Pharmacology Final

Testosterone Cypionate

Generic Name:

• Cypionate

Brand Name(s):

• Depo-Testosterone

Drug Class:

• Androgen (Male Hormone)

Mechanism of Action:

• Synthetic form of testosterone that stimulates the development of male sexual characteristics and promotes protein anabolism.

Indication:

• Hypogonadism (low testosterone levels) in males.

• Delayed puberty in males.

• Breast cancer in women (off-label).

Route:

• Intramuscular (IM) injection

Side Effects:

• Common: Acne, hair loss, increased red blood cell count, mood swings.

• Serious: Liver toxicity, cardiovascular issues (e.g., hypertension), prostate enlargement, sleep apnea.

Nursing Considerations:

• Monitor for signs of fluid retention, mood changes, or liver dysfunction.

• Assess cardiovascular health and liver function tests before starting treatment.

• Educate patients about potential side effects (e.g., acne, mood swings).

• Inject into large muscle (e.g., gluteus) and rotate sites to avoid irritation.

Contraindications:

• Prostate or breast cancer in men.

• Severe liver disease.

• Pregnancy and breastfeeding (for women).

Testosterone Gel (Androgel)

Generic Name:

• Testosterone Gel

Brand Name(s):

• Androgel, Testim, Fortesta

Drug Class:

• Androgen (Male Hormone)

Mechanism of Action:

• Synthetic testosterone that works by stimulating androgen receptors to promote male sexual characteristics and protein synthesis.

Indication:

• Hypogonadism (low testosterone levels) in men.

Route:

• Topical (applied to the skin)

Side Effects:

• Common: Skin irritation, acne, increased red blood cell count, mood swings.

• Serious: Liver dysfunction, cardiovascular issues, sleep apnea, gynecomastia (enlarged breasts in men).

Nursing Considerations:

• Monitor testosterone levels and liver function tests.

• Apply to clean, dry skin on upper arms, shoulders, or abdomen (avoid genitals).

• Instruct patient to wash hands after application and avoid skin-to-skin contact with others to prevent transfer.

• Monitor for signs of abuse or misuse (e.g., increased aggression).

Contraindications:

• Prostate or breast cancer in men.

• Pregnancy and breastfeeding (for women).

• Severe liver disease.

Sildenafil (Viagra)

Sildenafil (Viagra)

• Generic Name: Sildenafil

• Brand Name: Viagra

Drug Class:

• Phosphodiesterase Type 5 (PDE5) Inhibitor

Mechanism of Action:

• Inhibits PDE5, increasing cGMP levels, leading to smooth muscle relaxation and increased blood flow to the penis, resulting in an erection.

Indications:

• Erectile Dysfunction (ED)

• Pulmonary Arterial Hypertension (PAH)

Route:

• Oral (tablet)

Side Effects:

• Headache

• Flushing

• Dyspepsia (indigestion)

• Nasal congestion

• Dizziness

• Visual disturbances (e.g., blue tinge to vision)

• Priapism (prolonged erection)

Nursing Considerations:

• Assess cardiovascular status (e.g., history of heart disease, stroke, hypotension).

• Monitor for signs of priapism (painful erection lasting >4 hours).

• Teach patient to take 30 minutes to 1 hour before sexual activity, not more than once per day.

• Avoid alcohol as it may enhance the side effects of dizziness and hypotension.

• Caution in patients taking nitrates (contraindicated due to severe hypotension risk).

Contraindications:

• Nitrate use (e.g., nitroglycerin): risk of severe hypotension.

• Severe cardiovascular disease: increased risk of cardiovascular events.

• Hypersensitivity to Sildenafil.

Finasteride

• Generic Name: Finasteride

• Brand Name: Proscar, Propecia

Drug Class:

• 5-alpha reductase inhibitor

Mechanism of Action:

• Inhibits the enzyme 5-alpha reductase, which converts testosterone to dihydrotestosterone (DHT), reducing DHT levels and promoting shrinkage of the prostate in benign prostatic hyperplasia (BPH) or reducing hair loss in male pattern baldness.

Indications:

• Benign Prostatic Hyperplasia (BPH): To shrink the prostate and improve urinary symptoms.

• Male Pattern Baldness: To promote hair growth and reduce hair loss.

Route:

• Oral (tablet)

Side Effects:

• Sexual dysfunction: Decreased libido, erectile dysfunction, ejaculatory disorder

• Gynecomastia (breast enlargement/tenderness)

• Depression

• Dizziness

• Decreased semen volume

Nursing Considerations:

• Monitor for sexual side effects: Assess for changes in libido, erectile dysfunction, and ejaculation issues.

• Educate patient about potential hair regrowth timeline: It may take several months to see effects.

• Pregnant women should avoid handling crushed tablets, as it can cause birth defects in male fetuses.

• Monitor for signs of depression or mood changes.

• Take consistently at the same time each day for optimal results.

Contraindications:

• Pregnancy: Can cause birth defects (especially in male fetuses).

• Hypersensitivity to finasteride.

• Liver impairment: Caution in patients with liver disease.

Tamsulosin

Tamsulosin

• Generic Name: Tamsulosin

• Brand Name: Flomax

Drug Class:

• Alpha-1 Adrenergic Blocker

Mechanism of Action:

• Selectively blocks alpha-1 receptors in the smooth muscle of the prostate and bladder neck, leading to relaxation of these muscles and improved urine flow in patients with benign prostatic hyperplasia (BPH).

Indications:

• Benign Prostatic Hyperplasia (BPH): To improve urinary symptoms like difficulty urinating, frequent urination, and weak stream.

• Off-label use: Kidney stones (to help pass stones by relaxing the urinary tract).

Route:

• Oral (capsule)

Side Effects:

• Orthostatic hypotension (low blood pressure when standing up)

• Dizziness or lightheadedness

• Headache

• Ejaculatory dysfunction

• Rhinitis (nasal congestion)

• Fatigue

Nursing Considerations:

• Monitor blood pressure: Risk of orthostatic hypotension, especially during the first dose.

• Administer 30 minutes after the same meal each day to enhance absorption.

• Assess urinary symptoms: Improvement may take several days or weeks.

• Patient education: Instruct patients to rise slowly from sitting or lying positions to reduce the risk of dizziness.

• Monitor for signs of sexual dysfunction: Difficulty with ejaculation or decreased libido.

• Avoid sudden discontinuation: Can lead to worsening symptoms of BPH.

Contraindications:

• Hypersensitivity to tamsulosin.

• Severe liver impairment: Caution in patients with liver disease.

• Concurrent use with other alpha-blockers: Increased risk of severe hypotension.

Heparin

Heparin

• Generic Name: Heparin

• Brand Name: No specific brand (Generic name commonly used)

Drug Class:

• Anticoagulant (Antithrombotic)

Mechanism of Action:

• Inhibits thrombin and factor Xa by enhancing the activity of antithrombin III, which prevents the conversion of fibrinogen to fibrin, reducing clot formation.

Indications:

• Prevention and treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE)

• Prevention of clotting during procedures (e.g., dialysis, surgeries)

• Acute coronary syndrome (ACS): To prevent clot formation

• Atrial fibrillation (AF): To prevent stroke due to clot formation

Route:

• Subcutaneous (for prevention or treatment)

• Intravenous (IV) (for acute situations like PE, ACS)

• IV push or infusion in a hospital setting

Side Effects:

• Bleeding (most serious; e.g., hematuria, bleeding gums, nosebleeds)

• Heparin-induced thrombocytopenia (HIT): A severe allergic reaction that leads to low platelet count

• Osteoporosis (with long-term use)

• Local irritation or pain at injection site

• Hypersensitivity reactions: Rash, fever

Nursing Considerations:

• Monitor aPTT (activated partial thromboplastin time): Ensure therapeutic range (typically 1.5–2.5 times the normal value).

• Monitor for signs of bleeding: Hematomas, bruising, blood in urine/stool.

• Check platelet count: To detect heparin-induced thrombocytopenia (HIT).

• Administer subcutaneous injections in the abdomen, avoiding 2 inches around the navel.

• Ensure proper dosing: Weight-based dosing for IV heparin.

• Avoid IM injections to reduce the risk of bleeding and hematoma formation.

Contraindications:

• Active bleeding disorders (e.g., peptic ulcer disease, recent surgery)

• Hypersensitivity to heparin

• Severe liver or renal disease (use with caution)

• Thrombocytopenia (low platelet count)

• History of heparin-induced thrombocytopenia (HIT)

Enoxaparin (Lovenox)

Enoxaparin (Lovenox)

• Generic Name: Enoxaparin

• Brand Name: Lovenox

Drug Class:

• Low Molecular Weight Heparin (LMWH)

Mechanism of Action:

• Inhibits factor Xa and, to a lesser extent, thrombin (factor IIa) by enhancing the activity of antithrombin III, which prevents the conversion of fibrinogen to fibrin, reducing clot formation.

Indications:

• Prevention and treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE)

• Acute Coronary Syndrome (ACS): Including unstable angina and non-ST-elevation myocardial infarction (NSTEMI)

• Prevention of DVT in patients undergoing surgery (e.g., hip or knee replacement)

Route:

• Subcutaneous (SC): Most commonly used for prevention and treatment of DVT/PE and ACS.

Side Effects:

• Bleeding (e.g., nosebleeds, gum bleeding, hematuria)

• Hematoma (at injection site)

• Thrombocytopenia (low platelet count)

• Pain or irritation at the injection site

• Elevated liver enzymes (rare)

Nursing Considerations:

• Monitor for signs of bleeding: Check for hematuria, bruising, and unusual bleeding.

• Monitor platelet count: For signs of thrombocytopenia (low platelets).

• No routine monitoring of aPTT (activated partial thromboplastin time) is required, unlike heparin.

• Administer subcutaneous injection in the abdomen (avoid the area around the navel and previous injection sites).

• Rotate injection sites to prevent irritation and tissue damage.

• Educate patient on bleeding precautions (e.g., using a soft toothbrush, avoiding razors).

Contraindications:

• Active bleeding disorders (e.g., peptic ulcer disease, gastrointestinal bleeding)

• Severe thrombocytopenia (low platelet count)

• Hypersensitivity to enoxaparin, heparin, or pork products

• Severe renal impairment: Use with caution in patients with renal dysfunction.

• Spinal or epidural anesthesia: Risk of spinal hematoma in patients receiving anticoagulants.

Warfarin

Warfarin

• Generic Name: Warfarin

• Brand Name: Coumadin, Jantoven

Drug Class:

• Anticoagulant (Vitamin K Antagonist)

Mechanism of Action:

• Inhibits vitamin K-dependent clotting factors (II, VII, IX, and X) in the liver, which decreases the production of these clotting factors, thus preventing clot formation.

Indications:

• Prevention and treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE)

• Stroke prevention in patients with atrial fibrillation or mechanical heart valves

• Post-surgical DVT prophylaxis

• Prevention of embolism in patients with prosthetic heart valves

Route:

• Oral (tablet)

Side Effects:

• Bleeding (e.g., hematuria, bruising, bleeding gums)

• Purple toe syndrome (rare)

• Skin necrosis (rare, typically in the first few days of therapy)

• Gastrointestinal upset (nausea, diarrhea)

• Hepatotoxicity (rare)

Nursing Considerations:

• Monitor PT/INR (Prothrombin Time/International Normalized Ratio): Ensure INR is within therapeutic range (usually 2-3 for most indications).

• Assess for signs of bleeding: Monitor for hematuria, bruising, or any unusual bleeding.

• Educate the patient on dietary restrictions: Maintain a consistent intake of vitamin K (found in green leafy vegetables), as it can affect warfarin's effectiveness.

• Teach bleeding precautions: Use a soft toothbrush, electric razor, and avoid activities that increase the risk of injury.

• Avoid alcohol: It can interfere with warfarin’s action and increase bleeding risk.

• Patient education: Instruct patients to inform all healthcare providers of warfarin use, as it interacts with many drugs (e.g., antibiotics, antiplatelet agents).

Contraindications:

• Active bleeding disorders (e.g., peptic ulcer disease, gastrointestinal bleeding)

• Pregnancy (Category X): Warfarin can cause birth defects and fetal bleeding.

• Severe liver disease or severe renal impairment: May increase bleeding risk.

• Hypersensitivity to warfarin.

• Recent major surgery or trauma.

Dabigatran (Pradaxa)

Dabigatran (Pradaxa)

• Generic Name: Dabigatran

• Brand Name: Pradaxa

Drug Class:

• Direct Thrombin Inhibitor (Anticoagulant)

Mechanism of Action:

• Inhibits thrombin (factor IIa), preventing the conversion of fibrinogen to fibrin, which inhibits clot formation.

Indications:

• Prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation

• Treatment and prevention of deep vein thrombosis (DVT) and pulmonary embolism (PE)

• Prevention of DVT and PE in patients undergoing hip or knee replacement surgery

Route:

• Oral (capsule)

Side Effects:

• Bleeding (e.g., easy bruising, hematuria, gastrointestinal bleeding)

• Dyspepsia (indigestion)

• Gastrointestinal discomfort (abdominal pain, nausea)

• Elevated liver enzymes (rare)

• Anemia (rare)

Nursing Considerations:

• Monitor for signs of bleeding: Assess for bruising, hematuria, or any unusual bleeding.

• No routine lab monitoring (like INR) required, unlike warfarin, but renal function should be checked periodically.

• Patient education: Inform patients to take at the same time each day and not to stop abruptly.

• Discontinue use 1-2 days before surgery or procedures to reduce bleeding risk.

• Use caution in elderly patients and those with renal impairment, as the drug is primarily excreted via the kidneys.

• Teach bleeding precautions: Avoid activities that increase bleeding risk, use a soft toothbrush, and electric razor.

Contraindications:

• Active bleeding disorders (e.g., peptic ulcer disease, gastrointestinal bleeding)

• Severe renal impairment (CrCl < 15 mL/min)

• Hypersensitivity to dabigatran or any of its components

• Mechanical heart valves: Not recommended for use.

Rivaroxaban

Rivaroxaban

• Generic Name: Rivaroxaban

• Brand Name: Xarelto

Drug Class:

• Direct Factor Xa Inhibitor (Anticoagulant)

Mechanism of Action:

• Inhibits Factor Xa, which prevents the conversion of prothrombin to thrombin, thereby inhibiting the formation of fibrin and preventing clot formation.

Indications:

• Prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation

• Treatment and prevention of deep vein thrombosis (DVT) and pulmonary embolism (PE)

• Prevention of DVT and PE after hip or knee replacement surgery

• Prevention of major cardiovascular events in patients with coronary artery disease or peripheral artery disease

Route:

• Oral (tablet)

Side Effects:

• Bleeding (e.g., easy bruising, hematuria, gastrointestinal bleeding)

• Elevated liver enzymes (rare)

• Anemia (rare)

• Gastrointestinal discomfort (nausea, abdominal pain)

Nursing Considerations:

• Monitor for signs of bleeding: Check for bruising, hematuria, and unusual bleeding.

• No routine monitoring of INR is required (unlike warfarin).

• Renal function should be assessed before starting treatment, and periodically thereafter (use caution in patients with renal impairment).

• Patient education: Take at the same time each day, even if they miss a dose. Do not double the dose.

• Discontinue use prior to surgeries or invasive procedures to reduce bleeding risk (usually 24 hours before).

• Bleeding precautions: Avoid activities that increase bleeding risk, use a soft toothbrush, and an electric razor.

Contraindications:

• Active bleeding disorders (e.g., peptic ulcer disease, gastrointestinal bleeding)

• Severe renal impairment (e.g., CrCl < 15 mL/min)

• Hypersensitivity to rivaroxaban or any of its components

• Liver disease with coagulopathy

• Pregnancy: Not recommended due to potential risks (Category C for pregnancy).

Apixaban

Apixaban (Eliquis)

• Generic Name: Apixaban

• Brand Name: Eliquis

Drug Class:

• Direct Factor Xa Inhibitor (Anticoagulant)

Mechanism of Action:

• Inhibits Factor Xa, which reduces thrombin generation and prevents clot formation.

Indications:

• Prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation

• Treatment and prevention of deep vein thrombosis (DVT) and pulmonary embolism (PE)

• Prevention of DVT and PE following hip or knee replacement surgery

Route:

• Oral (tablet)

Side Effects:

• Bleeding (e.g., easy bruising, hematuria, gastrointestinal bleeding)

• Anemia (rare)

• Elevated liver enzymes (rare)

• Gastrointestinal discomfort (e.g., nausea, abdominal pain)

Nursing Considerations:

• Monitor for bleeding: Check for bruising, hematuria, and any unusual bleeding.

• No routine INR monitoring required.

• Monitor renal function: Use caution in patients with renal impairment.

• Patient education: Take at the same time each day; don’t double up on doses if a dose is missed.

• Discontinue prior to surgery: Stop 24–48 hours before invasive procedures to reduce bleeding risk.

• Bleeding precautions: Use a soft toothbrush, electric razor, and avoid activities that may cause injury.

Contraindications:

• Active bleeding disorders (e.g., peptic ulcer disease, gastrointestinal bleeding)

• Severe renal impairment (e.g., CrCl < 15 mL/min)

• Hypersensitivity to apixaban or any of its components

• Liver disease with coagulopathy

• Pregnancy: Category C—use with caution and consult a doctor.

