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NCLEX pharmacology
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NCLEX Pharmacology Drugs
NCLEX Pharmacology Drugs Term: Ciprofloxacin (Cipro) Definition: Antibiotic prescribed for a wide range of serious skin infections. Taking this... [Show More] with antacids can impair the absorption of the medication. Term: Cromolyn sodium (Intal) Definition: Antiasthmatic, antiallergic, and mast cell stabilizer that decreases airway hyper-responsiveness in some clients with asthma. It has no bronchodilating action. Term: Sulfonylureas Definition: Oral hypoglycemic medications that promotes insulin secretion by the pancreas Term: Protamine sulfate Definition: Antidote for heparin Term: Trimethobenzamide (Tigan) Definition: Antiemetic agent used for relief for nausea and vomiting Term: Gabapentin (Neurontin) Definition: Anticonvulsant, mood stabilizer that binds with a receptor site in the brain tissue reducing anticonvulsant activity and reducing neuropathic pain. Abrupt withdrawal may cause increased seizure frequency. SE: hypersensitivity reactions, suicidal thoughts, confusion, ataxia, and hypertension Term: Digoxin, Lithium, Dilantin (phenytoin), Bronchodilators Definition: Can easily cause toxicity, must monitor therapeutic range of medication Term: atropine Definition: Anticholinergic, increases heart rate. Decreases GI and respiratory secretions. Reversal of muscarinic effects. May have a spasmolytic action on the biliary and genitourinary tracts. Term: Amiodarone (Cordarone) Definition: Antiarrhythmic, anticholinergic used to treat life-threatening ventricular arrhythmias that do not respond to first-line agents. Requires continuous cardiac monitoring Term: metoprolol (Lopressor) Definition: Beta-blocker that decreases heart rate and blood pressure. It decreases the rate of CV mortality in heart failure pts. SE: bradycardia, HF, pulmonary edema, weakness, hyperglycemia, bronchospasms Term: norepinephrine (Levophed) Definition: Vasopressor, produces vasoconstriction and myocardial stimulation, which may be required after adequate fluid replacement in the treatment of severe hypotension and shock. High alert med sometimes given during codes Term: amlodipine (Norvasc) Definition: Calcium Channel Blocker, causes systemic vasodilation resulting in decreased BP; causes coronary vasodilation resulting in decreased frequency and severity of attacks of angina. Term: adenosine Definition: Adenocard, restores normal sinus rhythm by interrupting re-entrant pathways in the AV node; slows conduction time through the AV node; produces coronary artery vasodilation Term: Vitamin K Definition: The antidote to warfarin (Coumadin) Term: phenytoin (Dilantin) Definition: Antiarrhythmics, anticonvulsants: diminished seizure activity and termination of ventricular arrhythmias. SE: agranulocytosis, aplastic anemia, extrapyramidal syndrome and allergic reactions including Steven-Johnson syndrome This comes in a suspension and should be shaken. Term: Valproic acid (Depakote) Definition: Anticonvulsant, decreased manic episodes, decreased frequency of migraine headaches. Can cause hepatic toxicity! Term: Epinephrine (Adrenalin) Definition: Bronchodilation, maintenance of HR and BP, localization/prolongation of local/spinal anesthetic. SE: angina, arrhythmias, hypertension, tachycardia, tremor Term: verapamil (Calan) Definition: Calcium channel blocker: systemic vasodilation resulting in decreased BP, coronary vasodilation resulting in decreased angina, reduction of ventricular rate during A fib or atrial flutter Term: theophylline (Theo-Dur) Definition: Bronchodilator; long-term control of asthma or COPD. S/S of toxicity: tachycardia, arrhythmias, seizures, N +V, headache, increased urination, flushing, confusion, tremors. Toxicity typically shows signs of CNS stimulation. Term: lamotrigine (Lamictal) Definition: Anticonvulsant, maintenance treatment of bipolar disorder. Monitor pt for skin rash, which could be a sign of Steven-Johnson syndrome Term: estradiol (Climera) Definition: Estrogen hormone, can be used to restore balance in menopause or treat hormone-sensitive tumors. Pt should report S/S of fluid retention, thromboembolic disorders, mental depression or hepatic dysfunction. Term: amitriptyline (Elavil) Definition: Tricyclic antidepressant with anticholinergic properties. Has dangerous drug-drug interactions. SE: arrhythmias, torsade de pointes, hypotension, constipation, dry mouth. Term: sucralfate (Carafate) Definition: Antiulcer agent; protection of ulcers with subsequent healing. It forms a protective barrier over ulcers. Term: captopril (Capoten) Definition: ACE inhibitor, lowers BP, decreased symptoms with HF, decreased progression of diabetic nephropathy Term: baclofen (Lioresal) Definition: Antispasticity agent, skeletal muscle relaxant. Can be used for spinal injury pts to inhibit reflexes at the spinal level. Bowel and bladder function may also be improved. Term: Augmentin Definition: Combination of amoxicillin and clavulanate potassium Term: lisinopril (Zestril) Definition: ACE inhibitor, antihypertensive. Adverse effects to watch for: dry cough, mouth sores, fever, swelling of hands, irregular heart beat, swelling of face and difficulty breathing. Term: carbamazepine (Tegretol) Definition: Anticonvulsant, mood stabilizer. SE: Steven-Johnson syndrome, toxic epidermal necrolysis, agranulocytosis, aplastic anemia, thrombocytopenia and increased liver enzymes (may decrease effectiveness of oral contraceptives). May be teratogenic. Term: ferrous sulfate (Feosol) Definition: Antianemic, iron supplement. Take on an empty stomach or with a glass of water. Term: phenazopyridine (Pyridium) Definition: Nonopioid analgesic for urinary tract infections. Can turn urine reddish-orange color Term: rosiglitazone (Avandia) Definition: Antidiabetic medication for increased insulin resistance. Can cause stroke, HF, MI and edema. Monitor for S/S of heart failure. Term: ethambutol (Myambutol) Definition: Antituberculoars for TB. Can cause: optic neuritis and hepatitis Term: propranolol (Inderal) Definition: Beta-blocker: antianginal, antiarrhythmic, antihypertensive, vascular headache suppressant. Decreased BP and HR, suppresses arrhythmias and prevents MI. Term: hydrochloride (Tofranil) Definition: Tricyclic antidepressant, with overdose, there is a risk for arrhythmias, tachycardia and MI Term: hydroxyzine (Vistaril) Definition: Antianxiety agent, antihistamine, sedative/hypnotic with anticholinergic properties Term: isoniazid (INH) Definition: Antituberculars, can cause drug-induced hepatitis, so need to monitor pt's liver function including AST, ALT and serum bilirubin Term: Albuterol (Proventil) Definition: Bronchodilator, adrenergic, can be used as a rescue medication for acute bronchospasms and status asthmaticus. Term: procainamide (Pronestyl) Definition: Antiarrhythmic, can cause seizures, asystole, heart block, hypotension, agranulocytosis Term: benztropine (Cogentin) Definition: Anti-Parkinson's agent, anticholinergic used to reduce rigidity and tremors Term: gentamicin (Garamycin) Definition: Aminoglycoside - bactericidal action; can cause ototoxicity, nephrotoxicity