Exam 1: Commit to Memory Concepts & Material
Module 1 INTRODUCTION TO PHARMACOLOGY, PHARMACOLOGIC PRINCIPLES
Nine Rights” and other “Rights” associated with safe medication administration.
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
Think about the Nine Rights of Medication Administration as you are about to give medication:
o Mnemonic: Nine Rights of Medication Administration - 3Ds, 4Rs, P, T
(1) Right drug
(2) Right dose
(3) Right documentation
(4) Right patient
(5) Right route
(6) Right time
Current practice standards suggest these additional “Rights”:
(7) Right reason or indication
(8) Right response
(9) Right to refuse
Identify key enzyme inducers and enzyme inhibitors.

Cytochrome P-450 enzymes (CYP, CYP450, or P-450 enzymes): liver enzymes act on substrate
(original drug) to convert it to hydrophilic/polar state for elimination
o Some elements (foods, smoking/alcohol, other drugs) can alter/affect the rate of the liver
metabolism of drugs
o Mnemonic: inHibitor: Higher levels of drug in body/cells  higher risk for toxicity and
increased effect of drug
LIVER ENZYME (CYP) INDUCERS
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↑ liver activity  ↓ [drug] ↓ drug effect ↓ risk of toxicity
Key CYP liver enzyme inducers
o P - phenytoin (highly protein bound seizure medication)
o S - smoking
o P - phenobarbital
o O - oxcarbazepine
o R - rifampin
o C - carbamazepine
o S - St. John’s Wort (OTC herb)
HFEI: MEMORIZE LIST – acronym: PSPORCS
LIVER ENZYME (CYP) INHIBITORS
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↓ liver activity  ↑ [drug] ↑ drug effect ↑ risk of toxicity
Key CYP liver enzyme inhibitors
o P – protease inhibitor (HIV)
o A – azole antifungal (fluconazole, ketoconazole)
o C – cimetidine (H2RAs)
o M – macrolides (ACE, azithromycin, clarithromycin, erythromycin
o A – amiodarone
o N – non-DHP calcium channel blockers (diltiazem, verapamil)
o Grapefruit Juice
HFEI: MEMORIZE LIST – acronym: PACMAN ♥s GRAPEFRUIT JUICE
Identify common lab values, signs and symptoms of hepatic impairment (especially drug induced liver
injury- DILI).
COMMON SIGNS & SYMPTOMS OF LIVER DAMAGE

Common signs and symptoms of hepatic impairment/drug induced liver injury (DILI)
o Dark urine (bilirubin mixes with urine)
o Jaundice (yellow eyes, liver no longer filters bilirubin from blood, or can’t conjugate it so it
can’t be removed via bile)
o Swelling of abdomen (no longer making sufficient albumin)
o Bruising/Bleeding (lack of clotting factors)
o Non-specific fatigue
o Ammonia can concentrate (liver normally converts ammonia to urea)
 Ammonia accumulation- neurological changes including encephalopathy and
confusion
LIVER FUNCTION TEST (LFT) LAB VALUES

Important Liver enzymes: huge in recognizing drug induced liver injuries (DILIs); know their normal
ranges
o Aspartate aminotransferase (AST)
o Alanine aminotransferase (ALT)
 Elevation in enzyme(s) level suggests hepatotoxicity
 Usually elevated 2-3x above normal range

FOR ATI/NCLEX: know common S/S; know normal and abnormal lab values including units (high or
low) for liver impairment
o Per ATI Med-Surg Textbook: Liver function tests:
 aspartate aminotransferase (AST)
 alanine aminotransferase (ALT)
 alkaline phosphatase (ALP)
 bilirubin
 albumin
o Application:
 Know how to identify DILI from lab value respective
 Know how to recognize hepatotoxicity and when not appropriate to give a drug
metabolized by the liver
Identify common lab values, signs and symptoms of renal impairment.
RANGES OF RENAL/KIDNEY FUNCTION
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↑ SCr ↑ BUN means ↓ glomerular filtration by kidneys (elimination)  kidney impairment
↓ CrCl and GFR means ↓ rate of filtration of blood  kidney impairment
↓ rate of urine output means ↓ urine volume (elimination)  kidney impairment
suggestion of kidney injury: ↑ SCr (and BUN), ↓CrCl and eGFR

