Prepare for NCLEX pharmacology questions with this UWorld-style practice guide. This covers drug classifications, mechanisms, side effects, and nursing implications.
Q: Nephrotoxic Meds
Answer: -mycin antibiotics (aminoglycides)-keterolac (Toradol)-NSAIDs-digoxin
Q: Hepatotoxic Meds
Answer: -tylenol-NSAIDs
Q: Naloxone (Narcan)
Answer: -weans in 1-2 hours-IV or nasal spray-if unresponsive d/t anesthesia or opioids: administer oxygen, assess respiratory rate, notify HCP, prepare second dose Narcan, no need to call rapid response/code team
Q: NSAIDs
Answer: NON-STEROIDAL ANTI-INFLAMMATORY DRUGS-ex: aspirin, ibuprofen, naproxen-use at lowest dose necessary for short amount of time-risks: GI toxicity, kidney injury, HTN, heart failure, bleeding risk-do not use if hx cardiac problems
Q: Aspirin
Answer: -side effects: black tarry stools, ringing in ears (earliest sign), bruising, tachycardia, hypotension-ASA toxicity: treated with activated charcoal then IV sodium bicarbonate, sx disorientation/vomiting/diaphoresis/restlessness, tinnitus
Q: Opioids
Answer: -if taking extended release for chronic pain teach to take even if pain is not present-monitor respiratory status when taking with short acting opioids-IV 2-3 minute push then check 15-30 minutes after admin-nausea/vomiting usually subsides after initial treatment-take with foodEX-morphine-hydrocodone-codeine-fentanyl-heroin (illegal substance)SE-sedation-respiratory depression-hypotension-constipation-risk for addiction
Q: Codeine
Answer: -narcotic used for acute pain or cough suppressant-can cause accumulation of secretions so do not prescribe to people with respiratory disorders
Q: Topical Medications
Answer: -allow 30 minutes before washing off to ensure medication is absorbed-avoid heat-local irritation is common
Q: Clozapine
Answer: -antipsychotic-increased risk for infection-serial white blood count testing is necessary-report all s/s of infectionSE-weight gain-drooling-significant sedation-agranulocytosis
Q: Lithium
Answer: -prescribed for bipolar disorder-if kidney issues are present (including dehydration) question prescriptionLITHIUM TOXICITY-n/v, diarrhea, confusion, agitationSE-drowsiness-weight gain-dry mouth-avoid sodium depletion-eat regular diet-adequate fluids-avoid NSAIDs-takes up to 3 weeks to be effectiveTHERAPEUTIC RANGE-0.6-1.2
Q: Tricyclic Antidepressants
Answer: TYLINE/PRAMINEAmitriptyline, nortriptyline, imipramine, desipramine, clomipramine, doxepin, amoxapine.SE-constipation-restlessness-dizziness
Q: MAOIs
Answer: isocarboazid, phenelyzene, tranylcpromine-avoid tyramine containing foods (aged cheeses, cured meats, beers, overripe fruit)
Q: SSRIs
Answer: XETINE/PRAM/ALINEfluoxetine, paroxetine, sertaline, citalopramSEROTONIN SYNDROME-agitation-confusion-tachycardia-diaphoresis-tremors-hyperreflexia-insomnia-sexual dysfunctionSE-weight gain (long term use)-increased suicide risk at beginning of therapy (if reporting increase in energy and no change in depression further assessment is needed)-sexual dysfunction-serotonin syndrome*SE should subside in 3 months
Q: Antidepressant General Info
Answer: -do not immediately stop medications-takes weeks to take effect-do not take these drugs together-takes about 2 weeks for meds to get out of system so a 2 week “med break” is recommended if switching classes of antidepressants
Q: ADHD Meds
Answer: Neurostimulants (increase dopamine)-ritalin: only in school year bc it stunts growth-dexedrine-addreall-concerta-focalin/ focalin XR-daytrana-vyvanse-methylphenidate: short actingNon-stimulants:-strattera (NRI)-Intuniv: effectiveness depends on the ptSE-weight loss-stunt growth-HTN-tachycardia-tics-restlessness-insomnia-abuse potential-helps maintain focus on activity-improves listening skills
