50 most common meds on NCLEX

When taking Digoxin what should the nurse monitor?

POTASSIUM LEVELS

Low potassium increases digoxin levels increasing risk for toxicity

What should the nurse/patient monitor when taking prednisone?

Delayed wound healing

Steroids decrease the body's inflammation and immune systems

What should the nurse monitor when a patient is taking warfarin?

INR

When taking warfarin want number 2-3

What should be monitored when taking Zolpidem?

Sleep patterns

(Its Ambien)Sedative/hypnotic

What should be monitored when taking Olanzapine

a patients mood

atypical Antipsychotic

which meds are Inotropic agents

Digoxin- monitor levels and HR

Dopamine-Monitor HR, output, and BP

Dobutamine-Monitor HR, BP, and output

Loop Diuretics

Furosemide, Bumetanide

Given for Hypertension and Pulmonary Edema usually

Monitor for HYPOKALEMIA, hypotension, Dehydration, Ototoxicity

Thiazide Diuretics

Hydrochlorothiazide,

Chlorothiazide

Drug of choice for essential Hypertension

Monitor HYPOKALEMIA AND HYPONATREMIA, dehydration

Potassium sparing diuretics

Spironolactone (Aldactone)

Monitor for hyperkalemia

When should diuretics be taken?

In the morning if daily, morning and 2 pm if bid

What medication may be given to prevent heart disease?

Atorvastatin

Reduces Cholesterol which reduces the plaque build up

What medication may be given to prevent MI or Stroke?

Clopidogrel

What medication may be given to prevent may slow the progression of Arthritis?

Etanercept

Etanercept is a tumor necrosis factor (TNF) blocker that is used in adults to prevent joint damage caused by rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis.

What does oxybutynin do?

reduces muscle spasms of the bladder and urinary tract.

helps prevent urinary incontinence

What vaccine prevents Rubella

MMR

When is MMR given?

MMR vaccine is recommended routinely for all children at age 12 through 15 months, with a second dose at age 4 through 6 years.

What does pregabalin do?

treat neuropathy

Pregabalin is used to treat pain caused by fibromyalgia, or nerve pain in people with diabetes (diabetic neuropathy), herpes zoster (post-herpetic neuralgia), or spinal cord injury.

Controversial with pregnant women

When medication can help with GERD

esomeprazole

Esomeprazole is a proton pump inhibitor that decreases the amount of acid produced in the stomach.

Side effects: headache. diarrhea. nausea. flatulence (passing gas) stomach pain.

What is quetiapine used for?

This medication is used to treat certain mental/mood conditions (such as schizophrenia, bipolar disorder, sudden episodes of mania or depression associated with bipolar disorder).

Quetiapine is known as an anti-psychotic drug (atypical type)

Triotropium

helps with COPD- Relaxes the muscle in the airways

used to control and prevent symptoms (such as wheezing, shortness of breath) caused by ongoing lung disease (chronic obstructive pulmonary disease-COPD which includes bronchitis and emphysema).

Side effects: Dry mouth, sore throat, constipation

What meds help with decreasing symptoms of herpes zoster?

Valacyclovir

When it ends in -Vir its an antifungal!

Montelukast

Singulair

-Prevents bronchospasm

-prevent asthma attacks and for the long-term treatment of asthma in adults and children 1 year and older.

usually taken at Night!

Assess lung sounds for rhonchi & wheezing....Assess liver function/laboratory values......Monitor for cyanosis

Increase fluid intake

Do not discontinue the medication and to take it as prescribed even during symptom free periods

What pain medication class if taken for migraines?

Triptans

Watch for coronary spasms

*CONTRAINDICATED DURING PREGNANCY-- its a TERTAGENIC**

examples of the meds Imitrex (sumatriptan), Amerge (naratriptan), Zomig (zolmitriptan)

What type of pain should cannabinoids be taken for?

Neuropathic Pain

Watch for tachycardia

What type of pain are NSAIDS given for?

Inflammatory pain (Arthritis, bursitis and tendonitis)

Watch for GI bleeds and impaired renal function

When would you give opioid agonists

Moderate to Severe pain

Monitor for respiratory Depression, constipation, n/v, sedation

oxycodone, methadone, hydrocodone, morphine, opium

Shorts facts about thrombolytics (end in plase)

Alteplase, tenecteplase

Dissolve the thrombi that are already formed

Used for acute MI, ischemic CVA(atleplase is given)**, and PE

CONTRAINDICATED FOR ANYONE WITH HISTORY OF BLEEDING RISK

Want to be given within 3 hours of onset if not a candidate for cath lab (But have up to 4-6 hours by start of symptoms if needed)

Methotrexate (Rheumatrex)

DMARDs (disease modifying anti-rheumatic drugs) TYPE I

Adverse reactions: Bone marrow supression and hepatotoxicity

Increased risk for infections SO teach patients to report any fever, diarrhea, or bleeding to Doctor.