and hypersensitivity reactions Term: clopidogrel (Plavix) Definition: Platelet aggregation inhibitor; decreased occurrence of atherosclerotic event in pts at risk. SE: bleeding, neutropenia, thrombotic thrombocytopenic purpura, hypertension, fever, hypersensitivity reactions Term: digoxin (Lanoxin) Definition: Antiarrhythmic, causes increased cardiac output (positive inotropic effect) and slowing of the heart (negative chronotropic effect). S/S of toxicity: abdominal pain, anorexia, N+V, visual disturbances, bradycardia, and other arrhythmias. Term: acetylcysteine (Mucomyst) Definition: Mucolytic and antidote for acetaminophen toxicity. It lowers the viscosity of mucus and lessens liver damage following an overdose of acetaminophen (Tylenol). Term: acetazolamide (Diamox) Definition: Anticonvulsant, antiglaucoma agent, diuretic, and ocular hypotensive agent. Can be used for salicylate (aspirin) overdose or poisoning. Term: prednisone (Sterapred) Definition: Anti inflammatory steroidal, causes suppression of inflammation and modification of the normal immune response. SE: hyperglycemia, hypernatremia (due to mineralocorticoid action), hypokalemia, HTN, peptic ulceration, thromboembolism, osteoporosis, and decreased wound healing Term: naproxen (esomeprazole) Definition: NSAID, antiulcer agent, proton pump inhibitor. Use NSAIDs cautiously with aspirin allergies. SE: drug-induced hepatitis, GI bleeding, anaphylactic reactions, constipation. Term: spironolactone (Aldactone) Definition: Potassium-sparing diuretic, don't use salt substitutes with this because they could contain K Term: Levodopa (L-dopa) Definition: Relief of tremor and rigidity in Parkinson's syndrome. Watch for involuntary movements, nausea, vomiting Term: losartan (Cozaar) Definition: Antihypertensive, decreases progression of diabetic nephropathy. Assess for angioedema (dyspnea, facial swelling) Term: naproxen sodium (naprosyn) Definition: Nonopioid analgesic, NSAID, antipyretic. SE: fluid retention, rash, dizziness, headache, GI distress Term: What can lower serum K? Definition: Kayexalate, calcium chloride, regular insulin and sodium bicarbonate Term: Potassium iodine (SSKI) Definition: Antithyroid agent that can control hyperthyroidism and decrease bleeding during thyroid surgery. It can decrease the incidence of thyroid cancer following radiation emergencies. Term: propylthiouracil (PTU) Definition: Antithyroid agent that decreases S/S of hyperthyroidism Term: misoprostol (Cytotec) Definition: Prostagladin, antiulcer agent, pregnancy category X Term: Phenobarbital Definition: Barbiturate - anticonvulsant, sedative/hypnotic. SE: laryngospasms, hypersensitivity reactions including angioedema and serum sickness, hangover, hypotension Term: Alendronate (Fosamax) Definition: Tx of osteoporosis, bone resorption inhibitor Term: Tamsulosin (Flomax) Definition: Decreased Sx of prostatic hyperplasia Term: Losartan (Cozaar) Definition: angiotensin II receptor antagonists, antihypertensives, owering of BP. Slowed progression of diabetic nephropathy Term: carbamazepine (Tegretol) Definition: anticonvulsants, mood stabilizers; Prevention of seizures. Relief of pain in trigeminal neuralgia. Decreased mania. Term: flavocoxid (Limbrel) Definition: nonopioid analgesics, Term: Benzatropine (Cogentin) Definition: Treats symptoms of Parkinson's disease or side effects of other drugs Term: dantrolene Definition: skeletal muscle relaxants; Management of neuroleptic malignant syndrome. Term: paroxetine hydrochloride (Paxil) Definition: Therapeutic: antianxiety agents, antidepressants Pharmacologic: selective serotonin reuptake inhibitors (SSRIs) Tx of OCD Term: lithium Definition: mood stabilizers, Alters cation transport in nerve and muscle. May also influence reuptake of neurotransmitters. Therapeutic Effects: Prevents/decreases incidence of acute manic episodes. Term: ziprasidone (Geodon) Definition: antipsychotics, mood stabilizers; tx of Schizophrenia Term: sertraline (Zoloft) Definition: Therapeutic: antidepressants Pharmacologic: selective serotonin reuptake inhibitors (SSRIs) Tx of OCD, Panic Disorders, PTSD, GAD Term: haloperidol (Haldol) Definition: antipsychotics, Tx of schizophrenia, manic states, drug-induced psychoses Term: hetastarch (Hespan) Definition: volume expanders Use: Adjunct for fluid replacement and volume expansion in the early management of shock or impending shock Term: digoxin (Lanoxin) Definition: antiarrhythmics, inotropics Use: Heart failure. Atrial fibrillation and atrial flutter (slows ventricular rate). Paroxysmal atrial tachycardia. Term: nimodipine (Nimotop) Definition: antianginals, antiarrhythmics, antihypertensives Therapeutic Effects: Systemic vasodilation resulting in decreased BP. Coronary vasodilation resulting in decreased frequency and severity of attacks of angina. Term: cefaclor (Ceclor) Definition: second-generation cephalosporins Term: azithromycin (Zithromax) Definition: agents for atypical mycobacterium, anti-infectives Term: promethazine (Phenergan) Definition: antiemetics, antihistamines, sedative/hypnotics Use: Treatment of various allergic conditions and motion sickness. SE - N.M.S. Term: Leflunomide (Arava) Definition: Anti rheumatic for RA Term: Azathioprine (Imuran) Definition: Immunosuppressant, prevention of renal transplant rejection Term: Ticlopidine Definition: Antiplatelet agent, prevention of stroke in patients unable to tolerate aspirin Term: Lamivudine (Epivir) Definition: Antiretrovirals, antivirals, HIV infection [Show Less]
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NCLEX Pharmacology Questions and Answers
NCLEX Pharmacology Questions Pharmacological Therapies questions make up 14% of the questions on the NCLEXPN and 15% of the questions on the NCLEXRN... [Show More] . Pharmacology NCLEX questions focus on providing care in the administration of medications and the monitoring of client therapies. Some of the specific topics covered include contraindications, side effects, interactions, dosages, expected outcomes, and pharmacological pain management. Working through our free NCLEX pharmacology questions is a great way to practice and review these important topics. Pharmacological Therapies Practice Test Results 15 of 35 questions answered correctly Your time: 00:57:17 You have reached 15 of 35 points, (42.86%) A patient is started on a daily amount of Phenytoin (Dilantin) 200mg PO in two divided doses. What instruction, if given by the nurse to the patient, is INCORRECT? A patient taking Fluoxetine Hcl (Prozac) asks the nurse when the medication will start to work. The patient started this medication two weeks ago. The nurse’s response is CORRECT if she states: A client receiving Zyprexa (olanzapine) will most likely have another prescription of which medications? A patient on several medications is being cared for on a medical/surgical unit by the nurse. Which of the following laboratory values, if reported to the nurse, would require followup? SELECT ALL THAT APPLY: A patient takes Nardil for depression and is confused by the dietary restrictions and allowances that are required with the medication. Which food on the list below is NOT permitted when taking