NCLEX Pharmacology

Six Rights of Medication Administration

-Right pt

-Right drug

-Right dose

-Right route

-Right time

-Right documentation

Antibiotic cultures

1) Obtain Culture

2) Start Broad Spectrum

3) Get Results

4) Specific Antibiotic Therapy

Infiltration Nursing Care

-Stop Infusion

-Elevate Extremity

-Apply Cold Compress

Extraversion (Vesicant)

-Stop Infusion

-Aspirate Drug

-Apply Cold Compress

Phlebitis Nursing Care

-Stop Infusion

-Heat Compress

Hematoma Nursing Care

-Remove IV

-Apply pressure

Catheter Embolus Nursing Care

-Immediately apply tourniquet on arm

A hypertonic solution that contains dextrose, proteins, and electrolytes that is administered through a central line

Total Parenteral Nutrition (TPN)

Steroid or respiratory med inhaled first?

Resp med inhaled first to open up lungs so when steroid is administered it can be absorbed better

Inhaler Teaching

1) Remove cap and shake
2) Exhale deeply

3) Place the mouthpiece between your teeth and close your lips tightly around the mouthpiece

4) Breath in slow and steady and press down on inhaler

5) Hold breath for 5 to 10 seconds

Eye drop medication teaching

1) Pt tilts their head back

2) Hold dropper 1-2cm above eye

3) Drop medication in the conjunctival sac

4) Hold gentle pressure on the nasolacrimal duct for 30-60 seconds

Acetaminophen Antidote

Acetylcysteine

Benzo’s Antidote

Flumazenil

Cyanide Poisoining Antidote

Methylene Blue

Digoxin Antidote

Digoxin Immune FAB

Heparin & Enoxaprain Antidote

Protamine sulfate

Iron Antidote

Deferoxamine

Lead Antidote

Succimer

Magnesium Sulfate Antidote

Calcium Gluconate

Narcotic Antidote

Naloxone

Warfarin Antidote

Vitamin K (Phytonadione)

Antihypertensive Medications

-ACE Inhibitors → “pril”

-ARBS → “sartan”

-Calcium Channel Blockers → “dipine”

-Beta Blockers → “olol”

-Diuretics → Furosemide, Bumetanide, HCTZ, Sptonolactone

-Nitros

-Other → Clonidine

“prils” → Lisinopril

-Antihypertensive medication

-Common side effect → constant nonproductive cough

-Adverse → Angioedema

-Taken 1 hr before meals

“dipine” → Nifedipine, Amlodipine

-Antihypertensive Medication

-Contradicted in pts who have HF, bradycardia, and who take olol or digoxin

-Do not consume grapefruit juice

“olol” → Metaprolol (B1) & Propranolol (B2)

-Antihypertensive & cardiac medication

-Hold if HR is less than 60 or systolic is less than 100mm Hg

-Do not give propranolol (B2) to pts who have asthma because it affects the lungs

-Monitor pts who have diabetes for hypoglycemia

Nitros

-Antihypertensive & Antianginal Medication

-Side Effect → Hypotension & Headache

-Do not take with Sidenefil

Nitro Sublingual Steps

1) Take tablet

2) Rest for 5 mins

3) Pain is still there call 911 and take a second one

4) Repeat up to 3 max

(Keep nitro tablets in cool dark place, and replace every 6 months)

Nitro Topical Ointment and Patch Nursing Care

Topical Ointment → Wear gloves while putting it on pt, apply it to the place without hair

Patch → Apply it in the morning and take it off before bed (wear it 12-16 hours per day)

Furosemide, Bumetanide, HCTZ (Hydrochlorothiazide), Spironolactone

-Antihypertensive, HF Edema medication

-Contradicted in pregnancy

-Administer in the morning

-Adverse Effects (Furosemide, Bumetanide, HCTZ) → Ototoxicity, Hypokalemia, Hypotension (pt needs to eat foods high in K)

-Adverse Effects (Spironolactone) → Hyperkalemia (pt needs to eat foods low in K → Avoid salt substitutes)

Clonidine

-Antihypertensive Medication

-Do not take with anticoagulants & MAOI’s

-Monitor for rebound hypertension due to hypertensive crisis

Digoxin

-Heart Failure medication

-Pt needs to know how to take apical pulse for a full minute (no go if HR is below 60)

