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NCLEX Pharmacology

A Quick Review on Pharmacology

♣ Show Notes

NCLEX Review on Pharmacology

The fact is that pharmacology will always be a big part in your NCLEX Exam, and can be a huge catalyst in whether you pass or fail your NCLEX Exam.  It is quite important for us to focus a lot on the content that pertains to medications, if we are reviewing for the NCLEX.  The NCSBN (who is responsible for developing the NCLEX Exam) defines the category of Pharmacological and Parenteral Therapies as a sub-category within the Physiological Integrity area (of the exam)  in which the nurse is basically providing care related to the administration of medications and parenteral therapies.

To be more specific, Pharmacological and Parenteral Therapy has contents that  includes but is not limited to:

  • Adverse Effects/Contraindications/Side Effects/Interactions
  • Expected Actions/Outcomes
  • Medication Administration
  • Blood and Blood Products
  • Parenteral/Intravenous Therapies
  • Central Venous Access Devices
  • Pharmacological Pain Management
  • Dosage Calculation

First, I want to take a step back and look at Pharmacology from a technical sense and look at it more in depth.

What is Pharmacology?

♠ PHARMACOLOGY

Pharmacokinetics– The study if how drugs are being absorbed, distribuited, metabolized and excreted by the body.
Pharmacodynamics– is the study of how drugs are being used by the body.
Pharmacotherapeutics– the study of how the client responds to the particular drugs.

What’s in a drug name?
Chemical Name:
This tells you the chemical makeup of the drug.
Generic Name
This name is given by the company that developed the drug.
Trade Name
This is the name given to the drug by the company in which the medication originated.

The Seven Rights of Administering Drugs

  • Right Client
  • Right Route
  • Right Drug
  • Right Dose
  • Right Amount
  • Right Time
  • Right Documentation
  • Right to refuse treatment

Any drug can have a CHEMICAL NAME, A GENERIC NAME AND A BRAND OR TRADE NAME.

  • The generic name of a drug is suggested by the manufacturer, and accepted by the international committee.
  • How the drug is being affected affects the body and the patient’s response is called the effect.
  • Efficacy refers to the degree to which a drug is able to induce it’s maximal effects.
  • Adverse Effect is any unexpected or unintended response to a therapeutic use of a drug, it is also called side effect.

During this review, I want to focus specifically towards the drugs that is mostly in patients with hypertension.

DRUGS USED WITHIN THE CARDIAC SYSTEM

Cardiac Pharmacology

♣ Pharmacology Drugs for Hypertension:

DIURETICS

  • – Helps get rid of the sodium and fluid in the body.
  • – Used to lower the blood pressure.
    – Promotes the excretion of sodium and water
    – Diuretics interferes with the sodium absorption in the kidney.
    – Increases the urine output.  Decreases the preload and afterload..

If the patients blood pressure drop to low, it is important to give IV fluids to pt.

LETS GO OVER THE CATEGORIES OF DIURETICS ♠

♦ TYPES OF DIURETICS

♣ POTTASIUM SPARING DIURETICS

It promotes the excretion of soduium and water, while the retention of pottasium

Used for:

  • Hypertension
  • Edema
  • Hyperaldosteronism
  • Hypokalemia

Medication:

  • SPIRONOLACTON (ALDACTONE)
  • AMILORIDE (MIDAMOR)
  • TRIAMTERENE

Now lets go to the side effects:

First, of course the person can have too much potassium or HYPERKALEMIA:

Signs of HYPERKALEMIA

  • irregular heartbeat
  • nervousness
  • tingling in hands and feet
  • shortness of breath
  • tiredness or weakness

OTHER SIDE EFFECTS:

  1. Nausea and vomiting
  2. Cramping and diarrhea
  3. Dizziness & headache

Loop Diuretics

  • BUMETANIDE (BUMEX)
  • FUROSEMIDE (LASIX)

Osmotic Diuretics

MANNITOL

  • Thizade Diuretics

HYDROCHLOROTHIAZIDE (HYDRODIURIL)
CHLOROTHIAZIDE (DIURIL)
CAUSES THE DEPLETION OF SODIUM AND WATER.
♣ CAN INDUCE HYPERGLYCEMIA

Very Important for the NCLEX:

SIDE EFFECTS OF DIURETICS

  • Frequent urination
  • Electrolyte abnormalitie
  • Muscle cramps or weakness
  • Blurred vision
  • confusion
  • headache
  • increased perspiration (sweating)
  • restlessness

BETA (ADRENERGIC)  BLOCKERS

– Helps lower blood pressure, puls rate and cardiac output.
– Can be used to treat headaches.
– Can be used to treat glacauma and prevent myocardial infarctions.
– Acts on the system, by blocking the symathetic vasomotor response.

For the NCLEX, try to remember that the syllable for beta blockers is usally (olol).

SIDE EFFECTS:

  • Orthostatic hypotension
  • bradycardia
  • nausea and vomiting
  • diarrhea

NOTE: Some of the symptoms may MASK signs of Hypoglycemia

♠ HYPOGLYCEMIC SYMPTOMS

NURSING INTERVENTIONS FOR CLIENTS TAKING BETA BLOCKERS:

Make sure that you monitor the client’s blood pressure, heart rate and rhythm, before administering the beta blocker.  Monitor the client for signs of edema.  The nurse should also assess the lungs sounds for signs of rales and ronchi.  When patient are taking beta blockers, it is also very important to monitor the changes in lab values such as (protein, BUN and creatinine) which can indicate nephrotic syndrome.  Nursing teaching for the NCLEX would include: Teaching the Client to rise slowly (ORTHOSTATIC HYPOTENSION) * (A SAFETY ISSUE), report any signs of bradycardia, dizziness, confusion depression or fever.  It is also very important to taper off the medication properly.

Cardiac Pharmacology

♣ Calcium Channel Blockers

  1. – PREVENTS THE MOVEMENT MECHANISM OF CALCIUM WITHIN THE CARDIAC SYSTEM.
  2. – THEREFORE DECREASING THE CARDIAC WORKLOAD, AND CARDIAC MUSCLE CONTRACTILIY.
  3. – MEDICATIONS INCLUDE THE “DIPINE” : DILITAZEM (CARDIZEM), AMLOPIDINE (NORVASC), NEFEDIPINE, NICARDIPINE.
  4. – USED TO TREAT ANGINA.
  • Remember:

– Blocks the calcium channels in the heart, causing a decrease in contractility.
Decreases the workload of the heart.

Used for:
Hypertension

Medications:

  • Nifedipine (Procardia)
  • Amplodipine (Norvasc)
  • Do not give Norvasc with grapefruit, causees increase in drug level.
  • Verapamil (Isoptin)
  • Diltiazem (Cardizem)

SIDE EFFECTS:

Constipation
Nausea
Headache
Rapid heartbeat (tachycardia)
Drowsiness

Remember:

  • Make sure to monitor the heart rate and the blood pressure.
  • Hold medication if HR is less than 60 or if BP is less than BP.

♠ ACE INHIBITOR

  1. – ACE INHIBITORS “BLOCKS” THE CONVERSION OF ANGIOTENSIN 1 TO ANGIOTENSIN 2.
  2. – ALTERS THE “BLOOD PRESSURE” MECHANISM THROUGH THE RENIN-ANGIOTENSIN SYSTEM.
  3. MEDICATIONS INCLUDES THE “PRIL” : CATOPRIL, ENALAPRIL, LISINOPRIL, RAMIPRIL.

SIDE EFFECTS:

  • COUGH
  • TACHYCARDIA
  • NAUSEA AND VOMITING.

Remember:
GIVE ON AN EMPTY STOMACH OR 2-3 HRS. AFTER A MEAL.

NCLEX Review Pharmacology

Drugs Used for treating Hypertension:

♣ ACE INHIBITORS

♥ BETA BLOCKERS

♦ CALCIUM CHANNEL BLOCKERS

 REMEMBER FOR YOUR NCLEX EXAM:

  • ACE INHIBITOR
  1. – ACE INHIBITORS “BLOCKS” THE CONVERSION OF ANGIOTENSIN 1 TO ANGIOTENSIN 2.
  2. – ALTERS THE “BLOOD PRESSURE” MECHANISM THROUGH THE RENIN-ANGIOTENSIN SYSTEM.
  3. MEDICATIONS INCLUDES THE “PRIL” : CATOPRIL, ENALAPRIL, LISINOPRIL, RAMIPRIL.
  4. SIDE EFFECTS: COUGH, TACHYCARDIA, NAUSEA AND VOMITING.
  5. GIVE ON AN EMPTY STOMACH OR 2-3 HRS. AFTER A MEAL.
  • BETA BLOCKERS
  1. – REDUCES THE CARDIAC OUTPUT AND DECREASES THE SYMPATHETIC NERVOUS SYSTEM RESPONSE.
  2. – BLOCKS THE BETA RECEPTOR, CAUSING A DECREASE IN BLOOD PRESSURE.
  3. – MEDICATIONS INCLUDE THE “OLOL’S”: METROPOLOL, PROPANALOL, ACEBUTOLOL, NADOLOL.
  4. – USED FOR HYPERTENSION, MYOCARDIAL INFARCTION AND ANGINA.
  5. ADVERSE EFFECTS CAN INCLUDE: BRADYCARDIA, HYPOTENSION AND HYPOGLYCEMIA (DISTRUPTS THE LIVER’S ABILITY TO CONVERT GLYCOGEN TO GLUCOSE).
  • CALCIUM CHANNEL BLOCKERS
  1. – PREVENTS THE MOVEMENT MECHANISM OF CALCIUM WITHIN THE CARDIAC SYSTEM.
  2. – THEREFORE DECREASING THE CARDIAC WORKLOAD, AND CARDIAC MUSCLE CONTRACTILIY.
  3. – MEDICATIONS INCLUDE THE “DIPINE” : DILITAZEM (CARDIZEM), AMLOPIDINE (NORVASC), NEFEDIPINE, NICARDIPINE.
  4. – USED TO TREAT ANGINA.

