NCLEX Medication List
Generic (Brand)
Hydromorphone
(Dilaudid)
Insulin detemir
(Levemir)
Metformin
(Glucophage)
Clue
1. This analgesic
is used for a
client with
moderate to
severe pain.
2. This
medication
replaces a
missing
pancreatic
hormone.
3. This
medication may
cause a buildup
of lactic acid in
the body.
Speaker Notes
C Class: Opioid agonist
Indications: Moderate to severe pain.
SE: Respiratory depression, nausea
Ask: What should the nurse do if the client has a respiratory rate of 10
while on IV Hydromorphone?
Answer: Stop hydromorphone ; contact the provider
[have naloxone on hand if needed, oxygen 2L/BNC]
Class: Long acting insulin [ Onset 1-2 hours, duration up to 24 hours]
Indication: Type 1 & 2 diabetes mellitus.
SE: Nausea, vomiting, hypoglycemia,
Ask: Is detemir given prior to meals to control postprandial blood
glucose?
Answer: No, peak time is 6-8 hours. [May be taken in evenings]
Class: Oral anti-diabetic; [biguanide]
Indication: Type 2 diabetes
SE: Anorexia, nausea, and diarrhea.
[Toxicity results in lactic acidosis. Glucophage is held 48 hours before and
after iodinated contrast dye because the dye may cause renal failure,
which would increase the harm from lactic acidosis.]
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Methylergonovine
(Methergine)
4. This
medication
might be used
postpartum for a
woman who
delivered twins.
Ask: Is hypoglycemia an expected effect?
Answer: It is a rare occurrence unless combined with other
medications that lower glucose.
Class: Ergot Alkaloid
Indication: Postpartum bleeding.
SE: Nausea, headache; [life-threatening] hypertension
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Ask: What places a woman at risk for postpartum hemorrhage?
Answer: Uterine atony, laceration, impaired maternal clotting,
retained placenta fragments
Common causes of uterine atony include:
 Multiple gestation pregnancy (twins, large baby over-stretched uterus)
 Long labor, grand multipara (overworked uterus)
Methotrexate
(Mexate)
5. This is a
DMARD: disease
modifying antirheumatic drug.
Class: Antineoplastic; Immunosuppressant
Indication: Some types of cancer; rheumatoid arthritis (RA); psoriasis,
Crohn’s Disease
SE: Nausea, vomiting, diarrhea, elevated LFTs, fatigue, renal failure,
pulmonary fibrosis
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Ask: How does methotrexate improve symptoms of RA?
Answer: Immunosuppression [reduces inflammatory processes]
Gabapentin
(Neurontin)
6. This
medication is
approved for
epilepsy but is
often used for
neuralgia.
Class: Anticonvulsant
Indication: Partial seizures, neuropathic pain
SE: Drowsiness, dizziness, fatigue
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Ask: Why is gabapentin most effective 3 x/day?
Answer: Doses peak in 2-3 hrs
[Gabapentin is rapidly absorbed following oral dosing and reaches peak
plasma levels in 2 to 3 hours]
RA is an autoimmune condition. Methotrexate causes immunosuppression
which will help decrease inflammation caused by RA.
Nitroglycerin
7. Don’t take this
medication with
tadalafil! (Cialis)
Class: Organic Nitrate
Indication: Angina
SE: Headache, hypotension, tachycardia
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Oxytocin (Pitocin)
8. This
medication
might be used to
induce or
augment labor.
Ask: What safety precautions should the nurse implement?
Answer: Fall Risk ( vasodilation causes dizziness)
Class: Uterine stimulant
Indication: Induce or augment labor; post-partum hemorrhage
SE: Tachysystole, Uterine rupture, elevated BP, fetal hypoxia
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Ask: What is a tocolytic?
Answer: The opposite of oxytocin: Relaxes myometrium
Examples of tocolytics:
terbutaline, indomethacin, nifedipine, nitroglycerin, atosiban
Maternal hypertension, uterine tachysystole, and late FHR decelerations or
other signs of fetal distress may be indications to stop the oxytocin
perfusion.
Pantoprazole
(Protonix)
9. This
medication is
often used to
prevent GERD in
hospitalized
clients.
Uterine tachysystole is defined as more than 5 contractions within a 10
minute period, a series of contractions lasting more than 2 minutes each,
or contractions of normal duration that occur within 1 minute of each
other.
Class: Proton pump inhibitor (suffix: prazole)
Indication: GERD
SE: Diarrhea, osteoporosis, pneumonia
Long-term therapy can cause:
Osteoporosis and fractures (may inhibit calcium absorption)
C-diff, hospital-acquired infections
Hypomagnesemia
Rebound reflux after discontinuing
Gastric cancer, with very long-term use

Ask: When and why is a client at risk for pneumonia when using
pantoprazole?

