PHARMACOLOGY FOR THE NCLEX- RN

NCLEX-RN Need to Know Meds PDF V2 PHARMACOLOGY FOR THE NCLEX- RN M U S T K N OW D R U G S NCLEX-RN Need to Know Medications NCLEX-RN Need to Know Medications ALTEPLASE • MOA – thrombolytic – plasminogen activator • Indications – MI – Acute ischemic stroke – Occluded Central lines • Nursing Considerations – Contraindicated in active bleeding – Monitor for active bleeding (q15m x 1hr; q15-30m x 8hr) – May cause intracranial hemorrhage – Monitor for anaphylaxis – Use caution with uncontrolled hypertension – Assess neuro status during therapy NCLEX-RN Need to Know Medications A patient is admitted to the emergency department with chest pain.An electrocardiogram shows changes consistent with an evolving myocardial infarction.The patient’s cardiac enzymes are pending.The nurse caring for this patient will expect to: A. administer aspirin when cardiac enzymes are completed. B. give alteplase [Activase] within 2 hours. C. give tenecteplase [TNKase] immediately. D. obtain an order for an INR. NCLEX-RN Need to Know Medications A patient is admitted to the emergency department with chest pain.An electrocardiogram shows changes consistent with an evolving myocardial infarction.The patient’s cardiac enzymes are pending.The nurse caring for this patient will expect to: A. administer aspirin when cardiac enzymes are completed. B. give alteplase [Activase] within 2 hours. C. give tenecteplase [TNKase] immediately. D. obtain an order for an INR. NCLEX-RN Need to Know Medications ATORVASTATIN • MOA – HMG-CoA reductase inhibitor – lipid lowering agent • Indications – Management of hypercholesterolemia (primary prevention of cardiovascular disease) • Nursing Considerations – Contraindicated in active liver disease – May cause rhabdomyolysis – Monitor renal function – Monitor serum cholesterol before treatment and 4 weeks after starting therapy – Monitor LFTs – Instruct patient to report muscle weakness (sign of rhabdomyolysis) NCLEX-RN Need to Know Medications A patient who is recovering from a STEMI 3 months prior is in the clinic for a follow-up evaluation.The patient is taking 81 mg of aspirin, a beta blocker, and an ACE inhibitor daily and uses nitroglycerine as needed for angina.The patient’s BMI is 24.5 kg/m2, and serum LDL is 150 mg/dL.The patient has a blood pressure of 135/80 mm Hg.What will the nurse expect the provider to order for this patient? A. An antihypertensive medication B. Counseling about a weight loss diet C. Discontinuing the ACE inhibitor D. High-dose statin therapy NCLEX-RN Need to Know Medications A patient who is recovering from a STEMI 3 months prior is in the clinic for a follow-up evaluation.The patient is taking 81 mg of aspirin, a beta blocker, and an ACE inhibitor daily and uses nitroglycerine as needed for angina.The patient’s BMI is 24.5 kg/m2, and serum LDL is 150 mg/dL.The patient has a blood pressure of 135/80 mm Hg.What will the nurse expect the provider to order for this patient? A. An antihypertensive medication B. Counseling about a weight loss diet C. Discontinuing the ACE inhibitor D. High-dose statin therapy NCLEX-RN Need to Know Medications ACETAMINOPHEN • MOA – non-opioid analgesic – prostaglandin inhibitor • Indications – Pain – Fever • Nursing Considerations – Do not exceed 4g of acetaminophen per day to limit risk of renal, liver and cardiac damage – Overdose will lead to hepatotoxicity – Acetylcysteine (acetadote) is the antidote for overdose – May increase the risk for bleeding with warfarin therapy – May alter blood glucose measurements NCLEX-RN Need to Know Medications A patient who is taking gentamicin and a cephalosporin for a postoperative infection requests medication for mild postsurgical pain.The nurse will expect to administer which of the following medications? A. Acetaminophen B. Aspirin C. Ibuprofen D. Morphine NCLEX-RN Need to Know Medications A patient who is taking gentamicin and a cephalosporin for a postoperative infection requests medication for mild postsurgical pain.The nurse will expect to administer which of the following medications? A. Acetaminophen B. Aspirin C. Ibuprofen D. Morphine NCLEX-RN Need to Know Medications ACYCLOVIR • MOA – antiviral – purine analogue • Indications – Genital herpes – Herpes zoster – Chicken pox • Nursing Considerations – May cause seizures, renal failure, Stevens-Johnson syndrome, thrombotic thrombocytopenic purpura syndrome, diarrhea, dizziness, nausea – Monitor renal panel during administration – Assess lesions during therapy – Instruct patient to use proper protection during sexual intercourse NCLEX-RN Need to Know Medications The nurse is caring for a patient receiving intravenous acyclovir.To prevent nephrotoxicity associated with intravenous acyclovir, the nurse will: A. hydrate the patient during the infusion and for 2 hours after the infusion. B. increase the patient’s intake of foods rich in vitamin C. C. monitor urinary output every 30 minutes. D. provide a low-protein diet for 1 day before and 2 days after the acyclovir infusion. NCLEX-RN Need to Know Medications The nurse is caring for a patient receiving intravenous acyclovir.To prevent nephrotoxicity associated with intravenous acyclovir, the nurse will: A. hydrate the patient during the infusion and for 2 hours after the infusion. B. increase the patient’s intake of foods rich in vitamin C. C. monitor urinary output every 30 minutes. D. provide a low-protein diet for 1 day before and 2 days after the acyclovir infusion. NCLEX-RN Need to Know Medications ALBUTEROL • MOA – bronchodilator – binds to Beta2 adrenergic receptors in airway leading to relaxation of the smooth airway muscles • Indications – Airway obstruction – COPD – Asthma • Nursing Considerations – May decrease effectiveness of beta blockers – Use with caution: heart disease, diabetes, glaucoma, seizure disorder – Overuse of inhaler can lead to bronchospasm – Monitor for chest pain and palpitations – Can increase digoxin levels NCLEX-RN Need to Know Medications A patient is using a metered-dose inhaler containing albuterol for asthma. The medication label instructs the patient to administer “2 puffs every 4 hours as needed for coughing or wheezing.” The patient reports feeling jittery sometimes when taking the medication, and she doesn’t feel that the medication is always effective.Which action is outside the nurse’s scope of practice? A. Asking the patient to demonstrate use of the inhaler B. Assessing the patient’s exposure to tobacco smoke C. Auscultating lung sounds and obtaining vital signs D. Suggesting that the patient use one puff to reduce side effects NCLEX-RN Need to Know Medications A patient is using a metered-dose inhaler containing albuterol for asthma. The medication label instructs the patient to administer “2 puffs every 4 hours as needed for coughing or wheezing.” The patient reports feeling jittery sometimes when taking the medication, and she doesn’t feel that the medication is always effective.Which action is outside the nurse’s scope of practice? A. Asking the patient to demonstrate use of the inhaler B. Assessing the patient’s exposure to tobacco smoke C. Auscultating lung sounds and obtaining vital signs D. Suggesting that the patient use one puff to reduce side effects NCLEX-RN Need to Know Medications