N351 Prototype Drug Cards

Ibuprofen

Drug Class: NSAID (COX-1 + COX-2 inhibitor)

Therapeutic Effects: Reduces fever and inflammation, decreases pain

Side Effects: Abdominal cramps, nausea, and heartburn

Adverse Effects: Gastric ulcer and GI bleeding

Drug Interactions: ACE inhibitors, Angiotensin-II receptor blockers (ARBs), lithium, warfarin

Drug Dosage: 200-800mg orally every 4-6 hours PRN, Max dose = 3200mg

Nursing Implications: Assess before & after, track for maximum dose

Patient Education:

• Do NOT take with other NSAIDs

• Call provider for s/s of GI bleeding: black tarry stools, coffee-ground emesis

• Take with food or acid reducer

• Notify provider of new onset of acute stomach pain

Celecoxib

Drug Class: NSAID (COX-2 inhibitor only)

MoA: Inhibits prostaglandin synthesis primarily via COX-2 inhibition

Therapeutic Effects: Decreases inflammation and pain

Side Effects: Abdominal pain, dyspepsia (heartburn), photosensitivity

Adverse Effects: GI bleeding

Drug Dosage: 100-200mg orally twice daily

Contraindications: Sulfonamide allergy, CABG surgery, allergy to NSAIDs

Nursing Implications: Assess for sulfa allergies, track for max dose

Patient Education:

• Do NOT take with other NSAIDs

• Use sunscreen when outdoors

• Call provider for s/s of GI bleeding: black tarry stools, coffee-ground emesis

• Take with food or acid reducer

Methylprednisolone

Drug Class: Glucocorticoid (steroid)

MoA: Binds to glucocorticoid receptors, decreasing release of inflammatory molecules & inhibiting the immune response

Indications: Inflammatory conditions and autoimmune disorders

Therapeutic Effects: Decreases inflammation, suppresses the immune response

Side Effects: Increased appetite, mood changes, insomnia

Adverse Effects: Hypertension, increased infection risk, hyperglycemia

Drug Dosage: 4-200mg daily

Drug Interactions: Oral anticoagulants and aspirin

Contraindications: Systemic active fungal infections

Nursing Implications:

• Monitor for s/s of infection

• Monitor blood sugar levels

• Monitor weight and BP with long-term use

Patient Education:

• Do NOT stop abruptly → Taper the dose

• Do NOT take with NSAIDs, especially aspirin*

• Take in the morning

• No live vaccinations during therapy

Epinephrine

Drug Class: Adrenergic agonist (nonselective)

Indications: Emergency treatment of Type I Hypersensitivity reaction (anaphylaxis)

Therapeutic Effects: Increases HR + BP, bronchodilation

Side Effects: Anxiety, excitability, heart palpitations

Adverse Effects: Tachycardia, supraventricular tachycardia, ventricular arrhythmias, myocardial ischemia

Nursing Implications: Monitor every 1-5 minutes, monitor heart rhythms

Patient Education:

• Seek/call emergency care after self-administration

• S/s of anaphylaxis + administer at first sign of anaphylaxis

• How to self-administer using Epi pen

• Wear a medical ID bracelet

H1 Antihistamines

• Diphenhydramine

• Hydroxyzine

• Cetirizine

• Loratadine

Nasal Decongestant

Pseudoephedrine

Glucocorticoid Recognition Drugs

• Prednisone

• Prednisolone

• Dexamethasone

• Hydrocortisone

• Betamethasone

• Fluticasone*

• Mometasone*

Think -SONE/-LONE suffix

NSAID Recognition Drugs

• Aspirin

• Diclofenac

• Indomethacin

• Naproxen

• Meloxicam

Acetaminophen

Drug Class: Non-opioid analgesic

MoA: Inhibits prostaglandin synthesis in the CNS, primarily through inhibition of COX activity

Indications: Pain or fever; relieves minor aches and pain (no anti-inflammatory components)

