Final Exam Study Guide - Pharmacology

PHARMACOLOGY Final Exam Study Guide All lecture slides matched to study guide drugs · Grouped by category KEY: ★ Red text = KEY NOTES from your study guide card · Black text = Slide content GROUP 1: PHARMACOLOGY BASICS Pharmacokinetics vs. Pharmacodynamics ★ Pharmacodynamics = What the drug does to the body Pharmacokinetics: What the body does TO the drug. Four phases: Absorption, Distribution, Metabolism (liver – cytochrome P450), Excretion (kidneys primary site). Key PK Terms: • Loading dose: Initial dose HIGHER than maintenance to reach therapeutic range quickly • Maintenance dose: Keeps plasma level in therapeutic range • Onset: Time to therapeutic effect · Peak: Highest blood concentration · Trough: Lowest concentration • Half-life: Time for 50% of drug to be removed • Steady state: % removed = % absorbed per dose • Bioavailability: % of drug available for activity (0–100%) First-Pass Effect: Oral drugs absorbed from GI → liver → some metabolized before reaching circulation (reduces bioavailability). Pharmacodynamics: Mechanism of action, drug-receptor relationships. Therapeutic Index (TI): ratio of toxic to effective dose. Narrow TI drugs (warfarin, digoxin, phenytoin) require close monitoring. Brand vs. Generic ★ Brand vs generic: Same active ingredient, different inactive ingredients Generic drugs have the same active ingredient, strength, form, and route as brand. FDA approved for bioequivalence. Sustained-Release / Enteric-Coated Pills ★ Sustained release pills: Do NOT crush or chew — designed to dissolve slowly for extended effect Enteric-coated tablets must remain intact; sustained-release capsules increase compliance by reducing dosing frequency. Schedule Drugs ★ Schedule drugs: Patient MUST have a prescription order to get refills. No telephone orders. Controlled Substances Act divides drugs into 5 schedules based on abuse potential. Hospitals/pharmacies must maintain complete records. 9 Rights of Medication Administration select all that ★ Medications for administration: 9 rights Right patient · Right drug · Right dose · Right route · Right time · Right documentation · Right reason · Right response · Right to refuse. IM Injection Sites: ★ Intramuscular injection: Adult = Deltoid or Ventrogluteal | Child (infant <1yr) = Vastus lateralis ONLY • Adult: Deltoid (small volumes/vaccines) or Ventrogluteal (safest, up to 3 mL). Needle 1–1.5 inch, 22–25 gauge. • Infants (<1yr): Vastus lateralis ONLY. Needle 5/8–1 inch. Never dorsogluteal (sciatic nerve risk). applypicture Routes of Administration ★ Eardrops: Adult = Up and back | Child = Down and back ★ Eye drops: 5 minutes between eyedrop administration; place in LOWER conjunctiva PEG Tube (Gastrostomy Tube) Nursing Care: letters asks which w letter drops areeye placed ★ PEG tube: Flush before and after meds, crush only crushable meds, check residual every 4–6 hrs. HOB 30–45°. GROUP 2: PAIN MANAGEMENT & ANALGESICS Acetaminophen (Tylenol) ★ Antidote: Acetylcysteine (Mucomyst) Class: Non-opioid analgesic and antipyretic (little anti-inflammatory effect). MOA: Blocks pain impulses peripherally by inhibiting prostaglandin synthesis. Use: Mild to moderate pain, fever. Alternative for those who cannot take aspirin. Dosing: Max 4,000 mg/day healthy adults · 3,000 mg small-bodied person · 2,000 mg elderly/liver disease. Contraindications: Liver dysfunction, alcohol use, G6PD deficiency. Toxicity: Overdose causes hepatic necrosis (hepatotoxicity). Antidote: Acetylcysteine (Mucomyst). NSAIDs — General (Ibuprofen, Naproxen, etc.) ★ NSAID Safety: Anyone with GI bleed, peptic ulcer disease, or bruising = notify healthcare provider MOA: Inhibit COX-1 and COX-2 enzymes → reduce prostaglandin synthesis → decrease inflammation, pain, fever. Uses: Mild-moderate pain, fever, arthritis (RA, OA), dysmenorrhea, gout. Adverse Effects: GI ulceration/bleeding (especially with long-term use), renal impairment, increased cardiovascular risk (MI, CVA). Contraindications: Active PUD, renal/hepatic impairment, anticoagulant use (increased bleeding), angioedema, bronchospasm. Black Box Warning: Increased risk of serious thrombotic events, MI, CVA. GI bleeding risk. Interactions: Avoid anticoagulants, other NSAIDs, ACE inhibitors, diuretics. Avoid feverfew, garlic, ginger, ginseng (bleeding risk). Meperidine (Demerol) ★ Opioid. Antidote is Naloxone (Narcan). ASSESS respiratory system before and after. Class: Opioid agonist analgesic (controlled substance). Use: Moderate to severe pain. Key Nursing: Assess