NLN Pharmacology Study Guide
There is no official study guide for the NLN Pharmacology Exam. This guide is not meant to be all-inclusive of the information
you will need to know to successfully pass the NLN Pharmacology exam. You should utilize other resources as necessary to
prepare for the exam. Please note that after taking the exam, NLN provides access to review resources on-line.
The test is composed of 100 scored questions plus some trial questions (about 25). You will not know which are which. All are
multiple choice questions, including calculations.
Content is divided in three areas on the exam: calculations, principles of medication administration and medication effects. They
are pretty evenly divided. The questions are very similar to the NCLEX questions. You should also use traditional NCLEX testtaking tips to prepare for this exam also.
References:
Pearson nurses’s drug guide. (2013). Upper Saddle River, NJ: Pearson.
Silvestri, L. A. (2011). Saunders comprehensive review for the NCLEX-RN® examination. St. Louis, MO: Mosby.
Adams, M. P. & Urban, C. Q. (2013). Pharmacology: Connections to nursing practice (2nd ed.). Upper Saddle River, NJ: Pearson.
Calculations
Please remember this is about 1/3 of the pharmacology exam. It may be beneficial for you to practice calculations and/or review
a nursing math book to help prep. You may not have used all the calculation methods recently. Questions may include one or
more type of calculation.
Tips:
1. READ CAREFULLY. Always be sure you know what the end result should be (mg, pills, ml, etc.). This can help you select
the correct formula and eliminate unnecessary information.
2. Double (and triple) check actual math. Did you clear the calculator correctly?
3. Does the answer make sense?
4. There are both adult and pediatric calculations.
5. Watch ‘per dose’, ‘per day’.
6. How you calculate the answer does not matter (desired over have, ratio : proportion, etc.); accuracy does.
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
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2Common calculations include (but are not limited to):
1. Kg to mg to mcg conversion (any which way)
L
K
H
D
M
D
C
M
mcg
G
liter
(kilo – hecto – deca – meter – deci – centi – milli – skip – skip – micro)
gram
2. Dosage calculations
a. Tablets
b. mg. to tablets
c. mg. to ml
d. units to ml
e. kg to ml
f. Half-life calculation
g. IV rate calculation (hourly infusion rate) AND adjustment
h. IV rate dosage calculation (based on units per ml, etc.)
i. Macro- vs. micro-drop tubing
j. Calculating drops/minute (gtts/min)
Examples: (abbreviated to type of question; exam will add extra information)
1. Have 5 mg tablets; ordered dose 2.5 mg. How many tablets will the nurse administer?
2. Have 2 mg/2 ml; order is 1 mg. How many milliliters will the nurse administer?
3. Prepare a 20 mEq dose of a medication. Available solution is 40 mEq/10 ml. How many ml will be administered?
Note: calculation method is not different in examples 1 - 3, just the unit of measure (mg, units, mEq, etc.). BE SURE AVAILABLE
AND HAVE ARE THE SAME UNIT OF MEASURE.
4. Half-life conversion: Half-life is known to be 2 hours. What percentage will be left in the body after six hours?
5. A person weighs 165 lbs. How many kg does the person weigh?
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
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6. The available medication has been reconstituted to 250 mg/5 ml. The order is 5 mg/kg/daily in two evenly divided doses.
Child weight 44 pounds. How many milliliters will be administered per dose? NOTE: More than one calculation method
must be used to answer this question.
7. IV was ordered at 1000 ml over 8 hour period. After two hours, only 900 ml has infused. Calculate the new infusion rate
for the medication to be administered within the original 8 hour period.
8. Order is for 3000 cc over a 24-hour period. What is the hourly flow rate? OR: What will the pump be set at per hour?
9. Order is for antibiotic to be mixed in 50 ml NS and administered over 45 minutes. What is the hourly flow rate? OR:
What will the pump be set at per hour?
10. Volume is 1000 ml. Ordered infusion time is 8 hours. Have tubing of 15 drops/ml. How many drops need to be counted to
deliver the identified milliliters per minute?
11. Available solution = 25,000 units in 250 ml NS. Order is to administer at 22 ml/hour. How many units will be given per
hour?
12. Available solution = 25,000 units in 250 ml NS. Administer at 2000 units/hour. How many ml will be given be hour? OR:
What will the pump be set at per hour?
Principles of Pharmacology
These include the basics! Review:
1. Routes of administration – benefits and problems
2. Sizes of needles and syringes for injections
3. Six Rights of Medication Administration; Three Checks
4. Side effects; adverse effects; paradoxical reactions; toxicity; antagonists
5. Half-life calculation
6. Allergic or hypersensitivity reactions
7. Absorption, metabolism, distribution and excretion
8. There may be questions on lab values as relevant.
9. There are pediatric and adult questions.
10. Immunosuppression precautions (due to meds for cancer, HIV/AIDS, etc.)
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
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Administration routes: some key points
Sublingual administration
□ absorbed in mucosa of oral cavities
□ rapid onset of action
□ Place tablet on floor of mouth, close mouth. Do not swallow, hold under tongue until dissolve.
□ Use spray on floor of mouth under tongue and close mouth.
Buccal
□ place tablet between gum and cheek near back of mouth, close mouth and keep in place until dissolve
□ slower to dissolve and absorb than sublingual
Intramuscular injections
□ Given in the vastus lateralis in children up to 3
□ Spread skin taught to bring muscle near surface of skin, with dart-like motion insert needle at 90 degrees
□ Aspirate to determine if needle enter a blood vessel. If there is blood return discard the needle and meds and start
procedure over.
NGtube / Gtube
□ NG usually temporary; G-tube for longer term
□ Follow instructions re crushing, dissolving medication – no sustained release meds
Eye drop administration
□ Clean exudates from eye; (2) tilt head toward side of affected eye; (3) pull lower eyelid down; (4) have pt. look up; (5)
instill drops in conjunctival sac formed by lower lid (not onto the eye); (6) Apply gentle pressure for 30 sec to 1 min over
inner cantus next to nose (this prevents absorption through the tear duct and drainage of the medication). Close eyes
gently massage the eyes to distribute the meds.
□ Slow absorption except in infants where they readily absorb
EYE OINTMENT
□ Same as eye drop except it is expressed directly into the conjunctival sac from the inner canthus to the outer canthus. Close
eyes and gently massage to distribute the medication
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Definitions:
Agranulocytosis / Neutropenia / agranulocytopenia
□ Definition: Acute decrease in the number of granulocytes/leukopenia (WBC) in peripheral blood
□ Causes include: treatment with broad spectrum PCN, sulfonamides or cephalosporin (piperacillin, tazobactam, cetazidime,
ticarcillin, gentamycin), bone marrow transplant, chemotherapy, radiation.
□ Generally is impaired resulting from bone marrow depression by drugs and chemicals or replacement by a neoplasm(oral
lesion, ulcer necrotic, gingivitis, buccal mucosa
□ Lymphadenopathy, lymphadenitis may be prevalent.
□ Could lead to respiratory infection, ulceration of mouth colon, high fever, UTI. But may be asymptomatic
Chelating agents
□ A form of detoxification
□ Chelating therapy involves an injection or oral administration of ethylene diamine Tetra acetic avide (a synthetic amino acid
which attaches to toxic substance such as lead, cadmium, aluminum and other metal in the blood to facilitate their removal
from the body.)
□ May be used to treat hardening of the arteries, heart attack, stroke, arthritis and gangrene because of its ability to remove
excess calcium from the body.
EDTA: Ethylenediaminetetraacetic acid
□ Use in children with lead level between 45&70 micron/dl.
□ EDTA binds to lead in blood and excreted by the bowel and kidney. EDTA may be toxic to kidney. Monitor urine output.
□ Give this by IV. Dose depends on weight of child, severity of the poison. Agent is given every 4 hours for 5 days. A second
course may be needed if there is a rebound in the blood level. Give oral and IV fluid to enhance excretion
□ Do not use EDTA with hypocalcemia or hypokalemia.
OTHER AGENTS
□ British antiLewisite (BAL) does not give with iron supplement and avoid in pt. with plant allergy. Give this by IM
□ Succimer (Chemer)
□ Chemet – oral medication - Do not give in pt. with encephalopathy
Epistaxis
□ Nose bleed. Can be anterior or posterior. Posterior is more serious.
□ due to rupture of blood vessels within richly perfuse nasal mucosa spontaneous or initiated by trauma
□ blood can come up through the eye, can also flow down the stomach causing nausea, vomiting
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
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Treat epistaxis
□ cauterization with silver nitrate, calcium alginate mesh, nasal cavity packed with sterile dressing ribbon gauze, absorbent
dressing or saline sprayed into the nose
□ Ice pack to forehead or back of the neck
□ pinch septum of nose for 5 minutes
□ Do not pack nose with tissue or gauze
Half-life
□ The time it takes for a medication to lose half of its pharmacologic or physiologic effect
□ To calculate half-life: There is a formula but the easiest way to decrease count.
□ Example: half- life is 1 hour.
Start 100%
1 hr.
50%
2 hrs. 25%
3 hrs. 12.5%
4 hrs.
6.25%
Question – Half-life of ‘xyz’ medication is 1 hour. After 3 hours, what percentage of the medication will be left? A = 12.5%
Osmotic agent - see entry under Mannitol
Paradoxical reaction
□ A response to a drug (or medical treatment) that is the opposite to the usual response, such as agitation produced in an
individual patient by a drug which is ordered to sedate or calm a person.
Sustained release / time released / extended release / controlled release
□ Pills or capsule formulated to dissolve slowly and release drug over time.
□ They can often be taken less frequently, keep steadier levels of the drug in the bloodstream
□ Contain in a matrix of insoluble substance (e.g. Acrylics) the drug swells up to form a gel so that the drug has first to dissolve
in matrix then exit through the outer surface.
□ Cannot be crushed, dissolved or opened
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
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Medication Effects
There is a bit of an overlap here with Principles of Pharmacology. These questions tend to be medication (or classification)
specific. There are many medications on the test and many could be. As applicable, both brand and generic names are used.
We recognize the attached grid is very lengthy, but have included some of the key components as identified below. Most
medications addressed are either high usage or high risk. Please note that auto-corrections will change generic names to
starting with caps. In the grid, we have tried to list generic first, then brand names.
Areas to know:
1. Use, dose, side effects, contraindications
2. Since there are a limited number of questions, not all medications are addressed. You may be asked to select which
medication would be given for a particular diagnosis. When studying, focus on the classifications – this may enable you
to answer without knowing the actual medication.
3. Focus on what are the major side effects of a medication or class? What makes it high risk? Why might one particular
med be used other than another?
4. Patient teaching is a major focus. What would you tell the patient about the medication? What would indicate
understanding? What would indicate need for further teaching?
Common classification of medications
Note letters in medication name and look for those letters that identify a particular classification:
◊
Androgens: end with –terone: testosterone (Testoderm)
◊
ACE Inhibitors: end with –pril: enalapril (Vasotec)
◊
Antidiuretic hormones: end with –pressin: desmopressin (DDAVP)
◊
Antilipidemic: end with –statin: atorvastatin (Lipitor)
◊
Antiviral: contain -vir: ritonavir (Norvir)
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
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◊
Benzodiazepines: include alprazolam (Xanax), chlordiazepoxide (Librium), clorazepate (Tranxene),
estazolam (ProSom), and triazolam (Halcion). Most others end with –pam: diazepam (Valium)
◊
Beta Blockers: end with –lol: atenolol (Tenormin)
◊
CCB: end with –pine: amlodipine (Norvasc); some exceptions include diltiazem (Cardizem), verapamil
(Isoptin)
◊
Carbonic anhydrase inhibitors: end with –mide: acetazolamide (Diamox)
◊
Estrogens: contain est: conjugated estrogen (Premarin)
◊
Glucocorticoids and corticosteroids: end with –sone: prednisone (Deltasone)
◊
Histamine H2 receptor antagonists: end with –dine: cimetidine (Tagamet)
◊
Nitrates: contain nitr: nitroglycerin (Nitrostat)
◊
Pancreatic enzyme replacements: contain pancre: pancrelipase (Pancrease)
◊
Phenothiazines: end with –zine: chlorpromazine (Thorazine)
◊
Proton Pump Inhibitors: end with –zole: lansoprazole (Prevacid)
◊
Sulfonamides: include –sulf: sulfasalazine (Azulfidine)
◊
Thiazide diuretics: end with –zide: hydrochlorothiazide (HydroDIURIL)
◊
Thrombolytics: end with -ase: alteplase (Activase)
◊
Thyroid hormones: contain –thy: levothyroxine (Synthroid)
◊
Xanthine bronchodialators: end with –line: theophylline
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
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Specific Diseases or treatments:
Aminoglycoside
□ antibiotics - Treats serious life threatening gram negative (and some positive) infections
All aminoglycoside ends Mycin but not all drugs that ends in Mycin are aminoglycosides such as (Erythromycin and
azithromycin)
Examples:
□ Gentamycin
□ Tobramycin
□ Vancomycin
□ Neomycin
□ Generally IM or IV.
□ Oral route is not recommended. It is only use for bowel prep prior to surgery (see Neomycin)
Adverse effects/toxicity:
Two most common MAJOR adverse effects: Nephrotoxicity and ototoxicity.
Also:
□ Photosensitivity
□ risk for superinfections
□ Pseudomembranous colitis (c-diff): stop med and treat with PO Flagyl
Peak level:
□ Drawn 15-30 min after the infusion is completed.
□ Peak concentration determines that toxic level does not occur.
□ If peak is too high, may reduce dose.
Trough level:
□ Drawn immediately (within 30 minutes) before next IV dose
□ Assures that therapeutic level of drug is maintained. Trough level is 1-2 g/ml between doses.
□ Dose will be adjusted if level is not sustained
□
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
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Blood administration
□ Start blood transfusion slow 2 ml/min. Remain with pt. for the first 15-30 min. if there is no sign of side effect, increase rate
to the desired rate
□ Administer using largest gauge IV access as possible.
□ Observe for acute reaction such as: allergic s/s – rash, itching, localized edema; febrile (even low grade); septic; air embolism;
circulatory overload.
□ Observe for delayed reaction: Graft vs. host; hepatitis; hemolysis
Crack abuse effect on newborns
□ Crack crosses the placenta and enters the fetus.
□ Common presentation: Infant may appear normal or develop neurological problem. Child may develop depression or
excitability, they may be lethargy, have poor suck; weak cry and difficulty in arousing, hypotonicity, rigidity, irritability,
inability to console and intolerance to change, small head, decreased birth length
□ Late symptoms: Some infant showed late symptoms 2-8 wks. There may be growth retardation - head growth is one of the
best indication
Diabetes treatment in children
□ Hypoglycemic reaction takes place most time before meals or when insulin effect is peaking.