 

 

CARDIAC GLYCOSIDES

Digoxin

  • IS A CARDIAC GLYCOSIDE
  • AN ANTIARRYTHMIC
  • IT INCREASES CARDIAC OUTPUT
  • SLOWS DOWN THE HEART RATE

Watch for Digoxin Toxicity:

Assessment and Signs of Digoxin Toxicity:

  • VISION CHANGES (HALO EFFECT)
  • NAUSEA AND VOMITING
  • BRADYCARDIA AND ANOREXIA
  • ANOREXIA

 

Anticoagulants

Avoid Herbs such as  ‘G’ HERBS (GINSING, GINGER, GINKO, GARLIC) when using anticoagulant drugs.

Aspirin

  • CAN ALSO BE USED AS A BLOOD THINNER
  • IRRITATES THE STOMACH AND INTESTINES
  • WATCH OUT FOR “BLACK TARRY” LOOKING STOOLS (COULD BE A SIGN OF INTESTINAL BLEEDING)
  • NEVER GIVE YOUR CHILDREN ASPIRIN, CAN CAUS  REYE’S SYNDROME.

Heparin:

  • MAKE SURE TO CHECK THE PTT
  • ANTIDOTE IS PROTAMINE SULFATE
  • CAN BE SAFELY GIVEN DURING PREGNANCY.

Coumadin

  • CHECK THE PT AND THE INR
  • ANTIDOTE IS VITAMIN K

Lovenox

  • LOVENOX, ALSO CALLED ENOXAPARIN, IS A FORM OF HEPARIN CALLED FRACTIONATED HEPARIN.

NCLEX Review: Pharmacology Adverse Reactions/ Side Effects

CARDIOVASCULAR DRUGS

ACE Inhibitors

  • HYPOTENSION (MOST COMMON)
  • COUGH ♣(COMMON NCLEX QUESTION)
  • CHECK ELECTROLYTES FOR (HYPERKALEMIA)

Calcium Channel Blocker

  • FATIGUE, HEADACHE
  • DROWSINESS
  • DYSRHYTMIAS
  • DO NOT GIVE TO PT’S WITH 2ND OR 3RD DEGREE HEARTBLOCK

Vasodilators

  • PALPITATIONS, CRAMPS
  • NAUSEA & VOMITING
  • BONE MARROW SUPPRESSION
  • CONTRAINDICATED IN PT’S W/ CAD
  • TAKE W/ FOOD TO DECREASE GI UPSET.

Diuretics

  • THIAZIDE
  • LOOP
  • OSMOTIC

Watch for electrolyte imbalance and dehydration.

Pottasium Sparing Diuretics

  • NAUSEA AND VOMITING
  • WATCH FOR ELECTROLYTE IMBALANCE SUCH AS
  • HYPERKALEMIA AND HYPONATREMIA.

ENDOCRINE SYSTEM PHARMACOLOGY

  • PROPYLTHIOURACIL (PTU) : HYPERTHYROID MEDICATION
  • FATIGUE, DROWSINESS
  • BRADYCARDIA, HEADACHE

Cortisone, Prednisone (Cortisole Replacement)

  • WEIGHT GAIN ♣
  • DECREASED IMMUNITY ♥
  • NAUSEA & VOMITING

Iodine Product (Loguls Solution)

  • USED FOR THYROID STORM
  • NAUSEA & VOMITING
  • BRADYCARDIA, HEADACHE

Levothyroixine (Synthroid) : Hypothyroid Medication

  • TACHYCARDIA ♦
  • NAUSEA & VOMITING

Glimepride (Amaryl), Glipizide (Glucotrol)

  • USED TO TREAT HYPERGLYCEMIA
  • BE CAREFUL TO WATCH FOR HYPOGLYCEMIA ♣

ENDOCRINE SYSTEM DRUGS

Corticosteroids (decreases inflammation)

  • INCREASED BP
  • HYPERGLYCEMIA ♥
  • WATCH OUT FOR CUSHING’S SYNDROME

Bronchodilators (relaxed bronchial muscle)

  • HEADACHE, TACHYCARDIA
  • PALPITATIONS
  • NAUSEA AND VOMITING

TUBERCULOSIS DRUGS

Isoniazid (INH)

  • B6 DEFICIENCY
  • OBSERVE PT. FOR JAUNDICE

 

 

 

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NCLEX Review Shownotes:

Understand that the Nervous system includes the Central Nervous System (CNS), the Peripheral Nervous Sytem (PNS) and the Autonomic Nervous System or the (ANS).

When I say the CENTRAL NERVOUS SYSTEM, We can simplify at as the BRAIN and the SPINAL CORD.

The PERIPHERAL NERVOUS SYSTEM on the other hand, contains the CRANIAL NERVES and the SPINAL NERVES.

  • WHEN WE TALK ABOUT THE AUTONOMIC NERVOUS SYTEM, WE ARE BASICALLY TALKING ABOUT THE “SYMPATHETIC” (FIGHT OR FLIGHT) SYSTEM OR THE “PARASYMPATHETIC” SYSTEM.
  • .THE BASIC COMPONENT OF THE NERVOUS SYSTEM IS THE NERVE CELL OR NEURON

NEURON

– is the primary component of the nervous system.

– it is composed of cell body (gray matter), axon and dendrites.

BRAIN  (Central Nervous System: Brain and Spinal Cord).

CEREBRUM- Outermost area (cerebral cortex) is gray matter, deeper area is composed of white matter

  • TWO HEMISPHERES: LEFT AND RIGHT AND EACH HEMISPHERE IS DIVIDED INTO TWO LOBES.

FRONTAL LOBE

  • PERSONALITY, BEHAVIOR
  • HIGHER INTELLECTUAL FUNCTIONING
  • BROCA’S AREA: (MOTOR SPEECH AREA)

PARIETAL LOBE

  • POSTCENTRAL GYRUS: REGISTERS SENSATION (TOUCH, PRESSURE)
  • INTEGRATES SENSORY INFORMATION

TEMPORAL LOBE

  • HEARING, TASTE, SMELL (HINT: LOCATION OF EARS – CLOSE THE TEMPLES)
  • WERNICKE’S AREA: SENSORY SPEECH AREA
  • (UNDERSTANDING, FORMATION OF LANGUAGE)

OCCIPITAL LOBE

  • VISION

Peripheral Nervous System- composed of Spinal Nerves (31)

Autonomic Nervous System- part of the Peripheral Nervous System

  • REGULATES FUNCTIONS OCCURRING AUTOMATICALLY IN THE BODY.
  • ANS REGULATES SMOOTH MUSCLE, CARDIAC MUSCLE AND GLANDS.

IT IS NOT NECESSARY TO KNOW EVERY PHYSIOLOGY FOR EVERY SINGLE PART OF THE BRAIN.  BUT JUST IN CASE WE END UP GETTING LOW LEVEL QUESTIONS ON THE EXAM, THEN IT IS IMPORTANT THAT WE UNDERSTAND THE BASIC CONCEPT AND FUNCTION OF EACH AREA. IT WOULD ALSO BE A GREAT IDEA TO KNOW THE CRANIAL NERVES.

Quick NCLEX Overview:

EYE AND EAR DISORDERS

GLAUCOMA

Glaucoma: there is an increased of intraocular pressure in the eye.

There are two types:

  1. OPEN ANGLE GLAUCOMA OR “PRIMARY” GLAUCOMA
  2. PRIMARY ANGLE GLAUCOMA.

Open angle glaucoma is slow in onset and chronic, while the primary angle glaucoma needs immediate treatment.

Open Angle Glaucoma

Bilateral

Acute Angle-closure Glaucoma

Unilateral

TREATMENT

Beta Adrenergic Blockers

Cholinergic Agents (Pilocarpine) ♣ (Make sure to know this for the NCLEX)

AVOID ANTICHOLINERGICS (Atropine)

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Ultimate NCLEX Review on Medications Pharmacology

NCLEX Review Neurological Pharmacology

Neurology Pharmacology

Amyotrophic lateral sclerosis (ALS) NCLEX Review

NCLEX Review on Seizure

Meningitis NCLEX Review

Meningitis  (By: AllNursingNotes)

Lets take a quick look at Meningitis and what we need to know for the NCLEX.

Meningitis is simply:

– an inflammation of the meninges within the brain and spinal cord.

