Monitor parathyroid hormone
CAPTOPRIL(ACE) CAPOTEN)
– Can cause neutropenia – check
WBCs regularly
– Use cautiously with K+ supplements
• MOA and K+ sparing diuretics
– ACE-inhibitor – antihypertensive – – Use cautiously with diuretic therapy
blocks conversion of angiotensin I
to angiotensin II, increases renin
– Administer 1 hour before meals
levels and decreases aldosterone – Monitor BP, weight, renal panel, and
leading to vasodilation fluid status
– Monitor CBC frequently
• Indications – May lead to rhabdomyolysis
– Hypertension, management of – Dry cough

CHF, decrease progression of DM – Angioedema
neuropathy
CARBAMAZEPINE(TEGRATOL
) • Nursing Considerations
– Interferes with oral contraceptives
– Do not use with MAOIs or
• MOA
grapefruit juice
– anticonvulsant – affects Na+
– May cause suicidal thoughts
channels in neurons leading to
decreased synaptic – May cause Stevens-Johnson
transmission syndrome, agranulocytosis,
aplastic anemia, thrombocytopenia
– Monitor CBC and platelet count
• Indications – Monitor serum blood levels of
– Seizures, DM neuropathy, pain medication often
associated with trigeminal
neuralgia, bipolar disease
CARBIDOPA/LEVODOPA

– (dopamine agonist – levodopa – May cause orthostatic
is converted to dopamine and hypotension
works as a neurotransmitter – May cause dark urine
and carbidopa prevents the – Weeks to month for full effect
destruction of levodopa – Do not use with MAOIs
– Don’t use with glaucoma or
melanoma
• Indications
– Assess for Parkinson’s symptoms
– Parkinson’s Disease
– B6 supplement
CEFACLOR (CECLOR)

– 2nd generation cephalosporin – Contraindicated in cephalosporin
– bactericidal, binds to and possibly penicillin allergies
bacterial cell wall causing – May lead to seizures,
cell death pseudomembranes colitis,
diarrhea, phlebitis at IV site,
anaphylaxis
• Indications – Assess infection and allergies

– Obtain cultures prior to therapy
– Treatment of respiratory tract
infections, skin infections, – Monitor bowel function
otitis media – May lead to super infection
CEFDINIR (OMMICEF)
– Contraindicated in cephalosporin
• MOAI and possibly penicillin allergies
– (2nd generation cephalosporin – May lead to seizures,
– binds to bacterial cell wall pseudomembranous colitis,
causing cell death diarrhea, phlebitis at IV site,
anaphylaxis
– Assess infection and allergies
• Indications
– Obtain cultures prior to therapy
– Treatment of skin infections, – Monitor bowel function
otitis media
– May lead to super infection
CELECOXIB (CELEBREX)

– antirheumatic/NSAID – – Use caution with
decreases pain and cardiovascular disease
inflammation by inhibiting – Increases risk for MI, CVA,
synthesis of prostaglandins thrombosis
– May cause GI bleeding,
• Indications dermatitis
– Osteoarthritis, rheumatoid – Notify HCP for new-onset
arthritis, acute pain abdominal pain or black stool
CEPHALEXIN (KEFLEX)

– Anti-infective (1st generation – Contraindicated with serious
cephalosporin) – bactericidal: penicillin allergies
binds to bacterial cell wall – May lead to seizures,
leading to cell death pseudomembranous colitis,
diarrhea, phlebitis at IV site,
anaphylaxis
• Indications – Obtain cultures prior to therapy
– Skin infections, pneumonia, – Monitor bowels

UTI, otitis media – May lead to super infection
– May cause elevated LFTs
CHLORPROMAZINE
(THORZINE)
• MOA
– Antipsychotic/antiemetic – • Indications
phenothiazines (dopamine D2 receptor
– May cause neuroleptic
antagonist) – exhibits anticholinergic
activity, alters effects of dopamine in
malignant syndrome,
CNS sedation, tardive dyskinesia,
hypotension, agranulocytosis
– Assess mental status prior to
• Indications
and during treatment
– 2nd line treatment of schizophrenia and
psychosis, nausea/vomiting, pre-op – Monitor BP
sedation, acute intermittent porphyria, – Monitor CBC and LFTs
headache, bipolar d/o
– Ensure adherence
CIMETIDINE (H2BLOCKER)
TAGAMENT
• MOA • Nursing Implications
– Antiulcer agent – histamine H2 – Increases serum warfarin level
antagonist – inhibits action of – Can lead to respiratory infection
histamine leading to inhibition of
– Monitor for arrhythmias
gastric acid secretion
– May cause agranulocytosis,
aplastic anemia
• Indications – Monitor CBC during therapy
– Treatment of duodenal ulcers, – Instruct pt to increase fluid and
GERD, heartburn, Zollinger fiber to decrease constipation
Ellison Syndrome, prevention of
GI bleeding in critical patients
CIPROFLOXACIN (CIPRO)

– Anti-infective – fluoroquinolone – May cause QT prolongation,
– inhibits bacterial DNA avoid use with other drugs that
synthesis cause QT prolongation
– Can cause seizures, arrhythmias,
pseudomembranous colitis,
• Indications anaphylaxis, Stevens Johnson
– UTI, gonorrhea, respiratory tract syndrome
infections, bronchitis, – May decrease phenytoin levels
pneumonia, skin and bone
– Monitor renal function and LFTs
infections, infectious diarrhea,
abdominal infections
CLINDAMYCIN (CLEOCIN)
OTHER ANTIINFECTIVE
– Anti-infective – inhibits – Potential for arrhythmias,
bacterial protein synthesis pseudomembranous colitis,
diarrhea, phlebitis
– Monitor bowel function
• Indications
– Monitor CBC and LFTs
– Skin infections, respiratory
tract infections, septicemia,
intra-abdominal infections,
osteomyelitis
CLOPIDOGREL (PLAVIX)

– Platelet aggregation inhibitor – May cause GI bleeding,
– antiplatelet agent neutropenia,
hypercholesterolemia
– May increase risk for bleeding in
• Indications warfarin, aspirin, heparin therapy
– Can increase risk for bleeding
– Atherosclerotic events, MI,
with garlic, gingko, ginger
CVA, PVD, ACS
– Monitor CBC and platelet count
– Discontinue use 5-7 days before
surgery
CODEINE
• MOA
– Opioid agonist – binds to opiate • Nursing Implications
receptors in the CNS and alters
– May cause alterations in
perception of pain while producing a
mentation, hypotension,
general depression of the CNS – the
depression also causes a decrease in constipation, nausea, vomiting
the cough reflex and GI motility – Assess BP, HR, and RR prior
to administration and
throughout therapy
• Indications
– Use caution in pt on MAOI
– Management of pain, diarrhea,
– Naloxone is antidote for
cough suppressant
opioid agonists
CORTISONE
• Nursing Implications
– Excreted by liver – monitor LFTs
– Avoid in active untreated infections
• MOA – May cause CNS alterations

– May cause peptic ulcers
– Corticosteroid – antiasthmatic,
corticosteroid – Replaces – May cause Cushingoid appearance
cortisol ins states of deficiency, (buffalo hump, mood face)
suppresses inflammation and – Weight gain
normal immune response – Osteoporosis
– Decreased wound healing
– May elevate blood sugars
• Indications
– May increase cholesterol and lipid
– Management of adrenocortical values
insufficiency (Addison’s
Disease)
A patient who has chronic adrenal insufficiency is admitted to the hospital
for an open cholecystectomy. The nurse obtaining the admission history
learns that the patient takes hydrocortisone 25 mg PO daily in the morning.
The patient’s surgery is scheduled for the next morning. The nurse will
expect an order to:
A. administer the usual morning dose of hydrocortisone 25 mg PO.

B. administer hydrocortisone 50 mg PO in the morning.
C. administer hydrocortisone 50 mg IV before surgery.
D. withhold the morning dose of hydrocortisone and give it after
surgery.
A patient who has chronic adrenal insufficiency is admitted to the hospital
for an open cholecystectomy. The nurse obtaining the admission history
learns that the patient takes hydrocortisone 25 mg PO daily in the morning.
The patient’s surgery is scheduled for the next morning. The nurse will
expect an order to:
A. administer the usual morning dose of hydrocortisone 25 mg PO.
B. administer hydrocortisone 50 mg PO in the morning.
C. administer hydrocortisone 50 mg IV before surgery.
D. withhold the morning dose of hydrocortisone and give it after
surgery.
CYCLOSPORINE
(GENGRAF)IMMUNOSUPPRESIVE
– May cause seizures, tremors,
hypertension, hepatotoxicity,
• MOA diarrhea, N/V, gingival hyperplasia
– Polypeptide (cyclic) – – Increase immune suppression with
immunosuppressant, corticosteroids
antirheumatic (DMARD) –
– Avoid grapefruit juice
inhibits normal immune response
– Assess for signs of organ rejection
– Monitor renal panel & LFTs
• Indications – Lifelong therapy required for
– Prevention of rejection in transplant patients
transplantation, treatment of – Instruct pt on how to take BP
severe RA, management of
ulcerative colitis
DEXAMETHASONE
– Excreted by liver – monitor LFTs
– Avoid in active, untreated infections
• MOA – May cause CNS alterations
– Corticosteroid – suppresses – May cause peptic ulcers
inflammation and normal – May cause cushingoid appearance
immune response – used in (buffalo hump, moon face)
inflammatory states to – Weight gain
decrease inflammation
– Osteoporosis
– Decreased wound healing
• Indications – May increase blood sugars and
cholesterol/lipid levels
– Cerebral edema
DIAZEPAM VALIUM

