Pharmacology

NCLEX will only ask the Generic name of drugs

1. Cancer drugs:

 Tamoxifen: -used for breast cancer

o Think the double “e”
o Risk for emboli and endometrial cancer
o Report heavy periods and excessive bleeding to the HCP -NCLEX tip
 Clot risk
 Contraindication with history of DVT or PE clarify order with HCP -NCLEX tip
 Side effect that is normal with this drug: hot flashes -don’t need to report
 Oprelvekin (new cell stimulators) -given to increase platelet production particularity with chemo
patients who have that thrombocytopenia (low platelet count)
o Reduces the bleeding
o Stimulates growth of hematopoietic stem cells
o Oprelvekin effectiveness = increased platelets
o Adverse effects: Fluid retention, A-fib, Anaphylaxis -NCLEX tip
 Neupogen (Filgrastim/Pegfilgrastim) -give to stimulate those WBCs or neutrophil production
o Expected outcome = increase neutrophil count
o No effect on hemoglobin -NCLEX tip
 Doxorubicin -chemotherapy, oncology patients
o Slow or stop the growth of tumors
o Monitor for hyperglycemia
 Side effects from chemo are hair loss, and weak skin
 Bone marrow suppression -the worst side effect because the bones are in charge
of making the important blood cells to help protect us
o Low platelet count -risk for bleeding
o Temperature over 100.3 -FEVER with any cancer patient this is priority -NCLEX tip
o Low WBC -most deadly called leukopenia
 Leading to immunodeficiency and immune compromised -NCLEX tip
o Low RBC and low CBC = anemia
 Patient teaching: use electric razors, stool softeners, no falls -avoid rugs
o Neutropenic precautions: -NCLEX tip
 NO fresh flowers or fresh fruit
 AVOID crowds and sick people
 NO rectal temperatures
 Nausea is a common side effect
 Cisplatin: -chemotherapy
o Renal toxicity:
 Monitor urine input and output -NCLEX tip
 Creatinine over 1.3
 BUN over 20
 Urine output less than 30mL/hr =kidney distress -NCLEX tip
 o Give antiemetics (nausea med) prophylactically (just in case)
o Saline rinse before and after meals
o Increase fluid intake for next 3 days
o Teach how to manage fatigue
o Check for dehydration:
 Good blood pressure, good skin turgor, adequate capillary refill, and good I/O
 Cyclophosphamide: -given to treat tumors and cancer from stopping protein synthesis
o Side effects:
 Bone marrow suppression, anemia, neutropenia, and thrombocytopenia
 Big risk for infections and bleeding
 Vincristine: -given to treat tumors and cancer by stopping cell division during mitosis
o Only drug that does not cause bone marrow suppression
o Main side effect: neuropathy -never damage that causes weakness, numbness and pain
typically in the hands and feet
 Interferon: -type of immunotherapy given to stimulate the body’s immune system
o Gives flu like symptoms:
 Fever, muscle aches, weakness and chills -are normal to be expected -NCLEX tip
o Interferon beta:
 Apply warm compress before giving injection to reduce risk of pain at site
 Administer medication late in the day so flu like symptoms occur during sleep
 Radiation: -cancer treatment
o Given outside the body with big X-ray looking machine
o Combination with chemotherapy to shrink down those cancerous tumors
o Harsh on the skin making it red, dry, itchy, and very sensitive so no skin irritation
 No lotions, creams, perfumes, powders, or makeup cosmetics
 No deodorants or shaving
 Use hands instead of washcloth to clean the radiation area
 Brachytherapy: -different type of radiation
o Goes inside the body
o Radioactive implant is placed directly inside the tumor for about 24-72 hours
 Patient is a radioactive hazard
 Usually in endometrial cancer and cervical cancer -NCLEX tip
Nursing interventions: -NCLEX tip
o Limit time:
 Cluster care 30 minutes per shift, typically rotate the staff
 Staff is to wear radiation film badge (dosimeter)
o Limit Distance:
 Teach all visitors to be at least 6 feet away from the patient
 No pregnant company
 No one less than 18 years old
 Private room and toilet
 Close door to room at all times and sign on door “caution radioactive”
o Shield the body:
 Use lead apron when in direct contact with patient called shielding -NCLEX tip
NCLEX tips for antibiotics:

o Finish medication to prevent super infection (take until all med is finished and DO NOT
stop taking when feeling better)
o Accidental pregnancy (oral contraceptives are ineffective so use additional contraception
like IUD)
 C: Childcare
 C: “-cillins” like penicillin and amoxicillin
 C: “-cycline” like doxycycline and tetracycline
o NO alcohol with these drugs
o NO food for MTF “move the food” (take on empty stomach with full glass of water)
 M: Macrolides -Azithromycin
 T: Tetracycline -Doxycycline
 F: Fluoroquinolones -Levofloxacin
o NO sun AVOID “Fun the sun”
 F: Fluoroquinolones -Levofloxacin
 T: Tetracycline -Doxycycline
 S: Sulfa drugs = sun burns (Trimethoprim -sulfa methox azole)
 Sulfonylureas (glyburide) and diuretics (thiazide/loops)
 Photosensitivity -avoid direct sun exposure and sun burns (wear sunblock)
o Super toxic to the kidneys (nephrotoxicity) and ears (ototoxicity)
 Vancomycin, gentamicin, and neomycin

