NUR 204 Simple nursing pharm (NCLEX will only ask the Generic name of drugs)/ Download To Score An A.

Pharmacology NCLEX will only ask the Generic name of drugs 1. Cancer drugs: • Tamoxifen: -used for breast cancer o Think the double “e” o Risk for emboli and endometrial cancer o Report heavy periods and excessive bleeding to the HCP -NCLEX tip ▪ Clot risk ▪ Contraindication with history of DVT or PE clarify order with HCP -NCLEX tip ▪ Side effect that is normal with this drug: hot flashes -don’t need to report • Oprelvekin (new cell stimulators) -given to increase platelet production particularity with chemo patients who have that thrombocytopenia (low platelet count) o Reduces the bleeding o Stimulates growth of hematopoietic stem cells o Oprelvekin effectiveness = increased platelets o Adverse effects: Fluid retention, A-fib, Anaphylaxis -NCLEX tip • Neupogen (Filgrastim/Pegfilgrastim) -give to stimulate those WBCs or neutrophil production o Expected outcome = increase neutrophil count o No effect on hemoglobin -NCLEX tip • Doxorubicin -chemotherapy, oncology patients o Slow or stop the growth of tumors o Monitor for hyperglycemia ▪ Side effects from chemo are hair loss, and weak skin ▪ Bone marrow suppression -the worst side effect because the bones are in charge of making the important blood cells to help protect us o Low platelet count -risk for bleeding o Temperature over 100.3 -FEVER with any cancer patient this is priority -NCLEX tip o Low WBC -most deadly called leukopenia ▪ Leading to immunodeficiency and immune compromised -NCLEX tip o Low RBC and low CBC = anemia ▪ Patient teaching: use electric razors, stool softeners, no falls -avoid rugs o Neutropenic precautions: -NCLEX tip ▪ NO fresh flowers or fresh fruit ▪ AVOID crowds and sick people ▪ NO rectal temperatures ▪ Nausea is a common side effect • Cisplatin: -chemotherapy o Renal toxicity: ▪ Monitor urine input and output -NCLEX tip ▪ Creatinine over 1.3 ▪ BUN over 20 ▪ Urine output less than 30mL/hr =kidney distress -NCLEX tip o Give antiemetics (nausea med) prophylactically (just in case) o Saline rinse before and after meals o Increase fluid intake for next 3 days o Teach how to manage fatigue o Check for dehydration: ▪ Good blood pressure, good skin turgor, adequate capillary refill, and good I/O • Cyclophosphamide: -given to treat tumors and cancer from stopping protein synthesis o Side effects: ▪ Bone marrow suppression, anemia, neutropenia, and thrombocytopenia ▪ Big risk for infections and bleeding • Vincristine: -given to treat tumors and cancer by stopping cell division during mitosis o Only drug that does not cause bone marrow suppression o Main side effect: neuropathy -never damage that causes weakness, numbness and pain typically in the hands and feet • Interferon: -type of immunotherapy given to stimulate the body’s immune system o Gives flu like symptoms: ▪ Fever, muscle aches, weakness and chills -are normal to be expected -NCLEX tip o Interferon beta: ▪ Apply warm compress before giving injection to reduce risk of pain at site ▪ Administer medication late in the day so flu like symptoms occur during sleep • Radiation: -cancer treatment o Given outside the body with big X-ray looking machine o Combination with chemotherapy to shrink down those cancerous tumors o Harsh on the skin making it red, dry, itchy, and very sensitive so no skin irritation ▪ No lotions, creams, perfumes, powders, or makeup cosmetics ▪ No deodorants or shaving ▪ Use hands instead of washcloth to clean the radiation area • Brachytherapy: -different type of radiation o Goes inside the body o Radioactive implant is placed directly inside the tumor for about 24-72 hours ▪ Patient is a radioactive hazard ▪ Usually in endometrial cancer and cervical cancer -NCLEX tip Nursing interventions: -NCLEX tip o Limit time: ▪ Cluster care 30 minutes per shift, typically rotate the staff ▪ Staff is to wear radiation film badge (dosimeter) o Limit Distance: ▪ Teach all visitors to be at least 6 feet away from the patient ▪ No pregnant company ▪ No one less than 18 years old ▪ Private room and toilet ▪ Close door to room at all times and sign on door “caution radioactive” o Shield the body: ▪ Use lead apron when in direct contact with patient called shielding -NCLEX tip NCLEX tips for antibiotics: o Finish medication to prevent super infection (take until all med is finished and DO NOT stop taking when feeling better) o Accidental pregnancy (oral contraceptives are ineffective so use additional contraception like IUD) ▪ C: Childcare ▪ C: “-cillins” like penicillin and amoxicillin ▪ C: “-cycline” like doxycycline and tetracycline o NO alcohol with these drugs o NO food for MTF “move the food” (take on empty stomach with full glass of water) ▪ M: Macrolides -Azithromycin ▪ T: Tetracycline -Doxycycline ▪ F: Fluoroquinolones -Levofloxacin o NO sun AVOID “Fun the sun” ▪ F: Fluoroquinolones -Levofloxacin ▪ T: Tetracycline -Doxycycline ▪ S: Sulfa drugs = sun burns (Trimethoprim -sulfa methox azole) ▪ Sulfonylureas (glyburide) and diuretics (thiazide/loops) ▪ Photosensitivity -avoid direct sun exposure and sun burns (wear sunblock) o Super toxic to the kidneys (nephrotoxicity) and ears (ototoxicity) ▪ Vancomycin, gentamicin, and neomycin 2. Antibiotics: • Penicillin o End in -cillin o Ex: Amoxicillin and Ampicillin and Piperacillin Tazobactam o Pregnancy and breastfeeding safe ▪ Accidental pregnancy since it bumps the pill ▪ Oral contraceptive are ineffective so use additional contraception -NCLEX tip ▪ Cross sensitivity (anaphylaxis allergy) -check allergy before giving and do not mix with other dugs -NCLEX tip and clarify prescription and request a new med o During a reaction: ▪ Stop “hold” medication ▪ Assess the type of reaction -always auscultate the lungs -NCLEX tip ▪ Prepare epinephrine to administer o Administration: ▪ Take with food if GI is upset (nausea/vomiting/diarrhea) ▪ Shake well before use ▪ Measuring device doppler or oral syringe to give med -NCLEX tip o Common side effect: bleeding (monitor platelet count) • Cephalexin o Start with -ceph and are cephalosporins o Ex: Cefazolin, and Ceftriaxone o Pregnancy and breastfeeding safe ▪ Can cause C-diff -NCLEX tip ▪ Cross sensitivity (anaphylaxis allergy) -check allergy before giving and do not mix with other dugs -NCLEX tip and clarify prescription and request a new med o Common side effect: diarrhea • Metronidazole o Number 1 drug to treat C-diff infection -NCLEX tip o Also treats STI (Trichomoniasis)-sexually transmitted infection o End in “dazole” o AVOID alcohol (ETOH) both during and 3 days after treatment -NCLEX tip ▪ Patient will have violent vomiting and cramping if alcohol is consumed o Side effects that are normal -no need to report ▪ Dark urine “discoloration” (brown and rusty) ▪ Metallic taste (metro-metallic taste) o Deadly side effect is report, any new rash or skin peeling =steven Johnson syndrome • Trimethoprim sulfamethoxazole o Sulfonamides antibiotics or UTI medication o Stops folic acid synthesis and is a sulfa drug so think “SULF” ▪ S: Sunburn -teach to use sunblock and avoid sun ▪ U: Urine crystals and specific gravity -high and dry ▪ L: Love the water -drink 2-3 liters of water per day ▪ F: Folic acid -take daily o Contraindications we have hypersensitivity to sulfa drugs, always assess for sulfa allergies ▪ To glyburide (oral anti-diabetic drug) ▪ Rash while on glyburide -potential allergy to sulfa drugs ▪ NOT pregnancy safe • Levofloxacin and Ciprofloxacin o Fluoroquinolones or UTI meds o Given to pneumonia and UTI patients ▪ AVOID sun “direct sun exposure” ▪ Achilles tendon rupture -NCLEX tip ▪ Report new muscle pain ▪ Contraindication: Tendonitis • Phenazopyridine -not an antibiotic o UTI analgesic given for pain relief during that burning and irritation of UTIs o Normal to have red and orange urine and body fluids -no need to report o REPORT liver toxicity symptoms like yellow skin/sclera = jaundice -NCLEX tip ▪ Teach patient to wear sanitary pads and also wear glasses instead of contacts ▪ NEVER stop antibiotic therapy not even when feeling better -NCLEX tip • Tetracycline and Doxycycline o Indication if mainly used for skin -acne o End in “-cycline” o NOT pregnancy safe o Tooth discoloration o Sun burns -wear sunscreen o Patient education: ▪ Use additional contraception ▪ Take on empty stomach usually 1-2 hours before or after meals ▪ Sit up 30 minutes after taking -DO NOT LAY DOWN -NCLEX tip ▪ AVOID calcium products -NO daily (milk, cheese), NO antacids (tums, milk of mag) and NO iron • Azithromycin and Erythromycin o Macrolides ending in “-thromycin” o Prolonged QT intervals -could lead to cardiac arrest o Monitor ECG -report changes to HCP o Liver toxic -monitor AST/ALT and report increases to the HCP o Side effects: -normal (do not stop drug for these) ▪ Nausea/vomiting, fever and decrease WBCs • Vancomycin o Glycopeptides class -very toxic to the kidneys and ears o Monitor the drug concentration in the blood o Peak and Trough -NCLEX tip ▪ Check 15-20 minutes before next dose or before the next administration ▪ Draw and review levels (therapeutic range 10-20) ▪ Report and hold over 20 for vancomycin o Report signs of toxicity ▪ Ear damage “ototoxicity” -monitoring for hearing and balance changes ▪ Vertigo (loss of balance) and ataxia (inability to walk) -NCLEX tip ▪ Tinnitus (ringing of the ears) -NCLEX tip ▪ Kidney damage “nephrotoxic” -report to HCP of increasing BUN and creatinine Creatinine over 1.3 and BUN over 20 o Vancomycin given for MRSA and C-diff -powerful drug and burns during administration ▪ Usually given via PICC as a preferred route ▪ Assess site every 30 minutes for pain, redness and swelling o Vancomycin can cause red mans syndrome caused by a rapid infusion ▪ Sudden onset of severe hypotension, flushing and pruritus (itching) and red rash on face, neck, chest and extremities ▪ Simply slow the infusion o Key words for vancomycin ▪ Monitor BP and infuse slowly at least over 60 minutes -NCLEX tip ▪ NO effect on mag levels, NO effect on mental status or deep tendon reflexes, and NO need for anti-nausea meds • Tobramycin, Gentamicin, Neomycin o Aminoglycosides class, and indication used to treat infections in cystic fibrosis o NO red mans syndrome o Neomycin is very toxic in combination with vancomycin o Notify HCP of increasing