Pharmacology Review Part 2 — Vitamins, Medication Administration, Respiratory & Dosage Calculations

What are vitamins and their two main types?

Essential nutrients from food/supplements; water-soluble and fat-soluble.

Which vitamins are water-soluble?

B-complex and vitamin C; they are easily absorbed into the bloodstream.

Which vitamins are fat-soluble?

Vitamins A, D, E, and K; absorbed with fat and stored mainly in the liver.

What is the most common anemia and major iron sources?

Iron-deficiency anemia; sources include red meat, poultry, fish, beans, nuts, and leafy greens.

What can cause iron-deficiency anemia?

Pregnancy, gastric bypass, pica, parasites, H. pylori, or poor GI absorption.

What is pica and what labs may be low with iron deficiency?

Pica = eating nonfood items. Hemoglobin, hematocrit, and transferrin may be low.

What are signs of iron-deficiency anemia?

Fatigue, shortness of breath, pale skin, and fast heart rate.

Why take vitamin C with iron?

Vitamin C increases iron absorption.

What forms of iron are listed?

Ferrous sulfate by mouth and iron dextran by IV or IM.

What teaching applies to oral iron?

Dark stools are expected. Take on an empty stomach and separate from food/medications as directed.

What is vitamin B12 used for?

Cyanocobalamin treats pernicious anemia and is naturally found in animal foods.

What is folic acid used for?

Vitamin B9 treats anemia and helps prevent neural tube defects when taken before pregnancy.

How do furosemide and Hydrochlorothiazide affect potassium?

Both can lower potassium. Furosemide is a loop diuretic; HCTZ is a thiazide.

How should IV potassium be given?

Use an IV pump and follow the ordered mEq rate. Never give potassium by IV push.

What is magnesium sulfate used for?

It relaxes the body and may be used for seizures, preterm labor, or torsades de pointes.

What are signs of magnesium sulfate toxicity?

Slow breathing, weak muscles, paralysis, and decreased deep tendon reflexes. Antidote: calcium gluconate.

What should be checked before herbal supplements?

Check medication interactions and planned surgery; many herbs are stopped 2–3 weeks before surgery.

Which supplements can increase bleeding?

Vitamin E, ginger, garlic, ginkgo, ginseng, and omega-3.

What major warning applies to ginkgo biloba?

It can increase bleeding risk, so use caution with blood thinners and stroke risk.

What is glucosamine used for?

Joint pain or arthritis; monitor blood glucose when used with diabetes medications.

What is hawthorn commonly used for?

It is marketed for heart conditions such as heart failure and high blood pressure.

What are evening primrose and saw palmetto used for?

Evening primrose: eczema. Saw palmetto: benign prostatic hyperplasia (enlarged prostate).

What is black cohosh used for?

Menopausal hot flashes; it may affect blood-pressure medicines and insulin.

What is valerian used for?

Insomnia and anxiety; it has a calming effect and increases GABA activity.

Why should St. John's wort not be mixed with some antidepressants?

It raises serotonin; SSRIs, MAOIs, and TCAs can increase serotonin syndrome risk.

What are signs and interactions of St. John's wort?

Serotonin syndrome may cause rigidity, fever, seizures; it can reduce warfarin INR and digoxin effect.

What is kava used for and what is its major danger?

Anxiety and insomnia; major risk is liver damage (hepatotoxicity).

What effects can licorice root cause?

Used for ulcers/infections in some products; it can cause high blood pressure and low potassium.

What is aloe vera used for?

Topical aloe may soothe burns/pain; oral aloe can have a laxative effect.

What should you know about echinacea?

May affect immunity/inflammation; can increase bleeding with warfarin, heparin, aspirin, or NSAIDs.

What are the Five Rights of Medication Administration?

Right patient, medication, dose, route, and time.

What should be checked before giving medication?

Order, rights, allergies, contraindications, and 2 patient identifiers.

What if a medication may be contraindicated?

Do not give it until the prescription is clarified.

Why check a patient's other medications?

To identify possible medication interactions.

What preparation is needed before medication administration?

Gather supplies, provide privacy, perform hand hygiene, use PPE if needed, and teach the patient.

What should be documented after medication administration?

Medication/care given, patient response, therapeutic effect, and adverse reactions.

What forms can oral medications come in?

Tablets, capsules, powders, and liquids.

What does EC mean and can it be crushed?

Enteric-coated; dissolves in the intestine and should not be crushed.

What does ER mean and can it be crushed?

Extended-release; releases slowly and should not be crushed. ER, XL, SR, XR, and SA may mean extended-release.

What does ODT mean?

Orally disintegrating tablet; it dissolves in the mouth.

When can tablets be split or crushed?

Scored tablets may be split; some regular tablets may be crushed if safe. Do not crush capsules.

Why does medication formulation matter?

Different forms release and absorb medication at different speeds.

What does parenteral medication mean?

Medication given by injection.

What are the main parenteral routes?

IV into a vein, SubQ under the skin, and IM into a muscle.

What is reconstitution and which route absorbs immediately?

Reconstitution adds liquid to a dry drug. IV medications have immediate, complete absorption.

What affects SubQ and IM absorption?

Blood flow and solubility; better blood flow and water solubility usually speed absorption.

What should be considered when choosing a medication route?

The medication form and how quickly it needs to work.

Where is the deltoid IM injection given?

Central upper arm, about 2–3 fingerbreadths below the acromion.

Where is the vastus lateralis IM injection given?

Middle third of the outer thigh; patient may sit or lie on the back.

What angle and method are used for IM injections?

90°; the Z-track method may be used.

What angle is used for SubQ injections?

Usually 45° or 90°.

How is an intradermal injection given?