2. Antibiotics:

 Penicillin
o End in -cillin
o Ex: Amoxicillin and Ampicillin and Piperacillin Tazobactam
o Pregnancy and breastfeeding safe
 Accidental pregnancy since it bumps the pill
 Oral contraceptive are ineffective so use additional contraception -NCLEX tip
 Cross sensitivity (anaphylaxis allergy) -check allergy before giving and do not mix
with other dugs -NCLEX tip and clarify prescription and request a new med
o During a reaction:
 Stop “hold” medication
 Assess the type of reaction -always auscultate the lungs -NCLEX tip
 Prepare epinephrine to administer
o Administration:
 Take with food if GI is upset (nausea/vomiting/diarrhea)
 Shake well before use
 Measuring device doppler or oral syringe to give med -NCLEX tip
o Common side effect: bleeding (monitor platelet count)
 Cephalexin
o Start with -ceph and are cephalosporins
o Ex: Cefazolin, and Ceftriaxone
 o Pregnancy and breastfeeding safe
 Can cause C-diff -NCLEX tip
 Cross sensitivity (anaphylaxis allergy) -check allergy before giving and do not mix
with other dugs -NCLEX tip and clarify prescription and request a new med
o Common side effect: diarrhea
 Metronidazole
o Number 1 drug to treat C-diff infection -NCLEX tip
o Also treats STI (Trichomoniasis)-sexually transmitted infection
o End in “dazole”
o AVOID alcohol (ETOH) both during and 3 days after treatment -NCLEX tip
 Patient will have violent vomiting and cramping if alcohol is consumed
o Side effects that are normal -no need to report
 Dark urine “discoloration” (brown and rusty)
 Metallic taste (metro-metallic taste)
o Deadly side effect is report, any new rash or skin peeling =steven Johnson syndrome
 Trimethoprim sulfamethoxazole
o Sulfonamides antibiotics or UTI medication
o Stops folic acid synthesis and is a sulfa drug so think “SULF”
 S: Sunburn -teach to use sunblock and avoid sun
 U: Urine crystals and specific gravity -high and dry
 L: Love the water -drink 2-3 liters of water per day
 F: Folic acid -take daily
o Contraindications we have hypersensitivity to sulfa drugs, always assess for sulfa
allergies
 To glyburide (oral anti-diabetic drug)
 Rash while on glyburide -potential allergy to sulfa drugs
 NOT pregnancy safe
 Levofloxacin and Ciprofloxacin
o Fluoroquinolones or UTI meds
o Given to pneumonia and UTI patients
 AVOID sun “direct sun exposure”
 Achilles tendon rupture -NCLEX tip
 Report new muscle pain
 Contraindication: Tendonitis
 Phenazopyridine -not an antibiotic
o UTI analgesic given for pain relief during that burning and irritation of UTIs
o Normal to have red and orange urine and body fluids -no need to report
o REPORT liver toxicity symptoms like yellow skin/sclera = jaundice -NCLEX tip
 Teach patient to wear sanitary pads and also wear glasses instead of contacts
 NEVER stop antibiotic therapy not even when feeling better -NCLEX tip
 Tetracycline and Doxycycline
o Indication if mainly used for skin -acne
o End in “-cycline”
 o NOT pregnancy safe
o Tooth discoloration
o Sun burns -wear sunscreen
o Patient education:
 Use additional contraception
 Take on empty stomach usually 1-2 hours before or after meals
 Sit up 30 minutes after taking -DO NOT LAY DOWN -NCLEX tip
 AVOID calcium products -NO daily (milk, cheese), NO antacids (tums, milk of
mag) and NO iron
 Azithromycin and Erythromycin
o Macrolides ending in “-thromycin”
o Prolonged QT intervals -could lead to cardiac arrest
o Monitor ECG -report changes to HCP
o Liver toxic -monitor AST/ALT and report increases to the HCP
o Side effects: -normal (do not stop drug for these)
 Nausea/vomiting, fever and decrease WBCs
 Vancomycin
o Glycopeptides class -very toxic to the kidneys and ears
o Monitor the drug concentration in the blood
o Peak and Trough -NCLEX tip
 Check 15-20 minutes before next dose or before the next administration
 Draw and review levels (therapeutic range 10-20)
 Report and hold over 20 for vancomycin
o Report signs of toxicity
 Ear damage “ototoxicity” -monitoring for hearing and balance changes
 Vertigo (loss of balance) and ataxia (inability to walk) -NCLEX tip
 Tinnitus (ringing of the ears) -NCLEX tip
 Kidney damage “nephrotoxic” -report to HCP of increasing BUN and creatinine
 Creatinine over 1.3 and BUN over 20
o Vancomycin given for MRSA and C-diff -powerful drug and burns during administration
 Usually given via PICC as a preferred route
 Assess site every 30 minutes for pain, redness and swelling
o Vancomycin can cause red mans syndrome caused by a rapid infusion
 Sudden onset of severe hypotension, flushing and pruritus (itching) and red rash
on face, neck, chest and extremities
 Simply slow the infusion
o Key words for vancomycin
 Monitor BP and infuse slowly at least over 60 minutes -NCLEX tip
 NO effect on mag levels, NO effect on mental status or deep tendon reflexes,
and NO need for anti-nausea meds
 Tobramycin, Gentamicin, Neomycin
o Aminoglycosides class, and indication used to treat infections in cystic fibrosis
o NO red mans syndrome
 o Neomycin is very toxic in combination with vancomycin
o Notify HCP of increasing BUN/creatinine -ototoxicity and nephrotoxicity
 Increased risk for toxic effects in the elderly population and those with
decreased renal function as well as when giving at high doses -NCLEX tip
 Normal to have muscle aches and cramping