FOR ATI/NCLEX: know common S/S; know normal and abnormal lab values (high or low) for renal
impairment
o Know normal ranges of kidney function and what is looked at to assess kidney function
Identify common causes of Adverse Drug Events (ADEs).
FOUR major drug classes that cause Adverse Drug Events:
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Antibiotics
Anticoagulants (blood thinners)
Diabetes medications
Opioids
Module 2 LIFESPAN CONSIDERATIONS, MEDICATION
CONCEPTS/CONSIDERATIONS, SAFETY AND ERROR REDUCTION
Describe the safety considerations of each pregnancy category

Category A: no risk to human fetus
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Category B: no risk to animal fetus; human info not available
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Category C: adverse effect reported in animal fetus; human info not available
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Category D: possible fetal risk in humans
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Category X: human fetus abnormalities have been reported; drugs are not to be used in pregnant
women
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B and C categories cause confusion because what may cause adverse effects in animal fetus may
not be adverse for humans and vice versa
o Studies in animals do not always correlate to humans either

FOR ATI/NCLEX: know Categories A through X
Differentiate the various categories of drug naming.
GENERIC NAME (refers to active ingredient in drug)
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Name given by United States Adopted Names Council
Active ingredient
begins with lower-case letter
FOR ATI/NCLEX: know GENERIC names of drugs (less so chemical names and brand/trade
names)
Differentiate the various categories of “scheduled” drugs.
CATEGORIES OF SCHEDULED DRUGS
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Scheduled drugs, controlled substances, narcotics
Drugs are grouped into “schedules” if they are found to have any dependency or abuse potential
5 schedules are categorized based on:
o abuse (substance use disorder (SUD), misuse) potential
o medical use
o dependency potential
Schedule 1 drugs: NO medical use
FOR ATI/NCLEX: know schedules in regard to misuse potential, medical use, and dependent
potential; know a few examples in each schedule
List the key elements that are legally required to be found on a prescription order.
SEVEN KEY ELEMENTS
(1) Patient Name
o need second identifier (DOB, MRN; room number is NOT allowed)
(2) Date the drug order was written
o Useful for outpatient world; drugs expire
(3) Name of drug
(4) Drug Dosage Amount
(5) Drug Dosage Frequency
(6) Route of Administration: oral, IV, etc.
(7) Prescriber’s Signature

Note: should include quantity and refills for outpatient world
Module 3 INFECTIOUS DISEASE: ANTIBIOTICS
KNOW ADMINSTRATION AND ADVERSE EFFECTS!!
Antibiotic
Beta-lactams
Overview
****cross sensitivity/reaction**** if allergic to one beta-lactam group,
you cannot take any other beta-lactam
ASSESS FOR ALLERGIES!!!!! Hold drugs until cleared of allergy
 ALL beta-lactams create risk for allergic reactions

Penicillins
NATURAL:
Penicillin G Potassium,
Penicillin V
Penicillinase-Resistant:
Nafcillin
Amino-penicillin: Ampicillin,
Amoxicillin
Extended Spectrum:
Piperacillin
Penicillin, cephalosporins, carbapenems, monobactams
Penicillin: PPR3SS (Press)
 P – piperacillin is extended
 P – pseudomonas treated with piperacillin
 R – renal damage risk
 3 – 3 take with food: penicillin V, amoxicillin, amoxicillin-clavulanic
acid
 S – Strep and syphillis treatment
 S – superinfection risk
Treats: Strep
Syphilis
Prophylaxis
Piperacillin: Pseudomonas, Klebsiella
Administration: TAKE THESE 3 WITH FOOD!: (1) Penicillin V, (2)
Amoxicillin, and (2) Amoxicillin-Clavulanic Acid
Zosyn
Take all others with 8 oz of water 1 hr before or 2
hr after meals
Adverse Effects:  ALLERGIC REACTIONS
 RENAL DAMAGE (rare)
 Penicillin G Potassium: Hyperkalemia
 Seizures/CNS confusion (high doses)
 Supra/Superinfections
 DRUG-DRUG INTERACTIONS: Probenecid,
Aminoglycosides, Oral Contraceptives,
Warfarin
Pharmacology Binds to protein of bacterial cell wall
Cephalosporins
Ceftriaxone
Nursing
Considerations:
“Cef” “Ceph” suffix
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
have many different generations (depend on type of bacteria they
kill)
o later generations have better CPF/BBB penetration
o think “ceph” —> enceph —> in brain —> seizure/CNS
confusion risks
NEVER MIX WITH CALCIUM --> precipitate formation can kill