5–15°, bevel up; a small bleb or wheal should form.

What should be done with a used needle?

Do not recap it; place it directly into a sharps container.

What Head of Bed and flush amounts are used for enteral medications?

HOB at least 30°. Flush 30 mL before and 15–30 mL between medications if allowed.

What should be done with a transdermal patch?

Use clean, dry, intact skin; remove the old patch and leftover adhesive first.

How are vaginal and rectal medications given?

Vaginal: insert downward and lie 5 min. Rectal: left side with knee flexed; insert along rectal wall.

How is nasal medication administered?

Blow nose, tilt head back, close opposite nostril, inhale gently, then avoid blowing nose 5–10 min.

What are key MDI steps?

Exhale, press while inhaling slowly/deeply, hold about 10 sec, and wait about 1 min between puffs.

What does a spacer do and which inhaler is used first?

Spacer improves lung delivery. Use beta2 bronchodilator before inhaled steroid; rinse mouth after steroid.

How are eye medications given?

Drops go in conjunctival sac; ointment is a ribbon inner-to-outer. Close eyes gently afterward.

Why press the inner canthus after certain eye drops?

It decreases systemic absorption.

How are ear drops given?

Adult: up/back. Under 3: down/back. Keep ear up 5 min and avoid touching the bottle tip.

How does the nurse check medication teaching?

Use teach-back or return demonstration; reteach if incorrect.

What should be assessed with respiratory medications?

Breathing, lung sounds, RR, oxygen level, and vital signs before; improvement and side effects after.

What is a rescue vs. maintenance inhaler?

Rescue treats sudden symptoms; maintenance prevents and controls symptoms.

What can frequent rescue-inhaler use mean?

The asthma or respiratory disease may not be well controlled.

Which inhaler is used first: bronchodilator or steroid?

Bronchodilator first because it opens airways so the steroid reaches deeper.

What is albuterol and how does it work?

A SABA rescue inhaler that stimulates beta2 receptors and quickly opens the airways.

What effects and teaching apply to albuterol?

Watch tremor, nervousness, fast HR, palpitations; it may be used before exercise.

What is salmeterol used for?

A LABA for long-term bronchospasm control; works about 12 hours and is not a rescue drug.

How is salmeterol used in asthma?

Usually with an inhaled corticosteroid; may cause tremor, fast HR, or palpitations.

What are inhaled corticosteroids used for?

Budesonide and fluticasone reduce airway inflammation for long-term control; not rescue drugs.

What teaching applies to inhaled corticosteroids?

Rinse/gargle after use; spacer may help. Report thrush, white patches, or hoarseness.

What is prednisone used for in respiratory disease?

Reduces airway inflammation during significant asthma or COPD exacerbations.

What short-term effects can prednisone cause?

High blood sugar, increased appetite, mood changes, GI upset, and infection risk.

What long-term problems can prednisone cause?

Adrenal suppression and bone loss; long-term therapy must be tapered.

What should be monitored with long-term prednisone?

Blood glucose, infection, adrenal problems, and bone complications.

What is ipratropium and how does it work?

A SAMA anticholinergic bronchodilator that blocks muscarinic receptors and opens airways.

What effects and cautions apply to ipratropium?

Dry mouth/blurred vision; use caution with glaucoma, urinary retention, or benign prostatic hyperplasia. Avoid eyes.

What is theophylline and why is it high risk?

A methylxanthine bronchodilator with a narrow therapeutic range.

What theophylline levels are therapeutic and toxic?

Therapeutic: 10–20 mcg/mL. Toxic: above 20 mcg/mL.

What are signs of theophylline toxicity?

Early: nausea, vomiting, restlessness, fast HR. Severe: seizures and dysrhythmias.

What teaching applies to theophylline?

Monitor blood levels, limit caffeine, and check for medication interactions.

What is guaifenesin and what teaching applies?

Expectorant that loosens mucus. Drink fluids if allowed, swallow ER whole, cough/deep breathe.

What should be reported with guaifenesin?

A worsening cough or high fever.

What is acetylcysteine and what side effect can occur?

A mucolytic that thins mucus; has a sulfur smell and can cause bronchospasm.

What should be monitored with acetylcysteine?

Lung sounds, breathing, and ability to cough out secretions; suction may be needed.

What overdose does acetylcysteine also treat?

Acetaminophen overdose.

What is codeine used for in respiratory care?

An opioid antitussive used to suppress a nonproductive cough.

What are codeine's important adverse effects?

Respiratory depression, sedation, dizziness, and constipation.

What if respirations are below 12/min with codeine?

Hold the opioid, assess the patient, and follow the facility's urgent-response protocol.

What safety teaching applies to codeine?

Avoid alcohol/CNS depressants; sedation and dizziness increase fall risk.

What is benzonatate and how should it be taken?

Nonopioid cough suppressant; swallow whole because chewing can numb the mouth/throat and cause choking.

What is phenylephrine and how does it work?

Alpha1 decongestant that constricts blood vessels and shrinks swollen nasal tissue.

What cautions apply to phenylephrine?

Watch BP/HR; use caution with hypertension, heart disease, or glaucoma. Limit nasal use to 3–5 days.

Why limit topical phenylephrine to 3–5 days?

To prevent rebound congestion.

What is diphenhydramine used for?

A first-generation H1 antihistamine used for allergic reactions and allergy symptoms.

What effects can diphenhydramine cause?

Sedation, dry mouth, constipation, urinary retention, and blurred vision.

What safety teaching applies to diphenhydramine?

Avoid driving/alcohol/CNS depressants; use caution in older adults, glaucoma, and BPH (enlarged prostate).

What is loratadine?

A second-generation H1 antihistamine for allergies that usually causes much less sedation.