BUN/creatinine -ototoxicity and nephrotoxicity ▪ Increased risk for toxic effects in the elderly population and those with decreased renal function as well as when giving at high doses -NCLEX tip ▪ Normal to have muscle aches and cramping 3. Respiratory Drugs: • Bronchodilators: “BAM” o B: Beta 2 Agonist -Albuterol and Levalbuterol ▪ Increases HR ▪ End in “-buterol” ▪ B- brutal asthma attacks ▪ 1st drug we use for severe asthma attacks -fasting acting bronchodilator ▪ The ONLY “rescue inhaler” during acute asthma attacks -NCLEX tip ▪ Before steroid inhaler -NCLEX tip ▪ S: salmeterol = S: slower acting (NOT rescue inhaler) ▪ NCLEX question: DO NOT use fluticasone or salmeterol for first sign of acute asthma attack ▪ Acute asthma attacks we give 3 drugs: (SEQUENCE IS KEY) “AIM” -NCLEX tip A: Albuterol 1st I: Ipratropium 2nd M: Methylprednisolone (steroid) last ▪ Expected Side Effects for Albuterol: 3 T’s T: Tachycardiac and palpitations T: Tremor T: Toss and turning at night (insomnia and difficulty sleeping) -NCLEX tip ▪ Do not take at bedtime -NCLEX tip ▪ AVOID beta blockers (atenolol) and NSAIDS (naproxen, ibuprofen) -NCLEX tip ▪ During attack we instruct patent to take 2-4 puffs every 20 minutes for 3 rounds If not working after 3 doses? -Notify HCP ▪ Drug was effective: decrease in RR, and oxygen sat. is at least 90% or higher ▪ Expected finding after treatment: -normal Increased productive cough Reports of decreased anxiety Mild bilateral hand tremors ▪ Administration: shake it before you take it -shake it well Breath all the way out Place inhaler in mouth Push the med from inhaler into the mouth Inhale the med and hold for a few seconds then exhale Clean the mouthpiece 1-2 times per week with warm water o A: Anticholinergics -Ipratropium ▪ End in “-tropium” ▪ Ex: Ipratropium and Tiotropium -dry the body out ▪ Used for moderate to severe asthma and COPD ▪ Used 2nd in line after albuterol ▪ Mechanism of action: Blocks secretions so you can see, pee, spit or shit called anticholinergic ▪ Common side effects: Dry mouth and hoarseness Treat the dry mouth and throat for all anticholinergics by using gym/candy and drink fluids - ▪ NO swallowing tiotropium capsules - ▪ Contraindication to ALL anticholinergics we never give for patients who are already DRY Patients with glaucoma, urinary retention and BPH, bowel obstructions o M: Methylxanthines -Theophylline ▪ End in “-phylline” ▪ Ex: Theophylline and Aminophylline ▪ 3 T’s: T: Toxic over 20 -do frequent blood draws -NCLEX tip T: Tonic clonic seizures -severe toxicit 1st priority (s/s of toxicity like anorexia, nausea/vomiting, restlessness and insomnia) T: Tachycardia and dysrhythmias -NCLEX tip ▪ Teach patient to AVOID beta blockers that lower the HR while on Theophylline ▪ Alert HCP of tachycardia BEFORE giving next dose ▪ Two drugs that increase toxicity risk -NCLEX tip Cimetidine (H2 blocker) and Ciprofloxacin (antibiotic) Take in the morning and AVOID caffeine STOP before cardiac stress test • Anti-inflammatory agents “SLM” o S: Steroids -Beclomethasone ▪ End in “-sone” ▪ S- Steroids = S-stress and swelling hormone -decrease the swelling ▪ Prescribed to patients with COPD, rheumatoid arthritis, psoriasis, lupus, and allergic reactions where everything swells up ▪ S’s: Swelling and inflammation (water gain=weight gain), words like “sudden, excessive, or rapid” -report 1 lb in 1 day and 2-3 lb in 2 days Respiratory (beclomethasone, fludrocortisone, methylprednisolone) Total body swelling (Prednisone, dexamethasone, hydrocortisone) Slow onset and slowly taper off (never abruptly stop) Sepsis (infection or illness) -low WBC fever is priority - Sugar increase -hyperglycemia -NCLEX tip Skinny -muscle and bones “osteoporosis” risk for fractures Sight -cataracts risk so refer to optometrist -NCLEX tip Stress or surgery (increase dose) -NCLEX tip Sores in mouth(infection)-most at risk for infection someone on steroids ▪ Use spacers to prevent oral THRUSH (candida) ▪ Rinse mouth after each use and DO NOT swallow the water ▪ Always wash mouthpiece out with warm water after each use o L: Leukotriene inhibitor -Montelukast ▪ End in “-lukast” ▪ Ex: Montelukast and Zafirlukast ▪ 3 L’s: L: Luke likes to sing (airway open) L: Long term management L: Long Onset (1-2 weeks to reach therapeutic range) ▪ Given for prevention of asthma attacks NOT during acute asthma attacks ▪ NOT a rescue drug ▪ This med will prevent inflammation that causes asthma attacks o M: Mast cell stabilizers – Cromolyn ▪ Blocks massive swelling ▪ Prevents activity induced asthma like before sports or exercise ▪ Take 10-15 minutes before exertion for maximum effects/physical activity 4. Antipsychotic Drugs: • Haloperidol -1st generation typical o For Schizophrenia and Tourette’s to control the motor movement o May be given with short acting benzodiazepines like Lorazepam o Normal side effects behavior found in extrapyramidal symptoms ▪ Dystonia or spams/muscle contractions of the neck, face, and tongue o Killer adverse effect: ▪ Neuroleptic Malignant Syndrome (NMS) -life threatening ▪ Key signs to look for: high fever and diaphoresis (sweating), change in mental status, muscle rigidity, and