respirations (hold if <10/min), LOC, HR. Monitor I&O.; Have Naloxone available. Adverse Effects: Respiratory depression (most dangerous), CNS depression, nausea/vomiting, constipation, urinary retention, orthostatic hypotension. Naloxone (Narcan) ★ Antidote for ALL opioids. Give for respiratory rate <10 breaths/min. MOA: Pure opioid antagonist — blocks mu and kappa receptors. Reverses opioid-induced respiratory depression. Route: IV/nasal — very fast onset. Also available as auto-injector (Evzio). Note: Causes immediate withdrawal symptoms in opioid-dependent patients. Short half-life — patient may need repeated doses. Methadone (Dolophine) ★ Opioid used for patients withdrawing from street drugs (opioid maintenance therapy) MOA: Full opioid agonist — lower euphoria than other opioids. Use: Opioid detox/maintenance. Does not cure dependence. Adverse Effects: Respiratory depression, QT prolongation. Patient must continue drug to avoid withdrawal. Colchicine (Antigout) ★ Anti-gout. Used for ACUTE gout attacks. MOA: Reduces inflammatory response to urate crystal deposits in joint tissue. Use: Acute gout attack, short-term prevention of gout. SE: Diarrhea, nausea, vomiting, myelosuppression. Avoid foods high in purines (red meat, organ meats, alcohol). Stay well hydrated. Acetylcysteine ★ Antidote for acetaminophen (Tylenol) overdose Given as a regimen (oral or IV) to prevent hepatic necrosis from acetaminophen toxicity. GROUP 3: MUSCULOSKELETAL, NEUROLOGIC & PARKINSON'S Diazepam (Valium) ★ Used to TERMINATE seizures (status epilepticus — IV). Also used for fractures/back surgery/muscle spasms. Class: Benzodiazepine — CNS depressant, skeletal muscle relaxant, anticonvulsant. MOA: Potentiates GABA (inhibitory neurotransmitter) → CNS depression. Uses: Status epilepticus (IV), anxiety, alcohol withdrawal, muscle spasms, sedation. Key: IV used as RESCUE for status epilepticus — must follow immediately with long-term AED (phenytoin, phenobarbital). Overdose antidote: Flumazenil (Romazicon). Levodopa/Carbidopa/Entacapone (Stalevo) ★ Given to Parkinson's patients. Teach patient to STAY AWAY from B6 and multivitamins. ★ Urine/sweat may turn orange-brown. Avoid high-protein meals (interferes with absorption). MOA: Levodopa = dopamine precursor (crosses blood-brain barrier). Carbidopa = prevents peripheral breakdown of levodopa. Entacapone (COMT inhibitor) = extends levodopa's half-life. Use: Parkinson's disease — restores dopamine in extrapyramidal areas. DO NOT stop abruptly: Risk of Neuroleptic Malignant Syndrome (NMS). Adverse Effects: Uncontrolled movements, N/V, orthostatic hypotension, muscle twitching (early toxicity sign), orange urine/sweat. Avoid: Glaucoma, melanoma, psychosis. B6/multivitamins decrease effect. High-protein meals slow absorption. Donepezil (Aricept) ★ Give at BEDTIME. Monitor for bradycardia and syncope (fall risk). NOT a cure — slows progression. Class: Cholinesterase inhibitor (anti-Alzheimer's). MOA: Inhibits acetylcholinesterase → increases acetylcholine levels in brain. Use: Alzheimer's disease (mild to moderate). Effects seen in 1–4 weeks; 6 months to fully evaluate. Adverse Effects: N/V, diarrhea, bradycardia, syncope, insomnia, abnormal dreams. Contraindications: GI bleeding, jaundice. Therapeutic effects of anti-Alzheimer's drugs may not be seen for up to 6 weeks. Benztropine (Cogentin) ★ Eliminates symptoms of EPS (Parkinsonism), tardive dyskinesia, muscle trembling. Decreases tremor, bradykinesia, muscle stiffness. Class: Anticholinergic — blocks effects of ACh. Use: Parkinsonism (drug-induced tremors/EPS from antipsychotics), tardive dyskinesia. Adverse Effects: Dry mouth, constipation, urinary retention, tachycardia. Remember: 'Can't spit, can't see, can't poop, can't pee.' Monitor: Heatstroke risk (decreased sweating). Avoid antihistamines. Contraindications: Narrow-angle glaucoma, BPH, myasthenia gravis. Overdose: Physostigmine IV or IM. Phenytoin (Dilantin) ★ Adverse effect: Gingival hyperplasia (gum overgrowth). Good oral hygiene is VITAL. Class: Anticonvulsant — hydantoin, Na+ channel stabilizer. MOA: Desensitizes sodium channels in the CNS, preventing spread of seizure activity. Use: Tonic-clonic (grand mal) seizures. NOT effective for absence seizures. Therapeutic Range: 10–20 mcg/mL. Narrow therapeutic index — monitor levels. IV Administration: Mix with NS ONLY (precipitates with dextrose). Max rate 50 mg/min. Avoid hand veins (purple glove syndrome). Long-Term SE: Gingival hyperplasia, acne, hirsutism, ataxia, nystagmus, cardiac