Q: Anti Seizure Medications
Answer: PHENYTOIN (anti seizure)-SE: gingival hyperplasia (folic acid can reduce risk), increase in body hair, rash, folic acid depletion, decreased bone density (osteoporosis), drowsinessLEVETIRACETAM-SE: drowsiness, fatigue, associated with SI (report any change in level of anxiety/mood), associated with Stevens Johnson syndrome (report any rash)
Q: Extrapyramidal Side Effects
Answer: COMMON WITH ANTIPSYCHOTIC DRUGS-psuedoparkinsonism: masklike face, shuffling gait, resting tremor-dystonia: abnormal muscle movements of face, neck, and trunk
Q: BEERS Criteria
Answer: antipsychotics, anticholinergics, antihistamines, antihypertensives, benzodiazepines, diuretics, opioids, and sliding insulin scales
Q: Benzodiazepines
Answer: ANXIETY TREATMENTValium (diazepam), ativan (lorazepam), Xanax (Alprazolam), Serax (oxazepam), Klonopin (clonazepam), Librium (chlordiazepoxide)-may cause sedation-give dose at bedtime-never stop abruptly-risk for addiction
Q: Buspirone
Answer: ANXIETY TREATMENT-no risk for addiction-works in 1 week with full effects in 2-4 weeks
Q: Sulfa Medications
Answer: TREAT ULCERATIVE COLITIS, RHEUMATOID ARTHRITIS, IBD-drink 8 glasses water daily (can crystallize in kidney if dehydrated)-photosensitivity-folic acid deficiency-agranulocytosis-Stevens Johnsons syndrome-urine/skin will turn orange yellow
Q: Loop Diuretics
Answer: furosemide, torsemide, bumetanide-can cause hypokalemia (muscle cramps, weakness, cardiac dysrhythmias)-supplemental potassium or high potassium diet
Q: Potassium Sparing Diuretics
Answer: Spironolactone (Aldactone), amiloride-weak diuretic and hypertensive-combined with thiazide diuretics to reduce K+ loss
Q: Thiazide Diuretics
Answer: hydrochlorothiazide, chlorthalidoneSE: hypokalemia, hyponatremia, hyperuricemia (may worsen gout attacks), hyperglycemia
Q: Treating Tuberculosis
Answer: ISONIAZID-causes liver damage (hold if elevated liver enzymes)-don’t take with antacids within 1 hr-report changes in visionSE-hepatotoxicity-peripheral neuropathyRIFAMPIN-red orange discoloration of body fluids-take with meals-causes liver damageBOTH-reduce efficacy of oral contraceptives-require liver enzyme testing every month
Q: Epinephrine Auto Injectors
Answer: -90 degree angle into outer thigh-hold in place for 10 seconds-seek immediate medical care-expect tachycardia/palpitations/dizziness-store at room temp in dark place
Q: Rheumatoid Arthritis Meds
Answer: – Prednisone (Glucocorticoid)- Adalimumab (DMARD)- Methotrexate-risk for infection
Q: Albuterol
Answer: -quick release-run canister under warm water and let dry once per week-SE: dizziness, palpitations, restlessness
Q: Inhaled Corticosteroids
Answer: Beclomethasone HFA (QVAR)Budesonide (Pulmicort Flexhaler, Pulmicort Respules)Ciclesonide (Alvesco)Fluticasone (Flovent HFA)Mometasone (Asmanex Twisthaler, Asmanex HFA)-rinse mouth after use-use of spacer decreases risk for thrush-use albuterol before steroid if needed-take inhaler apart and clean
Q: Acetylcysteine (Mucomyst)
Answer: -helps loosen secretions-worsens bronchospasm (consult with HCP if given to clients with reactive airway diseases such as asthma)
Q: Asthma
Answer: -use albuterol & then corticosteroids if albuterol is not helping-avoid NSAIDs and beta blockers–worsens sxASTHMA ATTACK TREATMENT-inhaled albuterol & ipratropium (anticholinergic) every 20 minutes-IV methylprednisolone-theophylline is a bronchodilator sometimes used (avoid caffeine, monitor blood levels to avoid seizures)*neb/inhaler corticosteroids are used for long term maintenance not for emergency tx