ALEDRONATE • MOA – biphosphnate – inhibits osteoclast activity leading to inhibition of resorption of bone • Indications – Osteoporosis (aging, menopause, corticosteroid induced) • Nursing Considerations – Take first thing in the morning with full glass of water 30 mins prior to eating – Assess serum calcium and vitamin D – May lead to muscle pain NCLEX-RN Need to Know Medications ALPRAZOLAM • MOA – benzodiazepine – works in CNS to produce anxiolytic effect causing CNS depression • Indications – Anxiety, panic disorder, manage symptoms of PMS, insomnia, mania, psychosis • Nursing Considerations – Use caution with existing CNS depression, sleep apnea, renal dysfunction, hepatic dysfunction – May cause CNS depression, drowsiness, lethargy – May lead to physical dependence, may experience tolerance effect – Assess anxiety and mental status – Flumazenil is antidote for overdose – Grapefruit juice may increase blood levels NCLEX-RN Need to Know Medications AMIODARONE • MOA – potassium channel blocker – class III antiarrhythmic – prolongs action potential, inhibits adrenergic stimulation, slows rate, decreases peripheral vascular resistance causing vasodilation • Indications – Ventricular arrhythmias, SVT – ACLS protocol for V-Fib and V-Tach • Nursing Considerations – May lead to ARDS, pulmonary toxicity, CHF, bradycardia, hypotension – Increases risk for QT prolongation – Increases digoxin levels – Increases activity of warfarin – Monitor EKG continuously while on therapy – Assess for signs and symptoms of ARDS – Monitor LFTs – Check dosage with another RN – Teach pt to monitor pulse daily and report abnormalities – Avoid drinking grapefruit juice NCLEX-RN Need to Know Medications A nurse is providing teaching to a patient who is admitted to the hospital for initiation of treatment with amiodarone [Cordarone] for atrial fibrillation that has been refractory to other medications.Which statement by the patient indicates a need for further teaching? A. “I may have itching, malaise, and jaundice, but these symptoms will subside.” B. “I need to use sunblock to help keep my skin from turning bluish gray.” C. “I should not drink grapefruit juice while taking this medication.” D. “I should report shortness of breath and cough and stop taking the drug immediately.” NCLEX-RN Need to Know Medications A nurse is providing teaching to a patient who is admitted to the hospital for initiation of treatment with amiodarone [Cordarone] for atrial fibrillation that has been refractory to other medications.Which statement by the patient indicates a need for further teaching? A. “I may have itching, malaise, and jaundice, but these symptoms will subside.” B. “I need to use sunblock to help keep my skin from turning bluish gray.” C. “I should not drink grapefruit juice while taking this medication.” D. “I should report shortness of breath and cough and stop taking the drug immediately.” NCLEX-RN Need to Know Medications AMITRYPTILINE • Nursing Considerations – Contraindicated in MI, heart failure, QT prolongation, glaucoma – May increase risk for suicidal ideation • MOA – tricyclic antidepressant – increases effect of serotonin and norepinephrine in the CNS, exhibits anticholinergic effects • Indications – Depression, anxiety, insomnia – May lead to photosensitivity, instruct pt to use sunscreen – May turn urine blue/green color – May cause arrhythmias, hypotension, EKG changes – May cause alterations in blood glucose levels – May lead to general sedation and lethargy – Do not use within 2 weeks of MAOIs – Instruct pt to take exactly as instructed – Monitor for orthostatic hypotension NCLEX-RN Need to Know Medications AMLODIPINE • MOA – Calcium channel blocker – antihypertensive – blocks transport of calcium into muscle cells inhibiting excitation and contraction • Indications – Hypertension – Angina • Nursing Considerations – May cause gingival hyperplasia – Grapefruit juice may increase drug level – Monitor BP and pulse prior to and during therapy – Monitor for signs of CHF – Assess characteristics of angina – Instruct patient of interventions for hypertension and how to take BP NCLEX-RN Need to Know Medications AMOXICILLIN • MOA – anti-infective/antiulcer agent – aminopenicillins - inhibits synthesis of bacterial cell wall leading to cell death • Indications – Skin infections, respiratory infections, sinusitis, endocarditis prophylaxis, lyme disease • Nursing Considerations – Contraindicated with penicillin allergy – May cause seizures – Assess for rash, anaphylaxis – Excreted by kidneys – monitor renal function – Monitor patient for diarrhea – bloody stool should be reported immediately NCLEX-RN Need to Know Medications AMPICILLIN • MOA – Anti-infective – aminopenicillin – bactericidal, broader spectrum that penicillin, binds to cell wall leading to bacterial cell death • Indications – Skin infections, soft tissue infections, otitis media, sinusitis, respiratory infections, GU infections, meningitis, septicemia • Nursing Considerations – Contraindicated in penicillin allergy – Use caution in renal insufficiency – May lead to seizures, diarrhea, anaphylaxes, super infection – Monitor LFTs – Instruct patient on signs of super infection: furry overgrowth on tongue, vaginal itching, loose and foul smelling stool – Pt should not use with oral contraceptive use NCLEX-RN Need to Know Medications ASPIRIN • MOA – non-opioid analgesic and antipyretic – salicylates – inhibits the production of prostaglandins which leads to a reduction of fever and inflammation, decreases platelet aggregation leading to a decrease in ischemic diseases • Indications – Rheumatoid arthritis, osteoarthritis, ischemic stroke, MI prophylaxis • Nursing Considerations – Use caution with bleeding disorders and chronic alcohol use – May lead to Stevens-Johnson syndrome, laryngeal edema, and anaphylaxis – Increases risk for bleeding with warfarin, heparin, and clopidogrel – Increased risk for GI bleeding with NSAID use – Monitor LFTs – Concurrent use with alcohol may increase risk for GI bleeding NCLEX-RN Need to Know Medications ATENOLOL • MOA – beta blocker – antianginal/antihypertensive – blocks the stimulation of beta 1 receptors in the SNS with minimal effects on beta 2 receptors • Indications – Hypertension, angina, prevention of MI • Nursing Considerations – Contraindicated in CHF, pulmonary edema, cardiogenic shock, bradycardia, heart block – Monitor HR/BP – May cause bradycardia, CHF, pulmonary edema – Masks symptoms associated with DM – Advise to change positions slowly – Instruct pt how to take BP NCLEX-RN Need to Know Medications ATROPINE • MOA – antiarrhythmic/anticholinergic – inhibits effects of the parasympathetic nervous system, specifically acetylcholine – increases HR, bronchodilation, decreased GI and respiratory secretions • Indications – Decreases oral and respiratory secretions, treats sinus bradycardia and heart block, treatment of bronchospasm • Nursing Considerations – Avoid in acute hemorrhage, tachycardia, and closed-angle glaucoma – Monitor pt for tachycardia and palpitations – May cause urinary retention in elderly patients – Patients may experience constipation due to slowed GI motility NCLEX-RN Need to Know Medications A patient is brought to the emergency department after ingesting a handful of