Clopidogrel

• Class: Antiplatelet

• MOA: Inhibits platelet aggregation (P2Y12 receptor blocker)

• Indication: Prevents clots (MI, stroke, PAD)

• Route: PO

• Side Effects: Bleeding, bruising, GI upset

• Nursing Considerations:

  • Monitor for bleeding (gums, stool, urine)

  • Stop 5-7 days before surgery

  • No NSAIDs, aspirin (↑ bleeding risk)

• Contraindications: Active bleeding, peptic ulcer, recent hemorrhagic stroke

• NCLEX Tip: Monitor platelet count, educate on bleeding precautions

Aspirin

• Class: NSAID, Antiplatelet

• MOA: Inhibits COX-1 & COX-2 → ↓ inflammation, pain, fever, platelet aggregation

• Indication: Pain, fever, MI/stroke prevention

• Route: PO, PR

• Side Effects: Bleeding, GI ulcer, tinnitus (toxicity)

• Nursing Considerations:

  • Avoid in kids → Reye’s syndrome

  • Take with food (↓ GI upset)

  • Stop 1 week before surgery

  • Monitor for bleeding (stool, gums)

• Contraindications: Bleeding disorders, PUD, children with viral infections

• NCLEX Tip: Report ringing in ears (toxicity), avoid with anticoagulants

Tirofiban

Tirofiban (Aggrastat) Flashcard

• Class: Antiplatelet (Glycoprotein IIb/IIIa inhibitor)

• MOA: Blocks platelet aggregation → prevents clots

• Indication: MI, unstable angina, PCI (stent placement)

• Route: IV

• Side Effects: Bleeding, thrombocytopenia, hypotension

• Nursing Considerations:

  • Monitor platelets, aPTT, bleeding

  • Use infusion pump for IV

  • Avoid other anticoagulants/NSAIDs

• Contraindications: Active bleeding, recent stroke, major surgery, severe HTN

• NCLEX Tip: Monitor for bleeding (IV site, gums, urine), platelet count before giving

Alteplase

Alteplase (tPA, Activase) Flashcard

• Class: Thrombolytic

• MOA: Dissolves clots by converting plasminogen → plasmin

• Indication: Stroke (ischemic), MI, PE

• Route: IV

• Side Effects: Bleeding (internal, superficial), hypotension

• Nursing Considerations:

  • Give within 3-4.5 hrs of stroke symptoms

  • Monitor neuro status, bleeding (IV sites, gums, urine)

  • No IM injections

• Contraindications: Active bleeding, recent surgery, hemorrhagic stroke, severe HTN

• NCLEX Tip: Frequent neuro checks, stop if LOC changes (brain bleed risk)

Protamine sulfate

• Class: Antidote

• MOA: Neutralizes heparin (forms stable complex)

• Indication: Heparin overdose

• Route: IV (slow push)

• Side Effects: Hypotension, bradycardia, flushing, bleeding (high dose)

• Nursing Considerations:

  • Monitor aPTT

  • Administer slowly (rapid → hypotension)

  • Watch for allergic reaction (fish allergy risk)

• Contraindications: Hypersensitivity, caution in fish allergy

• NCLEX Tip: Assess for heparin overdose (bleeding), have crash cart ready

Vitamin K (mephyton)

Vitamin K (Mephyton) Flashcard

• Class: Antidote, Fat-soluble vitamin

• MOA: Promotes clotting (activates clotting factors II, VII, IX, X)

• Indication: Warfarin overdose, Vitamin K deficiency

• Route: PO, IV, IM, SQ

• Side Effects: Flushing, injection site reaction, anaphylaxis (IV)

• Nursing Considerations:

  • Monitor PT/INR

  • Give IV slowly (risk of anaphylaxis)

  • Warfarin resistance for 1 week after administration

• Contraindications: Severe liver disease (caution), hypersensitivity

• NCLEX Tip: Assess for bleeding, avoid sudden diet changes (leafy greens affect warfarin therapy)

Atorvastatin

• Class: Statin (HMG-CoA Reductase Inhibitor)

• MOA: ↓ Cholesterol by inhibiting HMG-CoA reductase

• Indication: High cholesterol, CAD prevention

• Route: PO

• Side Effects: Muscle pain, liver damage, GI upset, rhabdomyolysis

• Nursing Considerations:

  • Monitor LFTs, CK levels

  • Take in the evening

  • Avoid grapefruit juice

• Contraindications: Liver disease, pregnancy (Category X)

• NCLEX Tip: Report unexplained muscle pain (rhabdomyolysis risk)

Cholestyramine

• Class: Bile Acid Sequestrant

• MOA: Binds bile acids → ↓ LDL cholesterol

• Indication: High cholesterol, pruritus r/t bile acid buildup

• Route: PO (powder, mix with water)

• Side Effects: Constipation, bloating, vitamin deficiency (A, D, E, K)

• Nursing Considerations:

  • Increase fiber & fluids

  • Take other meds 1 hr before or 4 hrs after

• Contraindications: Bowel obstruction, biliary obstruction

• NCLEX Tip: Monitor for fat-soluble vitamin deficiency

Fenofibrate

• Class: Fibrate (Lipid-lowering agent)

• MOA: ↑ Lipolysis → ↓ Triglycerides

• Indication: High triglycerides

• Route: PO

• Side Effects: GI upset, myopathy, liver toxicity, gallstones

• Nursing Considerations:

  • Monitor LFTs & CK levels

  • Take with food

  • Avoid alcohol

• Contraindications: Liver/kidney disease, gallbladder disease

• NCLEX Tip: Report muscle pain (↑ risk with statins)

4o

Ezetimibe

Ezetimibe (Zetia)

• Generic Name: Ezetimibe

• Brand Name: Zetia

Drug Class:

• Antilipemic, Cholesterol Absorption Inhibitor

Mechanism of Action:

• Ezetimibe works by inhibiting the absorption of cholesterol in the small intestine. This leads to a decrease in the amount of cholesterol delivered to the liver, which in turn increases the clearance of cholesterol from the bloodstream, lowering LDL and total cholesterol.

Indications:

• Hyperlipidemia: To lower LDL cholesterol levels, either alone or in combination with other cholesterol-lowering medications like statins.

• Homozygous familial hypercholesterolemia: To help reduce cholesterol levels in patients with this genetic disorder.

• Atherosclerotic cardiovascular disease: To reduce the risk of heart attacks and strokes when combined with statins.

Route:

• Oral (tablet)

Side Effects:

• Gastrointestinal disturbances: e.g., diarrhea, abdominal pain, nausea

• Headache

• Muscle pain or weakness (rare, but may occur when combined with statins)

• Elevated liver enzymes (especially when used with statins)

• Rash (rare)

• Fatigue (occasionally)

Nursing Considerations:

• Monitor liver function: Regularly check liver enzymes (AST, ALT) if used with statins or in patients with pre-existing liver conditions.

• Assess for muscle pain or weakness: In patients taking both ezetimibe and a statin, monitor for myopathy or rhabdomyolysis.

• Monitor cholesterol levels: Track LDL, total cholesterol, and triglycerides to assess treatment effectiveness.

• Patient education: Instruct patients to take the medication at the same time each day, with or without food.

• Educate on lifestyle changes: Encourage diet and exercise in combination with medication for optimal cholesterol management.

Contraindications:

• Hypersensitivity to ezetimibe or any of its components

• Severe liver disease: Particularly in patients using ezetimibe in combination with statins.

• Pregnancy and breastfeeding: Ezetimibe is not recommended for use during pregnancy (Category C) or while breastfeeding.

Alirocumab

lirocumab (Praluent)

• Generic Name: Alirocumab

• Brand Name: Praluent

Drug Class:

• PCSK9 Inhibitor, Antilipemic

Mechanism of Action:

• Alirocumab is a monoclonal antibody that inhibits PCSK9, a protein that decreases the liver's ability to remove LDL cholesterol from the bloodstream. By blocking PCSK9, alirocumab increases the liver’s clearance of LDL cholesterol, leading to lower LDL levels.

Indications:

• Hyperlipidemia: Used to lower LDL cholesterol in adults with heterozygous familial hypercholesterolemia or primary hyperlipidemia (as an adjunct to diet and statins).

• Atherosclerotic cardiovascular disease (ASCVD): To reduce the risk of heart attacks, strokes, and other heart-related issues when statins alone are not enough.

Route:

• Subcutaneous injection (typically every 2 weeks or monthly, depending on the dosage)

Side Effects:

• Injection site reactions (pain, redness, swelling)

• Flu-like symptoms (e.g., headache, fatigue)

• Muscle pain (myalgia)

• Back pain

• Allergic reactions (e.g., rash, itching, swelling)

• Elevated liver enzymes (monitor liver function)

Nursing Considerations:

• Monitor cholesterol levels: Regularly check LDL and total cholesterol to assess the effectiveness of treatment.

• Injection site reactions: Monitor for signs of local reactions (pain, redness, or swelling).

• Assess for muscle pain: Instruct patients to report any unexplained muscle pain, which may be associated with muscle toxicity.

• Patient education: Teach the patient how to self-administer the injection and emphasize adherence to the prescribed dosing schedule.

• Monitor liver function: Check liver enzymes (AST, ALT) periodically, especially if the patient is on other cholesterol-lowering medications.

Contraindications:

• Hypersensitivity to alirocumab or any of its components

• Pregnancy and breastfeeding: Limited safety data, and not recommended during pregnancy (Category C) or breastfeeding.

Niacin

Niacin Flashcard

• Generic Name: Niacin

• Brand Name: Niaspan

• Drug Class: Antilipemic (Vitamin B3)

• Mechanism of Action: Inhibits liver production of VLDL, reducing LDL and triglycerides

• Indication: Hyperlipidemia, dyslipidemia

• Route: Oral

• Side Effects: Flushing, itching, GI upset, hepatotoxicity

• Nursing Considerations: Take with food, monitor liver function, pre-medicate with aspirin for flushing

• Contraindications: Liver disease, active peptic ulcer

• NCLEX Tip: Flushing is common; monitor liver function tests.

Epoetin alfa

Epoetin Alfa (Epogen, Procrit)

• Generic Name: Epoetin alfa

• Brand Name: Epogen, Procrit

Drug Class:

• Hematopoietic Growth Factor, Erythropoiesis-Stimulating Agent (ESA)

Mechanism of Action:

• Epoetin alfa is a synthetic form of erythropoietin, a hormone produced by the kidneys that stimulates the bone marrow to produce red blood cells. It increases red blood cell count, thereby improving oxygen delivery to tissues.

Indications:

• Anemia due to chronic kidney disease (CKD)

• Anemia caused by chemotherapy in cancer patients

• Anemia in patients with HIV on zidovudine therapy

• Surgical patients: To reduce the need for blood transfusions

Route:

• Subcutaneous injection or IV injection

Side Effects:

• Hypertension (elevated blood pressure)

• Headache

• Fatigue

• Edema

• Injection site reactions (pain, redness, irritation)

• Thromboembolic events (e.g., deep vein thrombosis, stroke, myocardial infarction) in patients with cancer or CKD

• Severe allergic reactions (e.g., anaphylaxis) - rare

Nursing Considerations:

• Monitor hemoglobin and hematocrit levels: Check regularly to assess response and avoid excessive increases in red blood cell production. Target hemoglobin levels should generally be less than 12 g/dL to reduce the risk of cardiovascular events.

• Monitor blood pressure: Epoetin alfa can cause hypertension, so blood pressure should be controlled before starting therapy.

• Assess for thromboembolic events: Watch for signs of blood clots (e.g., swelling, redness, chest pain).

• Administer as prescribed: Dosage adjustments may be necessary based on hemoglobin levels.

• Patient education: Educate the patient about the potential for side effects, including signs of blood clots, and the need for regular blood tests.

Contraindications:

• Uncontrolled hypertension

• Hypersensitivity to epoetin alfa or any of its components

• Pure red cell aplasia (a rare condition of bone marrow failure)

• Myeloid malignancies: Epoetin alfa should be avoided in patients with certain cancers (e.g., leukemia) receiving chemotherapy, as it may stimulate tumor growth.

Filgrastim

lgrastim (Neupogen)

• Generic Name: Filgrastim

• Brand Name: Neupogen

Drug Class:

• Hematopoietic Growth Factor, Granulocyte Colony-Stimulating Factor (G-CSF)

Mechanism of Action:

• Filgrastim is a synthetic form of granulocyte colony-stimulating factor (G-CSF). It stimulates the bone marrow to produce neutrophils, a type of white blood cell, thus enhancing the body's ability to fight infections.

Indications:

• Chemotherapy-induced neutropenia: To reduce the risk of infection in patients undergoing chemotherapy.

• Bone marrow disorders: To treat conditions like myelodysplastic syndromes.

• HIV-related neutropenia: To increase neutrophil count in HIV patients with low white blood cells.

• Stem cell mobilization: To increase the number of stem cells in the bloodstream for collection and transplantation.

Route:

• Subcutaneous injection or IV injection

Side Effects:

• Bone pain (most common)

• Fever

• Fatigue

• Edema

• Injection site reactions (pain, redness, irritation)

• Splenomegaly (enlarged spleen)

• Leukocytosis (elevated white blood cell count)

Nursing Considerations:

• Monitor neutrophil count: Regularly check white blood cell count, particularly the neutrophil count, to avoid excessive leukocytosis.

• Assess for bone pain: It’s a common side effect; provide pain relief as needed.

• Monitor for splenic enlargement: Watch for signs of splenic rupture (left upper quadrant pain, shoulder pain).

• Patient education: Instruct the patient on how to administer the injection (if doing so at home) and the importance of adhering to prescribed dosages.

• Hydration: Encourage adequate fluid intake, especially if the patient experiences flu-like symptoms.

Contraindications:

• Hypersensitivity to filgrastim or any of its components

• Use with caution in patients with a history of spleen problems (e.g., splenomegaly or splenic rupture)

• Severe bone marrow disorders: If the bone marrow is already compromised, the use of filgrastim should be carefully evaluated.

Interferon alfa-2b

Interferon Alfa-2b (Intron A)

• Generic Name: Interferon alfa-2b

• Brand Name: Intron A

Drug Class:

• Immunomodulator, Interferon

Mechanism of Action:

• Interferon alfa-2b is a cytokine that enhances the body’s immune response. It works by stimulating immune cells to attack viruses and tumor cells. It also inhibits viral replication, promotes the activation of macrophages, and improves antigen presentation.

Indications:

• Chronic Hepatitis B and C: To reduce viral load.

• Hairy Cell Leukemia: A rare cancer of the bone marrow.

• Malignant Melanoma: To treat metastatic disease.

• Kaposi's Sarcoma: In HIV/AIDS patients.

• Chronic Myelogenous Leukemia (CML): To reduce disease progression.

• Follicular Lymphoma: A type of non-Hodgkin's lymphoma.

Route:

• Subcutaneous injection or IV injection

Side Effects:

• Flu-like symptoms (fever, chills, fatigue, muscle aches)

• Depression and mood changes

• Hematologic effects: Leukopenia, thrombocytopenia, anemia

• Liver toxicity (elevated liver enzymes)

• Fatigue

• Injection site reactions (redness, irritation, swelling)

• Nausea and vomiting

Nursing Considerations:

• Monitor liver function: Regularly assess liver enzymes (AST, ALT) as interferon can cause liver toxicity.

• Assess for depression: Be vigilant for changes in mood or suicidal thoughts, as interferon can cause or exacerbate psychiatric conditions.

• Monitor blood counts: Check for signs of bone marrow suppression (leukopenia, thrombocytopenia).

• Administer with caution: Dose may need to be adjusted in patients with pre-existing psychiatric conditions or liver disease.

• Patient education: Inform about flu-like symptoms and the importance of hydration. Advise to report mood changes or unusual symptoms promptly.

Contraindications:

• Hypersensitivity to interferon alfa or any of its components

• Severe hepatic or renal disease

• Autoimmune disorders (e.g., lupus)

• Depression or psychiatric disorders (due to the risk of mood alterations)

• History of cardiac arrhythmias or ischemic heart disease

Covid-19

COVID-19 Vaccines (Pfizer-BioNTech, Moderna)

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1. Pfizer-BioNTech (Comirnaty)

• Generic Name: BNT162b2

• Brand Name: Comirnaty

Drug Class:

• mRNA Vaccine

Mechanism of Action:

• Contains mRNA that encodes the spike protein of the SARS-CoV-2 virus. This prompts the immune system to recognize and create antibodies against the spike protein, thereby preparing the immune system to fight the actual virus if exposed.

Indications:

• Prevention of COVID-19 in individuals aged 12 years and older (emergency use authorization or full approval depending on country).

• Booster dose for enhanced immunity.

Route:

• Intramuscular injection (IM)

Side Effects:

• Pain at the injection site

• Fatigue

• Headache

• Muscle pain

• Chills

• Fever

• Swelling/redness at injection site

• Rare: Anaphylaxis, myocarditis, pericarditis

Nursing Considerations:

• Monitor for anaphylaxis: Observe patients for 15 minutes after vaccination, or 30 minutes for those with a history of severe allergic reactions.

• Administer with caution in those with a history of anaphylaxis to vaccines or ingredients (e.g., polyethylene glycol).

• Patient education: Inform about potential side effects and the importance of the second dose (3 weeks after the first).

• Encourage hydration and rest if flu-like symptoms occur.

Contraindications:

• Severe allergic reaction to any component of the vaccine (e.g., polyethylene glycol).

• Severe allergic reactions to a previous dose of the vaccine.

Hib

Generic Name:

• Haemophilus Influenzae Type b Conjugate Vaccine

Brand Name:

• PedvaxHIB, ActHIB, Hiberix

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Drug Class:

• Vaccine (Bacterial Conjugate Vaccine)

Mechanism of Action:

• The Hib vaccine contains a conjugated form of Haemophilus influenzae type b polysaccharide that stimulates the immune system to produce antibodies. The antibodies help the body recognize and fight off Haemophilus influenzae type b bacteria, preventing infections caused by this pathogen.

