Pharmacology Fast Test Reminders: Hold, Notify, and Safety

Vocabulary practice flashcards covering high-yield psychiatric, neurological, neuromuscular, and anesthetic medications, along with key adverse signs and nursing safety actions.

Fluoxetine

An SSRI taken in the AM for depression, OCD, PMDD, bulimia, and panic disorder. Key concerns include arrhythmias, prolonged QTc, suicidality, and skin rash as a potential early indicator of serotonin syndrome; nursing actions require holding the medication, notifying the provider immediately, and monitoring mood.

Serotonin syndrome

A potentially life-threatening condition characterized by hypertension, agitation, hyperreflexia, tachycardia or bradycardia, muscle rigidity, and tremors/shaking; requires immediate discontinuation of the causative drug and urgent provider notification.

Venlafaxine

An SNRI taken in the morning that can cause hypertension, low sodium, suicidal thoughts, and angle-closure glaucoma symptoms; nurses must monitor blood pressure, sodium, and mood, and report sudden eye pain or vision changes.

Phenelzine

An MAOI used for difficult-to-treat depression that carries a risk of prolonged QT and hypertensive crisis if taken with aged cheese, tyramine-containing foods, or other antidepressants.

Bupropion

An atypical antidepressant taken in the morning that lowers the seizure threshold; it is contraindicated in patients with a history of seizures, eating disorders, or concurrent use of seizure medications like phenytoin.

Amitriptyline

A tricyclic antidepressant (TCA) with anticholinergic effects taken at bedtime (PM); adverse clues include irregular rhythm, syncope/fainting, prolonged QTc, dry mouth, and bradycardia, requiring immediate cardiac evaluation, BP monitoring, and fall precautions.

Lithium

A mood stabilizer for bipolar disorder that affects the kidneys and thyroid; toxicity is precipitated by dehydration and sodium depletion, presenting with worsening tremors, ataxia, slurred speech, ECG changes, lethargy, and severe nausea, vomiting, or diarrhea.

Valproic acid

An agent used for seizures and bipolar disorder with major fetal risk in pregnancy; signs of liver toxicity or failure include right-upper abdominal pain, jaundice, and yellow sclera, requiring the nurse to hold the next dose and monitor liver function.

Lamotrigine

A medication for bipolar disorder and seizures requiring slow titration; signs of a rash, particularly on the torso, can indicate Stevens-Johnson syndrome (SJS) and must never be ignored.

Chlorpromazine

A typical antipsychotic used for schizophrenia and psychosis that causes extrapyramidal symptoms (EPS), anticholinergic dryness, and orthostatic hypotension; urgent nursing actions include monitoring for urinary retention and airway-compromising dystonia.

Risperidone

An antipsychotic for schizophrenia that can cause gynecomastia, galactorrhea, orthostatic hypotension, alterations in glucose and lipids, and concerning rapid weight gain of $2.5\,\text{lb/week}$; patients should be advised to rise slowly.

Aripiprazole

A dopamine stabilizer used for schizophrenia that carries a risk of neuroleptic malignant syndrome (NMS), alterations in blood sugar and lipids, and knotty EPS including muscle stiffness, pseudoparkinsonism, dystonia, and tardive dyskinesia.

Acute dystonia

An urgent extrapyramidal side effect characterized by sudden, painful muscle spasms, including neck spasms (torticollis) and upward eye rolling (oculogyric crisis).

Akathisia

A motor extrapyramidal side effect characterized by subjective restlessness, an inability to sit still, and constant pacing.

Tardive dyskinesia

A potentially irreversible extrapyramidal complication involving repetitive, involuntary movements of the face, including lip smacking, chewing, and tongue movements.

Phenobarbital

A sedative/barbiturate taken at bedtime whose primary danger is respiratory depression, along with lowered blood pressure and decreased alertness; concurrent alcohol consumption must be strictly avoided.

Zolpidem

A bedtime-only sleep medication associated with morning grogginess and dizziness; requires a full $7\text{--}8\,\text{hours}$ of sleep, avoiding alcohol, avoiding heavy machinery until alert, and skipping bedtime snacks or high-fat meals.

Ramelteon

A sedative sleep medication that requires avoidance of high-fat meals and careful evaluation/monitoring in patients with obstructive sleep apnea (OSA) due to increased breathing risks.

Levetiracetam

An anticonvulsant used for seizure prevention that must not be stopped abruptly even if the patient feels better; patients should report severe mood changes and avoid driving if experiencing drowsiness.

Gabapentin

A medication prescribed for neuropathic pain that causes drowsiness; requires safety precautions and client education to never discontinue therapy abruptly without direction.

Phenytoin

A seizure management drug that interacts with warfarin, carries a risk of GI bleeding, and causes oral/dental issues (e.g., gingival hyperplasia), requiring meticulous oral hygiene and regular dental checkups.

Carbidopa-levodopa

A Parkinson's disease medication that must be separated from iron supplements because iron reduces absorption; patients should rise slowly for orthostasis, avoid high-iron meals at dosing time, and may have a small low-protein snack.

Amantadine

A Parkinson's disease medication associated with livedo reticularis (skin mottling), dizziness, and confusion, which must be assessed and reported if severe.

Baclofen

A centrally acting muscle relaxant that works mainly on the spinal cord to alleviate muscle spasms in multiple sclerosis; causes drowsiness and should not be combined with OTC antihistamines or sedatives.

Neostigmine

An acetylcholinesterase inhibitor used for myasthenia gravis; toxicity results in cholinergic crisis ('WET') from excess acetylcholine, presenting with muscle weakness, excessive salivation, diarrhea, bradycardia, and low blood pressure.

Pancuronium

A nondepolarizing neuromuscular blocker that paralyzes respiratory muscles without muscle twitching during mechanical ventilation; it provides NO sedation, pain relief, or amnesia, requiring continuous ventilator and vital sign monitoring.

Succinylcholine

A depolarizing neuromuscular blocker that causes rapid paralysis by activating ACh receptors (brief muscle contraction followed by flaccidity) without sedation or analgesia; risks severe hyperkalemia (especially post-burns) and malignant hyperthermia.

Dantrolene

A skeletal muscle relaxant acting directly on skeletal muscle used to treat malignant hyperthermia and neuroleptic malignant syndrome (NMS); the expected outcome is a decrease in muscle rigidity and lowering of temperatures exceeding $>104^\circ\text{F}$.

Lidocaine toxicity

Systemic local anesthetic toxicity identified early by periorbital or mouth numbness, metallic taste, tinnitus, and dizziness, which can progress to hypotension, seizures, bradycardia/tachycardia, and cardiac arrest.

Donepezil

An Alzheimer's disease medication taken in the evening (PM) that elevates acetylcholine levels to improve cognition, memory, and movement; nurses must monitor for therapeutic improvements and cholinergic adverse effects.

Medication error protocol

The standard sequence of nursing safety actions when the wrong medication or dose is administered: assess the client first for safety and adverse reactions, notify the provider, and then follow facility reporting procedures.