□ First teaching: (1) let child wear bracelet or tag; (2) Teach how to give injection. Inject at 90 degree angle.
□ Teach only the essentials on the first few visits and intense later. Keep session for children to 14-20 min and adult may go up
to 45-60
□ Have same meal as normal child time intake of food. Eat at the same time each day.
□ Children can start learn to assume responsibility for self-management as soon as age 4-5. At age 9, they can start giving
their own insulin with supervision.
□ Exercise: do not restrict exercise. Have extra snack before and after exercise. Exercise very regularly as it decreases the
need for insulin
□ Carry a source of glucose at all times (hard candy, sugar cubes glucose tablets, insta glucose). The rapid releasing sugar is
followed by complex CHO and protein such as slice of bread or cracker spread with peanut butter
□ After glucagon injection, vomiting may occur. Place child on the side to prevent aspiration.
□ Preferred way of treating ketoacidosis is by insulin IV of low dosing. Note. Run a mixture of insulin through the tubing
before starting the drip because the insulin can chemically bind to plastic. Replace fluid over 24-48 hrs.
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
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Diabetes – Intravenous insulin administration
□ Can only be done with regular insulin in management of DKA, HHNK.
□ Premature discontinuation can cause prolongation of DKA.
□ Begin SQ insulin therapy before stopping the infusion. If not, there might be prolonged hyperglycemia.
Hepatitis – see below
HIV treatment – antiretinoviral therapy
Side effects:
START therapy:
Common meds:
(1) all symptomatic HIV people
□ Assess for opportunistic infection
(presenting with a AIDS-defining illness)
□ abacavir (ziagen)
(cancer, neurological disease); HA,
or
fatigue, nausea, vomiting, diarrhea,
□ stavudine (Zerit)
abdominal discomfort, anemia, taste (2) with a CD4 count less than 350 mm3.
□ zidovudine (AZT)
(3) also start pregnant women (AZT is
perversion, asthenia, circumoral
used to prevent maternal transmission
paresthesia with ritonivair,
Antiviral protease inhibitor. End in AVIR
of HIV)
Adverse/toxicity
□ Use prophylactically.
STOP if severe rash or other
□ Hepatoxicity, Hepatotoxicity: AST,
□ Use in combination to decrease viral
hypersensitivity reaction occurs.
ALT, bilirubin; observe for nausea,
load and increase CD4.
Excluding reaction to medications
vomiting jaundice upper right
Reverse transcriptase inhibitors: Ends in
and/or ineffectiveness of medication,
abdominal quad enlargement and
INE
treatment will be long-term.
tenderness. Reduce dose in liver
□ Stop replication/growth. Reduces
dysfunction.
viral load.
TEACH
□ One major advantage is that they do □ Nephrotoxicity; creatinine, BUN,
creatinine clearance, urinalysis, keep □ Use neutropenic precautions
not affect adversely affect
□ Eat small frequent meals with
accurate I& O, monitor for SE of
development of blood cells.
complete or complementary proteins
neutropenic, observe occult signs of
□ Use in combination with other meds
infection. (lower back, flank or
because resistant strains may rapidly
suprapubic pain, normal temp or low
evolve if used as single agent
grade fever related to UTI
therapy.
□ Inhibit cell protein synthesis that
interfere with viral replication; block
protease activity in HIV.
□ Treat AIDS and AIDS-related complex
to decrease viral load
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
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Inotropic medications:
Positive inotropic meds increase cardiac contractility – examples: epinephrine, norepinephrine, dopamine
Negative inotropic meds decrease cardiac contractility, lower BP: examples – quinidine; betablockers (most end in ‘olol”)
Sulfonamides
Side effects:
CAUTION: do not use:
□ Rash common; most are urticaria and □ known allergies to sulfa drugs
□ Anti-infective.
maculopapular.
□ In polyuria, advanced renal or hepatic
□ Bacteriostatic which action on
□ GI symptoms
dysfunction
bacteria results from interference
□ Bone marrow depression
□ with intestinal and urinary blockage,
with the functioning of enzyme
□ Headache, dizziness, vertigo, ataxia,
□ asthma
systems necessary for normal
convulsion, depression
metabolism, growth and
Adverse effects/toxicity:
□ Take adequate amount to fluid 3000multiplication
□ Hepatotoxicity
4000ml/day to promote urinary
□ Treat: UTI, Chlamydia causing
output, at least 1500ml/d to prevent
□ Nephrotoxicity
blindness, pneumonia, brain abscess, □ Stevens Johnson syndrome (an
crystalluria/stone formation
ulcerative colitis, active Crohn’s
□ May be taken after meals to prolong
adverse reaction of skin that
disease, rheumatoid arthritis
time in intestine.
resembles appearance of partial
Examples:
□ Collect C&S prior to beginning
thickness burns)
□ Bactrim
therapy
Thiazide diuretics:
Side effects:
□ Take early in the day to avoid
Examples:
□ Dizziness, vertigo, HA, weakness,
nocturia
chlorothiazide (Hydrodiuril),
dehydration, orthostatic hypotension □ Take with food to avoid GI upset.
hydrochlorothiazide (HCTZ, Diuril)
□ N/V, abdominal pain, diarrhea,
□ Thiazide is ineffective if creatinine
Name ends in ZIDE
constipation, frequent urination
clearance is < 30ml/min
□ non-potassium sparing diuretic.
□ dermatitis and rash
□ Eat foods high in potassium, restrict
□ Acts on distal tubes, blocks
□ Electrolyte imbalance
sodium, do not use salt substitute if
reabsorption of sodium, chloride and □ impaired glucose tolerance
taking potassium supplement
water. Leads to increased loss of
Adverse effects/toxicity:
□ weigh self daily, report sudden
Potassium.
weight gains or losses
□ Renal failure,
□ Use for edema and mild to moderate □ aplastic anemia, agranulocytosis,
Avoid use with:
hypertension
□ Children
thrombocytopenia
□ will see effect of within 1-4 wks.
□ anuria
□ anaphylactic reaction
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
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Tricyclic Antidepressants
□ Initial mechanism of TCA takes 1-3
weeks to develop.
□ Maximum response is achieved in 6-8
wks.
□ Has long half-life.
Most Tricyclics ends in INE
□ nortriptyline (Pamelor)
□ amitriptyline (Elavil)
□ doxepin (sinequan)
□ imipramine (tofranil)
□ Block the reuptake of norepinephrine
or serotonins or both, leaving more
available in the CNS. It intensifies
the effect of norepinephrine and
serotonin which can elevate mood,
increase activity and alertness,
decrease preoccupation with
morbidity, improve appetite and
regulate sleep pattern.
□ It is used to treat insomnia, attention
deficit/hyperactivity and panic
disorder.
Side effects:
□ orthostatic hypotension,
□ sedation and anticholinergic effects.
Adverse effects/toxicity:
□ Most serious adverse effect is cardiac
toxicity; in the absence of overdose
or preexisting cardiac impairment,
serious cardiotoxicity is rare.
□ URINARY RETENTION IS URGENT
□ Overdose may cause convulsions
□ Take at nights, it causes sedation.
□ Do not take with MAO it will cause
hypertensive crisis from excessive
adrenergic stimulation of the heart
and blood vessels,
□ monitor orthostatic BP of pt. in
hospital
Use with caution:
□ Glaucoma
□ Elderly
□ constipation, prostatic hyperplasia,
as they are more sensitive to
anticholinergic effect
Avoid use with:
□ hypersensitivity,
□ MI, Cardiovascular disease
Vesicant – Chemotherapy
□ See precautions under “Vincristine”
Hepatitis: inflammation of liver caused by virus, bacteria or exposure to meds or hepatotoxins
Stages of viral hepatitis:
(1) Pre-icteric – precedes appearance of jaundice, may have flulike symptoms
(2) Icteric – appearance of jaundice, elevated bilirubin, dark or tea colored urine, clay-colored stools
(3) Post-icteric – convalescent stage; jaundice improves; color of urine and stool returns to normal
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
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Hepatitis A (formerly
“infectious hepatitis”)
Cause: enterovirus
At risk:
□ Young children
□ Institutionalized
people
□ Health care
personnel
Transmission:
□ fecal-oral
□ ingestion of food or
liquids
contaminated with
the virus.
□ person by person
contact
Incubation: 3-5 wks.
Infectious: usually 2
wks. before the onset
of jaundice and 1 wk.
after onset of jaundice.
s/s: May have no
symptoms initially.
Complications:
□ Fulminant hepatitis
Hepatitis B.
Hepatitis C
Hepatitis D
Hepatitis E
At risk:
□ IV drug users
□ People on
Hemodialysis
□ Health care
personnel
At risk:
□ IV drug users
□ People receiving
frequent
transfusions
□ Healthcare
personnel
Cause: Occurs only with
Hepatitis B and only
causes problems with
an acute HepB
infection.
Cause: waterborne
virus
Transmission:
□ blood and body
fluids
□ contaminated
needles, parenteral
□ sexual activity
Incubation: 6-24 weeks
s/s:
□ progression of
symptoms is more
insidious and
prolonged than
Hep A virus.
□ Initially may be
asymptomatic.
□ 1 week -2 months of
Prodromal
symptoms: fatigue,
anorexia, transient
fever, abdominal
Transmission:
□ Same as Hep B
□ Blood and body
fluids
Incubation period: 5-10
weeks
s/s: similar to HBV but
often less severe.
Complications:
□ chronic liver disease
□ Cirrhosis.
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
At risk:
□ common in Middle
east, south Africa
and Mediterranean
□ same as HepB
Transmission:
□ same as Hepatitis B.
Incubation period: 7-8
weeks
HepD along with HepB
causes superinfection
and worsening of
condition and rapid
progression of cirrhosis
Complications:
As per Hep B
At risk:
□ Travel to areas
where sewage
disposal is
inadequate and/or
people bathe in
contaminated rivers
□ At higher risk with
higher mortality:
women in third
trimester of
pregnancy
Transmission:
□ Same as HepA
Incubation: 2-9 weeks
Complications:
□ Maternal and fetal
demise
14
□ death
discomfort N/V, HA.
□ Then expanding to:
Hepatic S/S,
photophobia,
angioedema, rash,
vasculitis, jaundice
in Icteric phase
Complication:
□ Cirrhosis
□ Fulminant hepatitis
A grid follows with a listing of medications that may be on the exam.
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
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Drug
Acetylsalicylic acid
(Aspirin)
□ Non-narcotic
analgesic
□ Antipyretic
□ Antiplatelets
Activated charcoal
(Actidose)
□ Antidote
□ Adsorbent
Use and dosage
□ Blocks pain impulse
in peripheral and
some CNS;
□ antipyretic result;
□ inhibit platelets
aggregation
□
□
□
□
□
□
Side effect
□ Increases
coagulation times
□ Reye’s syndrome
(encephalopathy
and fatty liver),
□ GI bleed,
□ tinnitus,
Treat TIA, Post MI, □ liver toxicity (dark
Stroke, angina
urine, clay stool,
itching, yellowing
sclera and skin),
□ visual changes
Treat poison and
□ Vomiting with rapid
overdose following
administration
oral ingestion.
□ pulmonary
Binds to poison and
aspiration
prevent its
absorption by the
GI tract and then
eliminates in the
feces.
Administer within
60 minutes of
ingestion.
Give once or twice
depending on the
level of toxin.
May come premixed with water
12.5-25 grams
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
Teaching and labs
□ Monitor coagulation
studies
□ Take with full glass
of water, milk for
food to prevent
stomach upset
□ Do not crush enteric
coated
□ given daily (81-325
mg) for cardiac
prophylaxis post MI,
stents, strokes, etc.
□ Binding is
irreversible so
cathartic such as
sorbitol may be
added as well.
□ It allows certain
drugs/toxins to be
drawn out of the
blood and bind to
charcoal in the
intestine a kind of
“gut dialysis”
□ Stools will be black
□ Charcoal does not
change the stomach
PH.
contraindication
Do not use with:
□ children under 12
and/or children or
teenagers with
chicken pox or flu
like symptoms
(because of risk of
Reye’s syndrome);
□ pregnancy in 3rd
trimester; and
□ vitamin K deficiency
Do not administer with
Ingestion of:
□ caustic alkali agent,
□ high viscosity
petroleum products
OR when:
□ convulsions are
occurring,
□ cardiac
dysrhythmias are
present, or
□ there is emesis of
blood
Implement antidote
supportive care and
prevent aspiration are
if gastric lavage is not
to be performed.
16
Drug
Acyclovir
(Zovirax)
□ Antiviral
- Herpes simplex
virus – HSV
- Herpes zoster
- varicella
Alteplase recombinant
(Activase)
Streptokinase is similar.
Urokinase is given
mostly in emergency
situation.
□ Thrombolytic agent
Cath-flo Activase – is
for occluded catheters
Use and dosage
□ Used for herpes
simplex. Does not
eradicate latent
herpes. It reduces
viral shedding and
formation of new
lesions and speeds
healing time.
(oral, IV and topical)
□ To decrease
symptoms with
varicella zoster
(chicken pox/
shingles).
□ Dissolves or break
down clots to
reestablish
perfusion.
□ Indicated for clients
at risk for
developing
thrombus with
resultant ischemia
such as MI,
ischemic stroke,
arterial thrombosis,
DVT, PE
□ occlusion of IV
catheters.
Side effect
Side effects:
□ Headache, dizziness
□ seizure
□ nausea, vomiting,
diarrhea
□ acute renal failure
□ thrombocytopenia
□ purpura hemolytic
□ uremia syndrome
Teaching and labs
□ Even after HSV
infection is
controlled, latent
virus can be
activated by stress,
trauma, fever
exposure to
sunlight, sexual
intercourse.
□ Refrain from sex if
S/S of herpes.
Adverse effects/toxicity:
□ nephrotoxicity
contraindication
□
□
□
□
Do not give with:
□ pregnancy,
□ active bleeding,
□ recent Hx of CVA,
□ Uncontrolled HTN,
Hemorrhage,
N/V,
hypotension
cardiac
dysrhythmias.
□ Dose related is the
highest problem
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
□ Watch for s/s
bleeding; VS
changes, s/s of
impending shock
□ If bleeding is
occurring stop
treatment and
notify doctor. May
start on FFP and
PRBC.
□ Aminocaprionic acid
(Amicar) may be
ordered for
overdose or
excessive bleeding.
IM medication route is
contraindicated when
using thrombolytics.
□ Do not take NSAIDs
or Aspirin because
of enhanced
bleeding.
17
Drug
Aluminum hydroxide
(Amphogel)
□ Antacid
Ampicillin (Ampicin)
IV, PO, IM.