---

Indications:

• Prevention of invasive diseases caused by Haemophilus influenzae type b (Hib), such as:

  • Meningitis

  • Pneumonia

  • Epiglottitis

  • Bacteremia

• Recommended for infants and young children (usually given as part of the routine childhood vaccination schedule).

---

Route:

• Intramuscular injection (IM)

---

Side Effects:

• Pain, redness, or swelling at the injection site

• Fever (low-grade)

• Irritability

• Fatigue

• Loss of appetite

• Rare: Severe allergic reactions (e.g., anaphylaxis)

---

Nursing Considerations:

• Monitor for allergic reactions: Observe the patient for 15-30 minutes after vaccination for any signs of anaphylaxis.

• Educate parents or caregivers: Inform them about common side effects like mild fever or irritability and how to manage them (e.g., using fever reducers like acetaminophen).

• Proper injection site care: Apply pressure to the injection site to reduce pain or swelling.

• Encourage vaccination compliance: Ensure the child completes the full vaccination series (usually 3-4 doses depending on the vaccine brand).

---

Contraindications:

• Severe allergic reaction (e.g., anaphylaxis) to a prior dose of Hib vaccine or any of its components.

• Severe allergic reaction to any part of the vaccine (e.g., polysaccharide or conjugated protein).

---

Relevant NCLEX Points:

• Hib vaccine is a key part of the childhood immunization schedule.

• Monitor for any allergic reactions after administration.

• Educate caregivers about the importance of completing the vaccination series and potential side effects.

• Contraindications mainly involve severe allergic reactions to previous doses.

Herpes zoster

Zoster Vaccine (Shingrix)

• Generic Name: Recombinant zoster vaccine

• Brand Name: Shingrix

Drug Class:

• Vaccine (Inactivated)

Mechanism of Action:

• Stimulates the immune system to produce antibodies against the varicella-zoster virus, preventing the development of shingles and postherpetic neuralgia.

Indications:

• Prevention of shingles (Herpes Zoster) in adults 50 years and older.

Route:

• Intramuscular injection (IM)

Side Effects:

• Pain at the injection site

• Fatigue

• Fever

• Headache

• Muscle pain

Nursing Considerations:

• Monitor for allergic reactions after injection (rare).

• Educate patients: Inform them about potential side effects, including temporary soreness and fever.

• Encourage two-dose schedule: The second dose is given 2 to 6 months after the first.

Contraindications:

• Severe allergic reaction to any component of the vaccine.

• Pregnancy: Not recommended during pregnancy.

• Immunocompromised patients should consult their doctor before receiving the vaccine.

---

Relevant NCLEX Points:

• Acyclovir and Valacyclovir are first-line treatments for Herpes Zoster (Shingles).

• Shingrix is the preferred vaccine for preventing shingles in older adults.

• Monitor renal function in patients receiving antiviral therapy.

• Educate patients on completing the full course of antiviral medications for maximum efficacy.

Hep A

Generic Name:

• Hepatitis A Vaccine (inactivated)

Brand Names:

• Havrix, Vaqta

---

Drug Class:

• Vaccine (Inactivated viral vaccine)

---

Mechanism of Action:

• The Hep A vaccine contains inactivated Hepatitis A virus, which stimulates the immune system to produce antibodies. This prepares the body to fight the actual virus if exposed.

---

Indications:

• Prevention of Hepatitis A virus infection in individuals aged 1 year and older.

• Recommended for high-risk groups including:

  • Travelers to areas with endemic Hepatitis A.

  • People with chronic liver disease.

  • People working in certain occupations (e.g., food handlers).

  • Children in areas with higher Hepatitis A rates.

---

Route:

• Intramuscular injection (IM)

---

Side Effects:

• Pain, redness, or swelling at the injection site

• Headache

• Fatigue

• Low-grade fever

• Loss of appetite

• Rare: Allergic reactions (e.g., anaphylaxis)

---

Nursing Considerations:

• Monitor for allergic reactions: Observe patients for 15-30 minutes after vaccination.

• Educate patients on the need for the second dose for full immunity (6 months after the first dose).

• Administer IM: Ensure proper injection technique to reduce discomfort.

• Assess for history of severe allergies to vaccine components (e.g., neomycin, aluminum hydroxide).

---

Contraindications:

• Severe allergic reaction to any component of the vaccine (e.g., neomycin).

• Pregnancy: Use during pregnancy only if clearly needed, and after assessing risks/benefits.

• Severe allergic reaction to a previous dose of Hepatitis A vaccine.

---

Relevant NCLEX Points:

• Hep A vaccine is part of routine vaccination for children in certain regions and high-risk populations.

• Monitor for any allergic reactions after vaccination, especially in those with a history of severe allergies.

• Complete vaccination involves two doses, administered 6 months apart.

• The vaccine is effective for long-term protection against Hepatitis A.

Hep B

Generic Name:

• Hepatitis B Vaccine (recombinant)

Brand Names:

• Engerix-B, Recombivax HB, Heplisav-B

---

Drug Class:

• Vaccine (Inactivated recombinant vaccine)

---

Mechanism of Action:

• The Hep B vaccine contains inactivated Hepatitis B virus surface antigens. It stimulates the immune system to produce antibodies against the virus, providing immunity in case of future exposure.

---

Indications:

• Prevention of Hepatitis B virus infection.

• Recommended for all newborns (usually as part of the routine childhood vaccination schedule).

• High-risk populations include:

  • Health care workers, infants of infected mothers, people with chronic liver disease.

  • Travelers to areas with high rates of Hepatitis B.

---

Route:

• Intramuscular injection (IM)

---

Side Effects:

• Pain, redness, or swelling at the injection site

• Fever

• Fatigue

• Headache

• Rare: Severe allergic reactions (e.g., anaphylaxis)

---

Nursing Considerations:

• Monitor for allergic reactions after administration, especially if the patient has a history of severe allergies.

• Administer IM (usually in the deltoid muscle for adults).

• Complete vaccination: Ensure the patient receives all required doses for full protection (3 doses over 6 months for standard series).

• Provide education: Inform patients about the need for the complete vaccine series for long-term protection.

---

Contraindications:

• Severe allergic reaction to any component of the vaccine (e.g., yeast).

• Severe allergic reaction to a previous dose of Hepatitis B vaccine.

• Moderate to severe acute illness (delay vaccination until recovery).

---

Relevant NCLEX Points:

• Hepatitis B vaccine is a part of the routine childhood vaccination schedule.

• Essential for healthcare workers and individuals at high risk for Hepatitis B exposure.

• Ensure the patient receives the full 3-dose series for immunity.

• Monitor for anaphylaxis after administration, especially in patients with known allergies to vaccine components.

HPV

Generic Name:

• Human Papillomavirus Vaccine (recombinant)

Brand Names:

• Gardasil, Gardasil 9, Cervarix

---

Drug Class:

• Vaccine (Inactivated recombinant vaccine)

---

Mechanism of Action:

• The HPV vaccine contains non-infectious virus-like particles that stimulate the immune system to produce antibodies against certain high-risk HPV strains (types 16, 18, etc.), preventing cervical cancer, genital warts, and other HPV-related cancers.

---

Indications:

• Prevention of HPV infections that cause:

  • Cervical cancer

  • Anal cancer

  • Genital warts

  • Vulvar, vaginal, and throat cancers

• Recommended for individuals:

  • Pre-teens (ages 11-12), males and females.

  • Up to age 26 (if not previously vaccinated).

  • Adults 27-45 may benefit from vaccination (consult healthcare provider).

• Before sexual activity for maximum effectiveness.

---

Route:

• Intramuscular injection (IM)

---

Side Effects:

• Pain, redness, or swelling at the injection site

• Fever

• Headache

• Fatigue

• Nausea

• Rare: Fainting (mostly in adolescents after vaccination)

---

Nursing Considerations:

• Monitor for fainting: Have patients remain seated for 15 minutes after administration, especially adolescents.

• Administer IM: Typically in the deltoid muscle.

• Educate patients: Explain the importance of receiving all doses of the vaccine (typically 2 or 3 doses depending on age).

• Discuss safe sex practices: Even after vaccination, the vaccine does not protect against all types of HPV, so using condoms is still recommended.

---

Contraindications:

• Severe allergic reaction (e.g., anaphylaxis) to any component of the vaccine (e.g., yeast).

• Moderate to severe illness (delay vaccination until recovery).

• Pregnancy: Not recommended during pregnancy, although there is no evidence suggesting harm if inadvertently given.

---

Relevant NCLEX Points:

• HPV vaccination is a prevention strategy to protect against several cancers and genital warts caused by HPV.

• Best administered before individuals become sexually active to ensure the vaccine is most effective.

• Two-dose series for individuals starting the vaccine series before age 15, and three doses for those starting at age 15 or older.

• Encourage monitoring for fainting and patient education on completing the full vaccination series.

Influenza (IIV4)

Generic Name:

• Inactivated Influenza Vaccine (Quadrivalent)

Brand Names:

• Fluzone, FluLaval, Afluria, Fluvirin

---

Drug Class:

• Vaccine (Inactivated viral vaccine)

---

Mechanism of Action:

• The Influenza IIV4 vaccine contains inactivated (killed) influenza virus strains. It stimulates the immune system to produce antibodies that protect against four strains of influenza (two A strains and two B strains), preventing the flu.

---

Indications:

• Prevention of influenza caused by the influenza virus.

• Recommended for everyone aged 6 months and older, especially for:

  • Children (6 months and older)

  • Pregnant women

  • Older adults (65+)

  • Healthcare workers

  • Individuals with chronic conditions (e.g., asthma, diabetes)

---

Route:

• Intramuscular injection (IM)

---

Side Effects:

• Pain, redness, or swelling at the injection site

• Low-grade fever

• Fatigue

• Headache

• Muscle aches

• Rare: Severe allergic reactions (e.g., anaphylaxis)

---

Nursing Considerations:

• Administer IM: Typically in the deltoid muscle.

• Monitor for allergic reactions: Especially within 15-30 minutes of administration.

• Do not administer if the patient has a history of severe allergic reaction to any vaccine component (e.g., egg proteins).

• Educate the patient: Explain that the vaccine does not cause the flu, but may cause mild symptoms like muscle aches or fever.

• Promote vaccination in high-risk groups (e.g., elderly, pregnant women, and healthcare workers).

---

Contraindications:

• Severe allergic reaction to any vaccine component, especially egg proteins (for egg-based vaccines).

• Severe allergic reaction to a previous dose of the influenza vaccine.

• Moderate to severe illness: Delay vaccination until the patient has recovered.

• History of Guillain-Barré Syndrome (GBS): Patients who developed GBS after a prior influenza vaccination should generally not receive the vaccine.

---

Relevant NCLEX Points:

• Annual flu vaccination is recommended for everyone aged 6 months and older.

• It’s important for high-risk individuals (e.g., elderly, pregnant women) to receive the flu vaccine to prevent complications.

• The flu vaccine typically includes 4 strains (quadrivalent) of the influenza virus for broader protection.

• Monitor for anaphylaxis and observe for a short period after vaccination, particularly if the patient has a history of severe allergies.

MMR

Generic Name:

• Measles, Mumps, and Rubella Vaccine (Live)

Brand Names:

• MMR II, Priorix

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Drug Class:

• Vaccine (Live attenuated viral vaccine)

---

Mechanism of Action:

• The MMR vaccine contains live, attenuated (weakened) viruses for measles, mumps, and rubella. It stimulates the immune system to produce antibodies, offering protection against these three viral diseases.

---

Indications:

• Prevention of measles, mumps, and rubella in children and adults who are at risk or have not been vaccinated.

• Recommended for:

  • Children at 12-15 months (first dose) and at 4-6 years (second dose).

  • Non-immune adults (e.g., healthcare workers, college students).

  • International travelers or those exposed to outbreaks.

---

Route:

• Subcutaneous injection (SC)

---

Side Effects:

• Pain, redness, or swelling at the injection site

• Fever

• Rash

• Mild joint pain (particularly in females)

• Temporary low platelet count (rare)

• Rare: Severe allergic reactions (e.g., anaphylaxis), febrile seizures, Guillain-Barré syndrome

---

Nursing Considerations:

• Administer subcutaneously (SC), usually in the outer aspect of the upper arm.

• Monitor for allergic reactions: Especially within 15-30 minutes post-injection.

• Provide education: Inform patients about the common mild side effects like fever or rash, which generally resolve in a few days.

• Ensure two doses for maximum effectiveness.

• Assess for pregnancy: Women should avoid pregnancy for 4 weeks after receiving the vaccine.

• Assess for recent exposure to measles or rubella: Especially in areas with outbreaks.

---

Contraindications:

• Severe allergic reaction to any vaccine component (e.g., gelatin, neomycin).

• Pregnancy: Do not administer to pregnant women, as the vaccine contains live virus.

• Immunocompromised patients: Avoid in individuals with weakened immune systems (e.g., HIV, cancer treatments).

• Recent administration of blood products: Wait at least 3 months if blood products were received.

• Moderate or severe acute illness: Delay vaccination until recovery.

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Relevant NCLEX Points:

• MMR vaccine is a part of the routine childhood vaccination schedule.

• Two doses are required for full protection: 12-15 months and 4-6 years.

• Live vaccine: Should not be administered during pregnancy or to immunocompromised individuals.

• Monitor for adverse reactions like fever, rash, or allergic reactions after vaccination.

• Wait 4 weeks after receiving the vaccine before trying to conceive to avoid risk to the fetus.

Meningococcal (ACWY)

Generic Name:

• Meningococcal Polysaccharide Vaccine (ACWY)

Brand Names:

• Menactra, Menveo, Menomune

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Drug Class:

• Vaccine (Polysaccharide conjugate vaccine)

---

Mechanism of Action:

• The Meningococcal ACWY vaccine contains inactivated Neisseria meningitidis bacteria (serogroups A, C, W, Y). It stimulates the immune system to produce antibodies that protect against meningococcal disease, which can cause meningitis and sepsis.

---

Indications:

• Prevention of meningococcal disease caused by serogroups A, C, W, and Y, which can lead to meningitis and sepsis.

• Recommended for:

  • Adolescents: First dose at 11-12 years, with a booster at 16 years.

  • Adults at high risk of exposure: (e.g., military recruits, travelers to endemic areas, individuals with a damaged spleen or immune system).

  • College students in dormitories.

  • People with certain medical conditions (e.g., asplenia, HIV).

---

Route:

• Intramuscular injection (IM)

---

Side Effects:

• Pain, redness, or swelling at the injection site

• Fever

• Fatigue

• Headache

• Rare: Severe allergic reactions (e.g., anaphylaxis)

---

Nursing Considerations:

• Administer IM: Typically in the deltoid muscle.

• Monitor for allergic reactions: Especially during the first 15-30 minutes post-vaccination.

• Educate patients: Inform patients about common side effects like pain at the injection site, fever, and headache.

• Ensure completion of the vaccine series: If the patient is receiving a booster or hasn't received prior doses.

• Document lot number and expiration date of the vaccine for tracking purposes.

---

Contraindications:

• Severe allergic reaction to any component of the vaccine (e.g., latex, neomycin).

• Moderate to severe illness: Delay vaccination until recovery.

• Pregnancy: Use with caution; consult a healthcare provider before administration, as the vaccine should only be used in pregnancy if absolutely necessary.

---

Relevant NCLEX Points:

• The Meningococcal ACWY vaccine is important for preventing meningitis and sepsis caused by Neisseria meningitidis.

• Recommended for adolescents and young adults in high-risk settings (e.g., dormitories, travel to endemic areas).

• Two doses for adolescents: the first at 11-12 years, the second at 16 years.

• Monitor for allergic reactions and ensure proper vaccine documentation.

• The vaccine may cause mild symptoms like pain at the injection site and fever.

Pneumococcal (PCV 15)

Generic Name:

• Pneumococcal Conjugate Vaccine (15-Valent)

Brand Name:

• Vaxneuvance

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Drug Class:

• Vaccine (Conjugate vaccine)

---

Mechanism of Action:

• The PCV15 vaccine contains inactivated Streptococcus pneumoniae bacteria. It stimulates the immune system to produce antibodies against 15 serotypes of the pneumococcus bacteria, preventing pneumococcal diseases, including pneumonia, meningitis, and bacteremia.

---

Indications:

• Prevention of pneumococcal disease caused by 15 serotypes of Streptococcus pneumoniae.

• Recommended for:

  • Adults 65 years and older (one dose, with possible booster after 5 years).

  • Adults 19-64 years with risk factors (e.g., chronic conditions like asthma, diabetes, or heart disease).

  • Children with specific health conditions or immunocompromising factors (often used in combination with PCV13).

---

Route:

• Intramuscular injection (IM)

---

Side Effects:

• Pain, redness, or swelling at the injection site

• Fever

• Fatigue

• Headache

• Rare: Severe allergic reactions (e.g., anaphylaxis)

---

Nursing Considerations:

• Administer IM: Typically in the deltoid muscle.

• Monitor for allergic reactions: Especially during the first 15-30 minutes post-vaccination.

• Educate patients: Inform about possible mild side effects like pain at the injection site, fever, and fatigue.

• Administered after 2nd dose of PCV13 in children and certain adults, especially those with chronic medical conditions.

• Document lot number and expiration date of the vaccine for tracking purposes.

---

Contraindications:

• Severe allergic reaction to any component of the vaccine (e.g., gelatin, diphtheria toxoid).