  • * Usually caused by Niesseria meningitidis, Group B Strep and Streptococcus pneumoniae

Again, the two main culprit for Meningitis are

  1. Niesseria meningitidis
  2. Streptococcus pneumoniae

Assessment findings on the patient:

  • * Positive Brudzinski’s Sign

– There is some neck stiffness that causes a patient’s hips and knees to flex when the neck is flexed

  • * Positive Kernig’s Sign

– With the patient lying flat, if the patient flexes a hip 90 degrees, and then attempts to extend the lower leg at the knee. Pain on extension is a positive sign.

  • Chills
  • Fever
  • Headache
  • Malaise

Diagnostic Evaluation:

  • Lumbar Puncture
  • Chest X rays

NCLEX Review on Bells Palsy

We are going  to look at NCLEX Review on Neurological Medications (Pharmacology)

To review neurological pharmacology for the NCLEX, it is very important to simplify and of course UNDERSTAND  Neuro medications.

NCLEX Review Neurological Pharmacology: Lets first look at the drugs that affects the PNS.  For the NCLEX, it is very important to understand that the Parasympathetic Nervous System is focused primarily on:

  • – Pupil Constriction (Miosis)
  • – Lacrimation
  • – Salivation
  • – Bronchoconstriction

PNS Medications can also decrease the Heart rate and stimulate gastric secretions.

We can divide the PNS Medications into 4 different groups:

  1. Cholinergic Agonists
  2. Cholinesterase Inhibitor
  3. Anticholinergics
  4. Dopaminergics

NCLEX Review on Cholinergic Medications

Cholinergic Drugs

– Is also called Cholinergic Agonist
– stimulates cholinergic receptors
– mimics acetylchoine

– Used for Urinary Retention (Bethanicol Chloride *Urecholine)

Remeber for the NCLEX, that when we talk about Cholinergic Medications we focus towards the PNS.

Cholinergic drugs produce the same effects as acetylcholine.

Remember for the NCLEX:
– Direct acting cholinergicd are contraindicated with patients with asthma, because it can cause BRONCHOSPASM.

Uses:
Cholinergic muscle stimulants are used to diagnose and treat myasthenia gravis

NCLEX Drugs:

  • ambenonium chloride (Mytelase)
  • edrophonium chloride (Tensilon)
  • neostigmine (Prostigmine)
  • piridogstimina (Mestinœn).

Cholinergic drugs are also used in control of glaucoma.

NCLEX Drugs:

  • demecarium (Humorsol)
  • echthiophate (Phospholine iodide).

Drugs:

  • Bethanecol Chloride
  • Pilocarpine (Pilocar) *used for glaucoma

Side Effects:

  • Headaches
  • Hypotension
  • Miosis
  • Diarrhea/Cramping
  • Increased Salivation (Dry Mouth)
  • Nausea and Vomiting

Anticholinergic Medications

– Is called Acetylcholinesterase Inhibitor

  • Inhibits ACh/ Acetylcholine.

– Is also called (Cholinergic Blockers)-
– Helps control the tremors-
– Used to help improve memory in pts. w/ Alzheimer’s Disease (Donezepil Hydrochloride).
– Diphenhydramine Hydrochloride (Benadryl)
– Benztropine Mesylate (Cogentin)
– Diphenhydramine Hydrochloride (Benadryl)

  • Side Effects
    – Salivation
  • – Sweating
  • – Flushing
  • – Headache
  • – Hypotension
  • – Bradycardia

 

Anti-Myasthenic Pharmacology NCLEX Review

– A good use for anti-cholinergic drugs would be for Myasthenia Gravis.

Anti-Myasthenic Medications
– relieves muscle weakness with myasthenia gravis.
– used to diagnose Myasthenia Gravis
– used to distinguish cholinergic crisis from myasthenia gravis.

NCLEX DRUGS:
– Ambenonium Chloride (Mytelase)
– Endrophonium Chloride (Tensilon)
– Neostigmine Bromide (Prostigmin)
– Pyridostigmine Bromide (Mestinon)

ANTICONVULSANTS 

NCLEX Review: Anticonvulsant Medications act upon the CNS or the Central Nervous System.  Anticonvulsant medications helps decrease the firing and inhibits the spread of nerve impulses which results in stabilization of abnormal cells.

The 4 Main Types of Anticonvulsant Medications to know for the NCLEX includes:

  1. Hydantoins
  2. Barbituates
  3. Benzodiazepines
  4. Succinimides

Carbamazepine (Tegretol):
– Can be used for Trigeminal Neuralgia
Used when no response to Lithium

Side Effects:
S/E: Sedation,
granulocytosis
aplastic anemia so
* Make sure to MONITOR the CBC in patient.

NX: monitor CBC and alert for fever/sore throat; birth defects

Valproic Acid: Valproate (Depakene, Depakote):
A psychiatric medication that is used w/manic or schizoaffective;

Other Uses for this psychiatric medication:

  • Generalized Tonic-Clonic Seizures
  • Myoclonic Seizures
  • Partial Seizures

Side Effects:
Severe/Fatal Hepatotoxicity, ↓ platelets, neural tube defects
NEURAL TUBE DEFECTS in Fetus
Rare but FATAL  HEPATOTOXICITY
GI Distress
Weight Gain

Clonazepam (Klonopin):
Benzodiazepine medication for acute mania, acute help while waiting
for Lithium effects to occur ƒ

S/E: Sedation, Anoxia, Disinhibition
effect

HYDANTOINS
– used to treat seizures.
PHENYTOIN (Dilantin)A medication usually seen on the NCLEX exam.
* Decreases the effects of birth control pills.
Dilantin/Phenytoin  10-20 mcg/ml
– Diluted with Normal Saline.

Side Effects:

  • Gingival Hyperplasia (gums that bleed easily)
  • Slurred Speech
  • Confusion
  • Depression
  • Nausea and vomiting
  • Constipation

BARBITUATES
– used for tonic-clonic (grand mal) seizures.

NCLEX DRUGS:
– Phenobarbital (Luminal)
– Primidone (Mysoline)

*Interacts with ALCOHOL.

Side Effects:

  • Dizziness
  • Drowsiness
  • Hypotension
  • Respiratory Depression

Patient with Bell’s Palsy can be given TYLENOL (Acetominophen)
If overdose, antidote for TYLENOL is Acetylcysteine (Mucomyst)

 

(Neuro Medications)Based on the 4 Neuromuscular diseases

NCLEX Review on Anti-Parkinsonian Medications
– releases dopamine
– restores balance of neurotransmitters acetylcholine and dopamine in CNS.
* Virtually all of the available drug therapies act to increase the level of dopamine in the brain.

– TWO TYPES:
1. Anticholinergic Medications
2. Dopaminergic Medications

Anticholinergic Medications (Cholinergic Blockers)
– Helps control the tremors
– Benztropine Mesylate (Cogentin)
– Diphenhydramine Hydrochloride (Benadryl)

Dopaminergic Medications
– Levodopa (Dopar)
– Carbidopa-Levodopa (Sinemet)

* Levodopa is contraindicates with patients with angle-closure glaucoma.

SIDE EFFECTS:
Nausea
Orthostatic Hypotension

Dopamine agonists.
Unlike levodopa, dopamine agonists don’t change into dopamine.
Instead, they mimic dopamine effects in your brain.

NCLEX DRUGS:

  • pramipexole (Mirapex)
    ropinirole (Requip)
    apomorphine (Apokyn)

Side effects:
similar to carbidopa-levodopa
includes hallucinations
swelling
sleepiness
hypersexuality
gambling and eating.

NCLEX Review: Neuromuscular Drugs used for Increased in ICP.

Mannitol (Osmitrol)

A loop Diuretic

  • is used to decrease cerebral edema during increased ICP.
  • It is an osmotic diuretic,
  • Electrolytes are also drawn into blood and excreted, so monitor for electrolyte imbalance
  • Hyponatremia is a life threatening side effect, causes seizures and death.
  • Maintain strict I&O.
  • Dobutamine (Dubutrex)
  • Norepinephrine (Levophed)
    – cardiac stimulants used to maintain cerebral perfusion during increased ICP.

Dexamethasone (Decadron)

  • Corticosteroid used to decrease inflammation surrounding a brain tumor
  • Used in medical management of meningitis.
  • Used post craniotomy for cerebral edema
  • Administer IV q 6 hours for 24-72 hours, change to oral a.s.a.p., taper dosage over 5-7 days
  • As with any steroid, fluid retention, increased sugar, lowed immune system
  • Common side effect nasal irritation, cardiovascular edema, hyperglycemia, cataract, oral candidiasis, impaired would healing
  • If using with Mannitol (makes electrolytes be excreted) (by the way the two together are contraindicated according to the book) add potassium-rich foods or supplement to diet.
  • Use good oral hygiene to prevent oral candidiasis

Phenytion (Dilantin)

  • Anticonvulsant – to reduce risk of seizures
  • Especially after supratentorial neurosurgical procedure (prone to seizures)
  • Used to prevent grand mal and complex partial seizures
  • During Ictal phase of seizure give ativan (lorazepam), then start dilantin
  • Life threatening side effects are cardiovascular collapse, Agranulocytosis, aplastic anemias, dermatitis (bullous, exfoliative, or purpuric), Steven-Johnson syndrome.
  • Common side effects gingival hyperplasia (swollen gums), give good mouth care.  Self care pt should brush, floss and massage gums after each meal.

therapeutic level is 10-20 mcg/ml

Do not stop drug abruptly, may precipitate status epilepticus.