□ Antibiotic
□ Aminopenicillin
Similar side effects,
allergic reaction, etc.
for all Penicillins (PCN)
Use and dosage
□ Neutralizes gastric
acid,
□ antflatulent to
alleviate symptoms
of gas and bloating
Treat bacterial
infection
Commonly used with:
□ Shigella,
□ salmonella,
Escherichia coli,
□ haemophilus
influenza,
□ Neisseria
gonorrhea,
□ Neisseria
meningitis,
□ gram positive
organism
Side effect
□ Increases gastric pH,□
□ Decreases
absorption of other
drugs such as dig, □
antibiotic, iron
supplement.
□ Toxicity causes
dementia,
Hypercalcemia,
□
metabolic alkalosis,
worsening of HTN,
heart failure from
increased intake.
□ allergic reaction:
Skin rash, urticaria,
swelling, pruritus,
angioedema.
□ Severe allergy:
hives, wheezing,
anaphylactic
reaction. Medical
emergency requires
immediate tx or can
lead to death.
□ side effects: GI, N/V,
diarrhea, abdominal
pain.
□ Pruritic rash like
measles is not a true
allergic reaction
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
Teaching and labs
Given 2 hrs. apart from
other drugs where
interaction may occur.
Observe for signs and
symptoms of altered
phosphate levels;
anorexia, muscle
weakness and malaise.
Increase fluid, exercise
and fiber to prevent
constipation.
contraindication
Do not use:
□ abdominal pain,
N/V, diarrhea,
□ severe renal
dysfunction,
□ fecal impaction,
rectal bleeding,
□ colostomy,
ileostomy
□ dehydration
□ hypercalcemia and
hypercalciuria
□ Do not give with
fruit juice, milk or
carbonated
beverages because
of poor absorption.
□ Watch for
hypokalemia
□ Take on empty
stomach.
□ May not be
necessary to stop
treatment if mild
diarrhea develops.
□ Give yogurt or
buttermilk to
restore normal flora
(or probiotics)
Avoid with:
□ Hypersensitivity to
any penicillins; use
cautiously if history
of hypersensitivity
to cephalosporins;
□ Exfoliated
dermatitis
□ Loop diuretic may
exacerbate
hypokalemia and
rash.
□ Potassium-sparing
diuretic may
contribute to
hyperkalemia
18
Drug
Atropine Sulfate.
Use and dosage
□ Use to increase
heart rate (not
Two different uses:
necessarily first
drug of choice).
□ Anticholinergic
□ Decreases
(such as for
involuntary
Parkinson’s disease)
movement and
□ For ophthalmic use
rigidity in
Parkinson’s disease
□ Pre-op to decrease
secretions and
prevent aspiration
Systemic effect is more
of secretions while
pronounced in infant
under anesthesia
and children with blue
eyes and blond hair.
□ Use for
Also increased risk of
inflammation of the
toxicity with Down
iris and uveal tract.
syndrome
Side effect
□ Dry mouth,
constipation, urinary
retention or
hesitancy headache,
dizziness
Adverse effects/toxicity:
□ Paralytic ileus.
□ Treat overdose
(resp. depression
and circulatory
collapse)
symptomatically.
Adverse effect when
used for the eye
□ Transient stinging,
□ increase IOP,
photophobia,
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
Teaching and labs
contraindication
□ Monitor dosage of
□ Increased
meds carefully, even
anticholinergic
slight overdose can
effect with
lead to toxicity.
phenothiazine,
antidepressant,
□ Assess for
MAO’s amantadine.
constipation and
urinary retention;
increase fluids, bulk □ Contraindicated in
and exercise, assess
pt. with narrow
bowel sound to rule
angle glaucoma,
out paralytic ileus,
myasthenia gravis,
or GI obstruction.
□ Avoid driving or
other hazardous
activities,
drowsiness may
occur.
For the Eye
□ Acute glaucoma can
be precipitated by
papillary dilation; if
not recognized and
treat, acute
glaucoma can result
in blindness.
□ Wear dark sunglass
and avoid bright
light for
photophobia,
□ Monitor intraocular
pressure and vision
19
Drug
Beclomethasone
diproprionate
(Beclovent)
□ inhaled
corticosteroid
medication
note: also nasal
inhalant as Beconase
Use and dosage
□ Used in bronchial
asthma, allergic
rhinitis
Side effect
Side Effects:
□ Pharyngeal irritation
and sore throat,
coughing, dry mouth,
oral fungal infections,
and sinusitis.
Teaching and labs
□ Decrease dose if pt.
is on systematic
corticosteroid.
□ Assess for impaired
bone growth in
children receiving
inhaled
□ Increased
corticosteroid
susceptibility to
Considerations:
infection,
□ Monitor for
dermatologic effects
hyperglycemia
and osteoporosis,
□ Rinse mouth after
diarrhea, N/V, HA,
use for medication;
fever, dizziness
oropharyngeal
angioedema rash
candidiasis and/or
urticaria and
hoarseness can
paradoxical
occur.
bronchospasm
□ Use bronchodilator
inhalant before
Adverse effects/toxicity
corticosteroid when
□ Adrenocortical
both are ordered.
insufficiency
□ Do not abruptly
□ fluid and electrolyte
stop meds taper
disturbances,
over 2 weeks.
□ nervous system
□ Be aware of steroids
effects and
symptoms - Moon
endocrine effects if
face, acne, edema,
absorbed
increased fat pads
systemically.
- notify doctor.
□ Report weight gain
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
contraindication
Do not use with:
□ children under
□ Clients with known
allergy
□ May require
adjustment of
antidiabetic agent
as there is a
potential for
elevated blood
glucose levels with
corticosteroids are
administered orally.
□ Not use in
bronchospasm or
status asthmaticus.
20
Drug
Benztropine mesylate
(Cogentin)
□ Anticholinergic
(cholinergic
receptor
antagonist)
□ Anti-Parkinson
Use and dosage
□ Treat Parkinson
symptoms:
Suppresses
tremors and
rigidity, not tardive
dyskinesia
□ Decreases
hypersalivation and
irregular
movement related
to Parkinson
disease.
□ Reduces extrapyramidal side
effects
Buspirone (Buspar)
□ Anxiety
□ anxiolytic
□ Desired response 710 days; Make take
3-4 weeks for full
effect
Side effect
Side effects:
□ dry mouth,
□ urinary
retention/hesitancy,
□ HA,
□ dizziness.
Teaching and labs
□ Monitor dose
carefully; even slight
overdose can lead
to toxicity.
Nursing considerations:
□ Monitor I&O’s,
Adverse effects/toxicity:
Education:
□ paralytic ileus
□ Avoid driving, or
other hazardous
activities;
drowsiness may
occur.
□ Avoid cough
OTC medication
unless
prescribed.
Side effects:
□ When switching to
□ Dizziness
Buspar, taper off
benzodiazepines
□ headache
□ Less likely to have
□ drowsiness
cognitive
impairment than
other CNS meds
□ Does not cause
withdrawal s/s and
thus does not need
to be tapered off
when stopping
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
contraindication
Avoid use with:
□ narrow-angle
glaucoma,
□ myasthenia gravis,
□ GI obstruction
Avoid use with:
□ MAO Inhibitors
□ Lactation
□ Caution with:
moderate to severe
renal impairment
21
Drug
Chlordiazepoxide
hydrochloride
(Librium)
□ Anxiolytic
□ Sedative-hypnotic
benzodiazepine
IM & tablet form
Peak:
□ 1-4 hours PO,
□ 15-30 min IM.
Half-life 5-30hr
Use and dosage
□ To relieve tension
and/or anxiety
□ To manage alcohol
withdrawal
Side effect
Adverse effect:
□ respiratory distress,
drowsy, dizziness,
lethargy, orthostatic
hypotension
□ photosensitivity
□ do not to stop
taking drug
abruptly – will have
withdrawal
symptoms (usually
in 5-7 days)
Suicidal tendencies may
be present and
protective measures
may be necessary.
□ Monitor closely for
paradoxical
reactions –
excitement,
stimulation, acute
rage – usually early
in tx – withhold
drug and notify dr.
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
Teaching and labs
□ Give with milk or
food to prevent GI
upset.
□ Check BP and pulse
early in tx. If BP falls
delay medication
and notify dr.
□ Labs: Monitor CBC,
renal and hepatic
enzyme levels
□ watch for
dependency
Education:
□ Avoid alcohol
□ no OTC meds unless
prescribed
□ Avoid driving and
other hazardous
activities until
effects known.
contraindication
Avoid use with:
□ Narrow angle
glaucoma,
□ under 12 year old
□ lactation
Use cautiously with:
□ impending
depression,
□ impaired hepatic or
renal function,
□ COPD
22
Drug
Chloramphenicol
(Chloromycetin)
Oral, injection,
ophthalmic drops and
ointment
□ Anti-bacterial
Chlorothiazide (Diuril)
□ Thiazide diuretic,
non-Potassium
sparing
□ Anti-hypertensive
Use and dosage
□ severe infection for
susceptible
organisms when
other anti-infective
are ineffective.
□ Sty, conjunctivitis,
uveitis
Side effect
Side effects:
dermatitis, itching,
stinging, swelling
Adverse effects/toxicity
(oral and injection)
□ edema
□ super infection,
□ aplastic anemia.
□ Stevens-Johnson
syndrome
Teaching and labs
□ obtain culture
specimen from eye
before initiation of
treatment
□ remove exudates.
□ Monitor for pain,
drainage, redness,
swelling.
□ Monitor for
bleeding or bruising
contraindication
Avoid use with:
□ hypersensitivity
□ Increases urinary
excretion sodium
and water by
inhibiting sodium
reabsorption.
□ Use for edema and
HTN, HF, cirrhosis,
corticosteroid and
estrogen therapy,
diabetes insipidus,
Side effects:
□ Dizziness, vertigo,
frequent urination,
electrolyte
imbalance, impaired
glucose tolerance,
hyperuricemia,
photosensitivity
Adverse effects/toxicity:
□ Renal failure,
aplastic anemia, and
anaphylaxis
□ Take early in the
morning to avoid
nocturia.
□ Give with food,
□ allow for 3-4 weeks
for maximum effect,
□ Will not be effective
if creatinine
clearance Is less
than 30ml/min
Avoid use:
□ Client with anuria.
□ Use cautiously with
impaired renal or
hepatic function.
□ If pregnant.
□ Will increase serum
lithium level
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
23
Drug
Chlorpromazine
hydrochloride
(Thorazine)
□
□
□
□
Use and dosage
□ Block dopamine
receptor in CNS to
□ Use: treat
psychotic disorder
phenothiazine
(schizophrenia,
Antipsychotic
bipolar, and other
medication
mental illnesses);
prevent acute
Anti-emetic
exacerbation and
maintain highest
possible level of
function
Give bromocripitine
□ Use to control
(Parlodel) and
manic phase
dantrolene
(bipolar)
(Dantrium) for
□ intractable hiccups
NMS.
□ nausea/vomiting
□ Low potency antipsychotic which
can reduce the risk
of EPSE (extrapyramidal side
effects)
Side effect
Side effects:
□ Sedation,
orthostatic
hypotension,
□ anticholinergic
effect (dry mouth,
blurred vision,
urinary retention,
photophobia,
constipation,
tachycardia)
□ liver damage,
tremor are two
major side effects.
□ photosensitivity
Adverse effects/toxicity:
□ Neuroleptic
malignant
syndrome (NMS),
catatonia, rigidity,
stupor, unstable
blood pressure
profuse sweating,
dyspnea. Can be
toxic effect and
MAY last for 5-10
days after
discontinuation of
the med.
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
Teaching and labs
□ get baseline ECG,
thorough baseline
evaluation lab tests
before treatment.
□ Give bromocripitine
(Parlodel) and
dantrolene
(Dantrium) for
NMS.
□ Withdrawal of drug
is necessary
□ Take measures to
protect eyes
exposed to sunlight
contraindication
□ Monitor diabetics
closely for glucose
intolerance
24
Drug
Cimetidine (Tagamet)
□ GI meds,
□ H2 receptor
antagonist
Cisplatin (Platinol)
Half-life 20-30 minutes
□ Antineoplastic
medication
□ Alkylating agent
** Major allergic
reaction can occur
within first 15 mins. of
administration.
Anaphylaxis may occur
within minutes of drug
initiation.
Use and dosage
□ Works against
histamine
receptors,
decreases gastric
secretion.
□ Use short term for
duodenal ulcer,
benign gastric
ulcer, acute upper
GI bleed
□ Treat ovarian and
testicular cancer by
interfering with
DNA replication
Side effect
Side effects:
□ Cardiac dysrhythmia,
diarrhea, dry mouth,
constipation
Adverse effects/toxicity:
□ Rare but may
include
agranulocytosis
neutropenia ,
thrombocytopenia
aplastic anemia,
anaphylaxis
Side effects:
□ anorexia,
uncontrolled N/V,
fluid retention,
weight gain
Adverse effects/toxicity:
□ Major toxicities
occur in the blood,
GI, and reproductive
system.
□ Watch urine output
and specific gravitynephrotoxicity may
occur within 2 wks.
□ ototoxicity (tinnitus
or difficulty hearing
in the high
frequency range)
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
Teaching and labs
□ May be given with
meals and at
bedtime
□ Avoid smoking
which cause gastric
stimulation
□ Avoid antacid use
within one hour of
dose
contraindication
Avoid use:
□ hypersensitivity
Use caution:
□ impaired renal or
hepatic function
□ maintain fluid at
least 3000 ml in 24
hr. ; report reduced
urine output
□ Avoid food high in
thiamine (beer,
wine cheese,
brewer’s yeast,
chicken liver &
banana) - may lead
to hypertension &
intracranial
hemorrhage
Avoid use:
□ Hx of sensitivity to
platinum-containing
compounds,
□ impaired renal
function and
hearing,
□ Hx of gout, renal
stones.
Incompatible with
□ dextrose and
Reglan, Vanco
□ Lasix may increase
otoxicity
□ other nephrotoxic
drugs may increase
nephrotoxicity and
renal failure.
25
Drug
Codeine sulfate
□ Opioid analgesic
(agonist)
□ Antitussive (cough
suppressant)
Use and dosage
□ To treat mild to
severe pain
□ most oral
preparations
combined with ASA
or acetaminophen
□ hyperactive cough
Rapid onset if IM or IV.
Peak 1-2 hrs.,
Duration up to 7 hours.
Cyanocobalamin
(Vitamin B12)
Half- life: 6 days
□ Vitamin B12 helps in
the formation of
red blood cells
essential for the
proper production
of blood platelets
and red and white
blood cells and the
nervous system
□ Malabsorption
syndrome
□ Pernicious anemia
Side effect
Side effects:
□ Constipation, urinary
retention, dizziness,
lightheadedness.