Etanercept and Infliximab

DMARDS TYPE II

Adverse Reactions: Serious infections**** Hepatitis B and TB

Considerations: Test for TB and HBV prior to starting Meds******

Monitor for signs of heart failure

What class are meds that end in -pril

ACE Inhibitors

Catopril, enalapril, etc.

used high blood pressure, heart failure, heart attack, and preventing kidney damage associated with high blood pressure and diabetes

WATCH FOR COUGH** They may increase K+ levels as well.

THey lower both BP and HR--> check pulse before and check for Bradycardia during

What class are meds that end in -vir

ANTIVIRALS

acyclovir, Valacyclovir

antiviral drugs do not destroy their target pathogen; instead they inhibit their development.

What class are meds that end in -azole

Antifungals

Fluconazole and voriconazole

What class are meds that end in statin

antilipidemics--> used for

Atorvastatin, simvastatin

primary hypercholesterolemia and mixed dyslipidemia. Primary prevention of coronary heart disease(Atorvastatin)

Instruct patient to notify health care professional if unexplained muscle pain, tenderness, or weakness occurs, especially if accompanied by fever or malaise

** If patient develops muscle tenderness during therapy, CPK levels should be monitored. If CPK levels are 10 times the upper limit of normal or myopathy occurs, therapy should be discontinued. ****

What class are meds that end in -olol

Betablockers

***These drugs may trigger a severe asthma attack and can mask signs of low blood sugar.

Beta blockers may not work as well in people of African descent as in other racial or ethnic groups.****

What class are meds that end in -dipine

calcium channel blocker

amlopidine, nifedipine

Calcium channel blockers (CCBs) dilate the arteries, reducing pressure within and making it easier for the heart to pump blood, and, as a result, the heart needs less oxygen---->>>>>help decrease blood pressure, prevent angina, and treat dysrhythmias.

dont stop abruptly.

*Grapefruit juice interacts with the drug and can affect heart rate and blood pressure.**

What class are meds that end in -afil

Erectile Dysfunction

Sildenafil, tadalafil

Dont take these medications if you take nitrates!****

What class are meds that end in -dine

Histamine Blockers

rantidine, famotidine

usually used for duodenal ulcers but can be used for others.

What class are meds that end -prazole

Proton Pump Inhibitor

The most common side effects reported include headache, diarrhea, nausea, and vomiting.

Reports of more serious side effects include kidney disease, fractures, infections and vitamin deficiencies, but these are very rare and are generally associated with long-term use (using these products for more than a year)

tricyclic antidepressants

block reuptake of serotonin and norepinephrine

Amitriptyline and doxepin-->used to treat depression, bipolar disorder, and other conditions such as chronic pain and insomnia.

Side effects commonly seen include sedation and weight gain**

start seeing benefits anywhere from 2 to 6 weeks for most people, while most people will start to feel a benefit within 3 to 4 weeks.

Monoamine Oxidase Inhibitors (MAOIs)

Isocarboxazid (Marplan)

MANY DRUG DRUG AND DRUG-FOOD interactions with these medications!

Foods with Tyramine cause hypertension

Foods with tyramine (MAOIs)

strong or aged cheeses like cheddar, blue cheese, or gorgonzola.

cured or smoked meats or fish, such as sausage or salami.

beers on tap or home-brewed.

some overripe fruits.

certain beans, such as fava or broad beans.

Lithium

Used for a mood stabilizer- bipolar

S/e anorexia, confusion, thirst

What are the signs of lithium toxicity?** Vomitting, diarrhea, drowsiness and slurred speech

Lithium level and toxicity

0.5-1.2

Early signs of toxicity: diarrhea, vomiting, drowsiness, muscle weakness, lack of coordination

Haloperidol

Antipsychotic

used for schizophrenia, acute psychosis, and tourette's

S/e mild leukopenia, EPS(HIGH RISK), Tardive, Laryngospasm, respiratory distress, NMS (very high fever (102 to 104 degrees F), irregular pulse &tachycardia, muscle rigidity, tachypnea)

Zolpidem

Ambien (sedative hypnotic)

Insomnia

S/e= daytime sleepiness and fatigue

Patients may act out and have night terrors with this medication without realizing it at night time.

epoetin

Growth factor

used for anemia (from CKD or Chemo)

S/e= HTN, Thrombotic stroke, clotting of AV fistula

What labs should be monitored? hemoglobin and hematocrit

Riserdronate

Bisphosphate

used for osteoporosis

S/e= Bone pain, leg cramps, colitis.