tremors ▪ Priority Action: 1st Hold the Haloperidol, 2nd Assess patient, 3rd Notify HCP immediately • Clozapine and Risperidone-2nd generation A-typical o For schizophrenia and schizoaffective disorder typically who have not responded to other antipsychotics o Common side effects -no need to report to HCP ▪ Weight gain -teach patients about weight management ▪ Hypersalivation -drooling ▪ Sedation -usually improves with increased tolerance o Major adverse side effects ▪ Granular cytosis or low WBCs ▪ Low immunity (leukopenia) and decreased neutrophils -high infection risk ▪ Clozapine = ZAPS those WBCs ▪ Sore throat, fever, and flu like symptoms -NCLEX tip Priority action -immediately report to the HCP o Contraindication with patient who have dementia ▪ Never give clozapine which will actually increase mortality ▪ Risperidone = Remove from Dementia • Ziprasidone hydrochloride: o Bipolar mania or acute psychosis with agitation o Major adverse side affects ▪ Seizures but cardiac issues are more common ▪ Hypotension and monitor for widened QT intervals which can lead to cardiac arrest and then death (so monitor BP and ECG closely) 5. Bi-polar Drugs: • Carbamazepine o Bi-polar, also given for seizures and treatment of trigeminal neuralgia (neuropathic pain) o Side effects: ▪ Leukopenia -low WBCs increased risk for massive infection ▪ Report fever and sore throat -NCLEX tip ▪ Accidental pregnancy so oral contraceptive are ineffective and will need alternative birth control methods -NCLEX tip • Valproic Acid o L: Liver toxic -monitor for jaundice and liver labs (ALT/AST) o L: Low platelets -thrombocytopenia big bleed risk o Not pregnancy safe o Teach not to STOP this drug abruptly • Lithium (big momma) o Long term treatment for bipolar and schizoaffective disorder o Narrow therapeutic range: 0.6-1.2 o Toxicity over 1.5 ▪ Highest risk are those with decreased renal function ▪ Be cautious with patients in kidney disease and elderly patients who naturally have decreased kidney function ▪ Creatinine over 1.3 = BAD kidney ▪ Urine 30mL/hr or less = kidneys distress ▪ S/S of tinnitus (ringing of the ears) = ototoxicity o L: Levels over 1.5 = toxic -blood is drawn regularly to maintain that therapeutic dose (can take up to 3 weeks) NCLEX question: is lithium at a therapeutic level, if yes then continue at current dose o I: Increase fluid and sodium -since lithium lets go of the fluid ▪ Contraindication: CANNOT give lithium during dehydration and low sodium (hypernatremia below 135) ▪ DO NOT limit sodium or water intake ▪ Highest risk patient for toxicity is someone with stomach flu (diarrhea and vomiting) ▪ Teach patients to drink 1-3 liters of water a day and limit diuretics including food that have diuretic properties like coffee, colas, and teas o T: Toxic signs: -report to the HCP ▪ Report excessive urination and extreme thirst -lead to dehydration ▪ Vomiting and diarrhea -add more dehydration ▪ Neuro muscular excitability (tremors/myoclonic jerks/horse hand tremors, ataxia or confusion or agitation) o H: Hold NSAIDS (ibuprofen, naproxen) ▪ NSAIDS (Ibuprofen) decrease renal blood flow increasing risk for toxicity ▪ AVOID!! Need further teaching if still wanting to use, instead use Tylenol ▪ Common expected side effects -don’t need to report to HCP Dry mouth and thirst -teach clients to use ice chips, gum, or sugarless candy and plenty of fluids and also do oral hygiene Drowsiness and fatigue -teach clients to avoid driving and other hazardous activities Weight gain -teach proper diet and exercise Decreased appetite -client has weight loss = anorexia and mild GI upset 6. Anxiolytics: • Benzodiazepines -given for anxiety, seizures, alcohol withdrawal and sedation (induced coma) o Dangerous they are sedatives o End in “-lam” like Alprazolam and Midazolam o End in “-pam” like Temazepam and Clonazepam o Fast acting but highly addictive and hard to come off, not safe for long-term use o Side effects: ▪ Sedation -low and slow ▪ Low HR, BP, and low RR (bradypnea) -leading to deadly respiratory depression o Patient Teaching: Sedation, sleepiness, and the suppression of ABCs ▪ Take at bedtime -NCLEX tip ▪ Do not skip doses -NCLEX tip -sedation and rebound anxiety are the dangers ▪ Keep taking even when patient is feeling okay ▪ Always taper off and never abruptly or suddenly stop taking ▪ STOP drinking alcohol (wine) and do not operate dangerous machines ▪ AVOID valerian root, and muscle relaxants o Antidote for Benzos: Flumazenil -NCLEX tip o Antidote for Opioids: Naloxone -NCLEX tip • Barbiturates -given for anxiety and seizures o Dangerous they are sedatives o End in “-barbital” like Phenobarbital o Lasts longer in the body usually 3-5 days but takes longer to get out of the body o Higher risk for toxicity leading to hypotension and respiratory depression • Buspirone -given for anxiety and seizures o Not a sedative, slow acting (takes a long time to kick in) and very easy to quit o Atypical anxiolytic -no depressant effects o 2-4 weeks for full effect o NO withdrawal symptoms! -NCLEX tip ▪ Not addictive, no dependence, no tolerance, and no sedation o Patient teaching: ▪ Driving is okay, not for acute attacks