3. Respiratory Drugs:

 Bronchodilators: “BAM”
o B: Beta 2 Agonist -Albuterol and Levalbuterol
 Increases HR
 End in “-buterol”
 B- brutal asthma attacks
 1st drug we use for severe asthma attacks -fasting acting bronchodilator
 The ONLY “rescue inhaler” during acute asthma attacks -NCLEX tip
 Before steroid inhaler -NCLEX tip
 S: salmeterol = S: slower acting (NOT rescue inhaler)
 NCLEX question: DO NOT use fluticasone or salmeterol for first sign of acute
asthma attack
 Acute asthma attacks we give 3 drugs: (SEQUENCE IS KEY) “AIM” -NCLEX tip
 A: Albuterol 1st
 I: Ipratropium 2nd
 M: Methylprednisolone (steroid) last
 Expected Side Effects for Albuterol: 3 T’s
 T: Tachycardiac and palpitations
 T: Tremor
 T: Toss and turning at night (insomnia and difficulty sleeping) -NCLEX tip
 Do not take at bedtime -NCLEX tip
 AVOID beta blockers (atenolol) and NSAIDS (naproxen, ibuprofen) -NCLEX tip
 During attack we instruct patent to take 2-4 puffs every 20 minutes for 3 rounds
 If not working after 3 doses? -Notify HCP
 Drug was effective: decrease in RR, and oxygen sat. is at least 90% or higher
 Expected finding after treatment: -normal
 Increased productive cough
 Reports of decreased anxiety
 Mild bilateral hand tremors
 Administration: shake it before you take it -shake it well
 Breath all the way out
 Place inhaler in mouth
 Push the med from inhaler into the mouth
 Inhale the med and hold for a few seconds then exhale
 Clean the mouthpiece 1-2 times per week with warm water
o A: Anticholinergics -Ipratropium
 End in “-tropium”
 Ex: Ipratropium and Tiotropium -dry the body out
  Used for moderate to severe asthma and COPD
 Used 2nd in line after albuterol
 Mechanism of action:
 Blocks secretions so you can see, pee, spit or shit called anticholinergic
 Common side effects:
 Dry mouth and hoarseness
 Treat the dry mouth and throat for all anticholinergics by using
gym/candy and drink fluids -NCLEX tip
 NO swallowing tiotropium capsules -NCLEX tip
 Contraindication to ALL anticholinergics we never give for patients who are
already DRY
 Patients with glaucoma, urinary retention and BPH, bowel obstructions
o M: Methylxanthines -Theophylline
 End in “-phylline”
 Ex: Theophylline and Aminophylline
 3 T’s:
 T: Toxic over 20 -do frequent blood draws -NCLEX tip
 T: Tonic clonic seizures -severe toxicit 1st priority (s/s of toxicity like
anorexia, nausea/vomiting, restlessness and insomnia)
 T: Tachycardia and dysrhythmias -NCLEX tip
 Teach patient to AVOID beta blockers that lower the HR while on Theophylline
 Alert HCP of tachycardia BEFORE giving next dose
 Two drugs that increase toxicity risk -NCLEX tip
 Cimetidine (H2 blocker) and Ciprofloxacin (antibiotic)
 Take in the morning and AVOID caffeine
 STOP before cardiac stress test
 Anti-inflammatory agents “SLM”
o S: Steroids -Beclomethasone
 End in “-sone”
 S- Steroids = S-stress and swelling hormone -decrease the swelling
 Prescribed to patients with COPD, rheumatoid arthritis, psoriasis, lupus, and
allergic reactions where everything swells up
 S’s:
 Swelling and inflammation (water gain=weight gain), words like “sudden,
excessive, or rapid” -report 1 lb in 1 day and 2-3 lb in 2 days
Respiratory (beclomethasone, fludrocortisone, methylprednisolone)
Total body swelling (Prednisone, dexamethasone, hydrocortisone)
 Slow onset and slowly taper off (never abruptly stop) -NCLEX tip
 Sepsis (infection or illness) -low WBC fever is priority -NCLEX tip
 Sugar increase -hyperglycemia -NCLEX tip
 Skinny -muscle and bones “osteoporosis” risk for fractures
 Sight -cataracts risk so refer to optometrist -NCLEX tip
 Stress or surgery (increase dose) -NCLEX tip
 Sores in mouth(infection)-most at risk for infection someone on steroids
  Use spacers to prevent oral THRUSH (candida)
 Rinse mouth after each use and DO NOT swallow the water
 Always wash mouthpiece out with warm water after each use
o L: Leukotriene inhibitor -Montelukast
 End in “-lukast”
 Ex: Montelukast and Zafirlukast
 3 L’s:
 L: Luke likes to sing (airway open)
 L: Long term management
 L: Long Onset (1-2 weeks to reach therapeutic range)
 Given for prevention of asthma attacks NOT during acute asthma attacks
 NOT a rescue drug
 This med will prevent inflammation that causes asthma attacks
o M: Mast cell stabilizers – Cromolyn
 Blocks massive swelling
 Prevents activity induced asthma like before sports or exercise
 Take 10-15 minutes before exertion for maximum effects/physical activity

