Pharmacology Review for Nursing Exam

A set of flashcards designed to review key pharmacological concepts, nursing considerations, and medications relevant for nursing students.

Lithium

A medication used as a mood stabilizer in the treatment of bipolar disorder.

Therapeutic Range of Lithium

0.6–1.2 mEq/L, the optimal range to avoid toxicity.

diuretics classes

• thiazide and thiazide like

• loop diuretics

• carbonic anhydrase inhibitors

• potassium sparing diuretics

• osmotic diuretics

Signs of Lithium Toxicity

Nausea/Vomiting, diarrhea, tremors, confusion, ataxia, seizures.

nursing considerations for lithium

• Monitor renal function & thyroid levels

• Maintain consistent sodium intake

• Avoid dehydration (↑ risk of toxicity)

• Regular blood level monitoring

Phases of General Anesthesia

Induction: administration of anesthetic agents → loss of consciousness

Maintenance: sustaining anesthesia during surgery

Emergence: recovery from anesthesia

Adverse Effects of Opioids

Respiratory depression, sedation, constipation, hypotension, urinary retention, nausea/vomiting.

Succinylcholine Contraindications

Hyperkalemia (increased risk of cardiac arrest), history of Malignant Hyperthermia, severe burns/trauma (risk of K+ release), neuromuscular disorders (MS, ALS).

CNS Stimulants

Medications indicated for ADHD (methylphenidate, amphetamines), narcolepsy, and obesity.

Benzodiazepines Indications

Used for anxiety, seizures, alcohol withdrawal, and sedation.

Benzodiazepines Contraindications

Pregnancy, respiratory depression, history of substance abuse

Neuroleptic Malignant Syndrome (NMS) Signs

Severe fever (>103), muscle rigidity (lead pipe), mental status changes (confusion, agitation), autonomic instability (BP changes, tachycardia, diaphoresis).

Benzodiazepines – Overdose

• Antidote: Flumazenil

• Signs: Respiratory depression, sedation, confusion

Flumazenil

Antidote for benzodiazepine overdose.

Parkinson’s Medications

Levodopa/Carbidopa (^ dopamine in CNS), dopamine agonists (ropinirole, pramipexole), and MAO-B inhibitors (selegiline, rasagiline) that increase dopamine in the CNS.

Dopamine

A neurotransmitter affecting mood and movement.

Serotonin

Mood, sleep, appetite

Norepinephrine

Alertness, BP

GABA

Inhibitory, relaxation

Phenytoin Therapeutic Range

10-20 mcg/mL, important for monitoring drug levels.

Phenytoin – Nursing Considerations

• Toxicity Signs: Ataxia, nystagmus, confusion

• Teaching: Good oral hygiene (gingival hyperplasia risk), avoid alcohol

Nitroglycerin Administration for Angina

Sublingual every 5 minutes, maximum of 3 doses.

Nitroglycerin – Nursing Considerations & Client Teaching

• For angina: Sublingual every 5 min, max 3 doses

• Avoid: Sildenafil (hypotension risk)

• Side effects: Headache, hypotension

• Patient Monitoring: Assess blood pressure and heart rate regularly.

Adrenergic Agonists Indications

• Epinephrine for anaphylaxis and cardiac arrest;

• Dopamine/Dobutamine for shock and heart failure.

Types of Diuretics

• Loop (furosemide): potent, hypokalemia risk

• Thiazide (HCTZ): first line for HTN

• Potassium-sparing (spironolactone): hyperkalemia risk

• Osmotic (mannitol): reduces ICP

Digoxin

Cardiac glycoside that increases myocardial contractility.

Heart Failure Drugs – Increase Myocardial Contractility

• Digoxin (cardiac glycoside)

• Dopamine/Dobutamine (adrenergic agonists)

Right vs. Left-Sided Heart Failure Symptoms

• Right HF: Peripheral edema, JVD, ascites;

• Left HF: Pulmonary congestion, dyspnea, crackles.

Sympathetic Nervous System

• Responsible for the 'Fight or Flight' response

• increases heart rate

• bronchodilation.