usually taken on a regular basis 7. Antidepressants: 4 rules for Antidepressants: 1. Increased risk of suicide -elevated the mood it gives patient energy to go out and carry out the suicide (can increase suicidal thoughts in first few weeks of treatment) in young adults 18-24 o Notify provider of any suicidal thoughts o Clarify any new prescription and monitor for o New thoughts of suicide, unusual behavior, worsening depression, sudden change mood 2. Slow onset and slow taper off o Never STOP abruptly o Takes a few weeks to reach therapeutic level o Teach about sexual dysfunction so they are aware and won’t stop taking the drug 3. NEVER mix o SSRI with St. John’s Wort o MAOI with any Antidepressant (TCA, SSRI, SNRI) o 2-week washout period is needed -NCLEX tip o NEVER start a new antidepressant while tapering off an MAOI or another 4. ALL psych drugs o Decrease BP (slow position changes) o Cause weight changes -mostly weight gain • SSRI o Sertraline, Citalopram, Escitalopram -NCLEX tip o Also have Paroxetine and Fluoxetine o Given for depression, anxiety, and PTSD o Common side effects that usually improve after 3 months ▪ Weight gain ▪ Sexual dysfunction -NCLEX tip ▪ NO sedation usually cause insomnia o Priority key points: “SSSRI” ▪ S: Suicide risk increased when starting med or changing dose Reports of more energy without change in depression -NCLEX tip ▪ S: Slow onset and slow taper off -usually takes 2-4 weeks to reach full effect ▪ S: Serotonin Syndrome -NEVER MIX SSRI with St. John’s wort, MAOI, or tramadol Sweaty and hot with fever -not cold and clammy ▪ R: Rigid muscles and restlessness and agitation -tremors, hyperreflexia, increased deep tendon reflexes ▪ I: Increased heart rate “tachycardia” • SNRI o Duloxetine o Give for depression and pain like with neuropathy and fibromyalgia o Patient teaching -helps with chronic pain and improves sleep in patients = fibromyalgia • TCA o Amitriptyline (slow position changes) and Imipramine (inhibit my peeing) o Given for depression and anxiety and also helps with neuropathy o Orthostatic hypotension -slow position changes and urinary retention o Side effects -big dry the anticholinergic effects ▪ Cannot see -blurred vision and photophobia -teach to wear sunglasses and eyedrops ▪ Cannot pee -urinary retention -NCLEX tip -drinking the fluids ▪ Cannot spit -dry mouth -teach to chew gum ▪ Cannot shit -constipation -give fiber ▪ Sweating, seizures, and sedation = drowsiness/dizziness • MAOI o Phenelzine, Selegiline, and Isocarboxazid o These are the first and oldest antidepressants known as the big guns o Very powerful used for depression, panic disorder and social phobia o M: Massive hypertension crisis risk ▪ Key sign is a massive headache and increased agitation -NCLEX tip o A: Avoid tyramine ▪ NO Wine and cheese (NO wine tasting) ▪ NO Bear and sausage, salami (NO beer festival) ▪ NO Chocolate ▪ Start this diet at least 2 weeks before starting an MAOI and continue 2 weeks after stopping MAOI o O: OTC drugs = hypertension crisis ▪ C: Calcium ▪ A: Anti acids ▪ A: Acetaminophen ▪ N: NSAIDS (naproxen, ibuprofen) o O: Other antidepressants to avoid ▪ SSRIs, SNRIs, TCAs -trigger a serotonin syndrome ▪ 2-week washout period when changing or swapping out antidepressants ▪ Fully tapper off the other before starting the next -NCLEX tip o I: Increased suicide risk ▪ When starting med or increasing the dose -NCLEX tip ▪ Usually in children, adolescents, or young adults ▪ Patient states: “This med is not working after 2 weeks” -1st assess Further expressions of: hopelessness, despair, suicidal thoughts, or thoughts of self-harm =report to the HCP 8. Atypical Antidepressant: • Trazodone: o Makes you sleepy and sedated o Avoid ETOH (alcohol) and other sedatives (benzos and antihistamines) o Take at night o Causes orthostatic hypotension -teach slow position changes o Rare complication is a priapism -teach if erection lasts longer that 4 hours to go to the hospital • Bupropion SR (sustained release), XL (extended release): o Given for depression and an aid to stop smoking o Side effects: ▪ Insomnia ▪ Headache ▪ Weight loss o Teaching: ▪ NEVER double up on missed doses ▪ Nicotine gum may be prescribed in addition to help stop smoking o Administration: ▪ XL (extended release), SR (sustained release) pill -NEVER crush, chew, or cut ▪ Swallow whole with or without food 9. Blood Thinners: • Acetylsalicylic (aspirin) and Clopidogrel -antiplatelet o Lower platelet aggregation -anti clogging of the arteries or clot prevention o Use for post -Percutaneous coronary intervention (PCI) -cath lab to clear the clot o Before giving always assess -NCLEX tip ▪ Hemoglobin (Hgb) 7 =heaven ▪ Platelets less than 150,000 =notify HCP ▪ Platelets less than 50,000 =very risky ▪ These meds should not decrease platelet levels o Common question -platelet count of 75,000 or 40,000 what is the priority ▪ 1st Hold the drug ▪ 2nd Question the prescription ▪ 3rd Notify the HCP o Salicylate poisoning -aspirin toxicity ▪ Treatment: activated charcoal and sodium bicarb second-NCLEX tip ▪ Activated Charcoal = Aspirin overdose ▪ Mechanism of action is the activated charcoal actually binds to