Adverse effects/toxicity:
□ Respiratory
depression,
respiratory arrest,
circulatory
depression, ICP.
□ Long term use may
cause withdrawal
symptoms when
stopped
Adverse effects/toxicity:
□ Anaphylactic shock,
sudden death,
□ severe optic nerve
atrophy (may
develop after years
of use or with
Leber’s disease)
□ water-soluble
vitamin that is
stored in the liver.
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
Teaching and labs
Assess for:
□ respiration and
usually hold <12
breaths per minute,
□ CNS changes (LOC),
□ allergic reaction
TEACH:
□ no alcohol
□ no OTC pain meds
unless ordered
□ Avoid driving until
drug response is
known.
contraindication
Do not use:
□ Hypersensitivity
□ Increased ICP, head
injury
□ Acute alcoholism
□ labor
Teach:
□ Injection is once per
month for life with
pernicious anemia .
□ Oral preps may be
mixed with fruit
juice but give
immediately since
ascorbic acid (Vit. C)
affects stability of
B12.
□ Dietary B12: best are
organ meats, egg
yolk, clams, oysters,
crabs, sardines,
salmon
Do not use:
□ Hypersensitivity
□ Lactation
26
Drug
Cyclosporine
(Sandimmune)
□ Immunosuppressant
medication
Metabolized in the
liver.
Peak 4-5hr,
Duration 20-54 hrs.
Half-life 19-27 hrs.
Use and dosage
□ Inhibit T helper and
T suppressor cells.
□ Prevent rejection of
kidney, liver and
heart transplants.
□ Treat chronic
rejection in people
who have received
immunosuppressive agent,
rheumatoid
arthritis,
recalcitrant plaque
psoriasis
Side effect
Side effects:
□ Hypertension,
□ increased risk of
infection
□ Tremor is an
expected side effect
Teaching and labs
□ Monitor labs: AST,
ALT, BUN, creat,
platelet count, K,
TEACH:
□ Take with food to
reduce GI upset
□ mix with milk,
Adverse effects/toxicity:
chocolate milk or
orange juice but not
□ Renal toxicity,
with Grapefruit juice
□ hepatotoxicity
□ Mix in glass, not
plastic
□ Avoid use of live
vaccine
□ Prevention of
infection and report
signs of infections
contraindication
□ Do not use:
Pregnant/lactating
mom,
□ Use cautiously in
renal and hepatic
impairment
□ Antiepileptic
medications
decrease
cyclosporine levels
□ oral contraceptive
increase levels
□ Immunosuppressed
precautions
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
27
Drug
Debrox drops
□ Ear drops to dewax
Use and dosage
□ used to soften and
loosen ear wax,
making it easier to
remove.
Side effect
Side effects:
□ temporary decrease
in hearing after
using the ear drops
□ mild feeling of
fullness in the ear
□ mild itching inside
the ear.
Adverse effects/toxicity:
□ Get emergency
medical help if you
have any of these
signs of an allergic
reaction: hives;
difficulty breathing;
swelling of your
face, lips, tongue, or
throat
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
Teaching and labs
Use:
□ Tilt head with ear
facing upward. Pull
back on ear to open
up the ear canal.
Drop the correct
number of ear drops
into the ear.
□ After using the ear
drops, stay lying
down or with your
head tilted for at
least 5 minutes. You
may use a small
piece of cotton ball
to plug the ear and
keep the medicine
from draining out.
□ A bubbling sound
inside may be heard
after putting in the
drops. This is caused
by the foaming
action of carbamide
peroxide, which
helps break up the
wax
□ May come with bulb
syringe.
contraindication
Do not use:
□ With a ruptured ear
drum.
□ any signs of ear
infection or injury
□ Do not use this
medication in a
child younger than
12 years old without
the advice of a
doctor.
□ Do not use for
longer than 4 days
in a row.
28
Drug
Diazepam (Valium)
□ Benzodiazepine
(have zep and zap
in them)
□ minor tranquilizers,
□ anticonvulsant,
□ anxiolytic
□ Absorbed from GI,
metabolize in liver
Onset 30 min IM, 60
PO, 15 IV. Works
quickly.
Peak 1-2hr PO,
Duration 15 min to 1hr
IV; up to 3 hrs. PO.
Half-life 20-50 min
Use and dosage
□ Relieve pain and
discomfort from
musculoskeletal
disorders,
□ manage anxiety,
□ Manage acute
alcohol withdrawal
Maximum effect will
be seen in 1-2 weeks.
Can take 2-4 wks. It has
addictive effect.
Side effect
Side effects: ABCD.
□ Anticholinergic (dry
mouth),
□ Blurred vision,
□ Constipation, &
□ Drowsiness,
Teaching and labs
□ Watch for CNS
effect.
□ Monitor CBC WBC
with diff.
□ notify dr. if drop in
BP of 20 mm Hg
□ Assess for allergic
reaction including
□ cardiovascular
idiosyncratic
collapse,
reaction,
laryngospasm,
anaphylaxis, rash
dizzy, weakness,
fever resp distress
nausea
Adverse effects/toxicity: Teach
□ Do not stop
□ Erythema
abruptly –
multiforme,
withdrawal
□ angioedema,
symptoms will
□ anaphylaxis,
occur (insomnia,
□ dysrhythmia
nausea HA,
□ seizure
spasticity,
tachycardia).
□ No alcohol (will
increase CNS
depression)
contraindication
Do not use:
□ compromised
pulmonary
function,
□ hepatic disease,
□ impaired
myocardial
function,
□ acute alcohol
intoxication
□ infant < 6 months
□ narrow angle
glaucoma, open
angle glaucoma
□ Suicide prevention
precautions
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
29
Drug
Digoxin (Lanoxin)
□ Cardiac glycoside,
antiarrhythmic
drug.
□ Therapeutic range:
0.5-2.0ng/ml
□ Toxic level > 2
Antidote: digibind
(digoxin immune fab)
Use and dosage
□ Positive inotropic
effect
□ In heart failure it
Increase
contraction of the
heart muscle.
□ In atrial fib, it slows
the heart rate
Side effect
Side effects:
□ Nausea, HA, loss of
usual appetite.
Adverse effects/toxicity:
□ Toxicity may go
unrecognized since
it presents with
same symptoms as
flu (N/V, anorexia,
diarrhea, vomiting
visual disturbance).
□ Blurred green or
yellow vision or halo
effect**
□ In HF, early sign of
toxicity includes
dysrhythmias.
□ Children rarely show
signs of N/V,
diarrhea, visual
problem, anorexia
(could become dig toxic
without showing usual
s/s)
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
Teaching and labs
□ may give without
regard for food
□ IVP over 5 min, do
not give IM, it will
cause tissue
irritation.
□ Monitor apical
pulse, if <60/min.,
usually hold meds
and notify doctor.
□ Monitor labs (K,
calcium,
magnesium,
creatinine
clearance),
□ Monitor Dig level
every 6 months.
□ weigh daily and
report weight
greater than 2 lbs.
per day
contraindication
Avoid use with:
□ hypersensitivity to
dig
□ Caution with kidney
failure
Interaction:
□ IV calcium with dig
may increase risk of
cardiac
dysrhythmias,
□ erythromycin will
increase dig level,
□ quinidine,
verapamil and
amiodarone will
increase dig levels
and dig dose should
be decreased by
50%
□ Cyclophosphamide
combined with dig
cause dig toxicity
30
Drug
Disulfiram (Antabuse)
The only alcohol
antagonist in use.
□ Enzyme inhibitor
□ Anti-alcohol agent.
Half-life 24-36 hour
Onset up to 12 hrs.
Duration up to 2 wks.
Absorbed from the GI
excreted in feces or in
the breath as carbon
disulfide
Use and dosage
□ Adjunct treatment
of patient with
chronic alcoholism
who sincerely
wants to maintain
sobriety.
□ At least 12 hours
should elapse from
the time of last
alcohol intake and
the initial dose
□ Use only in people
with high physical
health.
□ Use for 1-2 wks.
Side effect
Side effects:
□ Rare in the absence
of alcohol
Adverse
effects/toxicity:
** Acetaldehyde
syndrome
□ hypotension to
shock level
arrhythmias,
□ acute congestive
failure,
□ marked respiratory
depression,
INTENDED Reaction
□ unconsciousness,
with alcohol ingestion: □ convulsions
□ flushing face, chest, □ sudden death
arms
□ pulsating HA
□ Nausea
□ violent vomiting
□ thirst
□ sweating
□ marked uneasiness
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
Teaching and labs
□ The effects of
disulfiram may
persist for 2 weeks
after last dose is
taken; alcohol must
not be consumed
until this interval is
over.
□ Give in the morning
when the resolve
not to drink is the
strongest. Give at
bedtime to
minimize the effect
of drug
□ avoid alcohol of all
forms include those
found in sauces,
cough mixture and
after shave lotions,
colognes and
liniments
contraindication
Do not use:
□ In people who do
not want to stop
drinking.
□ Severe cardiac
disease,
□ psychoses,
□ pregnancy,
□ multiple drug
dependence.
31
Drug
Epinephrine
(Adrenalin)
□ alpha and beta
adrenergic agonist
□ vasopressor
□ bronchodilator
□ If given IM, SQ result seen in 5 min
& lasts up to 4 hrs.,
□ Also available eye
drops and
intranasal
Use and dosage
□ Reverses
anaphylactic
reaction
□ Restores cardiac
rhythm in cardiac
arrest
□ Acute asthmatic
attack
Side effect
Side effects:
□ nervousness,
□ tremors,
□ increased HR, BP,
□ insomnia,
□ anorexia
□ cardiac stimulation
□ vascular HA.
Teaching and labs
Teach
□ Report nervousness
and sleeplessness dose should be
reduced.
□ Administer eye
drops at bedtime.
May experience
headache and
stinging but subside
□ Also use in
Adverse effects/toxicity:
with continued use.
ophthalmic
□ Tachyarrhythmias,
Report if continues.
decongestant,
□ chest pain,
manage open angle □ restlessness,
□ Monitor VS
glaucoma
□ agitation,
especially HR and
□ nervousness and
BP because of
□ insomnia.
cardio effect.
□ Nasal burning
stinging,
□ eye burning
D/C if hypersensitivity
develops (develops of
lids, itching, discharge,
crusting eyelid). Notify
doctor
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
contraindication
If use with MOA
inhibitors may lead to
hypertensive crisis.
□ Narrow angle
glaucoma,
□ hemorrhagic
traumatic or
cardiogenic shock,
□ arrhythmias,
□ organic heart or
brain disease.
CAUTION in:
□ older adults,
□ HTN
□ TB, long standing
bronchial asthma
and emphysema
□ children < 6
□ No breastfeeding
32
Drug
Famotidine (Pepcid)
□ Histamine
□ H2 antagonist.
Onset 1 hr. Peak 1-3hr
Duration 10-12 hrs.
Half-life 2.5-4hr
Fluoxetine
hydrochloride (Prozac)
Use and dosage
□ Decreases output
of gastric acid
□ Short term
treatment in
duodenal ulcer or
benign gastric
ulcer.
□ Metabolized in
liver, excreted in
urine
□ Major depressive
disorder
□ Obsessive
compulsive
disorder,
□ bulimia,
□ panic disorder
□ obesity
□ alcoholism
□ chronic pain.
Side effect
Teaching and labs
Side effects:
□ May be taken with
□ diarrhea,
food.
constipation, dry
□ pain relief may not
mouth
be experienced for
Adverse effects/toxicity:
several days
□ thrombocytopenia
contraindication
□ Use cautiously with
impaired renal or
hepatic function.
□ Do not breastfeed
□ DO NOT stop
abruptly.
□ Give meds once a
day at about noon
because it causes
insomnia. If
prescribed 2 times
daily give dose in
the morning early
and 12 noon to
prevent insomnia
□ Teach side effects
of drugs
□ Therapeutic
response takes
some weeks to be
established.
□ MI, cerebrovascular
disease.
□ If suicide risk,
should not have
access to a large
quantity.
□ Do not take while
pregnant
Common side effects:
□ Orthostatic
hypotension
□ psych med.
□ sedation
□ Tricyclic
□ Anticholinergic
antidepressant.
□ Hypomania
□ Selective Serotonin
□ Sexual dysfunction
Reuptake inhibitors
Adverse effects/toxicity:
(SSRI)
□ Cardiac toxicity
□
Selective Serotonin
Half-life 1-6 days.
syndrome (early s/s:
Onset 2-3 weeks to be
diaphoresis, agitation,
Such as rash. Wait 4-6
effective.
weeks before switch to low grade temp.) Then
Peak 4-8hrs.
increase in BP, muscle
MAO Inhibitor
Metabolized in liver,
rigidity, temp, resp,
absorbed from GI tract,
pulse. Mental status
excreted in urine and
changes, tremors,
face.
hyperthermia, sweating
hypersalivation.
Notify dr ASAP.
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
□ avoid antacid use
within 1 hour of
dose
□ ** The combination
of TCA and MAOI
can lead to
hypertensive crisis
from excessive
adrenergic
stimulation of the
heart and blood
vessels.
33
Drug
Fluphenazine (Prolixin)
Use and dosage
□ Potent medication
for treatment of
□ phenothiazine; Ends
antipsychotic
with azine
symptoms,
including
□ antipsychotic
schizophrenia.
Half-life > 24 hours
□ Treatment is not
Onset: 1 hr.,
curative.
peak 0. 5 hr. meds
□ Adjust dose to
symptoms.
effect can be seen 1-2
days but full effect
□ Use injectable form
several weeks
for long term
maintenance
- the rate of relapse is
usually reduced and is
more favorable
Side effect
□ Produces EPS which
are reversible.
** Treat EPS with
Cogentin, Artane,
Benadryl, Symmetrel
Side effects: ABCDE
□ Anticholingergic
(dry mouth), Blurred
vision, Constipation,
Drowsiness, EPS
□ Photosensitivity
□ may increase risk of
agranulocytosis
□ gynecomastia,
□ amenorrhea
□ weight gain
Adverse effects/toxicity:
Neuroleptic malignant
syndrome (NMS) a fatal
side effect. Presents
with catatonia, rigidity,
stupor, unstable blood
pressure, hyperthermia
profuse sweating,
dyspnea, incontinence.
Stop drug. Tx with
Dantrium and Parlodel.
Condition lasts for 5-10
days after stopping
med.