diphenhydramine tablets.The patient has dilated pupils, a flushed face, and tremors.The patient is agitated and has a heart rate of 110 beats per minute.The nurse may anticipate administering which agents? (Select all that apply.) A. Activated charcoal B. Atropine C. Cathartics D. Lorazepam E. Second-generation H1 antagonists NCLEX-RN Need to Know Medications A patient is brought to the emergency department after ingesting a handful of diphenhydramine tablets.The patient has dilated pupils, a flushed face, and tremors.The patient is agitated and has a heart rate of 110 beats per minute.The nurse may anticipate administering which agents? (Select all that apply.) A. Activated charcoal B. Atropine C. Cathartics D. Lorazepam E. Second-generation H1 antagonists NCLEX-RN Need to Know Medications AZITHROMYCIN • MOA – macrolide – anti-infective for atypical mycobacterium – inhibits bacterial protein synthesis • Indications – URI, chronic bronchitis, lower respiratory infections, otitis media, skin infections, STIs, prevention of bacterial endocarditis, treatment of cystic fibrosis • Nursing Considerations – May lead to pseudomembranous colitis, pain diarrhea, nausea, Stevens- Johnson syndrome, angioedema – May increase risks for warfarin toxicity – Monitor for anaphylaxis – Notify PCP for diarrhea or blood or pus in stool – Instruct pt to take as prescribed NCLEX-RN Need to Know Medications BENZOTROPINE • MOA – Anti-Parkinson agent – anticholinergic – anticholinergic properties reduce tremors and rigidity • Indications – Treatment for Parkinson’s Disease • Nursing Considerations – May lead to arrhythmias, hypotension, palpitations, and tachycardia – Anticholinergic effects like constipation, dry mouth – Assess for extrapyramidal symptoms – Instruct pt to take as directed – Instruct pt to maintain good oral hygiene NCLEX-RN Need to Know Medications BISCODYL • MOA – stimulant laxative – stimulates peristalsis leads to fluid accumulation in the colon • Indications – Treatment of constipation – Bowel regimen • Nursing Considerations – May lead to hypokalemia – May cause abdominal pain and cramps – Use caution with milk – Assess for abdominal distension and bowel function – Instruct pt to drink mL/day during therapy – Monitor fluid and electrolyte levels NCLEX-RN Need to Know Medications BISMUTH SUBSALICYLATE • MOA – adsorbent antidiarrheal/antiulcer – stimulates the absorption of fluids and electrolytes in the intestinal wall, reduction in hypermotility of the stomach, and binds to toxins • Indications – Diarrhea, heartburn, indigestion, H. pylori- associated ulcers • Nursing Considerations: – Contraindicated in aspirin hypersensitivity – Increased risk for impaction with geriatric and pediatric patients – Monitor LFTs – Bismuth may interfere with radiologic exams NCLEX-RN Need to Know Medications A patient is taking bismuth subsalicylate to prevent diarrhea.The nurse performing an assessment notes that the patient’s tongue is black.What will the nurse do? A. Assess further for signs of gastrointestinal (GI) bleeding. B. Reassure the patient that this is an expected side effect of this drug. C. Request an order for liver function tests to evaluate for hepatotoxicity. D. Withhold the drug, because this is a sign of bismuth overdose. NCLEX-RN Need to Know Medications A patient is taking bismuth subsalicylate to prevent diarrhea.The nurse performing an assessment notes that the patient’s tongue is black.What will the nurse do? A. Assess further for signs of gastrointestinal (GI) bleeding. B. Reassure the patient that this is an expected side effect of this drug. C. Request an order for liver function tests to evaluate for hepatotoxicity. D. Withhold the drug, because this is a sign of bismuth overdose. NCLEX-RN Need to Know Medications BUPROPION • MOA – aminoketones – antidepressant/smoking deterrent – relieves anxiety by binding to dopamine and serotonin receptors • Indications – Depression, smoking cessation, treat ADHD in adults – Management of anxiety • Nursing Considerations – May lead to seizures, suicidal thoughts – Do not administer if pt is taking MAOIs or with grapefruit juice – Use caution with renal and liver impairment – Assess mental status – Instruct pt to avoid alcohol and CNS depressants while taking bupropion – May lead to dizziness, drowsiness, fatigue, and weakness – Pt may experience chest pain, palpitations, tachycardia NCLEX-RN Need to Know Medications A patient who has been taking an SSRI tells the nurse that the drug has caused reduced sexual performance, weight gain, and sedation.The nurse will suggest that the patient ask the provider about using which drug? A. Bupropion B. Imipramine C. Isocarboxazid D. Trazodone NCLEX-RN Need to Know Medications A patient who has been taking an SSRI tells the nurse that the drug has caused reduced sexual performance, weight gain, and sedation.The nurse will suggest that the patient ask the provider about using which drug? A. Bupropion B. Imipramine C. Isocarboxazid D. Trazodone NCLEX-RN Need to Know Medications BUTORPHANOL • MOA – opioid analgesic – alters perception and response to pain by binding to opiate receptors in CNS • Indications – Moderate to severe pain, labor pain, sedation • Nursing Considerations – Use caution with concurrent use of MAOIs – May cause confusion, hallucinations, sedations – Monitor for CNS depression – Assess BP/HR/RR during administration – Administer slowly through IV line NCLEX-RN Need to Know Medications CALCIUM ACETATE • MOA – (antacids – essential for nervous muscular and skeletal systems, helps maintain cell membranes, aids in nerve impulses and muscle contraction, aids in blood formation and coagulation • Indications – Treatment of hypocalcemia, prevention of postmenopausal osteoporosis, adjunct in cardiac arrest, control of hyperphosphatemia with ESRD • Nursing Considerations – May cause cardiac arrest and arrhythmias – Phlebitis at site of insertion – May cause hypotension, bradycardia, and arrhythmias – Administer slowly – Instruct pt on foods that contain Vit D and encourage adequate intake – Monitor parathyroid hormone NCLEX-RN Need to Know Medications CAPTOPRIL • MOA – ACE-inhibitor – antihypertensive – blocks conversion of angiotensin I to angiotensin II, increases renin levels and decreases aldosterone leading to vasodilation • Indications – Hypertension, management of CHF, decrease progression of DM neuropathy • Nursing Considerations – Can cause neutropenia – check WBCs regularly – Use cautiously with K+ supplements and K+ sparing diuretics – Use cautiously with diuretic therapy – Administer 1 hour before meals – Monitor BP, weight, renal panel, and fluid status – Monitor CBC frequently – May lead to rhabdomyolysis – Dry cough NCLEX-RN Need to Know Medications CARBAMAZEPINE • Nursing Considerations – • MOA – anticonvulsant – affects Na+ channels in neurons leading to decreased synaptic transmission • Indications – Seizures, DM neuropathy, pain associated with trigeminal neuralgia contraceptives – Do not use with MAOIs or grapefruit juice – May cause suicidal thoughts – May cause Stevens-Johnson syndrome, agranulocytosis, aplastic anemia, thrombocytopenia – Monitor CBC and platelet count – Monitor serum blood levels of medication often NCLEX-RN Need to Know Medications