Pharmacology Assessment 1 & 2 notecards - Capstone 2025

Isoniazid - Adverse effects

Hepatotoxicity

Anorexia, malaise, fatigue, nausea, and yellowish discoloration of skin and eyes

Alosetron - reinforce teaching

Therapeutic Uses: Approved only for female clients who have severe IBS-D that has lasted more than 6 months and has been resistant to conventional management.

Complications

Constipation

Can result in GI toxicity (ischemic colitis, bowel obstruction, impaction, or perforation).

Acetaminophen - key facts

Acute toxicity

Results in liver damage with early manifestations of nausea, vomiting, diarrhea, sweating, and abdominal discomfort progressing to hepatic failure, coma, and death.

Overt indications of hepatic injury appear 48 to 72 hours after ingestion.

Nursing Actions

• Ensure the client’s daily acetaminophen total intake does not exceed recommended limits (4 g/day for most clients, 3 g/day for undernourished clients, and 2 g/day for clients who consume more than three servings of alcohol daily).

• Administer the antidote, acetylcysteine via duodenal tube to prevent emesis and subsequent aspiration.

Bronchodilators

• Bronchodilators are given to reduce bronchospasms and reduce irritation.

• Short-acting beta2 agonists, such as albuterol, provide rapid relief.

• Cholinergic antagonists (anticholinergic medications), such as ipratropium, block the parasympathetic nervous system, allowing for increased bronchodilation and decreased pulmonary secretions.

• Methylxanthines, such as theophylline, require close monitoring of blood medication levels due to the narrow therapeutic range.

Digoxin Toxicity Manifestations

GI effects

Include anorexia (usually the first manifestation of toxicity), nausea, vomiting, and abdominal pain

Client education: Monitor for these effects and report to the provider if they occur.

CNS effects

Include fatigue, weakness, vision changes (blurred vision, yellow-green or white halos around objects)

Digoxin Complications & Nursing Actions

Complications: Dysrhythmias, cardiotoxicity

• Dysrhythmias caused by interfering with the electrical conduction in the myocardium

• Cardiotoxicity leading to bradycardia

• Conditions that increase the risk of developing digoxin-induced dysrhythmias include hypokalemia, increased blood digoxin levels, and heart disease. Older adult clients are particularly at risk. ​​​​​

Nursing actions

• Monitor blood levels of K+ to maintain a level between 3.5 to 5.0 mEq/L.

• Monitor digoxin level. Optimal therapeutic level 0.5-0.8 ng/mL. Obtain blood specimen at least 6-8 after the last dose, preferably just before the next scheduled dose.

• Therapeutic blood levels can vary between conditions and clients. Consider manifestations and digoxin level when toxicity is suspected.

• Dosages should be based on blood levels and client response to medication.

Prednisone - Counteracting Adverse Effects - Glucocorticoids

Glucocorticoids

• Diuretics that promote potassium loss increase the risk of hypokalemia. Monitor potassium level, and administer supplements as needed.

• Because of the risk for hypokalemia, concurrent use of glucocorticoids with digoxin increases the risk of digoxin-induced dysrhythmias. Monitor for digoxin-induced dysrhythmias and toxicity. Monitor potassium levels. 

• NSAIDs increase the risk of GI ulceration. Advise clients to avoid use of NSAIDs. If GI distress occurs, instruct clients to notify the provider.

• Glucocorticoids promote hyperglycemia, thereby counteracting the effects of insulin and oral hypoglycemics. The dose of hypoglycemic medications might need to be increased.

Prednisone side effects/things to watch & educate client on

Client Education

• Weigh daily. Notify the provider if there is a 1- to 2-lb gain in 24 hr, or a 3-lb gain in 1 week.

• If excessive sodium intake is the cause of fluid volume excess, consume a low-sodium diet, read food labels to check sodium content, and keep a record of daily sodium intake. QEBP

• Adhere to fluid restriction. Consult with the provider regarding prescribed restrictions and divide the 24-hr fluid allotment to allow for fluid intake throughout the day.

Imipenem/Cilastatin (Carbapenem) - Purpose

Expected Pharmacological Action

Carbapenems are beta-lactam antibiotics that destroy bacterial cell walls, causing destruction of micro-organisms. They have very broad antimicrobial spectra.

