Nursing Pharmacology: Calculations, Injections, and Reversal Agents

The provider orders 500 mg PO. Available is 250 mg tablets. How many tablets should the nurse administer? A. 1 tablet B. 2 tablets C. 3 tablets D. 4 tablets Answer

B. 2 tablets

The provider orders 1000 mL IV fluids over 8 hr. What is the infusion rate? A. 100 mL/hr B. 115 mL/hr C. 125 mL/hr D. 150 mL/hr Answer

C. 125 mL/hr

The provider orders 5 mg/kg/day divided BID for a patient weighing 44 lb. What is the total daily dose? A. 50 mg B. 100 mg C. 150 mg D. 200 mg Answer

B. 100 mg

The patient weighs 154 lb. What is the weight in kilograms? A. 60 kg B. 65 kg C. 70 kg D. 75 kg Answer

C. 70 kg

The provider orders heparin 5000 units SQ. Available is 10,000 units/mL. How many mL should the nurse administer? A. 0.25 mL B. 0.5 mL C. 1 mL D. 2 mL Answer

B. 0.5 mL

A patient needs 750 mg PO. Available is 250 mg/5mL. How many mL should be given? A. 5 mL B. 10 mL C. 15 mL D. 20 mL Answer

C. 15 mL

An IV bag contains 500 mL to infuse over 4 hr. What is the mL/hr rate? A. 100 mL/hr B. 125 mL/hr C. 150 mL/hr D. 175 mL/hr Answer

B. 125 mL/hr

The order is 2 mcg/kg/min for a 50 kg patient. How many mcg/min will the patient receive? A. 50 mcg/min B. 75 mcg/min C. 100 mcg/min D. 125 mcg/min Answer

C. 100 mcg/min

A medication order reads 0.25 g. Available is 125 mg tablets. How many tablets are needed? A. 1 tablet B. 2 tablets C. 3 tablets D. 4 tablets Answer

B. 2 tablets

The provider orders 1500 mL over 12 hr. Calculate the infusion rate. A. 100 mL/hr B. 115 mL/hr C. 125 mL/hr D. 135 mL/hr Answer

C. 125 mL/hr

Transdermal medications are absorbed through what?

Skin

Examples of transdermal medications

Fentanyl patch, nicotine patch

Where should transdermal patches be placed?

Clean dry hairless skin

Important nursing intervention for transdermal patches?

Remove old patch before applying new one

What angle is used for subcutaneous injections?

45-90 degrees

Common SQ injection sites

Abdomen, upper arm, thigh

Examples of SQ medications

Insulin, heparin

Typical SQ needle gauge

25-30 gauge

Typical SQ needle length

3/8 to 5/8 inch

What angle is used for IM injections?

90 degrees

Common IM sites

Deltoid, ventrogluteal, vastus lateralis

Typical IM needle gauge

20-25 gauge

Typical IM needle length

1-1.5 inches

What is the maximum IM injection volume for the deltoid?

1 mL

Best site for infant IM injections?

Vastus lateralis

Why are Z-track injections used?

Prevent medication leakage and staining

What gauge is commonly used for insulin?

28-31 gauge

How should ophthalmic drops be administered?

Into conjunctival sac

What should the nurse avoid touching with eye dropper?

Eye surface

After administering ophthalmic drops, what should the patient do?

Close eyes gently

What is the purpose of transdermal medication?

Slow continuous absorption

Why should insulin not be massaged after injection?

Can alter absorption

What is the reversal agent for opioids?

Naloxone (Narcan)

What medication class does naloxone reverse?

Opioids

Signs of opioid overdose

Respiratory depression, pinpoint pupils, decreased LOC

What is the reversal agent for benzodiazepines?

Flumazenil (Romazicon)

Examples of benzodiazepines

Lorazepam (Ativan), diazepam (Valium), alprazolam (Xanax)

What is the reversal agent for heparin?

Protamine sulfate

What is the reversal agent for warfarin (Coumadin)?

Vitamin K (Phytonadione)

What lab monitors warfarin?

INR

What lab monitors heparin?

aPTT

What is the reversal agent for digoxin?