4. Antipsychotic Drugs:

 Haloperidol -1st generation typical

o For Schizophrenia and Tourette’s to control the motor movement
o May be given with short acting benzodiazepines like Lorazepam
o Normal side effects behavior found in extrapyramidal symptoms
 Dystonia or spams/muscle contractions of the neck, face, and tongue
o Killer adverse effect:
 Neuroleptic Malignant Syndrome (NMS) -life threatening
 Key signs to look for: high fever and diaphoresis (sweating), change in mental
status, muscle rigidity, and tremors
 Priority Action:
 1st Hold the Haloperidol, 2nd Assess patient, 3rd Notify HCP immediately
 Clozapine and Risperidone-2nd generation A-typical
o For schizophrenia and schizoaffective disorder typically who have not responded to
other antipsychotics
o Common side effects -no need to report to HCP
 Weight gain -teach patients about weight management
 Hypersalivation -drooling
 Sedation -usually improves with increased tolerance
o Major adverse side effects
 Granular cytosis or low WBCs
 Low immunity (leukopenia) and decreased neutrophils -high infection risk
 Clozapine = ZAPS those WBCs
 Sore throat, fever, and flu like symptoms -NCLEX tip
 Priority action -immediately report to the HCP
o Contraindication with patient who have dementia
  Never give clozapine which will actually increase mortality
 Risperidone = Remove from Dementia
 Ziprasidone hydrochloride:
o Bipolar mania or acute psychosis with agitation
o Major adverse side affects
 Seizures but cardiac issues are more common
 Hypotension and monitor for widened QT intervals which can lead to cardiac
arrest and then death (so monitor BP and ECG closely)

5. Bi-polar Drugs:

 Carbamazepine
o Bi-polar, also given for seizures and treatment of trigeminal neuralgia (neuropathic pain)
o Side effects:
 Leukopenia -low WBCs increased risk for massive infection
 Report fever and sore throat -NCLEX tip
 Accidental pregnancy so oral contraceptive are ineffective and will need
alternative birth control methods -NCLEX tip
 Valproic Acid
o L: Liver toxic -monitor for jaundice and liver labs (ALT/AST)
o L: Low platelets -thrombocytopenia big bleed risk
o Not pregnancy safe
o Teach not to STOP this drug abruptly
 Lithium (big momma)
o Long term treatment for bipolar and schizoaffective disorder
o Narrow therapeutic range: 0.6-1.2
o Toxicity over 1.5
 Highest risk are those with decreased renal function
 Be cautious with patients in kidney disease and elderly patients who naturally
have decreased kidney function
 Creatinine over 1.3 = BAD kidney
 Urine 30mL/hr or less = kidneys distress
 S/S of tinnitus (ringing of the ears) = ototoxicity
o L: Levels over 1.5 = toxic -blood is drawn regularly to maintain that therapeutic dose (can
take up to 3 weeks)
NCLEX question: is lithium at a therapeutic level, if yes then continue at current dose
o I: Increase fluid and sodium -since lithium lets go of the fluid
 Contraindication: CANNOT give lithium during dehydration and low sodium
(hypernatremia below 135)
 DO NOT limit sodium or water intake
 Highest risk patient for toxicity is someone with stomach flu (diarrhea and
vomiting)
 Teach patients to drink 1-3 liters of water a day and limit diuretics including food
that have diuretic properties like coffee, colas, and teas
o T: Toxic signs: -report to the HCP
  Report excessive urination and extreme thirst -lead to dehydration
 Vomiting and diarrhea -add more dehydration
 Neuro muscular excitability (tremors/myoclonic jerks/horse hand tremors, ataxia
or confusion or agitation)
o H: Hold NSAIDS (ibuprofen, naproxen)
 NSAIDS (Ibuprofen) decrease renal blood flow increasing risk for toxicity
 AVOID!! Need further teaching if still wanting to use, instead use Tylenol
 Common expected side effects -don’t need to report to HCP
 Dry mouth and thirst -teach clients to use ice chips, gum, or sugarless
candy and plenty of fluids and also do oral hygiene
 Drowsiness and fatigue -teach clients to avoid driving and other
hazardous activities
 Weight gain -teach proper diet and exercise
 Decreased appetite -client has weight loss = anorexia and mild GI upset

6. Anxiolytics:

 Benzodiazepines -given for anxiety, seizures, alcohol withdrawal and sedation (induced coma)
o Dangerous they are sedatives
o End in “-lam” like Alprazolam and Midazolam
o End in “-pam” like Temazepam and Clonazepam
o Fast acting but highly addictive and hard to come off, not safe for long-term use
o Side effects:
 Sedation -low and slow
 Low HR, BP, and low RR (bradypnea) -leading to deadly respiratory depression
o Patient Teaching: Sedation, sleepiness, and the suppression of ABCs
 Take at bedtime -NCLEX tip
 Do not skip doses -NCLEX tip -sedation and rebound anxiety are the dangers
 Keep taking even when patient is feeling okay
 Always taper off and never abruptly or suddenly stop taking
 STOP drinking alcohol (wine) and do not operate dangerous machines
 AVOID valerian root, and muscle relaxants
o Antidote for Benzos: Flumazenil -NCLEX tip
o Antidote for Opioids: Naloxone -NCLEX tip
 Barbiturates -given for anxiety and seizures
o Dangerous they are sedatives
o End in “-barbital” like Phenobarbital
o Lasts longer in the body usually 3-5 days but takes longer to get out of the body
o Higher risk for toxicity leading to hypotension and respiratory depression
 Buspirone -given for anxiety and seizures
o Not a sedative, slow acting (takes a long time to kick in) and very easy to quit
o Atypical anxiolytic -no depressant effects
o 2-4 weeks for full effect
o NO withdrawal symptoms! -NCLEX tip
  Not addictive, no dependence, no tolerance, and no sedation
o Patient teaching:
 Driving is okay, not for acute attacks usually taken on a regular basis