Imipenem/Cilastatin (Carbapenem) - Adverse effects

Complications

Allergy, hypersensitivity, possible cross-sensitivity to penicillin or cephalosporins

Nursing actions

• Monitor for indications of allergic reactions (dyspnea, rashes, and pruritus).

• Question clients carefully about their history of allergy to a penicillin or other cephalosporin and notify the provider if present.

Gastrointestinal upset (nausea, vomiting, diarrhea)

Nursing actions

• Observe for manifestations and notify the provider if they occur.

• Monitor I&O.

Suprainfection

Nursing actions: Monitor for indications of colitis (diarrhea), oral thrush, black furry overgrowth on the tongue, and vaginal yeast infection.

Bethanechol - Adverse effects

Complications

Extreme muscarinic stimulation can result in increased gastric acid secretion, abdominal cramps, diarrhea, sweating, tearing, urinary urgency, bradycardia and hypotension; bronchoconstriction causing exacerbation of asthma, dysrhythmias in clients who have hyperthyroidism. This is often referred to as muscarinic poisoning.

Nursing Actions

Administer on an empty stomach to reduce effects.

Prazosin - reinforced teaching

Complication

First-dose orthostatic hypotension

Nursing actions

• Start treatment with low dosage of medication.

• First dose often is given at night.

• Monitor blood pressure for 2 to 6 hr after initiation of treatment.

Levothyroxine - reinforced teaching

Nursing administration

• Obtain baseline vital signs, weight, and height, and monitor periodically throughout treatment.

• Monitor and report manifestations of cardiac excitability (angina, chest pain, palpitations, dysrhythmias). Check apical pulse.

• Daily therapy begins with a low dose that increases gradually over several weeks. Full effect of medication can take 6 to 8 weeks.

• Monitor T₄ and TSH levels.

• Medication is generally dosed in micrograms.

• Medication that will be administered IV requires reconstituting and verification of the final concentration, which should be obtained prior to administering medication. QS

Levothyroxine - reinforced teaching pt. 2

Client education

• Take the medication daily on an empty stomach 30 to 60 min before breakfast.

• Lifelong replacement is important even after improvement. Do not discontinue the medication without checking with the provider.

• Check with the provider before switching to another brand of levothyroxine because different brands might have varied effects, and dosage adjustments can be necessary. QTC

Medication-Food interactions

• Consuming foods with tyramine while taking monoamine oxidase inhibitors (MAOIs) can lead to hypertensive crisis. Clients taking MAOIs should be aware of foods containing tyramine (cheese and processed meats) and avoid them.

• Vitamin K can decrease the therapeutic effects of warfarin and place clients at risk for developing blood clots. Clients taking warfarin should include a consistent amount of vitamin K in their diet.

• Tetracycline can interact with a chelating agent (milk), and form an insoluble, unabsorbable compound. Instruct clients not to take tetracycline within 2 hr of consuming dairy products.

• Grapefruit juice seems to act by inhibiting medication metabolism in the small bowel, thus increasing the amount of medication available for absorption of certain oral medications. This increases either the therapeutic effects or the adverse reactions. Instruct clients to not drink grapefruit juice if they are taking such a medication. QEBP​​​​​​​

• Food often decreases the rate of medication absorption. However, some foods increase the rate of absorption of certain medications.

Hydrochlorothiazide - reinforced teaching

Client Education

• Take the medication first thing in the morning; if twice-a-day dosing is prescribed, be sure the second dose is taken by 1400 to prevent nocturia.

• Consume foods high in potassium and maintain adequate fluid intake (1,500 mL/day, unless contraindicated).

• If GI upset occurs, take the medication with or after meals.

• If the medication is used for hypertension, self-monitor blood pressure and weight by keeping a log.

• Report significant weight loss, lightheadedness, dizziness, GI distress, or general weakness to the provider. These can indicate hypokalemia or hypovolemia.

• If with diabetes, monitor for elevated blood glucose levels.

• Observe for manifestations of low magnesium levels (weakness, muscle twitching, tremors).