Diazepam (Valium)

  • To reduce anxiety

Antiseizure Medications: NCLEX Exam

  • Tegretol
  • Klonopin
  • Keppra
  • Luminal
  • Dilantin-Phenytoin
  • Topamax
  • Depakote

TYLENOL
– Check Direct Bilirubin to determine drug toxicity.

DEMEROL
– Check for Urinary Retention

ASPIRIN Intoxication
– Tinnitus= ear infection

OPIODS
– increase tolerance to pain, decrease perception of pain

highest potency opioids
– morphine, merperidine, methadone

fast acting & high potency opioid
– heroin

lower potency opioid
hydrocodone, codeine

all opioids cause miosis EXCEPT for merperidine.
Because merperidine has muscarinic blocking activity. it actually causes miadriasis
* opioid overdose= Naloxone

Psychiatric Pharmacology

NCLEX Review Psychiatric Pharmacology (Medications)

It will be a guarantee that you will at some point encounter NCLEX questions that challenges your knowledge of Psychiatric Medications/Pharmacology.  For the NCLEX, it is important to simplify the Psychiatric Medications by breaking them down into 4 groups that includes:

  • ♠ ANTIANXIETY/ ANXIOLYTICS
  • ♣ ANTIPSYCHOTICS
  • ♥ ANTIDEPRESSANTS
  • ♦ ANTI-MANIC/ MOOD STABILIZERS

1. Antianxiety/ Anxiolytics

Classes of primary anxiety disorders 
1.Generalized anxiety disorder (GAD)
2.panic disorder
3.OCD
4.Phobias
5. PTSD
6. Acute stress disorder

Benzodiazepines
(mechanism of action)
increase response to GABA

2. Antipsychotics

  • Phenothiazines
  • Non Phenothiazines

3. Antidepressants

  • TCA
  • MAOI
  • SSRI

4. AntiManic/ Mood Stabilizers

  • Lithium

NCLEX Review Psychiatric PharmacologyAntianxiety Drugs

♦ Antianxiety Drugs

Benzodiazepines
(- can also be used with seizures and epilepsy)

Alprazolan (Zanax): Short term only as ↑ dose needed over time

These drugs are used to manage anxiety disorders & for short term treatment of anxiety symptoms.

USE: Panic attacks, anxiety disorders, muscle relaxation, seizures, pre-anesthetic sedation, alcohol withdrawal.

NCLEX MEDS:
alproxolam (Xanax)
lorazepam (Ativan)
diasepam (Valium)
busprione (BuSpar)
hydroxyzine (Vistral)

Librium

SIDE EFFECTS:

  • Early: drowsiness
  • orthostatic hypotension
    dizziness
  • dry mouth
  • Parkinsonian Symptoms
    lightheadedness
    headache.

Later: Lethargy, apathy, fatigue, Anger Psychosis (irrational).

Indications for use: Recurrent depression, Psychomotor retardation,
Depression w/no clear cause, Family Hx, Chronic pain, Eneuresis

 ♣ Antipsychotics

NCLEX Drugs : Antipsychotics

  • Chloropromazine HCL (Thorazine)
  • Haloperidol (Haldol)
  • Resperidone (Risperdal)

Side Effects of these drugs would include:

  • Drowsiness
  • Orthostatic Hypotension
  • Diziness
  • Dry Mouth
  • Parkinsonian Symptoms
  • Tardive Dyskenesia
  • Dystonia

♣ Antidepressants 

– All but MAOI block reuptake of serotonin and sometimes norepi
making more available in synapse (↑ mood, ↑ alert, ↑ concentration);
Can be given once a day, but often has 3-4 wk time to therapeutic
effectiveness

Indications for use: Recurrent depression, Psychomotor retardation,
Depression w/no clear cause, Family Hx, Chronic pain, Eneuresis

SSRI (selective serotonin reuptake inhibitor)

SSRI
S/E: Sexual depression/dysfunction, N/V/D, insomnia, anxiety, dry
mouth, tremor, fatigue, H/A, toxic s/e rare

Remember with SSRI’s: 

Never take w/MAOIs, Liver/renal/CBC test, d/c meds slow

NCLEX Medications:

Fluoxetine (Prozac): ↓ sedation, ↓ S/E
Sertraline (Zoloft): ↓ toxicity in OD, ↓ S/E, ↓ halflife than Prozac
Paroxetine (Paxil): Safest for elderly, Lowest halflife
Fluvoxamine (Luvox) ƒ Citalopram (Celexa)
Escitalopram oxalate (Lexapro)

SNRIs (Serotonin/Norepinephrine reuptake inhibitor)

Pros: ↓ sex probs, ↓ insomnia, response quicker, anxiolytic like
Cons: ↑ BP, Sedating, Anticholinergic s/e (constipation, sweat)
Effexor (Venlafaxine): S/E: dizziness, migraine, wt gain
Serzone
Trazodone (Desyrel)
Remeron: S/E: somnolence, dizzi, wt gain; Adverse: agranulocytosis,
neutropenis; NX: some respond well only to this

Norepi/dopamine agonist

Facts: Stimulant inhibits reuptake and ↑ release of Norepi/dopa
Cons: ↑ seizure risk ƒ Bupropion HCl (Wellbutrin): No effect on serotonin/ MAO

Tricyclics

NCLEX Medications:

Imapramine (Tofranil), Desipramine (Norpramine, Pertofrane),
Amitriptyline (Elavil, Endep), Nortriptyline (Pamelor, Aventyl),
Protriptyline (Vivactil), Doxepin (Sinequan)

Side Effects:

Anticholinergic effects (dry mouth, constipation, urinary
hesitant/retention, sweating, drowsiness, blurred vision); EPS
Cardiovascular (postural ↓ BP, ↑ HR, heart conduction probs); Glaucoma
worsened, Toxic confusion/psychosis; Wt gain, SZ,
Overdose: 1000-4000 mg can be Fatal

MAOIs

Facts: Monoamine (epi, norepi, sero, dopa) oxidase responsible for
destroying excess/used MAs; Inhibiting enzyme ↑ level of all

NCLEX Medications:

  • Phenelzine (Nardil)
    Isocarboxazide (Marplan)
    Tranylcypromine (Parnate)

Remember for the NCLEX:

Some foods contain (tyramine) which if not metabolized in
liver causes ↑↑ HT and CVA; Foods include aged cheese, chicken liver,
beer, red wine, chocolate, cold/sinus meds, diet pills; Avoid certain
restaurants (Chinese); 1o s/s is severe h/a

Side Effects:  ↓BP most critical; Orthostatic ↓BP, dizziness, ↑ appetite
Key: ↑ BP is toxic effect (wrong food); ↓ BP is med caused S/E

Antimanic Drugs 

Lithium***
Used in psychiatric disorders non-responsive to other meds;
Blood level of 0.1-1.5 key as toxic death possible. Higher only
w/psychosis; Must maintain adequate salt in diet (consistent level,
not too ↑ or ↓)
Indications: Acute Mania, Bipolar prophylaxis

Possible use:

Bulimia, Alcohol abuse, Schizoaffective (mania or
depression with schizo like delusions/hallucinations/etc)

Side Effects:

Major risk of hypothyroidism and urine concentration probs;
Parkinson like, cog wheeling, sluggish, forgetful; Chronic N/V/D so
take w/food; Wt gain, Polydypsia, Polyuria, Allergic rash w/capsules

Remember: Never take with diuretics or Anticholinergic meds

Endocrine Pharmacology

NCLEX Review Endocrine Pharmacology (Medications)

NCLEX Review on the Endocrine System: HYPERTHYROIDISM

NCLEX Review on the Endocrine System: HYPERPARATHYROIDISM

♠ Growth Hormones

Drugs:
Somatropin (Genotropin)

SIDE EFFECTS:
Causes skin lesions

ANTIDIURETIC HORMONES

– Enhances the reabsorption of water in the kidneys.
– causes vasoconstriction
– promotes an anti diuretic effect.
– Used to treat DIABETES INSIPIDUS

– Desmopressin
– Vasopressin (pitressin)

SIDE EFFECTS:

– water intoxication
– hyponatremia
– abdominal cramps
– heaadachesl
– nausea
– hypertension

THYROID GLAND

Thyroid Hormones

  • – Levothyroxine T4
  • – Levothroid
  • – Synthroid

Anti-thyroid Drugs

  • – Iodine
  • – Iodine Iodide
  • – Prophythioracil (PTU)

PARATHYROID GLAND  (Anti-hypercalcemic Drugs)

Drugs:
– Calcitrol (Rocatrol)
– Calcium Carbonate
– Calcium Citrate

ANTIDIABETIC DRUGS 
(INSULIN DRUGS)

Insulin
– reduces the serum glucose level by increasing glucose transport into cells.

