High-Alert and Clinical Pharmacology Review

A complete set of vocabulary flashcards covering high-alert medications, cardiovascular, respiratory, endocrine, neurologic, psychiatric, GI, infectious disease, labor, and emergency medications based on lecture notes.

Heparin

An unfractionated anticoagulant used to prevent or treat thrombosis, DVT/PE, and ACS.

Heparin Monitoring

Monitor aPTT, anti-Xa, and evaluate for bleeding.

Protamine sulfate

The specific antidote used to reverse the effects of Heparin or unfractionated anticoagulants.

Enoxaparin (Lovenox)

A Low-Molecular-Weight Heparin (LMWH) used to treat or prevent DVT/PE.

Enoxaparin Administration

Inject subcutaneously in the abdomen; do not expel the air bubble or massage the injection site.

Warfarin (Coumadin)

A Vitamin K antagonist used for long-term anticoagulation.

Warfarin Monitoring

Monitor the International Normalized Ratio (INR) and maintain a consistent intake of vitamin K.

Phytonadione (vitamin K)

The specific antidote used to reverse the effects of Warfarin (Coumadin).

Apixaban (Eliquis)

A Factor Xa inhibitor used for the prevention of stroke, DVT, and PE that does not require routine INR monitoring.

Eliquis Monitoring

Monitor renal and hepatic function along with signs of bleeding.

Insulin

Medication used for diabetes management; requires verification of type, dose, timing, and blood glucose level.

Digoxin (Lanoxin)

A cardiac glycoside used for heart failure and dysrhythmias.

Digoxin Assessment

Check the apical pulse for $1\,\text{min}$ and hold the medication if the heart rate is low.

Digoxin Toxicity Signs

Symptoms include nausea, visual changes, and is influenced by potassium levels.

Opioids

Analgesics used for moderate to severe pain; requires assessment of respirations, sedation, and fall risk.

Naloxone

The specific antidote used to reverse the effects of opioid medications.

Magnesium sulfate

A CNS depressant used to prevent seizures in patients with preeclampsia.

Magnesium sulfate Toxicity Signs

Monitoring focuses on respirations, Deep Tendon Reflexes (DTRs), and urine output.

Calcium gluconate

The antidote used for magnesium sulfate toxicity.

Metoprolol (Lopressor)

A beta blocker used for hypertension and heart failure.

Metoprolol Safety

Assess heart rate and blood pressure; note that it may mask symptoms of hypoglycemia.

Propranolol (Inderal)

A nonselective beta blocker used for HTN, tremors, and migraines.

Propranolol Precautions

Can cause bronchospasms; use with caution in patients with asthma or COPD.

Atorvastatin (Lipitor)

A statin used for hyperlipidemia; patients should report muscle pain or dark urine.

Lipitor Contraindications

Avoid use during pregnancy and monitor liver function during therapy.

Cholestyramine (Questran)

A bile acid sequestrant used for hyperlipidemia.

Cholestyramine Administration

Mix with fluid, separate from other oral medications, and monitor for constipation.

Niacin (Nicotinic acid)

Used for hyperlipidemia; common side effects include flushing and pruritus.

Clopidogrel (Plavix)

An antiplatelet medication used to prevent arterial thrombus; inform providers before procedures.

Cilostazol (Pletal)

A PDE-3 inhibitor used for intermittent claudication.

Cilostazol Contraindication

This medication is contraindicated in patients with heart failure.

Nitroglycerin

A nitrate used for acute angina; assess blood pressure and pain level.

Nitroglycerin Interaction

The medication should not be used in combination with PDE-5 inhibitors.

Lisinopril

An ACE inhibitor used for HTN and heart failure; monitor for cough and angioedema.

Lisinopril Labs

Monitor blood pressure, potassium levels, and renal function; avoid use during pregnancy.

Losartan

An Angiotensin II Receptor Blocker (ARB) used for HTN and heart failure.

Losartan Precautions

Monitor blood pressure and potassium; watch for angioedema and avoid in pregnancy.

Furosemide (Lasix)

A loop diuretic used for edema and heart failure; assess daily weight and blood pressure.

Lasix Monitoring

Monitor potassium levels and evaluate hearing if high doses are administered.

Hydrochlorothiazide

A thiazide diuretic used for HTN and mild edema.

Hydrochlorothiazide Monitoring

Monitor sodium levels, potassium levels, and the patient's hydration status.

Spironolactone

A potassium-sparing diuretic used for heart failure and HTN.

Spironolactone Precaution

Avoid potassium supplements and monitor for endocrine effects.

Argatroban (Acova)

A direct thrombin inhibitor used for anticoagulation in patients with Heparin-Induced Thrombocytopenia (HIT).

Argatroban Monitoring

Monitor aPTT and adjust the dose for patients with hepatic impairment.

Albuterol

A Short-Acting Beta Agonist (SABA) used as a rescue treatment for bronchospasms.

Albuterol Common Side Effects

Common side effects include tremors and tachycardia.

