PHARM FINAL REVIEWSTUDY GUIDE
SUMMER 2021
Calcium Citrate
Oral calcium supplements are used for clients who have hypocalcemia or deficiencies
of parathyroid hormone, vitamin D, or dietary calcium.
o Hypocalcemia SS - numbness/ tingling around the mouth, spasms, or seizures, muscle
twitching, cardiac dysrhythmias.
Oral dietary supplements are used for adolescents, older adults, and clients who
are postmenopausal, pregnant, or breastfeeding.
IV medications are used for clients who have critically low levels of calcium.
Oral vitamin D supplements can assist with the absorption of dietary calcium.
Calcium and vitamin D supplements used in conjunction with calcitonin, or a
bisphosphonate can reduce the risk of osteoporosis.
Monitor blood calcium levels to maintain between 9 and 10.5 mg/dL.
Depending on therapeutic intent, effectiveness is evidenced by blood calcium level within
expected reference range: 9 to 10.5 mg/dL – Patient reports of decrease paresthesias as
a therapeutic response of the medication (calcium levels are increasing)
The nurse should assess for hypercalcemia –
o Calcium level greater than 10.5 mg/dL
o FINDINGS: Initially, tachycardia and elevated blood pressure eventually leading to
bradycardia and hypotension. Other findings include muscle weakness, hypotonia,
constipation, nausea, vomiting, abdominal pain, lethargy, and confusion.
o Medications used to reverse hypercalcemia include IV furosemide, and
calcium chelators (plicamycin).
o Medications used to prevent hypercalcemia include bisphosphonates (alendronate
and oral inorganic phosphates).
Clozapine
The first atypical antipsychotic developed. Despite its effectiveness for schizophrenia spectrum
disorders, it is no longer considered a first-line medication because of its serious adverse effects.
Complications
o Low risk of EPS
o High risk of weight gain, diabetes mellitus, dyslipidemia
o Agranulocytosis can occur. Obtain baseline WBC and monitor weekly, bi-
weekly, to monthly per protocol.
o The nurse should review the client’s total cholesterol before because this
medication can cause hyperlipidemia
o Monitor for indications of infection (fever, sore throat, lesions in mouth), and notify
the provider if manifestations occur.
o Other adverse effects: sedation, hypersalivation, orthostatic hypotension,
and anticholinergic effects
o Pregnancy Risk Category B
PHARM FINAL REVIEWSTUDY GUIDE
SUMMER 2021 pg. 1
,PHARM FINAL REVIEWSTUDY GUIDE
SUMMER 2021
Zolpidem
Take medication allowing for at least 8 hr. of sleep.
More rapid absorption occurs when the medication is taken when the stomach is empty.
Avoid alcohol and other CNS depressants.
Take the medication just before bedtime.
Use medication for a short period of time
Depending on therapeutic intent, effectiveness can be evidenced by effective sleep pattern.
Ferrous Sulfate
Vitamin C (orange juice) increases absorption, but also increases incidence of GI
complications.
Medical error – incident report
Common medication errors:
Wrong medication or IV fluid
Incorrect dose or IV rate
Wrong client, route, or time
Administration of known allergic medication.
Omission of dose
Incorrect discontinuation of medication or IV fluid
Notify the provider of all errors and implement corrective measures immediately.
o Complete an incident report within the time frame the facility specifies, usually
24 hr. This report should include:
Client’s identification
Name and dose of the medication
Time and place of the incident
Accurate and objective account of the event
Who you notified.
What actions you took
Your signature (or that of the person who completed the report)
Do not reference or include the incident report in the client’s medical record.
Medication errors relate to systems, procedures, product design, or practice patterns.
Report all errors to help the facility’s risk managers determine how errors occur and
what changes to make to avoid similar errors in the future.
PHARM FINAL REVIEWSTUDY GUIDE
SUMMER 2021 pg. 2
,PHARM FINAL REVIEWSTUDY GUIDE
SUMMER 2021
Digoxin
This medication slows and strengthens the heart (harder squeeze and more time to fill)
Effects – dysrhythmias, cardiotoxicity GI effects, CNS effects
Therapeutic serum level 0.5-2.0
Conditions that increase the risk of developing digoxin-induced dysrhythmias include
hypokalemia, increased blood digoxin levels, and heart disease. Older adult clients
are particularly at risk.
Instruct clients to observe for indications of digoxin toxicity (fatigue, weakness, vision changes,
GI effects), and to notify the provider if they occur.
Do not give to patients with a disturbance in ventricular rhythm, or an AV block.