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
Teaching and labs
Monitor LFTs
TEACH
□ Avoid alcohol use
and other CNS
depressants
□ Do not alter dose or
stop abruptly
□ Avoid sun exposure
□ With oral
concentrate, avoid
spills. Rinse skin
with warm water
immediately if there
is contact
contraindication
Avoid with:
□ Caution with
narrow angle
glaucoma, hepatic
or renal dysfunction
and seizure
disorder.
□ Do not breastfeed
□ Dose should be
reduced in the
elderly.
□ Dilute liquid drug
with fruit juice
water, carbonated
beverage, milk,
soup – avoid mixing
with caffeine, tea,
apple juice.
34
Drug
Furosemide (Lasix)
□ Loop diuretics,
□ Anti-hypertensive
Peak 60-70 min PO, 2060 min IV.
Onset 30-60 min PO, 5
min IV,
Duration 2 hrs.,
Half-life 30 min
Use and dosage
□ Rapid acting loop
diuretic
□ Inhibits
reabsorption of
sodium and water
(in Loop of Henle)
□ Lowers BP by
decreasing edema
and intravascular
fluid
Treat
□ acute pulmonary
edema, edema,
□ heart failure,
□ chronic renal
impairment,
□ hypertension,
□ hypercalcemia
Side effect
Side effects:
□ Ototoxicity
□ headache
□ Dizziness
□ Orthostatic
hypotension
□ weakness
Teaching and labs
TEACH
□ change position
slowly to avoid
dizziness and
orthostatic
hypotension
□ report ringing in the
ear immediately
□ Take with food or
milk
Adverse effects/toxicity:
□
Give early in day to
□ s/s hypokalemia –
avoid nocturia
□ Hyponatremia,
□ Replace potassium
□ hypochloremia,
(dietary or meds)
□ hypomagnesaemia
□ hypocalcemia
□ Monitor labs,
especially
electrolytes. Also
IV form:
hgb, hct, platelet as
□ Administer slowly;
these increase d/t
hearing loss can
hemoconcentration
occur if injected
rapidly (ototoxicity).
□ Monitor body
□ Give over 1-2
weight and I&O.
minutes to prevent
hypotension.
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
contraindication
Avoid with:
□ anuria, electrolyte
depletion,
increasing oliguria,
anuria
□ hepatic coma,
□ pregnancy,
lactation
□ Interaction with
digitalis can
increase
arrhythmias.
□ Interaction with
aminoglycosides
increases risk of
ototoxicity.
35
Drug
Gentamicin
(Garamycin)
□ Aminoglycosides.
□ Antibiotic
Peak level:
□ Drawn 15-30 min
after the infusion is
completed.
□ Peak concentration
determines that
toxic level does not
occur.
□ If peak is too high,
may reduce dose.
Trough level:
□ Drawn immediately
(within 30 minutes)
before next IV dose
□ Assures that
therapeutic level of
drug is maintained.
Trough level is 1-2
g/ml between
doses.
□ Dose will be
adjusted if level is
not sustained
Peak 30-90 min
Half-life 2-4 hr.
Use and dosage
□ Broad-spectrum
antibiotic
□ Parenteral use
limited to severe
infections,
unresponsive to
other antibiotics.
Ophthalmic:
□ treat superficial
infection of the
eye.
□ Have pt. keep eyes
closed for 1-2 min
after instillation.
□ Vision will be
blurred initially
Side effect
Side effects:
□ HA, parenthesia,
skin rash fever
contraindication
Avoid with:
□ Maintain hydration
□ Pre-existing renal
to protect kidney
disease
damage. Fluid
□ Use caution with
Adverse effects/toxicity:
intake should be
pre-existing hearing
2,500-3000 ml/day
□ Nephrotoxicity
loss
□ give high protein
□ Ototoxicity.
□ Pregnancy,
foods
This may cause
lactation
LABS
irreversible auditory
□ Increased risk with
□ WBC to monitor the
impairment and
nephrotoxic drugs,
vestibular damage
effectiveness of
prolonged
Signs of ototoxicity
therapy
treatment with
include HA, NV unsteady □ Watch kidney
aminoglycosides,
gait, tinnitus, vertigo,
function tests (BUN,
impaired renal
high frequency, hearing
Creat) closely due to
function and other
loss and dizziness
toxicity risk
ototoxic drug such
□ Hypersensitivity
as Lasix, Vanco.
reactions
□ Report sore throat,
□ Superinfection: a
watery stools
secondary infection
greater than 4-6 per
caused by
day, severe nausea
eradication of
or vomiting,
normal flora:
indicating possible
Candidiasis, skin and
super infection
mucous membrane
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
Teaching and labs
36
Drug
Glipizide (Glucotrol)
□ oral antidiabetic
□ Sulfonylurea
duration: 12-24 hours
Onset: 15-30 min
Peak: 1-2hr
Metabolized by the
liver
Glucagon
□ Anti-hypoglycemic
Onset 5-20 min,
Peak 30 min
Duration 1-1.5 hr.,
Half-Life; 3-10 minutes
Metabolizes in liver,
plasma and kidneys
Use and dosage
□ Stimulates
pancreatic beta
cells to secrete
insulin.
□ Type 2 diabetes
mellitus
□ Give dose 1-3 time
daily
□ may use alone or in
combination with
insulin
□ Emergency
treatment of
severe
hypoglycemia in
unconscious client
or those unable to
swallow
□ Comes in powder
form. Reconstitute
with provided
diluent.
□ Give IV, IM or SQ
immediately
□ Give IV through
D5W only, not NS
Side effect
Side effects:
□ GI distress
□ dizziness
□ drowsiness
□ headache
Teaching and labs
□ Monitor labs
including glucose,
Hgb A1C
TEACH
□ Take with first daily
meal.
Adverse effects/toxicity: □ Take any missed
dose as soon as
□ Severe skin rash,
remembered.
pruritus
□
Report s/s of
□ Hypoglycemia
hypoglycemia if
they occur
□ Avoid alcohol
Side effects:
□ Should awaken
□ Nausea/ vomiting
within 5-20 min
after giving.
Adverse effects/toxicity: □ Give 50% glucose if
□ Hypersensitivity
no response to
reaction,
glucagon
Teach
□ hyperglycemia
□ test blood sugar,
□ Hypokalemia
□ teach family how to
administer SQ or IM
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
contraindication
Avoid with:
□ Pregnancy,
lactation
□ Allergy to sulfa or
urea
□ Diabetic
ketoacidosis
Caution with:
□ impaired renal and
hepatic function
□ Adrenal or pituitary
insufficiency.
□ Incompatible with
sodium chloride
solution.
37
Drug
Glyburide
(Micronase, DiaBeta)
□ Oral antidiabetic,
□ more potent drug
□ Sulfonylurea
Onset 15-60 min
Peak 1-2 hrs.
Duration up to 24 hrs.
Half-life 10 hours
Metabolized in the
liver, excreted in urine
and feces.
Haloperidol (Haldol)
High potency drug
□ Antipsychotic
□ Butyrophenone
□ Antiemetic
Onset: 30-45 min IM
Effects can be seen in 12 days. Substantial
improvement 2-4 wks.
Full effect several
months.
Use and dosage
□ Lowers blood sugar
concentration in
diabetics and
nondiabetics by
sensitizing
pancreatic beta
cells to release
insulin in the
presence of serum
glucose.
□ Type 2 diabetes
□ Use as adjunct to
diet and exercise to
lower blood sugar
□ Psychotic disorders
□ Long acting drug
for maintenance –
to control
symptoms
□ Tourette’s
syndrome
Side effect
Side effects:
□ Hypoglycemia,
□ epigastric fullness
□ heartburn
□ pruritus
Teaching and labs
□ Give once in the
morning with
breakfast or with
first main meal
□ Monitor labs
including glucose,
HgbA1c
Adverse effects/toxicity:
Teach
□ hypoglycemia
□ Report reaction
□ Loss of control of
blood glucose level
may be due to
fever, surgery,
trauma, stress,
infection.
Side effects: ABCDE:
□ EPSE: usually first
□ Anticholinergic (dry
few days of tx, dose
mouth)
related, controlled
by dose or anti□ Blurred vision
Parkinson’s drugs
□ Constipation
□
Oral: Give with milk
□ Drowsiness
or food.
□ Extrapyramidal
□ Taper dose slowly
syndrome (such as
when stopping.
Parkinson’s s/s)
□
Injection: deep IM –
□ Photosensitivity
risk for orthostatic
Adverse effects/toxicity:
hypotension
□ Elderly patient may
develop Neuroleptic □ no alcohol or driving
until response
Malignant
known
Syndrome (NLMS)
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
contraindication
Avoid use with:
□ diabetic
ketoacidosis
□ Type I diabetes
Caution with:
□ renal or hepatic
insufficiency
□ older adult
□ malnourished pt.
□ adrenal or pituitary
insufficiency
Avoid with:
□ Parkinson’s disease
□ seizure disorder
□ severe mental
depression
Use caution:
□ older adults,
□ lithium therapy
□ HTN
□ Lactation
38
Drug
Heparin
□ Anticoagulant
Antidote = Protamine
sulfate (see separate
listing)
Hydrochlorothiazide
hydrochloride
(Hydrodiuril, HCTZ)
□ Electrolyte and
water balance
□ Thiazide diuretic
□ Effects noted 3-4
days; max effect
takes 3-4 weeks
Use and dosage
□ As anticoagulant –
given IV or SQ
□ Use as continuous
IV infusion for DVT,
Pulmonary
embolus, angina,
acute MI
□ SQ for prevention
Side effect
Side effects:
□ Bleeding
□ Heparin-induced
Thrombocytopenia
(HIT) – may appear
up to several weeks
later.
□ Hep-lock (flush) is
to maintain
patency of IV
catheters; not for
anticoagulant
therapy
Side effects:
□ Act on distal
tubules of nephron □ Glucose intolerance,
and increases
hyperglycemia
urinary excretion of □ Hypokalemia (low
sodium, chloride,
K+)
potassium, water,
bicarbonate
□ Decreases edema
and lowers blood
pressure
□ Most widely
prescribed diuretic
for HTN
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
Teaching and labs
□ Does not dissolve
clots – prevents
enlargement and
development of
new clots.
□ Use bleeding
precautions
□ Monitor labs: aPTT
Normal = 25-40
Coagulated = 1.5-2
times normal = 60-80
contraindication
Avoid use with:
□ Hemorrhage, active
bleeding
□ Do not give IM.
□ Adjust IV dose
based on labs.
□ Give with food or
mild to reduce GI
upset.
□ Give dose(s) early in
the day to avoid
nocturia
□ Limit Sodium intake
□ Eat foods high in K+.
– replacement med
usually not needed
□ photosensitivity
reaction occur 10-14
days after initial sun
exposure
Avoid with:
□ Anuria
□ Hypersensitivity to
thiazide
Use caution:
□ Bronchial asthma
□ hepatic cirrhosis
□ renal dysfunction
□ history of gout
□ diabetes
□ SLE
□ Lactation
39
Drug
Hydroxyzine HCl
(Atarax, Vistaril)
□ Anti-emetics
□ Anti-histamine (H1
receptor
antagonist)
□ antipruritic
Onset 15-30 min PO
Peak 4-6 hrs.
Duration
Absorbed form GI.
Metabolized in the liver
Ibuprofen
(Advil, Motrin)
□ Analgesic
□ Non-steroidal antiinflammatory
(NSAID)
□ For high dose
therapy:
therapeutic effect
may take up to one
month
Use and dosage
□ Treat N/V (use
anticipatorily)
□ Relieve anxiety
□ Reduce narcotic
requirement before
and after surgery.
□ Treat acute or
chronic alcoholism
with withdrawal
symptom or DTs
□ Pruritus
Side effect
Side effects:
□ CNS depression,
□ Drowsiness
□ Dizziness
□ dry mouth,
anticholinergic
effect
□ constipation
□ visual changes
□ photosensitivity
Teaching and labs
IM:
□ Administer deep IM,
Z-track – gluteus
maximum or vastus
lateralis in adults;
vastus lateralis in
children
Side effects:
□ CNS, renal system,
eyes
□ Nephrotoxicity
□ dysuria, hematuria,
oliguria, azotemia,
□ Blurred vision.
□ Ototoxicity
Children toxicity:
□ Rash, StevensJohnson syndrome
□
□
□
□
Usually PO for
maintenance
□ Treat mild to
moderate pain
□ absorbed in GI;
metabolized in liver
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
□
contraindication
Avoid with:
□ CNS depression and
coma.
□ Other CNS meds
Use caution with:
□ glaucoma
□ seizure
□ intestinal
monitor mouth daily
obstruction
no alcohol
□ prostatic
hard candy, ice
hyperplasia
chips or rinse mouth □ asthma
with warm water
□ cardiac, pulmonary
frequently to relieve
or hepatic disease
dry mouth
Increases toxicity of Avoid with:
□ GI bleed
anticoagulant,
lithium
□ Reaction to other
NSAIDs
Avoid alcohol, ASA, □ Children under 6
other NSAIDs
months
40
Drug
INSULINS
-
quick acting:
short acting
intermediate acting
long acting
Insulin is also available
in a premixed form of
Regular and NPH
(example: 70/30 = 30%
regular, 70% NPH).
Use and dosage
□ Diabetes mellitus,
type 1 or type 2
□ Could be made of:
pork/beef, pork or
human insulin type.
□ Short acting and
intermediate acting
insulin may be
given more than
once per day.
Side effect
Side effects:
□ Hypoglycemia
(anxiety, confusion,
nervousness,
hunger, diaphoresis,
cool, clammy skin)
□ Lipodystrophy
(abnormal deposits
of subcutaneous fat
at injection sites),
□ local allergic
reaction
Adverse effects/toxicity:
□ Somogyi
phenomenon: a
rebound response
with high blood
sugar in response to
low level at night.
□ Coma
□ Hyperosmolar
hyperglycemic state
(HHS)
□ Diabetic
ketoacidosis (DKA)
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
Teaching and labs
□ obtain med alert
bracelets
□ Open vial can be
stored at room
temp for up to one
month.
□ Rotate sites
□ Alcohol will increase
blood sugar
contraindication
□ Do not use
beef/pork insulin if
sensitivity
□ Requires long-term
monitoring of blood
sugar control and
potential
complications.
41
Drug
Insulin – Regular
(Humulin R)
**THIS IS THE ONLY TYPE
OF INSULIN WHICH CAN BE
GIVEN
IV. **
Isophane (NPH) insulin
(Humulin N)
Insulin – Glargine
(Lantus)
** LANTUS CANNOT BE
MIXED IN SAME SYRINGE
Use and dosage
Side effect
□ Short acting insulin □ hypoglycemia
□ Given IV or SQ
□ type 1 and type 2
diabetes mellitus
and ketoacidosis.