• pupil dialtion

Parasympathetic nervous system

• responsible for "Rest & Digest"):

• ↓ HR,

• pupil constriction,

• digestion

Atorvastatin Indications

• Used to manage hyperlipidemia.

• Adverse Effects: Myopathy, hepatotoxicity

types of anticoagulants

• Anticoagulants are medications that prevent blood clots. They work by inhibiting various steps in the clotting process. Here are the main types of anticoagulants

indications of anticoagulants

• Atrial fibrillation: An irregular heart rhythm that can lead to stroke 

• Venous thromboembolism (VTE): Includes deep vein thrombosis (DVT) and pulmonary embolism (PE) 

• Heart valve replacement: Used to treat patients with mechanical heart valves 

• Acute myocardial infarction (AMI): A heart attack 

• Left ventricular (LV) thrombus: A blood clot in the left ventricle of the heart 

• Left ventricular aneurysm: An aneurysm in the left ventricle of the heart 

adverse Effects of anticoagulants

bleeding complications, hematoma and increased risk of thrombocytopenia.

Heparin Monitoring Lab Value

• PTT,

• with a normal range of 25-35 sec;

• goal is 1.5-2x normal.

Warfarin INR Therapeutic Range

• INR

• 2-3 for effective anticoagulation theraputic range

• A blood test used to determine the clotting tendency of blood, with a therapeutic range of 2-3 for preventing thrombosis..

adverse effects of anticoagulants

• Adverse Effects: Bleeding risk, HIT

Spironolactone Indications

• Prescribed for hypertension and heart failure.

• Adverse Effects: Hyperkalemia, gynecomastia

spironolactone nursing considerations

• Monitor potassium levels and renal function.

• Educate patients about signs of hyperkalemia.

• Assessment: 

  • Assess for allergies to spironolactone or other aldosterone antagonists.

  • Obtain a thorough medical history, including renal function, electrolyte levels, and liver function.

  • Monitor blood pressure and heart rate. 

  Administration:

  • Administer as prescribed by the healthcare provider.

  • Take with food to reduce gastrointestinal upset.

  • Monitor for signs of hyperkalemia (high potassium levels), such as muscle weakness, fatigue, and arrhythmias. 

  Monitoring: 

  • Monitor serum potassium levels regularly.

  • Monitor urine output and report any significant changes.

  • Assess for signs of electrolyte imbalances, such as dehydration, confusion, and seizures.

  • Monitor blood pressure and heart rate periodically. 

  Precautions: 

  • Use caution in patients with renal impairment or liver disease.

  • Avoid potassium supplements while taking spironolactone.

  • Monitor for signs of gynecomastia (breast enlargement) in males.

  • Inform patients about the potential for increased sensitivity to the sun. 

  Interactions: 

  • Spironolactone can interact with other medications, such as ACE inhibitors, ARBs, and salt substitutes.

  • Avoid alcohol while taking spironolactone. 

  Patient Education: 

  • Inform patients about the potential side effects of spironolactone, including hyperkalemia, gynecomastia, and electrolyte imbalances. 

  • Encourage patients to avoid foods high in potassium and salt substitutes. 

  • Instruct patients to report any changes in their condition or any new symptoms to their healthcare provider promp

HCTZ Adverse Effects

• Hypokalemia and hyperglycemia.

• Indications: HTN, edema

HCTZ (Thiazide) nursing considerations

1. Monitoring and Assessment:

• Electrolyte Imbalances:

  • Thiazide diuretics can cause electrolyte imbalances, particularly hypokalemia (low potassium) and hyponatremia (low sodium). 

  • Monitor serum electrolyte levels regularly, especially potassium, sodium, calcium, and magnesium. 

  • Be vigilant for signs of hypokalemia (muscle weakness, fatigue, irregular heartbeat) and hyponatremia (confusion, lethargy, seizures). 

  • If the patient is also taking digoxin, monitor for digoxin toxicity, as hypokalemia can increase the risk. 

• Dehydration:

  • As a diuretic, HCTZ can lead to fluid loss and dehydration. 

  • Monitor intake and output, daily weight, and assess for signs of dehydration (dry mucous membranes, decreased skin turgor, dizziness). 