CARBIDOPA/LEVODOPA • MOA – (dopamine agonist – levodopa is converted to dopamine and works as a neurotransmitter and carbidopa prevents the destruction of levodopa • Indications • Nursing Considerations – May cause orthostatic hypotension – May cause dark urine – Weeks to month for full effect – Do not use with MAOIs – melanoma – – Assess for Parkinson’s symptoms – B6 supplement NCLEX-RN Need to Know Medications CEFACLOR • MOA – 2nd generation cephalosporin – bactericidal, binds to bacterial cell wall causing cell death • Indications – Treatment of respiratory tract infections, skin infections, otitis media • Nursing Considerations – Contraindicated in cephalosporin and possibly penicillin allergies – May lead to seizures, pseudomembranes colitis, diarrhea, phlebitis at IV site, anaphylaxis – Assess infection and allergies – Obtain cultures prior to therapy – Monitor bowel function – May lead to super infection NCLEX-RN Need to Know Medications CEFDINIR • MOA – (2nd generation cephalosporin – binds to bacterial cell wall causing cell death • Indications – Treatment of skin infections, otitis media • Nursing Considerations – Contraindicated in cephalosporin and possibly penicillin allergies – May lead to seizures, pseudomembranous colitis, diarrhea, phlebitis at IV site, anaphylaxis – Assess infection and allergies – Obtain cultures prior to therapy – Monitor bowel function – May lead to super infection NCLEX-RN Need to Know Medications CELECOXIB • MOA – antirheumatic/NSAID – decreases pain and inflammation by inhibiting synthesis of prostaglandins • Indications – Osteoarthritis, rheumatoid arthritis, acute pain • Nursing Considerations – Use caution with cardiovascular disease – Increases risk for MI, CVA, thrombosis – May cause GI bleeding, Stevens-Johnson syndrome, dermatitis – Notify HCP for new-onset abdominal pain or black stool NCLEX-RN Need to Know Medications NCLEX-RN Need to Know Medications CEPHALEXIN • MOA – Anti-infective (1st generation cephalosporin) – bactericidal: binds to bacterial cell wall leading to cell death • Indications – Skin infections, pneumonia, UTI, otitis media • Nursing Considerations – Contraindicated with serious penicillin allergies – May lead to seizures, pseudomembranous colitis, diarrhea, phlebitis at IV site, anaphylaxis – Obtain cultures prior to therapy – Monitor bowels – May lead to super infection – May cause elevated LFTs NCLEX-RN Need to Know Medications CHLORPROMAZINE • MOA – Antipsychotic/antiemetic – phenothiazines (dopamine D2 receptor antagonist) – exhibits anticholinergic activity, alters effects of dopamine in CNS • Indications – 2nd line treatment of schizophrenia and psychosis, nausea/vomiting, pre-op sedation, acute intermittent porphyria, headache, bipolar d/o • Indications – May cause neuroleptic malignant syndrome, sedation, tardive dyskinesia, hypotension, agranulocytosis – Assess mental status prior to and during treatment – Monitor BP – Monitor CBC and LFTs – Ensure adherence NCLEX-RN Need to Know Medications CIMETIDINE • MOA – Antiulcer agent – histamine H2 antagonist – inhibits action of histamine leading to inhibition of gastric acid secretion • Indications – Treatment of duodenal ulcers, GERD, heartburn, Zollinger Ellison Syndrome, prevention of GI bleeding in critical patients • Nursing Implications – Increases serum warfarin level – Can lead to respiratory infection – Monitor for arrhythmias – May cause agranulocytosis, aplastic anemia – Monitor CBC during therapy – Instruct pt to increase fluid and fiber to decrease constipation NCLEX-RN Need to Know Medications CIPROFLOXACIN • MOA – Anti-infective – fluoroquinolone – inhibits bacterial DNA synthesis • Indications – UTI, gonorrhea, respiratory tract infections, bronchitis, pneumonia, skin and bone infections, infectious diarrhea, abdominal infections • Nursing Implications – May cause QT prolongation, avoid use with other drugs that cause QT prolongation – Can cause seizures, arrhythmias, pseudomembranous colitis, anaphylaxis, Stevens Johnson syndrome – May decrease phenytoin levels – Monitor renal function and LFTs NCLEX-RN Need to Know Medications CLINDAMYCIN • MOA – Anti-infective – inhibits bacterial protein synthesis • Indications – Skin infections, respiratory tract infections, septicemia, intra-abdominal infections, osteomyelitis • Nursing Implications – Potential for arrhythmias, pseudomembranous colitis, diarrhea, phlebitis – Monitor bowel function – Monitor CBC and LFTs NCLEX-RN Need to Know Medications CLOPIDOGREL • MOA – Platelet aggregation inhibitor – antiplatelet agent • Indications – Atherosclerotic events, MI, CVA, PVD, ACS • Nursing Implications – May cause GI bleeding, neutropenia, hypercholesterolemia – May increase risk for bleeding in warfarin, aspirin, heparin therapy – Can increase risk for bleeding with garlic, gingko, ginger – Monitor CBC and platelet count – Discontinue use 5-7 days before surgery NCLEX-RN Need to Know Medications CODEINE • MOA – Opioid agonist – binds to opiate receptors in the CNS and alters perception of pain while producing a general depression of the CNS – the depression also causes a decrease in the cough reflex and GI motility • Indications – Management of pain, diarrhea, cough suppressant • Nursing Implications – May cause alterations in mentation, hypotension, constipation, nausea, vomiting – Assess BP, HR, and RR prior to administration and throughout therapy – Use caution in pt on MAOI – Naloxone is antidote for opioid agonists NCLEX-RN Need to Know Medications CORTISONE • MOA – Corticosteroid – antiasthmatic, corticosteroid – Replaces cortisol ins states of deficiency, suppresses inflammation and normal immune response • Indications – Management of adrenocortical insufficiency (Addison’s Disease) • Nursing Implications – Excreted by liver – monitor LFTs – Avoid in active untreated infections – May cause CNS alterations – May cause peptic ulcers – May cause Cushingoid appearance (buffalo hump, mood face) – Weight gain – Osteoporosis – Decreased wound healing – May elevate blood sugars – May increase cholesterol and lipid values NCLEX-RN Need to Know Medications A patient who has chronic adrenal insufficiency is admitted to the hospital for an open cholecystectomy.The nurse obtaining the admission history learns that the patient takes hydrocortisone 25 mg PO daily in the morning.The patient’s surgery is scheduled for the next morning.The nurse will expect an order to: A. administer the usual morning dose of hydrocortisone 25 mg PO. B. administer hydrocortisone 50 mg PO in the morning. C. administer hydrocortisone 50 mg IV before surgery. D. withhold the morning dose of hydrocortisone and give it after surgery. NCLEX-RN Need to Know Medications A patient who has chronic adrenal insufficiency is admitted to the hospital for an open cholecystectomy.The nurse obtaining the admission history learns that the patient takes hydrocortisone 25 mg PO daily in the morning.The patient’s surgery is scheduled for the next morning.The nurse will expect an order to: A. administer the usual morning dose of hydrocortisone 25 mg PO. B. administer hydrocortisone 50 mg PO in the morning. C. administer hydrocortisone 50 mg IV before surgery. D. withhold the morning dose of hydrocortisone and give it after surgery. NCLEX-RN