□ given before meals
according to blood
levels
□ Intermediate
□ If given before
acting insulin
breakfast,
hypoglycemic
□ Give 30 min before
episode is most
first meal of the
likely to occur
day. If necessary, a
between midsecond smaller
afternoon and
dose may be
dinner, when it
prescribed 30 min
peaks. Eat snack in
before bedtime.
midafternoon and
carry sugar candy.
Teaching and labs
□ Regular insulin is
clear and colorless.
□ Long acting insulin
□ Type 1 children &
adults; Type 2
adults
□ SQ injection
□ With Type 2
diabetes, may or
may not be given
concurrently with
oral agents.
contraindication
□ NPH Insulin is a
cloudy suspension.
□ Roll the bottle to
mix; do not shake.
□ NOTE: NPH may be
mixed with Regular
insulin injection
without altering
either solution.
WITH ANY OTHER
INSULIN.**
□ Usually given one
per day at bedtime.
May be given two
times per day.
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
42
Drug
Iron
Use and dosage
□ Mineral
replacement
Ipecac Syrup
Adverse effects/toxicity: □ Use of this
□ For overdose on
□ Cardiotoxicity is
certain drug or
medication is not
poison
most serious if
automatic – verify
vomiting does not
appropriateness
□ stimulates vomiting
occur
and
the
with Poison control
within 20-30 min
substance is
center
retained.
□ Emetic
□ Antidote
Alternate: Activated
Charcoal (see separate
listing)
Side effect
Side effects:
□ Nausea/vomiting
□ Staining of teeth
□ Constipation
□ Black stools
(normal)
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
Teaching and labs
□ Taking on empty
stomach preferred
with full glass of
water or citrus juice
□ Calcium inhibits iron
absorption – do not
take with milk.
□ Vitamin C increases
iron absorption
□ Liquid form can
stain teeth
contraindication
Do not use:
□ With reduced level
of consciousness or
convulsions
□ poison by
Petroleum
distillates, strong
alkaline, acid or
strychnine
43
Drug
Lidocaine HCl
(Xylocaine)
□ Antiarrhythmic
□ Topical Anesthetic
Bolus dose – may
repeat – then start
continuous infusion –
stop when stable.
Therapeutic level: 1.56mcg/ml
Use and dosage
□ Treat VENTRICULAR
arrhythmias, PVC’s,
V-Tach.
□ Use for rapid
control of
ventricular
dysrhythmias
during acute MI or
Cardiac cath
□ Use microdrip
tubing and infusion
pump.
Side effect
Side effects:
□ Drowsiness,
headache, dizziness,
mild hypotension.
Adverse effects/toxicity:
□ convulsions,
respiratory
depression
□ CV: hypotension,
bradycardia, heart
block CV collapse,
and arrest
Teaching and labs
LAB
□ Monitor Lidocaine
levels assess,
therapeutic level is
1.5 -6mcg/ml
□ Assess electrolyte,
check baseline liver
and renal blood
studies.
Report:
□ lightheadedness,
□ dizziness, confusion,
□ numbness or
□ Stop infusion with
tingling of lips,
EKG changes such as
tongue or fingers
prolonged PR,
□ visual changes or
widened QRS, heart □ ringing in ears
block.
□ Correct
hypokalemia before
giving Lidocaine
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
contraindication
Avoid with:
□ Sinus bradycardia
□ Severe degrees of
SA, AV and
intraventricular
heart block.
Use caution:
□ hepatic or renal
disease
□ CHF
□ Hypovolemia
□ shock
□ hyperthermia
□ elderly
□ BETA BLOCKERS
increase the effect
of lidocaine
44
Drug
Lithium carbonate
(Eskalith)
□ Mood stabilizer
□ Antipsychotic
□ Therapeutic level
0.8-1.5meq/L.
□ Toxic level >2.
□ Lithium has short
half-life (about 1
day) and high
toxicity.
Lorazepam (Ativan)
□ Anxiolytic
□ Sedative-hypnotic
□ Benzodiazepines.
Onset
1-5 min IV, 15-30 IM,
Peak
60-90 min IM, 2 hrs. PO
Duration 12-24 hrs.
Use and dosage
□ Drug of choice to
control manic
episodes in bipolar
disorder
□ Anti manic effects
are usually seen in
5-7 days after initial
doses, but full
effect does not
occur for 2-3 wks.
□ Lithium is a salt;
exact action
uncertain
□
□
□
□
Side effect
□ This med does not
cause sedation.
Mild Side effects:
□ fine tremor, nausea,
thirst, polyuria,
Adverse effects/toxicity:
□ Vomiting, diarrhea,
slurred speech, lack
of coordination,
drowsiness, muscle
weakness, or
twitching) –
withhold dose and
notify provider but
DO NOT stop
abruptly.
Side effects:
anxiety disorder
short term for relief □ Drowsiness
□ sedation
of symptoms of
anxiety
□ Mild medication
Pre-anesthetic
with limited toxic
medication to
potential
produce sedation
□ respiratory
and reduce anxiety.
depression is rate
Status epilepticus
Paradoxical reactions
(nightmares, mania,
etc.) may occur in
children, psych patients
and the elderly.
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
Teaching and labs
□ Give with meals
□ Hydration is
essential –
dehydration will
increase levels
□ Watch for weight
gain (fluid
retention)
□ Avoid NSAIDs and
diuretics.
□ Essential to monitor
mood and behaviors
□ Labs: Lithium level
every 3 months
initially, then every
6 months.
□ Avoid alcohol
□ Taper dose when
stopping to avoid
withdrawal
symptoms
□ Watch for suicidal
risk
contraindication
Do not use with:
□ Dehydration,
severe debilitating,
severe
cardiovascular.
Use caution:
□ elderly,
□ pt. with cardiac,
renal, thyroid or
diabetes
□ pregnancy
Do not use with:
□ Acute narrow-angle
glaucoma,
□ Primary depression
□ acute alcohol
intoxication.
□ Pregnancy and
Lactation
Use caution:
□ renal or hepatic
impairment
□ myasthenia gravis
□ suicidal tendencies
45
Drug
Magnesium Sulfate
iron(Epsom salt – oral
form)
Onset 1-2 hrs. PO; 1 hr.
IM.
Duration 30 min IV, 3-4
hr. PO
Eliminated by kidneys
Use and dosage
□ Oral: laxative (by
osmotic retention
of fluid which
distend the colon,
increase content of
feces and cause
bowel stimulation)
□ Parenteral: CNS
depressant; used in
seizures of
toxemia; for
hypomagnesemia
Normal Magnesium
level: 1.8-3 mEq/L
□ 4 gm. loading dose
is give over 20-20
min via pump.
Side effect
Side effects:
□ Flushed warm
feeling
□ fluid and electrolyte
imbalance
□ hyponatremia
□ N/V
Adverse effects/toxicity:
Early indication of
magnesium toxicity
□ Respiratory
depression
□ Cathartic effect
□ profound thirst
□ feeling of warmth
□ sedation
□ confusion
□ depressed deep
tendon reflexes
□ muscle weakness
□ can lead to cardiac
arrest
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
Teaching and labs
s/s hypomagnesemia:
□ irritability
□ tremors, tetany
□ tachycardia
□ hypertension
□ psychotic behavior
□ Monitor urinary
output and hydrate
adequately with
parenteral
administration.
contraindication
Avoid with:
□ MI, heart block,
cardiac arrest
except for certain
arrhythmias.
Use caution:
□ impaired kidney
function
□ other cardiac
glycosides
□ Lactating moms
and children
46
Drug
Mannitol (Osmitrol)
Use and dosage
□ Use in oliguria and
acute renal failure.
□ Electrolyte and
Help to prevent
water balance
renal failure and
agent
reduce increased
intracranial or
□ osmotic diuretic
intraocular
pressure
Onset
1-3 hr. diuresis; 30 to 60 □ It acts by increasing
min IOP, 15 min. for ICP
the osmolality of
Duration
plasma, glomerular
4-6 hr. IOP,
filtrate, and tubular
3-8 hr. ICP
fluid. This
decreases the
Serum osmolality is 275reabsorption of
300 mmol/kg.
fluid and
electrolytes, which
increases excretion
of water, chloride
Give IV.
and sodium and
Usually give test dose
slightly increase the
which should result in
excretion of
Output of 30 to 50
Potassium.
ml/hr. and is produced □ In intraocular (IOP)
2-3 hrs. after
and CSF (ICP), it
administration.
pulls the fluid and
sends it to the
plasma and
extravascular
systems
Side effect
Side effects:
□ HA, confusion,
syncope
□ fluid and electrolyte
imbalance, esp.
hyponatremia
□ pulmonary
congestion, rhinitis
□ Water intoxication
Teaching and labs
□ Use filter needle
and/or filter in
infusion tubing
because crystals
may form in the
solution.
□ Mannitol is held if
serum osmolality
exceeds 310 -320.
□ Daily weights
Adverse effects/toxicity: Teach
□ Non-narcotics such
□ Seizure,
as Tylenol if there is
□ thrombophlebitis,
headache
□ CHF, Cardiovascular
□ Therapy is based on
collapse
urine flow rate.
□ Hyponatremia
□ Reassure pt. that
excessive thirst,
Warning: There may be
blurred vision,
a rebound increase in
rhinitis should
ICP about 12 hours after
subside when
administration of med.
Mannitol is
Pt may complain of HA,
discontinued
or confusion.
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
contraindication
Do not use:
□ severely impaired
renal function
□ marked
dehydration
□ breast feeding
□ hepatic failure,
□ active ICP
□ anuria
□ Intracranial bleed
shock
□ Question the
administration of
mannitol if the
patient has cor
pulmonae (right
sided heart failure)
because Mannitol
pulls fluid and it
may lead to
circulatory overload
which the heart
could not handle.
This client would
need loop diuretic
to prevent serious
complications
47
Drug
Meperidine HCl
(Demerol)
□ Narcotic analgesic
(opioid agonist)
Use and dosage
□ Given for moderate
to severe pain.
□ Potent, long acting
Give Narcan for
toxicity - It is use to
reverse respiratory
depression induced by
overdose
Onset: 15 mins. PO, 10
mins. IM, 5 mins IV
duration 2-4 hours
Metoprolol tartrate
(Lopressor, Toprol)
□ Beta adrenergic
antagonist
(beta blocker)
□ Antihypertensive
□ Antianginal = same
action as with
propanolol
Side effect
Side effects:
□ N/V, Anorexia
□ Sedation, dizziness
□ elevated BP
□ rash, urticaria
□ tremors
□ hyperventilation
Adverse effects/toxicity:
□ Resp depression,
□ respiratory arrest,
□ circulatory
depression,
□ increased
intracranial pressure
□ Decreases heart
rate and cardiac
output
□ Lowers BP
□
□
□
□
Side effects:
□ Usually well
tolerated
□ Nausea, vomiting
□ Weight gain
Mild to severe HTN □ worsening CHF
angina pectoris
□ insomnia
**Post - acute MI** Adverse effects/toxicity:
□ profound
Max effect may
bradycardia
take 1 week
□ heart block
□ acute CHF,
□ bronchospasm
□ laryngospasm
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
Teaching and labs
Assess:
□ LOC
□ rash, urticaria
□ respiratory rate.
If respirations < 12 per
minute – withhold
meds.
contraindication
Avoid use with:
□ acute bronchial
asthma, upper
airway obstruction
□ increased
intracranial
pressure
□ convulsive disorder
□ pancreatitis, acute
ulcerative colitis
□ severe liver or
kidney insufficiency
Caution with:
□ children and elderly
□ Give with or w/o
food, but consistent
□ Do not stop
abruptly; may cause
rebound effect.
Gradually decrease
over 1-2 wks.
□ Hold meds if BP < 90
or pulse < 60
□ Watch for s/s heart
failure
□ Can lead to elevated
BUN, creat.
□ May mask
hypoglycemia
Avoid use with:
□ Heart block greater
than 1st degree
□ Sinus brady,
□ cardiogenic shock
Use caution:
□ hyperactive airway
syndrome ( asthma
or bronchospasm)
□ Increases chance of
both Dig and
Lithium toxicity
48
Drug
Morphine Sulfate
(MS Contin = sustained
release form)
□ Narcotic analgesic
(Opioid agonist)
Use and dosage
□ Produces effect by
binding to opioid
receptors
throughout the
CNS.
□ Schedule II drug,
major drug abuse.
□
Give Narcan for
toxicity.
□
Onset, Peak, Duration
depend on route of
□
medication.
Onset: Immediate IV,
rapid if given IM or oral,
except MS Contin
□
Side effect
Side effects:
□ Nausea vomiting
anorexia, GI,
□ pruritus,
□ light headedness
□ constipation
Adverse effects/toxicity:
□ Classic triad of
symptoms:
For severe, chronic
respiratory
or acute pain.
depression, coma,
Most commonly
pinpoint pupils.
use in post□ Withdrawal begins
operative setting.
6-8 hrs. After the
mild bronchodilator
last dose, reach
to improve
peak intensity within
breathing
48-72 hrs. S/S
include craving,
MS Contin is
chills, sweating
sustained release;
piloerection (goose
it will not control
flesh), abdominal
break-through pain
pain and cramps,
because it is time
diarrhea, runny
release.
nose, irritability.
□ Morphine induced
CNS stimulation –
paradoxical reaction
common in women
and older adults.
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
Teaching and labs
contraindication
Avoid use with:
□ Avoid alcohol use
□ Hypersensitivity to
opiates)
□ Hold medication if
□ acute bronchial
respirations < 12/min
asthma or upper
airway obstruction,
□ Hydrate adequately □ ICP
to prevent
□ convulsive
constipation
disorders
□ pancreatitis, acute
ulcerative colitis
□ severe liver or
kidney disease
□ Do not give
morphine to
children
49
Drug
Use and dosage
Naloxone HCl (Narcan) □ Competes with
opioids at the
opiate receptor
□ Opioid antagonist.
sites, blocking the
effects of the
Onset
opioids
1-2 min IV;
□ Reverses effects of
2-5 mins. SQ or IM
opiates, including
respiratory
Duration
depression,
1 hr. IV; up to 4 hrs. IM
sedation and
but start to diminish
hypotension.
after 20 mins.