7. Antidepressants:
4 rules for Antidepressants:
1. Increased risk of suicide -elevated the mood it gives patient energy to go out and carry out the
suicide (can increase suicidal thoughts in first few weeks of treatment) in young adults 18-24
o Notify provider of any suicidal thoughts
o Clarify any new prescription and monitor for
o New thoughts of suicide, unusual behavior, worsening depression, sudden change mood
2. Slow onset and slow taper off
o Never STOP abruptly
o Takes a few weeks to reach therapeutic level
o Teach about sexual dysfunction so they are aware and won’t stop taking the drug
3. NEVER mix
o SSRI with St. John’s Wort
o MAOI with any Antidepressant (TCA, SSRI, SNRI)
o 2-week washout period is needed -NCLEX tip
o NEVER start a new antidepressant while tapering off an MAOI or another
4. ALL psych drugs
o Decrease BP (slow position changes)
o Cause weight changes -mostly weight gain
 SSRI
o Sertraline, Citalopram, Escitalopram -NCLEX tip
o Also have Paroxetine and Fluoxetine
o Given for depression, anxiety, and PTSD
o Common side effects that usually improve after 3 months
 Weight gain
 Sexual dysfunction -NCLEX tip
 NO sedation usually cause insomnia
o Priority key points: “SSSRI”
 S: Suicide risk increased when starting med or changing dose
Reports of more energy without change in depression -NCLEX tip
 S: Slow onset and slow taper off -usually takes 2-4 weeks to reach full effect
 S: Serotonin Syndrome -NEVER MIX SSRI with St. John’s wort, MAOI, or tramadol
Sweaty and hot with fever -not cold and clammy
 R: Rigid muscles and restlessness and agitation -tremors, hyperreflexia,
increased deep tendon reflexes
 I: Increased heart rate “tachycardia”
 SNRI
o Duloxetine
o Give for depression and pain like with neuropathy and fibromyalgia
o Patient teaching -helps with chronic pain and improves sleep in patients = fibromyalgia
  TCA
o Amitriptyline (slow position changes) and Imipramine (inhibit my peeing)
o Given for depression and anxiety and also helps with neuropathy
o Orthostatic hypotension -slow position changes and urinary retention
o Side effects -big dry the anticholinergic effects
 Cannot see -blurred vision and photophobia -teach to wear sunglasses and
eyedrops
 Cannot pee -urinary retention -NCLEX tip -drinking the fluids
 Cannot spit -dry mouth -teach to chew gum
 Cannot shit -constipation -give fiber
 Sweating, seizures, and sedation = drowsiness/dizziness
 MAOI
o Phenelzine, Selegiline, and Isocarboxazid
o These are the first and oldest antidepressants known as the big guns
o Very powerful used for depression, panic disorder and social phobia
o M: Massive hypertension crisis risk
 Key sign is a massive headache and increased agitation -NCLEX tip
o A: Avoid tyramine
 NO Wine and cheese (NO wine tasting)
 NO Bear and sausage, salami (NO beer festival)
 NO Chocolate
 Start this diet at least 2 weeks before starting an MAOI and continue 2 weeks
after stopping MAOI
o O: OTC drugs = hypertension crisis
 C: Calcium
 A: Anti acids
 A: Acetaminophen
 N: NSAIDS (naproxen, ibuprofen)
o O: Other antidepressants to avoid
 SSRIs, SNRIs, TCAs -trigger a serotonin syndrome
 2-week washout period when changing or swapping out antidepressants
 Fully tapper off the other before starting the next -NCLEX tip
o I: Increased suicide risk
 When starting med or increasing the dose -NCLEX tip
 Usually in children, adolescents, or young adults
 Patient states: “This med is not working after 2 weeks” -1st assess
 Further expressions of: hopelessness, despair, suicidal thoughts, or
thoughts of self-harm =report to the HCP

8. Atypical Antidepressant:

 Trazodone:
o Makes you sleepy and sedated
o Avoid ETOH (alcohol) and other sedatives (benzos and antihistamines)
o Take at night
 o Causes orthostatic hypotension -teach slow position changes
o Rare complication is a priapism -teach if erection lasts longer that 4 hours to go to the
hospital
 Bupropion SR (sustained release), XL (extended release):
o Given for depression and an aid to stop smoking
o Side effects:
 Insomnia
 Headache
 Weight loss
o Teaching:
 NEVER double up on missed doses
 Nicotine gum may be prescribed in addition to help stop smoking
o Administration:
 XL (extended release), SR (sustained release) pill -NEVER crush, chew, or cut
 Swallow whole with or without food