“Meet my pet cat Ceph, The Great CATSBY, he has 5 lives”
o
o
o
o
o
o
o
o
G – 5 generations: successively better at BBB penetration,
fighting beta-lactamase, and 5th generation treats MRSA
C – Calcium: do not combine with Ca2+—> precipitate
A – Alcohol: no alcohol —> vomiting
T – Thrombophlebitis risk via IV
S – Seizures/CNS confusions (Ceph – enceph – head)
B – Bleeding risk
Y – Yummy: take with food or lidocaine of IM in
ventrogluteal site for comfort
5 – 5 generations
Treats: Wide Array of infections
Administration: 

Take ALL with Food
Make sure to fridge store oral
solutions/suspensions in the FRIDGE
 For IV meds: Dilute, large vein, rotate sites,
slow infusion, check IV for irritation
 For IM meds: mix Cef with lidocaine to
prevent pain (in ventrogluteal site)
Adverse Effects:  Seizures/CNS confusion
 No Alcohol!: Disulfiram-like effect  profuse
vomiting
 BLEEDING RISK! (interferes with Vitamin K
metabolism)
 THROMBOPLHEBITIS with IV Infusion
 Drug-Drug Interactions
o Probenecid (gout med that can
increase half-life)
o Oral Contraceptives
o Warfarin
o CALCIUM and CEFTRIAXONE
(precipitate)
 ALLERGIC REACTIONS
 Supra/Superinfections
Pharmacology Binds to protein of bacterial cell wall
Carbapenems
Nursing
Considerations:
“-penems”
“Carbapenems  car crash  broad spectrum (pseudomonas
fighter)
 head injury  HIGH SEIZURE/
CNS confusion
RISK
 reduces valproic
acid levels (seizure
med)
“Carbapenems  parenteral route
Treats: RESERVED FOR SERIOUS INFECTIONS
Pseudomonas aeruginosa
Very broad spectrum
Administration: 
All parenteral (IV, IM, subQ)
Adverse Effects: 
HIGH Seizure Risk!/CNS confusion (highest
risk for seizures)
 Reduces levels of Valproate/valproic acid
(seizure med)
 Allergic Reactions
 Supra/Superinfections (b/c broad spectrum)
Pharmacology Binds to protein of bacterial cell wall
Nursing
Considerations:
Monobactams
Treats: RESERVED FOR SERIOUS INFECTIONS
Pseudomonas aeruginosa
Gram negative bacteria (harder to kill)
Administration:
Aztreonam (Azactam®)
IV, inhaled
Adverse Effects:  Relatively Safe
 ALLERGIC REACTIONS
 Supra/Superinfections
 Drug Interactions
Pharmacology Binds to protein of bacterial cell wall
Beta-lactamase
Inhibitors
Nursing
Considerations:
 ALWAYS combined with an antibiotic, never given alone
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
azobactam- IV (Zosyn®- piperacillin/tazobactam)
clavulanate/clavulanic acid-PO (Augmentin®amoxicillin/clavulanic acid)
Others you may see:
 sulbactam- IV (Unasyn®- ampicillin/sulbactam)
 Avibactam (Avycaz-ceftazidime/avibactam)
Assists: Beta-Lactams BODYGUARDS
Adverse Effects: N/A
Glycopeptides
Vancomycin (Vancocin®)
IV, PO, PR
Pharmacology Bind to and inactivate the beta-lactamase
inhibitor enzymes
Nursing NOT antibiotics
Considerations:
**NARROW Therapeutics Range Drug**
Vancomycin aka MC NOT RED
M – MSRA fighter
C – C. Diff fighter
T – trough level: 10-20 mcg/mL
Treats: MRSA (IV only)
Clostridium difficile (C.diff) (PO only)
pneumonia, meningitis, osteomyelitis, UTIs,
sepsis, etc
Alternative for penicillin allergy
Administration: Dilute the IV infusion, rotate sites for IM, SLOW
INFUSION (at least 1 hour)
Adverse Effects:  Nephrotoxicity
 Ototoxicity
 Histamine Flushing Syndrome (Red Man
Syndrome)  rashes, redness/flushing, and
itching  reduce rate of med (slow it down)
and DILUTE further
 Trough levels: 10-20 mcg/mL
 Be careful using with other nephrotoxic and
ototoxic drugs
 Supra/Superinfections
Pharmacology Bactericidal
Macrolides
Azithromycin (Zithromax®/ZPack)
IV, PO
Erythromycin
IV, PO
Nursing Hearing, Kidney Function, Drug levels
Considerations: Get kidney and hearing baseline
“Although a MAC and a G, Big ACE has a Heart, Hear Him Out, Peni”
 Macrolides, GI complications, ACE drugs, Heart – QT
prolongation/cardiac arrest risk, Hear – ototoxicity, Penicillin
alternative
Unique effect: QT prolongation (heart effect) —> Torsades —> death
MACROLIDES: LIVER ENZYME INHIBITOR (PACMAN <3’s Grapefruit!)
Clarithromycin
Treats: 
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Administration:
Great for Penicillin Allergy
Respiratory Infections (pneumonia)
Chlamydia
Broad spectrum
Adverse Effects: 

