Pharmacology Made Insanely
Easy!
Pharmacology Made Insanely EASY for the
® !
NCLEX-RN
The important
thing…
National Student Nurses Association
Charlotte, NC
Presented by:
Loretta Manning, MSN, RN, GNP
The important
thing… is not
The most important
thing in pharmacology
so much to obtain more and more facts, but to
TRANSFORM
How we THINK about the facts!
Loretta Manning, MSN, RN, GNP
Make mistakes
MACH 1
Ask dumb questions
M
A
Collaborate
C
Have fun
H
1
1
CRAM
Create
Retention
Accelerate
More with less
AGE 0–4
AMOXICILLIN
4–12
RITALIN
12–18
18–24
APPETITE
NO-DOZ
SUPPRESANT
24–38
PROZAC
38–65
ZANTAC
65–
EVERYTHING
ELSE
1
Trivialize
Funnel
Tedious
Terrorize
What concerns me
concerns
me…
is notWhat
the way
things
are, but
rather the way people think
things are.
-Epictetus, Philosopher
REMEMBER!!!
Remember…
It’s not what you KNOW,
but what you
REMEMBER
that counts!
Which of these clients should the nurse question
the provider of care regarding the appropriateness
for an order to administer an anticholinergic
medication?
1.
2.
3.
4.
A client going to surgery for GI
surgery.
A client who is presenting with
Parkinson’s symptoms from an
antipsychotic drug.
A client who has glaucoma.
A client who is going to surgery for
an exploratory lap.
2
1.
figures…
2.Littlepuzzle
Grid
Grid solution
3.
4.
5.
6.
7.
8.
9.
CEF THE GIANT
During the history, a client reports a previous
allergic reaction to penicillin. The provider of care
orders cefaclor (Ceclor). What is the highest
priority of care?
a. Immediately start an IV.
G I: nausea, vomiting, diarrhea
Cef the Giant
I ncrease in glucose values
may occur;
A naphylaxis
alcohol may cause vomiting
b. Identify wrist bracelet for correct
client identity.
N ephrotoxicity
c. Verify accuracy of order.
T hrombocytopenia
d. Monitor BUN and creatinine prior to
administering the medication.
©2009 I CAN Publishing, Inc.
©2001 I CAN PUBLISHING, INC.
“Words are of
course the most
powerful DRUG
used by mankind.”
Thinking Brain
as Seen on
fMRI
Copyright 2006 ICAN Publishing
Inc.
7
3
Memory Trace Categories Are
Small in Number
Neural Networks
Knowledge Nodes
(Memory Traces):
Knowledge learned from
lecture, reading &
memorizing
There Are
Few
Linkages
Connections: Knowledge
learned from experience,
stored in the form of
interconnections among
memory traces
Copyright 2006 ICAN Publishing, Inc.
19
Copyright 2006 ICAN Publishing
Inc.
20
9 BRAIN RULES FOR
SUCCESSFUL LEARNING!
Connections Required for Learning
• More connections formed; the
greater number can be formed
Exercise
Attention
Memory (repeat to remember)
Memory (remember to repeat)
Sleep
Stressed brains don’t learn the same
Sensory
Vision trumps all other senses
Wiring
• "Neurons that fire together wire
together“
(Donald Hebb)
• Initial learning is temporary.
Repetition is critical for learning
• Brain re-contouring can be
positive or negative
GALANTAMINE (RAZADYNE)
Which of these statements indicate the client has an
appropriate understanding of how to take galantamine
(Razadyne) after being discharged from the hospital?
•
•
•
•
1.
2.
3.
4.
“I will take this medication on an empty stomach.”
“I will take this medication one time a day.”
“This medication should be reordered after 3 weeks.”
“I will notify my HCP if my HR goes below 60 bpm.”
©2013 I CAN Publishing®, Inc.
4
Novices Unable to Distinguish
Relevant
From
Irrelevant
Data
Novice Critical Thinkers
• Low tolerance for ambiguity –
Novices want it perfectly clear
They just want
someone to tell
them what to do!!!
Copyright 2006 ICAN Publishing
Inc.
19
Copyright 2006 ICAN Publishing
Inc.
18
KAYEXALATE
Links are needed to understand, remember,
and apply information.
©2013 I CAN Publishing®, Inc.