Q: Penicillin Allergy
Answer: If penicillin allergy also don’t take cephalexin & ampicillin
Q: ACE Inhibitors
Answer: PRIL-do not take if pregnant-can cause kidney damage-do not give if current hyperkalemia or hypotension-SE: hyperkalemia, angioedema, persistent/dry cough-does not lower HR
Q: ARBs
Answer: TAN-do not take if pregnant-usually prescribed if ace inhibitor side effects are intolerable
Q: Beta Blockers
Answer: LOL-SE: bronchospasm (assess for respiratory issues)-lowers HR & BP
Q: Calcium Channel Blockers
Answer: ZEM, PINE-goal is to reduce HR-vasodilator-SE: dizziness, flushing, headache, peripheral edema, constipation-avoid grapefruit juice
Q: Nitrates
Answer: NITROGLYCERIN-treats angina-vasodilator-IV, PO, patch (usually used daily for 12-14 hours for chronic stable angina)-if 1 dose given without relief call EMS, patient can take up to 3 doses-do not take with “afil” meds-rotate sites-SE: headache
Q: Cardiac Medication Teaching
Answer: -ask HCP before taking cold/cough suppressants, high sodium antacids, and appetite suppressants-avoid NSAIDs
Q: Anticoagulants
Answer: CLOT PREVENTIONWARFARIN (Coumadin)-given for several days until it takes effect-may be given with heparin until INR is in therapeutic range-prevent injury-avoid aspirin/NAIDs/alcohol-therapy usually lasts 3-6 months-vitamin K reverses effects-do not change diet-watch INR levels (therapeutic range 2-3)-if discontinued, is expelled from body in 3-5 daysHEPARIN-watch aPTT levels: therapeutic is 1-2x normal (46-70), prepare to give protamine (reverses effects of heparin) and notify HCPENOXAPARIN-low molecular weight heparin-subq injection-watch aPTT-mild bruising and bleeding may occur at injection siteAPIXABANBLEEDING PRECAUTIONS-assess invasive sites for bleeding-check hemoglobin and platelet count-place on continuous cardiac monitoring-report black tarry stools to HCP
Q: Statin Medications
Answer: -check liver function before starting therapy-SE: rhabdomyolysis (decreased UO, dark urine, muscle aches–report all to HCP)-take in evening or at bedtime
Q: Digoxin
Answer: -watch levels (>2 indicates toxicity) and for hypokalemia-toxicity: dizzy/lightheaded-check pulse before admin and if < 60 or skipping beats do not take-SE to report: vision changes, fatigue, weakness, confusion
Q: Drugs Commonly Associated with Orthostatic Hypotension
Answer: -Most antihypertensive medications, particularly sympathetic blockers such as beta blockers (eg, metoprolol) and alpha blockers (eg, terazosin)-Antipsychotic medications (eg, olanzapine, risperidone)-Antidepressants (eg, selective serotonin reuptake inhibitors)-Volume-depleting medications such as diuretics (eg, furosemide, hydrochlorothiazide)-Vasodilator medications (eg, nitroglycerine, hydralazine)-Narcotics (eg, morphine)
Q: Antiplatelet Agents
Answer: clopidogrel, ticagrelor, prasugrel, aspirin-bleeding precautions-do not take with gingko biloba-assess: bruising, tarry stools, platelets
Q: Levothyroxine
Answer: SYNTHROID-take in morning on empty stomach-treats hypothyroidism which causes high TSH levels-goal of treatment is to decrease TSH-do not take with antacids-takes 3-4 weeks to take effect-therapeutic effect: heart rate WNL, improved mood and energy levels
Q: Proton Pump Inhibitors
Answer: PRAZOLE-long term use: decreased bone density, increased risk for pneumonia & C. diff-take 30 minutes before meals on empty stomach-do not take within 30 min antacids-used to prevent stress ulcers after surgery
Q: Antiemetics