Hydrochlorothiazide - reinforced teaching pt. 2

Nursing Administration

• Chlorothiazide is administered orally and IV; all others are given orally.

• Ensure the collection of baseline data and regularly monitor orthostatic blood pressure, weight, electrolytes, and location and extent of edema. QS​​​​​​​

• Monitor potassium levels.

• Alternate-day dosing can decrease electrolyte imbalances. 

• Weigh clients at the same time each day with same amount of clothing and bed linen (if using a bed scale), usually upon awakening.

• Monitor blood pressure and I&O.

• If potassium level drops below 3.5 mEq/L, monitor the ECG, and notify the provider because the client might require a potassium supplement.

• Advise clients to get up slowly to minimize postural hypotension, monitor blood pressure, and monitor for hypovolemia. If faintness or dizziness occurs, instruct clients to sit or lie down.

Hypoglycemia manifestations

Reinforce teaching with the client about measures to take in response to manifestations of hypoglycemia

mild shakiness

mental confusion

sweating

palpitations

headache

lack of coordination

blurred vision

seizures

coma

When glucose declines slowly, manifestations relate to the central nervous system:

headache

confusion

fatigue

drowsiness

With rapid glucose decline, the sympathetic nervous system is affected:

tachycardia

diaphoresis

nervousness

Erythromycin - reinforced teaching

Nursing Administration

• If this medication is given to treat an STI, clients should abstain from intercourse until they finish their medication, manifestations have resolved, and partners have been treated.

• Administer oral preparations on an empty stomach (1 hr before meals or 2 hr after) with 8 oz of water, unless GI upset occurs. QEBP

• Administer erythromycin IV only for severe infections or for clients who cannot take oral doses.

• Carefully monitor the PT or INR of clients who take warfarin concurrently with erythromycin. QS​​​​​​​

• Monitor liver function tests for therapy lasting longer than 2 weeks.

Treating Antibiotic Related Diarrhea: Probiotics

Therapeutic Use: Probiotics are used to treat the manifestations of IBS, ulcerative colitis, and Clostridium difficile-associated diarrhea and rotavirus diarrhea in children. Probiotics help restore gut flora after antibiotic use.

Amitriptyline - reinforced teaching

Complications

Orthostatic hypotension

Nursing Actions: Monitor blood pressure and heart rate for clients in the hospital for orthostatic changes before administration and 1 hr after. If a significant decrease in blood pressure or increase in heart rate is noted, do not administer the medication, and notify the provider.

Nursing actions

• Be aware of the effects of postural hypotension (lightheadedness, dizziness). If these occur, sit or lie down. Orthostatic hypotension is minimized by changing positions slowly.

• Avoid dehydration, which increases the risk of hypotension.

• Monitor the client for suicidal tendencies

Propranolol - reinforced client teaching

Nursing actions

• The myocardium becomes sensitized to catecholamines with long-term use of beta blockers.

• Discontinue use of beta blockers over 1 to 2 weeks.

Client Education: Do not stop taking beta blockers abruptly, but follow the provider’s instructions.

Peptic Ulcer - medication to administer

Histamine₂-receptor antagonists

Select Prototype Medication: Cimetidine

Other Medications

• Famotidine

• Nizatidine: PO use only

Expected Pharmacological Action: Block H2 receptors, which suppress secretion of gastric acid and lowers the concentration of hydrogen ions in the stomach

Therapeutic Uses

• Prevent or treat gastric and duodenal ulcers, GERD, hypersecretory conditions (Zollinger-Ellison syndrome), heartburn, and acid indigestion.

• Used in conjunction with antibiotics to treat ulcers caused by H. pylori.

Zolpidem - reinforced teaching

Complications

Daytime sleepiness and lightheadedness, headache

Nursing Actions: Administer medication at bedtime.

Client Education

• Take medication allowing for at least 8 hr of sleep.

• More rapid absorption occurs when the medication is taken when the stomach is empty.

Latanoprost - reinforced teaching

Complications

Bulging of ocular blood vessels

Client education: Inform clients about the possibility of this effect.

Increased pigmentation

Permanent increased brown pigmentation of the iris, usually occurring in individuals with a brown tint to the iris (can also cause pigmentation of lids, lashes)

Client education: This change is permanent but does not progress further after medication is discontinued.

