Perhaps one of the toughest dilemmas of student nurses, nurse examinees and even registered nurses is PHARMACOLOGY.
Students struggle memorizing all those drug names and relating them to their respective indications. Licensure examinees need to recall all concepts not missing any single topic before the dreaded exam day. Even when you are a registered nurse, mastering your medication before administering it to your patients is a dire must. Across our entire nursing career, the study of drugs is always a major area of concern. Thus, an easy dashboard tickler of the ‘must-not-forget’ pharma concepts is every nurse’s best companion.
- Common Administration Routes
A. Oral – most common, convenient, and least expensive
- absorption is slow and maybe unpredictable
- undergoes hepatic first – pass effect
- may cause GIT irritation
- preparations: tablets; capsules; pills; powders; liquids
- SUSTAINED RELEASE and ENTERIC COATED – SHOULD NOT BE CRUSHED OR BROKEN
- SUSPENSION SHOULD BE SHAKEN WELL BEFORE POURING
B. Sublingual – placed under the tongue; absorbed rapidly into the bloodstream
C. Parenteral– requires use of sterile technique
D. Intradermal– small volume (0.1ml) under epidermis; most commonly used for allergy and tuberculin testing.
E. Subcutaneous– 0.5 to 2 ml into the tissues just below the skin (SC tissues)
F. Intramuscular– up to 3ml into muscle; sites include ventrogluteal, dorsogluteal, vastus lateralis, rectus femoris, and deltoid.
2. Antibiotics work by disrupting protein or enzyme systems within a bacterium, causing cell death (bactericidal) or preventing multiplication ( bacteriostatic).
3. The AIM of antibiotic therapy is to decrease the number of bacteria so that the normal immune system can deal with the infection.
4. The most common adverse effects of antibiotics involve the GIT (nausea, vomiting, diarrhea, anorexia, abdominal pain) and SUPERINFECTION invasion of the body by normally occurring microorganisms that are usually kept in check by the normal flora).
5. It is very important to use antibiotics with utmost caution, to complete the full course of an antibiotic prescription, and to avoid saving antibiotics for self – medication in the future to prevent or contain the growing threat of resistant strains.
6. Influenza A and respiratory viruses cause the s/sx of the common cold.
7. Herpes and CMV (Cytomegalovirus) are DNA viruses that cause a multitude of problems, including cold sores, encephalitis, infections of the eye and liver and genital herpes.
8. Helper T cells are essential for maintaining a vigilant, effective immune system. When that cells are decreased in number, opportunistic infections occur. AIDS is an example of opportunistic infections that occur when the immune system is depressed.
9. Antivirals that are effective against HIV and AIDS include reverse transcriptase inhibitors, protease inhibitors, nucleotides and antiretroviral drugs, all of which affect the way the virus communicates, replicates, or matures within the cell. These drugs are given in combination to most effectively destroy the HIV and prevent mutation.
10. Systemic antifungals alter the cell membrane permeability leading to the leaking of cellular components – this causes prevention of fungal cell replication and cell death.
11. Because systemic antifungals can be very toxic, patient should be monitored closely while receiving these drugs. Adverse effects may include hepatic and renal failure.
12. Local fungal infections include vaginal and oral yeast infections (Candida) and a variety of tinea infections, including athlete’s foot and jock itch.
13. Topical antifungals are agents that are too toxic to be used systematically but are effective in the treatment of local fungal infections.
14. Topical antifungals can cause serious local irritation, burning, and pain. These drug should be stopped if these conditions occur.
15. Malaria, is caused by Plasmodium protozoa, which must go through a cycle in the anopheles mosquito before being passed to humans by the mosquito bite. Once in humans, the protozoa invades the RBC.
16. The characteristic cyclic chills and fever in malaria occur when RBC burst releasing more protozoa into the bloodstream.
17. Malaria is treated using combination of drugs that attack the protozoan at various stages in its life cycle.
18. The blood brain barrier is not fully developed in infants and CNS depressants can easily penetrate.
19. Indomethacin may cause visual filed changes or corneal cloudiness. Clients should have periodic ophthalmic examinations to monitor for visual change.
20. Acetaminophen is as effective as aspirin in reducing fever. Both have similar antipyretic actions.
21. Due to aspirin’s antiplatelet effect , aspirin can be used to decrease TIA.
22. Ibuprofen (Motrin) is the drug of choice to treat primary dysmenorrheal.
23. Narcotics should be taken before pain becomes intense so the client can receive the fullest analgesic effects. By adhering to this, the client will have a good pain control and will not be requesting additional doses.
24. RESPIRATORY RATE needs to be assessed before giving the client narcotic as narcotics can have a life – threatening effect.
25. Hyperglycemia is one of the many adverse effects of narcotics (other a/e: urine retention, constipation, hypotension)
26. TREMORS are an adverse effect of naloxone hydrochloride (Narcan) and indicate an overdose of the drug.
27. If naloxone hydrochloride (Narcan) is given to a client who is addicted to narcotics, the client will experience withdrawal syndrome. Thus narcotic addicts should use this drug cautiously.