Ototoxicity
Cardiac Effects: QT prolongation  delayed
relaxation of ventricles  V Tach
(Torsade)/heart attack risk
 GI: N/V/D - (Erythromycin is used to promote
GI motility)
 Serious Drug-Drug Interactions
o Can cause other drugs to accumulate
(digoxin, warfarin, seizure meds)
o Other drugs like CCB, antifungals can
cause build-up of Macrolides (HEART
ISSUE)
 Supra/Super Infections- C.diff, Candida
albicans
Pharmacology Inhibits protein synthesis
Tetracyclines
Doxycycline, Minocycline,
Demeclocyline
Tigecycline (Tygacil®)
Nursing Hearing, EKG/telemetry
Considerations:
End in –cycline
(Tetra)Cyclines treats CALA (atypical things)
 Chlamydia
 Acne
 Lyme disease
 Anthra
Tetracyclines – teeth discoloration (both start with T)
Don’t take Cyclines with milk because they give you PHENGS at night!
(“fangs”) – TEETH problems —> discoloration; night – do not take at
night
 P - Photosensitivity
 H - Hepatotoxicity – lethargy and jaundice
 E - Esophageal irritation/ulceration
 N - Not at night/bedtime/lying down  esophageal ulcers
 G - GI irritation/ulceration
 S - Superinfection risk
Treats:
Acne (topical and oral preparations)
Lyme Disease
Chlamydia
Anthrax
Broad spectrum
Administration: Take with FULL GLASS OF WATER
AVOID BEDTIME and lying down —> esophageal
irritation
AVOID CALCIUM!  can cause ulcers
Adverse Effects: 
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Aminoglycosides
Binds to calcium/dairy products – bones,
teeth, drugs  tooth discoloration
(contraindications:AVOID CHILDREN < 8,
PREGNANT PATIENTS, Breastfeeding women)
Photosensitivity
GI irritation
Hepatotoxicity
Alternative Contraception needed
Supra/Superinfections
Pharmacology Bacteriostatic
Inhibits binding of tRNA/inhibits protein synthesis
Nursing Get baseline AST, ALT lab levels
Considerations:
Mostly “-Cins”
Gentamicin
IV/IM, topical, ophthalmic
NARROW THERAPEUTIC DRUG – get baseline + check peak/trough
levels at correct times
**Serious adverse effects: like vancomycin**
Tobramycin, Neomycin
(Neosporin), Amikacin
AMinoglycosides: top of A – peak, bottom of M – trough
“Do you want to play with AMI? NOPE!”
 AM – peak and trough levels
 N – nephrotoxicity
 O – ototoxicity
 P – pseudomonas fighter
 E – effectiveness decreased/inactivated in same IV with
penicillin (do not mix)
Treats: Pseudomonas (serious gram-negative infections)
Neomycin (Neosporin) can be used topically for
skin, eye, ear infections
Administration:
Adverse Effects: 
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Ototoxicity - tinnitus, balance issues, hearing
loss
Nephrotoxicity
o Careful with other ototoxic/nephrotoxic
drugs
DO NOT MIX WITH PENICILLIN IN SAME
SYRINGE  bind together  reduced
effectiveness
Supra/Super Infections
Pharmacology Bactericidal
Disrupts bacteria protein synthesis
Nursing CHECK LEVELS! PEAKS AND TROUGHS
Considerations:  Serum drug levels are monitors
Sulfonamides
“Sulfa” meds
SulfamethoxazoleTrimethoprim (Bactrim®)
IV, PO
5:1 ratio
Welcome to KLUB Sulfa!
 K - Kernicterus: brain damage from high levels for bilirubin in
baby’s blood
 L – lung infection treatment
 U – uti treatment
 B – blood dyscrasia; pancytopenia