Need to Know Medications CYCLOSPORINE • MOA – Polypeptide (cyclic) – immunosuppressant, antirheumatic (DMARD) – inhibits normal immune response • Indications – Prevention of rejection in transplantation, treatment of severe RA, management of ulcerative colitis • Nursing Considerations – May cause seizures, tremors, hypertension, hepatotoxicity, diarrhea, N/V, gingival hyperplasia – Increase immune suppression with corticosteroids – Avoid grapefruit juice – Assess for signs of organ rejection – Monitor renal panel & LFTs – Lifelong therapy required for transplant patients – Instruct pt on how to take BP NCLEX-RN Need to Know Medications DEXAMETHASONE • Nursing Implications – Excreted by liver – monitor LFTs – Avoid in active, untreated • MOA – Corticosteroid – suppresses inflammation and normal immune response – used in inflammatory states to decrease inflammation • Indications – Cerebral edema infections – May cause CNS alterations – May cause peptic ulcers – May cause cushingoid appearance (buffalo hump, moon face) – Weight gain – Osteoporosis – Decreased wound healing – May increase blood sugars and cholesterol/lipid levels NCLEX-RN Need to Know Medications DIAZEPAM • MOA – Benzodiazepine – depresses CNS response • Indications – Anxiety, pre-op sedation, conscious sedation, treatment of seizures, insomnia, management of alcohol withdrawal • Nursing Implications – Contraindicated in hepatic dysfunction – Use caution with renal impairment – Can cause dizziness, drowsiness, lethargy, hypotension, physical dependence, tolerance – Avoid concurrent alcohol use – Flumazenil is reversal agent (antidote) NCLEX-RN Need to Know Medications DIGOXIN • MOA – Digitalis glycoside (antiarrhythmic, inotropic) – positive inotropic effect (increases force of myocardial contraction), prolongs refractory period, decreases conduction through SA and AV nodes  give to increase cardiac output and slow the rate • Indications – CHF,A-Fib, A-Flutter • Nursing Implications – Excreted by kidneys – Assess for hypersensitivity – Contraindicated with uncontrolled ventricular arrhythmias – Hypokalemia increase risk for toxicity – Hypercalcemia increases risk for toxicity – Use with caution with diuretic use as they may cause electrolyte abnormalities that can lead to toxicity – Assess patient for cardiac arrhythmias including bradycardia – Monitor for signs of toxicity (blurred vision, yellow, green vision disturbances) – Monitor pulse rate for 1 full minute before dosing pt (hold HR 60) NCLEX-RN Need to Know Medications A patient who will begin taking colchicine for gout reports taking nonsteroidal anti-inflammatory drugs, simvastatin, amoxicillin, and digoxin. What will the nurse do? A. Contact the provider to discuss using a different antibiotic while this patient is taking colchicine. B. Notify the provider about the potential risk of muscle injury when simvastatin is taken with colchicine. C. Request an order for cardiorespiratory monitoring, because the patient is taking digoxin. D. Suggest that the nonsteroidal anti-inflammatory drugs (NSAIDs) be withdrawn during colchicine therapy. NCLEX-RN Need to Know Medications A patient who will begin taking colchicine for gout reports taking nonsteroidal anti-inflammatory drugs, simvastatin, amoxicillin, and digoxin. What will the nurse do? A. Contact the provider to discuss using a different antibiotic while this patient is taking colchicine. B. Notify the provider about the potential risk of muscle injury when simvastatin is taken with colchicine. C. Request an order for cardiorespiratory monitoring, because the patient is taking digoxin. D. Suggest that the nonsteroidal anti-inflammatory drugs (NSAIDs) be withdrawn during colchicine therapy. NCLEX-RN Need to Know Medications DILTIAZEM • MOA – Calcium-channel blocker (antianginal, antiarrhythmic, antihypertensive) – inhibits calcium transport resulting in inhibition of excitation and contraction, leads to depression of AV and SA node leading to decreased HR, leads to vasodilation and decreased BP • Indications – HTN, angina, SVT, A-Fib, A-Flutter • Nursing Implications – Contraindicated in 2nd and 3rd AV block – May cause arrhythmias, CHF, bradycardia, peripheral edema, gingival hyperplasia – Increases digoxin levels – Avoid grapefruit juice – Assess for signs CHF – Monitor EKG – Pt should change positions slowly – Monitor K+ – Instruct pt how to take BP NCLEX-RN Need to Know Medications DIPHENHYDRAMINE • MOA – Antihistamine/antitussive – antagonizes effects of histamine, CNS depression • Indications – Allergy, anaphylaxis, sedation, motion sickness, antitussive • Nursing Implications – May cause drowsiness, anorexia, dry mouth, nausea, chest tightness, thick secretions, hypotension, blurred vision, headache – Anticholinergic effects – Assess purpose of medication prior to giving it – Assess allergies, sleep patterns, cough and lung sounds – Patient should avoid other over- the-counter cough and cold remedies NCLEX-RN Need to Know Medications DIPHENOXYLATE/ATROPINE • MOA – Anticholinergic, antidiarrheal – inhibits GI motility via anticholinergic effects • Indications – Treatment for diarrhea • Nursing Implications – Contraindicated in angle- closure glaucoma, dehydration – Structurally related to opioids so use caution with patients that have allergies to opioids – Side effects: constipation, tachycardia, dizziness, ileus – Monitor LFTs NCLEX-RN Need to Know Medications DIVALPROEX (VALPROIC ACID DERIVATIVE) • MOA – Anticonvulsant – increases the level of GABA in CNS • Indications – Seizures, manic episodes, prevention of headache • Nursing Implications – May cause suicidal thoughts, agitation, dizziness, insomnia, hepatotoxicity, pancreatitis – Increases risk for bleeding with warfarin – Use caution with MAOIs – Monitor LFTs NCLEX-RN Need to Know Medications DOBUTAMINE • MOA – Beta-adrenergic agonist (inotropic) – positive inotropic effect (increases cardiac output) with very little effect on heart rate – stimulates Beta1 receptors in the heart • Indications – Short-term management of heart failure • Nursing Implications – Monitor hemodynamics: HTN, increased HR, PVCs – Skin reactions may occur with hypersensitivity – Beta blockers may negate therapeutic effects of dobutamine – Monitor cardiac output – Monitor peripheral pulses before, during and after therapy – DO NOT confuse dobutamine with dopamine NCLEX-RN Need to Know Medications A patient is receiving dobutamine as a continuous infusion in the immediate postoperative period.The patient also is receiving a diuretic. What adverse drug reactions are possible in this patient? (Select all that apply.) A. Angina B. Dysrhythmias C. Hypotension D. Oliguria E. Tachycardia NCLEX-RN Need to Know Medications A patient is receiving dobutamine as a continuous infusion in the immediate postoperative period.The patient also is receiving a diuretic. What adverse drug reactions are possible in this patient? (Select all that apply.) A. Angina B. Dysrhythmias C. Hypotension D. Oliguria E. Tachycardia NCLEX-RN Need to Know Medications DOPAMINE • MOA – Adrenergic (inotropic, vasopressor) – smaller doses result in renal vasodilation; doses 2-10 mcg/kg/min result in cardiac stimulation by acting on beta1 receptors; doses 10 mcg/kg/min stimulate alpha receptors leading