28. Barbiturates ( e.g. pentobarbital(Nembutal) ) are teratogenic and are contraindicated for pregnant women.
29. Gingival hyperplasia is a common adverse – effect of phenytoin (Dilantin) seen most often in children and adolescents.
30. Diazepam (Valium) is the drug of choice for STATUS EPILEPTICUS.
31. Due to the depressant effects of skeletal muscle relaxant baclofen (Lioresal) , the client should not engage in any potentially dangerous activities such as driving and operation of machines.
32. Handling the parenteral or liquid forms of chlorpromazine (Thorazine) may cause contact dermatitis.
33. Thorazine during initial use can cause orthostatic hypotension; ambulation should be supervised to prevent falls until tolerance develops.
34. HALOPERIDOL (Haldol) an antipsychotic drug, is also used to treat TOURETTE’S syndrome( neurological disorder marked by repetitive motor and verbal tics) and causes fewer sedative effects than other phenothiazines.
35. Clients need to maintain sodium intake (usually 6 to 10 g daily) to prevent lithium toxicity.
36. Imipramine (Tofranil), a tricyclic antidepressant can cause drowsiness; the client should avoid driving or operating machines.
37. It takes several weeks (2 – 4 weeks) before clients on imipramine therapy may see improvement of depression.
38. While taking phenelzine (Nardil) , a MAO inhibitor , the client should avoid foods or beverages containing tyramine or tryptophan including : caffeine, soy sauce, red wine, beer, cheese, yogurt, sour cream, raisins, bananas, avocado, herring, beef and chicken liver, Italian green beans to prevent HYPERTENSIVE CRISIS ( maybe characterized by occipital headache).
39. A skin rash resulting from use of fluoxetine (Prozac) indicates an allergic reaction and should be reported to the physician immediately.
40. Dopamine HCL at low dose causes dilation of renal and mesenteric arteries, which in turn causes increased urine output.
41. If extravasation (escape or leakage into insterstitial space) occurs when dopamine HCL is administered , the IV site should be infiltrated with phentolamine (Regitine) immediately after discontinuing the infusion.
42. High doses of dopamine HCL (Inotropin) stimulate alpha – adrenergic activity, which causes increased BP.
43. Ergotamine tartrate (Ergomar) , an adrenergic – blocking and antimigraine agent, has EMETIC effects; vomiting is a common side effect. The client needs an antiemetic to help control this problem.
44. Ergotamine tartrate has oxytocic effects; it is contraindicated in pregnant women.
45. Ergotamine tartrate is a drug that is abused by clients by altering dosage amount. ONLY the physician should change the dose of the drug.
46. Bethanechol chloride (Urecholine) a CHOLINERGIC agent causes brochospasm, therefore breathsound should be assessed for wheezing.
47. Atropine sulfate, an antiholinergic, is the antidote for neostigmine (Prostigmin).
48. Atropine sulfate causes dry mouth and decreases secretions, which is why it is given as a preanesthetic agent.
49. Atropine sulfate can cause constipation; high fiber foods and fluids should be encouraged.
50. Trihexylphenidyl HCl (Artane) is an anticholinergic that can cause constipation, and NOT DIARRHEA.
51. Vitamin B6 (pyridoxine) reverses the therapeutic effects of levodopa; clients on levodopa therapy should restrict their intake of foods high in vitamin B6 such as whole grain cereals, fortified cereals, liver, green vegetables.
52. Oral contraceptives antagonize the effects of bromocriptine (Parlodel), an antiparkinsonian Another method of birth control should be used.
53. Regular insulin should be drawn up before NPH insulin when putting the two together in one syringe.
54.Insulin should be at room temperature before injecting to decrease occurrence of lipodystrophy.
55. Exercise increases glucose use in the body, so a DECREASED dose of insulin is needed.
56. Oral antidiabetic or Oral Hypoglycemic Agent (OHA) can only work when the client has endogenous insulin, which is not the case in Type 1 DM.
57. Clients who are allergic to sulfa drugs cannot take tolbutamide (Orinase), which is a sulfonylurea.
58. ALCOHOL combined with an oral hypoglycemic agent can trigger a hypoglycemic reaction.
59. The goal of vasopressin (Pitressin) an AntiDiureticHormone (ADH) replacement therapy , is to lower urine output.
60. Client on vasopressin therapy can decrease GI distress associated with this drug by consuming a glass of water with each dose.
61. Hydrocortisone (Cortisol), a corticosteroid agent, can cause GI distress and even lead to a peptic ulcer with long – term use. Caffeine and alcohol can further increase GI distress and should be restricted.
62. Adrenal insufficiency can occur with abrupt removal of corticosteroids. Corticosteroids are gradually discontinued so that the adrenal glands can begin to secrete corticosteroids independently.