Nardil? SELECT ALL THAT APPLY: The nurse is administering an unpleasanttasting liquid medication to a 2yearold child. Which intervention should the nurse implement? A patient who is taking Lasix knows that he should increase intake of what food? A patient has the following medication orders: Pantaprozole 40mg PO qAM, Metoprolol 50mg PO bid, Lorazepam 0.5mg PO now, Albuterol 1 puff PRN. The patient’s medical history includes high cholesterol and asthma. Which of the orders should the nurse question? The nurse notes that a physician new to the hospital’s computer system has input three out of four orders INCORRECTLY for a patient. Which of the following medications is CORRECT for a patient with the following criteria: Diabetes Insipidus, Dehydration, Hypertension. The nurse is reviewing the client’s medications and she noticed a prescription of Versed. Which medication is important to have available for clients who have received Versed? A patient is ordered to receive omeprazole (Prilosec) 40mg PO daily. The pharmacy dispenses Prilosec 20mg capsules. How many capsules should the nurse administer to this patient for a single dose? A patient on the psychiatric unit has been taking Haldol for three days as ordered by the physician. During the nurse’s shift, she enters the patient’s room to find the patient in a prolonged muscle spasm, with his eyes looking upward, and a fever of 103.5 degrees. Which of the following actions, if performed by the nurse, would be considered CORRECT? SELECT ALL THAT APPLY: A patient has been prescribed the medication spironolactone (aldasterone). When preparing the patient for discharge, the nurse should include which of the following instructions? SELECT ALL THAT APPLY: A busy, harriedlooking physician comes onto the floor and writes out four orders in less than one minute. He leaves, shoving over a stack of the nurse’s charting on the way out the door. Which of the following four orders should the nurse question? A physician on the medical/surgical unit orders Mellaril (thioridazine hydrochloride) 75mg PO once daily for one of the nurse’s patients. The pharmacy sends up liquid Mellaril with a concentration of 30mg/mL. How much Mellaril, in mL, will the nurse give for ONE dose? A patient is sent home on prescribed Nitroglycerin, to be taken as needed for angina. Which of the following instructions, if stated by the patient to the nurse, would require further teaching? SELECT ALL THAT APPLY: A primipara is in the transition phase of labor on the maternity unit. On the fetal heart monitor, the nurse observes a contraction begin. Shortly after a delay, the fetal heart rate dips. It only recovers after the contraction has already been ended for a period of 30 seconds. Please place the following actions in order from first to last. The nurse gives discharge teaching to a patient going home on Doxycycline. Which of the following patient statements, if made by the patient to the nurse, requires further teaching? SELECT ALL THAT APPLY: The physician has ordered an I.V. of 5% dextose in Lactated Ringers solution at 125mL/hr. The I.V. tubing available delivers 10 drops per mL. At how many drops per minute will the Lactated Ringers infuse? The nurse on an oncology unit is administering Cisplatin to a patient. The nurse knows that which of the following symptoms, if reported by the patient, is expected with this type of medication? SELECT ALL THAT APPLY: The physician prescribes alprazolam (Xanax) 0.25 mg p.o. TID for a client with anxiety and physical symptoms related to work pressures. The nurse should assess the client for the most common adverse effect of this drug, which is? A graduate nurse prepares a patient to undergo a liver biopsy. The graduate nurse administers what preop medication? The nurse works on a medical/surgical unit and cares for a patient receiving Lanoxin (Digoxin) and Furosemide (Lasix). The nurse knows that which of the following, if reported by the patient, must be assessed IMMEDIATELY? A client with myasthenia gravis is instructed to take anticholinesterase medications on time to eat meals 4560 minutes later. The client asks the nurse why the timing of the medication is so important. What is the nurse’s best response? A patient with tuberculosis asks why he must take two drugs for his one disease. The nurse explains that: A 9yearold weighs 55 pounds and is to receive cefuroxime sodium 750 mg IV every 6 hours. The recommended dose of cefuroxime sodium for children older than 1 month is 50 133 mg/kg every 24 hours. Is the ordered dose within the recommended limits? (YES or NO) The nurse reads from the doctor’s order “Give 0.1 mL of PPD”, then prepares to administer the medication. Which technique shown below is the most correct way to give a PPD? A patient with type I diabetes asks the nurse why he can’t take the new diabetic drug that he sees on the commercials. Which of the following is the best explanation for the nurse to give the patient? The nurse works in a NICU (neonatal intensive care unit). The doctor orders Digoxin 6mcg/kg/day IV in two divided doses to be given to one of the nurse’s patients. The patient weighs 7 pounds. Calculate the amount, in mcg, the nurse will give per dose. The nurse cares for a patient on the medical/surgical unit. The patient rings the call bell and exclaims, “My urine has been orange today! What medication is doing this to me?” Which of the following medications, if noted in the patient’s chart, would explain this side effect? SELECT ALL THAT APPLY: Which of the following statements is true regarding the responsibility of the Licensed Practical Nurse when it comes to IV therapy? The LPN may: A patient has been taking a heavy aspirin regimen for the past two months. Which side effects, if noted by the patient, are directly related to overdose of aspirin? SELECT ALL THAT APPLY: A 40 yearold client who is receiving a MAOI is going home on a weekend pass. Considering the drug, the nurse plans to instruct the client to avoid? SELECT ALL THAT APPLY: A nurse is caring for a patient with 2nd degree burns all over her body. The nurse knows that which of the following measures is appropriate when the patient is prescribed application of silver sulfadiazine cream? SELECT ALL THAT APPLY: The nurse correctly administers the PPD to a client when she: [Show Less]
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NCLEX Pharmacology Questions