to vasoconstriction (increases SVR) • Indications – Improve BP, cardiac output and urine output • Nursing Implications – Monitor hemodynamics closely: BP, HR, EKG, CVP, PAOP – Obtain parameters for hemodynamic values – Titrate to obtain appropriate BP (more potent vasoconstrictors may be required) – Irritation may occur at IV site – Beta blockers may counteract therapeutic effects NCLEX-RN Need to Know Medications ENALAPRIL • MOA – ACE inhibitor (antihypertensive) – blocks conversion of angiotensin I to angiotensin II, increases renin levels and decreased aldosterone leading to vasodilation • Indications – HTN, management of CHF • Nursing Implications – Can cause neutropenia – check WBCs regularly – Use cautiously with K+ supplements and potassium sparing diuretics – Use cautiously with diuretic therapy – Administer 1 hour before meals – Monitor BP and daily weights – Monitor renal profile – Note SE of dry cough NCLEX-RN Need to Know Medications ENOXAPARIN • MOA – Antithrombotic (anticoagulant) – prevents thrombus formation by potentiating the inhibitory effect of antithrombin on factor Xa and thrombin • Indications – Prevention of DVT/PE • Nursing Implications – Contraindicated in pork hypersensitivity – Monitor for signs of bleeding – Administer in subcutaneous tissue (far left/right abdomen) – DO NOT eject air bubble prior to injection – DO NOT aspirate or massage site – D/C 12-24 hours before surgery NCLEX-RN Need to Know Medications A patient has been receiving heparin while in the hospital to treat deep vein thromboses and will be discharged home with a prescription for enoxaparin.The nurse provides teaching for the nursing student who asks about the advantages of enoxaparin over heparin.Which statement by the student indicates a need for further teaching? A. “Enoxaparin does not require coagulation monitoring.” B. “Enoxaparin has greater bioavailability than heparin.” C. “Enoxaparin is more cost-effective than heparin.” D. “Enoxaparin may be given using a fixed dosage.” NCLEX-RN Need to Know Medications A patient has been receiving heparin while in the hospital to treat deep vein thromboses and will be discharged home with a prescription for enoxaparin.The nurse provides teaching for the nursing student who asks about the advantages of enoxaparin over heparin.Which statement by the student indicates a need for further teaching? A. “Enoxaparin does not require coagulation monitoring.” B. “Enoxaparin has greater bioavailability than heparin.” C. “Enoxaparin is more cost-effective than heparin.” D. “Enoxaparin may be given using a fixed dosage.” NCLEX-RN Need to Know Medications EPINEPHRINE • MOA – Adrenergic agonist (antiasthmatic, bronchodilator, vasopressor) – affects both beta1 and beta2 also alpha agonist properties – results in bronchodilation, increases HR and BP • Indications – Asthma and COPD exacerbations, allergic reactions, cardiac arrest, anesthesia adjunct • Nursing Implications – S/E: angina, tachycardia, HTN, restlessness, nervousness, hyperglycemia – Use with MAOI may lead to hypertensive crisis – Patients should not use stimulants (caffeine, guarana, etc.) – Excessive use may cause bronchospasm – Assess lung sounds, HR, BP – Monitor for chest pain – Increase fluids to liquefy secretions – Mouth should be rinsed post inhalation – Beta blocker may negate effects – May increase blood glucose levels NCLEX-RN Need to Know Medications A nurse is caring for a patient who has been taking low-dose aspirin for several days.The nurse notes that the patient has copious amounts of watery nasal secretions and an urticarial rash.The nurse will contact the provider to discuss: A. administering epinephrine. B. changing to a first-generation NSAID. C. reducing the dose of aspirin. D. giving an antihistamine. NCLEX-RN Need to Know Medications A nurse is caring for a patient who has been taking low-dose aspirin for several days.The nurse notes that the patient has copious amounts of watery nasal secretions and an urticarial rash.The nurse will contact the provider to discuss: A. administering epinephrine. B. changing to a first-generation NSAID. C. reducing the dose of aspirin. D. giving an antihistamine. NCLEX-RN Need to Know Medications EPOETIN • MOA – Hormones (antianemic) – stimulates erythropoiesis • Indications – Anemia • Nursing Implications – Contraindicated in albumin hypersensitivity – May cause seizures, CHF, MI, CVA, HTN – Monitor BP during therapy – Monitor for signs of anemia – Assess HD shunts – Monitor bleeding times – Initiate seizure precautions – Do not shake vial NCLEX-RN Need to Know Medications ERYTHROMYCIN • MOA – Macrolide (anti-infective) – suppresses bacterial protein synthesis, bacteriostatic • Indications – Useful in place of penicillin when patient cannot take penicillin, upper and lower respiratory tract infections, otitis media, skin infections, pertussis, syphilis, rheumatic fever • Nursing Implications – Causes QT prolongation, ventricular arrhythmias – Diarrhea – Assess infection – Monitor LFTs – Instruct pt to complete course even if feeling better – Medication should not be shared NCLEX-RN Need to Know Medications ESCITALOPRAM • MOA – SSRI (antidepressant) – selectively inhibits reuptake of serotonin • Indications – Major depressive disorder, anxiety disorder, OCD, PTSD, social phobia • Nursing Implications – Contraindicated with MAOI – May cause suicidal thoughts, insomnia, drowsiness, diarrhea, nausea, serotonin syndrome – May cause QT prolongation with certain medications – Assess for sexual dysfunction – May take 4-6 weeks for full effect to take place NCLEX-RN Need to Know Medications FAMOTIDINE • MOA – Histamine H2 antagonist (antiulcer agent) – blocks action of histamine located in gastric parietal cells, inhibits gastric acid secretion • Indications – Short-term treatment of active ulcer, GERD, treatment of heartburn, indigestion, Zollinger Ellison syndrome, prevention of GIB in critically-ill pts, management of sx associated with overuse of NSAIDs • Nursing Implications – May cause arrhythmias, agranulocytosis, aplastic anemias – Assess for abdominal pain and occult blood – Monitor CBC – Instruct pt to increase fluid and fiber intake to prevent constipation NCLEX-RN Need to Know Medications FENTANYL • MOA – Opioid agonist (opioid analgesic) – binds to opiate receptors in CNS altering perception of pain, producing CNS depression • Indications – Supplement to general anesthesia, continuous IV infusion for purpose of analgesia • Nursing Implications – Use caution with increased ICP, head trauma, adrenal insufficiency – Avoid use with MAOIs – May cause apnea, laryngospasm, decreased respirations, bradycardia, hypotension – Do not consume grapefruit juice while taking – Monitor hemodynamics and assess pain frequently NCLEX-RN Need to Know Medications An adult male patient is 1 day postoperative from a total hip replacement. On a pain scale of 0 to 10, with 10 being the greatest pain, the patient reports a pain level of 10.Which medication would be most appropriate for the nurse to administer to this patient? A. 60 mg morphine sulfate PO B. 75 mg meperidine [Demerol] intramuscularly C. 6 mg morphine sulfate intravenously D. Fentanyl [Duragesic] patch 50 mcg transdermally NCLEX-RN Need to Know Medications An adult male patient