– Benzodiazepine – depresses – Contraindicated in hepatic
CNS response dysfunction
– Use caution with renal
impairment
• Indications – Can cause dizziness, drowsiness,
– Anxiety, pre-op sedation, lethargy, hypotension, physical
conscious sedation, treatment dependence, tolerance
of seizures, insomnia, – Avoid concurrent alcohol use
management of alcohol – Flumazenil is reversal agent
withdrawal (antidote)
DIGOXIN
– Excreted by kidneys
– Assess for hypersensitivity
– Contraindicated with uncontrolled ventricular
• MOA arrhythmias
– Digitalis glycoside – Hypokalemia increase risk for toxicity
(antiarrhythmic, inotropic) – – Hypercalcemia increases risk for toxicity
positive inotropic effect (increases – Use with caution with diuretic use as they may
force of myocardial contraction), cause electrolyte abnormalities that can lead to
prolongs refractory period, toxicity
decreases conduction through SA – Assess patient for cardiac arrhythmias including
and AV nodes  give to increase bradycardia
cardiac output and slow the rate
– Monitor for signs of toxicity (blurred vision,
• Indications yellow, green vision disturbances)
– CHF, A-Fib, A-Flutter – Monitor pulse rate for 1 full minute before
dosing pt (hold HR <60)
A patient who will begin taking colchicine for gout reports taking
nonsteroidal anti-inflammatory drugs, simvastatin, amoxicillin, and
digoxin. What will the nurse do?
A. Contact the provider to discuss using a different antibiotic
while this patient is taking colchicine.
B. Notify the provider about the potential risk of muscle injury
when simvastatin is taken with colchicine.
C. Request an order for cardiorespiratory monitoring, because the
patient is taking digoxin.
D. Suggest that the nonsteroidal anti-inflammatory drugs
(NSAIDs) be withdrawn during colchicine therapy.
A patient who will begin taking colchicine for gout reports taking
nonsteroidal anti-inflammatory drugs, simvastatin, amoxicillin, and
digoxin. What will the nurse do?
A. Contact the provider to discuss using a different antibiotic
while this patient is taking colchicine.
B. Notify the provider about the potential risk of muscle injury
when simvastatin is taken with colchicine.
C. Request an order for cardiorespiratory monitoring, because the
patient is taking digoxin.
D. Suggest that the nonsteroidal anti-inflammatory drugs
(NSAIDs) be withdrawn during colchicine therapy.
DILTIAZEM (CARDIZEM)
ACLS • Nursing Implications
– Contraindicated in 2nd and 3rd AV block
• MOA – May cause arrhythmias, CHF,
bradycardia, peripheral edema,
– Calcium-channel blocker
gingival hyperplasia
(antianginal, antiarrhythmic,
antihypertensive) – inhibits calcium – Increases digoxin levels
transport resulting in inhibition of – Avoid grapefruit juice
excitation and contraction, leads to – Assess for signs CHF
depression of AV and SA node
– Monitor EKG
leading to decreased HR, leads to
vasodilation and decreased BP – Pt should change positions slowly
– Monitor K+
• Indications
– Instruct pt how to take BP
– HTN, angina, SVT, A-Fib, A-Flutter
DIPHENHYDRAMINE
BENEDRYL • Nursing Implications
– May cause drowsiness, anorexia,
• MOA dry mouth, nausea, chest tightness,
thick secretions, hypotension,
– Antihistamine/antitussive – blurred vision, headache
antagonizes effects of
– Anticholinergic effects
histamine, CNS depression
– Assess purpose of medication prior
to giving it
• Indications – Assess allergies, sleep patterns,
cough and lung sounds
– Allergy, anaphylaxis,
sedation, motion sickness, – Patient should avoid other over-the-
antitussive counter cough and cold remedies
DIPHENOXYLATE/ATROPINE
LOMOTIL
– Anticholinergic, antidiarrheal – Contraindicated in angle-
– inhibits GI motility via closure glaucoma, dehydration
anticholinergic effects – Structurally related to opioids
so use caution with patients
that have allergies to opioids
• Indications – Side effects: constipation,
– Treatment for diarrhea tachycardia, dizziness, ileus
– Monitor LFTs
DIVALPROEX (VALPROIC ACID
DERIVATIVE) DEPAKOT SPRINKLES

– Anticonvulsant – increases – May cause suicidal thoughts,
the level of GABA in CNS agitation, dizziness,
insomnia, hepatotoxicity,
pancreatitis
• Indications – Increases risk for bleeding
– Seizures, manic episodes, with warfarin
prevention of headache – Use caution with MAOIs
– Monitor LFTs
DOBUTAMINE ACLS
– Monitor hemodynamics: HTN,
• MOA increased HR, PVCs
– Beta-adrenergic agonist – Skin reactions may occur with
(inotropic) – positive inotropic hypersensitivity
effect (increases cardiac output) – Beta blockers may negate therapeutic
with very little effect on heart effects of dobutamine
rate – stimulates Beta1 receptors
– Monitor cardiac output
in the heart
– Monitor peripheral pulses before,
during and after therapy
• Indications – DO NOT confuse dobutamine with
dopamine
– Short-term management of heart
failure
A patient is receiving dobutamine as a continuous infusion in the
immediate postoperative period. The patient also is receiving a diuretic.
What adverse drug reactions are possible in this patient? (Select all that
apply.)
A. Angina
B. Dysrhythmias
C. Hypotension
D. Oliguria
E. Tachycardia
A patient is receiving dobutamine as a continuous infusion in the
immediate postoperative period. The patient also is receiving a diuretic.
What adverse drug reactions are possible in this patient? (Select all that
apply.)
A. Angina
B. Dysrhythmias
C. Hypotension
D. Oliguria
E. Tachycardia
DOPAMINE
• MOA
– Adrenergic (inotropic, vasopressor) – • Nursing Implications
smaller doses result in renal vasodilation;
– Monitor hemodynamics closely:
doses 2-10 mcg/kg/min result in cardiac
BP, HR, EKG, CVP, PAOP
stimulation by acting on beta1 receptors;
doses >10 mcg/kg/min stimulate alpha – Obtain parameters for
receptors leading to vasoconstriction hemodynamic values
(increases SVR)
– Titrate to obtain appropriate BP
(more potent vasoconstrictors
• Indications may be required)
– Improve BP, cardiac output and urine – Irritation may occur at IV site
output
– Beta blockers may counteract
therapeutic effects
ENALAPRIL VASOTEC ACE
– Can cause neutropenia – check
WBCs regularly
• MOA
– Use cautiously with K+
– ACE inhibitor (antihypertensive)
supplements and potassium sparing
– blocks conversion of
diuretics
angiotensin I to angiotensin II,
increases renin levels and – Use cautiously with diuretic therapy
decreased aldosterone leading to – Administer 1 hour before meals
vasodilation – Monitor BP and daily weights
– Monitor renal profile
• Indications – Note SE of dry cough
– HTN, management of CHF
ENOXAPARIN LOVENOX

– Antithrombotic – Contraindicated in pork
(anticoagulant) – prevents hypersensitivity
thrombus formation by – Monitor for signs of bleeding
potentiating the inhibitory – Administer in subcutaneous
effect of antithrombin on tissue (far left/right abdomen)
factor Xa and thrombin – DO NOT eject air bubble prior to
injection
– DO NOT aspirate or massage site
• Indications
– D/C 12-24 hours before surgery
– Prevention of DVT/PE
A patient has been receiving heparin while in the hospital to treat deep vein
thromboses and will be discharged home with a prescription for
enoxaparin. The nurse provides teaching for the nursing student who asks
about the advantages of enoxaparin over heparin. Which statement by the
student indicates a need for further teaching?
A. “Enoxaparin does not require coagulation monitoring.”
B. “Enoxaparin has greater bioavailability than heparin.”
C. “Enoxaparin is more cost-effective than heparin.”
D. “Enoxaparin may be given using a fixed dosage.”
A patient has been receiving heparin while in the hospital to treat deep vein
thromboses and will be discharged home with a prescription for
enoxaparin. The nurse provides teaching for the nursing student who asks
about the advantages of enoxaparin over heparin. Which statement by the
student indicates a need for further teaching?
A. “Enoxaparin does not require coagulation monitoring.”
B. “Enoxaparin has greater bioavailability than heparin.”
C. “Enoxaparin is more cost-effective than heparin.”
D. “Enoxaparin may be given using a fixed dosage.”
EPINEPHRINE EPI PEN
– S/E: angina, tachycardia, HTN,
restlessness, nervousness, hyperglycemia
– Use with MAOI may lead to hypertensive
• MOA crisis
– Adrenergic agonist (antiasthmatic, – Patients should not use stimulants
bronchodilator, vasopressor) – (caffeine, guarana, etc.)
affects both beta1 and beta2 also – Excessive use may cause bronchospasm
alpha agonist properties – results in – Assess lung sounds, HR, BP
bronchodilation, increases HR and
– Monitor for chest pain
BP
– Increase fluids to liquefy secretions
– Mouth should be rinsed post inhalation
• Indications
– Beta blocker may negate effects
– Asthma and COPD exacerbations, – May increase blood glucose levels
allergic reactions, cardiac arrest,
anesthesia adjunct
A nurse is caring for a patient who has been taking low-dose aspirin for
several days. The nurse notes that the patient has copious amounts of
watery nasal secretions and an urticarial rash. The nurse will contact the
provider to discuss:
A. administering epinephrine.
B. changing to a first-generation NSAID.
C. reducing the dose of aspirin.
D. giving an antihistamine.
A nurse is caring for a patient who has been taking low-dose aspirin for
several days. The nurse notes that the patient has copious amounts of
watery nasal secretions and an urticarial rash. The nurse will contact the
provider to discuss:
A. administering epinephrine.
B. changing to a first-generation NSAID.
C. reducing the dose of aspirin.
D. giving an antihistamine.
EPOETIN PROCRIT