Types:
Rapid-Acting
Intermediate acting
Long-Acting

ORAL HYPOGLYCEMICS

– Increases the serum calcium levels, causing a decrease in serum
phosphate levels.

Cardiac Pharmacology

Cardiac System NCLEX Review

Urinary System NCLEX Review (By: AllNursingNotes)

Below shows the (Cardiac Drug Categories)

that correlates to each of the individual initials.

NCLEX Review on Cardiac Pharmacology

As you have learned in Nursing School, beta adrenergic blockers are drugs that help lower blood pressure, puls rate and cardiac output. Beta Blockers are an important set of drugs to know for the NCLEX. Sometimes, beta blockers are also used to treat migraine headaches an other vascular headaches. Beta blockers are also used to treat glaucoma and used to prevent myocardial infarctions. Try to remember that what beta blockers do is they act by blocking the symathetic vasomotor response. For the NCLEX, try to remember that the syllable for beta blockers is usally (olol).

Potential side effects of beta blocker that is necessary to know for the NCLEX would include: Orthostatic hypotension, bradycardia, nausea and vomiting, diarrhea and some of the symptoms may MASK HYPOGLYCEMIC SYMPTOMS.

NURSING INTERVENTIONS FOR CLIENTS TAKING BETA BLOCKERS: Make sure that you monitor the client’s blood pressure, heart rate and rhythm, before administering the beta blocker. Monitor the client for signs of edema. The nurse should also assess the lungs sounds for signs of rales and ronchi. When patient are taking beta blockers, it is also very important to monitor the changes in lab values such as (protien, BUN and creatinine) which can indicate nephrotic syndrome.

Nursing teaching for the NCLEX would include: Teaching the Client to rise slowly (ORTHOSTATIC HYPOTENSION) * (A SAFETY ISSUE), report any signs of bradycardia, dizziness, confusion depression or fever. It is also very important to taper off the medication properly.

Cardiac Glycosides
– increases the force of contraction.
– a positive inotropic effects

ACE Inhibitor
– prevents vasoconstriction by blocking conversion of Angiotensin 1 to Angiotensin 2.
– Used to treat Hypertension
– Avoid using potassium suplemments

SIDE EFFECTS:

  • Nausea and Vomiting
  • Persistent Coughing
  • Hyperkalemia
  • Hypotension
  • Tachycardia
  • Headache

NCLEX Review on Hypertension

NCLEX Review Pharmacology: Corticosteroids and Antihistamines

Corticosteroids:

  • Triamcinoslone
  • Corticosteroid
  • allergy & ASTHMA
  • Nasocort spray, Amcort

Side Effect: 

Dysphonia, hoarseness
oropharyngeal fungal infec
headache
sore throart
nasal congestion,cold sym

Mometasone
Corticosteroid
allergy & ASTHMA
Nasonex
s,e: Dysphonia, hoarseness
oropharyngeal fungal infec
headache
sore throart
nasal congestion,cold sym

Fluticasone
Corticosteroid
allergy & ASTHMA
Flonase
Side Effects:

Dysphonia, hoarseness
oropharyngeal fungal infec
headache
sore throart
nasal congestion

Beclomethasone
Corticosteroid
allergy & ASTHMA
Beclovent, Beconase

Side Effects:

  • Dysphonia, hoarseness
  • oropharyngeal fungal infec
  • headache
  • sore throart
  • Dyspepsia

Triamcinoslone
Corticosteroid
allergy & ASTHMA
Nasocort spray, Amcort

Side Effects:

  • Dysphonia, hoarseness
    oropharyngeal fungal infec
    headache
    sore throart
    nasal congestion,cold sym

Antihistamine

Loratadine (Claritin)
antihistamine
Claritin
Side Effects:

  • drowsiness

Remember:
management of seasonal rhinitis
avoid alcohol, other CNS depressants
take on empty stomach, 1 hr b4 or 2 hrs after meals
Fexofenadine (Allegra)
antihistamine
Side Effects:

  • Drowsiness

nurse. consd.:
management of rhinitis, allergy symptoms, chronic idiopathic urticaria
avoid alcohol, other CNS depressants
Cetirizine HCI (Zyrtec)
Antihistamine

Side Effects:

  • drowsiness, fatique, dry mouth

Relief of seasonal allergic rhinitis
relief of perennial allergic rhinitis caused by molds, animal dander, and other allergens
avoid alcohol

Hydroxyzine (Atarax, Vistaril)
antihistamine
Side Effects:

  • drowsiness, dry mouth

Remember for the NCLEX:
tmt of pruritus, pre-op anxiety, post-op nausea and vomiting, to potentiate opioid analgesics, sedation
-avoid use of alchohol, other CNS depressants
-teach pt. dizziness/drowsiness may occur, use caution in potentially hazardous activities

NCLEX Review Respiratory Pharmacology

Respiratory Pharmacology

Bronchodilators
-Reverses bronchoconstriction
– opens air passages

can be: Adrenergics, Xanthines, Anticholinergic

Antitussives

– suppresses the cough reflex.
– inhibits the cough reflex

Drugs: Opiod, Codiene, hydrobromide (Robitussin)

ANTITUSSIVES

These drugs depress cough center in medulla or by anesthetizing
stretch receptors in respiratory tract.

USE: to relieve a nonproductive cough.

MEDS: Codeine Sulfate (narcotic based), Bensonatate (Tessalon Perles),
Dextromethorphan (Robitussin)

Antihistamines

– Blocks the action of Histamine

Opiod Antagonists

Gastrointestinal Pharmacology

Antiemetics
These drugs treat nausea & vomiting. Inhibits the CTZ and the brain’s neurotransmitters.
USE: Treat nausea & vomiting.

MED: prochloperazine HCL (Compazine)
promethazine HCL (Phenergan)

Antacids

ANTACIDS These drugs neutralize or reduce acidity.

USE: GERD & heartburn.

MED: aluminum hydroxide gel (Amphojel -constipate)
Magnesia (Milk of Magnesia -diarrhea) magaldrate (Riopan).
ANTACIDS A/R: diarrhea, constipation.

S/I: DO NOT GIVE with any other drugs or within 2 hours of taking other drugs. 1-2 hours after meals.

Histamine 2 Antagonists

USE: duodenal ulcer, gastric hyper-secretory conditions, GERD.

MED: All end in “dine”. cimetidine (Tagamet), ranitidine (Zantac), famatidine (Pepcid). HISTAMINE2 ANTAGONISTS A/R: Dizziness, somnolence (sleepy) headache.

MED: All end in “dine”). cimetidine (Tagamet), ranitidine (Zantac), famatidine (Pepcid). HISTAMINE2 ANTAGONISTS S/I: Do not give with any other drugs or within 2 hours of taking other drugs. 1-2 hours after meals.

MED: All end in “dine”). cimetidine (Tagamet), ranitidine (Zantac), famatidine (Pepcid). PROTON PUMP INHIBITORS These drugs supress enzyme called AT pase (without ATpase – do not have gastric secretions).

USE: hypyloric bacteria (H Pyloric).

MED: esomeprazole magnesium (Nexium), omeprazole (Prilosec), Pantoprazole sodium (Protonix). PROTON PUMP INHIBITORS A/R: Headache, Nausea, Diarrhea.

MED: esomeprazole magnesium (Nexium), omeprazole (Prilosec), Pantoprazole sodium (Protonix). ANTICHOLINERGICS These drugs decrease amount of acid secretion (dry out).

USE: Peptic ulcer.

MED: propantheline (Pro-Banthine), glycopyrrolate (Robinul) ANTICHOLINERGICS A/R: dry mouth, blurred vision.

S/I Give ice.

MED: propantheline (Pro-Banthine), glycopyrrolate (Robinul)

ANTIDIARRHEAL

These drugs decrease intestinal peristalsis.

USE: Diarrhea

MED: diphenozylate with atropine (Lomotil), loperamide (Imodium A-D) ANTIDIARRHEAL A/R: abdominal discomfort, nausea, vomiting & constipation. NOTE: atropine based = opioids feeling and is habit forming.

MED: diphenozylate with atropine (Lomotil), loperamide (Imodium A-D) ANTIDIARRHEAL S/I: give after every episode of diarrhea.

NCLEX Review Gastrointestinal Pharmacology

NCLEX Review on Hiatal Hernia

Antiemetics
– helps alleviate nausea and vomiting.

  • Drugs:
    Ondansetron (Zofran)
    Prochlorperazine (Compazine)

Antacids
– provide protection coating on the stomach lining.
– helps neutralize gastric acid.

  • Drugs:
    – Aluminum Hydroxide Gel (Amphojel)
    – Aluminum/Magnesium Hydroxide (Maalox)
    – Ranitidine (Zantac)

Side Effects:
Constipation
Diarrhea
Alkalosis

Anticholinergics
– helps alleviate pain from peptic ulcer

  • Drugs:
    Atropine Sulfate
    Dicyclomine (Bentyl)
    Glycopyrrolate (Robinul)

Side Effects:
– Dry Mouth (decrease salivation)
– Constipation (decrease persitalsis)
– Urinary Retention

Antisecretory Agents (H2 Antagonists and PPI’s)

– inhibits gastric acid secretion

H2 Antagonists
– Famotidine (Pepcid)
– Ranitidine (Zantac)
– Cimetidine (Tagament)

Proton Pump Inhibitor
– Omeprazole (Prilosec)
– Lansoprazole (Prevacid)
– esomeprazole (Nexium)

Side Effects:
– Decrease in bone density with long term use.