Do not give with thiazide diuretics, ACE and ARB inhibitors, and antacids.
Check pulse rate and rhythm before administration of digoxin and record. Notify the provider
if heart rate is less than 60/min in an adult, less than 70/min in children, and less than 90/min
in infants.
Administer digoxin at the same time daily.
Evaluate manifestations and the client’s digoxin level when toxicity is suspected.
MANAGEMENT OF DIGOXIN TOXICITY
o Stop digoxin and potassium-wasting diuretics immediately.
o Monitor K+ levels. For levels less than 3.5 mEq/L, administer potassium IV or by
mouth. Do not give any further K+ if the level is greater than 5.0 mEq/L or AV block is
present.
o Treat dysrhythmias with phenytoin or lidocaine.
o Treat bradycardia with atropine.
o For excessive toxicity, activated charcoal, cholestyramine, or digoxin immune
Fab(DIGIBIND) can be used to bind digoxin and prevent absorption.
Normal sinus rhythm to identify that antidote was effective
Neuroleptic Malignant Syndrome (Complications of antipsychotic medications)
Manifestations include sudden high-grade fever, blood pressure fluctuations (either hypo or
hypertension), dysrhythmias, muscle rigidity, diaphoresis, tachycardia, and change in level
of consciousness developing into coma.
NURSING ACTIONS
o Stop antipsychotic medication.
o Monitor vital signs.
o Apply cooling blankets.
o Administer antipyretics (aspirin, acetaminophen).
o Increase fluid intake.
o Administer diazepam to control anxiety.
o Administer dantrolene and bromocriptine to induce muscle relaxation.
o Administer medication as prescribed to treat dysrhythmias.
o Assist with immediate transfer to intensive care.
o Wait 2 weeks before resuming therapy. Consider switching to an atypical agent.
PHARM FINAL REVIEWSTUDY GUIDE
SUMMER 2021 pg. 3
, PHARM FINAL REVIEWSTUDY GUIDE
SUMMER 2021
Calcium Gluconate (IV administration)
Note – reverse severe hypotension caused by verapamil with calcium gluconate, given slowly
IV. The calcium counteracts vasodilation caused by
verapamil. Interventions
Concurrent use of glucocorticoids reduces absorption of calcium.
o NURSING ACTIONS: Give at least 1 hr. apart.
Concurrent use of calcium decreases absorption of tetracyclines and thyroid hormone.
o NURSING ACTIONS: Ensure 1 hr. between administration of tetracyclines and
calcium and at least 4 hr. between the administration of thyroid hormone and
calcium.
Concurrent administration of thiazide diuretics increases risk of hypercalcemia.
o NURSING ACTIONS: Assess for hypercalcemia. Avoid concurrent use.
Spinach, rhubarb, beets, bran, and whole grains can decrease calcium absorption.
o NURSING ACTION: Do not administer calcium with foods that decrease absorption.
Instruct clients to avoid consuming these foods at the same time as taking
calcium.
IV calcium precipitates with phosphates, carbonates, sulfates, and tartrates.
o NURSING ACTIONS: Do not mix parenteral calcium with compounds that
cause precipitation.
Concurrent use of digoxin and parenteral calcium can lead to severe bradycardia.
o NURSING ACTIONS: IV injection of calcium must be given slowly with careful
monitoring of client cardiac status.
Anaphylaxis
Anaphylaxis is a life-threatening, immediate systemic reaction caused from an allergic
response to a medication, dye, food, or insect bit or sting.
Manifestations of anaphylaxis can start with anxiety, weakness, generalized itching and hives
that progress to erythema and angioedema of the head and neck.
Crackles, wheezing, decreased breath sounds, a feeling of a lump in the throat, hoarseness,
and stridor can develop into a life-threatening condition that results in respiratory failure,
hypoxemia, hypotension, tachycardia, and death.
Patient going home with an Epi-Pen should be instructed that it is only ONE injection. Keep it
at ALL times and give it IM. Massage the site afterwards.
NURSING ACTIONS
o Prevention and rapid intervention are vital to avoid a fatal outcome. If the allergy is
known, the client should wear a medical alert bracelet. The client should have
available at all times injectable epinephrine.
o Stop the medication immediately if that is the antigen and notify the Rapid Response
team.
o Establish an airway to maintain ventilation. Administer bronchodilators if needed.
o Treat with epinephrine IM or IV to constrict blood vessels, improve cardiac
PHARM FINAL REVIEWSTUDY GUIDE
SUMMER 2021 pg. 4
SUMMER 2021
Calcium Citrate
Oral calcium supplements are used for clients who have hypocalcemia or deficiencies
of parathyroid hormone, vitamin D, or dietary calcium.
o Hypocalcemia SS - numbness/ tingling around the mouth, spasms, or seizures, muscle
twitching, cardiac dysrhythmias.