aspirin and inhibits the absorption in the small intestine ▪ S/S of aspirin toxicity: -tinnitus (ringing of the ear) ▪ A: Altered mental status with disorientation and restless ▪ B: Barfing “vomiting” ▪ C: Crazy breathing “hyperventilating” • Abciximab -glycoprotein (GP) receptor inhibitors o Eptifibatide and Tirofiban o Lower platelet aggregation, mainly used after cardiac procedures like heart catheter or coronary stent placement where we want to prevent vessel reocclusion o Adverse effects: ▪ Thrombocytopenia and bleeding o Nurse should implement: ▪ Assessment of hemoglobin and platelets ▪ Assess for bleeding -report to the HCP ▪ Red tinged urine “hematuria” -NCLEX tip ▪ Dark tarry stools/Black or blood stools -NCLEX tip ▪ Monitor groin (insertion site) for s/s of bleeding ▪ Place client on cardiac monitor for ECG changes ▪ NO needles (no new IV or IM injections) • Heparin -anticoagulant o Given for prevention of NEW clots and preventing growth of existing clots -NCLEX tip o Typically for patients recovering from an MI heart attack or PE in the lung or those at risk for a DVT like after a hip or knee surgery o Works quickly and can only be injected IV or Sub-Q o PTT: 46-70 -NCLEX tip o Antidote: Protamine sulfate -NCLEX tip o If heparin is over 70 priority action: ▪ 1st STOP the heparin -NOTIFY HCP ▪ 2nd Prepare antidote protamine sulfate 3rd Reassess labs in 1 hour o Bleeding at the IV site what’s the priority action: ▪ “Blood oozing” at surgical incision or IV site do the same as heparin over 70 o Enoxaparin and Dalteparin -low molecular weight heparin given for prevention of clots after surgery ▪ Administration of 25-gauge needle, 5/8 inch and inject at 90-degree angle ▪ 2 inches from umbilicus -NCLEX tip NOT thigh or IV route ▪ NEVER aspirate SQ and NEVER rub site ▪ Normal to have mild “pain, bruising, irritation, redness at site” -NCLEX tip ▪ Can use ice chips with irritation ▪ Enoxaparin heparin -assess H & H before giving to patients with open fractures Notify HCP and clarify order for enoxaparin if H/H slightly low -NCLEX tip Monitor for low platelets, hold med if less than 50,000 o Heparin induced thrombocytopenia (HIT) -deadly condition happens if platelets decrease by half in 24 hours after starting heparin of any type ▪ Priority action -alert the HCP -NCLEX tip • Warfarin -anticoagulant o Given for prevention of NEW clots and preventing growth of existing clots -NCLEX tip o Typically for patients recovering from an MI heart attack or those at risk for a DVT like after a hip or knee surgery o Works slowly -typically takes 5 days to reach effect o Taken lifelong therapy -typically in mechanical valve replacements, frequent blood tests o INR: 2-3 Therapeutic range -NCLEX tip ▪ 2.5-3.5 (heart valve replacements) -NCLEX tip o Antidote: Vitamin K -NOT to be given if warfarin is within therapeutic range -NCLEX tip ▪ NOT to be given until at least 5 days of warfarin when switching from IV heparin o Vitamin K foods: ▪ Liver and green leafy vegetables (broccoli and spinach) ▪ Teach patients to keep it consistent and in moderation -keep K consistent ▪ Key words: NOT increased, NOT decreased, NOT avoid totally -NCLEX tip • Fondaparinux -anticoagulant o Major advantage is NO risk for HIT o Disadvantage: can cause epidural bleeds ▪ DO NOT give to a patient that’s reporting severe back pain, decreased LOC or paralysis -Call HCP and hold the med o NO Fondaparinux for at least 6 hours after surgery -NCLEX tip o NO anticoagulants with spinal epidural catheter is in place -NCLEX tip • Rivaroxaban -anticoagulant o Edoxaban and Apixaban o New oral anticoagulant for atrial fibrillation patients end in -xaban o AVOID aspirin while taking this med (avoid all OTC meds and NSAIDS and supplements like vitamin, garlic, ginseng, gingko and omega 3) o Risk for neurological impairments (head bleeding) ▪ Teach client methods to reduce bleeding -NCLEX tip • Dabigatran o Argatroban o Used to prevent clots in high risk atrial fibrillation patients o DO NOT stop the med for GI issues -NCLEX tip this is a normal side effect o STOP med if black tarry stools -NCLEX tip o NOT stored in pill box, keep in original container o NOT crushed, taken whole ▪ Hold before surgery -NCLEX tip ▪ Do not take clopidogrel or aspirin 10. Thrombolytics • tPa -clot buster (most powerful one-time push only) o End in “-ase” o Ex: Alteplase, Reteplase, and Streptokinase o Only drugs that dissolve clots o Can only be given 3-4.5 hours from the onset of symptoms -NCLEX tip o Big caution here is the massive bleeding risk -most deadly o NO injections at all so NO IVs, NO Sub-Q, NO IMs, NO ABG -NCLEX tip ▪ These drugs can only be given in a compressible site like an peripheral IV ▪ Yes to “existing” peripheral line but NOT central line o NCLEX key contraindications: ▪ AVOID giving to active bleeding patients like peptic ulcer -NCLEX tip ▪ Uncontrolled hypertension 180/110 or higher ▪ Recent surgery within 2 weeks -NCLEX tip o Clarify prescription with provider: ▪ A: Accidents “recent trauma” -NCLEX tip ▪ A: Aneurysm -history of hemorrhagic CVA -NCLEX tip ▪ A: AV malformation -NCLEX tip Side Note: Patient teaching for bleeding: Black tarry