Risperidone
(Risperdal)
10. A decrease in
hallucinations
and delusions
should be seen
with this
medication.
Answer: Initially there is an alteration in GI flora/impairment of
WBCs
Medication: Risperidone
Class: Atypical antipsychotic
Indication: Schizophrenia, acute bipolar mania, autism
SE: Weight gain, dyslipidemia, diabetes [ orthostatic hypotension and
sedation]. EPS risk increases with dose. EPS risk is substantial with depot
form
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Ask: Why does the client using risperidone need routine blood
tests?
Answer: To monitor for elevated cholesterol and hyperglycemia
Follow-up by asking students about normal cholesterol level: Less than 200
mg/dL
Methylprednisolone
(Solu-Medrol)
Budesonide/
formoterol
(Symbicort)
11. Prolonged
use of this
injection may
cause Cushing’s
Syndrome.
(Note: IM or IV
routes)
12. This inhaled
medication is
used to prevent
asthma attacks.
Class: Glucocorticoid (suffix: solone)
Indication: Inflammation
SE: Euphoria, Infection, Cushing’s syndrome


Ask: What are symptoms of Cushing’s syndrome?
Answer: Buffalo hump, moon face, general weakness,
hypokalemia, hyperglycemia, hypernatremia
Class: Glucocorticoid/bronchodilator. (suffix: terol)
Indication: Prophylaxis in chronic restrictive airway diseases (asthma,
COPD)
SE: GI upset, infection


Ask: Why does this medication place the client at risk for
infection?
Answer: Immunosuppression [Steroids suppress the immune
system.]
This medication is administered by inhalation
Discontinuing abruptly may cause adrenal insufficiency
Levothyroxine
(Synthroid)
13. This hormone Class: Hormone
should be taken
Indication: Hypothyroidism
after rising in the SE: Tachycardia, nervousness, insomnia
morning and
before eating.
 Ask: Why is levothyroxine prior to eating breakfast ?
 Answer: Absorbed best when taken on an empty stomach; ↑
metabolic rate may cause interference with sleep
Many drug interactions
• Many GI drugs reduce the effect of thyroid hormone
• Some antiepileptics, rifampin, sertraline increase effect
• Thyroid hormone accelerates breakdown of warfarin and increases
cardiac response to catecholamine's (epinephrine, dopamine,
dobutamine)
• Can ↑ requirements for digoxin and insulin
Vancomycin
(Vancocin)
14. A client with
an intestinal
infection caused
by clostridium
difficile is likely
to receive this
medication.
Class: Antibacterial – glycopeptide. (Vancomycin is NOT an
aminoglycoside, despite the common suffix, “mycin”.
Indication: Clostridium difficile, MRSA [drug of choice for client who has
penicillin allergies.]
SE: Nephrotoxicity, “red man syndrome”
Many side effects:
• Major toxicity: nephrotoxicity → renal failure
• Ototoxicity is rare and usually reversible
• Thrombophlebitis
• Immune mediated thrombocytopenia
• Rapid IV infusion can cause ‘Red man syndrome’
characterized by flushing, rash, chills, pruritus,
urticarial, tachycardia, and hypotension
(collectively known as “red man syndrome”) Infuses over 1 hr


Ask: What labs would the nurse monitor for signs of
nephrotoxicity?
Answer: Blood urea nitrogen (BUN): 10-20 mg/dL, serum
creatinine: 0.6-1.2 mg/dL
NOTE: Peak and trough levels drawn to monitor therapeutic levels
Draw trough level 15 minutes prior to administration, Draw peak level 30
minutes after IV administration
Piperacillin/
tazobactam
(Zosyn)
15. Clients
allergic to
penicillin should
not take this
medication.
Class: Antibiotic (an extended-spectrum penicillin)/beta-lactamase
inhibitor (suffix: cillin)
Indication: Bacterial infection
SE: GI upset, leukopenia.