NCLEX Pharmacology Questions and Answers Question 1 A 2 year-old child is receiving temporary total parental nutrition (TPN) through a central venous lin... [Show More] e. This is the first day of TPN therapy. Although all of the following nursing actions must be included in the plan of care of this child, which one would be a priority at this time? A Use aseptic technique during dressing changes B Maintain central line catheter integrity C Monitor serum glucose levels D Check results of liver function tests Question 2 Nurse Jamie is administering the initial total parenteral nutrition solution to a client. Which of the following assessments requires the nurse’s immediate attention? A Temperature of 37.5 degrees Celsius B Urine output of 300 cc in 4 hours C Poor skin turgor D Blood glucose of 350 mg/dl Question 3 Nurse Susan administered intravenous gamma globulin to an 18 month-old child with AIDS. The parent asks why this medication is being given. What is the nurse’s best response? A “It will slow down the replication of the virus.” B “This medication will improve your child’s overall health status.” C “This medication is used to prevent bacterial infections.” D “It will increase the effectiveness of the other medications your child receives.” Question 4 When caring for a client with total parenteral nutrition (TPN), what is the most important action on the part of the nurse? A Record the number of stools per day B Maintain strict intake and output records C Sterile technique for dressing change at IV site D Monitor for cardiac arrhythmias Question 5 The nurse is administering an intravenous vesicant chemotherapeutic agent to a client. Which assessment would require the nurse’s immediate action? A Stomatitis lesion in the mouth B Severe nausea and vomiting C Complaints of pain at site of infusion D A rash on the client’s extremities Question 6 Nurse Celine is caring for a client with clinical depression who is receiving a MAO inhibitor. When providing instructions about precautions with this medication, the nurse should instruct the client to: A Avoid chocolate and cheese B Take frequent naps C Take the medication with milk D Avoid walking without assistance Question 7 While providing home care to a client with congestive heart failure, the nurse is asked how long diuretics must be taken. The BEST response to this client should be: A “As you urinate more, you will need less medication to control fluid.” B “You will have to take this medication for about a year.” C “The medication must be continued so the fluid problem is controlled.” D “Please talk to your physician about medications and treatments.” Question 8 George, age 8, is admitted with rheumatic fever. Which clinical finding indicates to the nurse that George needs to continue taking the salicylates he had received at home? A Chorea B Polyarthritis C Subcutaneous nodules D Erythema marginatum Question 9 An order is written to start an IV on a 74-year-old client who is getting ready to go to the operating room for a total hip replacement. What gauge of catheter would best meet the needs of this client? A 18 B 20 C 21 butterfly D 25 Question 10 A client with an acute exacerbation of rheumatoid arthritis is admitted to the hospital for treatment. Which drug, used to treat clients with rheumatoid arthritis, has both an anti-inflammatory and immunosuppressive effect? A Gold sodium thiomalate (Myochrysine) B Azathioprine (Imuran) C Prednisone (Deltasone) D Naproxen (Naprosyn) Question 11 Which of the following is least likely to influence the potential for a client to comply with lithium therapy after discharge? A The impact of lithium on the client’s energy level and lifestyle. B The need for consistent blood level monitoring C The potential side effects of lithium D What the client’s friends think of his need to take medication Question 12 Which of the following is least likely to influence the potential for a client to comply with lithium therapy after discharge? A The impact of lithium on the client’s energy level and lifestyle B The need for consistent blood level monitoring C The potential side effects of lithium D What the client’s friends think of his need to take medication Question 13 The nurse is caring for an elderly client who has been diagnosed as having sundown syndrome. He is alert and oriented during the day but becomes disoriented and disruptive around dinnertime. He is hospitalized for evaluation. The nurse asks the client and his family to list all of the medications, prescription and nonprescription, he is currently taking. What is the primary reason for this action? A Multiple medications can lead to dementia B The medications can provide clues regarding his medical background C Ability to recall medications is a good assessment of the client’s level of orientation D Medications taken by a client are part of every nursing assessment Question 14 A 25-year-old woman is in her fifth month of pregnancy. She has been taking 20 units of NPH insulin for diabetes mellitus daily for six years. Her diabetes has been well controlled with this dosage. She has been coming for routine prenatal visits, during which diabetic teaching has been implemented. Which of the following statements indicates that the woman understands the teaching regarding her insulin needs during her pregnancy? A “Are you sure all this insulin won’t hurt my baby?” B “I’ll probably need my daily insulin dose raised.” C “I will continue to take my regular dose of insulin.” D “These finger sticks make my hand sore. Can I do them less frequently?” Question 15 Mrs. Johanson’s physician has prescribed tetracycline 500 mg po q6h. While assessing Mrs. Johanson’s nursing history for allergies, the nurse notes that Mrs. Johanson’s is also taking oral contraceptives. What is the most appropriate initial nursing intervention? A Administer the dose of tetracycline B Notify the physician that Mrs. Johanson is taking oral contraceptives C Tell Mrs. Johanson, she should stop taking oral contraceptives since they are inactivated by tetracycline D Tell Mrs. Johanson, to use another form of birth control for at least two months Question 16 An adult client’s insulin dosage is 10 units of regular insulin and 15 units of NPH insulin in the morning. The client should be taught to expect the first insulin peak: A as soon as food is ingested. B in two to four hours. C in six hours. D in ten to twelve hours. Question 17 An adult is hospitalized for treatment of deep electrical burns. Burn wound sepsis develops and mafenide acetate 10% (Sulfamylon) is ordered bid. While applying the Sulfamylon to the wound, it is important for the nurse to prepare the client for expected responses to the topical application, which include: A severe burning pain for a few minutes following application. B possible severe metabolic alkalosis with continued use. C black discoloration of everything that comes in contact with this drug. D chilling due to evaporation of solution from the moistened dressings. Question 18 Ms.Clark has hyperthyroidism and is scheduled for a thyroidectomy. The physician has ordered Lugol’s solution for the client. The nurse understands that the primary reason for giving Lugol’s solution preoperatively is to: A decrease the risk of agranulocytosis postoperatively. B prevent tetany while the client is under general anesthesia. C reduce the size and vascularity of the thyroid and prevent hemorrhage. D potentiate the effect of the other preoperative medication so less medicine can be given while the client is under anesthesia. Question 19 A two-year-old child with congestive heart failure has been receiving digoxin for one week. The nurse needs to recognize that an early sign of digitalis toxicity is: A bradypnea B failure to thrive C tachycardia D vomiting Question 20 Mr. Bates is admitted to the surgical ICU following a left adrenalectomy. He is sleepy but easily aroused. An IV containing hydrocortisone is running. The nurse planning care for Mr. Bates knows it is essential to include which of the following nursing interventions at this time? A Monitor blood glucose levels every shift to detect development of hypo- or hyperglycemia. B Keep flat on back with minimal movement to reduce risk of hemorrhage following surgery. C Administer hydrocortisone until vital signs stabilize, then discontinue the IV. D Teach Mr. Bates how to care for his wound since he is at high risk for developing postoperative infection. [Show Less]