Antidiahrreals
– helps alleviate diarrhea
– promote formation of stools

Drugs:
– Bismuth Subsalicylate (Pepto Bismol)

Side Effects:
Constipation
Urinary Retention

Laxatives/ Cathartics
– helps alleviate or prevent constipation
– promotes evacuation of stools.
– Oral or rectal

Fecal Softeners
– Docusate Sodium (Colace)

Bulk Forming Laxatives
– psyllium (Metamucil)

Colon Irritants
– Bisacodyl (Dulcolax)

Saline Cathartics
– increases osmotic pressure within intestine
– Magnesium Hydroxide (Milk of Magnesia)

Side Effects:
Dependency of Use

NCLEX Review Neurological Pharmacology

Urinary Pharmacology

NCLEX Review: Urinary Pharmacology

NCLEX Review on the Diseases of the Urinary System

NCLEX Review on Urilothiasis

Thiazide Diuretics
– used for Hypertension
– Edema
– Heart Failure

DRUGS:
Chlorothiazide (Diuril)
Hydrochlorothiazide (HyroDIURIL)

Side Effects:
Orthostatic Hypotension
Hypokalemia
Hypoglycemia
Diziness
Heaches

Loop Diuretics

DRUGS:
Furosemide (Lasix)
Bumetanide (Bumex)

SIDE EFFECTS:
Hypokalemia
Hyponatremia
Metabolic Alkalosis

* Monitor Digoxin Levels if patient is taking Digoxin.

Osmotic Diuretics

Drugs; Mannitol
Used for: Cerebral Edema

Side Effects:

Potassium Sparing Diuretics

Drugs: Spironolactone (Aldactone)

SIDE EFFECTS:
Hyperkalemia
Increased BUN Levels
Nausea & Vomiting
Anorexia
Diarrhea

* Monitor for signs of Hyperkalemia
– Confusion
– Hyperexcitability
– muscle weakness
– flaccid paralysis

NCLEX Review Hematological Pharmacology

Hematological Pharmacology

NCLEX Review on Anemia

NCLEX Review on Polycythemia Vera

NCLEX Review on Hematology Medications

– prevents formation of clots by inhibiting factors in the clotting.
– used for DVT, PE, and atrial fibrillation

– Enoxaparin sodium  (Lovenox)
– Warfarin Sodium (Coumadin)

THROMBOLYTICS

– activates the plasminogen, leads its conversion to plasma

– Streptokinase (Streptase)
– Alteplase (Activase)

ANTIPLATELET DRUGS

Anticoagulants

Heparin
anticoagulant
s.e.: hemorrhage
tissue irritation/pain w/injection
anemia
thrombocytopenia
fever
N.C.: maintain patency of IV-(heparin flush in low doses)
-therapeutic PPT @1.5-2.5 X the control w/out signs of hemorrhage

-antidote: protamine sulfate w/in 30 min
-hemorrhage: bleeding gums, nose, unusual, black tarry stools, hematuria, fall in hemacrit or bl. pressure, guaiac-positive stools
-avoid ASA & NSAIDs (watch for addition in OTC)
-wear med. info tag
RX- preg C

Warfarin (Coumadin)
AnticoagulantAn
s.e.: hemorrhage
Diarrhea, Rash, Fever
N.C.: mgmt of pulmonary emboli, deep-vein thrombosis, MI, atrial dysrhythmias, postcardiac valve replacement

-antidote: vit. K, whole bl, plasma
-avoid foods high in Vit K, green leafy vegs.
-do not interchange brands, potencies may not be equivalent
-avoid ASA & NSAIDS + OTC meds that contain them

NCLEX Review Antibiotics Pharmacology

Anti-Infective Pharmacology

Aminoglycosides

Amikacin, Gentamicin, Tobramycin (Amikin, Garamycin, Tobrax)
Anti-infective
s.e.:do not use during preg. may cause bilateral congenital deafness,
Ototoxicity cranial nerve VIII
Nephrotoxicity
Allegric reactions: fever, diff. breathing, rash
Remember for the NCLEX:

  • -monitor for superinfection(diarrhea, URI, coated tongue)
  • -immediately report hearing or balance problems
  • -encourage fluids 8-10 glasses daily

Antifungals: Amphotericin B (Fungizone)
Anti-infective
s.e.: bl, kidney, heart,liver abnormalities
GI upset, Hypokalemia-induced muscle pain, CNS disturbances, inefficient hearing, skin irritation and thrombosis if IV infiltrates
N.C.: trmt of histoplasmosis, skin infections, septicemia, meningitis in HIV pts
-monitor vital signs, report fever or change in function, especially NS
-check for hypokalemia
-meticulous care and observation of injection site
-benefits balanced agst serious
preg B

Antifungals: Fluconazole (Diflucan)
s.e.: Nausea, Diarrhea, Headache, Abd. pain, taste distortion
N.C.: trmt of vaginal, esophageal, or systemic candidiasis
-prothrombin time is increased after warfarin usage
-take missed dose asap, but do not double dose
-reduces metabolism of tolbutamide, glyburide, and glipizide, so bl. glucose levels shoud be monitored in diabetics
-preg C

Anti-malarials: Hydrozychloroquine (Plaquenil)
s.e.: eye disturbances, NV, Anorexia
N.C.: mgmt of malaria, lupus erythematosus, rheumatoid arthritis
-peak 1-2 hrs
-take at same time ea day to maintain bl levels
-for malaria, prophylaxis should be started 2 wks b4 exposure and for 4-6 wks after leaving exposure area
preg C

Anti-malarials:
Quinine Sulfate
Anti-infective
s.e.: eye disturbances, NV, Anorexia
N.C.: mgmt of malaria,nocturnal leg cramps
-peak 1-3 hrs
-take same time ea day to maintain bl. levels
-avoid OTC cold meds, tonic water
-preg X

Anti-protozoals: Metronidazole (Flagyl, Flagyl ER)
anti-infective
CNS symptoms, abd cramps, metallic taste,
N.C.: trtmt of wide variety of inf.including trichomoniasis and giardiasis
=IV:immediate onset, PO-pk 1-2 hrs
=dark-reddish brown urine
=avoid hazardous activities
=trtmt in both partners for trichomoniasis
=do not drink alcohol in any form, during and 48 hrs after use, disulfiram-like reaction can occur
preg B

Anti-tuberculars: Isoniazid (INH)
anti-infective
s.e.: peripheral neuropathy, liver damage
N.C.: prevention and trtmt of TB
=PO/Im:onset rapid, pk 1-2 hrs, dur: up to 24 hrs
=contact MD if signs of hepatitis:yellow eyes or skin, NV, anorexia, dark urine, unusual tiredness, or weakness
-contact MD if signs of peripheral neuropathy: numbness, tingling or weakness
preg C

Anti-virals: Acyclovir (Zovirax)
anti-infective
s.e.: headache, bl. dyscrasias
N.C: trmt of herpes, varicella
=IV: onset & peak immediate
=PO: absorbed minimally, onset unknown, pk 1-1/2 hrs
=do not break, crush or chew
=PO: take w/out regard to meals w/full glass water
=if does missed take asap, up to 1 hr b4 next does
=contact MD if sore throat, fever and fatique, could be signs of superinfection
preg B

Anti-viral: Oseltamivir Phosphate (Tamiflu)
anti-infective
s.e.: NV
N.C:-used as prophylaxis in adults for influenza, including Avian Bird Flu
-treats uncomplicated acute flu symptoms in pts that are symptomatic for 2 days or less
-should not be used as substitute for flu vaccine
-may be taken w/out regard for meals
preg C

Anti-virals: Valacyclovir HCI
(Valtrex)
anti-infective
NV, abd. cramps, headache
N.C: trtmt genital herpes
=treats Herpes Zoster(shingles)
=treats Herpes labialis (cold sores)
=pts shoudl drink plenty of fluids during trtmt
=avoid sexual ontact when lesions are visible
=use with caution in preg & nursing mothers
preg B

Anti-Viral: Zidovudine (AZT, Retrovir
anti-infective
s.e.: fever, headache, malaise, NVD, Dizziness, insomnia, dyspepsia, anorexia, rash
N.C: mgmt of HIV inf. & prevention of HIV following needlestick
-GI upset and insomnia resolve after 3-4 wks
-PO: pk 1/2-1 1/2 hrs
preg C

Cephalosporins, 1st generation :
Cefadroxil (Duricef)
anti-infective
s.e. Diarrhea
N.C: tmt of upper and lower respiratory tract, urinary tract, and skin infections, otitis media, tonsillitis & UTIs
=peak 1- 1 1/2 hrs, dur: 12-24 hrs
=take for 10-14 days to prevent superinfection
preg B