Ask: What client allergy should alert the nurse?
Answer: Allergy to penicillin. [Zosyn is a combination drug and
classified as an extended release penicillin. ]
Crossword
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A completed crossword follows the Speaker Notes.
Down numbers, in the left column, are shaded in grey.
Crossword slides open with the location on the crossword.
Next to animate is: Class, Indications, and Use. These are also on the HO.
Please ask the group for their answer/s.
Fly in the answer.
Fly in, ask, and discuss the application question.
Across
2
Generic /Brand
Clue
Clopidogrel / Plavix
Anti-platelet.
Uses: prevent MI &
CVA.
SE: bleeding,
hemorrhage.
Speaker Notes: Ask the group for answers. Focus on application of information
as it might occur in an NCLEX question for an entry level nurse.
Class: Platelet Aggregation Inhibitor
Indication: Prevent stenosis after cardiac stent placement, MI & CVA prevention
SE:
Abdominal pain, dyspepsia, diarrhea, rash bleeding, hemorrhage
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Ask: What would you assess in a client taking clopiogrel?
Answer: H&H, epistaxis, bruising and bleeding
Clopidogrel is a platelet aggregation inhibitor; platelets can’t aggregate, or ‘stick
together’. This reduces the risk of clot formation.
Must stop 5 days prior to elective surgery.
4
Lithium / Eskalith
Mood Stabilizer
Use: BPD.
SE: tremors, polyuria.
Toxicity: GI upset,
CNS changes,
convulsions, coma,
death.
Class: Mood stabilizer
Indication: Bipolar disorder: control of manic episodes and prophylaxis
SE: Tremors, polyuria
Toxicity: GI upset, CNS changes, convulsions, coma, death
 Ask: What are the signs of toxicity?
 Answer: Vomiting, diarrhea, drowsiness, slurred speech
Reinforce the following information with students:
 Therapeutic level is 0.4-1.4 mEq/L.
 A level > 2mEq/L is considered toxic; >2.5 mEq/L death can occur
 S/S of toxicity include: tremor, ataxia, dysarthria, nystagmus, renal
impairment
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To avoid toxicity sodium intake should be consistent (lithium is a salt);
hyponatremia precipitates toxicity. NSAIDS also can cause toxicity.
Dehydration can put the client at risk for toxicity For that reason caffeine
should be avoided because of the diuretic effect.
Lithium is pregnancy Category D – should only be used when there are no
alternatives and the benefits clearly outweigh the risks.
5
Haloperidol / Haldol
Antipsychotic.
Uses: schizophrenia;
acute psychosis;
Tourette’s.
SE: neutropenia; high
risk of EPS.
11 Zolpidem / Ambien
Sedative-hypnotic.
Use: insomnia.
SE: changes in
behavior and mental
health; sleep walking.
Class: Antipsychotic
Indication: Schizophrenia; Acute psychosis; Tourette’s
SE: Mild leukopenia, EPS (high risk), TD, laryngospasm, respiratory depression,
NMS
 Ask: What are the symptoms of neuroleptic malignant syndrome?
 Answer: Rigidity, sudden high fever, blood pressure instability
 Follow-up:
What are signs of EPS? Dystonia; akathisia (can’t sit still); tardive dyskinesia.
What is Tourette’s syndrome? Involuntary movements and vocalizations called
‘tics’.
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Class: Sedative-hypnotic (most widely-used)
Indication: Short-term treatment of insomnia
SE: Dizziness, daytime drowsiness, sleep complex behaviors (like sleepdriving), depression
Ask: What changes in behavior and mental health may occur?
Answer: Sleep complex behaviors: sleep walking, sleep driving, sleep eating,
etc.); depression
Drugs affecting the CNS should be avoided: alcohol, antidepressants, anti-seizure,
and tranquilizers.
Zolpidem is absorbed very quickly; it should be taken right at bedtime.
12 Esomeprazole /
Nexium
PPI.
Uses: GERD; gastric
ulcer.
SE: headache;
diarrhea;
osteoporosis.
Class: Proton Pump Inhibitor (Almost chemically identical to omeprazole) (suffix:
prazole)
Indication: GERD, gastric ulcers
SE:
Same as omeprazole: pneumonia, osteoporosis/fractures, rebound
heartburn when d/ced, vertigo, agitation, depression, N&V, diarrhea,
constipation, abd. pain, dry mouth
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Ask: When is esomeprazole taken?
Answer: 1 hour prior to eating (allows medication to reach effective level
prior to eating and stimulation of gastric acid).
Change in gastric acid affects absorption of nutrients and medications; Examples:
calcium and B12 absorption are impaired.
Use of PPI for >1 year may increase hip fracture by 44%.
14 Amiodarone /
Cordarone
Antidysrhythmic.
Uses: a-fib; v-fib; vtach.
SE: lung damage;
heart failure; liver &
thyroid toxicity.
16 Aripiprazole / Abilify
Atypical
antipsychotic.
Uses: schizophrenia;
BPD, major
depression; autism.
SE: headache;
agitation; EPS (low
risk).
Class: Antidysrhythmic
Indication: Approved only for recurrent V-fib and recurrent unstable V-tach; not
approved for A-fib but used widely to treat
SE: Lung damage, heart failure; liver and thyroid damage; toxicity can continue
for weeks or months after drug is d/c’d due to very long half-life
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Bradydysrhythmias can occur which could lead to hypotension.
The client should not consume any grapefruit (can ↑ levels of medication).
NCLEX tip: when administering antipsychotics – think safety. What would you
look for? Fall risk, dizziness, impaired thinking/cognition, driving a motor vehicle.
Class: Atypical antipsychotic (note that even though it has a “prazole” suffix, this
is not a PPI)
Indications: Schizophrenia; major depressive disorder; bipolar mania, autism.
SE: Anxiety, insomnia, agitation, EPS (low risk)