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NCLEX Pharmacology Study Guide
NCLEX Pharmacology Study Guide *Contains main drugs questioned in UWorld and mentioned in MK; Antibiotics, CV drugs, Diuretics, Diabetic drugs, Mental hea... [Show More] lth drugs, and Respiratory drugs (in that order) plus other main drugs. i.e. proton pump inhibitors, dilantin, NSAIDs DRUG LIST NCLEX ANTIBIOTICS *All antibiotics have GI effects lOMoARcPSD|4577335 Aminoglycosides -micin i.e. gentamicin - mycin i.e. vancomycin, neomycin Side effects: -Ototoxicity -Nephrotoxicity -GI irritation Vancomycin: Red man syndrome; administer over 60 minutes -Assess for allergies esp. anaphylactic allergies -Monitor appropriate lab values prior to administration i.e. aminoglycosides with BUN and Cr -Monitor for adverse effects and report to HCP if they occur -Monitor ins and outs -Encourage fluid intake - Emphasize importance of completing full prescribed course Cephalosporins (broad spectrum) Cef- i.e. cefaclor, cefradoxil, cefdinir, cefotaxime, cephalexin -GI disturbances - Nephrotoxicity - Superinfections i.e. C. difficile Similar to penicillins; contraindicated for clients with penicillin sensitivity Floroquinolones Floroquinol(one) bone marrow depression -floxacin i.e. ciprofloxacin, gatifloxacin Headache, dizziness, insomnia, depression -GI effects -bone marrow depression i.e. thrombocytopenia - photosensitivity, fever, rash Macrolides -thromycin i.e. azithromycin, erythromycin -GI effects - pseudomembranous colitis (c. diff colitis) -superinfections -Hepatotoxic -causes a prolonged QT interval, which may lead to sudden cardiac death due to torsades de pointes Penicillins -cillin i.e. amoxicillin, carbenicillin, ampicillin -hypersensitivity reactions, including anaphylaxis -related to cephalosporins -GI effects Sulfonamides Sulfa- i.e. sulfadiazine, sulfasalazine -hepatotoxic and nephrotoxic -bone marrow depression i.e. thrombocytopenia - photosensitivity -ANY RASH WITH SULFONAMIDES MUST BE REPORTED TO HCP! Tetracyclines -cyclines i.e. doxycycline, tetracycline -GI effects -hepatotoxicity -teeth staining and bone damage - photosensitivity, hypersensitivity **Can cause pill induced esophagitis. Clients taking this should sit upright for a period of time after ingestion to prevent tablet from lodging in esophagus Antifungal medications Amphotericin B - nazole i.e Fluconazole Ketoconazole -gastrointestinal effects -neuritis, dizziness, headache, malaise, drowsiness, hallucinations Antiviral medications -clovir i.e. acyclovir, -hearing loss (ototoxicity) ganciclovir, foscarnet -peripheral neuritis CARDIOVASCULAR MEDICATIONS lOMoARcPSD|4577335 Anticoagulants Oral: Warfarin, Dabigatran, Rivaroxaban Parenteral: Dalteparin, Heparin, Enoxaparin, Desirudin, Fondaparinux, Tinzaparin, Argatroban Prevent clot formation by inhibiting factors in clotting cascade and decreasing blood coagulability i.e. in MI, mechanical heart valves, DVT, atrial fibrillation, unstable angina Side effects: Hemorrhage Hematuria Thrombocytopenia Hypotension -contraindicated in clients taking NSAIDs, gingko and ginseng, corticosteroids, vit K containing foods (have this in moderation; no sudden increase or decrease) -contraindicated with active bleeding -Heparin- Induced Thrombocytopenia can be ironic in that it can cause stroke and embolism Thrombolytic medications -teplase i.e. alteplase, reteplase, tenecteplase Activates plasminogen which digests plasmin and dissolves clots in cases of MI, DVT, occluded shunts and Bleeding Dysrhythmias Allergic reactions -Contraindicated in active bleeding, history of hemorrhagic brain attack (stroke), intracranial or intraspinal surgery within the last 2 pulmonary emboli months, uncontrolled HTN -Apply direct pressure over a puncture site for 20 to 30 minutes -Used only for acute, life- threatening conditions Antidote: Aminocaproic acid Antiplatelet medications Aspirin, clopidogrel, cilostazol, dypiridamole, ticlopidine Inhibit aggregation of platelets in clotting process, thereby prolonging bleeding time GI bleeding Bruising Hematuria Tarry stools -may be used with anticoagulants -used in prophylaxis of long-term complications following MI, CAD, stents, and strokes Positive inotropes/cardiotonic medications Dobutamine Dopamine Imanrinone Milrinone Stimulate myocardial contractility and produce a positive inotropic effect for heart failure -increases CO, decreasing preload, improving blood flow to periphery and kidneys and increasing fluid excretion Dysrhythmias Hypotension Thrombocytopenia Adverse effects: Hepatotoxicity Hypersensitivity- wheezing, SOB, pruritus, urticaria (hives, clammy skin and flushing -used for IV administration; administer with IV infusion pump -monitor electrolyte (may lower K) and liver enzyme levels (may increase due to hepatotoxicity), platelet count, and renal function studies Cardiac glycosides Digoxin Stimulates myocardial contractility by inhibition of sodium-potassium pump -slows HR (negative chronotrope) and slows conduction velocity (negative dromotrope) -GI effects - headache -visual disturbances: diplopia, blurred vision, photophobia - drowsiness - bradycardia -fatigue, weakness -used for HF and cardiogenic shock, anything atrial (tach, fibrillation, flutter) - Early signs of digoxin toxicity present as GI symptoms (anorexia, nausea, vomiting, diarrhea); then heart rate abnormalities and visual disturbances appear -hypokalemia can cause digoxin toxicity; toxic levels above 0.5 to 2 are toxic (POTASSIUM COMPETES WITH DIGOXIN) Peripherally acting Alpha Adrenergic blockers -zosin i.e. doxazosin, prazosin, terazosin Decrease sympathetic vasoconstriction resulting in vasodilation and decreased BP Orthostatic hypotension Reflex tachycardia Drowsiness Nasal congestion Sodium and water retention -Monitor for fluid retention and edema - Avoid over the counter meds -change positions slowly to prevent orthostatic hypotension Centrally acting Adrenergic blockers Clonidine Guan- i.e. Guanabenz, Guanfacine Methyldopa Causes vasodilation, reducing peripheral resistance Na and water retention Drowsiness Bradycardia Hypotension -contraindicated in impaired liver function - Do not discontinue meds abruptly as it can lead to severe rebound HTN ACE inhibitors and ARBs -prils i.e. perindopril, enalapril -sartans i.e. losartan, eprosartan Causes vasodilation; treats HTN and CHF Hyperkalemia Hypotension Persistent dry cough (ACEI) Angioedema (ACEI)** Hypoglycemia with DM -can cause hyperkalemia! Avoid use with potassium supplements and potassium- sparing diuretics -Report side effect angioedema to the HCP right away -teratogenic drugs Nitrates Isosorbide Nitroglycerin Vasodilates and improves blood flow in MI Vasodilation/ Orthostatic hypotension