Oral dietary supplements are used for adolescents, older adults, and clients who
are postmenopausal, pregnant, or breastfeeding.
IV medications are used for clients who have critically low levels of calcium.
Oral vitamin D supplements can assist with the absorption of dietary calcium.
Calcium and vitamin D supplements used in conjunction with calcitonin, or a
bisphosphonate can reduce the risk of osteoporosis.
Monitor blood calcium levels to maintain between 9 and 10.5 mg/dL.
Depending on therapeutic intent, effectiveness is evidenced by blood calcium level within
expected reference range: 9 to 10.5 mg/dL – Patient reports of decrease paresthesias as
a therapeutic response of the medication (calcium levels are increasing)
The nurse should assess for hypercalcemia –
o Calcium level greater than 10.5 mg/dL
o FINDINGS: Initially, tachycardia and elevated blood pressure eventually leading to
bradycardia and hypotension. Other findings include muscle weakness, hypotonia,
constipation, nausea, vomiting, abdominal pain, lethargy, and confusion.
o Medications used to reverse hypercalcemia include IV furosemide, and
calcium chelators (plicamycin).
o Medications used to prevent hypercalcemia include bisphosphonates (alendronate
and oral inorganic phosphates).
Clozapine
The first atypical antipsychotic developed. Despite its effectiveness for schizophrenia spectrum
disorders, it is no longer considered a first-line medication because of its serious adverse effects.
Complications
o Low risk of EPS
o High risk of weight gain, diabetes mellitus, dyslipidemia
o Agranulocytosis can occur. Obtain baseline WBC and monitor weekly, bi-
weekly, to monthly per protocol.
o The nurse should review the client’s total cholesterol before because this
medication can cause hyperlipidemia
o Monitor for indications of infection (fever, sore throat, lesions in mouth), and notify
the provider if manifestations occur.
o Other adverse effects: sedation, hypersalivation, orthostatic hypotension,
and anticholinergic effects
o Pregnancy Risk Category B
PHARM FINAL REVIEWSTUDY GUIDE
SUMMER 2021 pg. 1
,PHARM FINAL REVIEWSTUDY GUIDE
SUMMER 2021
Zolpidem
Take medication allowing for at least 8 hr. of sleep.
More rapid absorption occurs when the medication is taken when the stomach is empty.
Avoid alcohol and other CNS depressants.
Take the medication just before bedtime.
Use medication for a short period of time
Depending on therapeutic intent, effectiveness can be evidenced by effective sleep pattern.
Ferrous Sulfate
Vitamin C (orange juice) increases absorption, but also increases incidence of GI
complications.
Medical error – incident report
Common medication errors:
Wrong medication or IV fluid
Incorrect dose or IV rate
Wrong client, route, or time
Administration of known allergic medication.
Omission of dose
Incorrect discontinuation of medication or IV fluid
Notify the provider of all errors and implement corrective measures immediately.
o Complete an incident report within the time frame the facility specifies, usually
24 hr. This report should include:
Client’s identification
Name and dose of the medication
Time and place of the incident
Accurate and objective account of the event
Who you notified.
What actions you took
Your signature (or that of the person who completed the report)
Do not reference or include the incident report in the client’s medical record.
Medication errors relate to systems, procedures, product design, or practice patterns.
Report all errors to help the facility’s risk managers determine how errors occur and
what changes to make to avoid similar errors in the future.
PHARM FINAL REVIEWSTUDY GUIDE
SUMMER 2021 pg. 2
,PHARM FINAL REVIEWSTUDY GUIDE
SUMMER 2021
Digoxin
This medication slows and strengthens the heart (harder squeeze and more time to fill)
Effects – dysrhythmias, cardiotoxicity GI effects, CNS effects
Therapeutic serum level 0.5-2.0
Conditions that increase the risk of developing digoxin-induced dysrhythmias include
hypokalemia, increased blood digoxin levels, and heart disease. Older adult clients
are particularly at risk.
Instruct clients to observe for indications of digoxin toxicity (fatigue, weakness, vision changes,
GI effects), and to notify the provider if they occur.
Do not give to patients with a disturbance in ventricular rhythm, or an AV block.