Low risk for EPS and neuroleptic malignant syndrome
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20 Epoetin / Epogen,
Procrit
Colony stimulating
factor.
Use: anemia from
chronic kidney
disease;
perioperative.
SE: blood clots.
Ask: What findings indicate respiratory failure?
Answer: Dyspnea, diminished breath sounds, rales, friction rub
Ask: What mental health safety concerns are associated with this
medication?
Answer: Increased depression, suicidal ideation
Class: Growth factor
Indication: Anemia of chronic kidney disease; chemotherapy-induced anemia
(carefully – hgb ↑ 12 gm/dL due to epoetin is associated with accelerated
tumor grow), HIV clients taking zidovudine, anemia in preoperative clients
SE: HTN, thrombotic stroke, clotting of AV fistula
Risk for cardiovascular events are greatest when hgb exceeds 11gm/dL or the rise
in hgb, within two weeks of receiving therapy, exceeds 1gm/dL; medication is
held if either of these occur
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Ask : What labs should the nurse monitor?
Answer: H&H, CBC, BUN, potassium, iron
What is erythropoietin? Hormone released by kidneys when O2 levels are low.
Stimulates production of RBCs.
Routes: SQ or IV.
21 Risedronate /
Actonel
Bisphosphonate.
Use: osteoporosis.
SE: jaw problems;
pain in bones,
muscles, and joints.
Class: Biophosphonate
Indication: Osteoporosis
SE: Bone pain, leg cramps, colitis
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
Ask: How is risedronate taken?
Answer: With a full glass of water; after taking: must sit or stand and
remain NPO for 30 minutes to one hour
Note: The delayed release tablets must be taken immediately after breakfast.
Follow-up:
Ask students what increases risk for osteoporosis: Heredity, immobility,
menopause, Paget’s disease, Cushing’s
What diet is important? One high in calcium and vitamin D.
22 Pregabalin / Lyrica
Anticonvulsant.
Use: neuralgia,
partial seizures,
fibromyalgia.
SE: changes in
behavior or mood;
muscle twitching;
confusion.
Class: Anticonvulsant
Indication: Post-herpatic and diabetic neuralgia, partial seizures, fibromyalgia
SE: Dizziness (most frequent SE), somnolence, weight gain, blurred vision,
difficulty thinking, H/A, peripheral edema, dry mouth, ataxia
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Ask: How would the nurse assess pain in a nonverbal patient
Answer: Observe for grimacing, guarding, restlessness; Determine if client
can communicate by pointing, nodding, blinking. Consider if pain is
expected with client’s condition. Remind students that non-verbal patients
are more likely to have their pain needs neglected. (Students may come up
with additional answers.)
NCLEX tip: effectiveness is assessed based upon the ‘use’ of a medication. For
example, what would the nurse assess if pregabalin is used for:
Fibromyalgia? Reduction in the S&S of pain, headache, fatigue, depression, etc.
Partial seizures? Reduction in seizure activity.
Diabetic neuralgia? Reduction in pain (not blood glucose levels).
23 Aspart / Novolog
Insulin. Rapid –
acting.
Use: Type 1 & 2
diabetes mellitus.
SE: Hypoglycemia
Class: Insulin (Rapid-acting)
Indication: Type 1 and type 2 Diabetes Mellitus
SE:
Hypoglycemia
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
Ask: When is insulin aspart given in relationship to food?
Answer: 5-10 minutes before eating a meal.
Follow-up:
What is the onset/peak/duration of action? Onset 10-20 minutes; Peak 40-50
minutes; Duration 3-5 hours
Note: NovoLog Mix 70/30 (aspart/aspart protamine) is given 15 minutes prior to
a meal.
24 Diltiazem / Cardizem
Ca++ Channel
Blocker. Uses: HTN;
angina; a-fib; aflutter; SVT.
SE: heart failure;
peripheral edema.
25 Varenicline / Chantix
Smoking cessation
aid.
Use: Aid efforts to
stop smoking.
SE: change in
appetite; unusual
dreams.
Down:
1 Furosemide / Lasix
Loop diuretic.
Uses: renal failure;
heart failure.
SE: hypokalemia;
ototoxicity.
Class: Calcium Channel Blocker
Indication: HTN; Angina; A-fib; A-flutter; SVT
SE: Heart failure; peripheral edema
 Ask: What are the signs and symptoms of heart failure?
 Answer: Weight gain, dyspnea, edema
How does this medication work? Diltiazem produces vasodilation and a reduction
in heart rate (in part by ‘calming’ SA & AV node).
Which VS is important to check? BP. Why? Vasodilation which may decrease BP.
Pulse. Why? Diltiazem affects the conductivity in the heart.
What assessment findings may indicate heart failure? Weight gain, dyspnea,
edema.
Class: Smoking cessation aid
Indication: Aid efforts to stop smoking
SE: Nausea, anorexia, unusual dreams, mood changes, suicidal thoughts
 Ask: How long will the client expect to take varenicline?
 Answer: 12 weeks
The client should start taking 1 week prior to stop-smoking-date.
Blocks pleasant feelings from nicotine.
Class: Loop diuretic
Indication: Heart failure, renal or hepatic failure, uncontrolled HTN, pulmonary
edema
SE:
Hypokalemia; ototoxicity
Ask: How would the nurse assess for ototoxicity?
Answer: Observe for s/s of hearing loss: Indifference, turning up volume on TV,
irritability when conversing (students may come up with others)
Remind students that a baseline hearing test may be indicated prior to
medication initiation.
A client received IV furosemide. After 15 minutes there is no increase in UO.
What should the nurse do? Check for obstruction of the catheter tubing; listen to
lung sounds. UO should increase within 5 minutes of IV furosemide.
A client received oral furosemide. After 15 minutes there is no increase in UO.
What would the nurse do? Continue to assess. UO should increase about 60
minutes after an oral dose of furosemide.