Flushing or pallor Confusion Reflex tachycardia Dry mouth -administer up to three times in 15 mins; if after 5 mins symptoms have not been relieved at home, call 911 right away -always assess BP before administration and lower head of bed if hypotension occurs -administer sublingually 4 Beta blockers Calcium channel blockers Miscellaneous vasodilator Adrenergic Agonists HMG-CoA Reductase Inhibitors (statins) Antidysrhythmics -lol i.e. metroprolol, bisoprolol -dipine i.e. amlodipine, felodipine Verapamil Diltiazem Nesiritide Dopamine Epinephrine -statin i.e. atorvastatin, rosuvastatin Amiodarone Block release of cathecholamines thus decreasing HR and BP Promote vasodilation of coronary and peripheral vessels Vasodilates arteries and veins in CHF Positive inotropes increases BP and cardiac output Lowers serum cholesterol lOMoARcPSD|4577335 Bradycardia Bronchospasm Hypotension Dizziness Bradycardia Reflex tachycardia as a result of hypotension Changes in liver and kidney function Hypotension Confusion Dysrhythmias Tachycardia Elevated liver enzyme levels Muscle cramps (myopathy) Nausea, abd pain or cramps Dizziness, headache Blurred vision (Cataract formation) Pulmonary fibrosis Photosensitivity Peripheral neuropathy Tremor -keep in a dark tightly closed bottle; cannot be mixed with other drugs -contraindicated in clients with asthma, bradycardia or stroke, DM -assess for resp distress and for signs of wheezing and dyspnea -can mask symptoms of hypoglycemia i.e. tachycardia and nervousness; monitor BG -better choice for clients with asthma -monitor kidney function tests -DO NOT ADMINISTER WITH GRAPEFRUIT JUICE as it can lead to severe hypotension Administer by continuous infusion via IV pump Monitor BP, cardiac rhythm, urine output and body weight -Epinephrine used for cardiac stimulation in cardiac arrest (asystole) -Lovastatin is highly protein-bound and should not be administered with anticoagulants and should be administered with caution in clients taking immunosuppressive medications -instruct client to receive annual eye exam because meds can cause cataract formation -Hepatotoxic -HCP should be notified when client experiences muscle aches (monitor CK and myoglobin levels) DIURETICS *All diuretics are contraindicated in clients taking lithium! Hyponatremia can induce lithium toxicity *ALL diuretics can induce Digoxin toxicity except potassium-sparing diuretics i.e. spironolactone! Thiazide diuretics -thiazide i.e. Chlorothiazide, cholorthalidone, hydrochlorothiazide, indapamide, metolazone Increase sodium and water excretion by inhibiting sodium reabsorption in kidneys Hypokalemia, hyponatremia Hypovolemia Hypotension Photosensitivity *Hyperglycemia -not effective for IMMEDIATE diuresis -used with caution in the client taking lithium because lithium toxicity can occur (due to lack of sodium) -instruct client to take meds in morning to prevent nocturia and sleep interruption - change positions slowly to prevent orthostatic hypotension -instruct client with DM to check BG periodically Loop diuretics (Potassium- wasting diuretics) -ide i.e. Furosemide, Torsemide, ethacrynic acid, bumetanide Inhibit sodium and chloride reabsorption from the loop of Henle and the distal tubule Hypokalemia, hyponatremia Thrombocytopenia Hyperuricemia Dehydration Orthostatic hypotension Ototoxicity and deafness -more rapid than thiazide diuretics - causes hypo of all electrolytes; monitor electrolytes, Mg, BUN, Cr, and uric acid levels -monitor digoxin (due to hypokalemia) or lithium (hyponatremia) toxicity -administer furosemide IV slowly to prevent ototoxicity Potassium- sparing diuretics Spironolactone, triamterene, amiloride HCl, eplerenone Promotes sodium and water excretion AND potassium retention Hyperkalemia Nausea, vomiting, diarrhea Rash Dizziness, weakness -contraindicated in severe kidney or hepatic disease and severe hyperkalemia - monitor for HYPERKALEMIA!! - avoid salt substitutes because they contain potassium 6 Downloaded by Azaharia Segura ([email protected]) *Contains main drugs questioned in UWorld and mentioned in MK; Antibiotics, CV drugs, Diuretics, Diabetic drugs, Mental health drugs, and Respiratory drugs (in that order) plus other main drugs. i.e. proton pump inhibitors, dilantin, NSAIDs DIABETIC DRUGS **Watch for hypoglycemia during peaks! INSULIN lOMoARcPSD|4577335 Osmotic diuretics Mannitol Increases osmotic pressure of the GFR, inhibiting reabsorption of water and electrolytes -used with chemo to induce diuresis Fluid and electrolyte imbalances Pulmonary edema Tachycardia from the rapid fluid loss Hyponatremia and dehydration -can be used to decrease ICP NPH Glargine (lantus), Detemir Regular i.e. humulin R, novolin R Basal long acting Basal long acting Postprandial short acting Onset: 6 h Peak: 8-10 h Duration: 12 h No essential peak Duration: 12-24 h Cloudy suspension; precipitates and therefore cannot be given IV (can overdose client) “N for not so fast and not in the bag” -never given at bedtime (can cause hypoglycemia while asleep) -given twice daily -best for IV use (i.e. DKA) -“R for rapid and run insulin” Lispro (Humalog), Aspart, Glulisine (LAG) Postprandial short acting Onset: 1 h Peak: 2 h Duration: 4 h Onset: 15 mins Peak: 30 mins Duration: 3 h -give as client begins to eat, with meals not before meals (not AC) -ensure client eats within 15 minutes of administration -little to no risk for hypoglycemia; only safe insulin for bedtime ORAL HYPOGLYCEMIC AGENTS Biguanides Sulfonylureas Meglitinides Gliptins (DPP-4 inhibitors) Thiazolidinediones Metformin Chlorpropamide Gli( )ide i.e. glimepiride, glipizide, glyburide Tol( )ide i.e. tolazamide, tolbutamide -linide i.e. nateglinide, repaglinide -gliptins i.e. sitagliptin, saxagliptin -glitazone i.e. ciglitazone, darglitazone, englitazone Supresses hepatic production of glucose and increases insulin sensitivity Stimulate the beta cells to produce more insulin Stimulate beta cells to produce more insulin -short duration of action; less chance of blood glucose-lowering effects Block the action of DPP-4, which destroys the hormone incretin (incretin help body produce more insulin when needed; inhibition causes more insulin to be produced) Insulin-sensitizing agents that lower blood glucose by decreasing hepatic glucose production and improving target cell response to insulin lOMoARcPSD|4577335 Diarrhea Lactic acidosis GI disturbances Metallic taste in mouth Hypoglycemia Hypersensitivity reaction Weight gain GI disturbances Hypoglycemia Hypoglycemia GI disturbances Flulike symptoms (runny nose, headache, nausea, stomach pain) Rash GI problems Hepatotoxicity Increased bone fractures Increased LDLs -DO NOT TAKE same day of iodine contrast procedures i.e. cardiac catheterization (can induce lactic acidosis) Discontinue 24-48 hours prior to test -Cross reaction with sulfa antibiotics (sulfonamides); if client has allergic reaction to either one, DISCONTINUE Very fast onset of action allows client to take medication with meals and skip medication when a meal is skipped -Monitor for elevated ALTs and ASTs PSYCH DRUGS *All psych drugs have indications for WEIGHT GAIN and HYPOTENSION *Always taper medications down and never stop dosing abruptly