What would be the desired outcome for a pediatric client who
received Kayexalate?
1.
2.
3.
4.
“LIFE IS NOT ABOUT WAITING FOR
THE STORMS TO PASS… IT’S ABOUT
LEARING TO DANCE IN THE RAIN.
An increase in bowel movements.
A sodium level of 138 mEq/L.
A potassium level of 4.5 mEq/L.
A depressed T wave on the ECG monitor.
Vivian Greene
©2009 I CAN Publishing, Inc.
© 2013 I CAN Publishing®, Inc.
29
5
Pg. 251
NARCAN
Pg. 253
Pain Scale:
1 – 3 Mild
4 – 6 Moderate
7 – 10 Severe
Pg. 56
B1 and B2
*carteolol
(Cartrol)
B1 ONLY
•Atenolol
(Tenormin)
•Bisoprolol
(Zebeta)
*Carvedilol
(Coreg)
•Esmolol
(Brevibloc)
*Propanolol
(Inderal)
•Metropolol
(Lopressor
and Toprol XL)
*Nadolol
(Corgard)
PME-57
A client with asthma has received an order for
propranolol (Inderal). What is the highest
priority nursing action before initiating the
order?
1.Assess
breath sounds 90 minutes after
administering the medication.
2.Evaluate heart rate to determine a problem
with tachycardia.
3. Monitor the BP prior to administering the
medication.
4. Verify the accuracy for this medication
order.
PME 56, 59
©2009 I CAN Publishing, Inc.
E motional depression & Exhaustion
6
Which of these clinical findings should be
reported for a client taking atenolol (Tenormin)?
1.Blood pressure 132/78.
2.Weight loss of 1 lb.
3.Heart rate from 80 to 52 BPM.
4.Serum glucose of 200.
AS YOU WANDER THROUGH
LIFE, WHATEVER BE YOUR GOAL,
KEEP YOUR EYE UPON THE DONUT,
AND NOT UPON THE HOLE.
©2009 I CAN Publishing, Inc.
PHARMACO-KARAOKE
©2009 I CAN Publishing, Inc.
PHARMACO-KARAOKE
Pharmaco-karaoke is the way to go
You will learn all the meds that you need to know.
It is as easy as learning the ABC’s
When you learn your facts with Pharmaco-karaoke.
Pharmacology Made Easy! Pharmacology Made Easy!
©2009 I CAN Publishing, Inc.
©2009 I CAN Publishing, Inc.
AMINO MICE
You may ask about all of the drug interactions?
Just listen to our songs for your direction.
Reviewing meds can be fun and exciting;
And can be very enlightening.
Pharmacology Made Easy! Pharmacology Made Easy!
Just check out the icons and images in our book,
You will soon be singing and just look how smart you will
look!
Pharmacology Made Easy! Pharmacology Made
Easy!
Gentamycin
AMINO MICE
Amikacin
Kanamycin
Neomycin
Streptomycin
Tobramycin
8th Cranial Nerve
Monitor BUN
Creatinine
I&O
©2009 I CAN Publishing, Inc.
©2001 I CAN PUBLISHING, INC.
7
Which of these clinical data findings
would be the highest priority to report to
the provider of care for a client who has
been taking gentamicin (Garamycin) ?
THREE AMINO MICE
(sung to the tune of “Three Blind Mice”)
One can’t feel,
One can’t hear.
One can’t pee —
They’re toxic mice, all three.
1.
2.
3.
4.
Vestibular function and audiograms
Should always be studied in patient
care plans [or “as part of your
plan”]
Grab BUNs and creatinine quick as you
can,
Yes! Three amino mice.
©2009 I CAN Publishing, Inc.
Which statement made by the UAP
indicates the nurse should intervene with a
client who is taking Streptomycin?
1.
2.
3.
4.
“The client’s temperature is 99.1 degrees F.”
“The client does not seem to hear me.”
“The client is requesting to walk.”
“The client is drinking a lot of water.”
©2009 I CAN Publishing, Inc.
BUN – 15.
Nausea.
Temp.– 98.9 degrees F.
Tinnitus.
©2009 I CAN Publishing, Inc.
What should be the priority plan for a client
who is taking streptomycin?
1.
2.
3.
4.
Monitor the vital signs prior to
administering the medication.
Monitor the AST / ALT.