Dose: Max Dose = 4,000 mg orally in 24 hrs; take 2 tablets every 4-6 hours

Side Effects: Reddening blisters and rash

Adverse Effects: Hepatic failure

Contraindications: Liver disease, pregnant or breastfeeding

Drug Interactions: Other drugs containing acetaminophen or Warfarin

Food Interactions: Alcohol

Nursing Implications: Overdose antidote = Acetylcysteine; assess pain before + after administration, calculate all combo drugs to avoid max dose

Patient Education: Avoid alcohol; if rash occurs, stop med + report; do not take more than 10 days without provider evaluation

Morphine

Drug Class: Opioid Analgesic

MoA: Activates opioid receptors to modulate & reduce incoming pain signals and pain perception

Indications: Moderate to severe pain

Drug Dose:

• IV = 0.1-0.2mg/kg every 1-4 hours PRN

• Oral = 15-30 mg orally every 4 hours PRN

Side Effects: Itching, constipation, nausea

Adverse Effects: Hypotension, CNS depression, Respiratory Depression, Drowsiness

Contraindications: Respiratory depression, hypotension, hepatic/renal impairment

Drug Interactions: Alprazolam, Diphenhydramine, Cyclobenzaprine

Nursing Implications: MONITOR LOC; assess pain before + after, assess bowel movements, HR & BP, match dose to pain level & order, scheduled drug waste— witness waste

Education:

• Do not crush extended-release medication

• Hydrate and use stool-softeners if constipation occurs

• Take ONLY as directed

• Safe disposal of unused doses

• Risk of abuse

• Avoid alcohol → It’s another CNS depressant

• Do not drive

Naloxone

Drug Class: Opioid Antagonist

MoA: Used as a partial agonist at the Mu opioid receptor; produces opioid withdrawal symptoms

Indications: Maintenance treatment of opioid dependence or overdose

Dose: Intranasal spray

Side Effects: Diaphoresis, agitation, disorientation

Contraindications: Acute opioid withdrawal, substance abuse/misuse, respiratory/CNS depression

Drug Interactions: Benzodiazepines, Cytochrome P450 3A4 inhibitors, Cyclobenzaprine, Diphenhydramine, opioid antagonists

Nursing Implications: Prepare for repeat dose, assess pain after dose, monitor for signs of returning opioid overdose →

• Decreased LOC

• Unresponsive

• Pinpoint pupils

• Bradypnea or apnea

• Vomiting

Education: Seek medical care immediately

Gabapentin

Drug Class: Anticonvulsant & Analgesic for Neuropathic Pain

MoA: Potentially binds to calcium channels

Indications: Neuralgia in adults or adjunctive therapy in patients with epilepsy

Drug Dose: Maximum = 1,800mg/day titrated; Day 1 = 300mg; Day 2 = 600mg; Day 3 = 900mg

Side Effects: Dizziness, Somnolence, Ataxia (disjointed movement)

Adverse Effects: Respiratory depression, Suicidal ideations

Contraindications: Pregnancy; May cause fetal harm

Nursing Implications: Monitor for respiratory depression when combined with other CNS depressants → Decreased RR, shallow breathing, decreased SpO₂

Education: Take 1^ST dose at bedtime to decrease side-effects, do not drive until effects are known, report mood changes or thoughts of suicide

Amoxicillin

Drug Class: Aminopenicillin (antibiotic)

MoA: Inhibits bacterial cell wall synthesis, leading to bacterial cell wall lysis

Indications: Treatment of infections due to susceptible organisms (only beta-lactamase negative)

Drug Dose: 500mg orally every 12 hours

Side Effects: Nausea, Vomiting, Diarrhea

Contraindications: Renal impairment

Drug Interactions: Aminoglycosides, Methotrexate, Tetracyclines, Probenecid, Mycophenolate

Nursing Implications: Monitor urine output (30mL/hr), monitor BUN + creatinine, monitor for severe diarrhea, keep dosing intervals consistent

Education: Take full course, take at even intervals, maintain good hydration, don’t double-dose

*-cillins take on empty stomach

Acyclovir

Drug Class: Antiviral Agent

MoA: Inhibits DNA synthesis and viral replication by competing for viral DNA polymerase & being incorporated into viral DNA

