NCLEX REVIEW Pharmacology

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NCLEX REVIEWPharmacology

• Rae Brooks RN MSN CCRN

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Objectives

• Student will be able to easily recognize prefixes
  and suffixes of medications
• Student will identify these medications more
  easily
• Student will be able to categorize side effects
  of medications

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Antibiotics and Antivirals
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Common Antibiotics and Antivirals

• Cephalosporins
• Tetracycline
• Metronidazole (Flagyl)
• Isoniazid (INH)
• Aminoglycosides
• Antiretrovirals
• Quinolones

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Ways to remember.

• -micin Aminoglycosides
• -mycin Aminoglycosides
• -cillin Aminoglycosides
• -oxacin Fluroquinolones
• -vir Antivirals
• -cef Cephalosporins

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Important facts to remember
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Tetracycline

• Causes photosensitivity
• Stains teeth (usually is not prescribed to
  children because of this)

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Aminoglycosides -cins

• Nephrotoxicity
• Ototoxicity
• Drugs Amikacin, Neomycin, Tobramycin, Gentamicin

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Cuties (QT) say no to OBs

• Quinolones and Tetracyclines
• Contranindicated during pregnancy. These drugs
  can cause birth defects or death.

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Other common side effects of Antibiotics and
Antivirals

• GI upset (nausea, vomiting, flatulence, anorexia,
  diarrhea)
• Rash
• Headache
• Photosensitivity
• Metallic bitter taste

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Antipsychotics, neuroleptics, major tranquilizers
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Antipsychotics, neuroleptics, major tranquilizers

• Phenothiazine- compazine, thorazine, thioridazine
  (mellaril)
• Butyrophenones- haldol, droperidol
• Atypical- resperidone (Risperidal), olanzapine
  (zyprexia), seroquel, clozapine

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Ways to remember.

• -ine tricyclics and phenothiazines
• Ine Crazy

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Important facts to remember
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Common side effects of antipsychotics

• EPS (extrapyramidal symptoms)- extra movement of
  the skeletal muscles
• Parkinsonism- shuffling gait, pill rolling, mask
  like face, tremors
• Aystonia- muscle spasticity
• Akathisia- restlessness, pacing, agitation,
  tapping
• Tardive dyskinesia- exessive blinking, extra
  tongue movement, involuntary sucking, chewing,
  licking, pursing movements of tongue and mouth,
  rocking

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Antidepressants
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-ine sad

• I feel better on my antidepressants.

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Antidepressants

• Tricyclic antidepressants- TCA
• Monoamine oxidase inhibitor MAOIs
• Selective serotonin reuptake inhibitors- SSRIs

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TCAs

• imipramine, desiprmine, nortriptyline,
  clomipramine, amoxapine, wellbutrin, trazodone,
  elavil, amytriptyline,
• Can cause- hypotension, sedation, tachycardia,
  dysrhythmias

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MAOIs

• Nardil, parnate, niamid
• Remember. Beware of tyramine foods can cause
  hypertensive crisis.
• Remember the foods high in tyramine???

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SSRIs

• Fluoxitine (prozac), paroxetine (paxil),
  setraline (zoloft), celexa

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Antianxiety Agents

• The pams -lams

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Antianxiety agents

• Benzodiazepines- lorazepam (ativan), librium,
  oxazepam, diazepam (valium), alprazolam (xanax),
  clonazepam (klonopin)

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Analgesics, anesthetics, antiinflammatory
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Opiate analgesics -done hurt me!!!

• Hydromorphone, oxycodone, methadone, fentanyl,
  codeine

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Anesthetic -aine

• Lidocaine, benzocaine, bupivicaine, xylocaine,
  marcaine

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Analgesics antiinflammatory

• Acetaminophin, aspirin, ibuprofen, celebrex,
  naproxen, nubaine, toradol (ketorolac), indocin
• -sones steroids beclomethsone, prednisone,
  cortisone, hydrocortisone, dexamethasone,
  methylprednisolone

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Side effects of Analgesics, anesthetics,
antiinflammatory

• Infections
• Water retention
• Weight gain (steroids)
• Cushings syndrome (steroids)
• Hyperglycemia (steroids)
• GIB
• Liver dysfunction (acetaminophen, ibuprophen)