9. Blood Thinners:

 Acetylsalicylic (aspirin) and Clopidogrel -antiplatelet

o Lower platelet aggregation -anti clogging of the arteries or clot prevention
o Use for post -Percutaneous coronary intervention (PCI) -cath lab to clear the clot
o Before giving always assess -NCLEX tip
 Hemoglobin (Hgb) < 7 =heaven
 Platelets less than 150,000 =notify HCP
 Platelets less than 50,000 =very risky
 These meds should not decrease platelet levels
o Common question -platelet count of 75,000 or 40,000 what is the priority
 1st Hold the drug
 2nd Question the prescription
 3rd Notify the HCP
o Salicylate poisoning -aspirin toxicity
 Treatment: activated charcoal and sodium bicarb second-NCLEX tip
 Activated Charcoal = Aspirin overdose
 Mechanism of action is the activated charcoal actually binds to aspirin and
inhibits the absorption in the small intestine
 S/S of aspirin toxicity: -tinnitus (ringing of the ear)
 A: Altered mental status with disorientation and restless
 B: Barfing “vomiting”
 C: Crazy breathing “hyperventilating”
 Abciximab -glycoprotein (GP) receptor inhibitors
o Eptifibatide and Tirofiban
o Lower platelet aggregation, mainly used after cardiac procedures like heart catheter or
coronary stent placement where we want to prevent vessel reocclusion
o Adverse effects:
 Thrombocytopenia and bleeding
 o Nurse should implement:
 Assessment of hemoglobin and platelets
 Assess for bleeding -report to the HCP
 Red tinged urine “hematuria” -NCLEX tip
 Dark tarry stools/Black or blood stools -NCLEX tip
 Monitor groin (insertion site) for s/s of bleeding
 Place client on cardiac monitor for ECG changes
 NO needles (no new IV or IM injections)
 Heparin -anticoagulant
o Given for prevention of NEW clots and preventing growth of existing clots -NCLEX tip
o Typically for patients recovering from an MI heart attack or PE in the lung or those at risk
for a DVT like after a hip or knee surgery
o Works quickly and can only be injected IV or Sub-Q
o PTT: 46-70 -NCLEX tip
o Antidote: Protamine sulfate -NCLEX tip
o If heparin is over 70 priority action:
 1st STOP the heparin -NOTIFY HCP
 2nd Prepare antidote protamine sulfate
3rd Reassess labs in 1 hour
o Bleeding at the IV site what’s the priority action:
 “Blood oozing” at surgical incision or IV site do the same as heparin over 70
o Enoxaparin and Dalteparin -low molecular weight heparin given for prevention of clots
after surgery
 Administration of 25-gauge needle, 5/8 inch and inject at 90-degree angle
 2 inches from umbilicus -NCLEX tip NOT thigh or IV route
 NEVER aspirate SQ and NEVER rub site
 Normal to have mild “pain, bruising, irritation, redness at site” -NCLEX tip
 Can use ice chips with irritation
 Enoxaparin heparin -assess H & H before giving to patients with open fractures
 Notify HCP and clarify order for enoxaparin if H/H slightly low -NCLEX tip
 Monitor for low platelets, hold med if less than 50,000
o Heparin induced thrombocytopenia (HIT) -deadly condition happens if platelets
decrease by half in 24 hours after starting heparin of any type
 Priority action -alert the HCP -NCLEX tip
 Warfarin -anticoagulant
o Given for prevention of NEW clots and preventing growth of existing clots -NCLEX tip
o Typically for patients recovering from an MI heart attack or those at risk for a DVT like
after a hip or knee surgery
o Works slowly -typically takes 5 days to reach effect
o Taken lifelong therapy -typically in mechanical valve replacements, frequent blood tests
o INR: 2-3 Therapeutic range -NCLEX tip
 2.5-3.5 (heart valve replacements) -NCLEX tip
o Antidote: Vitamin K -NOT to be given if warfarin is within therapeutic range -NCLEX tip
 NOT to be given until at least 5 days of warfarin when switching from IV heparin
 o Vitamin K foods:
 Liver and green leafy vegetables (broccoli and spinach)
 Teach patients to keep it consistent and in moderation -keep K consistent
 Key words: NOT increased, NOT decreased, NOT avoid totally -NCLEX tip
 Fondaparinux -anticoagulant
o Major advantage is NO risk for HIT
o Disadvantage: can cause epidural bleeds
 DO NOT give to a patient that’s reporting severe back pain, decreased LOC or
paralysis -Call HCP and hold the med
o NO Fondaparinux for at least 6 hours after surgery -NCLEX tip
o NO anticoagulants with spinal epidural catheter is in place -NCLEX tip
 Rivaroxaban -anticoagulant
o Edoxaban and Apixaban
o New oral anticoagulant for atrial fibrillation patients end in -xaban
o AVOID aspirin while taking this med (avoid all OTC meds and NSAIDS and supplements
like vitamin, garlic, ginseng, gingko and omega 3)
o Risk for neurological impairments (head bleeding)
 Teach client methods to reduce bleeding -NCLEX tip
 Dabigatran
o Argatroban
o Used to prevent clots in high risk atrial fibrillation patients
o DO NOT stop the med for GI issues -NCLEX tip this is a normal side effect
o STOP med if black tarry stools -NCLEX tip
o NOT stored in pill box, keep in original container
o NOT crushed, taken whole
 Hold before surgery -NCLEX tip
 Do not take clopidogrel or aspirin

10. Thrombolytics

 tPa -clot buster (most powerful one-time push only)

o End in “-ase”
o Ex: Alteplase, Reteplase, and Streptokinase
o Only drugs that dissolve clots
o Can only be given 3-4.5 hours from the onset of symptoms -NCLEX tip
o Big caution here is the massive bleeding risk -most deadly
o NO injections at all so NO IVs, NO Sub-Q, NO IMs, NO ABG -NCLEX tip
 These drugs can only be given in a compressible site like an peripheral IV
 Yes to “existing” peripheral line but NOT central line
o NCLEX key contraindications:
 AVOID giving to active bleeding patients like peptic ulcer -NCLEX tip
 Uncontrolled hypertension 180/110 or higher
 Recent surgery within 2 weeks -NCLEX tip
o Clarify prescription with provider:
  A: Accidents “recent trauma” -NCLEX tip
 A: Aneurysm -history of hemorrhagic CVA -NCLEX tip
 A: AV malformation -NCLEX tip
 Side Note: Patient teaching for bleeding:
Black tarry stools -GI bleed
Hematuria (blood tinged urine)
Epistaxis -nosebleed
Petechiae on the chest
Easy bruising
o Avoid trauma- no small rugs or dim halls = well light halls
o NO hard brushing = soft bristle toothbrush
o NO flossing
o NO alcohol-based mouth wash
o NO razors =electric shaver
o NO constipation =fiber and fluids -NCLEX tip
o NO contact sports
o Always wear medic alert bracelet