Cephalosporins, 1st gen:
Cephalexin (Keflex, Keflet)
anti-infective
s.e. Diarrhea
N.C: tmt of upper and lower respiratory tract, urinary tract, and skin infections, otitis media,
=IM:peak 1 hrs, dur: 6-12 hrs;
IV: pk 5 min, dur 4-6 hrs
preg B

Cephalosporins, 1st gen.
Cephapirin (Cefadyl)
anti-infective
s.e. Diarrhea
N.C: tmt of lower respiratory tract,skin infections, endocarditis, bacterial peritonitis
=peak 30 min, dur: 4-6 hrs; up to 12 w/decreased urinary ouput
=take for 10-14 days to prevent superinfection
preg B

Cephalosporins, 1st gen:
Cephradine (Velosef)
anti-infective
s.e. Diarrhea
N.C: tmt of serious respiratory tract, and skin infections, otitis media,& UTIs
=peak 1- 2 hrs, dur: usually 6 but up to 12 hrs w/decreased renal function
=take for 10-14 days to prevent superinfection
preg B

Cephalosporins 2nd gen:
Cefaclor (Ceclor, Ceclor CD)
anti-infective
s.e. Diarrhea
N.C: tmt of respiratory tract, urinary tract,bone, joint and skin infections, otitis media,
=peak 1/2- hrs,extended release pk 1 1/2-2 1/2 hrs
=take for 10-14 days to prevent superinfection
preg B

Cephalosporins 2nd. gen:
Cefamandole (Mandol)
anti-infectives.e. Diarrhea
N.C: tmt of respiratory tract, urinary tract, and skin infections, peritonitis, septicemia, surgical prophylaxis
=peak 1/2-1 hrs
IV or IM
-avoid alcohol
preg B

NCLEX Review Opiods and Opiod Analgesic Pharmacology

Opiod Analgesic

Opioid Analgesic

  1. Methadone
  2. Hydromorphone (Dilaudid)
  3. Meperidine
  4. Codeine
  5. Opioid Analgesic
  6. Morphine
    (MS Contin)

Side Effect:

  • Drowsiness, sedation
    nausea, vomiting, anorexia
    Respiratory depression
    constipation, cramps
    orthostatic hypotension
    confusion, headache

 

Analgesic

Acetaminophen (Tylenol)
Analgesics-nonopioid
s.e.: anemia (long-term use)
Liver and kidney failure (high doses)

Remember:
-take crushed or whole w/ full glass of water
-can give / food or milk to decrease GI upset
-signs of chronic poisoning: rapid, weak pulse, dyspnea, cold, clammy extremities
-signs of chronic overdose; bleeding, bruising, malaise, fever, sore throat
Aspirin
Analgesics- nonopioid
s.e: nausea, vomiting, rash

Remember:

– long-term use: liver damage, dark urine, clay-colored stools
-arthritis, give 30 min b4 exercise, may take 2 wks b4 full effect is felt
-discard tabs if vinergar-like smell
-do not give to children under 18-Reyes syndrome
OTC: preg C

Celecoxib (Celebrex)
analgesics-nonopioid
s.e: Fatique, anxiety, depression, nervousness, NV, anorexia, dry mouth, constipation
-can take w/out meals
-do not take if allergic to sulfonamides, aspirin or NSAIDs
-Rx: preg C for 1st & 2nd trimester
Preg D for 3rd trimester

Ibuprofen (Motrin, Advil)
analgesic-nonopioid
s.e.: headache, Nausea, anorexia, GI bleeding, blood dyscrasias
-contact clinician if ringing or roaring in ears, =toxicity
-if changes in urinary pattern, increase wgt, edema, increased, pain in joints, fever, bl in urine=may indicate kidney damage
-use sunscreen for photosensitivity
-avoid use w/ ASA. NSAIDs, and alcohol,

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NCLEX Review on Hepatitis

Hepatitis is a very important topic in the NCLEX.

Hepatitis is basically a viral infection that causes  inflammation of the liver cells.

Classifications of Hepatitis Virus and its way of TRANSMISSION:

(If we look at the transmission: Hepatitis B and C are the only ones transmitted through blood and sexual contact).

Hepatitis A (transmitted through oral/fecal/water route)
Hepatitis B (transmitted through blood/drug use/sexual contact/childbirth)
Hepatitis C (transmitted through blood/drug use/sexual contact/childbirth)
Hepatitis D (transmitted through oral/fecal/water route)
Hepatitis E (transmitted through oral/fecal/water route)

Hepatitis A

– Incubation period usually lasts from 15-45 days.

– Transmitted primarily through fecal/ oral route.

– Prevention includes sanitation and handwashing.

– There is a vaccine available for Hepatitis A.

– Prevention against Hepatitis A includes:

  • Proper Handwashing
  • Avoidance of contaminated food and water
  • Recieving the HAV Vaccine

Hepatitis B

transmitted through blood to blood contact sexual contact or drug use (needles, razors).

– There is a vaccine available for Hepatitis B.

Hepatitis C

Hepatitis C is transmitted through blood to blood contact sexual contact or drug use (needles, razors)

– The patient can be asymptomatic and others are only diagnosed once abnormality is detected in the liver enzymes.

SYMPTOMS OF ACUTE HEPATITIS C

  • Fever
    Fatigue
    Loss of appetite
    Nausea
    Vomiting
    Abdominal pain
    Dark urine
    Clay-colored bowel movements
    Jaundice (yellow color in the skin or eyes)

Some of these symptoms can also be present on other classifications of Hepatitis* .

Keep in mind: ↓↓↓↓↓↓↓↓

Hepatitis B and Hepatitis C is connected with cirrhosis and liver cancer.

Blood and Blood Products before 1992 were not screened for Hepatitis.

Enzyme-linked immunosorbent assay (ELISA) is the initial screening test for clients suspected of infected of the Hepatitis C (HCV) Virus.

Liver Biopsy can also be used to confirm the diagnosis of Hepatitis.

Treatment most often used for Hepatitis C is a combination of two medicines, interferon and ribavirin.


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NCLEX Review Cirrhosis

So what is cirrhosis and why is it very important to review for the the NCLEX ?

Cirrhosis is basically scarring of the liver.  It occurs when there is severe hepatic inflammation or necrosis.

Common causes of cirrhosis:

  • Alcohol
  • Hepatits C
  • Hepatitis B

Complications of Cirrhosis:

(It is very important to understand these complications for the NCLEX.)

Portal Hypertension

An increase in the pressure in the portal vein.  It is usually due to an obstruction of blood flow within the portal vein.

Ascites

– an accumulation of fluid within the peritoneal cavity.

– there will be retention of water and sodium in the body.

Esophageal Varices

– occurs when thin walled esophageal veins become distended from an increase in pressure.

Jaundice

– is caused by hepatic cirrhosis.  Develops because the liver cells cannot effectively excrete bilirubin.

Portal-Systemic Encephalopathy

– a manifestation by neurological symptoms

Physical Assessment

in patients with Cirrhosis:

  • Fatigue
  • Abdominal pain
  • Weight Loss
  • Asterixis

Laboratary Assessment:

There will be an increase in serum levels of (AST)/ Aspartate aminotransferase, (ALT) / Alanine aminotransferase and (LDH) / Lactate Dehydrogenase.

♣ Interventions:

– depends on the SYMPTOM and the COMPLICATION.

FOR ASCITES

  • Intervention for ascities includes *PARACENTESIS – if diet and drug management fails.

♠ PARACENTESIS

– The procedure is performed in the bedside.

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“Pharmacology Review”

Lets start with the definition of Pharmacology: Pharmacology is the study of the mechanism of action, uses, side effects and fate of drugs in the body.

Pharmacodynamics is how the biologically active compounds do in the body.

Pharmacokinetics is  how the body reacts the drugs.

Most of the drugs are synthetic in origin which means that they are made and discovered in the laboratory.  Although others can still be obtained from natural sources.  Any drug can have a chemical name, a generic name and a brand or trade name.

Usually, the generic name of a drug is suggested by the manufacturer, and accepted by the international committee.

Drugs, hormones and neurotransmitters that activate receptors are called agonists.

How the drug is being affected affects the body and the patient’s response is called the effect.

Efficacy refers to the degree to which a drug is able to induce it’s maximal effects.

Adverse Effect is any unexpected or unintended response to a therapeutic use of a drug, it is also called side effect.

First I want to talk about drugs that are used to treat infections:

ANTIBIOTICS

– basically an antibiotic is a drug that us used to treat infectious diseases.

B Lactam Antibiotics-  are antibiotics that have a B-Lactam ring in their molecule.  Example of B Lactam Antibiotics would include Penicillins and Cephalosporins.

I just want to go over the two basic types of Penicillin Antibiotics:

  1. Natural Penicillin (penicillin G pottasium)- used to treat moderate to severe infections.
  2. Broad Spectrum penicillin (amoxicillin)- also used to treat mild and moderate infections.

Contraindications: penicillins are contraindicated for patients with a history of allergic reaction to any penicillin or cephalosporins (this is always very important to know).