• Blood Pressure:

  • HCTZ is used to treat hypertension, so closely monitor blood pressure to ensure effectiveness and prevent hypotension. 

  • Assess for orthostatic hypotension, especially in the elderly. 

• Renal Function:

  • Monitor blood urea nitrogen (BUN) and creatinine levels to assess renal function. 

  • Be cautious in patients with impaired renal function. 

• Hyperglycemia:

  • Thiazides can increase blood glucose levels, so monitor blood glucose levels, especially in patients with diabetes. 

• Gout:

  • Thiazides can increase uric acid levels, potentially triggering gout flares, so monitor for signs of gout (joint pain, inflammation). 

• Edema:

  • Assess for and document the location and amount of edema, as HCTZ is used to treat edema. 

• Lung Sounds:

  • Assess for signs of pulmonary edema such as dyspnea and rales/crackles 

• Daily Weight:

  • Monitor the patient's daily weight each morning, soon after voiding, and before breakfast. Use the same scale every day and ensure they wear the same clothing. 

• Skin Turgor:

  • Assess the patient daily for skin turgor 

2. Patient Education:

• Medication Adherence:

  • Explain the purpose of HCTZ and the importance of taking it as prescribed. 

  • Emphasize the need to continue taking the medication even if feeling well. 

• Side Effects:

  • Review potential side effects, such as electrolyte imbalances, dehydration, and hyperglycemia. 

  • Instruct the patient to report any concerning symptoms promptly. 

• Diet and Lifestyle:

  • Encourage a potassium-rich diet (bananas, spinach, potatoes) to help prevent hypokalemia. 

  • Advise the patient to avoid excessive sodium intake. 

  • Encourage adequate fluid intake to prevent dehydration. 

• Timing of Medication:

  • Advise the patient to take the medication in the morning to prevent nocturia (excessive urination at night). 

• Fall Prevention:

  • Caution the patient and family/caregivers to guard against falls and trauma due to dizziness and weakness. 

3. Interprofessional Collaboration:

• Pharmacist: Consult with the pharmacist regarding medication interactions and dosage adjustments.

• Physician: Report any concerns or adverse effects to the physician.

• Dietician: Consult with a dietician for dietary recommendations. 

Anti-platelet drugs

• Drugs: Aspirin, Clopidogrel

• Indications: Prevent stroke/MI

• Adverse Effects: Bleeding, GI ulcers

MAOIs Contraindications

Patients must avoid tyramine to prevent hypertensive crisis.

TCAs – Contraindications

• TCAs: Contraindicated in seizures, cardiac disease

Ferrous Sulfate Administration Advice

• Take with Vitamin C for better absorption

• avoid dairy & antacids (decreases absorption)

Doxazosin Indications

• Used to treat hypertension and BPH

• alpha blocker

Antiplatelet Drugs nursing considerations

• Monitoring for Bleeding:

  • Signs and Symptoms: Be vigilant for signs of bleeding, such as bruising, nosebleeds, bleeding gums, blood in urine or stool, or prolonged bleeding from cuts. 

  • Neurological Assessment: Monitor for signs of intracranial hemorrhage, including sudden onset of confusion, vision changes, trouble speaking, or one-sided weakness. 

  • Laboratory Monitoring: Monitor hemoglobin and hematocrit levels, and liver function tests (as needed). 

  • Vital Signs: Monitor vital signs, including blood pressure, as hypotension can be a side effect of some antiplatelet medications. 

• Patient Education:

  • Medication Adherence: Emphasize the importance of taking medications as prescribed, including the correct dosage and timing. 

  • Bleeding Precautions: Advise patients on measures to prevent bleeding, such as using a soft-bristled toothbrush, an electric razor, and avoiding contact sports. 

  • Medication Interactions: Inform patients about potential drug interactions and the importance of informing all healthcare providers about their antiplatelet medication use. 

  • Side Effects: Educate patients about common side effects, such as gastrointestinal upset, and when to seek medical attention. 

  • Emergency Care: Teach patients to seek immediate emergency care for signs of severe bleeding or other concerning symptoms. 

• Interprofessional Collaboration:

  • Communication: Communicate any concerns or adverse reactions to the healthcare provider and pharmacist. 