□ May need given
every few hours
until the opioids
has dropped to a
nontoxic level
Nedocromil (Tilade)
□ asthma prophylaxis
NOT for acute
□ Inhaled nonasthma attacks
steroidal
□ up to a week for
medication
full effectiveness
□ anti-inflammatory
□ Must be taken
and antiasthmatic.
regularly to be
effective
Side effect
Side effects:
□ Increased BP, HR,
hyperpnea
□ tremors,
□ hyperventilation,
□ drowsiness,
□ nervousness
□ N/V
Teaching and labs
□ Watch vital signs
and respiratory
function closely
with administration
of medication
contraindication
Avoid use with:
□ Known allergy
□ Respiratory
depression d/t nonopioids
□ Substance abuse
□ Titrate dose slowly (may lead to
if too much is given
withdrawal
the client will swing
symptoms)
from a state of
Adverse effects/toxicity:
intoxication to one
□ Hypotension,
of withdrawal
□ V-tach and V-fib
□ convulsion,
□ hepatitis
□ pulmonary edema,
Adverse effect:
□ abnormal bitter
taste
□ N/V, HA, dizziness,
sore throat.
□ Rinse mouth after
taking medication
to avoid dry mouth
□ Do not use for
acute attack
□ Non-compliance is a
concern due to
bitter taste
Avoid use with:
□ acute
bronchospasm or
status asthmaticus.
□ Hypersensitivity
Use with caution:
□ hepatic or renal
function
(also available as optic
form – for ocular
allergic conjunctivitis)
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
50
Drug
Neomycin sulfate
(Mycifradin)
□ ORAL
aminoglycoside
□ antibiotic
Nifedipine (Procardia)
□ Calcium Channel
Blocker
□ Antianginal
□ Antihypertensive
□ Negative inotropic
Use and dosage
Antibacterial – ORAL
□ GI tract
□ Hepatic coma
Side effect
Side effects: skin rash
(esp. topical)
Teaching and labs
□ Poorly tolerated GI
so it is usually for
bowel cleansing.
contraindication
Adverse effects/toxicity:
Main form is topical for □ Nephrotoxicity
eye, ear and skin
□ Ototoxicity.
infection.
NEOMYCIN IS NOT GIVEN IV
□ angina
□ mild to moderate
HTN (sustained
release form)
□
□
□
□
□ Do not give 1-2 wks.
after an acute MI.
□ Do not give with
grapefruit juice
(could lead to
toxicity)
Dilates coronary
□ Report gradual
arteries and relaxes
coronary spasm
weight gain and
evidence of edema;
Increases cardiac
may indicate onset
output; decreases
of CHF.
peripheral vascular Adverse effects/toxicity:
□
Do not stop
resistance.
□ Gingival hyperplasia
suddenly (will have
Blocks calcium ion
rebound symptoms)
flow into cells of
□ Smoking decreases
myocardial and
arterial smooth
efficacy of med
muscle (cardiac and
□ Monitor pulse rate –
peripheral blood
report irregular or
vessels)
slower than normal
Slows HR;
rate. Hold for BP
decreases O2 need
below 90/60.
Side effects:
□ Usually well
tolerated
□ Headache
□ fatigue
□ Dizziness
□ Postural
hypotension
□ peripheral edema
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
Avoid use with:
□ Known
hypersensitivity
□ Unstable angina
□ Lactation
51
Drug
Oxytocin (Pitocin)
□ Oxytocic
Labor and delivery.
Onset is immediate.
After stopping med,
contractions should
stop in 2-3 minutes
Half-life 3-5 min
Pancrelipase
(Creon, Pancrease)
□ Pancreatic enzyme
replacement
therapy
Use and dosage
□ To initiate or
improve uterine
contractions at
term
□ Induce labor
□ Management of
incomplete or
missed abortion
(miscarriage)
□ reduce postpartum
bleeding
□ Help to breakdown
fat, proteins and
carbs for better
absorption.
□ cystic fibrosis
□ chronic
pancreatitis, post
pancretectomy
□ steatorrhea
□ malabsorption
syndrome
Side effect
Teaching and labs
Side effects:
□ Careful monitoring
□ subarachnoid bleed
of uterine
contraction pattern,
□ fetal trauma
fetal heart rate and
□ seizure, coma
maternal BP.
Adverse effects/toxicity:
Hypertensive crisis.
□ Postpartum;
monitor lochia and
For fetal anoxia:
BP.
□ stop infusion, turn
contraindication
Avoid use with:
□ Hypersensitivity
□ Cepahalopelvic
disproportion
□ Obstetric
emergencies
mom on left side,
oxygen prn
Stop infusion for:
□ Contractions which
occur more often
than every 2 mins.
or last over 90 sec.
□ Do not increase
dose after desired
contraction pattern
is achieved
(contraction
frequency of 2-3 min
lasting 60 sec).
Side effects:
□ Take with or just
□ Nausea, diarrhea,
prior to eating
and cramps
□ Do not mix brand
names; there is a
Adverse effects/toxicity:
variance in
Hyperuricemia.
concentration of
□ Report joint or
enzymes
swelling pain (high
□ Swallow tablet or
uric acid level)
capsule whole; do
not crush or chew.
□ Can mix powder or
open capsule with
food.
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
Drug interaction:
□ Allergy to med or
pork
□ Do not give with
magnesiumcontaining antacid.
May be ordered
with H2 blockers or
with proton pump
inhibitors.
□ Iron will decrease
effectiveness of
med.
52
Drug
Phenobartial
(Phenobarbital Sodium
= Luminal) – this is the
short-acting form.
For status epilepticus:
Administer slow IV
□ Anticonvulsant
□ Sedative-hypnotic
Pilocarpine
hydrochloride (Pilocar)
□ Eye preparation.
□ Miotic (Antiglaucoma agent).
□ Direct acting
cholinergic agent
for ophthalmic use.
□ It is an antidote to
Atropine
Use and dosage
□ Long-term
management of
grand mal, partial
seizure and status
epilepticus.
□ Sedative effect to
decrease anxiety
and tension.
□ No analgesic effect
□ For acute or
chronic Glaucoma –
decreases
intraocular
pressure
□ Will reverse the
effects of Atropine
(and Atropine will
reverse the effects
of Pilocarpine).
Side effect
Side effects:
□ Somnolence,
hangover effect
Adverse effects/toxicity:
□ CNS depression,
□ Stevens-Johnson
□ Blood dyscrasias
□ Paradoxical
reactions may occur
in children, older
adults and
debilitated people
Teaching and labs
□ Okay to crush and
mix with food or
fluids
□ Monitor IV infusion
closely.
□ Do not stop
abruptly
□ Avoid alcohol and
other CNS
depressants
Side effects:
□ Apply gentle
□ Visual blurring,
pressure for 1-2
myopia, irritation,
mins. to
brow pain and HA.
nasolacrimal
(with ophthalmic)
drainage area after
administering eye
□ Normal: Increased
gtts
pigmentation of iris
□ Eye therapy will
and eyelids; long
eyelashes.
continue long term
Adverse effects/toxicity:
□ Retinal detachment
□ Ataxia
□ Confusion
□ seizure
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
contraindication
Avoid use with:
□ Hypersensitivity
□ Resp or kidney
failure
□ Pregnancy and
lactation
Avoid use with:
□ Asthma, COPD
□ HTN
□ Acute eye
infections, retinal
detachment,
contact lens use
53
Drug
Prazosin hydrochloride
(Minipress)
□ Antihypertensive
□ Alpha-adrenergic
receptor antagonist
□ vasodilator
□ Treat benign
prosthetic
hyperplasia (BPH)
Use and dosage
□ Mild to moderate
HTN – mainly
diastolic
□ little effect on
cardiac output and
HR
□ BPH (due to
vasodilator effects)
Optimal effects may
take 4-6 weeks
Prochlorperazine
(Compazine)
□ Antiemetic
□ Antipsychotic
□ Phenothiazine
□
□
□
□
Side effect
Side effects:
□ Dizziness,
drowsiness
□ Fatigue, weakness.
□ Priapism, impotence
□ Orthostatic
hypotension
Adverse effects/toxicity:
□ First-dose
phenomenon:
syncope within 30
min to 1 hr. Effect is
transient, may
diminish by giving
at bedtime.
Severe nausea and Side effects:
□ drowsiness,
vomiting
dizziness,
Management of
□ EPSE
psychotic
disorders,
Adverse effects/toxicity:
excessive anxiety
□ Persistent tardive
and agitation
dyskinesia
□ Tremor, twitching
Take 30-60 min
□ Agranulocytosis,
before any activity □ thrombocytopenia
that causes nausea □ After 1-2 months:
for best effect.
Akathisia (inner
restless, inability to
Start doses low and
sit still) – may tx
increase slowly
with propranolol.
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
Teaching and labs
□ monitor for
decreased BP,
especially with
initial administration
□ Monitor urine vol.
□ change position
slowly to prevent
orthostatic
hypotension
□ stop smoking and
avoid alcohol intake
□ avoid driving and
hazardous tasks
until effect of med
is known
□ Avoid excessive
sunlight – may turn
skin gray-blue
□ Urine may turn
reddish brown
□ Use sugarless hard
candy or ice chips to
avoid dry mouth.
□ Avoid skin contact
with concentrate
□ Do not crush or
chew – swallow
whole
□ Deep IM, not SQ
injection
contraindication
Avoid use with:
□ Prior sensitivity
□ hypotension
Use caution with:
□ impaired hepatic
function
□ older adults
Avoid use with:
□ Hypersensitivity
□ Blood dyscrasias
□ Dementia related
psychosis in elderly
□ Young children
□ Seizures
□ Lactation
54
Drug
Promethazine
(Phenergan)
□ Antiemetic
□ Antihistamine
□ Anti-vertigo
Protamine sulfate
□ Antidote for
Heparin toxicity.
□ Heparin antagonist
Onset = 5 minutes
Duration = 2 hours
Longer half-life than
heparin
Ranitidine
hydrochloride (Zantac)
□ H2-receptor
antagonist.
□ Higher potency
than cimetidine
(Tagamet)
Use and dosage
□ Long-acting med
□ motion sickness
□ nausea
Side effect
Side effects:
□ Resp depression,
□ drowsiness,
confusion
□ IM route: Give deep □ agranulocytosis
□ blurred vision
IM; not SQ (can
cause necrosis)
□ dry mouth
□ Avoid intra-arterial □ EPSE
injection – can
cause necrosis.
Teaching and labs
□ Decrease GI distress
by giving oral dose
with milk or food.
□ May crush and mix
with food.
□ Avoid sunlight
exposure
□ Avoid alcohol and
other CNS
depressants
contraindication
Avoid use with:
□ Acute MI, angina,
atrial fib
Use caution with:
□ Narrow angle
glaucoma
□ peptic ulcer
□ duodenal
obstruction
□ Antidote for
Heparin overdose
□ Given IV; maximum
dose of 50 mg in 10
min time period;
should be titrated
according to the
time and length of
time the heparin
was administered
□ Reduce gastric
secretion.
□ Active duodenal
ulcer, maintenance
after healing
□ GERD
□ benign gastric ulcer
(short-term)
□ Monitor vital signs
and labs closely
(aPTT)
Avoid use with:
□ Hemorrhage not
induced by heparin
overdose.
Side effect:
□ Abrupt drop in BP if
administered too
rapidly.
See listing for HEPARIN
Side effects:
□ headache
□ taste disorder,
diarrhea,
constipation
□ dry mouth
Adverse effects/toxicity:
□ hepatotoxicity
□ thrombocytopenia
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
□ Give without regard
to meals
□ Usually give 1 x day
□ reduce dose in renal
patient
□ avoid smoking to
□ avoid antacid within
1 hour of dose
Avoid use with:
□ Hypersensitivity
Use caution with:
□ Impaired renal of
hepatic function.
□ May increase
effects of alcohol,
aspirin, Coumadin
and sulfonylureas
55
Drug
Rh0(D) immune
globulin (RhoGAM)
□ Biological response
modifier
□ Immunoglobulin
(IgG)
Peak 2 hour
Half-life 25 days
Use and dosage
□ Given to Rhnegative moms
with RH positive
babies.
□ Provides passive
immunity by
suppressing active
antibody response
and formation of
anti-RHo when (1)
positive fetal RBC
enters maternal
circulation during
the third stage of
labor; (2) there is
fetal maternal
hemorrhage or other
trauma during
pregnancy; (3)
termination of
pregnancy or
miscarriage; or (4)
following a Rh+
transfusion.
Side effect
Side effects:
□ Injection site
irritation
□ slight fever
□ myalgia
□ lethargy
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
Teaching and labs
contraindication
Avoid use with:
□ Send sample of
newborn cord blood □ Known sensitivity
to lab for cross
to human
match and typing
immunoglobulins.
immediately after
delivery before
administer RHo (D)
□ Give to mom IM via
deltoid. (Only a few
forms can be given
IV).
□ Give immediately
after reconstitution
□ Recommended at
28 weeks gestation
and then within 72
hours after delivery
or 3 hrs. of
termination of
pregnancy or
miscarriage.
□ Keep epinephrine
available; systemic
allergic reactions
sometimes occur.
□ TEACH it will
prevent hemolytic
disease in a
subsequent
pregnancy
56
Drug
Setraline
hydrochloride (Zoloft)
□ Antidepressant
□ SSRI (selective
serotonin reuptake
inhibitor)
Spironolactone
(Aldactone)
□ Fluid & electrolyte
balance
□ antihypertensive
□ Potassium sparing
diuretic
Use and dosage
□ panic disorders
□ Anxiety disorders
□ OCD
□ PTSD
□ 2-3 wks. to be
effective
□ Increases sodium
excretion; does not
decrease
potassium
□ treatment of
primary
aldosteronism
□ Use for edema and
HTN associated
with heart failure.
Side effect
Side effects:
□ Cause fewer
disorders than other
antidepressants
□ fewer side effects
on HR and HTN
□ Sexual dysfunction
□ Weight gain
Major complication
□ (Selective Serotonin
Syndrome): Pt. can
die from it. Elevated
temp up to 105.
Every speed up. BP,
HR, Temp. May
progress to coma.
Side effects:
□ Headache
□ dizziness, weakness
□ orthostatic
hypotension
Adverse effects/toxicity:
□ Hyperkalemia
(nausea, vomiting,
diarrhea, cramps,
tachycardia then
bradycardia)
□ aplastic anemia
□ thrombocytopenia
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
Teaching and labs
□ Give with food in
the morning to
prevent insomnia
□ Watch for suicide
risk
□ Increases effect of
Coumadin
□ Avoid grapefruit
juice
contraindication
Avoid use:
□ Within 14 days of
using MAO inhibitor
□ Seizure disorder
□ Take with food
□ avoid salt substitute
high in K+
□ Avoid excessive
ingestion of foods
high in potassium.
