lOMoAR cPSD| 9085132
NURS 480 EXAM PHARMACOLOGY REVIEW EXAM GUIDE A+
1
➔ Treatment of Hypermagnesemia→
◆ Have CALCIUM GLUCONATE available → ANTIDOTE
◆ When magnesium goes UP → everything goes DOWN→ TOXICITY→
● Decreased HR
● Decreased RR
● Decreased urine output → BELOW < 30 ml/hr
● Absent reflexes
● Altered level of consciousness
○ HAVE CALCIUM GLUCONATE available
◆ When magnesium goes DOWN→ everything goes UP
● Polymorphic Ventricular Tachycardia
● Hypertension
● Hyperreflexia
◆ Magnesium can be very dangerous for the KIDNEYS → Renal Failure→ especially if
Magnesium is increased
➔ Fluid Volume EXCESS
◆ Ex→ If someone has a condition like SIADH→ Retaining water
◆ Ex→ When you're implementing plenty of fluids→ It can cause neck vein distention →
central venous pressure (CVP) is INCREASED
◆ Manifestations→ Cough,dyspnea, crackles, increased BP, tachycardia, tachypnea,
bounding pulse, weight gain, JUGULAR vein distention, pitting edema
● Heart rate of 190/min during sleep
● Periorbital edema
● Crackles upon auscultation
➔ Fluid Volume DEFICIT
◆ CVP is DECREASED→ Patient can be DEHYDRATED
◆ Manifestations→ Weight loss, dry mucous membranes, INCREASED HR and RR, thready
pulse, capillary refill less than 3 seconds, weakness, fatigue, poor skin turgor, orthostatic
hypotension, flattened neck veins
◆ Children→ Sunken Fontanelles, sunken eyes, dry/pale skin, weight loss
➔ LITHIUM→ Bipolar Disorder
◆ Monitor electrolytes→ especially SODIUM → Na+
, lOMoAR cPSD| 9085132
NURS 480 EXAM PHARMACOLOGY REVIEW EXAM GUIDE A+
2
◆ If someone is taking Spironolactone→ retaining Potassium→ K+ → but removing
sodium and can go into LITHIUM TOXICITY
◆ Monitor drug interactions→ NSAIDS
◆ Lithium therapeutic level → 0.4-1.4
◆ Lithium Toxicity→ Increased thirst, vomiting, diarrhea, tremors
◆ Careful with Lithium→ Tremors, Diarrhea, Hypothyroidism
◆ THYROID testing is essential for long term use of Lithium
➔ Hypothyroidism→
◆ Levothyroxine→ Toxicity→ Tremors and Anxiety
● Clinical manifestations
○ Bradycardia
○ Cold intolerance
○ Impaired short term memory
➔ Adverse Reactions→
◆ Gentamicin→ Should worry about KIDNEYS→ Monitor Creatinine, GFR → can cause
Nephrotoxicity → Watch out for Proteinuria
● Serum Creatinine → Females: 0.5-1.1 / Males: 0.6-1.2
● Gentamicin
○ ringing of the ears (tinnitus)
○ complaints of dizziness
◆ Nephrotoxic→ Ibuprofen, Cisplatin, Cyclosporine, Gentamicin, Contrast dye
◆ Hepatotoxicity→ TB medications, Acetaminophen, Aspirin, Statins → CHECK LIVER
● Aspirin in children can cause Reye's Syndrome
◆ Statins→ watch out for LIVER enzymes
◆ Heparin→ Heparin-induced Thrombocytopenia → Platelet levels can go very low
● Antidote for Heparin→ Protamine Sulfate
● When administering Heparin→ monitor aPTT
○ aPTT→ 30-40 sec → check every 4 hours
○ CAN be given to pregnant women
● Administering via deep subq intrafat
○ Small needle: 25 gauge for subq injection
○ Short needle ½ to ⅝ inch
○ Inject into the abdomen above iliac crest→ 5cm (2in) from umbilicus
○ Apply firm pressure for 1 to 2 mins
◆ When administering Coumadin→ monitor PT & INR
● PT→ 11-12.5 sec
● INR→ 0.7-1.8 → Therapeutic level→ 2.0-3.0
● Cannot be given to pregnant women
● Cannot be given with multivitamins → VITAMIN K is the ANTIDOTE for
warfarin
◆ When administering Steroids→ monitor for GLUCOSE levels
, lOMoAR cPSD| 9085132
NURS 480 EXAM PHARMACOLOGY REVIEW EXAM GUIDE A+
3
◆ When on glucocorticoid medications→ Take CALCIUM supplements to prevent