Stinging, burning, reddened conjunctiva

Client education: Do not rub the eyes.

Blurred vision

Client education: Report to the provider.

Migraine

Rare adverse effect

Client education: Report to the provider.

ABCs

Airway Breathing Circulation (ABC) Framework

• The ABC framework identifies, in order, the three basic needs for sustaining life.

  • An open airway is necessary for breathing, so it is the highest priority.

  • Breathing is necessary for oxygenation of the blood to occur.

  • Circulation is necessary for oxygenated blood to reach the body’s tissues. 

• The severity of manifestations should also be considered when determining priorities. A severe circulation problem can take priority over a minor breathing problem.

• Some frameworks also include a “D” for disability and “E” for exposure.

Priority Interventions

• First: Airway

  • Identify an airway concern (obstruction, stridor).

  • Establish a patent airway if indicated.

  • Recognize that 3 to 5 min without oxygen causes irreversible brain damage secondary to cerebral anoxia. 

• Second: Breathing

  • Assess the effectiveness of breathing (apnea, depressed respiratory rate).

  • Intervene as needed (reposition, administer naloxone).

• Third: Circulation

  • Identify circulation concern (hypotension, dysrhythmia, inadequate cardiac output, compartment syndrome).

  • Institute actions to reverse or minimize circulatory alteration. 

• Fourth: Disability

  • Assess for current or evolving disability (neurological deficits, stroke in evolution).

  • Implement actions to slow down development of disability.

• Fifth: Exposure

  • Remove the client’s clothing to allow for a complete assessment or resuscitation.

  • Implement measures to reduce the risk for hypothermia (provide warm blankets and IV solutions or use cooling measures for clients exposed to extreme heat).

Priority interventions - pt. 2

Safety/Risk Reduction QS​​​​​​​

• Look first for a safety risk. For example, is there a finding that suggests a risk for airway obstruction, hypoxia, bleeding, infection, or injury?

• Next ask, “What’s the risk to the client?” and “How significant is the risk compared to other posed risks?”

• Give priority to responding to whatever finding poses the greatest (or most imminent) risk to the client’s physical well-being.

Assessment/Data Collection First

Use the nursing process to gather pertinent information prior to deciding on a plan of action. For example, determine if additional information is needed prior to calling the provider to ask for pain medication for a client.

Survival Potential

• Use this framework for situations in which health resources are extremely limited (mass casualty, disaster triage).

• Give priority to clients who have a reasonable chance of survival with prompt intervention. Clients who have a limited likelihood of survival even with intense intervention are assigned the lowest priority.

Priority interventions pt. 3

Least Restrictive/Least Invasive

• Select interventions that maintain client safety while posing the least amount of restriction to the client. For example, if a client who has a high fall risk index is getting out of bed without assistance, move the client closer to the nurses’ work area rather than choosing to apply restraints.

• Select interventions that are the least invasive. For example, bladder training for the incontinent client is a better option than an indwelling urinary catheter.

Acute vs. Chronic, Urgent vs. Nonurgent, Stable vs. Unstable

• A client who has an acute problem takes priority over a client who has a chronic problem.

• A client who has an urgent need takes priority over a client who has a nonurgent need.

• A client who has unstable findings takes priority over a client who has stable findings.

Priority interventions pt. 4

Evidence-Based Practice

• Use current data to make informed clinical decisions to provide the best practice. Best practice is determined by current research collected from several sources that have desirable outcomes.

• Use knowledge of evidence-based practice to guide prioritization of care and interventions (responding to clients experiencing wound dehiscence or crisis). For example, initiating CPR in the proper steps for a client experiencing cardiac arrest.

Methods to promote evidence-based practice

• Use a variety of sources of research.

• Keep current on new research by reading professional journals and collaborating with other nurses and professionals in other disciplines.

• Change traditional nursing practice with new research-based practices.

Time management

Organize care according to client care needs and priorities. QPCC​​​​​​​

• What must be done immediately (administration of analgesic or antiemetic, assessment of unstable client)?

• What must be done by a specific time to ensure client safety, quality care, and compliance with facility policies and procedures (routine medication administration, vital signs, blood glucose monitoring)?