Monitor the BUN / creatinine.
Monitor the serum glucose.
©2009 I CAN Publishing, Inc.
RUDOLPH THE RED-NECK REINDEER
RUDOLPH
Rudolph the red-neck reindeer
Had an adverse side effect
From the drug Vancomycin,
Must keep all labs in check.
Caution with renal failure,
Hearing loss and allergies,
Take a temp and blood cultures,
‘Specially a CBC!!!
What action should be a priority for a client who
is receiving vancomycin (Vancocin) over 30
minutes and begins presenting with a flushed
neck and face?
1.Assess the client’s temperature
immediately.
2.Administer the antihistamine that was
ordered.
3.Immediately discontinue the med. and
call Dr.
4.Slow the rate of the medication
infusion.
8
AMPHOTERICIN B
Verse 1
Am-pho-ter-i-cin B
Foe of Fun-gus, You see
But’s hard on the Kid-neys.
Am-pho-ter-i-cin B
Verse 2
Will kill Hist o plas mo sis
Coc cid io my co sis,
This drug’s really ferocious.
Am-pho-ter-i-cin B
©2009 I CAN Publishing, Inc.
Chorus
Strict I & O (click finger x2)
Kidney functions must know (finger x2)
ALT below 60 (note: these are liver fx tests that also
need to be watched) 
AST below 40
Keep IV a’flow. (click finger x2)
Verse 3
So watch for low K+ levels,
And Dig Toxic signs as well.
Catch problems before they swell.
Am-pho-ter-i-cin B
©2009 I CAN Publishing, Inc.
What lab values would be a most
important to evaluate for a client who is
taking Amphotericin B?
1.
2.
3.
4.
AST / ALT.
Serum amylase.
Serum glucose.
Serum lipase.
©2009 I CAN Publishing, Inc.
©2009 I CAN Publishing, Inc.
What clinical assessment finding should
be a priority to report to the provider of
care for a client who is taking
Amphotericin B?
1.
2.
3.
4.
Anorexia.
Muscle cramps.
Spiked T waves.
Skin hot and dry.
©2009 I CAN Publishing, Inc.
9
The Itsy Bitsy Dig Level
(Tune: Itsy Bitsy Spider)
What clinical assessment finding should
be a priority to report to the provider of
care for a client who is taking Digoxin
and furosemide (Lasix)?
The Itsy Bitsy Dig Level;
Went up the range real quick!
Then came vomiting and washed the patient out!
Then up came muscle cramps that caused patient to shout!
1.
2.
3.
4.
We all know the level should be .5 to 1.5.
Oops we better take the heart rate, so we can keep patient alive!
The magic no. is not to give if HR is < 60;
Assess for halos and interactions, so pt. will not die before age 50 !
p. 28
Hyperactivity.
Muscle cramps.
Spiked T waves.
Skin hot and dry.
©2009 I CAN Publishing, Inc.
Spoon Full of Lipitor
Tune: Spoon Full of Sugar
In every job that must be done,
There is an element of fun!
You find the fun and SNAP!
The job is a game!
And every task you undertake
Becomes a piece of cake;
Pushing fluid;
A special diet, it’s very clear to see!
Just a spoon full of Lipitor makes the cholesterol go down, the
cholesterol go down, the cholesterol go down!
Just a spoon full of Lipitor makes the cholesterol go
down, In the therapeutic range!
©2009 I CAN Publishing, Inc.
Always take this drug with food,
And at bed-time.
It would be great to in-crease fib-er in di-et.
It will take sev-eral weeks
Before lip-ids de-crease
So!
Just a spoon full of Lipitor can make the liver enzymes go up, the
liver enzymes go up, the liver enzymes go up!
Just a spoon full of Lipitor can make the liver enzymes
go up, out of therapeutic range!
Which observation indicates the LPN
understands how to safely administer
atorvastatin (Lipitor)?
1.
2.
3.
4.
Assesses vital signs daily.
Administers at bedtime with food.
Administers on an empty stomach.
Advises that level of cholesterol
should decrease within 7-10 days.
(One more time!)
Just a spoon full of Lipitor makes the cholesterol go down, the
cholesterol go down, the cholesterol go down!
Just a spoon full of Lipitor makes the cholesterol go
down, In the therapeutic range!
©2009 I CAN Publishing, Inc.