How is this medication taken???? with a full glass of water, AND have the patient sit up or stand up AND remain NPO for 30 mins after taking.

levofloxacin

antibiotic

Pneumonia, sinusitis, skin infections

side/effects (main ones to know) tendonitis and photosensitivity

If a patient reports joint pain while taking this have them stop immediately. bedrest. contact provider-->

*this medication is associated with tendon rupture **

Dutasteride

5 alpha reductase inhibitor.

Used for BPH

Side effects, decreased ejaculate and libido

*PATIENTS USING THIS MEDICATION CANNOT GIVE BLOOD!!! it is a teratogenic

(So pregnant women should not handle this medication) Use gloves.**

Warfarin

Anticoagulant, Vitamin K Antagonist.

Used for prophylaxis for thrombosis, tias, and MI

Side effects: serious bleeding/fatal events BLACK BOX warning.

**Patients should not avoid foods with vitamin K, they should just eat them at a normal level. (consistent intake)**

Phenytoin

Antiepileptic

used for seizures

s/e= gingival hyperplasia and thrombocytopenia.

teach and monitor patient about steven johnsons syndrome: flu like s/s with skin rash)--> stop taking and notify doctor.

Metronidazole

antimicrobial

Used for amoebiasis, trichomoniasis, giardiasis.. *Drug of choice for CDIFF*

s/e= nausea, headache, metallic taste, dark urine.

DO NOT TAKE WITH ALCOHOL-> can cause a disulfiram like reaction (severe nausea and vomitting)

Cyclobenzaprine

Muscle Relaxant

s/e= dizziness, dry mouth, drowsy, urinary retention, constipation.

NEED TO KNOW: do not take with MAOI medications (examples isocarboxazid (Marplan) and

phenelzine (Nardil))

taken together can cause hypertensive crisis and seizures*

Trazodone

Antidepressant

used for depression and insomnia

S/e= sedation, orthostatic hypotension, nausea.

When used for depression it is not used as the sole treatment-- its usually taken with other antidepressants and for insomnia

***It can take 1 to 2 weeks before trazodone starts to work, but may be 4 to 6 weeks before you feel the full benefit.

***Trazodone can make you feel sleepy. If you take it once a day, it's best to take it in the evening or before you go to bed.

hydrocodone/acetaminophen

opioid analgesic.

used for moderate to severe pain.

s/e= resp depression, constipation, urinary retention, sedation, *cough suppression (have them cough and deep breathe to prevent pneumonia)

teach the client to increase fluid and fiber intake, sit or lie down after taking, DONT crush or chew, avoid alcohol

Montelukast (Singulair)

Prevent bronchospasm and asthma attacks, relieve rhinitis

s/e= dizziness, GI disturbance, mood changes and suicidal ideation

Hydromorphone

used for moderate to severe pain

If respirations are 10 or less...stop med and let provider know asap. Assess patient

Insulin Detemir

This medication replaces a missing pancreatic hormone.

long-acting insulin

When taken once daily, inject the insulin with the evening meal or at bedtime; when taken twice daily, the evening dose should be taken with the evening meal, at bedtime, or 12 hours following the morning dose

Tramadol

This medication is used for pain control and should not be combined with alcohol.

Main points:

a. Low incidence of abuse

b. S/e= sedation, dizziness, HA, dry mouth, constipation

c. Shouldn't be given to a client with history of Seizure Disorder

Methylergonovine

This medication might be used postpartum for a woman who delivered twins--> helps uterus contract and prevent bleeding

**This drug should not be routinely administered IV because of the possibility of inducing sudden hypertensive and cerebrovascular accidents.**

Only use IV if essential as a life-saving measure. Give IV slowly over a period of no less than 1 minute, with careful monitoring of blood pressure.

methotrexate

1. DMARD-->Know this medication

a. Used for RA, cancer, Psoriasis, crohn's

b. s/e n, elevated LFT's, fatigue

c. improves symptoms of RA by surpressing immune response

gabapentin

This medication is approved for epilepsy but is often used as treatment for neuralgia.

most effective when taking 3x a day.

Give drug with food to prevent GI upset.

Nitrogylercin

for chest pain. Do not take the medication with tadalafil.**** (PDA5)

a. Se headache, hypotension, tachycardia

b. Implement fall precautions!!

i. Sit down or lie down due to vasodilation when taking med

oxytocin

This medication is prescribed to induce or augment labor.

a. S/e tachysytole, uterine rupture, elevated BP,

b. What is a tocolytic?