• Moderate to severe acute illness: Delay vaccination until recovery.

• Pregnancy: Consult healthcare provider before administration, as it should only be used in pregnancy if absolutely necessary.

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Relevant NCLEX Points:

• PCV15 vaccine is recommended for adults aged 65 and older and high-risk adults (those with chronic diseases or compromised immune systems).

• It is given as an IM injection, and side effects include injection site pain, fever, and fatigue.

• Vaccination schedule: For those aged 65 and older, one dose is usually given, and some individuals may require a booster.

• Monitor for allergic reactions post-vaccination.

• The vaccine prevents pneumonia, meningitis, and other severe infections caused by Streptococcus pneumoniae.

Poliomyelitis (IPV)

Generic Name:

• Inactivated Poliovirus Vaccine

Brand Name:

• IPOL

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Drug Class:

• Vaccine (Inactivated virus vaccine)

---

Mechanism of Action:

• The IPV vaccine contains inactivated poliovirus, which stimulates the immune system to produce antibodies without causing disease. This helps protect against poliomyelitis (polio), which can cause paralysis.

---

Indications:

• Prevention of poliomyelitis (polio) caused by the poliovirus.

• Recommended for:

  • Routine immunization of children (4 doses: at 2 months, 4 months, 6-18 months, and 4-6 years).

  • Adults at risk (e.g., travelers to areas with polio outbreaks, laboratory workers, healthcare workers).

---

Route:

• Intramuscular (IM) or subcutaneous (SC) injection

---

Side Effects:

• Pain, redness, or swelling at the injection site

• Fever

• Fatigue

• Rare: Severe allergic reactions (e.g., anaphylaxis)

---

Nursing Considerations:

• Administer IM or SC: Typically in the deltoid muscle or thigh (for infants).

• Monitor for allergic reactions: Especially during the first 15-30 minutes after vaccination.

• Educate parents and patients: Inform about mild side effects like injection site pain and fever, which typically resolve quickly.

• Record vaccine details: Document the lot number and expiration date.

• Check for contraindications before administration.

---

Contraindications:

• Severe allergic reaction to any component of the vaccine (e.g., neomycin, streptomycin, polymyxin B).

• Moderate to severe illness: Delay vaccination until recovery.

• Pregnancy: IPV is considered safe during pregnancy, but consult a healthcare provider for advice if needed.

---

Relevant NCLEX Points:

• IPV is a key vaccine for preventing polio, especially in children.

• Routine vaccination includes 4 doses: at 2, 4, 6-18 months, and 4-6 years.

• Safe during pregnancy: IPV is considered safe and can be administered to pregnant individuals if indicated.

• Side effects: Typically mild, including pain at the injection site and fever.

• Monitor for allergic reactions, especially for neomycin or streptomycin allergies.

• IPV prevents polio but does not cure it once contracted.

Rabies (HDCVPCECV)

Generic Name:

• Human Diploid Cell Vaccine (HDCV)

• Purified Chick Embryo Cell Vaccine (PCECV)

Brand Name:

• RabAvert, Imovax Rabies

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Drug Class:

• Vaccine (Inactivated virus vaccine)

---

Mechanism of Action:

• The Rabies vaccine contains inactivated rabies virus. It stimulates the immune system to produce antibodies against the rabies virus, providing immunity in case of exposure to the virus.

---

Indications:

• Pre-exposure prophylaxis: For individuals at high risk of rabies exposure (e.g., veterinarians, animal handlers, laboratory workers).

• Post-exposure prophylaxis: Administered after a potential exposure to rabies, in combination with rabies immune globulin (RIG).

• Travelers to regions with endemic rabies.

---

Route:

• Intramuscular (IM) injection

  • Typically given in the deltoid muscle.

---

Side Effects:

• Pain, redness, or swelling at the injection site

• Fever

• Headache

• Dizziness

• Rare: Allergic reactions (e.g., anaphylaxis)

---

Nursing Considerations:

• Administer IM: Usually in the deltoid muscle.

• Pre-exposure vaccination: Typically involves a 3-dose series (0, 7, and 21 or 28 days).

• Post-exposure vaccination: Administer 5 doses over 28 days (with rabies immune globulin on the first day).

• Monitor for allergic reactions: Especially during the first 15-30 minutes after vaccination.

• Document vaccine details: Lot number and expiration date.

• Educate patients: On possible side effects like pain at the injection site and fever.

• Ensure full vaccination schedule: Complete all doses as prescribed.

---

Contraindications:

• Severe allergic reaction to any component of the vaccine (e.g., neomycin).

• Severe illness: Delay vaccination until recovery.

• Pregnancy: The vaccine is typically safe during pregnancy if exposure to rabies is a concern, but consultation with a healthcare provider is recommended.

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Relevant NCLEX Points:

• Rabies vaccine (HDCV/PECV) is used for pre-exposure and post-exposure prophylaxis of rabies.

• Post-exposure prophylaxis requires 5 doses over 28 days, combined with rabies immune globulin (RIG).

• Pre-exposure prophylaxis involves a 3-dose series and is recommended for those at high risk.

• Side effects are generally mild, including injection site pain and fever.

• Monitor for allergic reactions, especially for neomycin allergies.

• Rabies is a fatal viral infection, so the vaccine is crucial for anyone at risk of exposure.

Rotavirus (RV)

Generic Name:

• Rotavirus Vaccine

Brand Name:

• Rotarix, RotaTeq

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Drug Class:

• Vaccine (Live, attenuated virus vaccine)

---

Mechanism of Action:

• The Rotavirus vaccine contains live, attenuated rotavirus strains. It stimulates the immune system to produce antibodies, which help prevent infection by the rotavirus, a leading cause of severe gastroenteritis (diarrhea and vomiting) in infants and young children.

---

Indications:

• Prevention of rotavirus gastroenteritis in infants and young children.

• Recommended for:

  • Infants, usually starting at 2 months of age.

  • The vaccine is given as part of the routine childhood immunization schedule.

---

Route:

• Oral administration

  • The vaccine is given by mouth (oral).

---

Side Effects:

• Mild diarrhea or vomiting after vaccination

• Fever

• Irritability

• Rare: Intussusception (a type of bowel obstruction, mostly in younger infants)

---

Nursing Considerations:

• Administer orally: Make sure the vaccine is swallowed; if the infant spits it out, consult with the healthcare provider for the next dose.

• Monitor for signs of gastrointestinal distress: Watch for symptoms like vomiting or diarrhea.

• Monitor for signs of intussusception (abdominal pain, pulling of legs to chest, vomiting).

• Follow the vaccination schedule: Typically, the series is given at 2, 4, and 6 months.

• Education: Inform parents about common side effects and the importance of completing the full series.

---

Contraindications:

• Severe allergic reaction to any component of the vaccine (e.g., latex in some vaccine packaging).

• Severe immunocompromised conditions: Vaccination should be delayed in infants with conditions like SCID (severe combined immunodeficiency).

• History of intussusception or gastrointestinal malformations.

• Moderate or severe acute illness: Delay vaccination until the child has recovered.

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Relevant NCLEX Points:

• The Rotavirus vaccine is part of the routine immunization schedule for infants, typically starting at 2 months of age.

• It is given orally and requires 3 doses: at 2, 4, and 6 months.

• Common side effects include mild diarrhea, fever, and irritability.

• Intussusception is a rare but serious side effect, particularly in infants, and nurses should be aware of signs of this condition.

• Contraindications include severe immunocompromised conditions and a history of intussusception.

• Monitor for gastrointestinal symptoms and inform caregivers about proper administration and the importance of completing the vaccine series.

Varicella (VAR)

Generic Name:

• Varicella Vaccine

Brand Name:

• Varivax

---

Drug Class:

• Vaccine (Live, attenuated virus vaccine)

---

Mechanism of Action:

• The Varicella vaccine contains live, attenuated varicella (chickenpox) virus. It stimulates the immune system to produce antibodies, providing immunity against varicella without causing the disease.

---

Indications:

• Prevention of varicella (chickenpox) in individuals who are not immune.

• Recommended for:

  • Children: Routine vaccination starting at 12-15 months and a second dose at 4-6 years.

  • Adults who have not had chickenpox or been vaccinated, especially those at risk (e.g., healthcare workers, pregnant women without immunity).

---

Route:

• Subcutaneous (SC) injection

  • Administered in the upper arm.

---

Side Effects:

• Pain, redness, or swelling at the injection site

• Fever

• Mild rash at the injection site

• Tiredness or mild discomfort

• Rare: Severe allergic reactions (e.g., anaphylaxis)

---

Nursing Considerations:

• Administer subcutaneously: Typically in the upper arm.

• Monitor for signs of allergic reactions: Observe the patient for 15-30 minutes after vaccination.

• Educate patients and families: Inform about common side effects like fever, rash, and pain at the injection site.

• Follow-up: Ensure the second dose is administered at the appropriate age if applicable (usually 4-6 years).

• Documentation: Record vaccine details, including lot number and expiration date.

---

Contraindications:

• Severe allergic reaction to any component of the vaccine (e.g., gelatin or neomycin).

• Immunocompromised conditions (e.g., HIV, leukemia, lymphoma, cancer treatments, etc.).

• Pregnancy: Women should avoid pregnancy for 1 month after receiving the vaccine.

• Moderate to severe acute illness: Delay vaccination until the patient has recovered.

---

Relevant NCLEX Points:

• The Varicella vaccine is a live attenuated vaccine that prevents chickenpox and shingles.

• Routine vaccination is recommended for children at 12-15 months, with a second dose at 4-6 years.

• Side effects are typically mild, including fever and injection site pain.

• Contraindications include pregnancy, severe immunocompromised conditions, and allergy to vaccine components.

• Monitor for allergic reactions (e.g., anaphylaxis) post-vaccination, particularly in the first 30 minutes.

• Pregnant women should not receive the vaccine, and pregnancy should be avoided for 1 month after administration

Diphtheria (DTaP)

Generic Name:

• Diphtheria, Tetanus, and Pertussis Vaccine

Brand Name:

• Daptacel, Infanrix

---

Drug Class:

• Vaccine (Combination vaccine)

---

Mechanism of Action:

• The DTaP vaccine contains inactivated (killed) toxins from diphtheria, tetanus, and pertussis bacteria.

• It stimulates the immune system to produce antibodies against these bacteria, providing protection without causing the diseases.

---

Indications:

• Prevention of Diphtheria, Tetanus, and Pertussis (whooping cough) in infants and children.

• Recommended for:

  • Routine childhood immunization:

    • Administered at ages 2, 4, 6, and 15-18 months, and a booster dose at 4-6 years.

  • Adults: A Tdap (tetanus, diphtheria, and acellular pertussis) booster is recommended, especially for those in close contact with infants.

---

Route:

• Intramuscular (IM) injection

  • Typically given in the anterolateral thigh for infants and in the deltoid muscle for older children and adults.

---

Side Effects:

• Pain, redness, or swelling at the injection site

• Fever

• Irritability

• Loss of appetite

• Rare: Severe allergic reactions (e.g., anaphylaxis), seizures, neurological reactions (e.g., persistent crying)

---

Nursing Considerations:

• Administer IM: Ensure correct injection technique, usually in the thigh for infants and the deltoid for older children/adults.

• Monitor for allergic reactions: Observe the patient for 15-30 minutes after vaccination.

• Educate parents: Explain common side effects, like pain at the injection site and fever.

• Give antipyretics as needed: For fever, provide acetaminophen or ibuprofen as advised.

• Follow-up: Ensure the child receives the full vaccination series and the booster dose at the appropriate age.

---

Contraindications:

• Severe allergic reaction (e.g., anaphylaxis) to any component of the vaccine (e.g., formaldehyde, aluminum salts).

• Severe reaction to a previous dose of DTaP (e.g., seizures or persistent crying).

• Moderate to severe acute illness: Delay vaccination until the child is fully recovered.

---

Relevant NCLEX Points:

• The DTaP vaccine is part of the routine childhood immunization schedule, typically given at 2, 4, 6, and 15-18 months, with a booster at 4-6 years.

• The vaccine prevents diphtheria, tetanus, and pertussis (whooping cough).

• Common side effects include pain and swelling at the injection site, fever, and irritability.

• Monitor for signs of severe allergic reactions (e.g., anaphylaxis) following vaccination.

• Contraindications include a history of severe allergic reactions or neurological issues from a prior dose.

• Administer via intramuscular (IM) route, usually in the thigh for infants and deltoid for older children.

Tetanus toxoid

Generic Name:

• Tetanus Toxoid

Brand Name:

• Tetanus Vaccine, Daptacel, Infanrix (in combination with diphtheria and pertussis vaccines)

---

Drug Class:

• Vaccine (Inactivated bacterial toxin)

---

Mechanism of Action:

• Tetanus toxoid contains inactivated tetanus toxin that stimulates the immune system to produce antibodies against Clostridium tetani, the bacteria responsible for tetanus.

• The body becomes immune to tetanus without causing the disease.

---

Indications:

• Prevention of tetanus (lockjaw), caused by infection with Clostridium tetani.

• Routine vaccination:

  • Part of the DTaP vaccine for children under 7 years.

  • Td (tetanus, diphtheria) or Tdap (tetanus, diphtheria, pertussis) vaccine for adults and adolescents (booster every 10 years).

• Post-exposure prophylaxis: Administered following a tetanus-prone wound in individuals who have not received a tetanus vaccine or whose last dose was over 10 years ago.

---

Route:

• Intramuscular (IM) injection

  • Typically given in the deltoid muscle for adolescents and adults or the thigh for infants and young children.

---

Side Effects:

• Pain, redness, or swelling at the injection site

• Fever

• Fatigue or irritability

• Headache

• Rare: Severe allergic reactions (e.g., anaphylaxis)

---

Nursing Considerations:

• Administer IM: Use correct technique, usually in the deltoid muscle or thigh.

• Monitor for allergic reactions: Observe the patient for 15-30 minutes after vaccination.

• Educate about side effects: Common side effects include pain at the injection site, fever, and fatigue.

• Provide comfort measures: Encourage the use of ice packs on the injection site and antipyretics (e.g., acetaminophen or ibuprofen) for pain or fever.

• Booster doses: Remind patients to get tetanus booster shots every 10 years or after significant injuries.

---

Contraindications:

• Severe allergic reaction (e.g., anaphylaxis) to a prior dose or to any component of the vaccine (e.g., formaldehyde).

• Moderate to severe acute illness: Delay vaccination until the patient recovers from illness.

• History of severe neurological reactions (e.g., encephalopathy) following a previous dose of the vaccine.

---

Relevant NCLEX Points:

• Tetanus toxoid is given as part of routine immunization, particularly in the DTaP series for children and Td/Tdap boosters for adolescents and adults.

• The vaccine is recommended every 10 years for adults or following a tetanus-prone wound.

• Common side effects include pain at the injection site, fever, and irritability.

• Monitor for allergic reactions (anaphylaxis) following administration.

• Contraindicated in individuals with a history of severe allergic reactions or neurological reactions from previous doses

Rh immune globulin

Generic Name:

• Rh Immune Globulin

Brand Name:

• RhoGAM, HyperRho

---

Drug Class:

• Immunoglobulin (antibody)

---

Mechanism of Action:

• Rh Immune Globulin contains anti-Rh antibodies that prevent the mother’s immune system from producing antibodies against Rh-positive blood cells in future pregnancies.

• It works by binding to any Rh-positive red blood cells that enter the mother’s bloodstream, preventing her immune system from recognizing and attacking the fetal cells as foreign.

---

Indications:

• Prevention of Rh immunization in Rh-negative mothers who have been exposed to Rh-positive fetal blood cells.

• Administered in the following situations:

  • After childbirth if the baby is Rh-positive.

  • After a miscarriage or abortion (spontaneous or elective) if the fetus is Rh-positive.

  • After amniocentesis or chorionic villus sampling (CVS) in Rh-negative pregnant women.

  • During the 28th week of pregnancy for Rh-negative women carrying an Rh-positive fetus (routine prophylaxis).

---

Route:

• Intramuscular (IM) injection

  • Administered in the upper arm or buttock.

---

Side Effects:

• Pain at the injection site

• Fever

• Headache

• Rash

• Rare: Allergic reactions (e.g., anaphylaxis), hemolytic anemia, or chills.

---

Nursing Considerations:

• Monitor for allergic reactions: Observe the patient for at least 20 minutes after administration.

• Administer via IM route: Use the appropriate technique, typically in the upper arm or buttock.

• Educate the patient: Explain the purpose of the treatment, especially in preventing Rh sensitization in future pregnancies.

• Check Rh status: Verify the Rh-negative status of the mother and Rh-positive status of the infant or fetus before administration.

• Administer at 28 weeks: For routine prophylaxis, ensure Rh-negative women receive the injection around 28 weeks of gestation, and a second dose within 72 hours after delivery if the baby is Rh-positive.

---

Contraindications:

• Hypersensitivity to any components of the vaccine or blood products.

• Rh-positive individuals: Not indicated for those who are already Rh-positive.

• Severe allergic reactions to previous doses.

---

Relevant NCLEX Points:

• Rh Immune Globulin is used to prevent Rh sensitization in Rh-negative women who are exposed to Rh-positive fetal blood.

• Administered routinely at 28 weeks of pregnancy for Rh-negative women carrying an Rh-positive fetus.

• Also given after childbirth, miscarriage, or invasive procedures (e.g., amniocentesis) if the fetus is Rh-positive.

• Monitor for side effects like pain at the injection site, fever, or rash.