– Hormones (antianemic) – – Contraindicated in albumin
hypersensitivity
stimulates erythropoiesis
– May cause seizures, CHF, MI,
CVA, HTN
– Monitor BP during therapy
• Indications
– Monitor for signs of anemia
– Anemia
– Assess HD shunts
– Monitor bleeding times
– Initiate seizure precautions
– Do not shake vial
ERYTHROMYCIN
• MOA
– Macrolide (anti-infective) – suppresses • Nursing Implications
bacterial protein synthesis, – Causes QT prolongation,
bacteriostatic
ventricular arrhythmias
– Diarrhea
• Indications – Assess infection
– Useful in place of penicillin when
– Monitor LFTs
patient cannot take penicillin, upper
and lower respiratory tract infections, – Instruct pt to complete course
otitis media, skin infections, pertussis, even if feeling better
syphilis, rheumatic fever
– Medication should not be
shared
ESCITALOPRAM LEXAPRO

– SSRI (antidepressant) – – Contraindicated with MAOI
selectively inhibits reuptake – May cause suicidal thoughts,
of serotonin insomnia, drowsiness, diarrhea,
nausea, serotonin syndrome
– May cause QT prolongation
• Indications with certain medications
– Major depressive disorder, – Assess for sexual dysfunction
anxiety disorder, OCD, – May take 4-6 weeks for full
PTSD, social phobia effect to take place
FAMOTIDINE PEPCID H2
• MOA
– Histamine H2 antagonist (antiulcer agent) –
blocks action of histamine located in
gastric parietal cells, inhibits gastric acid – May cause arrhythmias,
secretion
agranulocytosis, aplastic
anemias
• Indications
– Assess for abdominal pain
– Short-term treatment of active ulcer,
and occult blood
GERD, treatment of heartburn, indigestion,
Zollinger Ellison syndrome, prevention of – Monitor CBC
GIB in critically-ill pts, management of sx
associated with overuse of NSAIDs
– Instruct pt to increase fluid
and fiber intake to prevent
constipation
FENTANYL SUBLIMAZE

– Opioid agonist (opioid analgesic) – Use caution with increased ICP,
– binds to opiate receptors in head trauma, adrenal insufficiency
CNS altering perception of pain, – Avoid use with MAOIs
producing CNS depression – May cause apnea, laryngospasm,
decreased respirations,
bradycardia, hypotension
• Indications
– Do not consume grapefruit juice
– Supplement to general
while taking
anesthesia, continuous IV
infusion for purpose of analgesia – Monitor hemodynamics and assess
pain frequently
An adult male patient is 1 day postoperative from a total hip replacement.
On a pain scale of 0 to 10, with 10 being the greatest pain, the patient
reports a pain level of 10. Which medication would be most appropriate for
the nurse to administer to this patient?
A. 60 mg morphine sulfate PO
B. 75 mg meperidine [Demerol] intramuscularly
C. 6 mg morphine sulfate intravenously
D. Fentanyl [Duragesic] patch 50 mcg transdermally
An adult male patient is 1 day postoperative from a total hip replacement.
On a pain scale of 0 to 10, with 10 being the greatest pain, the patient
reports a pain level of 10. Which medication would be most appropriate for
the nurse to administer to this patient?
A. 60 mg morphine sulfate PO
B. 75 mg meperidine [Demerol] intramuscularly
C. 6 mg morphine sulfate intravenously
D. Fentanyl [Duragesic] patch 50 mcg transdermally
FERROUS SULFATE IRON

– Iron supplement (antianemic) – – May cause seizures, hypotension,
iron is essential for hemoglobin, constipation, epigastric pain,
diarrhea, skin staining, anaphylaxis
myoglobin and enzymes – it is
transported to organs where it – Assess nutritional status, bowel
function
becomes part of iron stores
– Monitor HGB, HCT, Fe levels
– May cause elevated liver enzymes
• Indications – Take on empty stomach and with
– Prevention and treatment of vitamin C to increase absorption
iron-deficiency anemia – Use z-track method for IM
injections
FLUOXETINE PROZAC
– Do not use if taking MAOIs
– May cause suicidal thoughts,
drowsiness, anxiety, sexual
• MOA dysfunction, insomnia, palpitations
– SSRI (antidepressant) – – Monitor closely for serotonin
inhibits reuptake of serotonin syndrome
– Concurrent use with certain
medications may lead to QT
• Indications prolongation
– Monitor for mood changes, suicidal
– Depressive disorder, OCD,
ideation, nutritional status
bulimia, panic disorder,
– May cause elevated LFTs
bipolar disorder, anorexia,
ADHD, DM neuropathy, – Instruct to maintain good oral hygiene
obesity, PMS
FLUTICASONE RESPIRATORY
INHALED • Nursing Implications
– Use cautiously with untreated infections
and suppressed immune function
• MOA
– May cause headache, insomnia,
– Corticosteroid bronchospasm, nasal congestion,
(antiasthmatic, anti- adrenal suppression
inflammatory) – locally – Monitor respiratory status
acting anti-inflammatory – May lead to decreased bone density
– Instruct pts using corticosteroids and
bronchodilators to use bronchodilators
• Indications first
– Prophylactic asthma – Instruct to stop smoking
treatment
FUROSEMIDE LASIX
DIURETICS • Nursing Implications
– Use caution with liver disease
– May cause hypotension, dry mouth,
• MOA excessive urination, dehydration,
electrolyte abnormalities, metabolic
– Loop diuretic – prevents alkalosis
reabsorption of sodium and – Hypokalemia may lead to increased risk
chloride in the kidneys, of digoxin toxicity
increase excretion of water, – Monitor renal function
sodium chloride, magnesium, – Use caution with other
potassium antihypertensives
– Causes arthritic symptoms/do not
administer with aminoglycosides due to
• Indications ototoxicity
– Edema, hypertension
GABAPENTIN NEUROTIN CNS

– Analgesic adjunct, – May cause suicidal thoughts,
anticonvulsant, mood confusion, depression,
stabilizer drowsiness, ataxia, facial edema,
hypertension
– Monitor pt closely for changes
• Indications in behavior and depression
– Seizures, peripheral – Assess for seizure activity

neuropathy, neuropathic pain, – Assess pain level
prevention of migraines, – Patient should take medication
bipolar dx exactly as prescribed
GENTAMYCIN

– Aminoglycoside (anti- – Causes tinnitus – hearing
infective) – inhibits bacterial loss/do not administer with
protein synthesis penicillin
– Use caution in renal
impairment
• Indications – Assess for infection
– Treatment of gram negative – Obtain cultures prior to therapy
infections when penicillin is – Monitor LFTs
ineffective
– Monitor blood levels of drug
GLIPIZIDE GLUCOTROL
SULFONYLUTREAS
– Stimulates release and – May cause aplastic anemia,
hypoglycemia, photosensitivity,
sensitivity to insulin to lower
dizziness, headache, diarrhea
blood glucose (anti-diabetic
– Monitor CBC
– sulfonylurea)
– Assess for allergy to sulfonamides
– Beta Blockers may create signs of
• Indication hypoglycemia
– Type 2 Diabetes Mellitus – Instruct on checking blood sugar

can carrying source of sugar in
case of hypoglycemia
A patient who has type 2 diabetes will begin taking glipizide. Which
statement by the patient is concerning to the nurse?
A. “I will begin by taking this once daily with breakfast.”

B. “It is safe to drink grapefruit juice while taking this drug.”
C. “I may continue to have a glass of wine with dinner.”
D. “I will need to check my blood sugar once daily or more.”
A patient who has type 2 diabetes will begin taking glipizide. Which
statement by the patient is concerning to the nurse?
A. “I will begin by taking this once daily with breakfast.”

B. “It is safe to drink grapefruit juice while taking this drug.”
C. “I may continue to have a glass of wine with dinner.”
D. “I will need to check my blood sugar once daily or more.”
GLUCAGON

– Stimulates production of – Many cause anaphylaxis
glucose and relaxes GI tract – May cause hypotension
(hormone – pancreatic)
– Assess for signs of
hypoglycemia and neuro
• Indications status
– Severe hypoglycemia, – Monitor serum glucose levels

antidote for Beta Blockers – Teach patient signs of
and Calcium Channel hypoglycemia
Blockers
GUAIFENESIN MUCINEX

– Decreases viscosity of and – Patient should avoid OTC
mobilizes secretions cold medications
(expectorant) – Assess lung sounds
– Maintain adequate fluid
• Indications intake
– Cough suppression
– Expectorant
HALOPERIDOL HALDOL 1 ST
GENERATION
– Alters effect of dopamine – Extrapyramidal symptoms
(antipsychotic – – Use caution in QT prolongation
butyrophenone) – May cause seizures, constipation,
dry mouth, agranulocytosis
– Assess for hallucinations
• Indications
– Monitor hemodynamics
– Schizophrenia
– Monitor for neuroleptic
– Mania
malignant syndrome
– Aggressive and agitated patient – Monitor CBC with differential
A patient with schizophrenia has been taking an antipsychotic drug for
several days. The nurse enters the patient’s room to administer a dose of
haloperidol and finds the patient having facial spasms. The patient’s head
is thrust back, and the patient is unable to speak. What will the nurse do?
A. Administer the haloperidol as ordered.

