Pharmacology & Course Prep – Comprehensive Class Notes

Administrative / Course Logistics

• Upcoming EXAM:
  • Practice test required; take screenshots of results.
  • Identify 5 items missed, answer two reflective questions for each, and create a concept map.
  • If <5 items are missed, still submit reflections for the actual number missed.
  • Extra time: use it to retake or practise more questions.
• Review sessions (Zoom):
  • Mental-health content: Sunday 17:00–18:00.
  • Pharmacology content: Sunday 18:00–19:00.
• Class times:
  • Regular lecture until 11:30 tomorrow, then working lunch (usually Chick-fil-A / pizza).
  • August 16–17 reserved for HESI/NCLEX review (keep calendars clear).
• Clickers for in-class polling are being replaced (Amazon delivery by 07:00 tomorrow).

Licensing & OBN (Board of Nursing) Application

• E-mail sent ~11:45 a.m. yesterday with:
  • Link to OBN online application.
  • Fingerprinting instructions (must be repeated even if done in the past; paid by school).
• Critical fields when filling form:
  • "Do you currently have a license?" → answer accurately.
  • "Where are you working with that license?" → DO NOT leave blank or fill incorrectly; errors create long delays.
• Choose one state licence (single-state). Multi-state licences require extra steps/fees.

Pharmacology Foundations

Medication-Safety Hierarchy

• Use Maslow, ABCs, & safety priority frameworks when triaging drug questions.
• Older adults & neonates = highest risk due to:
  • ↓ hepatic & renal metabolism.
  • Immature/declining organ function.
• Pregnant clients: avoid teratogens ("terato" = monster-forming).

Evaluating Drug Therapy

• Always assess intended effect and side/adverse/toxic effects:
  • Examples:
  • $\text{β-blocker} \rightarrow$ check BP/HR (desired ↓) ↔ dizziness, bradycardia (side) ↔ heart block (toxic).
  • Therapeutic drug monitoring: lithium, digoxin, phenytoin, vancomycin, theophylline, aminoglycosides (trough & peak).
• Hold a dose (do not discontinue) for:
  • NPO/vomiting, profound hypotension, HR 3c 60, etc.
  • Notify provider of hold.

Common Lab Targets

• INR (warfarin): $2.0!\text{–}!3.0$ (typical therapeutic).
• Lithium: $0.6!\text{–}!1.2\,\text{mEq/L}$ (toxic ≥ $1.5$).
• Digoxin: $0.5!\text{–}!2.0\,\text{ng/mL};$ hypokalaemia ↑ toxicity.
• HbA1c goal: <!6.5\%–$7\%$ for good diabetic control.

Key Medication Interactions & Contraindications

• Calcium/antacids bind many PO meds → separate by ≥2 h.
• Grapefruit/grapefruit juice inhibits CYP-450 → ↑ serum statins, CCBs, etc.
• Herbs that ↑ bleeding (avoid with anticoagulants):
  • Ginkgo, garlic, ginseng, ginger, fish-oil, vit-E.
• St. John’s wort ↓ efficacy of OCPs & can cause serotonin syndrome with SSRIs/SNRIs.
• Alcohol is contraindicated with most CNS depressants & hepatotoxic drugs ("No alcohol" is the safest exam answer).

Medication Order Requirements (NCLEX format)

• Must contain: Client name, drug, dosage, route, frequency/time, duration, PRN indication.
  • Example of an incomplete order: “Morphine 2 mg IV q3–12 h PRN” (missing route & PRN reason).

Strategies for Unknown Questions

• If you know the class, guess the body system for side effects:
  • PPI → GI complaints.
  • CNS drugs → fatigue, dizziness, sedation.
• Eliminate opposites (one is likely correct) & outliers (foot-pain for antidepressant? unlikely).
• Watch qualifiers: “common side effect” vs. “most serious adverse effect.”

Drug-Class Suffix Cheat Sheet

Autonomic Nervous System Refresher

• Sympathetic (adrenergic): “Fight or flight” – ↑ HR/BP, bronchodilation, ↓ GI motility.
• Parasympathetic (cholinergic): “Rest & digest” – ↑ saliva, GI peristalsis, urination.
• Anticholinergic effects mnemonic: “Can’t see, can’t pee, can’t spit, can’t ****.”
  • Pupillary dilation, urinary retention, dry mouth, constipation.