Note: furosemide is available in oral, sublingual, IV and IM routes.
3
Levofloxacin /
Levaquin
Fluoroquinolone.
Uses: pneumonia,
sinusitis, skin
infection.
SE: tendonitis,
photosensitivity.
Class: Antibiotic – Fluroquinolone
Note: -floxacin is a common suffix for fluroquinolones
Indication: Pneumonia; Sinusitis; Skin infections
SE: Tendonitis, photosensitivity
Ask: What should the nurse do if a client experiences joint pain while taking
levofloxacin?
Answer: Hold the next dose, place client on bed rest, and call provider.
Levofloxacin, and other fluroquinolones, may cause tendonitis and/or tendon
rupture during therapy and up to several months after therapy ends.
[Associated with tendonitis/tendon rupture ]
6
Atorvastatin / Lipitor
Statin.
Uses: lower
cholesterol & LDL;
raise HDL.
SE: rhabdomyolysis;
hepatotoxicity.
Tip: Suffix: -statin.
Class: Statin (suffix: statin)
Indication: Lower cholesterol & LDL levels; Raise HDL levels.
SE: Rhabdomyolysis; hepatotoxicity
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Ask: What labs should be assessed for side effects?
Answer: LFT: ALT/AST; rhabdomyolysis: myoglobin, CK
Follow-up:
What labs should be assessed for effectiveness? Cholesterol, LDL/HDL,
triglygerides
Grapefruit, alcohol are contraindicated.
7
Sildenafil / Viagra
Phosphodiesterase
inhibitor.
Use: ED.
SE: flushing, erection
lasting >4 hours, MI.
Tip: suffix –afil
Class: Phosphodiesterase inhibitor (suffix: afil)
Indication: Erectile dysfunction
SE: Hypotension, priapism, flushing, HA
Ask: Why is sildenafil contraindicated with NTG?
Answer: Life-threatening hypotension can occur.
The client must wait 24 hours after sildenafil to take a nitrate; Sildenafil is
absolutely contraindicated in men who are already taking nitrates
8
Sertraline / Zoloft
SSRI.
Uses: depression,
OCD, PTSD, panic
attacks.
SE: weight changes,
drowsiness, loss of
libido, hallucinations,
insomnia.
Class: SSRI
Indication: Depression, OCD, PTSD, Panic attacks
SE:
Insomnia, agitation, weight gain, sexual dysfunction; suicidal thoughts
 Ask: How many days should the client be instructed to wait when
stopping an MAOI and starting Sertraline?
 Answer:
MAOI should be withdrawn at least 14 days prior to
starting sertraline (and the reverse – sertraline should be withdrawn at
least 14 days prior
to starting an MAOI) due to risk of serotonin
syndrome
Follow-up:
Ask students for s/s of serotonin syndrome: Fever, excessive sweating, agitation,
diarrhea, heart and blood pressure changes, myoclonus, hyperreflexia, tremors,
and loss of coordination
Note: SSRI’s should not be stopped suddenly. Use in children and adolescents
may cause suicidal ideation. Alcohol should be avoided.
9
Fentanyl / Duragesic
transdermal
Narcotic Analgesic.
Use: chronic pain not
responding to other
analgesics.
SE: addiction,
respiratory
depression.
Class: Narcotic (opioid) analgesic
Indication: Chronic pain; surgical analgesia, control of breakthrough pain in
clients taking other opioids
SE:
Respiratory depression, sedation, constipation, urinary retention
Ask: How long is the patch worn?
Answer: 72 hours
The transdermal patch (Duragesic) is worn for 3 days; full analgesic effect takes
24 hours; short-term pain med may be required during that time.
Follow-up:
Ask students about considerations re: patch: Direct heat (heating pads, electric
blankets) at the site should be avoided since it accelerates absorption due to
vasodilation, as do fever, sunbathing and strenuous exercise.
Available in parenteral, transmucosal, transdermal, intranasal forms
High abuse potential; client may develop opioid tolerance
.
10 Fluticasone / Flonase
Corticosteroid.
Uses: seasonal and
perennial rhinitis.
SE: nausea,
dizziness, epistaxis.
Tip: suffix –sone.
Class: Glucocorticoid (suffix: sone)
Indication: Prophylaxis for asthma, allergic rhinitis
SE:
Oropharyngeal candidiasis, hoarseness
 Ask: How often should the client use fluticasone?
 Answer: Daily, on a regular basis
Fluticasone/salmeterol (Advair) is a commonly prescribed inhaler used for
asthma. Salmeterol is a long-acting beta 2 agonist (LABA) that causes
bronchodilation.
Eliminate grapefruit from diet.
The client should gargle after using medication to minimize chance of developing
candidiasis
13 Propranolol / Inderal
Non-selective beta
blocker.
Uses: HTN;
dysrhythmias;
migraine, many
others.
SE: bradycardia,
hypotension.
Note: fluticasone/salmeterol (Advair) is a commonly prescribed inhaler used for
asthma. Salmeterol is a long-acting beta 2 agonist (LABA) that causes
bronchodilation.
 Tip: suffix –olol.
Class: Beta blocker/Antihypertensive
Indication: HTN, angina, dysrhythmias, MI, acute anxiety (“stage fright”)
SE:
Bradycardia, AV heart block, heart failure, bronchoconstriction,
depression
• Tip: suffix –olol.
• Contraindicated or used with extreme caution for clients with restrictive
airway diseases, diabetes (inhibits glycogenesis), depression, heart failure,
heart block, severe allergy (can inhibit the action of epinephrine)
• Can cause rebound cardiac excitation resulting in tachycardia and
ventricular dysrthymias
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
Ask: What is the black box warning for propranolol?
Answer: Exacerbation of angina/MI if abruptly discontinued
First dose effect may cause fainting due to severe hypotension; the client should
be forewarned and advised not to drive or engage in other hazardous activities
for 12-24 hours; taking at bedtime can help minimize risk
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When might the nurse hold this medication? Systolic BP below 100, pulse
below 60 or client is showing signs of hypoxia.
15 Donepezil / Aricept
Cholinesterase
inhibitor. Use: Mild
to severe AD.
SE: may decrease
reaction time.
17 Lisinopril / Zestril
ACE inhibitor.
Uses: HTN, MI.
SE: persistent cough,
angioedema.
18 Rifampin / Rifadin
Antimycobacterial.
Uses: TB, some other
infections.
SE: hepatotoxicity.
Class: Cholinesterase inhibitor
Indication:
Mild to severe Alzheimer’s Disease
SE:
Nausea, vomiting, diarrhea, GI bleeding, anorexia, dizziness,
bronchoconstriction, bradycardia
Ask: What important teaching is needed?
Answer: Take donepezil at bedtime, may cause vivid unusual dreams,
implement safety precautions
Should be taken daily, at bedtime.
Low dose is started initially and slowly increased to minimize side effects of
nausea, diarrhea, dizziness, bronchoconstriction, and bradycardia. Should be
used cautiously in clients with asthma or COPD.
Do not discontinue suddenly as respiratory failure may result.
Tip: suffix -pril
Class: ACE Inhibitor (suffix -pril)
Indication: Hypertension, heart failure, acute MI
SE:
Persistent dry cough, hyperkalemia, renal failure, fetal injury, angioedema
Remind students of first dose effect (fainting due to hypotension) of
antihypertensives
 Ask: Should women use a reliable form of birth control while taking this
Lisinopril?
 Answer: Yes, black box warning of being associated with fetal
injury/death
Angioedema: swelling in the face, throat, tongue could close airway (could also
occur in extremities). Cough is annoying and may require a change in medication
but is not life-threatening.
Class: Antibiotic
Indication: TB, leprosy (Hansen’s disease) and to eliminate meningococcal
bacterium (Neisseria meningitidis) from the nasopharynx from asymptomatic
carriers, but should not be used for active disease.
SE: EPS, angioedema, hepatotoxicity