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Antihyperlipidemics
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-statins

• Atorvastatin, simvastatin
• Side effects- liver dysfunction, monitor liver
  function regularly, GI distress

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Antiulcer
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-dines and -zoles

• Famotadine, cimetidine, ranitidine,
• Lansoprazole, omeprazole
• Side effects- constipation and GI distress

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Cardiac drugs
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Antihypertensives

• Calcium Channel blockers
• ACE inhibitors
• Beta blockers
• Diuretics

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ACE inhibitors

• Ends in pril captopril, enalapril, benazepril

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Diuretic and Beta blockers

• -zides Hydrichlorothiazide
• -olol metropolol, carvedilol, labetalol,
  atenolol, propranolol

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Calcium Channel Blockers

• VERY, NICE, DRUGS
• V- verapamil
• N- nifedipine
• D- diltiazem

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Side effects of antihypertensives

• Dysrhythmias, dizziness, light headedness,
  headache, fatigue, hypotension, renal impairment
• Bronchospasm, impotence, bradycardia

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Digitalis

• Cardiac Glycoside digoxin
• Antidote Digibine
• Must memorize the digoxin serum therapeutic
  levels!!! Digoxin 0.5 2.0 ng/ml
• Get a baseline apical pulse for a full minute

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Drugs for bradycardia and low BP

• IDEA
• I isoproterenol
• D dopamine
• E epinephrine
• A atropine

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Nitroglycerin

• Sublingual, translingual, patch, ointment
• Side effect- severe headache, dizziness, syncope

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Emergency drugs to LEAN on

• LEAN
• L lidocaine
• E epinephrine
• A atropine
• N Nitroglycerine, Narcan

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Therapeutic Drug Levels

• Digoxin
• Lithium
• Dilantin
• Theophylline

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MEMORIZE!!!

• Digoxin 0.5 2.0 ng/ml
• Lithium 0.6 1.5 mEq/L
• Dilantin 10 20 mcg/dl
• Theophylline 10 20 mcg/ml

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Ways to remember

• Short-cuts

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Ways to remember!!!

• -mide Diuretics
• -nium Neuromuscular Blocking Agents
• -olol Beta Blockers
• -oxacin Antibiotics
• -pam Anti-Anxiety Agents
• -pril ACE Inhibitors
• -sone Steriods
• -statin Antihyperlipidemics
• -vir Antivirals
• -zide Diuretics

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Ways to remember

• -caine Local Anesthetics
• -cillin Antibiotics
• -dine H2 Blockers (Anti-Ulcers)
• -done Opioid Analgesics
• -ide Oral Hypoglycemics
• -lam Anti-Anxiety Agents
• -micin Antibiotics
• -mycin Antibiotics

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Insulin administration

• Category Agent Onset Peak Duration
• Humalog Rapid 30-60 minutes 3-4 hours
• Regular 30-60 minutes 2-4 hours 5-7 hours Rapid
  Acting
• Regular IV 10-30 mintes 15-30 minutes 30-60
  minutes
• Fast Acting NPH/Regular (70/30) 30 minutes 4-8
  hours 24 hours
• Lente 1-3 hours 8-12 Intermediate Acting hours
  18-28 hours
• NPH 1-4 hours 6-12 hours 18-28 hours
• Long Acting Ultra-Lente 4-6 hours 18-24 hours 36
  hours

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INSULINSLispro, regular, lente, NPH, lantus
The longer acting insulins are closest to the
needle, the fastest acting insulins are Closest
to the plunger.
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Ready to test your pro-skills???
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A nurse is monitoring a client with frequent PVCs
(premature ventricular contractions) of more than
6/min. The nurse prepares to bolus the client
with lidocaine as ordered. Which of the
following is important for the nurse to monitor
after administering the medication?

• A. Skin temperature and neurological status
• B. Vital signs, ECG, and neurological status
• C. Kidney and liver function and neurological
  status
• D. Visual changes and kidney and liver function

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A client with acute pulmonary edema is prescribed
a medication to reduce preload and afterload.
Which of the following drugs will the nurse
anticipate administering?