11. GI Drugs:

 Ondansetron -antiemetic
o Given to decrease nausea and vomiting
o Can cause serotonin syndrome which is a high risk for injury including
 Agitation, hypertension, muscle rigidity and tachycardia
o Side effect is headache and dizziness -normal
 Priority side effect is Torsades de pointes
o Give before going to chemo and before or with pain medications
o NCLEX question: During infusion, child reports nausea and vomits what is the priority
intervention? -STOP the chemo, flush the line and administer ondansetron
 Metoclopramide -antiemetic
o Given for nausea and vomiting but also for delayed gastric emptying called gastroparesis
o Works by accelerating gastric emptying by increasing intestinal motility -basically gets
food out of the stomach very quickly
o Contraindicated for patient with a bleed in the GI -bleeding duodenal ulcer -NCLEX tip
o Side effects the extrapyramidal
 Especially tardive dyskinesia -especially in older adults
 Question prescription “order” and report to HCP immediately
 Lip smacking, sucking lip motion, puffing of the cheeks, and excess blinking of
eyes, protruding and twisting of the tongue, chewing movement -NCLEX tip
 Sodium Docusate -only one tested on NCLEX
o Stool softener
o Teach patients to increase their fluid, fiber, and they’re walking
o Contraindicated for bowel obstruction -huge risk for death
 o Other drugs are psyllium husk -bulking fiber and magnesium hydroxide -considered a
laxative and anti-acid
 Lactulose
o Loosens the bowels to lower the ammonia levels -usually in cirrhosis patients
 L: Laxative for
 A: Ammonia levels -decreased
 C: Cognition returns “improved mental status” -NCLEX tip
o Treats hepatic encephalopathy -helps the body poop out all that ammonia basically
massive explosive diarrhea
o NOT a diuretic, so NO renal excretion of ammonia, NO it does not decrease portal
hypertension and NO abdominal distention will not improve with lactulose -NCLEX tip
o How does a nurse evaluate the effectiveness of this drug?
 2-3 soft stool per day -NCLEX tip
 Ammonia levels decrease
 Cognition improved “improved mental status” -NCLEX tip
 Sodium polystyrene Sulfonate
o Given for hyperkalemia that high potassium
o Administration: PO is the most effective or we can also use an enema
o Patient teaching:
 Helps the large intestine to remove excess K+ within the body -NCLEX tip
 Encourage patient to drink fluids after administration
o Nursing Care:
 We ensure normal bowel function prior to administration to prevent intestinal
necrosis
 Asses the abdomen
 Recent bowel patterns and frequency of stools
 Bowel function
 Potassium within normal limits (3.5-5.0)
o NCLEX question: focus on bowel assessment first
o Ensure close assess to the bathroom due to frequent loose stools
 Loperamide -anti-diarrheal opioid
o Given for active diarrhea to decrease the motility or movement of the intestines
o Makes thing low and slow and especially making the bowel low and slow
o Biggest side effect is constipation slowing things down too well
 Dicyclomine
o Anti-diarrheal given to patients with irritable bowel syndrome (IBS)
o Can have up to 20 loose stools per day
o Dicyclomine = helps to get the bowels on a regular cycle
o Side Effects:
 Constipation, dry mouth, and urinary retention
 Cannot see, pee, spit or shit -dries everything up so diarrheal is NOT a common
side effect -NCLEX tip
o Contraindications to AVOID:
  NOT for patients with paralytic ileus or bowel obstruction -NCLEX tip
So we always question the prescription
 NOT for narrowed-angle glaucoma patients (cataracts are ok)
 NOT for a full bladder (over 400 mL) “urinary retention”
 Sulfasalazine
o Sulfa-drug given for inflammatory bowel disease (IBD) including Crohns disease and
ulcerative colitis
o This med decreases colon inflammation by inhibiting prostaglandins
o Continue medication even after symptoms subside
o Contraindicated in patients with a sulfa allergy -NCLEX tip
o Side effects that are normal include
 Yellow orange discoloration of the skin and urine
o Adverse effects -the ones we worry about “SULF”
 S: Sun Dried -sunblock and dry body
 Photosensitivity -NCLEX tip teach to wear sunblock and avoid direct sun
 U: Urine Crystals -kidney stones
 L: Low urine output with high specific gravity over 1.030 -NCLEX tip
 Dehydration, elevated urine specific gravity and body is high and dry
 F: Fluid and Folic acid
 Drink 8 glasses of water daily and take folic acid 1mg/day
o Expected findings with ulcerative colitis we get blood diarrhea and inflammatory
markers will be elevated so do not stop the med, med will actually help -NCLEX tip
 Gastritis is an irritation of the stomach
 GERD = Gastro Esophageal Reflux Disease -heartburn and acid reflux that
irritates the esophagus
 Ulcers -breaking the lining like the holes and open sores
 Stomach ulcer -gastric ulcer or a peptic ulcer
 Small intestine -duodenal ulcer
 Antacids
o Reduce acid and prevent ulcers, goal is to protect the GI from its own acid
o Used for fast immediate relief but don’t last long -think “SCAM”
 S: Sodium bicarbonate
 C: Calcium carbonate (tums)
 A: Aluminum hydroxide
 M: Magnesium hydroxide
o Think anti mixing for anti-acids -there never to be taken with other meds -NCLEX tip
 So either 1 hour before or after other meds
 NOT for heart failure patients and nothing OTC
o Side effects:
 For aluminum or calcium they can constrict and cause constipation
 Magnesium hydroxide can mellow out the GI tract causing diarrhea
-can upset the stomach and liquid bowel movements
 Ranitidine and Famotidine
 o H2 Blockers Histamine 2 receptor antagonist -long lasting relief that turns down the
volume of acid production
o End in “-tidine”
o Take 30 minutes before meals -NCLEX tip
o Given for GERD and ulcers both duodenal and gastric
o Patient Education:
 DO NOT overeat
 NO stress or stress reduction
 NO smoking and NO NSAIDS
 Omeprazole, Esomeprazole, Pantoprazole
o Proton Pump Inhibitors (PPI)
o End in “-prazole”
o Given for heartburn and GERD but mainly used for ulcer prophylaxis especially in
hospitals due to the hospital related stress
o 3 P’s
 P: Prevent holes -stress ulcer prophylaxis -NCLEX tip
 P: Porous Bones -regular bone density tests -NCLEX tip
 P: Possible GI infections -C-diff
o Usually everyone on Med/Surg gets put on a PPI, so if patient asks why they are put on a
PPI or “stress ulcer prophylaxis” that they don’t use it at home we respond -NCLEX tip
 It helps prevent the development of an ulcer due to surgery or hospital stays
 Sucralfate
o To protect the lining from those holes or peptic ulcers we use mucosal protectant
o Given to treat and prevent both stomach and duodenum or duodenal ulcers in the small
intestine
o Key point: take on an empty stomach -food and meds at least 1-2 hours before or after
taking this med -NCLEX tip
 DO NOT take with any other meds
 Taken best at bedtime
 Misoprostol
o Mucosal protectant -synthetic prostaglandin to protect against gastric ulcers so it
increases protective mucus inside the stomach
o Usually given to patients on long-term NSAIDS therapy like naproxen and ibuprofen
o Major adverse effects:
 Dysmenorrhea
 Miscarriage risk NOT for pregnant woman-NCLEX tip
o So we always do a pregnancy test before giving this drug because this drug increases
cervical ripening.
 Teach reliable birth control and DO NOT take with any other antacids
 If pregnancy is suspected, then we STOP the med and contact HCP -NCLEX tip
 Pancrelipase
o Given to replace digestive enzymes in patients with cystic fibrosis
 Pancreases = helps break down food
 Lipase = fat
  Protease = protein
 Amylase = carb
o MUST be eaten WITH every meal and snack or med is not effective -NCLEX tip
o Pancrelipase Admin:
 Open capsule and sprinkle contents on food without chewing
 Reduction in fatty stools is an expected outcome