B. Discuss increasing the haloperidol dose with the provider.
C. Request an order to give diphenhydramine.
D. Request an order to give levodopa.
A patient with schizophrenia has been taking an antipsychotic drug for
several days. The nurse enters the patient’s room to administer a dose of
haloperidol and finds the patient having facial spasms. The patient’s head
is thrust back, and the patient is unable to speak. What will the nurse do?
A. Administer the haloperidol as ordered.

B. Discuss increasing the haloperidol dose with the provider.
C. Request an order to give diphenhydramine.
D. Request an order to give levodopa.
HEPARIN

– Increases inhibitory effect of – Monitor for signs of bleeding
antithrombin on factor Xa
– Monitor platelet count
(anticoagulant/antithrombotic)
– May cause hypokalemia
– Teach patient to report any
• Indications signs of bleeding
– Venous thromboembolism
prophylaxis and treatment
– Low-dose used to ensure
patency of IV catheters
HYDRALAZINE APRESOLINE
NITRATES VASODIALATORS
– Arterial vasodilator (anti- – May cause tachycardia,
hypertensive – vasodilator) sodium retention,
arrhythmias, angina
– Use caution with MAOIs
• Indications
– Monitor BP
– Hypertension
– Instruct patient on how to
take BP
HYDROCHLOROTHIAZIDE
HCTZ • Nursing Implications
• MOA
– May cause dizziness, hypokalemia,
– Increases sodium and water excretion
hyponatremia, hypophosphatemia,
and produces arterial dilation
(antihypertensive – thiazide diuretic) hypomagnesemia, dehydration
– Hypokalemia can increase risk for
digoxin toxicity
• Indications – Monitor BP and I&Os
– Hypertension
– Monitor electrolyte levels
– CHF
– Patient should take medication at the
– Renal dysfunction same time each day even if feeling
– Cirrhosis better
– Glucocorticoid therapy – Education pt on how to take BP
HYDROCODONE/
ACETAMINOPHEN LORTAB
• MOA – Use caution with concurrent use of
MAOI – avoid use within 14 days of
– Alters the perception and each other
reaction to pain by binding to
– Hypotension – monitor hemodynamics
opiate receptors in the CNS and
and respirations after administration
also suppresses cough reflex
– May cause ICP – use caution with
(opioid agonist/nonopioid
head trauma
analgesic combination)
– Naloxone in the antidote for overdose
– Do not exceed 4g of acetaminophen
• Indications per day
– Management of moderate to
severe pain
HYDROMORPHONE DIULADID
– Assess BP, respirations, and pulse
before administration – medication
• MOA
causes general CNS depression
– Alters the perception and – Naloxone is antidote for overdose
reaction to pain by binding to
– Use caution with concurrent use of
opiate receptors in the CNS
MAOI – avoid use within 14 days
and suppresses cough reflex
of each other
(opioid analgesic – opioid
agonist) – May be used as antitussive
– Advised to dilute with NS prior to
administration and to administer
• Indications slowly in CNS depression
– Moderate to severe pain
IBUPROFEN MOTRIN

– Decreases pain and – May cause GI bleeding, hepatitis,
inflammation by inhibiting Stevens-Johnson Syndrome
prostaglandins (nonsteroidal – May cause anaphylaxis
anti-inflammatory drug – – Monitor for headache, nausea,
nonopioid analgesics) vomiting, constipation
– Therapy should be discontinued
after first sign of rash
• Indications
– Monitor renal and liver labs
– Mild to moderate pain – Patient should avoid using
– Inflammatory states alcohol
INDOMETHACIN INDOCIN
– Monitor for hepatitis and GI bleeding
• MOA – Monitor for dizziness, drowsiness,
– Decreases pain and inflammation and headache
by inhibiting prostaglandin
– ASA may decrease effectiveness
synthesis (antirheumatic, ductus
arteriosis adjunct-IV, NSAID) – Monitor renal labs
– Shake suspension before
administration
– Patient should wear sunscreen and
• Indications protective clothing to protect against
– Inflammatory disorders when photosensitivity
patients do not respond to other
medications
REGULAR INSULIN HUMULIN
R Route: Subcutaneous
Onset: 30-45 mins
Peak: 1.5-2.5 hrs
Duration: 4.5-6 hrs

– Stimulates uptake of glucose – Assess for symptoms of
into muscle and fat cells, inhibits hypoglycemia or hyperglycemia
production of glucose in the – Monitor body weight over time
liver, prevents breakdown of fat
– May cause decreased inorganic
and protein (antidiabetic,
pancreatic hormone) phosphates, potassium, and
magnesium
– Monitor blood sugars every 6
• Indications hours, monitor HgbA1C every
– Hyperglycemia with T1/T2 DM; 3-6 months
diabetic ketoacidosis
NPH INSULIN HUMULIN N
Route: Subcutaneous
Onset: 1-2 hrs
Peak: 4-12 hrs
Duration: 18-24 hrs

magnesium
• Indications hours and HgbA1C every 3-6
– Hyperglycemia with T1/T2 DM, months
DETEMIR/GLARGINE
INSULIN LEVEMIR Determir
Onset: 3-4 hrs
Peak: 3-4 hrs
Glargine
Onset: 3-4 hrs
Peak: NONE
Duration: 24 hrs Duration: 24 hrs

magnesium
ASPART/LISPRO/GLULISINE
INSULIN/ NOVOLOG
magnesium
LISPRO/ASPART/NPH-
REGULAR INSULIN MIXTURES
magnesium
A patient with type 1 diabetes is eating breakfast at 7:30 AM. Blood sugars
are on a sliding scale and are ordered before a meal and at bedtime. The
patient’s blood sugar level is 317 mg/dL. Which formulation of insulin
should the nurse prepare to administer?
A. No insulin should be administered.

B. NPH
C. 70/30 mix
D. Lispro
A patient with type 1 diabetes is eating breakfast at 7:30 AM. Blood sugars
are on a sliding scale and are ordered before a meal and at bedtime. The
patient’s blood sugar level is 317 mg/dL. Which formulation of insulin
should the nurse prepare to administer?
A. No insulin should be administered.

B. NPH
C. 70/30 mix
D. Lispro
IODINE

– Inhibits the release of thyroid – May cause GI bleeding,
hormones diarrhea, hypothyroidism,
goiter
– Monitor for hypersensitivity
• Indications
– Thyroidectomy pretreatment
– Thyrotoxic crisis
– Radiation exposure
ISONIAZIDE
– Can cause jaundice
• MOA – May cause peripheral neuropathy,
– Inhibits synthesis of seizures, hepatitis
mycobacterial cell wall – Patient should avoid high amounts of
(antitubercular agent) tyramine (pickled meats, aged/smoked
meats, alcohol, exotic/aged cheese)
– Monitor LFTs!!!
• Indications – Complete full course of therapy (6-12
months
– Tuberculosis
– Often used in combination with
rifampin
KETOROLAC TORDAL

– Pain relief due to – May cause GI bleeding,
prostaglandin inhibition Stevens-Johnson Syndrome,
(NSAID – nonopioid anaphylaxis, drowsiness
analgesic – pyrroziline – Should not exceed 5 days of
carboxylic acid) therapy
– Bleeding risk increased with
garlic, ginger, and ginkgo
• Indications – May decrease effectiveness of
– Pain hypertensive medications and
diuretics
LACTULOSE

– Draws water into the stool and – Use with caution in DM
softens stool, inhibits ammonia
– May cause cramps,
passing into the colon
(stimulant laxative – osmotic)
abdominal distention,
hyperglycemia
– Assess mental status,
• Indications ammonia levels, abdominal
– Constipation distention
– Portal-systemic encephalopathy – Patient should average 2-3
– Liver failure bowel movements per day
LAMOTRIGINE

– Inhibits sodium transport in – May cause suicidal thoughts,
neurons (anticonvulsant) dizziness, behavior changes,
photosensitivity, & Stevens
Johnson Syndrome
• Indications – Use caution with oral
– Seizures r/t epilepsy contraceptives
– Bipolar disorder adjunct – Assess mental status
– Assess for seizures
– DO NOT discontinue abruptly
A patient who has a seizure disorder is admitted to the hospital after an
increase in seizure frequency, and the prescriber orders carbamazepine 100
mg twice daily to be added to the patient’s medication regimen. The nurse
reviewing the patient’s medical history notes that the patient is already taking
lamotrigine 375 mg twice daily. The nurse will contact the provider to
discuss which action?
A. Reducing the carbamazepine dose to 50 mg twice daily

B. Reducing the lamotrigine dose to 225 mg twice daily
C. Increasing the carbamazepine dose to 200 mg twice daily
D. Increasing the lamotrigine dose to 500 mg twice daily
A patient who has a seizure disorder is admitted to the hospital after an
increase in seizure frequency, and the prescriber orders carbamazepine 100
mg twice daily to be added to the patient’s medication regimen. The nurse
reviewing the patient’s medical history notes that the patient is already taking
lamotrigine 375 mg twice daily. The nurse will contact the provider to
discuss which action?
A. Reducing the carbamazepine dose to 50 mg twice daily