is 1 day postoperative from a total hip replacement. On a pain scale of 0 to 10, with 10 being the greatest pain, the patient reports a pain level of 10.Which medication would be most appropriate for the nurse to administer to this patient? A. 60 mg morphine sulfate PO B. 75 mg meperidine [Demerol] intramuscularly C. 6 mg morphine sulfate intravenously D. Fentanyl [Duragesic] patch 50 mcg transdermally NCLEX-RN Need to Know Medications FERROUS SULFATE • MOA – Iron supplement (antianemic) – iron is essential for hemoglobin, myoglobin and enzymes – it is transported to organs where it becomes part of iron stores • Indications – Prevention and treatment of iron- deficiency anemia • Nursing Implications – May cause seizures, hypotension, constipation, epigastric pain, diarrhea, skin staining, anaphylaxis – Assess nutritional status, bowel function – Monitor HGB, HCT, Fe levels – May cause elevated liver enzymes – Take on empty stomach and with vitamin C to increase absorption – injections NCLEX-RN Need to Know Medications FLUOXETINE • MOA – SSRI (antidepressant) – inhibits reuptake of serotonin • Indications – Depressive disorder, OCD, bulimia, panic disorder, bipolar disorder, anorexia, ADHD, DM neuropathy, obesity • Nursing Implications – Do not use if taking MAOIs – May cause suicidal thoughts, drowsiness, anxiety, sexual dysfunction, insomnia, palpitations – Monitor closely for serotonin syndrome – Concurrent use with certain medications may lead to QT prolongation – Monitor for mood changes, suicidal ideation, nutritional status – May cause elevated LFTs – Instruct to maintain good oral hygiene NCLEX-RN Need to Know Medications FLUTICASONE • MOA – Corticosteroid (antiasthmatic, anti- inflammatory) – locally acting anti- inflammatory • Indications – Prophylactic asthma treatment • Nursing Implications – Use cautiously with untreated infections and suppressed immune function – May cause headache, insomnia, bronchospasm, nasal congestion, adrenal suppression – Monitor respiratory status – May lead to decreased bone density – Instruct pts using corticosteroids and bronchodilators to use bronchodilators first – Instruct to stop smoking NCLEX-RN Need to Know Medications FUROSEMIDE • MOA – Loop diuretic – prevents reabsorption of sodium and chloride in the kidneys, increase excretion of water, sodium chloride, magnesium, potassium • Indications – Edema, hypertension • Nursing Implications – Use caution with liver disease – May cause hypotension, dry mouth, excessive urination, dehydration, electrolyte abnormalities, metabolic alkalosis – Hypokalemia may lead to increased risk of digoxin toxicity – Monitor renal function – Use caution with other – NCLEX-RN Need to Know Medications GABAPENTIN • MOA – Analgesic adjunct, anticonvulsant, mood stabilizer • Indications – Seizures, peripheral neuropathy, neuropathic pain, prevention of migraines • Nursing Implications – May cause suicidal thoughts, confusion, depression, drowsiness, ataxia, facial edema, hypertension – Monitor pt closely for changes in behavior and depression – Assess for seizure activity – Assess pain level – Patient should take medication exactly as prescribed NCLEX-RN Need to Know Medications GENTAMYCIN • MOA – Aminoglycoside (anti-infective) – inhibits bacterial protein synthesis • Indications – Treatment of gram negative infections when penicillin is ineffective • Nursing Implications – Causes tinnitus – hearing loss/do not administer with penicillin – Use caution in renal impairment – Assess for infection – Obtain cultures prior to therapy – Monitor LFTs – Monitor blood levels of drug NCLEX-RN Need to Know Medications GLIPIZIDE • MOA – Stimulates release and sensitivity to insulin to lower blood glucose (anti-diabetic – sulfonylurea) • Indication – Type 2 Diabetes Mellitus • Nursing Implications – May cause aplastic anemia, hypoglycemia, photosensitivity, dizziness, headache, diarrhea – Monitor CBC – Assess for allergy to sulfonamides – Beta Blockers may create signs of hypoglycemia – Instruct on checking blood sugar can carrying source of sugar in case of hypoglycemia NCLEX-RN Need to Know Medications A patient who has type 2 diabetes will begin taking glipizide.Which statement by the patient is concerning to the nurse? A. “I will begin by taking this once daily with breakfast.” B. “It is safe to drink grapefruit juice while taking this drug.” C. “I may continue to have a glass of wine with dinner.” D. “I will need to check my blood sugar once daily or more.” NCLEX-RN Need to Know Medications A patient who has type 2 diabetes will begin taking glipizide.Which statement by the patient is concerning to the nurse? A. “I will begin by taking this once daily with breakfast.” B. “It is safe to drink grapefruit juice while taking this drug.” C. “I may continue to have a glass of wine with dinner.” D. “I will need to check my blood sugar once daily or more.” NCLEX-RN Need to Know Medications GLUCAGON • MOA – Stimulates production of glucose and relaxes GI tract (hormone – pancreatic) • Indications – Severe hypoglycemia, antidote for Beta Blockers and Calcium Channel Blockers • Nursing Considerations – Many cause anaphylaxis – May cause hypotension – Assess for signs of hypoglycemia and neuro status – Monitor serum glucose levels – Teach patient signs of hypoglycemia NCLEX-RN Need to Know Medications GUAIFENESIN • MOA – Decreases viscosity of and mobilizes secretions (expectorant) • Indications – Cough suppression – Expectorant • Nursing Implications – Patient should avoid OTC cold medications – Assess lung sounds – Maintain adequate fluid intake NCLEX-RN Need to Know Medications HALOPERIDOL • MOA – Alters effect of dopamine (antipsychotic – butyrophenone) • Indications – Schizophrenia – Mania – Aggressive and agitated patient • Nursing Implications – Extrapyramidal symptoms – Use caution in QT prolongation – May cause seizures, constipation, dry mouth, agranulocytosis – Assess for hallucinations – Monitor hemodynamics – Monitor for neuroleptic malignant syndrome – Monitor CBC with differential NCLEX-RN Need to Know Medications NCLEX-RN Need to Know Medications A patient with schizophrenia has been taking an antipsychotic drug for several days.The nurse enters the patient’s room to administer a dose of haloperidol and finds the patient having facial spasms.The patient’s head is thrust back, and the patient is unable to speak.What will the nurse do? A. Administer the haloperidol as ordered. B. Discuss increasing the haloperidol dose with the provider. C. Request an order to give diphenhydramine. D. Request an order to give levodopa. NCLEX-RN Need to Know Medications A patient with schizophrenia has been taking an antipsychotic drug for several days.The nurse enters the patient’s room to administer a dose of haloperidol and finds the patient having facial spasms.The patient’s head is thrust back, and the patient is unable to speak.What will the nurse do? A. Administer the haloperidol as ordered. B. Discuss increasing the haloperidol dose with the provider. C. Request an order to give diphenhydramine. D. Request an order to give levodopa. NCLEX-RN Need to Know Medications HEPARIN • MOA – Increases inhibitory effect of antithrombin on factor Xa (anticoagulant/antithromboti c) • Indications – Venous thromboembolism