Indications: Treatment of infections due to susceptible viruses

Drug Dose: Maximum dose = 1200mg/day

• Oral = 400mg 3 times daily for 7-10 days

• IV = 10mg/kg/dose every 8 hours for 7 days

Side Effects: Nausea, Vomiting, Diarrhea

Adverse Effects: Acute kidney injury

Contraindications: IV injection extravasation, renal impairment

Drug Interactions: Clozapine, Theophylline, Tizanidine, Zidovudine

Nursing Implications: Monitor urine output (30mL/day), monitor BUN + creatinine

Education: Take full course, take at the symptom start, don’t double-dose, maintain good hydration

Flucanazole

Drug Class: Azole Antifungal

MoA: Inhibits cytochrome P450 activity, inhibiting cell membrane function

Indications: Treatment of fungal infections caused by susceptible fungi

Dose: 200mg orally on Day 1, followed by 100 mg/day orally for 2 weeks

Side Effects: Headache, abdominal pain, diarrhea

Adverse Effects: QT interval prolongation

Contraindications: Renal impairment, coadministration with QT interval-prolonging drugs

Drug Interactions: CYP3A4 substrates, Amiodarone, Carvedilol, Diazepam

Nursing Implications: Monitor urine output (30mL/hr), monitor BUN + creatinine, monitor ECG

Education: Take full course, take at the symptom start, don’t double-dose, maintain good hydration

Furosemide

Drug Class: Loop Diuretic (K⁺-Wasting)

MoA: Blocks reabsorption of Na⁺ in Loop of Henle, which causes Na⁺ and H₂O to be excreted

Indications: Hypertension; Congestion and/edema in heart failure

Drug Dose: Maximum = 600mg/day; 20-80mg orally twice daily

Side Effects: Excessive water loss, dizziness, ototoxicity

Adverse Effects: Electrolyte loss (hypokalemia), orthostatic hypotension, tinnitus and hearing loss

Contraindications: Anuria, hepatic/renal disease

Drug Interactions: Aminoglycoside; may increase risk of ototoxicity

Nursing Implications: IV administer SLOWLY over 1-2 minutes (decreases ototoxicity risk), monitor potassium levels, hold dose + notify provider if K⁺ <3.5

Education: Take dose in morning, report dizziness or lightheadedness, report tinnitus, eat potassium-rich foods (bananas)

Hydrochlorothiazide

Drug Class: Thiazide diuretic

MoA: Inhibits NaCl transport in the DCTs causing increased Na⁺ excretion in the kidneys, lowering BP

Indications: Hypertension and edema

Drug Dose: 12.5-50mg orally daily

Side Effects: Weakness, dizziness, frequent urination

Adverse Effects: Hypokalemia, hypoglycemia* (UWorld Only)

Contraindications: Anuria, orthostatic hypotension, impaired renal function, pregnancy, beast feeding

Drug Interactions: Dofetilide, Antidiabetic drugs, NSAIDs, Lithium

Food Interactions: Alcohol and tobacco

Nursing Implications: Monitor for decreased potassium levels, hold dose + notify provider if K⁺ <3.5

Education: Take dose in the morning, eat potassium-rich foods, report dizziness

Spironolactone

Drug Class: Mineralocorticoid Receptor Antagonist (MRA) K⁺-Sparing

MoA: Binds to nephron receptors so that aldosterone cannot bind, leading to increased diuresis

Indications: Heart failure, hypertension, edema associated with hepatic cirrhosis or nephrotic syndrome

Drug Dose: Maximum = 50mg/day; 12.5-50mg orally daily

Side Effects: Dizziness, headache, fatigue

Adverse Effects: Hyperkalemia and hypotension

Contraindications: TERATOGENIC

Drug Interactions: Agents that increase serum K⁺, Lithium, NSAIDs, Digoxin, Aspirin

Nursing Implications: Monitor for decreased potassium levels, hold dose + notify provider if K⁺ > 5

Education: Take dose in the morning, avoid potassium-rich foods, report dizziness

Albuterol

Drug Class: Beta-Adrenergic Receptor Agonist

MoA: Directly stimulates Beta receptors in the lungs, which cause smooth muscle dilation and opens airways

Indications: Relief of bronchospasm

Drug Dose: 2.5-5mg via nebulizer every 20 minutes for 3 cycles; may repeat every 1-4 PRN

Side Effects: Tremor and nervousness

Adverse Effects: Tachycardia

Contraindications: Cardiac disorder, hyperthyroidism, diabetes, severe cardiac disease

Drug Interactions: Other short-acting aerosol bronchodilators, Epinephrine, Monoamine oxidase inhibitors, Tricyclic antidepressants, Beta blockers

Nursing Implications: Assess baseline respiratory function →

• RR

• Lung sounds → decreased or no wheezing?