-Digoxin Toxicity → Blurred vision, yellow vision

Adenosine

-Used for SVT’s

-Heart stops for a few seconds

-Flush immediately with NS

Amiodarone

Used for V-Fib

Atropine

-Bradycardia

-Reduce secretions during bronchoscopy

-Side Effects → Blurry vision

“statin” → Atorvastatin

-Cholesterol Medication

-Take med at night (that is when cholesterol works)

-Adverse → Rhabdo (monitor liver enzymes)

Albuterol

Short Acting Asthma Medication

Salmeterol, Formoterol, Terbutaline,

Long acting control of asthma medication

Asthma medications side effects

Tachycardia, tremors, restlessness

“tropium” → Ipatropium

-Inhaled Anticholinergic used for COPD

-Peanut Allergy cannot have

-Side affects → hoarseness and dry mouth

Steriods nursing care

-Side Effects → Insomnia, hyperglycemia, increased appetite

-Teaching → Administer meds with meals, take with calcium, slowly taper off, use salt substitutes

Monteklast

-Steroid that is used to prevent exercise-induced bronchospasm

-Monitor suicidal ideation

Pseudoephedrine

-Medications for allergic rhinitis, sinusitis, common cold

-Do not use for longer than 3-5 days because it can cause rebound congestion (Sophia)

Diphenydramine

-Antihistamine

-Decreases allergic hypersensitivity reactions

-Side effects → Antichollinergic effects & Drowsiness

Metformin

-Oral Hypoglycemic Type 2 Diabetes Medication

-Withhold 48 hr before prior and after a test with contrast

Glipizide & Glyburide

-Oral Hypoglycemic Type 2 Diabetes Medication

-Extreme risk for hypoglycemia for pts with renal, hepatic, or adrenal disorders

-Hypoglycemic teaching is a must for pt on these

Insulin Lispro & Aspart

-Rapid Acting

-Onset → 15-30 minutes

Regular Insulin

-Short Acting

-Onset → 30-60 minutes

NPH Insulin

-Intermediate Acting

-Onset → 1 to 2 hours

Insulin Glargine

-Long Acting

-Onset → 1 to 2 hours

-NO PEAK

Mixing Insulin Steps

-Inject air into NPH

-Inject air into regular

*Then its clear before cloudy to draw up the medicine

-Pull up regular insulin

-Pull up NPH

What is emergency IM injection for severe hypoglycemia pts

Glucagon

Levothyroxine

-Synthetic Thyroid Hormone → Used for ppl with hypothyroidism

-Take in the morning

Methimazole

-Thyroid Hormone Antagonist → Used for ppl with hyperthyroidism

-Administer with food

-Increase fluids

Somatropin

Medication that increases growth hormone throughout the body

“pressin” → Desmopressin & Vasopressin

-Vasoconstrictor to bring BP up & Synthetic ADH Hormone → Treats Diabetes Insipidus

Transfusion to replace volume in the body from hemorrhage and trauma

Whole Blood Transfusion

Transfusion to increase RBC’s in a pt who has severe anemia

Packed RBC’s

Transfusion where pt needs increased platelet’s and is actively bleeding out

Platelet Transfusion

Transfusion used to replace clotting factors

Fresh Frozen Plasma (FFP) Transfusion

Blood Transfusion Protocol

-Obtain Consent

-Establish large-bore IV access and get baseline vitals

-Verified by 2 nurses

-30 minutes to infuse it once it gets to the floor

-4 hrs for the total infusion

-First 15 minutes stay with pt (if reaction occurs stop immediately, push fluids, and send all items to lab)

-No reaction than monitor vitals every hour

Medication that stimulates RBC production

Epoetin Alfa

Medication that stimulates WBC production

“grastim” → Filgrastrim & Pegfilgrastim

Ferrous Sulfate

-Treats iron deficiency

-Take with vitamin C

-Avoid calcium (dairy) & caffeine

-Stains teeth → use straw

-Causes green stools

Anticoagulant Therapy

-Heparin (aPTT) → Protamine sulfate

-Warfarin (INR or PT) → Vitamin K

-Side Effects → Bleeding, hemorrhage, thrombocytopenia

-Garlic, ginger, gingko can all increase the chance of bleeding for pts

Aspirin & Clopidogrel

-Antiplatelet Therapy → prevents stroke & MI

-Hold 7-10 days before surgery.

-Report any bleeding or black tarry stools.