--relaxes the myometrium

---Magnesium is not a tocolytic class but can be used as this

Meloxicam

This medication may be used to relieve pain from OA or RA

meloxicam can cause insomnia, dizziness. headache is a common, less serious side effect of meloxicam

Risperidone

used to decrease in hallucinations and delusions.

second generation antipsychotic (SGA) or atypical antipsychotic

a. Schizophrenia, acute bipolor, autism

b. s/e weight gain, dyslipidemia, diabetes

c. Routine blood tests need to be done to check lipid levels and glucose

Methylprednisolone

used to treat many different inflammatory conditions such as arthritis, lupus, psoriasis, ulcerative colitis, allergic disorders, gland (endocrine) disorders.

*Methylprednisolone can make you more likely to get infections or may worsen any current infections.*

This medication may make your blood sugar level rise, which can cause or worsen diabetes

a. S/e cushing syndrome (Too much steroid and glucocorticoid)

---Symptoms of cushings syndrome are Buffalo hump, weight gain, moon face, etc

Budesonide/Formoterol

used for Asthma and COPD

a. this medicine may cause fungus infection of the mouth or throat (thrush). Teach patient to rinse mouth before and after

b. SE= GI upset and infection

i. Why infection? it's a Steroid so it suppresses immune system response

Allopurinol

used to treat gout and certain types of kidney stones

a. s/e nausea, hypersensitivity, fever, rash

b. if nausea present tell them to take med with food!

c. The patient receiving this medication should decrease the intake of purines

*Encourage fluid intake to also help with excretion,* as well as reduce kidney stone formation. Monitor for joint pain and swelling and educate the patient regarding taking additional pain medication when experiencing acute gout flare-ups. This can happen frequently in the first few months of therapy

Vancomycin

antibiotic

*A client who has an intestinal infection caused by clostridium difficile is likely to receive this medication*

a. s/e= Red man, nephrotoxicity, and audotoxicity

b. Creatine and BUN should be monitored for Nephrotoxicity

piperacillin/tazobactam

Clients allergic to penicillin should not take this medication.

a combination penicillin antibiotic that is used to treat many different infections caused by bacteria, such as stomach infections, skin infections, pneumonia, and severe vaginal infections.

Causes GI upset and leukopenia

Monitor signs of pseudomembranous colitis, including diarrhea, abdominal pain, fever, pus or mucus in stools, and other severe or prolonged GI problems (nausea, vomiting, heartburn).

digoxin

Typically prescribed to treat heart failure. Positive Inotrop (strengthens the force of the heartbeat by increasing the amount of calcium in the heart's cells.)

The client should be closely monitored for toxicity. Therapeutic levels of digoxin are 0.8-2.0 ng/mL. The toxic level is >2-2.5 ng/mL

Monitor apical pulse for 1 full min before administering. Withhold dose and notify health care professional if pulse rate is <60 bpm in an adult, <70 bpm in a child, or <90 bpm in an infant

adenosine

A client who has paroxysmal supraventricular tachycardia receives this IV. "no heartbeat" when given= resets the heart to hopefully slow it down to regular level.

Varenicline

Smoking cessation aid

Use: Aid efforts to stop smoking

SE: change in appetite; unusual dreams

Amiodarone

Antidysrhythmic

*Uses: a-fib; v-fib; v-tachycardia*

SE: lung damage; heart failure; liver & thyroid toxicity

Rapid acting insulin

lispro, aspart, glulisine

Onset: 15 minutesPeak: 1 hourDuration: 3

*"15 minutes feels like an hour during 3 rapid responses."*

short acting insulin

Regular (Humulin R, Novolin R)

Onset: 30 minutes

Peak: 2 hours

Duration: 8 hours

*"Short-staffed nurses went from 30 patient to (2) 8 patients."*

Intermediate acting insulin

NPH (Humulin N, Novolin N)

Onset: 2 hours

Peak: 8 hours

Duration: 16 hours

*"Nurses Play Hero to (2) eight 16 year olds."*

Long acting insulin

glargine (Lantus)

detemir (Levemir)

Onset: 2 hours

Peak: NONE

Duration: 24 hours

*"The two long nursing shifts never peaked but lasted 24 hours."*

Notes about diabetes meds

Diabetes medication

- NPH is your cloudy insulin--> drawn up last

- Client should eat after getting fast/rapid acting (lispro or novolog)

- Regular insulin (Humulin R and Novolin R) is Clear and drawn last

- Metformin cant be given 24 hours before contrast

- Regular insulin is the only one given IV

How to draw up--> clear to cloudy*= NPH to Regular

Not- Air in NPH

Ready- Air in Regular

Ready- Draw up regular

Now- Draw up NPH