B. Reducing the lamotrigine dose to 225 mg twice daily
C. Increasing the carbamazepine dose to 200 mg twice daily
D. Increasing the lamotrigine dose to 500 mg twice daily
LEVETIRACETAM

– Decreases severity and – May cause suicidal thoughts,
incidence of seizures dizziness, weakness
(anticonvulsant) – May alter RBC, WBC, and
liver function
– May cause somnolence
• Indications
– Should be infused over 15
– Seizure disorders
minutes
LEVOFLOXACIN
– Assess for allergies
– May cause prolonged QT prolongation
• MOA
– avoid use with other drugs that can
– Inhibits DNA synthesis in bacteria impact QT
(anti-infective – fluoroquinolone)
– Can cause seizures, arrhythmias,
pseudomembranous colitis,
anaphylaxis, Stevens Johnson
• Indications
Syndrome
– UTI
– May decrease phenytoin levels
– Gonorrhea – Monitor renal panel and LFTs
– Respiratory tract infections – Assess for infection – OBTAIN
(bronchitis, pneumonia) CULTURES PRIOR TO THERAPY
– Skin and bone infections
LEVOTHYROXINE

– Thyroid hormone – Assess pulse and monitor for
replacement in tachyarrythmias and chest pain
hypothyroidism (hormone – – Monitor TSH levels
thyroid preparations) – Overdose is presented as
hyperthyroidism
– Start with low doses and titrate up
• Indications – Therapy is lifelong
– Thyroid hormone – Take directly after breastfeeding
replacement in – Increases the effects of warfarin
hypothyroidism
LISINOPRIL
– Dry cough
• MOA – Assess for hypotension on initial

dose
– Blocks conversion of angiotensin
I to angiotensin II, increases – Use cautiously with potassium
renin levels and decreases supplements and potassium sparing
aldosterone leading to diuretics
vasodilation (antihypertensive – – Use cautiously with diuretic therapy
ACE inhibitor) – Administer 1 hour before meals
– Monitor fluid status – daily weight
• Indications – Monitor renal panel and LFTs
– Hypertension
– Management of CHF
LITHIUM

– Alters cation transport and – Do not administer with NSAIDs
neurotransmitter reuptake – Monitor drug levels frequently

(mood stabilizer) • Therapeutic level: 0.5-1.5 mEq/L
– May cause seizures, arrhythmias,
fatigue, confusion anorexia,
• Indications hypothyroidism, tremors
– ACE inhibitors may increase
– Bipolar disorder (mania)
serum levels
– Instruct patient to maintain
adequate fluid intake
The spouse of a patient with bipolar disorder (BPD) tells the nurse that the
patient will not stay on the lithium ordered by the provider longer than 1 or 2
months at a time. The nurse understands that adherence to medication
regimens in patients with BPD is problematic and will tell the spouse:
A. “During manic episodes, many patients don’t see the benefit of
prophylactic medications.”
B. “Increased gastrointestinal side effects occur over time and
reduce compliance.”
C. “Long-term use of lithium causes memory impairment, causing
patients to forget to take their medications.”
D. “Patients who are depressed do not want to take their medications.”
The spouse of a patient with bipolar disorder (BPD) tells the nurse that the
patient will not stay on the lithium ordered by the provider longer than 1 or 2
months at a time. The nurse understands that adherence to medication
regimens in patients with BPD is problematic and will tell the spouse:
A. “During manic episodes, many patients don’t see the benefit of
prophylactic medications.”
B. “Increased gastrointestinal side effects occur over time and
reduce compliance.”
C. “Long-term use of lithium causes memory impairment, causing
patients to forget to take their medications.”
D. “Patients who are depressed do not want to take their medications.”
LOPERAMIDE

– Inhibits peristalsis, reduces the – May lead to constipation –
volume of feces while ensure proper use
increasing the bulk and
– Assess bowel function
viscosity (antidiarrheal)
– Assess fluid and electrolyte
levels
• Indications
– Acute diarrhea
– Decrease drainage post
ileostomy
LORAZEPAM

– General CNS depression – Use with caution in COPD and
(anxiolytic – sleep apnea patients
benzodiazepine) – Avoid alcohol use
– Antidote is flumazenil
– May cause apnea, cardiac arrest,
• Indications bradycardia and hypotension
– Anxiety – Use caution with other CNS
depressants
– Sedation
– Administer slowly and dilute to
– Seizures decrease complications
LOSARTAN

– Inhibits vasoconstrictive – May cause hypotension,
properties of angiotensin II tachycardia, angioedema,
(antihypertensive – angiotensin hyperkalemia
II receptor antagonist ARB)
– May increase digoxin levels
– Assess BP/HR, fluid levels,
• Indications daily weights
– Hypertension – Monitor renal and liver
– DM neuropathy function
– CHF
MAGNESIUM SULFATE
• MOA
– Use caution with renal insufficiency
– Magnesium plays a role in muscle
excitability (mineral and electrolyte – May cause decreased respiratory
replacement/supplement) rate, arrhythmias, hypotension,
muscle weakness
– Monitor EKG and respiratory status
• Indications
– Hypomagnesemia
– Monitor Mg levels
– Hypertension (anticonvulsant with – Ensure dosage with 2nd person
eclampsia) – Calcium gluconate is the antidote
– Preterm labor • Mg toxicity results in respiratory
– Torsade de pointes depression and loss of DTRs
– Asthma
MANNITOL

– Inhibits reabsorption of water and – May cause phlebitis at IV
electrolytes by increased osmotic
site
pressure, excreted by kidneys
(osmotic diuretic) – May cause dehydration, fluid
and electrolyte imbalances
• Indications – Monitor neuro status
– Increased ICP – Administer via filter
– Oliguric renal failure
– Edema
– Intraocular pressure
MEPERIDINE
– May cause alterations in mentation,
hypotension, constipation
• MOA – Assess BP, HR, RR prior to
– Binds to opiate receptors in the administration and frequently during
CNS and alters perception of therapy
pain while producing a general – Use caution if patient is receiving
depression of the CNS (opioid MAOIs
agonist) – Naloxone is the antidote
– Can cause seizures
– May increase pancreatic enzyme levels
• Indications – Assess bowel function – administer
– Moderate to severe pain with stimulant laxative
– Sedation
METFORMIN

– Decreases glucose production – Do not use with renal
in the liver, decreases dysfunction or metabolic acidosis
absorption, increases cellular – May cause N/V/D and lactic
insulin insensitivity acidosis
(antidiabetic – biguanide) – Monitor closely for ketoacidosis
and lactic acidosis – D/C
immediately if acidotic
• Indications – May cause metallic taste
– Management of Type II DM – Instruct pt that medication does
not cure diabetes
A patient with polycystic ovary syndrome (PCOS) asks the nurse what she
can do to improve her chances of getting pregnant. Which statement by the
A. “Clomiphene will help induce ovulation but will not treat the
other symptoms of polycystic ovarian disease.”
B. “If I lose weight, my infertility and irregular periods could
resolve without medications.”
C. “Metformin improves insulin sensitivity and reduces male
hormone levels.”
D. “Spironolactone, which reduces androgens and facial hair, is
helpful if I’m trying to conceive.”
A patient with polycystic ovary syndrome (PCOS) asks the nurse what she
can do to improve her chances of getting pregnant. Which statement by the
A. “Clomiphene will help induce ovulation but will not treat the
other symptoms of polycystic ovarian disease.”
B. “If I lose weight, my infertility and irregular periods could
resolve without medications.”
C. “Metformin improves insulin sensitivity and reduces male
hormone levels.”
D. “Spironolactone, which reduces androgens and facial hair, is
helpful if I’m trying to conceive.”
METHADONE
– Use caution if on MAOIs
• MOA
– Binds to opiate receptors in the – May cause QT prolongation,
CNS and alters perception of hypotension, respiratory depression,
pain while producing a general dependence, confusion, sedation
depression of the CNS. – Assess pain, VS, bowel function
Suppresses withdrawal – May increase pancreatic enzyme
symptoms. (opioid agonist) levels
– Assess withdrawal symptoms
• Indications – May decease cough reflex and GI
– Pain motility
– Withdrawal
METHYLERGONOVINE

– Stimulates uterine muscles – Can cause hypertension,
causing uterine contraction cramps, N/V, dyspnea
(oxytocic – ergot alkaloid) – Monitor BP, HR, uterine
response
– Assess calcium levels –
• Indications
effectiveness decreases with
– Treatment of post-partum hypocalcemia
hemorrhage
– Monitor uterine bleeding and
notify HCP of any changes
METHYLPHENIDATE
– Can cause sudden death, hypertension,
palpitations, anorexia, hyperactivity,
• MOA insomnia
– Improves attention span in – May decrease effects of warfarin and
ADHD by producing CNS phenytoin
stimulation (CNS stimulant) – Do not use with MAOIs
– Monitor cardiovascular status,
behavioral changes and dependence
• Indications – Do not consume caffeinated beverages
– ADHD – “Drug Holiday” used to assess
dependence
– Narcolepsy
METHYLPREDNISONE
– Monitor liver profile
– Avoid in active, untreated infections
• MOA – May cause CNS alterations and
– Suppresses inflammation and peptic ulcer disease
normal immune response – May cause Cushingoid appearance
(corticosteroid) (buffalo hump, moon face), weight
gain, osteoporosis, decreased wound
healing and elevated blood glucose,
• Indications may increase cholesterol and lipid
– Inflammation values
– Teach to report signs of infection
– Allergy/asthma
– Avoid grapefruit juice
– Autoimmune disorders
– Prevention of organ rejection
METOCLOPRAMIDE