Drug-Specific Clinical Pearls

β-Blockers (e.g., propranolol)

• Teach to change position slowly → orthostatic hypotension.
• Masks adrenergic signs of hypoglycaemia; rely on glucose checks, not sweating/tachycardia.
• Contra- or caution: reactive airway disease (bronchoconstriction).

Lactulose

• Osmotic laxative that traps $NH_3$ in gut for hepatic encephalopathy.
• Goal: ↓ ammonia (e.g., $120 \rightarrow 70\,\mu\text{mol/L}$) even if diarrhoea occurs.
• Do NOT give antidiarrheals; diarrhoea is therapeutic.

MAOIs (phenelzine, tranylcypromine)

• Avoid tyramine (aged cheese, smoked meats, wine, beer) → hypertensive crisis.
• Dizziness? Teach to stand up slowly (orthostatic hypotension common).
• Compatible foods: fresh apples (low tyramine).

Lithium Carbonate

• Maintain consistent Na⁺ intake; ↓ salt → ↑ lithium levels (toxicity).
• Early toxicity: N/V/D, tremor, blurred vision.
• Monthly levels during initiation, then q3–6 mo.

Amphotericin B

• "Ampho-terrible" → nephrotoxicity; monitor BUN/Cr – rising labs demand provider notification.
• Premedicate for infusion reactions (fever, chills).

Warfarin + SSRI/SNRI

• SSRIs inhibit platelet aggregation → additive bleeding risk with warfarin.

Vancomycin

• Rapid infusion → Red Man Syndrome (flushing/itching neck-up). Not allergy.
• Slow rate & pre-treat with antihistamine.

Digoxin

• Hold if HR < $60\,\text{bpm}$ (adults).
• Hypokalaemia (K⁺ < $3.5\,\text{mEq/L}$) ↑ toxicity risk even if serum dig level therapeutic.

Lisinopril

• Effectiveness: drop in BP (compare pre-/post-dose).
• Life-threatening: angio-edema (stop, give epinephrine).

Promethazine

• Antiemetic acting on CNS; common side effect: drowsiness/sedation (safety precautions).

Loperamide

• Antidiarrheal; effectiveness = formed stools & ↓ frequency, not hard pellets or N/V.

Theophylline

• Methylxanthine bronchodilator; structurally like caffeine.
• Avoid coffee/tea/colas → toxicity (tachy, seizures).

IV Infusion & Fluid Safety

• In suspected fluid overload (dyspnoea, crackles, chills) after rapid infusion:
  1. Stop/slow IV first.
  2. Assess VS, lung sounds.
  3. Notify provider.

Exam-Style Practice Highlights

1. Propranolol newly prescribed – teach to monitor BP/HR & rise slowly.
2. Lactulose decreased ammonia from $120 \rightarrow 70$ – continue medication.
3. Lithium pt complains of blurred vision – HOLD & evaluate (toxic sign).
4. MAOI pt feels dizzy – advise slow position changes.
5. Amphotericin B creatinine rises – potential nephrotoxicity.
6. Warfarin + SSRI – increased bleeding risk.
7. Allowed MAOI food – fresh apples.
8. Digoxin pt with K⁺ $2.9$ – greatest concern (toxicity risk).
9. Vancomycin “neck & face flushing” – Red Man Syndrome; slow infusion.
10. Lisinopril post-dose SBP $118 \rightarrow 100$ – intended effect achieved.

Ethical / Practical Implications

• Always verify OTC/herbal use; clients rarely perceive them as medication.
• Alcohol disclaimers protect liver & reduce CNS potentiation; safest universal guidance.
• Clear, complete prescriptions reduce med-error litigation.

Study & Test-Taking Tips

• Learn by class + suffix recognition; memorizing hundreds of uniques is inefficient.
• For side-effect questions, first decide whether they want common vs. serious vs. toxic.
• Read every word – “allowed” vs. “contraindicated” flips the answer.
• When two options are direct opposites, one is often correct.
• Talk through pathophysiology aloud to cement understanding (peer teaching).

Quick Reference: Anticholinergic vs. Cholinergic

Last-Minute Reminders

• Bring clicker & laptop fully charged.
• Check e-mail spam folder if class e-mails missing.
• Keep practicing NCLEX-style pharmacology stems; focus on why not just what.