• Contraindicated in Rh-positive women and those with a history of allergic reactions to immunoglobulin preparations

Varicella (VZIG)

Generic Name:

• Varicella Zoster Immune Globulin (VZIG)

Brand Name:

• Varitect

---

Drug Class:

• Immunoglobulin (antibody)

---

Mechanism of Action:

• VZIG contains concentrated varicella-zoster antibodies derived from the plasma of immunized donors.

• It provides passive immunity by neutralizing the varicella-zoster virus (VZV), reducing the severity and preventing complications of varicella (chickenpox) in individuals who are at high risk.

---

Indications:

• Post-exposure prophylaxis to prevent or lessen the severity of varicella infection in high-risk individuals, including:

  • Immunocompromised individuals (e.g., those with HIV, cancer, organ transplant recipients).

  • Pregnant women without immunity to varicella.

  • Newborns born to mothers who developed varicella close to delivery or within 5 days before or 48 hours after delivery.

• Prevention of varicella in those who are susceptible and have had a recent exposure to the virus.

---

Route:

• Intramuscular (IM) injection

---

Side Effects:

• Pain or swelling at the injection site

• Fever

• Rash

• Allergic reactions (e.g., hives, anaphylaxis) – though rare

• Headache

---

Nursing Considerations:

• Administer via IM route: Ensure correct technique, usually in the upper arm or buttock.

• Monitor for allergic reactions: Watch for hives, swelling, or difficulty breathing. Observe patients for 30 minutes post-administration.

• Confirm varicella exposure: Ensure the patient is a high-risk individual (e.g., immunocompromised, pregnant, or newborn) before administering VZIG.

• Educate the patient: Explain the purpose of the treatment, which is to prevent severe varicella infection.

• Post-exposure use: Best used within 96 hours of exposure to varicella.

---

Contraindications:

• Hypersensitivity to any components of the immune globulin product.

• Known allergy to human immunoglobulin or egg protein (as some preparations contain trace amounts of egg protein).

• Varicella vaccination: Not recommended in individuals who have already been vaccinated for varicella unless specifically directed by the healthcare provider.

---

Relevant NCLEX Points:

• VZIG is used for post-exposure prophylaxis to prevent or reduce the severity of varicella in high-risk individuals (e.g., immunocompromised patients, pregnant women, newborns).

• Best administered within 96 hours of exposure to varicella to be effective.

• Monitor for side effects like pain at the injection site, fever, or rash, and watch for allergic reactions.

• Contraindicated in individuals with hypersensitivity to human immunoglobulins or egg protein.

• VZIG is not a substitute for the varicella vaccine, but it is used when the vaccine is not appropriate.

Mycophenolate mofetil (CellCept)

Generic Name:

• Mycophenolate mofetil

Brand Name:

• CellCept

---

Drug Class:

• Immunosuppressant

• Antimetabolite

---

Mechanism of Action:

• Mycophenolate mofetil inhibits inosine monophosphate dehydrogenase (IMPDH), an enzyme critical for purine synthesis.

• By inhibiting this enzyme, it suppresses the proliferation of T and B lymphocytes (immune cells), which is essential for preventing organ rejection in transplant recipients.

---

Indications:

• Prevention of organ rejection in:

  • Kidney transplant

  • Heart transplant

  • Liver transplant

• Treatment of autoimmune diseases (e.g., lupus nephritis)

---

Route:

• Oral (tablet or liquid)

• Intravenous (IV) (for hospitalized patients who cannot take oral medications)

---

Side Effects:

• Gastrointestinal: Nausea, vomiting, diarrhea, abdominal pain

• Hematologic: Leukopenia (low white blood cell count), anemia, thrombocytopenia (low platelet count)

• Infections: Increased risk due to immunosuppression

• Increased liver enzymes (may indicate liver toxicity)

• Headache

• Hypertension

---

Nursing Considerations:

• Monitor for infections: Since mycophenolate mofetil suppresses the immune system, patients are at higher risk for infections.

• Assess blood counts: Regularly monitor CBC (complete blood count) for signs of leukopenia or thrombocytopenia.

• Monitor liver function: Check liver function tests (LFTs) for elevated enzymes, indicating possible hepatotoxicity.

• Take with food: To reduce gastrointestinal upset, take the medication with food.

• Pregnancy Category D: Contraindicated in pregnancy, as it can cause miscarriage and birth defects.

• Avoid live vaccines: As immunosuppression can interfere with vaccine effectiveness and increase the risk of infection from live vaccines.

---

Contraindications:

• Pregnancy: Category D (may cause fetal harm). Women of childbearing age should use effective contraception while on this medication.

• Hypersensitivity to mycophenolate mofetil or any of its components.

• Severe renal impairment without dose adjustment.

• Active infections: Should not be used in individuals with active infections unless necessary.

---

Relevant NCLEX Points:

• Mycophenolate mofetil is primarily used for preventing organ transplant rejection and treating autoimmune diseases (e.g., lupus nephritis).

• Monitor CBC for signs of bone marrow suppression, particularly leukopenia and thrombocytopenia.

• Monitor liver enzymes regularly for signs of liver toxicity.

• Contraindicated in pregnancy (Category D), and women of childbearing age should use effective contraception during therapy.

• Increased risk of infections due to immunosuppressive action.

• Avoid live vaccines during treatment to prevent infection due to immunosuppression.

Methotrexate

Generic Name:

• Methotrexate

Brand Name:

• Rheumatrex, Trexall

---

Drug Class:

• Antimetabolite

• Immunosuppressant

• Disease-modifying antirheumatic drug (DMARD)

---

Mechanism of Action:

• Methotrexate inhibits dihydrofolate reductase, leading to decreased folic acid availability, which interferes with DNA synthesis and cell replication.

• Immunosuppressive properties: Inhibits the activity of immune cells (T-cells, B-cells) and inflammatory cytokines, used to reduce inflammation in autoimmune diseases.

---

Indications:

• Cancer: Treatment for various cancers, including:

  • Leukemia

  • Lymphoma

  • Osteosarcoma

• Autoimmune diseases:

  • Rheumatoid arthritis

  • Psoriasis

  • Lupus

  • Crohn's disease

• Ectopic pregnancy (used in high doses for medical management)

---

Route:

• Oral (tablet)

• Intramuscular (IM)

• Intravenous (IV)

• Subcutaneous (SC)

---

Side Effects:

• Gastrointestinal: Nausea, vomiting, diarrhea, stomatitis (mouth sores)

• Hematologic: Bone marrow suppression (leading to leukopenia, anemia, thrombocytopenia)

• Hepatotoxicity: Elevated liver enzymes (can lead to liver damage)

• Renal toxicity: Can cause kidney damage, especially in high doses

• Pulmonary toxicity: Risk of interstitial pneumonitis or fibrosis

• Alopecia (hair loss)

---

Nursing Considerations:

• Monitor CBC: Regularly check for bone marrow suppression (leukopenia, thrombocytopenia, anemia).

• Monitor liver function: Periodically assess LFTs (liver function tests) for hepatotoxicity.

• Assess renal function: Ensure adequate hydration and monitor renal function (BUN, creatinine).

• Take with food: To reduce gastrointestinal side effects, take with food or at bedtime.

• Folic acid supplementation: Prescribed to reduce side effects (e.g., mouth sores, nausea).

• Pregnancy Category X: Contraindicated in pregnancy due to teratogenic effects. Women should use effective contraception.

• Avoid alcohol: Alcohol can increase the risk of liver toxicity.

• Use caution with infections: Methotrexate can increase the risk of infections due to immunosuppression.

---

Contraindications:

• Pregnancy: Category X, contraindicated in pregnancy due to teratogenic effects.

• Breastfeeding: Methotrexate is excreted in breast milk and is contraindicated in breastfeeding.

• Severe liver disease: Methotrexate is contraindicated in patients with hepatic insufficiency or significant liver disease.

• Immunodeficiency: Use cautiously in individuals with existing infections or suppressed immune function.

• Renal impairment: Use with caution in patients with renal dysfunction.

---

Relevant NCLEX Points:

• Methotrexate is used for autoimmune conditions (like rheumatoid arthritis) and cancer treatment.

• Monitor for side effects like bone marrow suppression, liver toxicity, renal toxicity, and pulmonary issues.

• Pregnancy Category X: Methotrexate is contraindicated in pregnancy and breastfeeding.

• Monitor liver function (LFTs), renal function, and CBC regularly while on methotrexate.

• Take with food to minimize gastrointestinal side effects and avoid alcohol.

• Folic acid supplementation may be recommended to reduce gastrointestinal and oral mucosal side effects.

Cyclosporine

Generic Name:

• Cyclosporine

Brand Name:

• Sandimmune, Neoral, Gengraf

---

Drug Class:

• Immunosuppressant

• Calcineurin inhibitor

---

Mechanism of Action:

• Cyclosporine inhibits T-cell activation by binding to cyclophilin, forming a complex that inhibits calcineurin, which is necessary for the activation of T-cells. This prevents the transcription of pro-inflammatory cytokines (such as IL-2), reducing the immune response.

---

Indications:

• Prevention of organ rejection in kidney, liver, and heart transplants.

• Autoimmune disorders:

  • Rheumatoid arthritis

  • Psoriasis

  • Systemic lupus erythematosus (SLE)

  • Crohn’s disease

• Severe dry eye syndrome (off-label use).

---

Route:

• Oral (capsules, solution)

• Intravenous (IV)

---

Side Effects:

• Nephrotoxicity: Kidney damage (elevated serum creatinine)

• Hypertension: Increased blood pressure

• Increased risk of infections: Due to immunosuppression

• Gingival hyperplasia: Swelling of the gums

• Hirsutism: Excessive hair growth

• Tremors: Fine hand tremors

• Hyperkalemia: Elevated potassium levels

• Liver toxicity: Elevated liver enzymes (LFTs)

• Nausea/vomiting and diarrhea

---

Nursing Considerations:

• Monitor kidney function: Regularly assess serum creatinine and BUN. Watch for signs of nephrotoxicity.

• Monitor blood pressure: Regular monitoring for hypertension; anti-hypertensive meds may be needed.

• Monitor for signs of infection: Cyclosporine is immunosuppressive, increasing the risk of infections.

• Monitor liver function: Check LFTs regularly for signs of liver toxicity.

• Educate on oral hygiene: Encourage frequent brushing and flossing to prevent gingival hyperplasia.

• Avoid grapefruit juice: It can increase cyclosporine levels, leading to toxicity.

• Take consistently: Take at the same time every day to maintain steady drug levels.

---

Contraindications:

• Hypersensitivity to cyclosporine or any components of the formulation.

• Severe renal impairment: Contraindicated in kidney failure or severe renal dysfunction.

• Uncontrolled hypertension: Cyclosporine may exacerbate high blood pressure.

• Active infections: Because of its immunosuppressive effects, it is contraindicated in patients with active infections.

• Pregnancy Category C: Use cautiously during pregnancy, as it may harm the fetus.

---

Relevant NCLEX Points:

• Monitor kidney function closely with serum creatinine and BUN.

• Cyclosporine is used for immunosuppression in organ transplants and autoimmune disorders.

• Hypertension, nephrotoxicity, and gingival hyperplasia are significant side effects.

• Infection prevention: Immunosuppressed patients are at high risk for infections.

• Grapefruit should be avoided as it may increase drug levels.

• Blood pressure monitoring is essential as cyclosporine can cause hypertension.

Infliximab

Generic Name:

• Infliximab

Brand Name:

• Remicade

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Drug Class:

• Monoclonal antibody

• TNF-alpha inhibitor (Tumor Necrosis Factor)

---

Mechanism of Action:

• Infliximab binds to TNF-alpha, a cytokine involved in inflammation. By inhibiting TNF-alpha, it reduces the inflammatory response and immune system activation, making it effective in autoimmune diseases.

---

Indications:

• Rheumatoid arthritis

• Crohn's disease

• Ulcerative colitis

• Ankylosing spondylitis

• Psoriatic arthritis

• Plaque psoriasis

• Chronic inflammatory conditions with excessive TNF-alpha production.

---

Route:

• Intravenous (IV) infusion

---

Side Effects:

• Infusion reactions: Fever, chills, pruritus (itching), hypotension, dyspnea (shortness of breath)

• Increased risk of infections: Due to immunosuppression (e.g., TB, fungal infections, pneumonia)

• Hepatotoxicity: Liver function abnormalities (elevated LFTs)

• Heart failure: Exacerbates heart failure symptoms

• Cytopenias: Low blood counts (e.g., anemia, thrombocytopenia)

• Malignancy risk: Increased risk of lymphoma and other cancers in long-term use

• Gastrointestinal issues: Nausea, vomiting, and diarrhea

---

Nursing Considerations:

• Monitor for infusion reactions: Watch for signs of fever, chills, and hypotension during and after the infusion.

• Screen for infections: Prior to therapy, screen for latent tuberculosis and other infections. Infliximab may reactivate TB.

• Monitor liver function: Check LFTs for signs of hepatotoxicity.

• Evaluate for heart failure: Use cautiously in patients with heart failure due to the risk of worsening symptoms.

• Pre-infusion medication: Patients may receive antihistamines, acetaminophen, and corticosteroids to reduce infusion reactions.

• Regular monitoring: Monitor complete blood count (CBC) for signs of cytopenias.

• Live vaccines: Avoid live vaccines during therapy due to immunosuppressive effects.

---

Contraindications:

• Active infections: Infliximab should not be used in patients with active infections (e.g., TB, fungal infections, hepatitis).

• Hypersensitivity: Contraindicated in patients with a known allergy to infliximab or any of its components.

• Moderate to severe heart failure: Not recommended in patients with NYHA class III or IV heart failure.

• Live vaccines: Avoid use of live vaccines during treatment.

---

Relevant NCLEX Points:

• Infliximab is used for autoimmune diseases like rheumatoid arthritis, Crohn’s disease, and psoriasis.

• Monitor for infusion reactions like fever, chills, and hypotension.

• Immunosuppressive effects increase the risk of infections, so assess for active infections (e.g., TB).

• Liver function tests (LFTs) should be monitored for potential hepatotoxicity.

• Avoid live vaccines due to the immunosuppressive effects of the drug.

• Heart failure patients may experience worsening symptoms.

Etanercept

Generic Name:

• Etanercept

Brand Name:

• Enbrel

---

Drug Class:

• Biologic response modifier

• Tumor necrosis factor (TNF) inhibitor

---

Mechanism of Action:

• Etanercept is a TNF-alpha inhibitor. It works by binding to and neutralizing TNF-alpha, a cytokine involved in inflammation, thus reducing inflammation and the activity of autoimmune diseases.

---

Indications:

• Rheumatoid arthritis

• Psoriatic arthritis

• Ankylosing spondylitis

• Plaque psoriasis

• Juvenile idiopathic arthritis

• Non-infectious uveitis (in certain cases)

---

Route:

• Subcutaneous injection (usually once or twice a week, depending on the condition being treated)

---

Side Effects:

• Injection site reactions: Redness, swelling, pain, itching

• Increased risk of infections: Due to immunosuppressive effects (e.g., upper respiratory infections, TB, fungal infections)

• Hematologic: Anemia, thrombocytopenia, leukopenia

• Gastrointestinal: Nausea, vomiting, abdominal pain

• Liver toxicity: Elevated liver enzymes (LFTs)

• Heart failure: Risk of exacerbating symptoms in patients with existing heart failure

• Cancer: Potential increased risk of certain malignancies (e.g., lymphoma)

---

Nursing Considerations:

• Assess for infections: Screen for active infections (e.g., TB) before starting treatment. Monitor for signs of infection during therapy.

• Monitor for injection site reactions: Educate patients about proper injection technique and rotate injection sites.

• Liver function tests: Monitor LFTs regularly for signs of hepatotoxicity.

• Monitor blood counts: Periodic CBC is recommended due to the risk of cytopenias (e.g., anemia, leukopenia, thrombocytopenia).

• Heart failure caution: Use with caution in patients with heart failure due to the risk of worsening symptoms.

• Avoid live vaccines: Do not give live vaccines during therapy due to immunosuppressive effects.

• Pre-infusion screening: Consider screening for hepatitis B and C, especially in patients with a history of liver disease.

---

Contraindications:

• Active infections: Contraindicated in patients with active infections (e.g., TB, fungal infections).

• Hypersensitivity: Contraindicated in patients who have a known allergy to etanercept or any of its components.

• Heart failure: Contraindicated in patients with NYHA class III or IV heart failure.

• Live vaccines: Contraindicated due to immunosuppressive effects.

---

Relevant NCLEX Points:

• Etanercept is used in autoimmune diseases like rheumatoid arthritis, psoriasis, and ankylosing spondylitis.

• Monitor for infections (e.g., TB) and injection site reactions.

• CBC and LFTs should be checked regularly to monitor for cytopenias and liver toxicity.

• Do not administer live vaccines during therapy due to immunosuppressive effects.

• Use cautiously in patients with heart failure, as it can worsen the condition.

Tamoxifen

Generic Name:

• Tamoxifen

Brand Name:

• Nolvadex

---

Drug Class:

• Selective Estrogen Receptor Modulator (SERM)

---

Mechanism of Action:

• Tamoxifen acts as an estrogen antagonist in breast tissue, blocking the effects of estrogen, which is necessary for the growth of certain types of breast cancer cells. In other tissues (e.g., bones, uterus), it acts as an estrogen agonist.