  • Medication Review: Review the patient's medication list to identify potential drug interactions. 

  • Dual Antiplatelet Therapy: Be aware of the need for dual antiplatelet therapy in certain situations, such as after a stent placement or after an acute coronary syndrome event. 

• Specific Medications:

  • Aspirin: Be aware of the potential for gastrointestinal upset with aspirin and the need for proton pump inhibitors in some cases. 

  • Clopidogrel: Be aware of the potential for GI upset and rash with clopidogrel. 

  • Cilostazol: Be aware of the potential for tachycardia, palpitations, headache, dizziness, and diarrhea with cilostazol. 

Hydroxyurea Indication

Decreases sickling episodes in sickle cell anemia.

Normal Potassium Lab Values

3.5 – 5.0 mEq/L, critical for assessing electrolyte balance.

Vitamin K Foods to Avoid with Warfarin

Limit intake of leafy greens to prevent interaction.

Mannitol Indication

• Used to reduce intracranial pressure

• treat acute kidney failure.

diuretics indications

• edema associated with CHF

• acute pulmonary edema

• liver disease (including cirrhosis)

• renal disease

• hypertension

• conditions that cause hyperkalemia

nursing considerations for diuretisc

• daily weight using the same scale

• measure I/O

• monitor electroylte levels (K)electrolyte

• monitor BUN/Cr (tells us the functions of the kidney levels if they are hight)

• time to give meds: in the moring. to not get up at night a lot

Thiazide & Thiazide-like Diuretics

• Thiazide diuretics:

  • Hydrochlorothiazide (HCTZ)

  • Chlorothiazide

• Thiazide-like diuretics (longer duration of action):

  • Chlorthalidone

  • Indapamide

  • Metolazone

hydrochlorothiazide

• Thiazide & Thiazide-like Diuretics

• first line drug for essential HTN

• blocks chloride pump

• do nt take if SULFA allergy

• masks diabetes (decreases glucode tolerance)

Loop Diuretics

• Furosemide

• Bumetanide

• Torsemide

• Ethacrynic acid (used when patients have a sulfa allergy)

furosemide (lasix)

• type of loop diuretic

• eat foods high in potassium: bananas, avocados, potatoes, oranges

• major adverse effects: orthostatic hypotension, tinnitus (ringing in ears), ototoxicity (hearing loss)

• prevent orotoxiticy: given IV, administer slower

• indications: edema

Acetazolamide (diamox)

• carbonic anhydrase inhibitors

• adverse effect: bone marrow suppression

potassium sparing diuretics

• monitor potassium levels

• 3.5-5.2 norm

• potassium sparing we want more

• if potassium too high, can cause arrythmias. put them on ECG monitoring

• yes you can combine with spironolactone since it is a potassium sparing

Mannitol

• osmotic diuretic

• treatment for cerebral edema

• reduces intracranial pressure

medications for UTI

• urinary anti infective: fosfomycin (monurol)

• antispasmodics: oxybutynin (ditropan XL) for bladder spasms

• urinary tract analgesic: phenazopyridine (used for pain and urgency. the dye used is going to be seen in the urine. reddish/orange is normal pee

• bladder protectant : pentosan (elmiron)

• meds for BPH

bengin prostatic hyperplasia (BPH)

• enlarged glad surrounding the urthra leading to discomfort nad difficulty peeing

• meds for BPH: doxazosin

Carbonic Anhydrase Inhibitors

• Acetazolamide

• Methazolamide
  (Diuretics in this class are weaker and primarily used for glaucoma, altitude sickness, and metabolic alkalosis.)

Potassium-Sparing Diuretics

• Aldosterone antagonists:

  • Spironolactone

  • Eplerenone

• Sodium channel blockers:

  • Amiloride

  • Triamterene

Osmotic Diuretics

• Mannitol

• Urea

• Glycerin
  (Primarily used to reduce intracranial or intraocular pressure.)

Proton Pump Inhibitors (PPIs)

• Example: Omeprazole

• Mechanism of Action:

  • Irreversibly inhibits the H⁺/K⁺-ATPase (proton pump) in gastric parietal cells, reducing the secretion of gastric acid.

  • Increases gastric pH, allowing ulcer healing.