Answer: Metoclopramide HCL (reglan), haloperidol (haldol)-indicated for NV-SE: headache, drowsiness, restlessness, fatigue, extrapyramidal symptoms-caution about decreased alertness, avoid alcohol, discontinue if EPS occurs
Q: Lactulose
Answer: used to reduce serum ammonia levels in hepatic encephalopathy-3 loose stools a day is expected-should see improvement in confusion and lethargy
Q: Adenosine
Answer: -treatment of supraventricular tachycardia-line closest to heart (preferably central line) and push rapidly-half life 5-10 seconds
Q: Anticholinergic Drugs
Answer: Oxybutynin (Ditropan, Gelnique), tolterodine (Detrol), Darifenacin (Enablex), Solifenacin (Vesicare), Trospium (Sanctura), Fesoterodine (Toviaz)SE: sedation, pupillary dilation, dry mouth, urinary retention, constipation, blurred vision, drowsiness, heat intolerance-do not administer with urinary retention or glaucoma
Q: Long Acting Insulin
Answer: glargine, detemir-once daily-do not mix with any other insulin
Q: Intermediate Acting Insulin
Answer: NPH (Humulin N, Novolin N)Onset: 1.5-4 hrPeak: 4-12 hrDuration: 12-18 hr-can be given with regular insulin in same syringe
Q: Short Acting/Regular Insulin
Answer: Regular (Humulin R; Novolin R)ONSET: 0.5-1 hour.PEAK: 2-5 hours.DURATION: 6 to 10 hours.-best for IV useLispro, aspartPEAK: 0.5-3 hours-best option post meal hyperglycemia-usually on sliding scale-can be given with intermediate acting insulin in same syringe
Q: Metformin
Answer: increases sensitivity to insulin and decreases sugar release by liver-minimal risk of hypoglycemia-do not administer if patient will be having a procedure done with contrast
Q: Long Term Corticosteroid Use
Answer: -Do not stop abruptly-Therapy masks signs of infection so report even a low grade fever to HCP-Increase dose of corticosteroids in times of stress-SE: Muscle weakness, Cataracts, Gastric irritation (take with food), Hyperglycemia-Monitor for s/s of cushing’s syndrome-Exercise-Supplement calcium
Q: Radioactive Iodine
Answer: treats hyperthyroidism-teaching: avoid pregnant women and children, use separate food utensils, towels, toilet if possible from family members, do not sit near other for prolonged amount of time
Q: Herbal Substances with Increased Bleeding Risk
Answer: -ginkgo biloba-ginseng-saw palmetto-garlic-ginger-feverfew
Q: Allopurinol
Answer: decreases uric acid production-used to treat gout sx and prevent tumor lysis syndrome-report any rash to HCP
Q: Carbidopa/Levodopa
Answer: treats sx of Parkinson’s diseaseTEACHING-fall precautions, several weeks to reach maximum effectiveness, harmless discoloration of secretions (reddish black), avoid high protein meals
Q: tissue plasminogen activator (tPA)
Answer: drug that breaks up blood clots-must be administered within 3-4.5 hours of sx start-recent surgery/stroke/hemorrhage/head trauma (within last 3 months) is a contraindicated
Q: Erythropoietin
Answer: used as replacement when kidney is injured for Hgb <11-therapy should be stopped when Hgb reaches 11 to prevent clots-SE: hypertension (maintain BP WNL before administering and periodically check)
Q: Supplements1. potassium2. calcium3. iron
Answer: 1. oral supplements take with full glass of water and sit upright > 30 minutes after taking2. protein and vitamin C help absorption, take in divided doses daily3. do not take with antacids or milk, vitamin C helps absorption
Q: Phenazopyridine hydrochloride (Pyridium)
Answer: analgesic to treat urinary tract infection pain-turns urine bright orange
Q: IUDs
Answer: TEACHING-assess string position weekly for the first 4 weeks then after every period-copper IUD 10 years protection, other kind 3 years protection