Ask: How would the nurse assess liver toxicity?
Answer: ↑ LFT, jaundice, dark urine, light stools, RUQ pain
When prescribed for TB, rifampin is often used with other medications such as
ethambutol and isoniazid.
Can decrease effectiveness of birth control pills.
Causes body secretions to turn orange and can permanently stain contact lenses.
Monitor blood sugar in diabetic clients.
19 Enoxaparin /
Lovenox
Anticoagulant.
Use: DVT prevention.
SE: bleeding;
neurological
impairment.
Tip: suffix –parin. Low molecular weight heparin (LMW) heparin.
Class: Anticoagulant (low molecular weight heparin --LMW)
Indication: DVT prevention, ischemia prevention in unstable angina and MI
SE:
Bleeding, severe neurological injury if given to patient undergoing any
type of spinal injection or puncture.
Tip: suffix –arin
Levels cannot be monitored with aPTT
All LMW heparins are administered subQ
Dosing is based on body weight
Ask: What is the antidote for enoxaparin?
Answer: Protamine sulfate
Fill-in-the-Blank
1
Generic
(Brand)
Adenosine
(Adenocard)
Speaker Notes
Class: Antidysrhythmic
Indications: Paroxysmal SVT
SE: Bradycardia, dyspnea, hypotension, flushing, chest discomfort