• Indications:

  • GERD (gastroesophageal reflux disease)

  • Peptic ulcer disease (PUD)

  • Zollinger-Ellison syndrome (gastric acid hypersecretion)

  • Prevention of NSAID-induced ulcers

GI Protectants

• Example: Sucralfate

• Mechanism of Action:

  • Forms a protective barrier by binding to ulcerated tissue and creating a viscous gel-like coating over the ulcer.

  • Does not neutralize acid or affect acid production.

  • Stimulates prostaglandin and bicarbonate secretion, promoting healing.

• Indications:

  • Peptic ulcer disease (PUD)

  • Stress ulcers

  • Prevention of ulcers in critically ill patients

Osmotic Laxative

• Example: Magnesium Citrate

• Mechanism of Action:

  • Draws water into the intestines via osmosis, softening the stool and increasing peristalsis.

  • Stimulates bowel movement by increasing stool volume.

• Indications:

  • Constipation

  • Bowel cleansing before procedures (e.g., colonoscopy)

Lubricant Laxative

• Example: Mineral Oil

• Mechanism of Action:

  • Coats the stool and intestinal walls, reducing water absorption and allowing easier stool passage.

  • Acts as a mechanical lubricant, easing defecation.

• Indications:

  • Constipation (especially in patients who should avoid straining, such as post-surgical or cardiac patients)

  • Fecal impaction

GI Stimulant (Prokinetic Agent)

• Example: Metoclopramide (Reglan)

• Mechanism of Action:

  • Dopamine (D₂) receptor antagonist → enhances gastric motility by increasing acetylcholine release.

  • Increases lower esophageal sphincter tone and promotes gastric emptying.

• Indications:

  • GERD

  • Gastroparesis (e.g., diabetic gastroparesis)

  • Nausea/vomiting (e.g., post-op, chemotherapy-induced)

  • Prevention of aspiration in tube-fed patients

Antidiarrheal (Opioid Receptor Agonist)

• Example: Loperamide (Imodium)

• Mechanism of Action:

  • Activates opioid receptors in the gut, reducing peristalsis and increasing absorption of water and electrolytes.

  • Slows stool transit time, leading to firmer stools.

  • Unlike opioids like morphine, it does not cross the blood-brain barrier → minimal CNS effects.

• Indications:

  • Acute and chronic diarrhea

  • Traveler’s diarrhea

  • Irritable bowel syndrome (IBS) with diarrhea

Antiemetic (Serotonin 5-HT3 Receptor Antagonist)

• Example: Ondansetron (Zofran)

• Mechanism of Action:

  • Blocks 5-HT₃ (serotonin) receptors in the chemoreceptor trigger zone (CTZ) and vagal nerve terminals.

  • Prevents nausea and vomiting caused by serotonin release (common in chemotherapy, surgery).

• Indications:

  • Prevention and treatment of nausea/vomiting

  • Chemotherapy-induced nausea/vomiting (CINV)

  • Postoperative nausea/vomiting

  • Radiation therapy-induced nausea

Barbiturates (-barbital drugs)

• Examples:

  • Phenobarbital

  • Secobarbital

  • Pentobarbital

• Mechanism of Action:

  • Enhances GABA-A receptor activity, leading to CNS depression by prolonging chloride channel opening.

  • At higher doses, can directly mimic GABA, leading to profound sedation.

• Indications:

  • Seizure disorders (e.g., phenobarbital for epilepsy)

  • Preoperative sedation

  • Anxiety disorders (historically used but replaced by benzodiazepines due to safety concerns)

  • Medically induced coma (e.g., pentobarbital coma)

• Key Risks:

  • High risk of respiratory depression and overdose

  • Addictive potential and withdrawal can be severe

  • Induces CYP450 enzymes (can interact with many drugs)

Benzodiazepines (-pam/-lam drugs)

• Examples:

  • Diazepam (Valium)

  • Lorazepam (Ativan)

  • Alprazolam (Xanax)

  • Midazolam (Versed)

  • Clonazepam (Klonopin)

  • Temazepam

• Mechanism of Action:

  • Enhances GABA-A receptor activity, increasing frequency of chloride channel opening → CNS depression.