– Accelerates gastric emptying by – Don’t use with GI obstruction
stimulating motility (antiemetic) – May cause extrapyramidal
reaction, neuroleptic malignant
syndrome, tardive dyskinesia,
• Indications
arrhythmias, BP alterations,
– Prevention of N/V hematologic alterations, facial
– Hiccups movements, sedation
– Migraines – Can decrease effects of
– Gastric stasis levodopa
– Monitor LFTs
METOPROLOL
• MOA
– Blocks the stimulation of beta1 receptors • Nursing Implications
in the SNS (antianginal/antihypertensive
– beta blocker) – Monitor hemodynamics
– May lead to bradycardia,
• Indications pulmonary edema
– Tachyarrhythmias – Use caution with MAOIs
– Hypertension – Assess I&Os and monitor
– Angina and prevention of MI signs of CHF
– CHF – Contraindicated in asthma
– Migraine prophylaxis
METRONIDAZOLE
• MOA
– Inhibits DNA and protein synthesis in • Nursing Implications
bacteria (anti-infective, antiprotozoal,
antiulcer agent) – Do not take with alcohol-
disulfiram reaction
• Indications – Cultures obtained prior to
– Intra-abdominal infections therapy
– Gynecological infections – Monitor neurologic status:
– Skin infections, bone and joint infections, paresthesia, weakness,
CNS infections, septicemia, endocarditis ataxia, or seizures
– Amebic liver disease
– Monitor I&Os, daily weights
– Peptic ulcer disease
– May alter LFTs
MIDAZOLAM

– Acts to produce CNS depression – Assess level of sedation
– may be mediated by GABA during and for 2-6 hours
(anxiolytic – benzodiazepine) following
– Monitor BP, HR, RR during
• Indications IV administration
– Sedation – The antidote for overdose is
– Conscious sedation flumazenil
– Anesthesia
– Status epilepticus
A patient will receive intravenous midazolam combined with fentanyl
while undergoing an endoscopic procedure. The nurse is explaining
the reasons for this to a nursing student before the procedure. Which
statement by the student indicates understanding of the teaching?
A. “The patient may appear anxious and restless during the

procedure.”
B. “The patient will be unconscious during the procedure.”
C. “The patient will not need cardiorespiratory support
during the procedure.”
D. “The patient will not remember the procedure.”
A patient will receive intravenous midazolam combined with fentanyl
while undergoing an endoscopic procedure. The nurse is explaining
the reasons for this to a nursing student before the procedure. Which
statement by the student indicates understanding of the teaching?
A. “The patient may appear anxious and restless during the

procedure.”
B. “The patient will be unconscious during the procedure.”
C. “The patient will not need cardiorespiratory support
during the procedure.”
D. “The patient will not remember the procedure.”
MONTELUKAST

– Disrupts the effects of leukotrienes
– Assess respiratory status
which effect airway edema, smooth
muscle constriction, and cellular – Assess LFTs
activity (leukotriene antagonist)
– Does not treat acute asthma
attacks
• Indications – Alter mood status
– Prevent or treat asthma, manage
seasonal allergies
– Prevent exercise-induced
bronchoconstriction
A 7-year-old child with asthma uses a daily inhaled glucocorticoid and an
albuterol MDI as needed. The provider has added montelukast to the
child’s regimen. Which statement by the child’s parent indicates
understanding of this medication?
A. “I may notice mood changes in my child.”
B. “I should give this medication twice daily.”
C. “I will give my child one 4-mg chewable tablet daily.”
D. “This drug can alleviate symptoms during an acute attack.”
A 7-year-old child with asthma uses a daily inhaled glucocorticoid and
an albuterol MDI as needed. The provider has added montelukast to the
child’s regimen. Which statement by the child’s parent indicates
understanding of this medication?
A. “I may notice mood changes in my child.”
B. “I should give this medication twice daily.”
C. “I will give my child one 4-mg chewable tablet daily.”
D. “This drug can alleviate symptoms during an acute attack.”
MORPHINE

– Binds to opiate receptors in the – May cause alterations in
CNS and alters perception of mentation, hypotension,
pain while producing a general constipation, N/V
depression of the CNS
– Assess BP, HR, RR prior to
and during therapy
• Indications – Use caution if pt receives
– Pain MAOI
– Pulmonary edema – Naloxone is the antidote for
– MI opioid agonists
A postoperative patient has orders for morphine sulfate 1 to 2 mg IV every 1
hour PRN for severe pain and acetaminophen-hydrocodone 7.5 mg PO every 4
to 6 hours PRN for moderate pain. The patient reports pain at a level of 8 on a
scale of 1 to 10, with 10 being the worst pain. Which action by the nurse is
appropriate?
A. Administer acetaminophen-hydrocodone 7.5 mg PO every 4 hours.
B. Administer acetaminophen-hydrocodone 7.5 mg PO every 6 hours
and change to every 4 hours if not effective.
C. Administer morphine sulfate 1 mg IV every 1 hour until pain
subsides.
D. Administer morphine sulfate 2 mg IV and evaluate the patient’s
pain in 15 to 30 minutes.
A postoperative patient has orders for morphine sulfate 1 to 2 mg IV every 1
hour PRN for severe pain and acetaminophen-hydrocodone 7.5 mg PO every 4
to 6 hours PRN for moderate pain. The patient reports pain at a level of 8 on a
scale of 1 to 10, with 10 being the worst pain. Which action by the nurse is
appropriate?
A. Administer acetaminophen-hydrocodone 7.5 mg PO every 4 hours.
B. Administer acetaminophen-hydrocodone 7.5 mg PO every 6 hours
and change to every 4 hours if not effective.
C. Administer morphine sulfate 1 mg IV every 1 hour until pain
subsides.
D. Administer morphine sulfate 2 mg IV and evaluate the
patient’s pain in 15 to 30 minutes.
NALBUPHINE

– Alters perception and response – Use caution with head trauma
to pain, causes CNS depression – Can cause dizziness, headache,
(opioid agonist)
N/V, respiratory depression
– Do not use with MAOIs
• Indications – Assess pain & hemodynamic
– Pain & analgesia during labor parameters
– Sedation before surgery – May elevate pancreatic
enzymes
– Supplement to balance
anesthesia – Naloxone is the antidote
NAPROXEN

– Inhibits prostaglandin – Use caution with GI bleeding
synthesis (NSAID) – May increase risk for CVA &
MI
– ASA can decrease blood
• Indications
levels and effectiveness
– Pain
– Assess pain
– Dysmenorrhea
– Patients should remain
– Fever upright for 30 minutes after
– inflammation administration
NIFEDIPINE

– Blocks calcium transport resulting – Use caution in heart block,
in inhibition of contraction causing decreased BP
systemic vasodilation
– Don’t consume grapefruit juice
(antianginal/antihypertensive –
Calcium channel blocker) while taking medication
– May cause arrhythmias and
elevated LFTs
• Indications
– May cause gingival hyperplasia,
– Hypertension/Angina Steven’s Johnson Syndrome
– Migraines – Monitor BP/HR/Ca levels
– CHF
NITROPRUSSIDE

– Peripheral vasodilation of – Monitor BP/HR/EKG
arteries and veins decreasing continuously during therapy
preload and afterload
– May cause cyanide toxicity
(antihypertensive –
vasodilator) – Sympathomimetics may
decrease effectiveness
– PAWP (pulmonary artery
• Indications wedge pressure) monitoring
– Hypertensive crisis may help with MI and CHF
– Cardiogenic shock patients
NOREPINEPHRINE

– Increase BP and cardiac output – Monitor BP continuously
by stimulating alpha-adrenergic – Double-check all calculations
receptors in the blood vessels, with another nurse
demonstrates minor beta – May result in rebound
activity (vasopressor) hypotension due to tissue
ischemia when D/C’d
– Monitor EKG and CVP
• Indications
– If pt is awake, instruct to report
– Treatment of severe
headaches, dizziness, or chest
hypotension and shock
pain
NYSTATIN

– Causes leakage of fungal cell – May cause N/V/D
contents (antifungal agent) – Can be used to soak dentures
– Assess mucous membranes
• Indications
– Candidiasis
– Denture stomatitis
OLANZAPINE
• MOA
– Antagonizes dopamine and serotonin
(antipsychotic/mood stabilizer – – Do not use while breastfeeding
thienobenzodiazepine) – Can cause neuroleptic
malignant syndrome, seizures,
• Indications suicidal thoughts, insomnia,
– Schizophrenia
tardive dyskinesia,
agranulocytosis, constipation,
– Mania
tremors
– Depression
– Anorexia nervosa
– Assess mental status,
– N/V r/t chemotherapy
hemodynamics, blood glucose,
I&Os, and LFTs
OMEPRAZOLE

– Prevents the transport of H+ ions – Take 30-60 prior to eating
into the gastric lumen by binding
to gastric parietal cells, decreasing – Capsules should be
gastric acid production (antiulcer swallowed whole
agent – proton pump inhibitor)
– Instruct pt to report black
tarry stool
• Indications
– GERD, gastric ulcers
– Zollinger-Ellison syndrome
– Reduces risk of GIB in critical pts
ONDANSETRON