Salmeterol

A Long-Acting Beta Agonist (LABA) used for maintenance bronchodilation.

Salmeterol Rule

Not for acute symptoms; must be used with an inhaled corticosteroid in asthma patients.

Ipratropium

An anticholinergic used for COPD and asthma that may cause dry mouth.

Tiotropium (Spiriva)

A long-acting anticholinergic used for maintenance of COPD.

Fluticasone

An inhaled corticosteroid used for the maintenance of asthma or COPD.

Fluticasone Oral Care

The patient should rinse their mouth after use to prevent candidiasis.

Montelukast (Singulair)

A leukotriene antagonist used for asthma and allergy maintenance.

Singulair Monitoring

Monitor the patient for mood or behavioral changes.

Diphenhydramine (Benadryl)

An antihistamine used for allergies or acute reactions that causes sedation.

Cetirizine (Zyrtec)

A second-generation antihistamine used for allergic rhinitis; less sedating than first-generation.

Pseudoephedrine (Sudafed)

A decongestant for nasal congestion that can increase heart rate and blood pressure.

Sudafed Contraindication

Avoid use if the patient's hypertension is uncontrolled.

Guaifenesin

An expectorant for a productive cough; nursing care involves encouraging fluid intake.

Dextromethorphan

An antitussive used for nonproductive coughs; check for interactions with MAOIs.

Acetylcysteine

A mucolytic used for thick secretions; monitor for bronchospasm during inhalation.

Regular insulin

Short-acting insulin that is the only type routinely administered intravenously (IV).

Insulin lispro

A rapid-acting insulin used for mealtime control.

Lispro Administration

Ensure that food is available before administration and monitor for hypoglycemia.

NPH insulin

Intermediate-acting insulin with a cloudy suspension that should be rolled gently.

Insulin glargine (Lantus)

A long-acting insulin used for basal control; give at the same time daily.

Lantus Mixing Rule

This medication should not be mixed with any other insulins.

Metformin (Glucophage)

A biguanide used for Type 2 diabetes that requires monitoring of renal function.

Metformin Procedure Precaution

The drug must be stopped before and after procedures using iodinated contrast.

Glipizide

A sulfonylurea used for Type 2 diabetes that can cause hypoglycemia.

Levothyroxine (Synthroid)

Thyroid hormone replacement for hypothyroidism; take on an empty stomach.

Levothyroxine Monitoring

Monitor TSH levels and observe for signs of excess dosing (hyperthyroidism).

Methimazole

An antithyroid medication used for hyperthyroidism; monitor liver function.

Methimazole Reporting

Patients should report fever or sore throat due to the risk of agranulocytosis.

Prednisone

A glucocorticoid used for inflammation; monitor for glucose elevation and infection.

Prednisone Cessation

This medication should never be stopped abruptly.

Alendronate

A bisphosphonate used for osteoporosis; take in the morning with water.

Alendronate Post-Administration

The patient must stay upright for $30\,\text{min}$ and avoid food for $30\,\text{min}$ after taking.

Levetiracetam (Keppra)

An antiseizure medication; monitor the patient for changes in mood, behavior, and sedation.

Phenytoin (Dilantin)

Antiseizure medication requiring monitoring of serum levels and oral health (gingival hyperplasia).

Phenytoin IV Precaution

When administered intravenously, the patient requires cardiac monitoring.

Valproate/divalproex

An antiseizure and mood stabilizer med; monitor for liver toxicity, low platelets, and pancreatitis.

Carbidopa/levodopa

A dopaminergic agent for Parkinson’s; can cause orthostatic hypotension.

Carbidopa/levodopa Diet Rule

The intake of protein can affect the absorption of this medication.

Donepezil

A cholinesterase inhibitor for Alzheimer’s that can cause nausea and bradycardia.

Mannitol

An osmotic diuretic used for elevated ICP or intraocular pressure; monitor urine output.

Sumatriptan

A triptan used for acute migraines; monitor for chest pressure.

Sumatriptan Contraindication

Avoid use in patients with coronary or cerebrovascular disease.

Lorazepam

A benzodiazepine used for anxiety or seizures; assess respirations and sedation.

Flumazenil

The reversal agent (antagonist) for benzodiazepines like Lorazepam.

Sertraline

An SSRI used for depression and anxiety; full effects take several weeks.

Sertraline Monitoring

Monitor for suicidality and symptoms of serotonin syndrome.

Venlafaxine

An SNRI used for depression; must be tapered rather than stopped abruptly.

Amitriptyline

A tricyclic antidepressant with high risks for anticholinergic effects and lethal overdose.

Phenelzine

An MAOI for treatment-resistant depression; carries a risk of hypertensive crisis.

Phenelzine Dietary Rule

Avoid foods rich in tyramine while taking this medication.

Lithium

A mood stabilizer for Bipolar disorder; monitor serum levels, renal, and thyroid function.

Lithium Intake

Maintenance of consistent sodium and fluid intake is required.

Haloperidol

A first-generation antipsychotic used for psychosis and agitation.