lOMoARcPSD|4577335 Serotonin Reuptake Inhibitors (SSRIs) Serotonin- Norepinephrin e Reuptake Inhibitors (SNRIs) -lopram i.e. citalopram Sertraline Fluoxetine Fluvoxamine Venlafaxine Duloxetine Antidepressan ts that work through inhibition of serotonin reuptake Contraindication s: St. John’s Wort, MAOIs Side effects: Anticholinergic- dry mouth Blurred vision Constipation Drowsiness *Insomnia Toxic effects: Agranulocytosis Priapism -Monitor client for increased risk of suicidality esp. during improved mood and increased energy levels, and changes in doses -Instruct to change positions slowly to avoid ortho hypotension -Be aware of potential for Serotonin Syndrome Signs and symptoms include: Mental status changes (Anxiety, agitation, restlessness) and autonomic/neuromuscul ar hyperactivity (fever, muscle rigidity, shivering, diaphoresis, tachycardia, HTN, tremors) Risk greatly elevated with concurrent use of MAOIs -Can cause insomnia; do not administer at bedtime Monoamine Oxidase Inhibitors (MAOIs) PITS Phenelzine Isocarboxacid Tranylcypramin e Selegiline Inhibits metabolism of amines, NE, and serotonin thus improving mood and preventing depression RISK OF: With SSRIs: Serotonin Syndrome With TCAs: hypertensive crisis Antidote for hypertensive crisis: phentolamine IV -given at the last resort when no other antidepressant therapies are effective -TYRAMINE- CONTAINING FOODS may cause hypertensive crisis; avoid BAR (bananas, avocadoes and raisins or dried fruit), organ meats and processed meats, and aged cheeses 9 *Contains main drugs questioned in UWorld and mentioned in MK; Antibiotics, CV drugs, Diuretics, Diabetic drugs, Mental health drugs, and Respiratory drugs (in that order) plus other main drugs. i.e. proton pump inhibitors, dilantin, NSAIDs lOMoARcPSD|4577335 Tricyclic Antidepressants (TCAs) -triptyline i.e. amitriptyline, nortriptyline -pramine i.e. desipramine, imipramine Antidepressants which block NE and serotonin reuptake Side effects: Anticholinergic Blurred vision Constipation Drowsiness *Sedation Urinary retention -Concurrent use with MAOIs can lead to hypertensive crisis -Cardiac toxicity can occur and all clients should receive an ECG before treatment and after -antidote for TCA overdose: physostigmine Mood stabilizers Lithium Quetiapine Olanzapine Risperidone Carbamazepine Stabilizes mood Lithium is a competitive binder with sodium- hyponatremia can cause toxicity -therapeutic level is 0.6-1.2; toxic is >2 -Lithium is teratogenic Side effects: Peeing Pooping Paresthesis -Avoid anything that has any diuretic effects i.e. diuretics, coffee, tea, cola -dehydration can cause lithium toxicity -Instruct client to maintain a fluid intake of six to eight glasses of water Weight gain Drowsiness Anticholinergic Benzodiazepines -zepam i.e. clonazepam, diazepam, oxazepam -lam i.e. alprazolam, triazolam Chlordiazepoxide Antianxiety; minor tranquilizer Side effects: Anticholinergic Blurred vision Constipation Drowsiness**- can lead to somnolence -contraindicated in glaucoma and should be used cautiously in children and older adults -used for induction of anesthesia, muscle relaxant, alcohol withdrawal syndrome, tranquilizer - antidote for benzo overdose: flumazenil -can only be given for 2-4 weeks, not a long term drug Barbiturates -barbital i.e. anobarbital sodium Choral hydrate Eszopiclone Used for short- term treatment of insomnia for sedation to relieve anxiety, tension and apprehension Side effects: Dizziness Confusion Agranulocytosis -maintain safety by supervising ambulation and using side rails at night 10 *Contains main drugs questioned in UWorld and mentioned in MK; Antibiotics, CV drugs, Diuretics, Diabetic drugs, Mental health drugs, and Respiratory drugs (in that order) plus other main drugs. i.e. proton pump inhibitors, dilantin, NSAIDs lOMoARcPSD|4577335 Zolpidem Zaleplon -avoid driving or operating hazardous equipment if drowsiness, dizziness or unsteadiness occurs Antipsychotics Typical: (older- think EPS as main side effect) Haloperidol Loxapine Chlorpromazine Atypical: Olanzapine Quetiapine Risperidone **Aripriprazole (not a proton pump inhibitor) Reduces psychotic symptoms Typical antipsychotics are better indicated for positive symptoms (t like +) i.e. delusions, hallucinations, illusions Atypical better for negative symptoms i.e. Side effects: Anticholinergic Blurred Vision Constipation Drowsiness *EPS- Typical i.e. parkinsonism, dystonia, rigidity, tremors Haldol- Torsades de pointes (can be fatal as it can lead to V. fib or pulseless V. tach) -Administer with food or milk to decrease gastric irritation -protect liquid concentration from light -inform that some meds may cause a harmless change in urine color to pinkish to red-brown **Neuroleptic Malignant Syndrome (Haldol is most commonly tested)- anhedonia, catatonia characterized by altered mental status (lethargy, decreased LOC), muscle rigidity, hyperthermia (>40 C), tachycardia, HTN, tachypnea Treated by: supportive measures i.e. control temp (dantrolene), control agitation by benzodiazepines, and add dopamine agonist (bromocriptine) antipsychotic decrease dopamine levels 11 *Contains main drugs questioned in UWorld and mentioned in MK; Antibiotics, CV drugs, Diuretics, Diabetic drugs, Mental health drugs, and Respiratory drugs (in that order) plus other main drugs. i.e. proton pump inhibitors, dilantin, NSAIDs RESPIRATORY MEDICATIONS *For any respiratory medication, think sympathetic effects! lOMoARcPSD|4577335 Bronchodilator s (beta 2 agonists) -ol i.e. albuterol, formoterol, salmeterol Terbutaline (also a tocolytic drug) Relax smooth muscle of bronchi and dilate airways; promotes sympathetic response Side effects: Palpitations and tachycardia Hypertension Dysrhythmias Restlessness, anxiety, tremors Hyperglycemia -assess vitals and lung sounds -given as rescue drug along with ipratropium (only drugs used for acute asthma exacerbations) Methylxanthine s -phylline i.e. Theophylline Aminophylline Stimulate CNS and respiration, dilate coronary and pulmonary vessels, cause diuresis and relax smooth muscle -muscle spasm relaxer Dysrhythmias Seizures* Tachycardia Insomnia Restlessness GI effects Signs of toxicity: Anorexia Nausea, vomiting Insomnia, restlessness Cardiac toxicity -if administered with beta 2 agonist, cardiac dysrhythmias may result -administer with or after meals to decrease GI irritation - therapeutic level is 10-20; toxic level is >20 -IV infusions should be administered slowly and via an infusion pump -Usually given to relax airways during bronchospasm before bronchodilator s can be effective - cimetidine and ciprofloxacin can dramatically increase serum theophylline levels and should not be used in these clients Anticholinergic s -tropium i.e. tiotropium, ipratroprium Results in bronchodilation due to blocking of muscarinic receptors in the bronchioles (anti-acetylcholine) antiparasympatheti c therefore sympathetic effects drying of secretions* Dry mouth Blurred vision Urinary retention Hypertension Constipation -clients with peanut allergies should not take ipratropium because it contains soya lecithin, which is in the same plant family as peanuts - contraindicate d in clients with glaucoma