63. An adverse effect of levothyroxine (Synthroid) is tachycardia; the nurse should check the client’s pulse before administration.
64. Symptoms of chills, fever and sore throat while receiving propylthiouracil (PTU) require throat culture and bloodwork right away. This drug causes AGRANULOCYTOSIS (decrease WBC) which increases client’s risk for infection.
65. If the client is taking birth control pills and believes she is pregnant, she should STOP taking the pills and see the physician.
66. Miotic eye medication causes a contraction of the eye pupil and contraction of the ciliary muscle, which helps to decrease intraocular pressure.
67. Treatment for glaucoma will continue throughout the client’s life. Eye medication should not be discontinued.
68. Digitoxin (Crystodigin) is eliminated and metabolized through the hepatic system and not the kidneys; is considered SAFER to use in client’s with renal failure.
69. Fewer than 90 bpm in an infant is a sign of bradycardia, which could indicate digoxin toxicity.
70. Vomiting and diarrhea are adverse effects of digoxin therapy and may also be symptoms of digoxin therapy; should be reported to physician for follow- up.
71. Headache is a frequently seen adverse effect of nitroglycerin that usually disappears with long term therapy. The physician may order aspirin or acetaminophen for headache.
72. The back of a transdermal nitroglycerin patch contains ALUMINUM, which could cause burns to client standing near microwave ovens or if defibrillation is needed.
73. Nitroglycerin should be taken before exercise to prevent an anginal attack.
74. Verapamil reduces afterload and with concurrent use of nitroglycerin can cause hypotension.
75. Cinchonism is a syndrome seen specifically when using quinidine (antiarrhythmic); manifested by tinnitus, GI distress, dizziness, visual disturbances, and headache.
76. Taking quinidine with meals will decrease GI distress.
77. Phenytoin (Dilantin) has a high alkalinity and can precipitate easily. Flushing the IV line and site with 0.9% normal saline will minimize venous irritation and prevent precipitation.
78. Hypoglycemia is an adverse effect associated with propranolol (Inderal) use.
79. Protamine sulfate is the antidote for heparin overdose.
80. A client on heparin therapy should not take aspirin due to increased potential for bleeding.
81. Changing dose of warfarin sodium (Coumadin) by missing a dose on one day and doubling the dose on the following day is UNACCEPTABLE as it will negatively affect blood coagulation.
82. Streptokinase is a foreign protein and does cause allergic reaction. Urticaria would be a sign of this.
83. Cholestyramine (Questran), an antlipemic agent, should be taken before meals for better absorption.
84. As with most antihypertensives, initial therapy of prazosin may produce orthostatic hypotension; client should rise slowly.
85. Renal damage is an adverse response to captopril (Capoten) that is more apt to develop in clients with renal dysfunction.
86. Nitroprusside is sensitive to light and becomes less active; therefore the IV tubing and container should be covered.
87. Reserpine (Serpasil), an antihypertensive agent, is known to cause suicidal depression; an increased incidence of breast cancer has also been noted with this drug.
88. Clonidine (Catapress) can cause dry mouth due to decreased salivary flow.
89.Taking hydrochlorothiazide, a diuretic agent, before going to bed may cause nocturia and interrupted sleep.
90. Furosemide (Lasix), a loop – diuretic, can cause hyperglycemia. Diabetics need close monitoring of urine output and blood glucose while on furosemide therapy.
91. If crystals are present in the solution of mannitol, the solution should be placed in a warm water bath, then cooled to body temperature prior to administration.
92. Cromolyn sodium is effective in preventing asthma attacks because it prevents histamine release.
93. Irritability and restlessness are sx of CNS stimulation, an adverse effect of
94. Hot chocolate contains caffeine, which can further increase CNS effects of theophylline.
95. Theophylline dilates the smooth muscle cells in the bronchi, which enhances breathing and counteracts bronchial constriction.
96. The sedation effects of antihistamines will be decreased if the client takes the drug at bedtime.
97. Acetylcysteine (Mucomyst), a mucolytic agent, can cause an outpouring of copious secretions , which may cause gagging. Suction may be needed to facilitate the removal of secretions to prevent aspiration.
98. Clients taking guaifenesin (Robitussin) need to increase fluid intake daily to help thin and loosen secretions. This allows the drug to be more effective.
99. An antitussive (cough suppressant) is not appropriate for a client with lung disease accompanied by increased sputum as pneumonia or atelectasis could occur.
100. Respiratory depression is an adverse effect associated with use of codeine. It is a life – threatening effect.
- Lazo, J.S., Parker, K., & Brunton, L.L. (2005). Goodman & Gilman’s The Pharmacological Basis Of Therapeutics.
- Katzung, B.G. (2006). Basic & Clinical Pharmacology.
- Wynne, A.L. (2007). Pharmacotherapeutics for Nurse Practitioner Prescribers.