• A. Digoxin
• B. Nitroprusside
• C. Morphine sulfate
• D. Furosemide

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A client with myesthinia gravis arrives to the
emergency room and crisis is suspected. The
nurse prepares to administer which of the
following medications if the client is in
cholinergic crisis?

• A. Atropine sulfate
• B. Morphine sulfate
• C. Pyridostigmine bromid (Mestinon)
• D. Isoproterenol (Isuprel)

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A client is seen in the clinic with ascites and
jaundice. The nurse assess the client for
chronic use of which of the following medications?

• A. Acetaminophen
• B. Aspirin
• C. Advil
• D. Ranitidine (Zantac)

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A nurse notes that the bag of TPN (total
parenteral nutrition) has become empty. The
nurse calls the pharmacy, but the next bag will
not be delivered for another 30 minutes. The
nurse hangs which of the following solutions
until the TPN arrives?

• A. 5 dextrose
• B. 10 dextrose
• C. 50 dextrose
• D. 5 dextrose in 0.45 saline

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A nurse caring for a client who is receiving
Lithium. The measured level is 1.8 meq/L. The
nurse analyzes this result as

• A. Within normal limits
• B. Higher than normal limits
• C. Lower than normal limits
• D. Insignificant

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A client has a pH of 7.5 with a bicarbonate of 29
meq/L. The nurse prepares to administer which of
the following medications?

• A. Sodium bicarbonate
• B. Furosemide (lasix)
• C. Acetazolamide (Diamox)
• D. Spironolactone (Aldactone)

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A home health nurse is visiting a client that was
discharged home on coumadin (warfarin sodium).
On assessment which of the following questions is
the highest priority?

• A. Have you been eating green leafy vegetables?
• B. Do you have constipation?
• C. Do you have nausea or vomiting?
• D. Do you have bleeding gums or bruises?

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Mannitol (osmitrol) is administered to the client
with a closed head injury with loss of
consciousness. The nurse would evaluate the
effectiveness of this medication by which of the
following outcomes?

• A. Diuresis of 500ml in 2 hours and BUN level of
  15
• B. Improved level of consciousness
• C. Weight loss of 1 kg and serum creatinine of
  0.8
• D. Serum creatinine of 2.0 and normal
  intracranial pressure

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A client with acute renal failure has been
treated with kayexelate by mouth. The nurse
would evaluate which of the following lab results
to check the effectiveness of this medication?

• A. Potassium 4.9
• B. Sodium 143
• C. Phosphorus 3.9
• D. Calcium 10

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A client with multiple sclerosis is treated with
diazepam (valium) for painful muscle spasms. The
nurse assesses the client for side effects of the
medication and monitors the client for

• A. Urinary frequency
• B. Headache
• C. Increased salivation
• D. Incoordination

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A client with a seizures is taking phenytoin
(dilantin). The dilantin blood level drawn is
35. Which of the following effects would be
expected as a result of this laboratory result?

• A. No results since this lab value is normal
• B. Slurred speech
• C. Tachycardia
• D. Nystagmus

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A nurse is caring for a client with Parkinsons
disease. The client is taking benztropine
mesylate (cogentin) po daily. The nurse needs to
monitor the client for which of the following
side effects

• A. Hemoglobin levels
• B. PTT partial prothrombin time
• C. Intake and output
• D. Prothrombin time

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A nurse is caring for a client who is newly
diagnosed with a SCI spinal cord injury. The
nurse would anticipate to administer which of the
following medications?

• A. Propranolol (inderal)
• B. Dexamethasone (Decadron)
• C. Furosemide (lasix)
• D. Morphine

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A client with diabetes recieves regular insulin
at 0730. The nurse would be most alert to the
signs of hypoglycemia at what time during the day?

• A. 0930-1130
• B. 1200-1400
• C. 1300-1600
• D. 1530-1730

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A nurse is about to administer topic
nitroglycerine as ordered to a client with an
inferior wall MI. The nurse also plans to
administer the prescribed acetaminophen ordered
because

• A. Headache is a common side effect of nitrates
• B. It potentiates the effects
• C. It does not interfere with aspirin
• D. Fever usually accompanies myocardial
  infarction