Altepase or tissue plasminogen activator (tPA)

-Thrombolytic Medication

-Used for ischemic strokes and MI’s

Hydroxide’s & Sodium bicarbonate

-Antacids → Neutralizes stomach acid → used for upset stomach

-Other medications need to be taken 1 hr after antacid is taken

Sucralfate

-Anti-ulcer → Coats the lining of the stomach

-Administer it before meals

Sulfasalazine

-UC medication

-Check if pt has sulfa allergies

-Side Effects → Photosensitivity & changes body fluids to orange

“mabs” → Infliximab

Crohn’s Medication

Antisecrotary Stomach Medications → GERD, PUD or Gastric Ulcers

-”prazole” → Omeprazole → Proton Pump Inhibitor → Inhibits gastric acid production

-”tidine” → Famotidine

-Do not crush or chew tablets

-Take 30-60 minutes before meal

Promethazine

-Antiemetic

-Side Affects → EPS

-Do not give to kids under the age of 2 causes respitory distress syndrome

Ondastron

-Antiemetic

-Adverse Effect → High risk for cardiac dysrhythmias & prolonged QT interval

-Administer 30 minuetes before chemotherapy

Diphenoxylate

Antidiarrheal

Psyllium

Bulk forming stool softener

Docusate Sodium

Laxative

Milk of Magnesium

Agressive laxative that promotes rapid evacuation

Isotretinoin (Accutane)

-Acne relief

-Tetragenic → Get pregnancy tests before refills

Mannitol

Lasix for the brain → Decreases ICP

-Side Affects → Right and left-sided HF manifestations

BPH medications

-”osin” → relaxes smooth muscle in the prostate → Orthostatic Hypotension

-”terides” → Shrinks the prostate → Takes up to 6 months

Oxybutin

-Anticholinergic for urinary incontinence

-Teach Kegal exercises

Sidenifil

-ED drug

-Do not take with nitros

-Side Effects → Hypotension, priapism

Names of Antibiotics

-”cillin”

-”micin” or “mycin” → used if pts have penicillin allergies, can cause nephrotoxicity (monitor BUN, creatinine, urine output & color)

-Ceph, Cef

-Ciproflaxcin → High risk of tendon rupture

Antiobiotic Education

-Take the full course of medication

-Increase oral fluid intake to atleast 3L

-Increase contraception methods

-Avoid sunexposure

Vancomycin

C. Diff medication → Administer slowly to avoid Red Man Syndrome

Fluconazole

Anftifungal

Hydroxychloroquine

Malaria medication & DMARD

-Can cause blindness → eye appointment every 6 months

Isoniazid & Rifampin

-TB treatment

-Eat foods high in Vitamin B

-Bodily fluids will have orange discoloration

Acyclovir

Treatment for genital herpes & HIV

“dronate” → Alendronate

-Bisphosphonates

-Treats Osteoporosis

-Administer medication on an empty stomach, a glass of water, sitting upright for 30 minutes

-No calcium with medication

“mab’s” + Methotrexate & Hydroxychloroquine (trouble makers)

-DMARDS → Rheumatoid Arthritis

-Administer with food

-Methotrexate is contraindicated in pretty much everything

-Hydroxychloroquine can cause blindness (eye exam every 6 months)

NSAIDS

-Ibuprofen, Celecoxib, Meloxicam

-Pain reduction, fever reduction, anti-inflammatory → Great for Osteoarthirits

-Administer with food & water

-Overuse can cause GI symptoms

-Wear sunscreen

Acetametaphine

-Pain reduction & fever

-Do not exceed 3000mg/24hr

-High risk of hepatotoxicity

-Antidote → Acetylcysteine

Fentanyl, Morphine

-Opiods

-Monitor for respiratory depression

-Causes constipation & urinary retention

-Antidote → Naloxone

Allopurinol

Chronic Gout treatment

Colchicine

Acute Gout treatment

Alcohol Abstinence Drug

-Disulfiram

-Throw up immediately if in contact with any alcohol

-Must wait 12 hrs for alcohol to get out of the system before taking it

Alcohol Withdrawal drug

Diazepam

Opioid Abstinence Drug

Methadone

Pyridostigmine

-Myasthenia Gravis Drug (acetylcholine inhibitor)

-Do not administer if HR is less than 60

-Side Effects → Resp. Depression

-Antidote → Anticholinergic like Atropine