– Blocks effects of serotonin – Administer slowly 2-5 minutes –
on vagal nerve and CNS fata QT prolongation and V-
(antiemetic – 5-HT3 tach, respiratory arrest
antagonist) – May cause headache,
constipation, diarrhea, dry
mouth
• Indications – Assess N/V
– Nausea/vomiting – Assess for extrapyramidal

symptoms
– Monitor LFTs
OXYCODONE

– Binds to opiate receptors in – May cause respiratory depression,
constipation, confusion, sedation,
CNS altering the perception
hallucinations, urinary retention
and sensation of pain (opioid
– Use caution with IICP
agonist)
– Don’t use with MAOIs
– Assess pain and hemodynamics
• Indications – May elevate pancreatic enzymes
– Pain – Can cause physical dependence

– Assess bowel function –
administer with stimulant laxative
OXYTOCIN

– Stimulates uterine smooth – Can cause ICH in fetus
muscle (oxytocic) – Can cause asphyxia in fetus
– May cause coma and seizures in
mother
• Indications – May cause painful contractions
– Labor induction – Assess fetus and contractions
– Post-partum bleeding – Monitor BP
– Assess maternal electrolytes
– May cause uterine tetany
PANCRELIPASE

– Replacement of pancreatic – Contraindicated with pig
enzymes: lipase, amylase, product allergies/objections
protease (digestive agent – – Can cause shortness of breath,
pancreatic enzyme N/V/D, rash
replacement/supplement)
– Assess nutritional status
– Monitor for steatorrhea
• Indications – May increase uric acid levels
– Pancreatic insufficiency – Take with meals and/or
– Ductal obstruction snacks
PANTOPRAZOLE

– Prevents the transport of H+ ions – Can cause hyperglycemia,
into the gastric lumen by binding
abdominal pain
to gastric parietal cells, decreasing
gastric acid production (antiulcer – Decreases absorption of
agent – proton pump inhibitor) certain drugs
– May increase bleeding with
• Indications warfarin
– GERD/heartburn – Assess for occult blood, liver
– Reduces risk of GIB in critically
enzymes, symptoms of heart
ill pts burn
PAROXETINE

– Blocks reuptake of serotonin in the – Do not use with MAOIs
CNS (antianxiety/antidepressant –
– Can cause neuroleptic
SSRI)
malignant syndrome, suicidal
thoughts, serotonin syndrome,
• Indications insomnia
– Major depressive disorder (MDD) – Decreases effectiveness of
– OCD digoxin
– Anxiety – Increases bleeding risk with

warfarin
– PTSD
– Assess for suicidal thoughts
PHENAZOPYRIDINE

– Provides analgesia to the – Will turn urine red or orange
urinary tract mucosa – May cause headache, vertigo,
(nonopioid analgesic) hepatic toxicity
– Monitor renal function
• Indications
– Urological pain
PHENYTOIN
– Monitor serum phenytoin levels
• MOA • Therapeutic range: 10-20 mcg/mL
– Interferes with ion transport, shortens – Can cause suicidal thoughts, ataxia,
action potentials and decreases extrapyramidal symptoms,
automaticity. Blocks sustained high hypotension, tachycardia, arrhythmias,
frequency repetitive firing of action gingival hyperplasia, drug-induced
potentials (antiarrhythmic, hepatitis, agranulocytosis, Steven’s
anticonvulsants – hydantoins) Johnson Syndrome
– Concurrent administration of enteral
feedings may decrease absorption
• Indications
– Assess for seizure activity,
– Tonic clonic seizures
hypersensitivity, hemodynamics
– Arrhythmias
– Neuropathic pain
PROCAINAMIDE
– May cause ventricular arrhythmias,
• MOA
seizure, asystole, heart block
– Decreases excitability and – Monitor EKG continuously may
slows conduction velocity cause widening of QRS complex
(antiarrhythmic – Class IA – May cause hypotension – keep pt
Na+ Channel Blocker) supine
– Monitor for signs of agranulocytosis
(monitor CBC frequently)
• Indications
– Can cause drug-induced lupus
– Wide variety ventricular and syndrome
atrial arrhythmias, PAC, PVC,
V-Tach, post-cardioversion
PROMETHAZINE
– IV administration may cause damage
• MOA to tissue, hypertension, impaired liver
– Blocks the effects of histamine function
and possesses anticholinergic – Monitor for neuroleptic malignant
properties producing CNS syndrome, confusion, sedation
depression (antiemetic –
– May cause CNS depression (avoid
phenothiazine)
alcohol)
– Assess sedation level and
• Indications anticholinergic effects
– Allergic reactions – May cause false results in pregnancy
– N/V testing
– Sedation
PROPOFOL

– Production of a hypnotic – Use cautiously with CVD, lipid
disorder, increased ICP
state and amnesia
(anesthetic) – Can cause apnea, bradycardia,
hypotension
– Burning and pain at insertion site
• Indications – Can turn urine green
– Anesthesia – Assess respiratory status and

hemodynamics
– Induction
– Maintain patent airway
– Sedation – Assess level of sedation
PROPRANOLOL
– Contraindicated in CHF, pulmonary
• MOA edema, cardiogenic shock,
– Blocks beta 1 & 2 adrenergic receptors bradycardia, heart block
(antianginal, antiarrhythmic – class II – May cause bradycardia, CHF,
beta blocker – antihypertensive,
pulmonary edema
headache suppressant
– Masks symptoms associated with DM
– Advise to change positions slowly
• Indications
– Stopping abruptly may result in life-
– Hypertension and cardiomyopathy
threatening arrhythmias
– Angina
– Advise to notify of difficulty in
– Arrhythmias breathing
– Alcohol withdrawal and anxiety
PROPYLTHIORURACIL
• MOA • Nursing Indications

– Inhibits thyroid hormones – Hepatotoxicity, N/V,
agranulocytosis
(anti-thyroid agent)
– Monitor symptoms of
hyperthyroidism
• Indications – Monitor for hypothyroidism
– Monitor WBC and LFTs
– Hyperthyroidism
– Weigh pt frequently
– May cause leukopenia,
thrombocytopenia, jaundice
– Take with meals
QUETIAPINE

– Dopamine and serotonin – May cause neuroleptic
antagonist (antipsychotic, malignant syndrome, seizures,
mood stabilizer) dizziness, palpitations, weight
gain, anorexia
– QT-interval prolongation
• Indications – Do not use with CNS depressant
– Schizophrenia – Assess weight frequently
– Depressive disorder – Monitor LFTs and CBC

– May increase cholesterol
– Mania
RANITIDINE

– Inhibits action of histamine in – May cause arrhythmias,
gastric parietal cells, decreases agranulocytosis, aplastic
gastric acid secretion (antiulcer anemia, confusion
agent – histamine H2
antagonist)
– Assess abdominal pain
– Monitor for blood in stool
– Monitor CBC
• Indications
– Duodenal ulcers, GERD,
heartburn, esophagitis, GI bleed
A patient admitted to the hospital has a history of peptic ulcer disease. The
patient takes ranitidine and sucralfate. The patient tells the nurse that
discomfort is usually controlled but that symptoms occasionally flare up.
What will the nurse do?
A. Ask the provider about ordering an endoscopic
examination.
B. Contact the provider to discuss serologic testing and an
antibiotic.
C. Contact the provider to discuss switching to a proton pump
inhibitor.
D. Counsel the patient to avoid beverages containing caffeine.
A patient admitted to the hospital has a history of peptic ulcer disease. The
patient takes ranitidine [Zantac] and sucralfate [Carafate]. The patient tells
the nurse that discomfort is usually controlled but that symptoms
occasionally flare up. What will the nurse do?
A. Ask the provider about ordering an endoscopic
examination.
B. Contact the provider to discuss serologic testing and an
antibiotic.
C. Contact the provider to discuss switching to a proton pump
inhibitor.
D. Counsel the patient to avoid beverages containing caffeine.
RIFAMPIN

– Inhibits RNA synthesis – Can turn body fluids red
(antitubercular – rifamycin) – May cause N/V/D and confusion
– Assess lung sounds and sputum
characteristics
• Indications – Evaluate renal and liver function
– Tuberculosis tests
– Instruct pt not to skip or double
dose
– Must complete entire dose (6-12
month therapy)
A nurse is performing a physical assessment on a
patient with tuberculosis who takes rifampin. What
would be an expected finding?
A. Crystalluria
B. Myopathy
C. Peripheral neuropathy
D. Red-orange-tinged urine
A nurse is performing a physical assessment on a
patient with tuberculosis who takes rifampin. What
would be an expected finding?
A. Crystalluria
B. Myopathy
C. Peripheral neuropathy
D. Red-orange-tinged urine
SALMETEROL

– Bronchodilation through – Instruct pt to avoid excessive use
stimulation of beta-2 – Can cause headache, palpitations,
adrenergic receptors tachycardia, abdominal pain,
(bronchodilator – adrenergic) paradoxical bronchospasm
– Beta blockers can decrease
effectiveness
• Indications – Assess respiratory status
– Reversible airway obstruction – May increase glucose levels
– Exercise-induced asthma – Always take bronchodilator first

SERTRALINE

– Inhibits uptake of serotonin – Don’t use with MAOIs
(antidepressant – SSRI) – Can cause neuroleptic
malignant syndrome, suicidal
thoughts, drowsiness, insomnia,
• Indications diarrhea, dry mouth, tremors,
serotonin syndrome, sexual
– Major depressive disorder
dysfunction
(MDD)
– Monitor mood changes in pt
– OCD
– Takes 1-4 weeks for therapy to
– Anxiety be effective
SPIRONOLACTONE