osteoporosis and risk fractures
◆ Any medications that can cause electrolyte imbalances→ Should be in Telemetry
● Measure Input & Output
● Weigh Patient daily
➔ Controlled Substances
◆ Schedule 1→ Schedule 5
◆ Schedule 1 is not particularly used
◆ Schedule 2-5 → you need to have another person verify or witness when you WASTE
● Count each dose of narcotics in inventory
● Match number of available doses
➔ Monitoring and Assessing for PAIN→
◆ Different age groups and scales
● FLACC → 2 months to 7 years
● FACES → 4-16 years
● Numerical
● Behavioral
◆ Even if a patient is on a PCA→ Still need to assess for Pain
◆ Ex→ Sometimes a patient is prescribed a Fentanyl patch→ Have to ask the doctor for
another medication for BREAKTHROUGH pain→ because the patch is removed ONCE
every 72 hours
● Patient’s need to STOP drinking grapefruit juice when using the patch
◆ Epidural→ Epidural/Morphine
● Contraindications→
○ Increased ICP, HYPOTENSION, bleeding disorders, coagulation
problems
● Administering epidural→ Make sure to give bolus before
● When weaning off of epidural→ Make sure they can wiggle their toes and
move well before getting the patient up and walking, if not they can FALL
● Morphine
○ Adverse effect of Morphine →
◆ BLADDER DISTENTION, Urinary retention
○ Allergic reaction→ PRURITUS
○ Increase fluid intake when on Morphine to reduce adverse effects
➔ Gerontological Considerations→
◆ Risk for toxicity is increased for elders especially in cases of POLYPHARMACY→
● Liver and Kidneys are not able to work properly→ should be very worried
about Liver and Kidney toxicity → dosage based on AGE
● Signs and Symptoms of toxicity can be falsely mistaken for elder age, rather
than adverse reactions
NURS 480 EXAM PHARMACOLOGY REVIEW EXAM GUIDE A+
1
➔ Treatment of Hypermagnesemia→
◆ Have CALCIUM GLUCONATE available → ANTIDOTE
◆ When magnesium goes UP → everything goes DOWN→ TOXICITY→
● Decreased HR
● Decreased RR
● Decreased urine output → BELOW < 30 ml/hr
● Absent reflexes
● Altered level of consciousness
○ HAVE CALCIUM GLUCONATE available
◆ When magnesium goes DOWN→ everything goes UP
● Polymorphic Ventricular Tachycardia
● Hypertension
● Hyperreflexia
◆ Magnesium can be very dangerous for the KIDNEYS → Renal Failure→ especially if
Magnesium is increased
➔ Fluid Volume EXCESS
◆ Ex→ If someone has a condition like SIADH→ Retaining water
◆ Ex→ When you're implementing plenty of fluids→ It can cause neck vein distention →
central venous pressure (CVP) is INCREASED
◆ Manifestations→ Cough,dyspnea, crackles, increased BP, tachycardia, tachypnea,
bounding pulse, weight gain, JUGULAR vein distention, pitting edema
● Heart rate of 190/min during sleep
● Periorbital edema
● Crackles upon auscultation
➔ Fluid Volume DEFICIT
◆ CVP is DECREASED→ Patient can be DEHYDRATED
◆ Manifestations→ Weight loss, dry mucous membranes, INCREASED HR and RR, thready
pulse, capillary refill less than 3 seconds, weakness, fatigue, poor skin turgor, orthostatic
hypotension, flattened neck veins
◆ Children→ Sunken Fontanelles, sunken eyes, dry/pale skin, weight loss
➔ LITHIUM→ Bipolar Disorder
◆ Monitor electrolytes→ especially SODIUM → Na+
, lOMoAR cPSD| 9085132
NURS 480 EXAM PHARMACOLOGY REVIEW EXAM GUIDE A+
2
◆ If someone is taking Spironolactone→ retaining Potassium→ K+ → but removing
sodium and can go into LITHIUM TOXICITY
◆ Monitor drug interactions→ NSAIDS
◆ Lithium therapeutic level → 0.4-1.4