10
SOGGY SID
SOGGY SID
©1994 I CAN PUBLISHING, INC.
S-I-A-D-H
S-I-A-D-H
(Syndrome of Inappropriate Antidiuretic Hormone)
Lyrics © (Sing to tune: BINGO) Darlene A. Franklin, RN MSN
Chorus
S-I-A-D-H, S-I-A-D-H, S-I-A-D-H,
This hormone stops the PeePee.
Verse 1
Brain tumors, trauma, and bad bugs
A complication might be—
S-I-A-D-H, S-I-A-D-H, S-I-A-D-H,
This hormone stops the PeePee.
Verse 2
Low output, sodium; gained weight
And high S. gravity (specific gravity)
S-I-A-D-H, S-I-A-D-H, S-I-A-D-H,
This hormone stops the PeePee.
(Syndrome of Inappropriate Antidiuretic Hormone)
Lyrics © (Sing to tune: BINGO) Darlene A. Franklin, RN MSN
Verse 3
But, Diabetes Insipidus
The opposite you’ll see
Pee, Pee…Give IVs…
Pee Pee…Give IVs…
Pee, Pee…Give IVs…
Vas-o-pressin they need!
Verse 4
High output, sodium; pounds lost,
And low S. gravity (specific gravity)
Pee, Pee…Give IVs…
Pee Pee…Give IVs…
Pee, Pee…Give IVs…
Vas-o-pressin they need!
http://www.marvistavet.com/assets/images/dog_IV.gif
Which statement indicates a client with
diabetes insipidus (DI) needs additional
information during the hospital discharge
teaching?
1. “I will weigh myself daily using the same
scales.”
2.“I will drink liquids equal to the amount
of my urine output.”
3.“I will always wear my medical alert
bracelet.”
4.“I will wean myself off the vasopressin.”
©2009 I CAN Publishing, Inc.
Which clinical outcome would indicate a
therapeutic response from vasopressin?
1.
2.
3.
4.
Blood glucose – 120 g/dl.
Oxygen saturation level of – 96%.
Heart rate – 88 / minute.
Urine specific gravity – 1.015.
©2009 I CAN Publishing, Inc.
11
BETA2-ADRENERGIC
AGONISTS
What would be the highest priority of care
for a client with syndrome of inappropriate antidiuretic hormone (SIADH)?
1. Instruct the UAP to encourage the
client to drink fluids.
2.Advise client to report large
amounts of urine output.
3.Evaluate for signs and symptoms
of dehydration.
4. Instruct the LPN to report a
weight gain of 2.5 pounds.
©2009 I CAN Publishing, Inc.
Puff the Magic Drug
(sung to the tune of “Puff the Magic Dragon”)
Verse 1
Puff, Puff on my inhaler
Rescue me please.
From bronchitis and asthma
Cough, Cough (actually do cough) and COPD.
Verse 4
I should have listened to my provider
1-3 min. please
From bronchitis and asthma
When using with a steroid inhaler
Verse 2
It works on beta receptors
Î vital capacity.
While Î BP and HR
Are major concerns to me.
Verse 5
I puffed on my inhaler
Got rid of my wheeze.
Now I blow up balloons and exercise
I am now breathing with ease!
Verse 3
I puffed too much on my inhaler
Rescue me please,
From shaky hands and racing heart
And weakness in my knees.
A client received 2 extra doses of
albuterol for relief of
bronchoconstriction from COPD.
What is priority of care?
a. Notify provider of care.
b. Document bradycardia.
c. Complete appropriate report and
document complications of
lethargy.
d. Document tachycardia and tremors and
notify provider of care.
.
©2009 I CAN Publishing, Inc.
© I CAN Publishing, Inc., 2008
TIOTROPIUM (SPIRIVA)
“Pharmacology is
always changing; our
response is what our
thoughts make it.”
.
©2013 I CAN Publishing®, Inc.
12
“Words are of
course the most
powerful DRUG
used by mankind.”
It is notaffirmation
the mountain that
gets moved that makes a
difference, it is the
little steps taken
one at a time.
I CAN Publishing, Inc. /Sylvia
affirmation
Rayfield & Associates
wants to thank
you for attending this session. We
Look forward to seeing you at Exhibit
203!
Remember with I CAN YOU CAN BE
SUCCESSFUL !
13