– Inhibits sodium reabsorption while – Contraindicated with
sparing potassium and hydrogen
hyperkalemia
(diuretic – potassium sparing
diuretic) – Monitor I&Os
– Monitor BP
• Indications – Monitor potassium levels and
– Potassium loss renal panel
– Hypertension
– Edema
– CHF
STREPTOKINASE

– Converts plasminogen to plasmin – Contraindicated with active
which degrades fibrin clots bleeding, hypersensitivity,
(thrombolytic – plasminogen bronchospasm, intracranial
activator) hemorrhage, hypotension
– Begin therapy as soon as possible
• Indications – Monitor VS continuously
– Pulmonary embolism – Monitor closely for bleeding
– DVT – Monitor hemodynamics
– Occluded lines – Avoid invasive procedures
– Arterial thrombus
SUCRALFATE

– Reacts with gastric acid to form – Use caution in renal failure
a paste that adheres to ulcer patients
(antiulcer agent – GI protectant)
– Concurrent use of antacids
may decrease the effect of
• Indications sucralfate – administer 30
– Management of GI ulcers mins before or after
– GI injury prevention from high – Administer on empty
dose aspirin and NSAID stomach 1 hour before meals
treatment
A nursing student is caring for a patient who is taking sucralfate and
ciprofloxacin to treat peptic ulcer disease. The student asks the nurse about
the pharmacokinetics of sucralfate. Which statement by the student
indicates a need for further teaching?
A. “Sucralfate adheres to the ulcer and blocks the back-
diffusion of hydrogen ions.”
B. “Sucralfate and ciprofloxacin should be administered 1 hour
apart.”
C. “Sucralfate does not cause systemic side effects.”
D. “Sucralfate has a moderate acid-neutralizing capacity.”
A nursing student is caring for a patient who is taking sucralfate and
ciprofloxacin to treat peptic ulcer disease. The student asks the nurse about
the pharmacokinetics of sucralfate. Which statement by the student
indicates a need for further teaching?
A. “Sucralfate adheres to the ulcer and blocks the back-
diffusion of hydrogen ions.”
B. “Sucralfate and ciprofloxacin should be administered 1 hour
apart.”
C. “Sucralfate does not cause systemic side effects.”
D. “Sucralfate has a moderate acid-neutralizing capacity.”
TERBUTALINE

– Produces bronchodilation – May cause nervousness,
(bronchodilator – adrenergic) restlessness, tremors
– Beta-blockers can reduce effect
– Assess respiratory status
• Indications
– Monitor maternal/fetal VS if
– Asthma using for preterm labor
– COPD – Monitor for hypoglycemia
– Preterm labor – May cause decreased
potassium level
TETRACYCLINE
– Use caution with liver impairment
• MOA
– May cause pseudomembranous
– Bacteriostatic by inhibiting colitis, N/V/D, photosensitivity, rash
protein synthesis (anti-infective
– May increase effects of warfarin
– tetracycline)
– Assess for infection
– Obtain culture prior to initiating
• Indications therapy
– Treatment of infection – Monitor renal and liver labs
– Gonorrhea & syphilis with – Instruct pt to complete entire course

penicillin allergy of treatment
– Chronic bronchitis
TRIMETHOPRIM/
SULFAMETHOXAZOLE
• MOA – May cause renal damage, Steven
– Bactericidal by preventing Johnson’s Syndrome, rash,
pseudomembranous colitis, N/V/D,
metabolism of folic acid (anti-
agranulocytosis, aplastic anemia,
infective, antiprotozoal – folate
phlebitis
antagonist, sulfonamide)
– Monitor CBC
– Obtain cultures prior to initiating therapy
• Indications – Monitor I&Os
– Bronchitis and pneumonia – Instruct pt to complete dose
– UTI – Drink 8-10 glasses of water daily
– Diarrhea
– Multiple other types of infection
VANCOMYCIN

– Can cause:
– Bactericidal agent (anti-
• Ototoxicity, N/V/D, nephrotoxicity,
infective) anaphylaxis, red-man syndrome
– Assess for infection
– Obtain culture prior to initiating
• Indications therapy
– Life-threatening infections – Monitor BP
– Sepsis – Dose dependent draw serum trough
levels frequently
– Administer over at least 60 minutes
to avoid skin irritation
The nurse is caring for a patient who is receiving vancomycin. The nurse
notes that the patient is experiencing flushing, rash, pruritus, and urticaria.
The patient’s heart rate is 120 beats per minute, and the blood pressure is
92/57 mm Hg. The nurse understands that these findings are consistent
with:
A. allergic reaction.
B. red man syndrome.
C. rhabdomyolysis.
D. Stevens-Johnson syndrome.
The nurse is caring for a patient who is receiving vancomycin. The nurse
notes that the patient is experiencing flushing, rash, pruritus, and urticaria.
The patient’s heart rate is 120 beats per minute, and the blood pressure is
92/57 mm Hg. The nurse understands that these findings are consistent
with:
A. allergic reaction.
B. red man syndrome.
C. rhabdomyolysis.
D. Stevens-Johnson syndrome.
VASOPRESSIN
• MOA – Use caution with HF and CVD
– Increases water permeability of the
– Contraindicated in renal failure and
kidney’s collecting duct and distal
hypersensitivity to pork
convoluted tubule leading to water
retention, also increases peripheral – Monitor BP/HR/EKG during
vascular resistance leading to therapy
increased BP (antidiuretic hormone) – Monitor urine specific gravity and
osmolality
– Weigh pt daily and assess for edema
• Indication
– Monitor electrolytes
– Management of diabetes insipidus,
VT/VF unresponsive to initial shock, – Do not use with alcohol
GI hemorrhage
VERAPAMIL
– Don’t use with 2nd and 3rd degree
• MOA heart block
– Prevents transport of calcium, leading

– Don’t use with systolic BP <90
to decreased contraction, decreases – May cause anxiety, confusion,
SA and AV node conduction cough, dyspnea, arrhythmias, CHF,
(antianginal, antiarrhythmic, bradycardia, hypotension, elevated
antihypertensive, vascular headache LFTs, Steven’s Johnson Syndrome,
suppressant – Ca+ channel blocker) hyperglycemia, gingival hyperplasia
– Grapefruit juice can increase effects
• Indications – Can increase levels of digoxin
– Hypertension, angina, SVT, migraine – Monitor heart rhythm, intake and
output, BP
– Assess angina
WARFARIN
– Contraindicated with severe HTN
– ASA and NSAIDs can increase
• MOA risk of bleeding
– Disrupts liver synthesis of vitamin – Azole antifungals increase effects
K dependent clotting factors – Cimetadine increases levels
(anticoagulant – coumarin)
– Obtain herbal supplement hx
– Monitor intake of vitamin K
• Indications
– Therapeutic range:
– Venous thrombosis
• PT 1.3-1.5; INR 2.5-3.5
– Pulmonary embolism
– Pt should not drink alcohol
– Atrial fibrillation
– Vitamin K is antidote
– Myocardial infarction

Pharmacology For Nclex PowerPoint

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Pharmacology For Nclex PowerPoint

Uploaded by

Copyright:

Available Formats

PHARMACOLOGY FOR

MUST KNOW DRUGS

• MOA • Nursing Considerations

activator – Monitor for active bleeding (q15m

– MI – Use caution with uncontrolled

• Indications – May lead to muscle pain

– Anti-infective – aminopenicillin – Use caution in renal insufficiency

• MOA • Nursing Considerations

• MOA • Nursing Considerations

• MOA • Nursing Considerations

– Bowel regimen – Monitor fluid and electrolyte

• MOA • Nursing Considerations

• Indications – Administer slowly

– Treatment of hypocalcemia, prevention – Instruct pt on foods that contain

• Indications – May lead to rhabdomyolysis

– Hypertension, management of – Dry cough

• MOA • Nursing Considerations

• MOA • Nursing Considerations

• Indications – Assess infection and allergies

• MOA • Nursing Considerations

• MOA • Nursing Considerations

– Skin infections, pneumonia, – Monitor bowels

• MOA • Nursing Implications

• MOA • Nursing Implications

• MOA – May cause CNS alterations

A. administer the usual morning dose of hydrocortisone 25 mg PO.

• MOA • Nursing Implications

• MOA • Nursing Implications

• MOA • Nursing Implications

• MOA • Nursing Implications

• MOA • Nursing Implications

• MOA • Nursing Implications

• MOA • Nursing Implications

– Prophylactic asthma – Instruct to stop smoking

• MOA • Nursing Implications

– Seizures, peripheral – Assess for seizure activity

• MOA • Nursing Implications

– Type 2 Diabetes Mellitus – Instruct on checking blood sugar

A. “I will begin by taking this once daily with breakfast.”

A. “I will begin by taking this once daily with breakfast.”

• MOA • Nursing Considerations

– Severe hypoglycemia, – Monitor serum glucose levels

• MOA • Nursing Implications

A. Administer the haloperidol as ordered.

A. Administer the haloperidol as ordered.

• MOA • Nursing Implications

• MOA • Nursing Implications

• MOA • Nursing Implications

• MOA • Nursing Implications

• MOA • Nursing Implications

A. No insulin should be administered.

A. No insulin should be administered.

• MOA • Nursing Implications

• MOA • Nursing Implications

• MOA • Nursing Implications

• MOA • Nursing Implications

A. Reducing the carbamazepine dose to 50 mg twice daily

A. Reducing the carbamazepine dose to 50 mg twice daily

• MOA • Nursing Implications

• MOA • Nursing Implications

• MOA – Assess for hypotension on initial

• MOA • Nursing Implications

neurotransmitter reuptake – Monitor drug levels frequently