NUR 521 Module 4 Exam Study Guide. University
of Alabama-Graded A
1. Review the mechanism of action of each of the following
medications. What adverse effects and drug-associated diseases
are problematic?
A. Clonidine-Used for : HTN, CA+ related pain(adjunct Tx),Tourette, ADHD
alpha-2 agonist, central
Interaction Characteristics:
• affects growth hormone diagnostic test results
• antihypertensive agent
• bradycardia
• CNS depression
• hypotensive effects
• interferes w/ radiolabeled norepinephrine analog effect
Appropriate Use
dilute 500 mcg/mL strength product prior to use in an appropriate solution
Obstetrical, Postpartum, or Perioperative Use
weigh risk/benefit; epidural clonidine generally not recommended for obstetrical, postpartum, or
perioperative pain management due to risk of hemodynamic instability, esp. hypotension and
bradycardia
Safety/Monitoring .
Monitoring Parameters
oral use: Cr at baseline; vital signs frequently if cardiac conduction disturbance; HR, BP at baseline in
ADHD pts, after dose increases, then periodically
epidural use: Cr at baseline; vital signs frequently, esp. during 1st few days of tx
Look/Sound-Alike Drug Names
clonidine confused with: Cardizem; cetirizine; clobazam; clonazepam; colchicine; Klonopin
Pregnancy/Lactation
Pregnancy
Clinical Summary
caution advised during pregnancy; risk of teratogenicity not expected, though possible risk of decr.
birth wt based on limited human data; risk of embryo-fetal death based on animal data at 0.067x to
8x MRHD
Lactation
Clinical Summary
NUR 521 Module 4 Study Guide
(Chapters 19, 20, 22, 23, 50, and 51)
Page 1 of 30
, consider alternative while breastfeeding; inadequate human data available to assess risk of infant
harm or effects on milk production
B. Metoprolol-Tx: HTN, angina, CHF, migrane
prophylaxis BETA BLOCKER
Interaction Characteristics:
• CYP2D6 substrate
• antihypertensive agent
• bradycardia
• hyperglycemia
• hypoglycemia
• prolongs PR interval
Avoid Abrupt Cessation
severe angina exacerbation, MI, and ventricular arrhythmias in angina pts
after abrupt D/C; taper gradually over 1-2wk and monitor when D/C chronic
tx, especially in ischemic heart dz; restart tx even temporarily if angina
worsens or acute coronary insufficiency develops; warn pts to avoid tx
interruption or D/C w/o MD advice; avoid abrupt D/C in all pts in case of
unrecognized CAD
Safety/Monitoring .
Monitoring Parameters
BP, HR
Look/Sound-Alike Drug Names
metoprolol confused with: atenolol; metoclopramide; metolazone; metronidazole; misoprostol
metoprolol succinate confused with: metoprolol tartrate
Pregnancy/Lactation
Pregnancy
Clinical Summary
caution advised during pregnancy, esp. in 2nd and 3rd trimesters; risk of teratogenicity not expected
based on limited human data; possible risk of intrauterine growth restriction and neonatal adverse
effects, incl. bradycardia and hypoglycemia, based on limited or conflicting human data
Lactation
Clinical Summary
may use while breastfeeding; no known risk of infant harm based on limited human data and drug
properties; no human data available to assess effects on milk production
C. Amlodipine: Tx: HTN,CAD
Contraindications / Cautions .
• hypersens. to drug/class/compon.
NUR 521 Module 4 Study Guide
(Chapters 19, 20, 22, 23, 50, and 51)
Page 2 of 30
, • caution in elderly pts
• caution if hepatic impairment
• caution if severe CAD
• caution if severe aortic stenosis
CCB, dihydropyridine
Interaction Characteristics:
• CYP3A4 substrate
• CYP3A4 inhibitor, weak
• antihypertensive agent
Contraindicated
• cisapride
Adverse Reactions .
Serious Reactions
• angina exacerbation
• MI
• hypotension, acute
• hepatit
is
• hypersensitivity rxn
• erythema multiforme
Common Reactions
• peripheral edema
• fatigue
• palpitations
• dizzines
s
• nausea
• flushing
• eczematous eruptions (chronic use, elderly pts)
Safety/Monitoring .
Monitoring Parameters
BP at baseline, then periodically
Look/Sound-Alike Drug Names
amlodipine confused with: amiloride; amiodarone; amitriptyline; felodipine; memantine
Pregnancy/Lactation
Pregnancy
Clinical Summary
caution advised during pregnancy; inadequate human data available to assess risk; no known risk of
teratogenicity based on animal data at up to 20x MRHD, though risk of embryo-fetal death based on
animal data at 10x MRHD
Lactation
Clinical Summary
NUR 521 Module 4 Study Guide
(Chapters 19, 20, 22, 23, 50, and 51)
Page 3 of 30
of Alabama-Graded A
1. Review the mechanism of action of each of the following
medications. What adverse effects and drug-associated diseases
are problematic?