Glucocorticoids -sone i.e. beclomethason e, Long term treatment of inflammation associated with asthma Immunosuppressio n -Monitor for signs of infection and report to HCP i.e. fever, high WBCs 12 Downloaded by Azaharia Segura ([email protected]) *Contains main drugs questioned in UWorld and mentioned in MK; Antibiotics, CV drugs, Diuretics, Diabetic drugs, Mental health drugs, and Respiratory drugs (in that order) plus other main drugs. i.e. proton pump inhibitors, dilantin, NSAIDs lOMoARcPSD|4577335 prednisone, fluticasone -ide i.e. ciclesonide, flunisolide -Not used for acute exacerbations - Rinse mouth after use to prevent oral candidiasis or thrush infection Leukotriene modifiers -lukast i.e. montelukast, zafirlukast Used in prophylaxis and treatment of chronic asthma (not used for acute exacerbations) -inhibit bronchoconstrictio n caused by specific antigens and reduce edema and smooth muscle constriction Immunosuppressio n Nausea, vomiting Dyspepsia Generalized pain, myalgia - Coadministratio n of inhaled glucocorticoids increase the risk of upper respiratory infections - monitor liver function lab values i.e. ALT, AST Antihistamine s Dimenhydrinate Dipenhydramine -tadine i.e. loratadine, olapatadine Cetirizine Prevents a histamine response; used for common cold, rhinitis, nausea and vomiting drying effect* Drowsiness, fatigue Dizziness Urinary retention Constipation Dry mouth -Can cause CNS depression if taken with alcohol, opioids, tranquilizers or barbiturates - suck on hard candy or ice chips for dry mouth -contraindicated for glaucoma Nasal decongestants Pseudoephedrin e (ephedrine looks similar to epinephrine) -zoline i.e. naphazoline, tetrahydrozoline , xylometazoline Reduce fluid secretion Major sympathetic effects* Hypertension (due to vasoconstriction) Hyperglycemia Restlessness, insomnia, nervousness -contraindicated in HTN, cardiac disease, hyperthyroidism , or DM -should NOT be used for longer than 48 hours due to tolerance and rebound nasal congestion (vasodilation) Opioid antagonists Naloxone Naltrexone Alvimopan Reverse respiratory depression in opioid overdose Nausea, vomiting Tremors, Sweating Hypertension Tachycardia -Avoid use for non-opioid respiratory depression -Re- occurrence of respiratory depression can occur if duration of opiate effects exceed duration 13 *Contains main drugs questioned in UWorld and mentioned in MK; Antibiotics, CV drugs, Diuretics, Diabetic drugs, Mental health drugs, and Respiratory drugs (in that order) plus other main drugs. i.e. proton pump inhibitors, dilantin, NSAIDs Other commonly tested drugs lOMoARcPSD|4577335 of antagonist- re-administer if needed Tuberculosis Agents Isoniazid Rifampin Ethambutol Pyrazinamide Rifabutin Rifapentine Treats active tb; treatment goes for 6-9 months for otherwise healthy clients (immunosuppressed clients can go for as long as 9-12 months) Isoniazid treatment can be used for latent tb Hepatotoxicity Ototoxicity Neurotoxicity (numbness and tingling) Dry mouth Dizziness Red secretions (rifampin) -after 2-3 weeks of treatment, risk of transmission is greatly reduced -when one med is discontinued abruptly, resistance can occur (MDR-TB) -decrease efficacy of oral contraceptives; other means of birth control must be used -Take pyridoxine (vit B6) to prevent neuropathy Folate antimetabolite, antineoplastic, immunosuppressan t drugs Methotrexat e -treats malignancies, Rheumatoid Arthritis and psoriasis - CONTRAINDICATE D in pregnancy unless abortion is warranted i.e. ectopic pregnancy Bone marrow suppression Immunosuppressio n Hepatotoxicity Photosensitivity -Clients should be instructed to get vaccinated with inactivated vaccines, avoid crowds and persons with known infections (as though they are being treated with chemo- antineoplastic drug) -Avoid alcohol as it is HEPATOTOXI C Anticonvulsants Phenytoin Used to treat tonic- clonic seizures Therapeutic range is 10-20 mcg/mL Anything >20 is toxic Main side effect: Gingival hyperplasia Toxic effects: Gait unsteadiness/Ataxi a Horizontal nystagmus CNS effects -Good oral hygiene can limit symptoms of gingival hyperplasia 14 NSAIDs Ibuprofen Naproxen Indomethacin Indicated for pain i.e. joint and inflammation Tarry stools (due to GI bleeding) Nephrotoxicity Hypertension (sodium retention) Fluid overload Contraindicated in CHF due to sodium retention and associated HTN -Contraindicated in clients taking Lithium (again due to associated sodium retention) -Take with food to prevent GI upset -Bleeding risk associated when taken with aspirin, anticoagulants and other NSAIDs Proton pump inhibitors -prazole i.e. Omeprazole Pantoprazole Decreases acid production in stomach Associated with increased risk of pneumonia C. diff diarrhea Calcium malabsorption (osteoporosis) -may increase risk of C. diff infection due to lack of acid production in stomach leading to loss of gastric protection Antipyretic, Tinnitus Hyperthermia Reye’s syndrome in peds Contraindicated in administration to children due to risk of Reye’s syndrome (except in Kawasaki disease) anti- inflammatory, Aspirin antiplatelet and prophylactic treatment in recurrent MI Corticosteroids -sone i.e. prednisone, bethametasone Used for lack of corticosteroids in body (i.e. Addison’s), immune diseases Hyperglycemia Immunosuppression Bone and muscle catabolism GI irritation -Do not discontinue abruptly -Increase dose of corticosteroid therapy in Addison’s disease during times of stress as a stress response can cause a sudden decrease in cortisol levels and can trigger an Addisonian crisis - Recommend diets high in calcium, protein and low in fat and simple carbs while on treatment -Cataracts are a side effect of corticosteroids Anticholinergics Benztropine Used to treat tremors in Parkinson’s disease Blurred vision Dry secretions Constipation -contraindicated in glaucoma as it can precipitate an acute glaucoma episode 15 *Contains main drugs questioned in UWorld and mentioned in MK; Antibiotics, CV drugs, Diuretics, Diabetic drugs, Mental health drugs, and Respiratory drugs (in that order) plus other main drugs. i.e. proton pump inhibitors, dilantin, NSAIDs Urinary retention (contraindicated in BPH) EXTRA TIPS: • • Do not administer anything sedative i.e. opioids, benzodiazepines, barbiturates to clients with increased ICP as it can mask somnolence and decreasing LOC • • Always monitor blood pressure in vasodilating medications prior to administration i.e. ACE inhibitors, nitrates • • Neuroleptic Malignant Syndrome and Malignant Hyperthermia are similar in terms of symptoms! i.e. muscle rigidity, hyperthermia, lOMoARcPSD|4577335 mental status changes, tachycardia, tachypnea—difference lies in causes Malignant Hyperthermia Neuroleptic Malignant Syndrome • • Causes: Antipsychotics and low dose phenothiazines used as antiemetics i.e. Haldol, chlorpromazine • • Treated by: dantrolene for hyperthermia, benzodiazepines for anxiety and agitation, and dopamine agonist bromocriptine • • Causes: inhaled anesthetics ie. Halothane, muscle relaxant i.e. succinylcholine • • Treated by: dantrolene for hyperthermia, benzodiazepines for anxiety and agitation, NO bromocriptine 16 [Show Less]
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