• Effort → Accessory muscle usage?

• SpO₂ → >92% on room air

Education: This is your RESCUE inhaler, use this first if needed, wait 5 minutes before using other inhalers, use only when needed, seek emergency care if symptoms don’t resolve in 1 hour

Ipratroprium

Drug Class: Anticholinergic

MoA: Inhibits vagally-mediated reflexes by antagonizing acetylcholine at muscarinic receptors on bronchial smooth muscle

Indications: Bronchospasm, relief of acute asthmatic symptoms (when combined with albuterol)

Drug Dose:

• Metered-Dose Inhaler (17mcg) = 4-8 inhalations with spacer every 20 minutes for 3 doses, then hourly PRN for up to 3 hours

• Nebulization (500mcg) = 3-4 times daily, with doses 6-8 hours apart

Side Effects: Dry mouth and cough

Adverse Effects: Tachycardia

Contraindications: Angle-closure glaucoma, bladder neck obstruction, prostatic hyperplasia

Drug Interactions: Other anticholinergics

Nursing Implications: OK to nebulize with albuterol, wait 5 minutes before using other inhalers, use only when needed, seek emergency care if symptoms don’t resolve in 1 hour

Education: This is a maintenance inhaler— don’t skip

Montelukast

Drug Class: Leukotriene Modifier

MoA: Decreases action of leukotrienes in inflammatory process

Indications: asthma or exercise-induced bronchospasm

Drug Dose: One 10mg tablet orally daily; in the evening

Side Effects: Headaches, upper respiratory infection (URI), diarrhea

Contraindications: Clients with mental health disorders

Drug Interactions: Gemofibrozil

Patient Education: Take as prescribed— Don’t skip, take with food to decrease GI side effects

Theophylline

Drug Class: Xanthine

MoA: Relaxes bronchial smooth muscles and pulmonary airways

Indications: Acute and chronic bronchospasm

Drug Dose: Oral extended-release

Side Effects: Nausea, vomiting, diarrhea

Adverse Effects: Palpitations and tachycardia

Contraindications: Peptic ulcer, poorly controlled seizure disorder, older adults, COPD, liver disease, diabetes

Drug Interactions: MANY; See the drug reference

Food Interactions: Caffeine, alcohol, high-carb and low-protein diet

Nursing Implications: NARROW THERAPEUTIC INDEX, monitor HR, no antidote

Education: Keep appointment for lab draws

Non-Opioid Analgesics

• NSAIDs

• Acetaminophen

• Gabapentin

Recognition Opioids

Moderate Pain:

• Tramadol (Do NOT give with SSRls)

• Hydrocodone

• Codeine

Moderate to Severe Pain:

• Morphine

• Oxycodone

• Fentanyl

• Methadone

• Hydromorphone

Cephalosporins

Antibiotics that inhibit cell wall synthesis:

• Cefazolin

• Cephalexin

• Cefatriaxone

• Cefepime

Carbapenems

Antibiotics that disrupt cell wall synthesis:

• Meropenem

• Imipenem-cilastatin

Aminoglycosides

• Antibiotics that stop protein production in the cell:

  • Gentamycin

  • Neomycin

  • Tobramycin

• Nephrotoxic and Ototoxic

• Teratogenic

• Narrow Therapeutic Index

• Nursing Implications: Monitor I/Os, creatinine, hearing/tinnitus, peak and trough

Floroquinolones

• Blocks enzymes for cell DNA repair

  • Ciprofloxacin

  • Levofloxacin

  • Moxifloxacin

• Prolongs QT interval = Risk of cardiac arrhythmias

• Peripheral neuropathy during medication

• Hyperglycemia risk

• Photosensitivity

• Risk of tendinitis and tendon rupture

Tetracyclines

• Inhibits bacterial growth:

  • Doxycycline

  • Minocycline

• Contraindicated in children under 8 and the 2nd/3rd trimesters of pregnancy → Teeth discoloration and bone malformation

• Do not take with dairy or calcium-containing products → Renders drug essentially ineffective

• Photosensitivity

• Take on empty stomach

• Backup contraception → May reduce effectiveness of hormonal birth control

Antifungal Recognition Drugs

• Fluconazole

• Miconazole

• Clotrimazole

• Ketoconazole

Recognition Penicillins

• Penicillin G

• Ampicillin

• Piperacillin/Tazobactam

Lisinopril

Drug Class: Angiotensin-converting enzyme (ACE) inhibitor

Indications: Heart failure & hypertension

Side Effects: Dizziness/vertigo, persistent dry cough

Adverse Effects: Angioedema, hyperkalemia, orthostatic hypotension

Contraindications: TERATOGENIC → Pregnancy and fetal toxicity

Dose: 2.5-40 mg orally twice daily

Drug Interactions: NSAIDs

Nursing Implications: Check BP 30-60 mins before + after, implement fall precaution, monitor K+, monitor for angioedema, hold & notify provider if SBP <100

Patient Education: Avoid high K+ foods, persistent coughing may occur, notify provider if lip or face swelling occur, how to check BP, do not stop abruptly, notify provider if you become pregnant

Losartan

Drug Class: Angiotensin II Receptor Blocker (ARB)

Indications: Heart failure & hypertension, nephropathy in clients DM2

Side Effects: Dizziness, syncope, angioedema (less risk than -prils), headache

Adverse Effects: Hyperkalemia and hypotension

Contraindications: TERATOGENIC → Pregnancy = Fetal toxicity

Dose: 25-150 mg orally daily

Drug Interactions: NSAIDs

Nursing Implications: Monitor 30-60 min before + after admin, monitor K+, monitor for angioedema, implement fall precautions, hold for SBP <100

Patient Education: Avoid high K+ foods, notify provider if lip or face swelling occur, do not stop abruptly, how to check BP, notify provider if you become pregnant

Amlodipine

Drug Class: Calcium channel blocker

MoA: Inhibits influx of Ca²⁺, decreasing peripheral vascular resistance

Indications: Hypertension control and angina

Side Effects: Peripheral edema, headache, dizziness

Adverse Effects: Hypotension

Dose: 5-10mg orally daily

Drug Interactions: Simvastatin, Clarithromycin, Ritonavir

Nursing Implications: Monitor BP 30-60 min before + after, implement fall precautions, hold for SBP <100

Patient Education: Do not stop abruptly, how to check BP

Metoprolol

Drug Class: Beta-adrenergic blocker

MoA: Blocks Beta-1 receptors, slowing the heart & decreasing BP

Indications: Hypertension, angina, acute myocardial infarction, heart failure

Side Effects: Fatigue/weakness, dizziness, nausea/vomiting/diarrhea

Adverse Effects: Hypotension and bradycardia

Contraindications: Asthma and COPD

Dose: 100-450 mg daily

Drug Interactions: Albuterol and Calcium channel blockers

Nursing Implications: Monitor BP 30-60 min before + after admin, 60 second apical HR before, fall precautions, hold for SBP <100, hold for HR <60

Patient Education: Do not stop abruptly, how to check BP, how to check pulse/HR

Atorvastatin

Drug Class: Statin

MoA: Inhibits cholesterol synthesis

Indications: Primary hyperlipidemia

Therapeutic Effects: Decreases LDLs & triglycerides

Side Effects: Myopathy, arthralgia/myalgia, pain in extremities

Adverse Effects: Rhabdomyolysis

Contraindications: Acute liver failure

Dose: 10-80 mg orally once daily

Drug Interactions: Rifampin, oral contraceptives, Digoxin, Amiodarone

Food Interactions: Grapefruit juice

Nursing Implications: Assess food + drug interactions, monitor for MSK symptoms, monitor LDLs, monitor urine output

Patient Education: Report changes in MSK status, report very dark urine