A. Clonidine-Used for : HTN, CA+ related pain(adjunct Tx),Tourette, ADHD
alpha-2 agonist, central
Interaction Characteristics:
• affects growth hormone diagnostic test results
• antihypertensive agent
• bradycardia
• CNS depression
• hypotensive effects
• interferes w/ radiolabeled norepinephrine analog effect
Appropriate Use
dilute 500 mcg/mL strength product prior to use in an appropriate solution
Obstetrical, Postpartum, or Perioperative Use
weigh risk/benefit; epidural clonidine generally not recommended for obstetrical, postpartum, or
perioperative pain management due to risk of hemodynamic instability, esp. hypotension and
bradycardia
Safety/Monitoring .
Monitoring Parameters
oral use: Cr at baseline; vital signs frequently if cardiac conduction disturbance; HR, BP at baseline in
ADHD pts, after dose increases, then periodically
epidural use: Cr at baseline; vital signs frequently, esp. during 1st few days of tx
Look/Sound-Alike Drug Names
clonidine confused with: Cardizem; cetirizine; clobazam; clonazepam; colchicine; Klonopin
Pregnancy/Lactation
Pregnancy
Clinical Summary
caution advised during pregnancy; risk of teratogenicity not expected, though possible risk of decr.
birth wt based on limited human data; risk of embryo-fetal death based on animal data at 0.067x to
8x MRHD
Lactation
Clinical Summary
NUR 521 Module 4 Study Guide
(Chapters 19, 20, 22, 23, 50, and 51)
Page 1 of 30
, consider alternative while breastfeeding; inadequate human data available to assess risk of infant
harm or effects on milk production
B. Metoprolol-Tx: HTN, angina, CHF, migrane
prophylaxis BETA BLOCKER
Interaction Characteristics:
• CYP2D6 substrate
• antihypertensive agent
• bradycardia
• hyperglycemia
• hypoglycemia
• prolongs PR interval
Avoid Abrupt Cessation
severe angina exacerbation, MI, and ventricular arrhythmias in angina pts
after abrupt D/C; taper gradually over 1-2wk and monitor when D/C chronic
tx, especially in ischemic heart dz; restart tx even temporarily if angina
worsens or acute coronary insufficiency develops; warn pts to avoid tx
interruption or D/C w/o MD advice; avoid abrupt D/C in all pts in case of
unrecognized CAD
Safety/Monitoring .
Monitoring Parameters
BP, HR
Look/Sound-Alike Drug Names
metoprolol confused with: atenolol; metoclopramide; metolazone; metronidazole; misoprostol
metoprolol succinate confused with: metoprolol tartrate
Pregnancy/Lactation
Pregnancy
Clinical Summary
caution advised during pregnancy, esp. in 2nd and 3rd trimesters; risk of teratogenicity not expected
based on limited human data; possible risk of intrauterine growth restriction and neonatal adverse
effects, incl. bradycardia and hypoglycemia, based on limited or conflicting human data
Lactation
Clinical Summary
may use while breastfeeding; no known risk of infant harm based on limited human data and drug
properties; no human data available to assess effects on milk production
C. Amlodipine: Tx: HTN,CAD
Contraindications / Cautions .
• hypersens. to drug/class/compon.
NUR 521 Module 4 Study Guide
(Chapters 19, 20, 22, 23, 50, and 51)
Page 2 of 30
, • caution in elderly pts
• caution if hepatic impairment
• caution if severe CAD
• caution if severe aortic stenosis
CCB, dihydropyridine
Interaction Characteristics:
• CYP3A4 substrate
• CYP3A4 inhibitor, weak
• antihypertensive agent
Contraindicated
• cisapride
Adverse Reactions .
Serious Reactions
• angina exacerbation
• MI
• hypotension, acute
• hepatit
is
• hypersensitivity rxn
• erythema multiforme
Common Reactions
• peripheral edema
• fatigue
• palpitations
• dizzines
s
• nausea
• flushing
• eczematous eruptions (chronic use, elderly pts)
Safety/Monitoring .
Monitoring Parameters
BP at baseline, then periodically
Look/Sound-Alike Drug Names
amlodipine confused with: amiloride; amiodarone; amitriptyline; felodipine; memantine
Pregnancy/Lactation
Pregnancy
Clinical Summary
caution advised during pregnancy; inadequate human data available to assess risk; no known risk of
teratogenicity based on animal data at up to 20x MRHD, though risk of embryo-fetal death based on
animal data at 10x MRHD
Lactation
Clinical Summary
NUR 521 Module 4 Study Guide
(Chapters 19, 20, 22, 23, 50, and 51)
Page 3 of 30