Adverse Reaction: Like I have mentioned before, penicillins are one of the most common cause of drug allergy.  Hypersensitivities to penicillins may appear in the form of rash, pruritis, fever, wheezing, severe dyspnea, nausea and vomiting.  It is also important to note that adverse effects of penicillins generally involves the gastrointestinal (GI) system with glostitis, mouths sores (stomatitis, abdominal bleeding.

Toxicity: Toxicity for penicillin involves  the neurologic, nephrologic,  and hematologic system.

Penicillins, when given with anticoagulants, increases bleeding time.

Nursing Interventions to take note when giving Penicillins:

  • It is very important to be aware of any allergies to penicillins
  • Take the drugs on an empty stomach with water.
  • Do not take with fruit juices or soft drinks.
  • Make sure to give patient an adequate hydration.

Aminoglycosides

  • gentamycin sulfate (garamycin)
  • kanamycin sulfate (kantrex)

Aminoglycosides are batericidal, they both bind irreversibly to both the 30 S and 50S ribosomes to prevent bacterial protein synthesism.  Aminnoglycosides are used to treat serious nosocomial infections (ie. gram negative bacteria, peritonitis, pneumonia).

– Aminoglycosides should be administered with caution in neonates because of their immature renal systems.

Nursing Responsibilies

  • Administer an aminoglycoside and penicillin at least 2 hours apart
  • draw peak and trough levels periodically throughout the therapy.
  • encourage patient to take the full course of treatment.

Tetracycline

– is used as a treatment of gram positive and gram negative infections.

– Remember: That a use of tetracycline with oral contraceptives leads to breakthrough bleeding, altered GI bacterial flora, decreased contraceptive effectiveness and an increased risk of pregnancy.

Now, I want to talk about drugs that are used to treat Nervous System Disorders:

The Sypathetic Nervous System: Hormones (norepinephrine and epinephrine) activate the sympathetic nervous system.  The sympathetic nerces release both of these hormones whereas tha drenal gland also releases epinephrine.    There are four types of receptor that is found in the autonomic nerve pathways:

  1. Alpha 1 Adrenergic
  2. Alpha 2 Adrenergic
  3. Beta 1 Adrenergic
  4. Beta 2 Adrenergic

You have to understand that several physiologic responses results when each type of receptor is activated.

Alpha 1 receptors affects:

  • pupil dilation
  • gastrointestinal tract motility
  • vasoconstriction of arterioles
  • bladder contraction, prostate contraction

Alpha 2 affects:

  • gastrointestinal motility
  • vasoconstriction of arterioles

Beta 2  receptors affects:

  • Heart rate
  • contractility, automaticity and conduction

Beta 2 receptors affects:

    • bronchodilation (breathing)
    • heart rate contractility
    • uterus (relaxation)

Adrenergic Agonists (Adrenergics or sympathomimetic agents)

  • Adrenergic Agonists can stimulate any one or any combination of Alpha or beta receptors.  Adrenergic agonsits that stimulate beta receptors are called Beta adrenergic agonists.
  • Example of adrenergic agonists drugs includes: phenylephrine (neo-synephrine): used to treat shocj and nasal congestion
  • Ephidrine (ephedsol) temporary relief for nasal and sinus congestion
  • Albuterol (Proventil) bronchospasm associated with asthma or bronchitis.

So, basically we can say that Adrenergic agonsists are used primarily for three reasons: hemodynamic compromise such as (hypotension resulting from shock or CHF, bronchospasm and nasal or sinus congestion)

  • Contraindications includes: For Phenylephrine, it is contraindicated in patients with pheochromocytoma.  Alpha agonists are contraindicated in patients who have tachycardia and severe hypertension because stimulation of the alpha receptor can further cause vasoconstriction and cause more potentiating hypertension.  Because alpha-agonists causes pupil dilation (mydriasis), they are contraindicated in patients with glaucoma.

Remember: Adrenergic agonists should be avoided in patients with cardiac diseases beacause these agents may precipitate angina or myocardial infarction (MI).

Adrenergic Antagonists

Adrenergic Antagonists: inhibits or blocks the effects of the sympathetic nervous system neurotransmitters and are antagonists to the adrenergic agonists.  Adrenegic antagonists are also sometimes calle antagonist blockers because they block the sympathetic effects of the body.

  • The action of the alpha adrenergic antagonists inclcudes:
  • pupil constriction (miosis), increase GI tract motility, vasodilation of arterioles which can result in a decrease in Blood pressure, and prostate relaxation.
  • Alpha adrenergic antagonists are used primarily to treat five conditions:  hypertension, migraine headaches, alzheimer’s disease and benign prostatic hyperthrophy
  • Examples of these drugs includes: doxazosin mesylate (Cardura) which is used for treatment of hypertension.

When administering  alpha adrenergic antagonist medications, always try to: monitor for orthostatic hypotension, monitor for tachycardia, and tell patient to report any gain of 1 to 2 pounds accompanied with peripheral edema.

Parasympathetic Nervous System Drugs

The parasympathetic Nervous System drugs is primarily concerned with conserving energy and promoting digestion.  Several responses of stimulation of the parasympathetic drugs includes: pupil constriction, lacrimation, salivation, bronchoconstriction, a decrease in heart rate, conduction, automaticity and contraction of the bladder and relaxation of the sphincter.  The parasympathetic nervous system drugs includes:

  1. Direct acting cholinergic agonists
  2. cholinesterase inhibitors
  3. anticholinergics
  4. Dopaminergics

Knowing your pharmacology is essential for the nclex.  The proper way to study pharmacology and the drugs for the nclex exam is to understand the interaction of the drug with our body.  Memorizing the purpose and side effects of this drugs without understanding fully the rationale of its actions will set you to fail the nclex exam.  Therefore, to prepare for the nclex, a firm understanding and knowledge of pharmacology is essential, and yes there will be a lot of “drug” related questions in the nclex exam.  In this nclex review, we will start with the Central Nervous System:

Local Anaesthetics includes Lidocaine (xylocaine). It is an anesthetic that blocks nerve conduction; metabolized by hepatic enzymes.

Non- narcotic analgesics and antipyretic: This group would include your aspirins, and your antipyretic.  Acetysaalicylic Acid (aspirin) (ASA):  Action: Analgesia: inhibits formation of prostaglandins invlolved with pain. It is important to understand for the nclex, that an analgesia acts on the body by acting on the hypothalamus and blocking the generation of the pain impulses.  An antipyretic inhibits the formation of prostaglandins in production of fever.  The aspirin acts on the hypothalamus (as you remember from nursing school, is the thermostat on the body).   What it can do when inside the body: It is used for moderate pain, control fever, it is also used as an anti inflammatory and helps reduce the risk for MI in men with unstable angina.

  • Adverse reaction includes: tinnitus, confusion, dizziness, drowiness and bleeding (this is big for the nclex).
  • Other type of non narcotic analgesic: Acetaminophen (Tylenol).

A sample nclex review question:

  • Which condition is an indication for aspirin use?
  • 1. Asthma
  • 2. TIA    (correct answer) due to aspirin’s antiplatelet effect, aspirin can be use to decrease TIA.
  • 3.  Gout
  • 4. Nasal Polyps

Other Nonsteroidal Anti-Inflammatory Drugs (NSAIDS) for the nclex includes:

  • Ibuprofen
  • Indomethacin (Indocin)
  • Ketorolac (Toradol)
  • Celecoxib (Celebrex)

Now we can talk about Narcotic Analgesics:

One of the most commonly used Narcotic Analgesic in the nclex is morphine or morphine sulfate:

  • Morphine Sulfate: acts on opiod receptors in the CNS and induces sedation, analgesia, and euphoria.  It is used to relief moderate to severe pain. Such as pain from an MI or myocardial infarction (big in the nclex).
  • Adverse effects can include: sedation, confusion, euphoria and impaired coordination.   A big adverse reaction to know (nclex) is respiratory depression, hypotension, tachycardia and bradycardia.
  • Observe for signs of tolerance with prolonged use  (nclex)
  • monitor respiratory rate and depth before giving the drug and periodically thereafter. (nclex)
  • Always remember to have narcotic antagonist (naloxone) Narcan available on hand.

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Two cardiac procedures that is normally done:

  • Percutaneous Transluminal Coronary Amgioplasty
  • Coronary Artery Bypass Surgery (CABG)

Percutaneous Transluminal Coronary Amgioplasty (PTCA) with or without placement of stent, can be performed as an alternative to coronary artery bypass graft surgery (CABG).  The aim of the PTCA is to revascularize the myoardiu, dercrease angina, and increase the survival of the patient.  The PTCA is performed in the cardiac atherization lab and involves the insertiopn of a balloon-tipped catheter into the stenotic diseased coronary artery.  Post op and preop nursing interventions is the same as for a lient undergoing cardiac catheterization.

Coronary Artery Bypass Surgery (CABG)

Coronary Artery Bypass Surgery (CABG): a coronary artery bypass graft is the surgery of choice for clients with sever CAD.  During a CABG or coronary artery bypass surgery, there is a new supply of blood brought to a diseased/occluded coronary artery by bypassing the obstruction with a graft that is attached to the aorta proximally and to the coronary artery.  Postoperatively after the procedure, make sure to try to promote lung expansion and monitor for drainage from the chest tubes and the chest systems.

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