Do not give with thiazide diuretics, ACE and ARB inhibitors, and antacids.
Check pulse rate and rhythm before administration of digoxin and record. Notify the provider
if heart rate is less than 60/min in an adult, less than 70/min in children, and less than 90/min
in infants.
Administer digoxin at the same time daily.
Evaluate manifestations and the client’s digoxin level when toxicity is suspected.
MANAGEMENT OF DIGOXIN TOXICITY
o Stop digoxin and potassium-wasting diuretics immediately.
o Monitor K+ levels. For levels less than 3.5 mEq/L, administer potassium IV or by
mouth. Do not give any further K+ if the level is greater than 5.0 mEq/L or AV block is
present.
o Treat dysrhythmias with phenytoin or lidocaine.
o Treat bradycardia with atropine.
o For excessive toxicity, activated charcoal, cholestyramine, or digoxin immune
Fab(DIGIBIND) can be used to bind digoxin and prevent absorption.
Normal sinus rhythm to identify that antidote was effective
Neuroleptic Malignant Syndrome (Complications of antipsychotic medications)
Manifestations include sudden high-grade fever, blood pressure fluctuations (either hypo or
hypertension), dysrhythmias, muscle rigidity, diaphoresis, tachycardia, and change in level
of consciousness developing into coma.
NURSING ACTIONS
o Stop antipsychotic medication.
o Monitor vital signs.
o Apply cooling blankets.
o Administer antipyretics (aspirin, acetaminophen).
o Increase fluid intake.
o Administer diazepam to control anxiety.
o Administer dantrolene and bromocriptine to induce muscle relaxation.
o Administer medication as prescribed to treat dysrhythmias.
o Assist with immediate transfer to intensive care.
o Wait 2 weeks before resuming therapy. Consider switching to an atypical agent.
PHARM FINAL REVIEWSTUDY GUIDE
SUMMER 2021 pg. 3
, PHARM FINAL REVIEWSTUDY GUIDE
SUMMER 2021
Calcium Gluconate (IV administration)
Note – reverse severe hypotension caused by verapamil with calcium gluconate, given slowly
IV. The calcium counteracts vasodilation caused by
verapamil. Interventions
Concurrent use of glucocorticoids reduces absorption of calcium.
o NURSING ACTIONS: Give at least 1 hr. apart.
Concurrent use of calcium decreases absorption of tetracyclines and thyroid hormone.
o NURSING ACTIONS: Ensure 1 hr. between administration of tetracyclines and
calcium and at least 4 hr. between the administration of thyroid hormone and
calcium.
Concurrent administration of thiazide diuretics increases risk of hypercalcemia.
o NURSING ACTIONS: Assess for hypercalcemia. Avoid concurrent use.
Spinach, rhubarb, beets, bran, and whole grains can decrease calcium absorption.
o NURSING ACTION: Do not administer calcium with foods that decrease absorption.
Instruct clients to avoid consuming these foods at the same time as taking
calcium.
IV calcium precipitates with phosphates, carbonates, sulfates, and tartrates.
o NURSING ACTIONS: Do not mix parenteral calcium with compounds that
cause precipitation.
Concurrent use of digoxin and parenteral calcium can lead to severe bradycardia.
o NURSING ACTIONS: IV injection of calcium must be given slowly with careful
monitoring of client cardiac status.
Anaphylaxis
Anaphylaxis is a life-threatening, immediate systemic reaction caused from an allergic
response to a medication, dye, food, or insect bit or sting.
Manifestations of anaphylaxis can start with anxiety, weakness, generalized itching and hives
that progress to erythema and angioedema of the head and neck.
Crackles, wheezing, decreased breath sounds, a feeling of a lump in the throat, hoarseness,
and stridor can develop into a life-threatening condition that results in respiratory failure,
hypoxemia, hypotension, tachycardia, and death.
Patient going home with an Epi-Pen should be instructed that it is only ONE injection. Keep it
at ALL times and give it IM. Massage the site afterwards.
NURSING ACTIONS
o Prevention and rapid intervention are vital to avoid a fatal outcome. If the allergy is
known, the client should wear a medical alert bracelet. The client should have
available at all times injectable epinephrine.
o Stop the medication immediately if that is the antigen and notify the Rapid Response
team.
o Establish an airway to maintain ventilation. Administer bronchodilators if needed.
o Treat with epinephrine IM or IV to constrict blood vessels, improve cardiac
PHARM FINAL REVIEWSTUDY GUIDE
SUMMER 2021 pg. 4