2
Dutasteride
(Avodart)
Ask: What client outcome should the nurse expect?
Answer: Conversion to normal sinus rhythm
Note: IV administration of adenosine is not within the PN scope of practice.
What should the nurse monitor? VS, EKG, lung sounds, UO.
Class: 5-alpha-reductase inhibitor
Indication: Benign prostatic hypertrophy
SE:
Decreased ejaculate, decreased libido


Ask: Should clients using dutasteride donate blood?
Answer: No; Dutasteride is teratogenic.
NOTE: It is pregnancy category X. Blood donation should not occur for at least six moths after
discontinuing because donated blood might be given to a pregnant woman. Pregnant woman
should not handle dutasteride as it is absorbed through the skin.
3
Warfarin
(Coumadin)
Class: Anticoagulant (Suffix: arin)
Indication: Prophylaxis for thrombosis, TIAs and MI
SE:
Black Box Warning: Serious/fatal bleeding events (Category X)


Ask: Should foods containing vitamin K be avoided while taking warfarin?
Answer: No. Clients should maintain a consistent intake of Vitamin K. Increasing or
decreasing intake will require a change in warfarin dosage.
Many medications adversely interact with warfarin (ex. Aspirin, amiodarone, phenytoin,
rifampin). Clients should wear a Medic Alert bracelet and inform provider(s) of warfarin use.
Note: there are lots of follow-up questions to ask students:
Q:
What are foods that are high in vitamin K?
A:
green leafy vegetable, mayonnaise, canola oil, soybean oil.
Q:
What is the antidote for warfarin overdose?
A:
Vitamin K
Q:
What bleeding precautions can be taken by clients?
A:
Use a soft toothbrush, use an electric razor.
Q:
What is the therapeutic INR level?
A:
2-3
What are foods that are high in vitamin K? green leafy vegetable, mayonnaise, canola oil,
soybean oil.
Not safe in pregnancy. A client who is pregnant and requires anticoagulant therapy will have a
change in therapy to heparin or lovenox.
4
Phenytoin
(Dilantin)
Class: Antieplileptic
Indication:
Seizures
SE:
Gingival hyperplasia, thrombocytopenia


Ask:
Is a client taking Phenytoin susceptible to Stevens Johnson Syndrome?
Answer: Yes, (flu like S&S, skin rash) instruct client to stop taking medication and
notify provider
Follow-up:
Q: Is a client taking Phenytoin susceptible to Stevens Johnson Syndrome?
A: Yes, (flu like S&S, skin rash) and they should stop taking medication and notify provider
Phenytoin is a teratogen, Pregnancy Category D:only used if seizure control is not possible
other medications
Phenytoin has many medication interactions (ex. Warfarin, oral contraceptives,
glucocorticoids, cimetidine). Patient should be instructed to avoid alcohol – increases the CNS
depressant actions of phenytoin and decreases phenytoin levels.
5
Metronidazole
(Flagyl)
Class: Antiprotozoal, antimicrobial, amebicide
Indication: Amoebiasis, trichomoniasis, giardiasis , Drug of choice for C-Difficele
SE: Nausea, headache, metallic taste, dark urine. These are unpleasant but do not require
discontinuing the medication.