• Indications:

  • Anxiety disorders (e.g., alprazolam, lorazepam)

  • Seizure disorders (e.g., diazepam, clonazepam, lorazepam)

  • Insomnia (e.g., temazepam)

  • Alcohol withdrawal (e.g., chlordiazepoxide, lorazepam)

  • Preoperative sedation (e.g., midazolam)

• Key Risks:

  • Dependence and withdrawal (taper required)

  • CNS depression (especially when combined with alcohol or opioids)

  • Fall risk in elderly (Beers Criteria)

Buspirone (Buspar) – Atypical Anxiolytic

• Mechanism of Action:

  • Partial agonist of 5-HT1A serotonin receptors, with some dopamine D2 receptor effects.

  • Does not affect GABA, so it has minimal sedation or addiction potential.

• Indications:

  • Generalized Anxiety Disorder (GAD)

  • Long-term anxiety treatment (takes 2-4 weeks for full effect)

• Key Benefits:

  • No risk of dependence or withdrawal

  • No sedation (can be used in daytime)

• Key Drawbacks:

  • Delayed onset (2-4 weeks to take effect)

  • Not useful for acute anxiety/panic attacks

Antidepressants

Tricyclic Antidepressants (TCAs)

• Example: Amitriptyline

• Mechanism of Action:

  • Blocks reuptake of serotonin and norepinephrine → increased levels in synapse.

  • Also has anticholinergic, antihistamine, and alpha-blocking effects.

• Indications:

  • Depression (but not first-line due to side effects)

  • Neuropathic pain (e.g., diabetic neuropathy, fibromyalgia)

  • Migraine prophylaxis

  • Insomnia (due to sedative effects)

• Key Risks:

  • Anticholinergic effects (dry mouth, constipation, urinary retention)

  • Sedation

  • Orthostatic hypotension (due to alpha blockade)

  • Risk of overdose → cardiotoxicity (QT prolongation, arrhythmias)

Monoamine Oxidase Inhibitors (MAOIs)

• Example: Phenelzine

• Mechanism of Action:

  • Inhibits monoamine oxidase (MAO), which breaks down serotonin, norepinephrine, and dopamine → increased neurotransmitter levels.

• Indications:

  • Depression (typically treatment-resistant depression)

  • Atypical depression

  • Panic disorder, social anxiety

• Key Risks:

  • Tyramine interaction (hypertensive crisis) → Avoid aged cheeses, wine, smoked meats.

  • Serotonin syndrome if combined with SSRIs/SNRIs.

  • Orthostatic hypotension

Selective Serotonin Reuptake Inhibitors (SSRIs)

• Examples: Fluoxetine (Prozac), Sertraline (Zoloft)

• Mechanism of Action:

  • Blocks serotonin reuptake, increasing serotonin levels in the synapse.

• Indications:

  • Depression

  • Anxiety disorders (GAD, panic disorder, OCD, PTSD)

  • Premenstrual dysphoric disorder (PMDD)

  • Bulimia (fluoxetine is FDA-approved)

• Key Risks:

  • Sexual dysfunction (decreased libido, delayed orgasm)

  • Weight changes

  • GI upset (nausea, diarrhea)

  • Serotonin syndrome (if combined with MAOIs, SNRIs, or St. John’s Wort)

  • Black Box Warning: Increased suicide risk in young adults

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

• Examples: Venlafaxine, Duloxetine

• Mechanism of Action:

  • Blocks reuptake of both serotonin and norepinephrine, increasing their levels.

• Indications:

  • Major depressive disorder (MDD)

  • Generalized anxiety disorder (GAD)

  • Neuropathic pain (e.g., diabetic neuropathy, fibromyalgia – duloxetine is FDA-approved)

• Key Risks:

  • Increased blood pressure (due to norepinephrine effect)

  • Similar side effects to SSRIs (nausea, sexual dysfunction, insomnia)

  • Withdrawal symptoms if stopped abruptly (taper required)

A nurse is caring for a client who has hypertension and asks the nurse about prescription for propranolol. The nurse should inform the client that this medication is contraindicated in client’s with a history of?

Asthma. Can cause bronchocpasms