Digoxin immune fab (Digibind)

What is the reversal agent for acetaminophen overdose?

Acetylcysteine (Mucomyst)

What is the reversal agent for magnesium sulfate toxicity?

Calcium gluconate

Signs of magnesium toxicity

Respiratory depression, absent reflexes, hypotension

What is the reversal agent for thrombolytics?

Aminocaproic acid (Amicar)

What is the reversal agent for factor Xa inhibitors?

Andexanet alfa

Examples of factor Xa inhibitors

Rivaroxaban (Xarelto), apixaban (Eliquis)

What is the reversal agent for dabigatran (Pradaxa)?

Idarucizumab (Praxbind)

What is the reversal agent for insulin overdose?

Dextrose or glucagon

What is the reversal agent for iron toxicity?

Deferoxamine

What is the reversal agent for anticholinergic toxicity?

Physostigmine

What is the reversal agent for methotrexate toxicity?

Leucovorin

-dril medications usually belong to what class?

ACE inhibitors

Examples of ACE inhibitors

Lisinopril (Zestril), enalapril (Vasotec)

What do ACE inhibitors treat?

Hypertension and heart failure

Common side effects of ACE inhibitors

Cough, hyperkalemia, angioedema

-sartan medications belong to what class?

ARBs

Examples of ARBs

Losartan (Cozaar), valsartan (Diovan)

-lol medications belong to what class?

Beta blockers

Examples of beta blockers

Metoprolol (Lopressor), propranolol (Inderal)

Common side effects of beta blockers

Bradycardia, hypotension

-statin medications belong to what class?

HMG-CoA reductase inhibitors

Examples of statins

Atorvastatin (Lipitor), simvastatin (Zocor)

Common statin side effects

Muscle pain, liver toxicity

-prazole medications belong to what class?

Proton pump inhibitors

Examples of PPIs

Omeprazole (Prilosec), pantoprazole (Protonix)

-floxacin medications belong to what class?

Fluoroquinolone antibiotics

Examples of fluoroquinolones

Ciprofloxacin (Cipro), levofloxacin (Levaquin)

-mycin medications are usually what?

Macrolide antibiotics

Examples of macrolides

Azithromycin (Zithromax), erythromycin

-cillin medications belong to what class?

Penicillin antibiotics

Examples of penicillins

Amoxicillin (Amoxil), penicillin G

-cef medications belong to what class?

Cephalosporin antibiotics

Examples of cephalosporins

Ceftriaxone (Rocephin), cephalexin (Keflex)

-azepam medications belong to what class?

Benzodiazepines

Examples of benzodiazepines

Lorazepam (Ativan), diazepam (Valium)

Common side effects of benzodiazepines

Sedation, respiratory depression

-done medications often belong to what class?

Opioids

Examples of opioids

Hydrocodone, oxycodone (OxyContin)

-parin medications belong to what class?

Anticoagulants

Examples of anticoagulants

Heparin, enoxaparin (Lovenox)

-gliptin medications belong to what class?

DPP-4 inhibitors

Examples

Sitagliptin (Januvia)

-gliflozin medications belong to what class?

SGLT2 inhibitors

Examples

Empagliflozin (Jardiance), canagliflozin (Invokana)

What do antihypertensives treat?

High blood pressure

Common side effects of antihypertensives

Dizziness, hypotension

Important nursing intervention for antihypertensives

Check blood pressure before administration

What should patients do slowly when taking antihypertensives?

Change positions slowly

What electrolyte imbalance can diuretics cause?

Hypokalemia

Examples of antihypertensives

Lisinopril (Zestril), metoprolol (Lopressor), losartan (Cozaar)

Examples of opioids

Morphine, hydromorphone (Dilaudid), oxycodone (OxyContin)

Main side effect of opioids

Respiratory depression

Other opioid side effects

Sedation, constipation, nausea

Important nursing assessment before giving opioids

Respiratory rate

What respiratory rate should make the nurse hold opioids?

Less than 12/min

What should the nurse have available when administering opioids?

Naloxone

Examples of loop diuretics

Furosemide (Lasix)

Common side effects of loop diuretics

Hypokalemia, dehydration