Ask: Why is alcohol contraindicated with this drug?
Answer: Metronidazole has disulfiram-like reactions with alcohol which may be
dangerous.
Symptoms include severe nausea, copious vomiting, flushing, HA, sweating, thirst, blurred
vision and hypotension; BP can potentially drop to shock levels; lasts 30 minutes to several
hours
Metronidazole is used to treat trichomoniasis. This is a sexually transmitted protozoal
infection, Symptoms in a woman include a green/yellow odiferous vaginal discharge, vaginal
itching, and dyspareunia. Men may not have symptoms. Both partners require treatment to
prevent re-infection.
It is the drug of choice for amebiasis and giardiasis
6
Gentamicin
(Gentamicin)
Class: Aminoglycoside antibiotic (suffix: micin)
Indications: Bacterial infections, topically for skin infections
SE:
Nephrotoxicity, ototoxicity


Ask: What lab work is done to evaluate the therapeutic effects or toxic levels?
Answer: Peak/Trough
(Ask as f/u, when peak and trough are drawn; peak ~ 30 minutes after IV administration;
trough drawn ~ 30 minutes before IV administration).
Reserved for serious infections due to toxic risk
Monitor: hearing and balance (inner ear functions), and kidney function.
Neuromuscular blockade can cause potentially fatal respiratory depression. Clients at highest
risk are those with myasthenia gravis and those receiving a muscle relaxant or general
anesthetic.
7
Digoxin
(Lanoxin)
Class: Cardiac Glycoside, Inotrope
Indications: Heart failure, cardiac dysrhythmias
SE:
Dysrhythmias, anorexia, nausea, fatigue, yellow tinge to vision
[client may report this as blurred vision, yellow tinge to vision, appearance of halos around
dark objects]
Ask: What should the nurse monitor?
Answer: Digoxin levels, potassium levels, apical pulse rate
The apical pulse must be auscultated for one full minute, prior to administering the
medication; potassium level must be monitored as hypokalemia as it can cause potentially
fatal dysrhythmias, most commonly from diuretics that are commonly used with digoxin.
Digoxin works by improving heart contractility and reducing heart rate.
Those commonly prescribed in the past, it is now considered a second line drug. Diuretics and
either an ACE inhibitor, ARB or beta blocker are first line for treatment of HF (note: Beta
blockers used to be contraindicated for HF, but, with carefully controlled dosage, they can
improve symptoms and prolong life)
The therapeutic range for Digoxin is very narrow – 0.8 – 2.0 ng/mL; toxicity occurs at a level
=/> 2.4 ng/mL
8
Memantine
(Namenda)
NMDA Antagonist
Use: Moderate to Severe Alzheimer’s disease (AD)
SE: dizziness, headache, confusion, constipation
 Ask: What medication might be used for mild AD?
 Answer: Donepezil
Unlike cholinesterase inhibitors (such as donepezil), Memantine is approved for moderate to
severe AD only. It does not benefit clients with mild AD.
It is generally well tolerated with only small percentages of the side effects listed above.
Sodium bicarbonate causes urine to become more alkaline and can decrease renal excretion of
memantine, leading to toxic levels.
9
Oxycodone
(Oxycontin)
Memantine should be avoided in clients with renal failure.
Opioid Analgesic
Use: Moderate to severe pain
SE: respiratory depression, constipation, urinary retention, cough suppression, miosis,
sedation, euphoria
Oxycodone tablets should not be broken, crushed, or chewed


Ask: What should the nurse monitor?
Answer: Respirations, BP (orthostatic hypotension), urine output
Oxycodone has high abuse potential, but concerns shouldn’t interfere with treatment of pain.
New formulations are available that discourage abuse (turns into a blob if exposed to fluid
making it difficult to inject; burns nasal passages if crushed and snorted)
10
Montelukast
(Singulair)
Class: Leukotriene Modifier
Use: Asthma maintenance and prophylaxis, prevention of exercise induced bronchospasm,
relief of allergic rhinitis
SE: mood changes, suicidal thoughts/actions
Ask: What medication would the nurse expect to give for acute asthma?
Answer: Albuterol, levalbuterol, perbuterol
[Ipratropium (Atrovent), an anticholinergic, and glucocorticoids may also be used.]
Montelukast is not indicated for acute asthma attacks.
Used for clients 1 year and older for asthma maintenance and prevention. Used in clients at
least 15 years old to prevent exercise-induced bronchospasm.