◆ Lithium Toxicity→ Increased thirst, vomiting, diarrhea, tremors
◆ Careful with Lithium→ Tremors, Diarrhea, Hypothyroidism
◆ THYROID testing is essential for long term use of Lithium
➔ Hypothyroidism→
◆ Levothyroxine→ Toxicity→ Tremors and Anxiety
● Clinical manifestations
○ Bradycardia
○ Cold intolerance
○ Impaired short term memory
➔ Adverse Reactions→
◆ Gentamicin→ Should worry about KIDNEYS→ Monitor Creatinine, GFR → can cause
Nephrotoxicity → Watch out for Proteinuria
● Serum Creatinine → Females: 0.5-1.1 / Males: 0.6-1.2
● Gentamicin
○ ringing of the ears (tinnitus)
○ complaints of dizziness
◆ Nephrotoxic→ Ibuprofen, Cisplatin, Cyclosporine, Gentamicin, Contrast dye
◆ Hepatotoxicity→ TB medications, Acetaminophen, Aspirin, Statins → CHECK LIVER
● Aspirin in children can cause Reye's Syndrome
◆ Statins→ watch out for LIVER enzymes
◆ Heparin→ Heparin-induced Thrombocytopenia → Platelet levels can go very low
● Antidote for Heparin→ Protamine Sulfate
● When administering Heparin→ monitor aPTT
○ aPTT→ 30-40 sec → check every 4 hours
○ CAN be given to pregnant women
● Administering via deep subq intrafat
○ Small needle: 25 gauge for subq injection
○ Short needle ½ to ⅝ inch
○ Inject into the abdomen above iliac crest→ 5cm (2in) from umbilicus
○ Apply firm pressure for 1 to 2 mins
◆ When administering Coumadin→ monitor PT & INR
● PT→ 11-12.5 sec
● INR→ 0.7-1.8 → Therapeutic level→ 2.0-3.0
● Cannot be given to pregnant women
● Cannot be given with multivitamins → VITAMIN K is the ANTIDOTE for
warfarin
◆ When administering Steroids→ monitor for GLUCOSE levels
, lOMoAR cPSD| 9085132
NURS 480 EXAM PHARMACOLOGY REVIEW EXAM GUIDE A+
3
◆ When on glucocorticoid medications→ Take CALCIUM supplements to prevent
osteoporosis and risk fractures
◆ Any medications that can cause electrolyte imbalances→ Should be in Telemetry
● Measure Input & Output
● Weigh Patient daily
➔ Controlled Substances
◆ Schedule 1→ Schedule 5
◆ Schedule 1 is not particularly used
◆ Schedule 2-5 → you need to have another person verify or witness when you WASTE
● Count each dose of narcotics in inventory
● Match number of available doses
➔ Monitoring and Assessing for PAIN→
◆ Different age groups and scales
● FLACC → 2 months to 7 years
● FACES → 4-16 years
● Numerical
● Behavioral
◆ Even if a patient is on a PCA→ Still need to assess for Pain
◆ Ex→ Sometimes a patient is prescribed a Fentanyl patch→ Have to ask the doctor for
another medication for BREAKTHROUGH pain→ because the patch is removed ONCE
every 72 hours
● Patient’s need to STOP drinking grapefruit juice when using the patch
◆ Epidural→ Epidural/Morphine
● Contraindications→
○ Increased ICP, HYPOTENSION, bleeding disorders, coagulation
problems
● Administering epidural→ Make sure to give bolus before
● When weaning off of epidural→ Make sure they can wiggle their toes and
move well before getting the patient up and walking, if not they can FALL
● Morphine
○ Adverse effect of Morphine →
◆ BLADDER DISTENTION, Urinary retention
○ Allergic reaction→ PRURITUS
○ Increase fluid intake when on Morphine to reduce adverse effects
➔ Gerontological Considerations→
◆ Risk for toxicity is increased for elders especially in cases of POLYPHARMACY→
● Liver and Kidneys are not able to work properly→ should be very worried
about Liver and Kidney toxicity → dosage based on AGE
● Signs and Symptoms of toxicity can be falsely mistaken for elder age, rather
than adverse reactions