FOUR S’s: (1) SULFA ALLERGY + (2) SUN PHOTOSENSITY + (3) SJS + (4)
STAY HYDRATED against renal crystallization
***water, water, water!***
Treats: UTI caused by E. Coli
Lung Infections (PJP/PCP pneumonia of
immunocompromised)
Administration: STAY HYDRATED
 Renal crystallization potential – drink lots of
water (2L)
Adverse Effects:  Blood Dyscrasias - PANCYTOPENIA (deficit in
all major blood cell types)
 Kernicterus (bilirubin brain damage with
jaundice) in newborns (avoid breastfeeding
mothers, infants under 2 months
 Birth defects (avoid pregnant women)
 Hypersensitivity reactions
o SJS
o PHOTOSENSITIVITY ( REPORT RASH,
FEVER!
 Renal crystallization
 Hyperkalemia —> cardiac effects
 AVOID IN SULFA ALLERGY
 Supra/Super Infections
Pharmacology Bacteriostatic
Inhibits bacteria from making its own folic acid
Nursing Watch Blood cell counts
Considerations:
Fluoroquinolones
Levofloxacin (Levaquin®)
IV, PO
Ciprofloxacin (Cipro®)
IV, PO, Otic, ophthalmic
“Floxacins”
“Floxacins are the cure to a FUPAs!”
 F – floxacins
 U – UTI
 P – Pneumonia
 A – Anthrax
“F(l)ox bites tendon”: tendon rupture/tendonitis
 not typically given
“F(l)ox and Cat(ion) like to eat meatballs in the sun”
 Fox - floxacin
 Cat - binds to cations like calcium
 Eat - take with food (not containing calcium)
 Meat - Myasthenia Gravis exacerbation
 Balls - Brain – CNS and neuropathy effects
 Sun - photosensitivity
Treats: UTI caused by E. Coli
Anthrax
Pneumonia
Administration: Take with food
Adverse Effects: 
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ATI/NCLEX: know adverse effects
Tendon rupture/tendonitis
Photosensitivity
Binds to Cations like Calcium, decrease
absorption
Supra/Superinfections (C. diff, Candida
albicans)
NOT Listed in ATI
QT prolongation, Neuropathies, Exacerbates
Myasthenia Gravis, Hypoglycemia, CNS Mental
Disturbance, Aortic Aneurysm
Pharmacology Inhibit bacterial DNA gyrase and topoisomerase IV
Nitrofuran
Nitrofurantoin
(Macrobid/Macrodantin®)
PO
Nursing Patient should report any s/s of tendon/joint pain
Considerations: or peripheral neuropathy; monitor EKG
”Nitros”
“Nitrofurans cause DENTUL Pain”
 D - Discoloration (of teeth and urine)
 E – eat; take with food
 N – N/V/D (GI complications)
 T – teeth discoloration
 U – urine discoloration


L – lower UTI treatment
P – pulmonary reactions
Treats: Lower UTI only (prevention and treatment)
Administration: Take with food
Adverse Effects: 
Discoloration or urine and teeth  dark
yellow to brown
 GI: N/V/D
 Pulmonary reactions: dyspnea, chest pain,
fever, cough- BIG CONCERN- could be allergy
 Peripheral neuropathy
Pharmacology Destroys bacterial DNA
Nursing
Considerations:
Phenazopyridine
(Pyridium®)
AZO (dye)  helps with UTI SYMPTOMS (not treatments)
**Not an antibiotic** but analgesic
Treats: UTI symptoms
Administration: Take with food or after meals in GI upset
Adverse Effects: 

Use for no more than 2 days; get real
treatment
Stains urine reddish/orange
Pharmacology Dye functions as local anesthetic in urinary tract
Nursing Intended Outcomes: soothe UTI symptoms
Considerations: Unintended Outcomes: urine discoloration can
stain clothes