stools -GI bleed Hematuria (blood tinged urine) Epistaxis -nosebleed Petechiae on the chest Easy bruising o Avoid trauma- no small rugs or dim halls = well light halls o NO hard brushing = soft bristle toothbrush o NO flossing o NO alcohol-based mouth wash o NO razors =electric shaver o NO constipation =fiber and fluids -NCLEX tip o NO contact sports o Always wear medic alert bracelet 11. GI Drugs: • Ondansetron -antiemetic o Given to decrease nausea and vomiting o Can cause serotonin syndrome which is a high risk for injury including ▪ Agitation, hypertension, muscle rigidity and tachycardia o Side effect is headache and dizziness -normal ▪ Priority side effect is Torsades de pointes o Give before going to chemo and before or with pain medications o NCLEX question: During infusion, child reports nausea and vomits what is the priority intervention? -STOP the chemo, flush the line and administer ondansetron • Metoclopramide -antiemetic o Given for nausea and vomiting but also for delayed gastric emptying called gastroparesis o Works by accelerating gastric emptying by increasing intestinal motility -basically gets food out of the stomach very quickly o Contraindicated for patient with a bleed in the GI -bleeding duodenal ulcer -NCLEX tip o Side effects the extrapyramidal ▪ Especially tardive dyskinesia -especially in older adults ▪ Question prescription “order” and report to HCP immediately ▪ Lip smacking, sucking lip motion, puffing of the cheeks, and excess blinking of eyes, protruding and twisting of the tongue, chewing movement -NCLEX tip • Sodium Docusate -only one tested on NCLEX o Stool softener o Teach patients to increase their fluid, fiber, and they’re walking o Contraindicated for bowel obstruction -huge risk for death o Other drugs are psyllium husk -bulking fiber and magnesium hydroxide -considered a laxative and anti-acid • Lactulose o Loosens the bowels to lower the ammonia levels -usually in cirrhosis patients ▪ L: Laxative for ▪ A: Ammonia levels -decreased ▪ C: Cognition returns “improved mental status” -NCLEX tip o Treats hepatic encephalopathy -helps the body poop out all that ammonia basically massive explosive diarrhea o NOT a diuretic, so NO renal excretion of ammonia, NO it does not decrease portal hypertension and NO abdominal distention will not improve with lactulose -NCLEX tip o How does a nurse evaluate the effectiveness of this drug? ▪ 2-3 soft stool per day -NCLEX tip ▪ Ammonia levels decrease ▪ Cognition improved “improved mental status” -NCLEX tip • Sodium polystyrene Sulfonate o Given for hyperkalemia that high potassium o Administration: PO is the most effective or we can also use an enema o Patient teaching: ▪ Helps the large intestine to remove excess K+ within the body -NCLEX tip ▪ Encourage patient to drink fluids after administration o Nursing Care: ▪ We ensure normal bowel function prior to administration to prevent intestinal necrosis ▪ Asses the abdomen ▪ Recent bowel patterns and frequency of stools ▪ Bowel function ▪ Potassium within normal limits (3.5-5.0) o NCLEX question: focus on bowel assessment first o Ensure close assess to the bathroom due to frequent loose stools • Loperamide -anti-diarrheal opioid o Given for active diarrhea to decrease the motility or movement of the intestines o Makes thing low and slow and especially making the bowel low and slow o Biggest side effect is constipation slowing things down too well • Dicyclomine o Anti-diarrheal given to patients with irritable bowel syndrome (IBS) o Can have up to 20 loose stools per day o Dicyclomine = helps to get the bowels on a regular cycle o Side Effects: ▪ Constipation, dry mouth, and urinary retention ▪ Cannot see, pee, spit or shit -dries everything up so diarrheal is NOT a common side effect -NCLEX tip o Contraindications to AVOID: ▪ NOT for patients with paralytic ileus or bowel obstruction -NCLEX tip So we always question the prescription ▪ NOT for narrowed-angle glaucoma patients (cataracts are ok) ▪ NOT for a full bladder (over 400 mL) “urinary retention” • Sulfasalazine o Sulfa-drug given for inflammatory bowel disease (IBD) including Crohns disease and ulcerative colitis o This med decreases colon inflammation by inhibiting prostaglandins o Continue medication even after symptoms subside o Contraindicated in patients with a sulfa allergy -NCLEX tip o Side effects that are normal include ▪ Yellow orange discoloration of the skin and urine o Adverse effects -the ones we worry about “SULF” ▪ S: Sun Dried -sunblock and dry body Photosensitivity -NCLEX tip teach to wear sunblock and avoid direct sun ▪ U: Urine Crystals -kidney stones ▪ L: Low urine output with high specific gravity over 1.030 -NCLEX tip Dehydration, elevated urine specific gravity and body is high and dry ▪ F: Fluid and Folic acid Drink 8 glasses of water daily and take folic acid 1mg/day o Expected findings with ulcerative colitis we get blood diarrhea and inflammatory markers will be elevated so do not stop the med, med will actually help -NCLEX tip ▪ Gastritis is an irritation of the stomach ▪ GERD = Gastro Esophageal Reflux Disease -heartburn and acid reflux that irritates the esophagus ▪ Ulcers -breaking