---

Indications:

• Breast cancer: Treatment and prevention (especially in estrogen receptor-positive cancers)

• Adjuvant therapy: After surgery or radiation for breast cancer

• Prevention: In high-risk patients for breast cancer

• Male breast cancer: Treatment of estrogen receptor-positive cancers in men

• Fertility: Occasionally used to treat anovulatory infertility (off-label use)

---

Route:

• Oral tablet (daily dosing, typically for 5-10 years in breast cancer therapy)

---

Side Effects:

• Hot flashes

• Nausea

• Menstrual irregularities

• Vaginal discharge

• Increased risk of uterine cancer (due to estrogen agonist effects on the uterus)

• Deep vein thrombosis (DVT) and pulmonary embolism (PE)

• Cataracts

• Endometrial hyperplasia (precursor to uterine cancer)

---

Nursing Considerations:

• Monitor for clotting disorders: Check for signs of DVT or PE (e.g., leg swelling, shortness of breath).

• Assess for endometrial cancer symptoms: Monitor for unusual vaginal bleeding or pain.

• Teach about hot flashes: May be a common side effect; ensure the patient is prepared.

• Monitor liver function: Tamoxifen can affect liver enzymes.

• Assess vision: Routine eye exams due to the risk of cataracts.

• Counsel on contraception: Tamoxifen is teratogenic and should not be used during pregnancy.

• Follow-up: Patients typically need long-term follow-up due to the prolonged treatment duration (5-10 years).

---

Contraindications:

• Pregnancy: Contraindicated during pregnancy due to teratogenic effects.

• History of DVT/PE: Use with caution or avoid in patients with a history of thromboembolic events.

• Hypersensitivity: Contraindicated in patients with a known allergy to tamoxifen.

• Liver disease: Use with caution in patients with significant liver dysfunction.

---

Relevant NCLEX Points:

• Tamoxifen is a SERM used primarily in the treatment and prevention of estrogen receptor-positive breast cancer.

• Side effects include hot flashes, DVT/PE, and increased risk of uterine cancer.

• Monitor for signs of thromboembolism and endometrial cancer during therapy.

• Tamoxifen is contraindicated in pregnancy due to teratogenicity, and liver function should be monitored.

• Educate patients about potential cataract development and menstrual changes.

Anastrozole

Generic Name:

• Anastrozole

Brand Name:

• Arimidex

---

Drug Class:

• Aromatase Inhibitor

---

Mechanism of Action:

• Anastrozole inhibits aromatase, the enzyme responsible for converting androgens to estrogens in postmenopausal women. This reduces estrogen levels, which can slow the growth of estrogen receptor-positive breast cancer cells.

---

Indications:

• Breast cancer: Treatment of estrogen receptor-positive (ER-positive) breast cancer in postmenopausal women.

• Adjuvant therapy: Used after surgery or radiation in early-stage breast cancer.

• Metastatic breast cancer: Used in advanced-stage or metastatic disease.

• Prevention: Off-label for prevention of breast cancer in high-risk postmenopausal women.

---

Route:

• Oral tablet (once daily)

---

Side Effects:

• Hot flashes

• Arthralgia (joint pain)

• Osteoporosis (due to decreased estrogen)

• Fatigue

• Nausea

• Headache

• Skin rash

• Increased risk of fractures due to decreased bone density

---

Nursing Considerations:

• Monitor bone health: Assess for signs of osteoporosis and consider bone mineral density testing.

• Manage hot flashes: Provide comfort measures and educate on symptom management.

• Monitor for joint pain: Encourage regular physical activity and joint exercises.

• Assess for fatigue: Teach energy conservation techniques.

• Liver function: Periodically monitor liver function tests (LFTs).

• Counsel on contraception: Although used in postmenopausal women, anastrozole may be contraindicated in those who may become pregnant, as it can harm a fetus.

• Adherence: Emphasize the importance of consistent daily use for effectiveness.

---

Contraindications:

• Pregnancy: Contraindicated during pregnancy due to potential harm to the fetus.

• Breastfeeding: Not recommended while breastfeeding.

• Hypersensitivity: Contraindicated in patients with a known allergy to anastrozole or any component of the formulation.

• Pre-menopausal women: Not effective in pre-menopausal women, as aromatase inhibitors work by decreasing estrogen in postmenopausal women.

---

Relevant NCLEX Points:

• Anastrozole is used in the treatment of estrogen receptor-positive breast cancer in postmenopausal women.

• Side effects include hot flashes, joint pain, and osteoporosis.

• Monitor bone health and consider calcium and vitamin D supplementation to prevent fractures.

• Anastrozole is contraindicated in pregnancy and breastfeeding.

• It is not effective in pre-menopausal women.

• Regular follow-up is needed for monitoring side effects like bone loss and fatigue.

Aspirin

Generic Name:

• Aspirin

Brand Name:

• Bayer, Ecotrin, Bufferin (varies by manufacturer)

---

Drug Class:

• Nonsteroidal Anti-Inflammatory Drug (NSAID)

• Antiplatelet agent

---

Mechanism of Action:

• Aspirin inhibits cyclooxygenase (COX) enzymes (COX-1 and COX-2), which are involved in the production of prostaglandins.

  • COX-1 inhibition: Reduces platelet aggregation (antiplatelet effect).

  • COX-2 inhibition: Provides anti-inflammatory and analgesic effects.

---

Indications:

• Pain relief: Mild to moderate pain, including headaches, toothaches, muscle pain, and minor arthritis.

• Fever reduction: Antipyretic (lowers fever).

• Cardiovascular:

  • Prevention of myocardial infarction (MI) and stroke in high-risk individuals (due to antiplatelet action).

  • Acute coronary syndrome (ACS): Administered to prevent blood clot formation in the heart.

---

Route:

• Oral: Typically as tablets, chewable tablets, or enteric-coated forms.

• Rectal: Suppository (less common).

---

Side Effects:

• Gastrointestinal (GI):

  • Gastric irritation/ulcers

  • Gastric bleeding (due to inhibition of COX-1)

• Increased bleeding risk

• Tinnitus (ringing in the ears)

• Rash

• Allergic reactions (e.g., anaphylaxis, especially in patients with asthma)

• Renal toxicity (with chronic use)

• Reye’s syndrome (in children with viral infections, especially influenza or chickenpox)

---

Nursing Considerations:

• Assess for GI symptoms: Monitor for signs of gastrointestinal bleeding, such as black, tarry stools or vomit with blood.

• Monitor renal function: Watch for signs of renal impairment with long-term use (e.g., decreased urine output, edema).

• Bleeding risk: Assess for easy bruising, nosebleeds, or other bleeding tendencies.

• Take with food: To reduce GI irritation, advise patients to take aspirin with food or milk.

• Educate on stopping before surgery: Discontinue aspirin at least 7 days before surgery to reduce bleeding risk.

• Reye's syndrome: Do not administer aspirin to children or adolescents with viral infections (e.g., flu, chickenpox).

• Monitor for signs of overdose: Symptoms of salicylate toxicity include tinnitus, nausea, and vomiting.

---

Contraindications:

• Active gastrointestinal bleeding or peptic ulcer disease

• Hypersensitivity to aspirin or other NSAIDs

• Children and teenagers with viral infections (risk of Reye’s syndrome)

• Severe renal or hepatic impairment

• Pregnancy (3rd trimester): Aspirin can cause premature closure of the ductus arteriosus in the fetus.

---

Relevant NCLEX Points:

• Aspirin is used for pain relief, fever reduction, and as an antiplatelet agent in cardiovascular diseases.

• Major side effects: GI bleeding, tinnitus, and Reye’s syndrome in children.

• Contraindicated in children with viral infections due to the risk of Reye’s syndrome.

• Nursing care:

  • Monitor for GI bleeding and renal impairment.

  • Educate patients to take aspirin with food to reduce GI irritation.

  • Discontinue aspirin before surgery to reduce bleeding risks.

Acetaminophen

Generic Name:

• Acetaminophen

Brand Name:

• Tylenol, Ofirmev (IV form)

---

Drug Class:

• Analgesic

• Antipyretic

---

Mechanism of Action:

• Acetaminophen inhibits prostaglandin synthesis in the central nervous system (CNS), specifically acting on the hypothalamic heat-regulating center to reduce fever and alleviate pain.

• It has no significant anti-inflammatory effects and does not significantly affect platelets or the gastrointestinal (GI) tract.

---

Indications:

• Pain relief: Mild to moderate pain (headaches, muscle pain, backaches, toothaches, arthritis).

• Fever reduction: Reduces fever (antipyretic effect).

• Postoperative pain (as an adjunct to opioid therapy).

• Osteoarthritis: Used as a first-line therapy for pain control.

---

Route:

• Oral: Tablets, capsules, liquid.

• Rectal: Suppositories (for patients who cannot take oral medications).

• IV: Ofirmev (for hospital use, typically post-surgery).

---

Side Effects:

• Hepatotoxicity: Liver damage (with chronic use or overdose).

• Allergic reactions: Rash, swelling, and rare anaphylaxis.

• Renal toxicity: Chronic high doses can affect kidney function.

• Hematologic: Rare thrombocytopenia and leukopenia.

---

Nursing Considerations:

• Monitor liver function: Assess liver enzymes (AST, ALT) for signs of liver toxicity, especially with prolonged use or high doses.

• Watch for overdose: Acetaminophen toxicity can lead to acute liver failure, symptoms include nausea, vomiting, confusion, and jaundice.

  • If overdose is suspected, administer N-acetylcysteine (NAC) as an antidote.

• Educate patients on safe dosing: Do not exceed 4,000 mg per day in adults to avoid liver damage.

• Avoid alcohol: Excessive alcohol consumption increases the risk of liver damage when taking acetaminophen.

• Use cautiously in patients with liver disease: Lower doses may be required.

---

Contraindications:

• Liver disease: Avoid in patients with severe liver impairment (e.g., cirrhosis).

• Alcoholism: Chronic alcohol use increases the risk of hepatotoxicity.

• Hypersensitivity to acetaminophen.

---

Relevant NCLEX Points:

• Acetaminophen is an analgesic and antipyretic, used for pain relief and fever reduction, but does not have anti-inflammatory effects.

• Major risk: Liver toxicity, especially with overdose or chronic use (more than 4g/day in adults).

• Important nursing care:

  • Monitor liver function.

  • Educate patients about safe dosing and avoiding alcohol.

  • Know the antidote for overdose: N-acetylcysteine (NAC).

• Contraindicated in patients with liver disease or those who consume excessive alcohol.

Ibuprofen

Generic Name:

• Ibuprofen

Brand Name:

• Advil, Motrin, Midol

---

Drug Class:

• Nonsteroidal Anti-inflammatory Drug (NSAID)

• Analgesic

• Antipyretic

• Anti-inflammatory

---

Mechanism of Action:

• Inhibits cyclooxygenase (COX-1 and COX-2) enzymes, leading to decreased production of prostaglandins which mediate pain, fever, and inflammation.

---

Indications:

• Pain relief: Mild to moderate pain (headaches, muscle pain, toothaches, arthritis).

• Fever reduction: Antipyretic effect to reduce fever.

• Inflammation: Used for conditions such as osteoarthritis, rheumatoid arthritis, and other inflammatory conditions.

• Dysmenorrhea: Relief of menstrual cramps.

---

Route:

• Oral: Tablets, capsules, liquid suspension.

• Topical: Gel, cream for localized pain (e.g., joint pain).

• IV: For short-term use in hospital settings (e.g., post-surgery).

---

Side Effects:

• Gastrointestinal (GI): Nausea, dyspepsia, gastritis, ulcers, and GI bleeding (with prolonged use).

• Renal: Kidney damage (elevated creatinine, renal failure) with prolonged use or in patients with pre-existing kidney conditions.

• Cardiovascular: Increased risk of stroke or heart attack (especially with high doses or prolonged use).

• Hematologic: Rare bleeding, anemia, or thrombocytopenia.

• Rash: Allergic skin reactions.

---

Nursing Considerations:

• Monitor kidney function: Check creatinine and BUN, especially in older adults or those with kidney disease.

• GI protection: Encourage use of with food or milk to reduce GI irritation. Long-term use may require proton pump inhibitors (PPI).

• Assess cardiovascular health: Be cautious with long-term use, especially in patients with hypertension, heart disease, or stroke risk.

• Pain management: Ensure appropriate dosing to avoid exceeding the max daily dose of 3200 mg/day for adults.

• Educate: Advise patients to take the drug with food or milk to decrease stomach upset. Avoid alcohol due to increased risk of GI bleeding.

---

Contraindications:

• Peptic ulcer disease or history of GI bleeding.

• Severe renal dysfunction or history of kidney disease.

• Cardiovascular disease: Use cautiously or avoid in those with recent history of stroke, heart attack, or coronary artery disease.

• Allergy to NSAIDs**: Contraindicated in patients with known hypersensitivity to ibuprofen or other NSAIDs.

• Third trimester of pregnancy: Avoid due to risk of premature closure of the ductus arteriosus.

---

Relevant NCLEX Points:

• Ibuprofen is an NSAID that relieves pain, fever, and inflammation, but can have serious side effects with prolonged use, particularly GI bleeding and kidney damage.

• Major nursing consideration: Monitor for GI issues (ulcers, bleeding), kidney function (BUN, creatinine), and cardiovascular risks (stroke, heart attack).

• Contraindicated in patients with GI disorders, renal impairment, or cardiovascular disease.

• Educate patients about the max daily dose of 3200 mg and the risks associated with long-term use

Naproxen sodium

Generic Name:

• Naproxen sodium

Brand Name:

• Aleve, Anaprox, Naprosyn

---

Drug Class:

• Nonsteroidal Anti-inflammatory Drug (NSAID)

• Analgesic

• Antipyretic

• Anti-inflammatory

---

Mechanism of Action:

• Inhibits cyclooxygenase (COX-1 and COX-2) enzymes, reducing the synthesis of prostaglandins, which are responsible for pain, fever, and inflammation.

---

Indications:

• Pain relief: For mild to moderate pain, including headaches, muscle pain, dental pain, and menstrual cramps.

• Anti-inflammatory: For conditions like rheumatoid arthritis, osteoarthritis, gout, and ankylosing spondylitis.

• Fever reduction: Used to reduce fever.

---

Route:

• Oral: Tablets, caplets, and liquid suspension.

• Topical: Available in gel for localized pain (e.g., joint pain).

---

Side Effects:

• Gastrointestinal (GI): Nausea, dyspepsia, gastritis, ulcers, and GI bleeding (with prolonged use).

• Renal: Risk of kidney damage or renal failure, especially with long-term use or pre-existing kidney conditions.

• Cardiovascular: Increased risk of stroke, heart attack, or hypertension (especially with long-term use).

• Hematologic: Rare bleeding, anemia, or thrombocytopenia.

• Rash: Allergic reactions may cause skin rash.

---

Nursing Considerations:

• Monitor renal function: Assess BUN, creatinine levels, and urine output, especially in older adults or those with kidney disease.

• GI protection: Take with food or milk to minimize irritation. Long-term use may require PPI therapy for gastric protection.

• Monitor for bleeding: Watch for signs of GI bleeding (e.g., black stools, vomiting blood), especially with prolonged use.

• Pain assessment: Reassess pain level to evaluate drug effectiveness.

• Educate patients: Instruct to take the drug with food to reduce GI upset. Encourage patients to avoid alcohol, as it increases the risk of GI irritation and bleeding.

---

Contraindications:

• Active gastrointestinal (GI) bleeding or history of peptic ulcer disease.

• Severe renal dysfunction or renal failure.

• Cardiovascular disease: Use with caution in patients with heart disease, stroke risk, or hypertension.

• Hypersensitivity to NSAIDs: Contraindicated in patients with known allergy to naproxen or other NSAIDs.

• Third trimester of pregnancy: Avoid use due to potential risk of premature closure of the ductus arteriosus.

---

Relevant NCLEX Points:

• Naproxen sodium is an NSAID commonly used for pain relief, fever reduction, and anti-inflammatory effects but carries significant risks with long-term use, including GI bleeding, renal damage, and cardiovascular events.

• Nursing considerations: Monitor kidney function, assess for GI symptoms (bleeding, ulcers), and educate patients to take with food to reduce stomach upset.

• Contraindications: Avoid in patients with active GI bleeding, severe renal disease, or cardiovascular disease. Use cautiously in pregnancy (especially the third trimester).

Meloxicam

Generic Name:

• Meloxicam

Brand Name:

• Mobic

---

Drug Class:

• Nonsteroidal Anti-inflammatory Drug (NSAID)

• Analgesic

• Anti-inflammatory

• Antipyretic

---

Mechanism of Action:

• Inhibits cyclooxygenase (COX-1 and COX-2) enzymes, thereby reducing the production of prostaglandins, which cause inflammation, pain, and fever.

---

Indications:

• Osteoarthritis

• Rheumatoid arthritis

• Juvenile arthritis

• Pain management: Mild to moderate pain, including acute pain and dysmenorrhea.

---

Route:

• Oral: Tablets, including extended-release formulations.

---

Side Effects:

• Gastrointestinal: Nausea, diarrhea, gastritis, dyspepsia, ulcers, GI bleeding (with long-term use).

• Renal: Risk of kidney damage, elevated creatinine, renal failure with prolonged use.

• Cardiovascular: Hypertension, heart failure, stroke (risk increased with long-term use).

• Hematologic: Rare anemia, thrombocytopenia.

• Rash: Possible allergic reaction with skin rashes.

---

Nursing Considerations:

• Monitor kidney function: Assess BUN, creatinine, and urine output, especially in patients with renal impairment.

• GI assessment: Watch for symptoms of GI bleeding, such as black stools, vomiting blood.

• Monitor blood pressure: Check for hypertension during long-term use.