• What must be done by the end of the shift (ambulation of the client, routine dressing change)?

• What can the nurse delegate?

  • What tasks can only the RN perform?

  • What client care responsibilities can the nurse delegate to other health care team members (practical nurses [PNs] and assistive personnel [APs])?

​​​​​​​Use time-saving strategies and avoid time wasters. 

• ​

Fluid Overload

Distended neck veins, increased blood pressure, tachycardia, shortness of breath, crackles in the lungs, edema, additional findings varying with the IV solution

Treatment

• Decrease the IV flow rate. and notify the provider of the change.

• Raise the head of the bed.

• Measure vital signs and oxygen saturation.

• Adjust the rate after correcting fluid overload.

• Administer diuretics.

Prevention

• Use an infusion pump.

• Monitor I&O.

Contraceptive Device for Patients with Mitral Valve Prolapse - Contraindications/Precautions

Contraindications/Precautions

• Warnings

  • Pregnancy: Hormonal contraceptives contraindicated.

  • Lactation: Combination oral contraceptives contraindicated. Progestin only (mini pills) is safe. 

  • Reproductive: Notify provider if pregnancy is planned or suspected. 

• Contraindicated for clients who QS

  • Are smokers and > 35 years of age.

  • Have a history of thrombophlebitis and cardiovascular events.

  • Have suspected on known breast cancer.

  • Liver conditions.

  • Are experiencing abnormal vaginal bleeding.

• Use cautiously in clients who have hypertension, diabetes mellitus, gallbladder disease, uterine leiomyoma, seizures, and migraine headaches.

Methadone substitution

Intended Effects

• Methadone substitution is an oral opioid agonist that replaces the opioid to which the client has a physical dependence.

• This will prevent abstinence syndrome from occurring and remove the need for the client to obtain illegal substances.

• It is used for withdrawal and long-term maintenance.

• Dependence will be transferred from the illegal opioid to methadone.

Nursing Actions: Observe the client to make sure the dosage is adequate to suppress withdrawal. (Client’s report of prior opiate usage can be unreliable).

Client Education

• The methadone dose must be slowly tapered to produce withdrawal.

• Participate in a 12-step self-help program. QPCC​​​​​​​

• Medication must be administered from an approved treatment center.

Aminoglycosides (Gentamycin)

Complications

Ototoxicity

Cochlear damage (hearing loss), vestibular damage (loss of balance)

Nursing actions

• Monitor for tinnitus, headache, hearing loss, nausea, dizziness, and vertigo.

• Ensure that the client has completed baseline audiometric studies (hearing tests). 

• Stop aminoglycoside if manifestations occur.

Client education: Notify the provider if tinnitus, hearing loss, or headaches occur.

Nephrotoxicity

Due to high total cumulative doses resulting in acute tubular necrosis (proteinuria, casts in the urine, dilute urine, elevated BUN, elevated creatinine)

Nursing actions

• Monitor I&O, BUN, and creatinine.

• Report hematuria and cloudy urine.

• Older adult clients and clients who have kidney disease have an increased risk for developing nephrotoxicity.

Nursing actions: Closely monitor use in clients who have myasthenia gravis, clients taking skeletal muscle relaxants, and clients receiving general anesthetics.

Ferrous sulfate - reduce gastric distress

Food reduces absorption but reduces gastric distress.

Nursing actions: Take with food at the start of therapy if gastric distress occurs.

Client Education

• Take iron on an empty stomach (1 hr before meals) as stomach acid increases absorption.

• Take with food if GI adverse effects occur. This might increase adherence to therapy even though absorption is also decreased.

Rifampin - reinforce client teaching

Complications

Discoloration of body fluids

Client education: There is an expected orange color of urine, saliva, sweat, and tears.

Hepatotoxicity (jaundice, anorexia, and fatigue)

Nursing actions: Monitor liver function.

Client Education

• Monitor for manifestations of anorexia, fatigue, and malaise, and notify the provider if they occur.

• Avoid alcohol.

Mild GI discomfort

Anorexia, nausea, and abdominal discomfort

Nursing actions: Abdominal discomfort is mild and usually does not require intervention.