the lining like the holes and open sores ▪ Stomach ulcer -gastric ulcer or a peptic ulcer ▪ Small intestine -duodenal ulcer • Antacids o Reduce acid and prevent ulcers, goal is to protect the GI from its own acid o Used for fast immediate relief but don’t last long -think “SCAM” ▪ S: Sodium bicarbonate ▪ C: Calcium carbonate (tums) ▪ A: Aluminum hydroxide ▪ M: Magnesium hydroxide o Think anti mixing for anti-acids -there never to be taken with other meds -NCLEX tip ▪ So either 1 hour before or after other meds ▪ NOT for heart failure patients and nothing OTC o Side effects: ▪ For aluminum or calcium they can constrict and cause constipation ▪ Magnesium hydroxide can mellow out the GI tract causing diarrhea -can upset the stomach and liquid bowel movements • Ranitidine and Famotidine o H2 Blockers Histamine 2 receptor antagonist -long lasting relief that turns down the volume of acid production o End in “-tidine” o Take 30 minutes before meals -NCLEX tip o Given for GERD and ulcers both duodenal and gastric o Patient Education: ▪ DO NOT overeat ▪ NO stress or stress reduction ▪ NO smoking and NO NSAIDS • Omeprazole, Esomeprazole, Pantoprazole o Proton Pump Inhibitors (PPI) o End in “-prazole” o Given for heartburn and GERD but mainly used for ulcer prophylaxis especially in hospitals due to the hospital related stress o 3 P’s ▪ P: Prevent holes -stress ulcer prophylaxis -NCLEX tip ▪ P: Porous Bones -regular bone density tests -NCLEX tip ▪ P: Possible GI infections -C-diff o Usually everyone on Med/Surg gets put on a PPI, so if patient asks why they are put on a PPI or “stress ulcer prophylaxis” that they don’t use it at home we respond -NCLEX tip ▪ It helps prevent the development of an ulcer due to surgery or hospital stays • Sucralfate o To protect the lining from those holes or peptic ulcers we use mucosal protectant o Given to treat and prevent both stomach and duodenum or duodenal ulcers in the small intestine o Key point: take on an empty stomach -food and meds at least 1-2 hours before or after taking this med -NCLEX tip ▪ DO NOT take with any other meds ▪ Taken best at bedtime • Misoprostol o Mucosal protectant -synthetic prostaglandin to protect against gastric ulcers so it increases protective mucus inside the stomach o Usually given to patients on long-term NSAIDS therapy like naproxen and ibuprofen o Major adverse effects: ▪ Dysmenorrhea ▪ Miscarriage risk NOT for pregnant woman-NCLEX tip o So we always do a pregnancy test before giving this drug because this drug increases cervical ripening. ▪ Teach reliable birth control and DO NOT take with any other antacids ▪ If pregnancy is suspected, then we STOP the med and contact HCP -NCLEX tip • Pancrelipase o Given to replace digestive enzymes in patients with cystic fibrosis ▪ Pancreases = helps break down food ▪ Lipase = fat ▪ Protease = protein ▪ Amylase = carb o MUST be eaten WITH every meal and snack or med is not effective -NCLEX tip o Pancrelipase Admin: ▪ Open capsule and sprinkle contents on food without chewing ▪ Reduction in fatty stools is an expected outcome 12. Antifungals Drugs • Fluconazole and Ketoconazole o Given to treat nail fungus and skin candida fungal infections o End in “-nazole” o Taken for 2-6 weeks and very liver toxic o Key point: Does NOT treat C-diff infections, Metronidazole treats C-diff -NCLEX tip • Amphotericin B o Causes serious tare on the body with lots of side effects o Adverse Effect -Renal injury ▪ Creatinine over 1.3 ▪ Urine 30 mL/hr or less ▪ Oliguria -low urine • Nystatin o Given to treat candida fungal infections in the mouth, GI, skin and vagina ▪ Treats oral candidiasis ▪ Shake well -liquid suspension ▪ Inspect mucus membranes for irritation ▪ Remove and soak client’s dentures ▪ Teach to swish in mouth for several minutes then swallow ▪ Continue after s/s subside 13. TB drugs All of these drugs are liver toxic, remember “RIPE” NCLEX tips for TB o Meds last 6-12 months o N-95 mask worn at all times o Family tested for TB o Sputum samples every 2-4 weeks o 3 negative cultures on 3 different days =NO longer infectious • R: Rifampin o Red for Rifampin o There are red and orange tears, urine and sweat -this is normal ▪ Teach to wear glasses instead of contacts due to discoloration of tears -NCLEXtip ▪ Oral contraceptives ineffective “use non-hormonal back-up birth control” ▪ Monitor for jaundice since its very liver toxic • I: Isoniazid (INH) -most tested drug o I: Interferes with absorption of B6 (pyridoxine) also called B-complex ▪ Low vitamin B6 = peripheral neuropathy ▪ Teach to take vitamin B6 (25-50 mg/day) o N: Neuropathy (peripheral neuropathy) ▪ Report: new numbness, tingling extremities, and ataxia -the inability to walk o H: Hepatotoxicity -liver toxic ▪ Monitoring and report immediately if ▪ Jaundice (yellow) skin or sclera -the eyes ▪ Dark urine -NCLEX tip ▪ Fatigue ▪ Elevated liver enzymes (AST/ALT) -hold the med ▪ Teach NO alcohol (ETOH) and limit acetaminophen • P: Pyrazinamide -didn’t come up once on the review • E: Ethambutol o Eye for Ethambutol o Report blurred vision and color changes -NCLEX tip o Teach patient to have baseline eye exams and routine eye exams Show Less