• Take with food: To reduce risk of GI upset and ulcers, advise patients to take with food or milk.

• Educate patients: On potential side effects and the importance of reporting any GI symptoms or signs of bleeding.

---

Contraindications:

• Active GI bleeding or peptic ulcer disease.

• Severe renal dysfunction or renal failure.

• Cardiovascular disease: Use with caution in patients with heart failure, stroke risk, or hypertension.

• Hypersensitivity to meloxicam or other NSAIDs.

• Third trimester of pregnancy: Avoid due to potential for premature closure of the ductus arteriosus.

---

Relevant NCLEX Points:

• Meloxicam is an NSAID primarily used for treating inflammatory conditions like arthritis and pain management.

• Nursing considerations include monitoring kidney function, GI symptoms, and blood pressure during therapy.

• Contraindications: Avoid in patients with active GI bleeding, severe renal impairment, and cardiovascular diseases. Pregnant women (especially in the third trimester) should avoid its use.

• Take with food to minimize gastric irritation.

Ketorolac

Generic Name:

• Ketorolac

Brand Name:

• Toradol

---

Drug Class:

• Nonsteroidal Anti-inflammatory Drug (NSAID)

• Analgesic

• Anti-inflammatory

• Antipyretic

---

Mechanism of Action:

• Inhibits cyclooxygenase (COX-1 and COX-2) enzymes, leading to reduced production of prostaglandins, which mediate inflammation, pain, and fever.

---

Indications:

• Short-term management of moderate to severe pain (e.g., post-surgical pain, trauma)

• Acute pain management (not intended for long-term use)

---

Route:

• Oral: Tablets (usually for short-term use).

• Parenteral: IV or IM (for acute pain).

• Intranasal: Available in certain countries for nasal administration.

---

Side Effects:

• Gastrointestinal: Nausea, vomiting, dyspepsia, ulcers, gastritis, GI bleeding.

• Renal: Kidney damage, elevated creatinine, renal failure.

• Hematologic: Anemia, thrombocytopenia.

• CNS: Headache, dizziness, drowsiness.

• Cardiovascular: Hypertension, fluid retention.

---

Nursing Considerations:

• Monitor kidney function: Check BUN, creatinine, and urine output, especially with prolonged use.

• GI assessment: Monitor for signs of GI bleeding (e.g., black stools, vomiting blood).

• Pain assessment: Ensure adequate pain relief, especially post-surgery.

• Blood pressure monitoring: Watch for elevated BP.

• Short-term use: Ketorolac should not be used longer than 5 days due to risk of renal damage and GI bleeding.

• Educate patient: On side effects, especially signs of GI distress and bleeding.

---

Contraindications:

• Active gastrointestinal bleeding or history of peptic ulcer disease.

• Severe renal impairment or renal failure.

• Hypersensitivity to ketorolac or other NSAIDs.

• Bleeding disorders: Use with caution in patients with coagulation abnormalities.

• Third trimester of pregnancy: Contraindicated due to the risk of premature closure of the ductus arteriosus.

---

Relevant NCLEX Points:

• Ketorolac is a powerful NSAID used for short-term pain management in moderate to severe pain, but it should not be used for more than 5 days.

• Monitor for gastrointestinal bleeding, renal function, and cardiovascular status.

• Contraindicated in patients with GI ulcers, active bleeding, and renal dysfunction.

• Not recommended for long-term use due to risks of renal damage, GI bleeding, and cardiovascular side effects.

Celecoxib

Generic Name:

• Celecoxib

Brand Name:

• Celebrex

---

Drug Class:

• Nonsteroidal Anti-inflammatory Drug (NSAID)

• COX-2 Inhibitor

---

Mechanism of Action:

• Selective inhibition of cyclooxygenase-2 (COX-2) enzyme, which reduces the formation of prostaglandins responsible for inflammation, pain, and fever.

---

Indications:

• Osteoarthritis

• Rheumatoid arthritis

• Acute pain (e.g., from surgery or injury)

• Dysmenorrhea (menstrual pain)

• Ankylosing spondylitis

• Other inflammatory conditions (off-label)

---

Route:

• Oral: Available in capsules.

---

Side Effects:

• Gastrointestinal: Dyspepsia, nausea, diarrhea, abdominal pain, gastritis, GI bleeding (though less common than non-selective NSAIDs).

• Cardiovascular: Hypertension, edema, increased risk of heart attack or stroke with long-term use.

• Renal: Kidney damage, increased serum creatinine, fluid retention.

• CNS: Headache, dizziness, somnolence.

• Skin: Rash, photosensitivity.

---

Nursing Considerations:

• Monitor kidney function: Check BUN, creatinine, and urine output, especially in patients with preexisting renal conditions.

• Monitor blood pressure: Watch for hypertension and edema.

• Assess GI function: Even though Celecoxib is more selective than traditional NSAIDs, monitor for signs of GI bleeding or irritation.

• Assess for cardiovascular risk: Long-term use increases the risk of heart attack or stroke.

• Educate patient: Advise on the importance of taking with food to reduce GI irritation.

• Monitor for signs of allergic reactions, especially in patients with known sulfa allergies.

---

Contraindications:

• Hypersensitivity to Celecoxib or other sulfonamides (due to possible cross-reactivity).

• Active gastrointestinal bleeding or history of peptic ulcer disease.

• Severe liver or renal impairment.

• Coronary artery bypass graft surgery (CABG): Contraindicated for pain management.

• Third trimester of pregnancy: Due to risk of premature closure of the ductus arteriosus.

---

Relevant NCLEX Points:

• Celecoxib is a COX-2 inhibitor with fewer GI side effects compared to traditional NSAIDs.

• Increased risk of cardiovascular events with long-term use, including heart attack and stroke.

• Monitor for GI issues, renal function, and cardiovascular symptoms.

• Contraindicated in patients with a history of GI bleeding, severe liver or renal disease, and sulfa allergies.

• Educate patients to take with food to minimize GI discomfort.

Colchicine

Generic Name:

• Colchicine

Brand Name:

• Colcrys

---

Drug Class:

• Antigout Agent

---

Mechanism of Action:

• Inhibits microtubule polymerization, reducing inflammation by blocking the activation and migration of neutrophils to the inflamed area in gout and familial Mediterranean fever.

• Interferes with leukocyte migration, decreasing the inflammatory response.

---

Indications:

• Acute gout flare: Reduces inflammation and pain during an active gout attack.

• Prophylaxis of gout flares: Prevents future gout attacks when taken daily.

• Familial Mediterranean fever: Reduces inflammation in this genetic condition.

• Other inflammatory conditions (off-label).

---

Route:

• Oral: Available as tablets.

---

Side Effects:

• Gastrointestinal: Diarrhea, nausea, vomiting, abdominal pain (most common).

• Hematologic: Bone marrow suppression, leukopenia, thrombocytopenia.

• Musculoskeletal: Rhabdomyolysis (rare but serious).

• Renal: Acute kidney injury (if used in high doses or with renal impairment).

• Hepatic: Hepatotoxicity (rare).

---

Nursing Considerations:

• Monitor for GI side effects: Common, but if severe, it may require dose adjustment or discontinuation.

• Monitor for signs of bone marrow suppression: Look for bruising, bleeding, fatigue, or fever.

• Renal function: Check BUN, creatinine, and urine output if the patient has existing renal problems.

• Educate patient:

  • Take colchicine at the first sign of a gout attack.

  • Do not exceed recommended dosage to avoid toxicity.

  • Stay hydrated to reduce the risk of renal toxicity.

---

Contraindications:

• Hypersensitivity to colchicine or any of its components.

• Severe renal impairment or hemodialysis: Risk of toxicity due to impaired elimination.

• Severe gastrointestinal disorders (e.g., ileus, intestinal perforation).

• Pregnancy: Category C (use with caution, especially during the first trimester).

• Liver disease: Use cautiously in those with hepatic impairment.

---

Relevant NCLEX Points:

• Colchicine is used in the treatment of gout and familial Mediterranean fever.

• It can cause significant GI distress, which is the most common side effect.

• Monitor for bone marrow suppression, rhabdomyolysis, and renal issues.

• Renal and hepatic impairment may require dose adjustments or avoidance.

• Hydration is key, as it helps avoid renal toxicity.

• Contraindicated in severe renal impairment, GI disorders, and pregnancy (category C).

Allopurionol

• Generic Name: Allopurinol

• Brand Name: Zyloprim

• Drug Class: Xanthine Oxidase Inhibitor

• Mechanism of Action: Inhibits xanthine oxidase, reducing uric acid production in the body.

• Indications:

  • Gout

  • Kidney stones (uric acid-related)

  • Tumor lysis syndrome (to prevent hyperuricemia)

• Route: PO (oral), IV

• Common Side Effects:

  • Rash (including Stevens-Johnson Syndrome – severe!)

  • Nausea, vomiting

  • Increased liver enzymes

  • Drowsiness

• Nursing Considerations:

  • Monitor renal and liver function tests.

  • Encourage increased fluid intake (prevents kidney stones).

  • Take with food to reduce GI upset.

  • Watch for rash → can be life-threatening!

  • Avoid alcohol and purine-rich foods (red meats, shellfish).

• Contraindications:

  • Hypersensitivity to allopurinol

  • Severe kidney or liver disease

• NCLEX Tip:

  • If a rash develops, STOP the medication immediately and notify the provider (Stevens-Johnson Syndrome risk).

Prednisone

• Generic: Prednisone

• Brand: Deltasone

• Class: Corticosteroid

• MOA: ↓ Inflammation, suppresses immune response

• Indication: Asthma, COPD, autoimmune disorders, allergies

• Route: PO

• Side Effects: Hyperglycemia, osteoporosis, weight gain, infection risk, adrenal suppression

• Nursing Considerations: Taper dose, monitor glucose, assess for infection, take with food

• Contraindications: Active infections, peptic ulcers, osteoporosis

• NCLEX Tip: Never stop abruptly—risk of adrenal crisis!

Betamethasone acetate and sodium phosphate

• Generic: Betamethasone Acetate & Sodium Phosphate

• Brand: Celestone

• Class: Corticosteroid

• MOA: ↓ Inflammation, suppresses immune response

• Indication: Preterm labor (lung maturity), inflammation, allergic reactions

• Route: IM, IV

• Side Effects: Hyperglycemia, infection risk, hypertension, osteoporosis

• Nursing Considerations: Monitor glucose, WBC, BP; given to moms <34 weeks for fetal lungs

• Contraindications: Systemic infections, uncontrolled diabetes

• NCLEX Tip: Given to preterm moms to boost fetal lung surfactant production!

Fluticasone

• Generic: Fluticasone

• Brand: Flonase (nasal), Flovent (inhaled)

• Class: Corticosteroid

• MOA: ↓ Inflammation, suppresses immune response

• Indication: Asthma, COPD, allergic rhinitis

• Route: Inhalation, nasal spray

• Side Effects: Oral thrush, hoarseness, cough, nasal irritation

• Nursing Considerations: Rinse mouth after use, not for acute attacks, use bronchodilator first if prescribed

• Contraindications: Acute asthma attack, untreated infections

• NCLEX Tip: Teach patient to rinse mouth to prevent thrush!

Hydrocortisone

• Generic: Hydrocortisone

• Brand: Cortef, Solu-Cortef

• Class: Corticosteroid

• MOA: ↓ Inflammation, suppresses immune response, replaces cortisol

• Indication: Adrenal insufficiency, inflammation, allergic reactions

• Route: PO, IV, IM, topical

• Side Effects: Hyperglycemia, infection risk, osteoporosis, weight gain, adrenal suppression

• Nursing Considerations: Taper dose, monitor glucose & electrolytes, assess for infection

• Contraindications: Systemic infections, peptic ulcers

• NCLEX Tip: Lifelong replacement for Addison’s disease—never stop abruptly!

Triamcinolone acetonide

• Generic: Triamcinolone Acetonide

• Brand: Kenalog

• Class: Corticosteroid

• MOA: ↓ Inflammation, suppresses immune response

• Indication: Dermatitis, eczema, arthritis, allergic reactions

• Route: Topical, IM, inhaled, intranasal

• Side Effects: Skin thinning (topical), hyperglycemia, infection risk, adrenal suppression

• Nursing Considerations: Avoid long-term use, do not apply to open wounds, monitor for systemic effects

• Contraindications: Untreated infections, systemic fungal infections

• NCLEX Tip: Do not cover with occlusive dressing—↑ absorption & side effects!

Penicillin G benzathine

• Generic: Penicillin G Benzathine

• Brand: Bicillin L-A

• Class: Beta-lactam antibiotic (Penicillin)

• MOA: Inhibits bacterial cell wall synthesis → bactericidal

• Indication: Syphilis, strep infections, rheumatic fever prophylaxis

• Route: IM (deep injection)

• Side Effects: Allergic reaction, anaphylaxis, pain at injection site, GI upset

• Nursing Considerations: Monitor for allergy (rash, SOB), do NOT give IV, complete full course

• Contraindications: Penicillin allergy, severe renal impairment

• NCLEX Tip: Always ask about penicillin allergy before giving!

Dicloxacillin

• Generic: Dicloxacillin

• Brand: Dynapen

• Class: Penicillin (Beta-lactam antibiotic)

• MOA: Inhibits bacterial cell wall synthesis → bactericidal

• Indication: Staph infections (MSSA), skin infections

• Route: PO

• Side Effects: Nausea, diarrhea, allergic reaction, superinfection

• Nursing Considerations: Take on an empty stomach, complete full course, monitor for allergy

• Contraindications: Penicillin allergy, renal impairment

• NCLEX Tip: Ask about penicillin allergy before giving!

Ampicillin

• Generic: Ampicillin

• Brand: Principen

• Class: Penicillin (Beta-lactam antibiotic)

• MOA: Inhibits bacterial cell wall synthesis → bactericidal

• Indication: Respiratory, GI, GU, meningitis, sepsis

• Route: PO, IV, IM

• Side Effects: Nausea, diarrhea, rash, allergic reaction, superinfection

• Nursing Considerations: Take on an empty stomach, monitor for allergy, complete full course

• Contraindications: Penicillin allergy, mononucleosis (↑ rash risk)

• NCLEX Tip: Watch for anaphylaxis—have epinephrine ready!

Amoxicillin

• Generic: Amoxicillin

• Brand: Amoxil

• Class: Penicillin (Beta-lactam antibiotic)

• MOA: Inhibits bacterial cell wall synthesis → bactericidal

• Indication: Respiratory, ear, throat, urinary, skin infections

• Route: PO

• Side Effects: Nausea, diarrhea, rash, allergic reaction, superinfection

• Nursing Considerations: Take with food if GI upset, complete full course, monitor for allergy

• Contraindications: Penicillin allergy, mononucleosis (↑ rash risk)

• NCLEX Tip: Ask about penicillin allergy before giving!

Amoxicillin-clavulanate

• Generic: Amoxicillin-Clavulanate

• Brand: Augmentin

• Class: Penicillin (Beta-lactam antibiotic) + Beta-lactamase inhibitor

• MOA: Inhibits bacterial cell wall synthesis & resists beta-lactamase enzyme

• Indication: Respiratory, ear, sinus, skin, UTI infections

• Route: PO

• Side Effects: Nausea, diarrhea, rash, allergic reaction, superinfection

• Nursing Considerations: Take with food, complete full course, monitor for allergy

• Contraindications: Penicillin allergy, severe liver disease

• NCLEX Tip: Clavulanate prevents bacterial resistance—stronger than amoxicillin alone!

Cephalexin

• Generic: Cephalexin

• Brand: Keflex

• Class: Cephalosporin (Antibiotic)

• MOA: Inhibits bacterial cell wall synthesis → bactericidal

• Indication: Skin, respiratory, ear, bone, UTI infections

• Route: PO

• Side Effects: Nausea, diarrhea, rash, allergic reaction, superinfection

• Nursing Considerations: Take with food, monitor for allergy, complete full course

• Contraindications: Cephalosporin or penicillin allergy

• NCLEX Tip: Cross-sensitivity with penicillin—ask about penicillin allergy!

Cefoxitin

• Generic: Cefoxitin

• Brand: Mefoxin

• Class: Cephalosporin (2nd generation antibiotic)

• MOA: Inhibits bacterial cell wall synthesis → bactericidal

• Indication: Intra-abdominal, pelvic infections, surgical prophylaxis

• Route: IV, IM

• Side Effects: Nausea, diarrhea, rash, allergic reaction, superinfection

• Nursing Considerations: Monitor for allergic reactions, check renal function, complete full course

• Contraindications: Cephalosporin or penicillin allergy

• NCLEX Tip: Cross-sensitivity with penicillin—watch for allergic reactions!

Ceftriaxone

• Generic: Ceftriaxone

• Brand: Rocephin

• Class: Cephalosporin (3rd generation antibiotic)

• MOA: Inhibits bacterial cell wall synthesis → bactericidal

• Indication: Pneumonia, UTI, meningitis, gonorrhea, sepsis

• Route: IV, IM

• Side Effects: Nausea, diarrhea, rash, allergic reaction, superinfection

• Nursing Considerations: Assess for allergy, monitor liver/kidney function, give IV slowly

• Contraindications: Cephalosporin or penicillin allergy, neonates (calcium salt risk)

• NCLEX Tip: Can cause biliary sludging in neonates—monitor carefully!