12. Antifungals Drugs

 Fluconazole and Ketoconazole

o Given to treat nail fungus and skin candida fungal infections
o End in “-nazole”
o Taken for 2-6 weeks and very liver toxic
o Key point: Does NOT treat C-diff infections, Metronidazole treats C-diff -NCLEX tip
 Amphotericin B
o Causes serious tare on the body with lots of side effects
o Adverse Effect -Renal injury
 Creatinine over 1.3
 Urine 30 mL/hr or less
 Oliguria -low urine
 Nystatin
o Given to treat candida fungal infections in the mouth, GI, skin and vagina
 Treats oral candidiasis
 Shake well -liquid suspension
 Inspect mucus membranes for irritation
 Remove and soak client’s dentures
 Teach to swish in mouth for several minutes then swallow
 Continue after s/s subside

13. TB drugs

All of these drugs are liver toxic, remember “RIPE”

NCLEX tips for TB

o Meds last 6-12 months
o N-95 mask worn at all times
o Family tested for TB
o Sputum samples every 2-4 weeks
o 3 negative cultures on 3 different days =NO longer infectious
 R: Rifampin
o Red for Rifampin
o There are red and orange tears, urine and sweat -this is normal
 Teach to wear glasses instead of contacts due to discoloration of tears -NCLEXtip
 Oral contraceptives ineffective “use non-hormonal back-up birth control”
 Monitor for jaundice since its very liver toxic
 I: Isoniazid (INH) -most tested drug
 o I: Interferes with absorption of B6 (pyridoxine) also called B-complex
 Low vitamin B6 = peripheral neuropathy
 Teach to take vitamin B6 (25-50 mg/day)
o N: Neuropathy (peripheral neuropathy)
 Report: new numbness, tingling extremities, and ataxia -the inability to walk
o H: Hepatotoxicity -liver toxic
 Monitoring and report immediately if
 Jaundice (yellow) skin or sclera -the eyes
 Dark urine -NCLEX tip
 Fatigue
 Elevated liver enzymes (AST/ALT) -hold the med
 Teach NO alcohol (ETOH) and limit acetaminophen
 P: Pyrazinamide -didn’t come up once on the review
 E: Ethambutol
o Eye for Ethambutol
o Report blurred vision and color changes -NCLEX tip
o Teach patient to have baseline eye exams and routine eye exams