prophylaxis and treatment – Low-dose used to ensure patency of IV catheters • Nursing Implications – Monitor for signs of bleeding – Monitor platelet count – May cause hypokalemia – Teach patient to report any signs of bleeding NCLEX-RN Need to Know Medications HYDRALAZINE • MOA – Arterial vasodilator (anti- hypertensive – vasodilator) • Indications – Hypertension • Nursing Implications – May cause tachycardia, sodium retention, arrhythmias, angina – Use caution with MAOIs – Monitor BP – Instruct patient on how to take BP NCLEX-RN Need to Know Medications HYDROCHLOROTHIAZIDE • MOA – Increases sodium and water excretion and produces arterial dilation (antihypertensive – thiazide diuretic) • Indications – Hypertension – CHF – Renal dysfunction – Cirrhosis – Glucocorticoid therapy • Nursing Implications – May cause dizziness, hypokalemia, hyponatremia, hypophosphatemia, hypomagnesemia, dehydration – Hypokalemia can increase risk for digoxin toxicity – Monitor BP and I&Os – Monitor electrolyte levels – Patient should take medication at the same time each day even if feeling better – Education pt on how to take BP NCLEX-RN Need to Know Medications HYDROCODONE/ACETAMINO PHEN • MOA – Alters the perception and reaction to pain by binding to opiate receptors in the CNS and also suppresses cough reflex (opioid agonist/nonopioid analgesic combination) • Indications – Management of moderate to severe pain • Nursing Implications – Use caution with concurrent use of MAOI – avoid use within 14 days of each other – Hypotension – monitor hemodynamics and respirations after administration – May cause ICP – use caution with head trauma – Naloxone in the antidote for overdose – Do not exceed 4g of acetaminophen per day NCLEX-RN Need to Know Medications HYDROMORPHONE • MOA – Alters the perception and reaction to pain by binding to opiate receptors in the CNS and suppresses cough reflex (opioid analgesic – opioid agonist) • Indications – Moderate to severe pain • Nursing Implications – Assess BP, respirations, and pulse before administration – medication causes general CNS depression – Naloxone is antidote for overdose – Use caution with concurrent use of MAOI – avoid use within 14 days of each other – May be used as antitussive – Advised to dilute with NS prior to administration and to administer slowly in CNS depression NCLEX-RN Need to Know Medications IBUPROFEN • MOA – Decreases pain and inflammation by inhibiting prostaglandins (nonsteroidal anti-inflammatory drug – nonopioid analgesics) • Indications – Mild to moderate pain – Inflammatory states • Nursing Implications – May cause GI bleeding, hepatitis, Stevens-Johnson Syndrome – May cause anaphylaxis – Monitor for headache, nausea, vomiting, constipation – Therapy should be discontinued after first sign of rash – Monitor renal and liver labs – Patient should avoid using alcohol NCLEX-RN Need to Know Medications INDOMETHACIN • MOA – Decreases pain and inflammation by inhibiting prostaglandin synthesis (antirheumatic, ductus arteriosis adjunct-IV, NSAID) • Indications – Inflammatory disorders when patients do not respond to other medications • Nursing Implications – Monitor for hepatitis and GI bleeding – Monitor for dizziness, drowsiness, and headache – ASA may decrease effectiveness – Monitor renal labs – Shake suspension before administration – Patient should wear sunscreen and protective clothing to protect against photosensitivity NCLEX-RN Need to Know Medications REGULAR INSULIN Route: Subcutaneous Onset: 30-45 mins Peak: 1.5-2.5 hrs Duration: 4.5-6 hrs • MOA – Stimulates uptake of glucose into muscle and fat cells, inhibits production of glucose in the liver, prevents breakdown of fat and protein (antidiabetic, pancreatic hormone) • Indications – Hyperglycemia with T1/T2 DM; diabetic ketoacidosis • Nursing Implications – Assess for symptoms of hypoglycemia or hyperglycemia – Monitor body weight over time – May cause decreased inorganic phosphates, potassium, and magnesium – Monitor blood sugars every 6 hours, monitor HgbA1C every 3-6 months NCLEX-RN Need to Know Medications NPH INSULIN • MOA – Stimulates uptake of glucose into muscle and fat cells, inhibits production of glucose in the liver, prevents breakdown of fat and protein (antidiabetic, pancreatic hormone) • Indications – Hyperglycemia with T1/T2 DM, diabetic ketoacidosis Route: Subcutaneous Onset: 1-2 hrs Peak: 4-12 hrs Duration: 18-24 hrs • Nursing Implications – Assess for symptoms of hypoglycemia or hyperglycemia – Monitor body weight over time – May cause decreased inorganic phosphates, potassium, and magnesium – Monitor blood sugars every 6 hours and HgbA1C every 3-6 months NCLEX-RN Need to Know Medications DETEMIR/GLARGINE INSULIN Determir Onset: 3-4 hrs Peak: 3-4 hrs Duration: 24 hrs Glargine Onset: 3-4 hrs Peak: NONE Duration: 24 hrs • MOA – Stimulates uptake of glucose into muscle and fat cells, inhibits production of glucose in the liver, prevents breakdown of fat and protein (antidiabetic, pancreatic hormone) • Indications – Hyperglycemia with T1/T2 DM, diabetic ketoacidosis • Nursing Implications – Assess for symptoms of hypoglycemia or hyperglycemia – Monitor body weight over time – May cause decreased inorganic phosphates, potassium, and magnesium – Monitor blood sugars every 6 hours and HgbA1C every 3-6 months NCLEX-RN Need to Know Medications ASPART/LISPRO/GLULISINE INSULIN • MOA – Stimulates uptake of glucose into muscle and fat cells, inhibits production of glucose in the liver, prevents breakdown of fat and protein (antidiabetic, pancreatic hormone) • Indications – Hyperglycemia with T1/T2 DM, diabetic ketoacidosis • Nursing Implications – Assess for symptoms of hypoglycemia or hyperglycemia – Monitor body weight over time – May cause decreased inorganic phosphates, potassium, and magnesium – Monitor blood sugars every 6 hours and HgbA1C every 3-6 months NCLEX-RN Need to Know Medications NCLEX-RN Need to Know Medications LISPRO/ASPART/NPH-REGULAR INSULIN MIXTURES • MOA – Stimulates uptake of glucose into muscle and fat cells, inhibits production of glucose in the liver, prevents breakdown of fat and protein (antidiabetic, pancreatic hormone) • Indications – Hyperglycemia with T1/T2 DM, diabetic ketoacidosis • Nursing Implications – Assess for symptoms of hypoglycemia or hyperglycemia – Monitor body weight over time – May cause decreased inorganic phosphates, potassium, and magnesium – Monitor blood sugars every 6 hours and HgbA1C every 3-6 months NCLEX-RN Need to Know Medications NCLEX-RN Need to Know Medications A patient with type 1 diabetes is eating breakfast at 7:30 AM. Blood sugars are on a sliding scale and are ordered before a meal and at bedtime.The patient’s blood sugar level is 317 mg/dL.Which formulation of insulin should the nurse prepare to administer? A. No insulin should be administered. B. NPH C. 70/30 mix D. Lispro NCLEX-RN Need to Know Medications A patient with type 1 diabetes is eating breakfast at 7:30 AM. Blood sugars are on a sliding scale and are ordered before a meal and at bedtime.The patient’s blood sugar level is 317 mg/dL.Which formulation of insulin should the nurse prepare to administer? A. No insulin should be administered. B. NPH C. 70/30 mix D. Lispro NCLEX-RN Need to Know Medications IODINE • MOA – Inhibits the release