Imipenem-cilastatin

• Generic: Imipenem-Cilastatin

• Brand: Primaxin

• Class: Carbapenem antibiotic

• MOA: Inhibits bacterial cell wall synthesis → bactericidal

• Indication: Severe infections (e.g., pneumonia, UTI, intra-abdominal)

• Route: IV, IM

• Side Effects: Nausea, diarrhea, rash, seizures (rare), allergic reaction

• Nursing Considerations: Monitor for seizures (especially with renal impairment), renal function

• Contraindications: Allergies to beta-lactams, renal impairment

• NCLEX Tip: Cilastatin prevents renal breakdown of imipenem—must always be combined!

Gentamicin

• Generic: Gentamicin

• Brand: Garamycin

• Class: Aminoglycoside antibiotic

• MOA: Inhibits bacterial protein synthesis → bactericidal

• Indication: Severe infections (e.g., sepsis, pneumonia, UTI)

• Route: IV, IM, topical

• Side Effects: Ototoxicity, nephrotoxicity, rash, tremors, vertigo

• Nursing Considerations: Monitor renal function, hearing, drug levels (peak/trough), hydrate

• Contraindications: Renal impairment, hearing loss

• NCLEX Tip: Watch for signs of ototoxicity and nephrotoxicity—do not give with other nephrotoxic drugs!

Neomycin

• Generic: Neomycin

• Brand: Neo-Fradin

• Class: Aminoglycoside antibiotic

• MOA: Inhibits bacterial protein synthesis → bactericidal

• Indication: GI infections, preoperative bowel sterilization, topical infections

• Route: PO, topical

• Side Effects: Ototoxicity, nephrotoxicity, GI upset, rash

• Nursing Considerations: Monitor renal function, hearing, drug levels (peak/trough)

• Contraindications: Renal impairment, hearing loss

• NCLEX Tip: Use caution with other nephrotoxic drugs, watch for hearing/renal toxicity!

Streptomycin

• Generic: Streptomycin

• Brand: No specific brand (generic only)

• Class: Aminoglycoside antibiotic

• MOA: Inhibits bacterial protein synthesis → bactericidal

• Indication: Tuberculosis, plague, tularemia

• Route: IM, IV

• Side Effects: Ototoxicity, nephrotoxicity, rash, fever, joint pain

• Nursing Considerations: Monitor renal function, hearing, drug levels (peak/trough), hydration

• Contraindications: Renal impairment, hearing loss

• NCLEX Tip: Monitor for ototoxicity and nephrotoxicity, avoid with other nephrotoxic drugs!

Ciprofloxacin

• Generic: Ciprofloxacin

• Brand: Cipro

• Class: Fluoroquinolone antibiotic

• MOA: Inhibits bacterial DNA gyrase → bactericidal

• Indication: UTI, respiratory infections, skin infections, anthrax

• Route: PO, IV, ophthalmic, otic

• Side Effects: Nausea, diarrhea, tendon rupture, photosensitivity, headache

• Nursing Considerations: Monitor for tendon pain/swelling, avoid sun exposure, assess for GI symptoms

• Contraindications: Children (risk of tendon rupture), myasthenia gravis

• NCLEX Tip: Avoid antacids—reduce absorption! Watch for tendon rupture, especially in elderly!

Moxifloxacin

• Generic: Moxifloxacin

• Brand: Avelox

• Class: Fluoroquinolone antibiotic

• MOA: Inhibits bacterial DNA gyrase → bactericidal

• Indication: Respiratory infections, skin infections, UTI

• Route: PO, IV

• Side Effects: Nausea, diarrhea, tendon rupture, photosensitivity, dizziness

• Nursing Considerations: Monitor for tendon pain, avoid sun, assess renal function

• Contraindications: Myasthenia gravis, children (tendon rupture risk)

• NCLEX Tip: Avoid antacids—reduce absorption! Watch for tendon rupture!

Tetracycline hydrochloride

• Generic: Tetracycline Hydrochloride

• Brand: Sumycin

• Class: Tetracycline antibiotic

• MOA: Inhibits bacterial protein synthesis → bacteriostatic

• Indication: Acne, respiratory infections, chlamydia, Lyme disease

• Route: PO, IV

• Side Effects: Nausea, vomiting, diarrhea, photosensitivity, tooth discoloration (in children)

• Nursing Considerations: Take on an empty stomach, avoid dairy/antacids, monitor for photosensitivity

• Contraindications: Pregnancy (category D), children <8 years

• NCLEX Tip: Avoid sun exposure—risk of severe sunburn!

Trimethoprim Sulfamethoxazole

• Generic: Trimethoprim-Sulfamethoxazole

• Brand: Bactrim, Septra

• Class: Sulfonamide antibiotic

• MOA: Inhibits folic acid synthesis → bactericidal

• Indication: UTI, respiratory infections, MRSA, pneumonia

• Route: PO, IV

• Side Effects: Nausea, vomiting, rash, photosensitivity, hyperkalemia

• Nursing Considerations: Drink plenty of fluids, monitor kidney function, avoid sun

• Contraindications: Sulfa allergy, renal impairment, pregnancy (near term)

• NCLEX Tip: Watch for allergic reactions—especially rash!

Silver sulfadiazine

• Generic: Silver Sulfadiazine

• Brand: Silvadene

• Class: Sulfonamide antibiotic

• MOA: Inhibits bacterial growth on burn wounds, bactericidal

• Indication: Burn wounds, prevention of infection

• Route: Topical

• Side Effects: Skin rash, burning sensation, allergic reaction, leukopenia

• Nursing Considerations: Apply to clean, dry skin, monitor for signs of infection or irritation

• Contraindications: Sulfa allergy, pregnant (third trimester), infants <2 months

• NCLEX Tip: Monitor for skin irritation and allergic reactions!

Nitrofurantoin

• Generic: Nitrofurantoin

• Brand: Macrobid, Macrodantin

• Class: Antibiotic

• MOA: Inhibits bacterial cell wall synthesis → bactericidal

• Indication: UTI (uncomplicated)

• Route: PO

• Side Effects: Nausea, diarrhea, brown urine, lung toxicity, hepatotoxicity

• Nursing Considerations: Take with food, monitor for signs of lung or liver toxicity, encourage fluid intake

• Contraindications: Renal impairment (CrCl <60), pregnancy at term

• NCLEX Tip: Warn about brown urine—harmless! Monitor lung function in long-term use!

Phenazopyridine hydrochloride

• Generic: Phenazopyridine Hydrochloride

• Brand: Pyridium

• Class: Urinary analgesic

• MOA: Relieves pain, burning, and discomfort in the urinary tract

• Indication: UTI symptoms (pain, burning, urgency)

• Route: PO

• Side Effects: Red-orange urine, headache, dizziness, GI upset

• Nursing Considerations: Inform patients about urine discoloration, avoid long-term use

• Contraindications: Renal impairment, glomerulonephritis

• NCLEX Tip: Warn patients about urine color change—harmless but alarming!

Erythromycin

• Generic: Erythromycin

• Brand: Ery-Tab, EryPed, Erythrocin

• Class: Macrolide Antibiotic

• MOA: Inhibits bacterial protein synthesis (50S ribosome)

• Indication: Bacterial infections (respiratory, skin, STI, etc.)

• Route: PO, IV, Topical, Ophthalmic

• Side Effects: GI upset, hepatotoxicity, QT prolongation, ototoxicity

• Nursing Considerations:

  • Take on an empty stomach with water

  • Monitor liver function

  • Watch for arrhythmias (QT prolongation)

  • Avoid grapefruit juice

• Contraindications:

  • Liver disease

  • QT prolongation

  • Hypersensitivity

• NCLEX Tip: Can be used for penicillin-allergic patients 🚨 Watch for C. diff superinfection!

Azithromycin

• Generic: Azithromycin

• Brand: Zithromax, Z-Pak

• Class: Macrolide Antibiotic

• MOA: Inhibits bacterial protein synthesis (50S ribosome)

• Indication: Respiratory, skin, ear infections, STIs

• Route: PO, IV, Ophthalmic

• Side Effects: GI upset, QT prolongation, hepatotoxicity

• Nursing Considerations:

  • Take on an empty stomach (↑ absorption)

  • Monitor liver enzymes

  • Watch for arrhythmias (QT prolongation)

  • Avoid antacids (↓ absorption)

• Contraindications:

  • Liver disease

  • QT prolongation

  • Hypersensitivity

• NCLEX Tip: Fewer GI effects than erythromycin 🚨 Risk of C. diff superinfection!

Chloramphenicol

• Generic: Chloramphenicol

• Brand: Chloromycetin

• Class: Broad-spectrum antibiotic

• MOA: Inhibits bacterial protein synthesis (50S ribosome)

• Indication: Serious infections (meningitis, typhoid fever, rickettsial infections)

• Route: IV, PO, Ophthalmic

• Side Effects: Bone marrow suppression, aplastic anemia, Gray Baby Syndrome, GI upset

• Nursing Considerations:

  • Monitor CBC (risk of anemia)

  • Watch for signs of infection/bleeding

  • Use only for severe infections (BBW: toxicity)

  • Avoid in neonates (Gray Baby Syndrome)

• Contraindications:

  • Pregnancy

  • Neonates

  • Bone marrow disorders

• NCLEX Tip: 🚨 Can cause fatal blood dyscrasias—monitor blood counts closely!

Metronidazole

• Generic: Metronidazole

• Brand: Flagyl

• Class: Antiprotozoal, Antibacterial

• MOA: Disrupts DNA synthesis in anaerobic organisms

• Indication: C. diff, trichomoniasis, bacterial vaginosis, anaerobic infections

• Route: PO, IV, Topical, Vaginal

• Side Effects: GI upset, metallic taste, dark urine, neuropathy

• Nursing Considerations:

  • 🚫 No alcohol (disulfiram-like reaction)

  • Monitor neurotoxicity (seizures, neuropathy)

  • Take with food to ↓ GI upset

• Contraindications:

  • Pregnancy (1st trimester)

  • Alcohol use

  • CNS disorders

• NCLEX Tip: 🚨 Avoid alcohol during & 48 hrs after treatment!

Vancomycin

• Generic: Vancomycin

• Brand: Vancocin

• Class: Glycopeptide antibiotic

• MOA: Inhibits bacterial cell wall synthesis

• Indication: MRSA, C. diff (oral), severe infections

• Route: IV, PO (for C. diff)

• Side Effects: Nephrotoxicity, ototoxicity, Red Man Syndrome, hypotension

• Nursing Considerations:

  • Monitor kidney (BUN, Cr) & hearing

  • Infuse slowly (Red Man Syndrome prevention)

  • Trough levels before next dose

  • Monitor for superinfection

• Contraindications: Renal impairment, hearing loss, allergy to vancomycin

• NCLEX Tip: Too fast infusion → Red Man Syndrome (rash, flushing, hypotension)

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Isoniazid

• Generic: Isoniazid

• Brand: Nydrazid

• Class: Antitubercular

• MOA: Inhibits mycolic acid synthesis (disrupts TB cell wall)

• Indication: Tuberculosis (TB) treatment & prophylaxis

• Route: PO, IM

• Side Effects: Hepatotoxicity, peripheral neuropathy, B6 deficiency

• Nursing Considerations:

  • Monitor liver (AST, ALT)

  • Give Vitamin B6 (prevents neuropathy)

  • Avoid alcohol

  • Take on empty stomach

• Contraindications: Liver disease, alcohol use, allergy

• NCLEX Tip: Watch for jaundice & numbness/tingling (signs of toxicity)

Rifampin

• Generic: Rifampin

• Brand: Rifadin

• Class: Antitubercular

• MOA: Inhibits RNA synthesis → kills TB bacteria

• Indication: Tuberculosis (TB), meningitis prophylaxis

• Route: PO, IV

• Side Effects: Hepatotoxicity, red-orange body fluids, GI upset

• Nursing Considerations:

  • Monitor liver (AST, ALT)

  • Warn about red-orange urine, sweat, tears

  • ↓ Effectiveness of oral contraceptives

  • Take on empty stomach

• Contraindications: Liver disease, alcohol use, allergy

• NCLEX Tip: Liver toxicity → watch for jaundice, avoid alcohol

Pyrazinamide

• Generic: Pyrazinamide

• Brand: PZA (no common brand name)

• Class: Antitubercular

• MOA: Inhibits fatty acid synthesis → kills TB bacteria

• Indication: Tuberculosis (TB)

• Route: PO

• Side Effects: Hepatotoxicity, hyperuricemia (gout), GI upset

• Nursing Considerations:

  • Monitor liver (AST, ALT)

  • Monitor uric acid levels (watch for gout)

  • Take with food if GI upset

  • Avoid alcohol

• Contraindications: Liver disease, gout, allergy

• NCLEX Tip: Watch for jaundice, joint pain (gout flare-up)

Ethambutol

• Generic: Ethambutol

• Brand: Myambutol

• Class: Antitubercular

• MOA: Inhibits cell wall synthesis → stops TB growth

• Indication: Tuberculosis (TB)

• Route: PO

• Side Effects: Optic neuritis (vision changes), hepatotoxicity, GI upset

• Nursing Considerations:

  • Monitor vision (color blindness, blurred vision)

  • Regular eye exams

  • Monitor liver (AST, ALT)

  • Take with food if GI upset

• Contraindications: Optic neuritis, liver disease, allergy

• NCLEX Tip: Report vision changes immediately!

Nirmatrelvir and Ritonavir

• Generic: Nirmatrelvir + Ritonavir

• Brand: Paxlovid

• Class: Antiviral (Protease Inhibitor)

• MOA: Inhibits viral replication (SARS-CoV-2)

• Indication: COVID-19 (high-risk patients)

• Route: PO

• Side Effects: GI upset, altered taste, liver toxicity, drug interactions

• Nursing Considerations:

  • Monitor liver (AST, ALT)

  • Many drug interactions (CYP3A inhibitor)

  • Take within 5 days of symptoms

• Contraindications: Severe liver/kidney disease, drug interactions

• NCLEX Tip: Check med list (many interactions), start early for best effect

Ganciclovir

• Generic: Ganciclovir

• Brand: Cytovene

• Class: Antiviral

• MOA: Inhibits viral DNA synthesis

• Indication: CMV (cytomegalovirus) infections

• Route: IV, PO, ocular implant

• Side Effects: Bone marrow suppression, nephrotoxicity, GI upset

• Nursing Considerations:

  • Monitor CBC (risk of infection, anemia)

  • Monitor kidney function (BUN, Cr)

  • Avoid in pregnancy (teratogenic)

  • Use contraception (both sexes)

• Contraindications: Pregnancy, severe neutropenia/thrombocytopenia

• NCLEX Tip: Watch for infection signs (low WBCs), renal function monitoring

Ribavirin

• Generic: Ribavirin

• Brand: Virazole

• Class: Antiviral

• MOA: Inhibits viral RNA/DNA synthesis

• Indication: RSV, Hepatitis C (with interferon)

• Route: PO, inhalation

• Side Effects: Hemolytic anemia, teratogenic, hepatotoxicity

• Nursing Considerations:

  • Monitor CBC (anemia risk)

  • Avoid in pregnancy (teratogenic)

  • Use contraception (both sexes)

  • Caution in heart disease

• Contraindications: Pregnancy (Category X), anemia, liver/renal disease

• NCLEX Tip: Pregnant nurses should avoid handling!

Amantadine hydrochloride

• Generic: Amantadine

• Brand: Symmetrel

• Class: Antiviral, Antiparkinsonian

• MOA: Inhibits viral replication, increases dopamine release

• Indication: Influenza A, Parkinson's disease

• Route: PO

• Side Effects: Dizziness, insomnia, nausea, edema, hallucinations

• Nursing Considerations:

  • Monitor mental status (confusion, hallucinations)

  • Caution in renal disease

  • Take with food if GI upset

• Contraindications: Renal impairment, allergy, pregnancy (caution)

• NCLEX Tip: Monitor for neuropsych effects (confusion, agitation)

Oseltamivir Phosphate

• Generic: Oseltamivir

• Brand: Tamiflu

• Class: Antiviral (Neuraminidase inhibitor)

• MOA: Inhibits viral enzyme → prevents virus release

• Indication: Influenza (A & B), prophylaxis

• Route: PO

• Side Effects: Nausea, vomiting, headache, neuropsychiatric effects

• Nursing Considerations:

  • Start within 48 hours of symptoms

  • Take with food to reduce GI upset

  • Monitor for behavioral changes (especially in children)

• Contraindications: Hypersensitivity

• NCLEX Tip: Take as prescribed, watch for unusual behavior changes

Lamivudine

• Generic: Lamivudine

• Brand: Epivir

• Class: Antiviral (NRTI)

• MOA: Inhibits viral reverse transcriptase → prevents HIV replication

• Indication: HIV, Hepatitis B

• Route: PO

• Side Effects: Headache, nausea, fatigue, lactic acidosis, hepatomegaly

• Nursing Considerations:

  • Monitor liver (AST, ALT)

  • Monitor for lactic acidosis, pancreatitis

  • Take with or without food

• Contraindications: Hypersensitivity, severe renal impairment

• NCLEX Tip: Monitor for liver function & lactic acidosis signs (muscle pain, fatigue)

Zidovudine

• Generic: Zidovudine

• Brand: Retrovir

• Class: Antiretroviral (NRTI)

• MOA: Inhibits HIV reverse transcriptase → prevents replication

• Indication: HIV, prevention of maternal-to-child HIV transmission

• Route: PO, IV

• Side Effects: Anemia, neutropenia, lactic acidosis, hepatotoxicity

• Nursing Considerations:

  • Monitor CBC (risk of anemia, neutropenia)

  • Monitor liver function (AST, ALT)

  • Take with or without food

• Contraindications: Hypersensitivity, severe liver disease

• NCLEX Tip: Watch for anemia, lactic acidosis, and liver toxicity signs