□ no potassium
supplement needed
□ Monitor VS and
urine output
□ Avoid direct
sunlight
Avoid use with:
□ Serum K+ level > 5.5
□ anuria, acute and
chronic renal
insufficiency
□ diabetic
nephropathy
□ hypersensitivity
□ impaired hepatic
function
□ Decreases effect of
Dig;
□ increases chance of
lithium toxicity
57
Drug
Sucralfate (Carafate)
□ Antiulcer
□ Gastro-protective
agent
Theophylline
(Theo-dur)
□ Bronchodilator
(resp. smooth
muscle relaxant)
□ xanthines
□ Normal level 10-20.
toxic level (> 20)
may develop
quickly
Use and dosage
□ Protects the ulcer
from gastric acid by
forming an
adherent coating; it
absorbs pepsin
decreasing its
activity.
□ Duodenal ulcer
□ Short term with
gastric ulcer
□ esophageal ulcer
related to radiation
or chemotherapy
□ bronchospasms
□ asthma
□ bronchitis
□ emphysema
Side effect
Side effects:
□ constipation
□ nausea
Side effects:
□ Tachycardia
□ Seizures
□ N/V, anorexia,
Adverse effects/toxicity:
□ restlessness,
agitation, HA, and
insomnia
□ note: restlessness
could be due to
toxicity or hypoxia
so close assessment
is required
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
Teaching and labs
□ No antacid use
within ½ hour of
this medication
contraindication
Avoid use with:
□ Chronic kidney
failure
□ Avoid gastric
irritants such as
caffeine, alcohol,
smoking and spicy
foods.
□ Decreases
absorption of Cipro,
Dig, Dilantin,
Tetracycline (so take
these med 2 hours
apart from Sucralfate)
□ PO: take with water
and after meals.
□ Wait 4-6 hours after
IV to start PO.
□ Take same time
each day
Avoid use with:
□ CAD, angina
□ Renal or liver
disease
□ Pregnancy,
lactation
□ children
□ CHF and acute viral
□ can cause seizure
(with high
doses/levels) so
avoid with seizure
disorder unless
bronchospasm is
unresponsive to
other treatments
□ Limit caffeine
□ Smoking decreases
effect of med
□ Increases lithium
excretion
58
Drug
Tobramycin sulfate
□ Aminoglycoside
□ Antibiotic
IV/IM
Inhalation (TOBI)
Ophthalmic (Tobrex)
Tolbutamide (Orinase)
□ Antidiabetic
□ Sulfonylureas
Peak: 3-5 hours
Duration: 6-12 hours
Use and dosage
□ broad spectrum
antibiotic
□ Kills bacteria cell by
affecting protein
synthesis. Kill Gram
negative infection.
□ Inhalation –
preventative with
cystic fibrosis (28
days on, 28 days
off)
□ Eye – external eye
infections
□ Mild to moderately
severe, stable Type
2 Diabetes
□ May be used as
adjunct therapy for
Type 1 Diabetes but
not sole medication
□ Give 1-2 x day after
meals
□ 1-2 weeks of
medication may be
required for full
therapeutic effect
Side effect
Side effects:
□ HA, paresthesia, skin
rash, fevers.
Adverse effects/toxicity:
□ Nephrotoxicity and
ototoxicity are two
common toxicities
associated with
aminoglycosides.
Eye – itching, swelling
REFER to sections on
aminoglycosides
(Gentamycin)
Side effects:
□ GI distress
□ Pruritus, rash (may
stop on own)
□ Photosensitivity
Adverse effects/toxicity:
□ Alcohol may cause
disulfiram like
reaction (flushing,
palpation and
nausea, flushing of
skin).
□ Hypoglycemia due
to too much med,
drug interactions,
N/V, inadequate
food intake.
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
Teaching and labs
□ Doses are based on
weight
□ Do not other meds
In the same IV
LAB
□ Peak and Trough
□ serum creatinine,
BUN to monitor
renal function
contraindication
Do not use with:
□ Known sensitivity
to other
aminoglycosides
□ Preexisting renal
disease.
Avoid use with:
□ Monitor blood
□ Allergy to sulfa or
sugars including
fasting and HgbA1C
urea
Teach
□ Signs and symptoms □ Beta adrenergic
of hypoglycemia
blocking agents
and notify
(betablockers) can
prescriber if they
suppress insulin
occur.
release and delay
response to
□ Wear medic alert
hypoglycemia
bracelet or tag
□ Avoid alcohol
□ Consult dr. when
pregnant
59
Drug
Triazolam (Halcion)
□ sedative hypnotic
□ Anxiolytic
□ Benzodiazepine
Has rapid onset (15-30
mins.)
Peak 1-2 hours
Duration 6-8 hours
Trihexyphenidyl HCl
(Artane)
□ Anticholinergic
□ Antispasmodic
Use and dosage
□ short term
management of
insomnia (4 weeks)
characterized by
difficulty falling
asleep, frequent
wakeful periods
Side effect
□ Drowsiness,
lethargy, confusion
□ sleepwalking
Adverse effects/toxicity:
□ Physical
dependence
□ Seizures (with rapid
withdrawal)
□ With overdose:
coma, respiratory
depression,
paradoxical anxiety
Teaching and labs
□ Do not use in
addictive prone pt.
□ Monitor symptoms
of overdose (slurred
speech, confusion,
somnolence,
impaired
coordination and
coma).
□ following long term
use, tolerance may
develop so do not
stop taking abruptly
contraindication
Avoid use with:
□ Known sensitivity
□ Alcohol intoxication
□ Suicidal ideas
□ Pregnancy,
lactation
□ Treat Parkinson’s
disease.
□ Diminishes hypersalivation; rigidity
and irregular
movements in
Parkinson’s.
□ Use to control
drug-induced extrapyramidal side
effects
Side effects:
□ Drowsiness
□ Decrease urine
output, retention or
hesitancy
□ Dry mouth
□ Constipation
Adverse effects/toxicity:
□ Paralytic ileus
□ Monitor I& O
□ increase fluids, bulk
and exercise
□ void before taking
to reduce urinary
retention
□ Avoid driving or
other hazardous
activities as
drowsiness may
occur.
□ Avoid OTC such as
cough medicine
with alcohol.
□ Very dose sensitive
Avoid use with:
□ narrow angle
glaucoma,
□ myasthenia gravis
□ GI obstruction
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
60
Drug
Vincristine sulfate
(Oncovin)
□ Antineoplastic
□ Vinca alkaloids
(from plant)
□ mitotic inhibitor
□ IS a vesicant;
administer into the
side arm portal of a
freely flowing IV.
□ Hyaluronidase is
given if this
vesicant should
infiltrate. May
apply heat to site to
disperse drug and
minimize sloughing.
Use and dosage
□ Acute
lymphoblastic and
other leukemias
□ lymphosarcoma,
□ Hodgkin’s disease
□ breast and lung
cancers
Side effect
□ Major toxicities
occur in the
hematopoietic,
integumentary,
neurologic and
reproductive,
system.
□ Peripheral
neuropathy
□ Paralytic ileus (more
common in young
children)
□ Alopecia
Adverse effects/toxicity:
□ Neurotoxicity - loss
of sensation of the
soles of feet and
fingertips
□ Depression of the
Achilles reflex is the
earliest sign of
neuropathy
□ Children are
especially likely to
develop neuro
changes
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
Teaching and labs
□ Neutropenic
precautions prn
□ Assess hand grasp
and deep tendon
reflexes
□ Maintain a regimen
against constipation
and paralytic ileus;
report a change in
bowel habits.
Vesicant safety
precautions:
□ Good vein, prefer
central line access
or fresh butterfly
stick
□ chemo-trained
nurse
□ remain during
infusion
□ have antidote
handy
contraindication
Avoid use with:
□ Obstructive
jaundice
□ Pre-existing
neuromuscular
disease
□ Active infection
□ Pregnancy,
lactation
□ Bronchospasm may
occur in pt
previously treated
with mitomycin
61
Drug
Vitamin B6
(Pyridoxine HCl)
□ Water-soluble
vitamin
Absorbed by GI tract
s/s of deficiency:
□ Lack of energy
□ Decreased brain
functioning
□ skin lesions,
□ conjunctivitis
Vitamin B12
Vitamin C
(Ascorbic acid)
□ Water soluble
vitamin
s/s of Deficiency which
is called Scurvy
□ Malaise, lethargy
□ pinpoint
hemorrhages
□ bleeding gums,
rough skin and
blotchy spots
especially legs
Use and dosage
□ Prevention and
treatment of
pyridoxine
deficiency (see
causes)
□ Co-enzyme in
amino acid
metabolism and
red blood cell
production
□ Treats acute
toxicity of INH,
hydralazine.
(see entry under
Cyanocobalamin)
□ Protects
connective tissue,
strengthens blood
vessel walls, forms
scar tissue,
provides matrix for
bone growth
□ Supports immune
system
□ helps in absorption
of iron and to
metabolize amino
acid
□ acidifies urine
Side effect
Teaching and labs
Causes of deficiency:
Side effects:
□ Alcoholism
□ Pain at injection site □ Malabsorption
Adverse effects/toxicity:
disorders
□ Neuropathy
□ Oral contraceptives
□ Ataxia
Dietary sources:
□ seizures
□ green leafy veg.
□ organ meats, fish,
poultry
□ legumes, chickpeas
□ bananas
□ whole grains,
□ potatoes
Side effects:
Rare at normal doses
□ Mix oral solutions
with food
Adverse effects/toxicity: Causes of deficiency:
□ crystalluria
□ Normal aging
□ Alcohol
□ Other meds
□ Increases
absorption of Iron
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
Dietary Sources:
□ citrus fruits,
cantaloupe,
strawberries,
□ broccoli, cabbage,
cauliflower
□ tomatoes
contraindication
Use with caution:
□ Renal disease
□ Cardiac disease
Common drug
interactions:
□ INH, hydralazine,
oral contraceptives
□ Reverses or
antagonizes effects
of levodopa.
Avoid use with:
□ Prone to kidney
stones
□ Megadoses of Vit. C
can interfere with
absorption of
Vitamin B12.
62
Drug
Vitamin D2
(Ergocalciferol)
□ Fat-soluble vitamin
s/s deficiency which is
called rickets
□ bones fail to calcify
□ bowed legs
□ osteomalacia
□ muscle spasm
Use and dosage
□ Calcium and
phosphate
metabolism
Remember calcium
and phosphorus are
inverse (high one,
lower other)
□ Necessary to
develop and
maintain strong
bones
□ osteomalacia and
osteoporosis
□ hypoparathyroidism
□ Treat and prevent
rickets
Side effect
Side effects:
□ Uncommon at
normal doses
□ Metallic taste
Teaching and labs
Causes of deficiency:
□ Inadequate sunlight
□ Dietary intake
□ hypoparathyroid
Adverse effects/toxicity:
□ n/v,
□ fatigue, headache,
□ hallucinations
□ dysrhythmias
□ Hypercalcemia
□ Stones
Dietary Sources:
□ Egg yolks
□ fortified cereals and
milk
□ Cod liver oil
□ some fish
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
contraindication
Avoid use with:
□ Hypersensitivity to
Vit. D
□ Hypercalcemia
□ Hyperphosphatemia
□ Also obtained from
sunlight
63
Drug
Vitamin E
(alpha-tocopherol)
□ Fat-soluble vitamin
s/s deficiency:
□ Hemolytic anemia
Vitamin K1
(Aquamephyton)
(Phytonadione)
□ Fat soluble vitamin
s/s deficiency:
□ Deficiency causes
hemorrhage.
Given as antidote for
Coumadin (warfarin)
overdose.
Onset IV = 6 hours
Use and dosage
□ Dietary supplement
□ Hemolytic anemia
in neonates
□ Topical to chapped
skin
□ Prevents cell
membrane damage
protects against
blood clot
development
Side effect
Side effects:
□ Uncommon at
normal doses
Teaching and labs
Causes of deficiency:
□ normal aging
□ Prematurity
□ Malabsorption
Adverse effects/toxicity:
diseases
□ N/V
Dietary Sources:
□ fatigue,
□ Wheat germ
□ headache
□ Vegetable oils
□ blurred vision
□ Green leafy
Toxic:
vegetables
□ jaundice
□ Nuts
□ brain damage
□ Dairy, eggs
□ Promotes liver
synthesis of
clotting factors
Side effects:
□ Swelling and pain at
injection site
□ SQ administration
preferred over IM.
□ Labs: Monitor
PT/INR (see note
□ Given to newborns Adverse effects/toxicity:
under ‘warfarin’)
to prevent bleeding □ Hypersensitivity or
Causes of deficiency:
anaphylaxis
–
like
□ Given as antidote
□ fat malabsorption
reaction
for coumadin
□ medication
□ Bronchospasm,
toxicity.
Dietary Sources:
Cardiac arrest
□ Also reverses hypo□ Asparagus, broccoli,
prothrombinemia
cabbage, Green
from various
leafy vegetables
causes
□ Green tea
□ Tomatoes
contraindication
Use with caution:
□ Bleeding disorders
□ Pregnancy
□ Avoid mineral oil
Avoid use with:
□ Known
hypersensitivity to
med
See entry under
Warfarin (Coumadin)
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
64
Drug
Use and dosage
□ Coumadin
Warfarin sodium
interferes with
(Coumadin)
synthesis of
clotting factor(s)
□ ORAL anticoagulant
that require Vit. K.
To reserve
hyperanticoagulation –
(1) Hold and/or skip
doses of Coumadin
(2) Antidote which is
Vitamin K1
(Aquamephyton)
□
□
□
□
□
Side effect
Side effects:
□ Ecchymotic skin
□ GI & skin problem
□ Hypotension
□ thrombocytopenia
Teaching and labs
□ Coumadin may be
started while pt is
still on continuous
IV heparin therapy).
Heparin is tapered
off slowly over 2-3
days. Pt. remains on
Given PO.
Adverse effects/toxicity:
oral Coumadin.
□ Bleeding is the
□ Often given in the
Has narrow
major adverse
evening with lab
therapeutic range.
effect.
draws in the
Can take 1 week for
morning – it must
Therapeutic effect
be taken same time
each day
PT level will be
□ Avoid or use
maintained at 1.5 –
consistently foods
2.5 the times the
high in Vit. K
control value
□ May be long-term
(which is 12-15 sec.)
medication
INR range from 2.0depending on
3.0 (control 1.0)
reason for
Labs need
medication
monitored often
□ Teach bleeding
(sometimes 2-3 x
precautions
week) initially,
□ Observe closely and
then are decreased
over time
report s/s bleeding
WSU – CONH STUDY GUIDE FOR NLN PHARMACOLOGY EXAM (REVISED 6/3/2013)
contraindication
Avoid use with:
□ hemorrhaging or
bleeding
tendencies
□ malignant
hypertension
□ past history of
allergic reaction to
Coumadin
□ Many, many meds
have drug
interactions with
Coumadin
65