dysrhythmias. Interactions: Many drug interactions. Phenytoin + TCAs = seizure risk. Valproic Acid (Depakote) ★ Migraine prophylaxis and anti-seizure. CONTRAINDICATION: liver disease. Monitor LFTs and platelets. MOA: Increases GABA effects; blocks Na+ and Ca2+ channels. Uses: Seizures (petit mal, grand mal), bipolar disorder, migraine prophylaxis. Adverse Effects: Hepatotoxicity (BBW), pancreatitis, thrombocytopenia, sedation, GI upset, prolonged bleeding. Pregnancy: Category X — causes neural tube defects. Avoid. Administration: Do not chew; do not mix syrup with carbonated beverages. Avoid anticoagulants. Phenobarbital ★ Used to induce medical coma. Can be taken as anticonvulsant and hypnotic agent. Stay away from alcohol. Take with or without meals. Class: Barbiturate — CNS depressant. MOA: Mimics and enhances GABA (longer duration than benzodiazepines). Uses: Seizures (first-line), sedation, status epilepticus (second-line). Adverse Effects: Severe respiratory depression, profound CNS sedation. Narrow therapeutic index: Induces liver enzymes (speeds metabolism of other drugs like warfarin — may need higher warfarin doses). Tardive Dyskinesia ★ Involuntary movement due to long-term use of antipsychotic drugs Potentially irreversible. Involves involuntary movements: tongue protrusion, lip-smacking, choreoathetosis (wavelike movements of extremities). Nurses must use the AIMS Scale (Abnormal Involuntary Movement Scale) for early detection. Treated with dose reduction or switching to atypical antipsychotic. Benztropine (Cogentin) used for EPS. Disulfiram (Antabuse) ★ Causes violent reaction to alcohol. Educate patient to avoid hidden alcohol: mouthwash, vanilla extract, hand sanitizer, perfume. MOA: Enzyme inhibitor — when alcohol consumed, causes severe reaction: vomiting, flushing, tachycardia, hypotension. Use: Substance use disorder — alcohol abstinence support. Methylphenidate (Ritalin) ★ Used for children with ADHD. Give EARLY MORNING before breakfast to prevent insomnia. Long half-life 6–8 hours. MOA: CNS stimulant; increases dopamine and norepinephrine. Use: ADHD — increases focus and attention. Schedule II: High abuse potential; may require 'holiday' periods. Adverse Effects: Insomnia, anorexia, weight loss, increased HR/BP, stunted growth in children — monitor height/weight. Contraindications: Anxiety, agitation, psychosis, glaucoma, Tourette's. Atropine ★ Anticholinergic drug. ANTIDOTE when there is a cholinergic crisis. MOA: Blocks acetylcholine receptors (muscarinic) → induces fight-or-flight response: increased HR, bronchodilation, decreased GI motility, mydriasis, decreased secretions. Uses: Symptomatic bradycardia (ACLS), cholinergic crisis antidote, preanesthesia to reduce secretions, diagnosis of sinus node dysfunction. SE: Dry mouth, urinary retention, constipation, tachycardia, blurred vision, confusion. Overdose antidote: Physostigmine. GROUP 4: CARDIOVASCULAR DRUGS ACE Inhibitors (Captopril, Enalapril, Lisinopril — end in '-pril') ★ Antihypertensive (ends in -PRIL). Adverse effects: Dry cough, angioedema. Monitor BP before giving. Provides RENAL PROTECTION in diabetic patients. MOA: Inhibits ACE in lungs → Angiotensin I does not convert to Angiotensin II → prevents vasoconstriction and aldosterone secretion → diuresis → decreased BP. Uses: Hypertension, heart failure, post-MI cardioprotection, diabetic nephropathy. Adverse Effects: Dry nonproductive cough (most common — do NOT give cough meds, it reverses when drug stopped), angioedema (rare but fatal), first-dose hypotension, hyperkalemia. Pregnancy: Category X — stop if pregnant/lactating. Captopril advantage: Does not need liver metabolism. Atenolol — Beta Blocker ★ Beta blocker. Nursing teaching: Used to DECREASE HR, decrease contractility. Monitor pulse and BP before giving. Class: Selective Beta-1 adrenergic blocker. MOA: Blocks beta-1 receptors → reduces HR, reduces myocardial contractility, delays AV conduction. Uses: Hypertension, angina, post-MI, atrial fibrillation, tremors, headache prophylaxis. HOLD if: HR <60 bpm or low blood pressure. Contraindications: 2nd/3rd degree AV block, sinus bradycardia. Non-selective types contraindicated in COPD. Black Box Warning: Do NOT stop abruptly — taper over 1–2 weeks (risk of rebound hypertension, angina). Doxazosin (Cardura) — Alpha-1 Blocker ★ Used in BPH. Patient needs to LIE DOWN after taking to prevent orthostatic hypotension. MOA: Blocks alpha-1 adrenergic receptors → vasodilation → decreased BP; also relaxes smooth muscle in prostate. Uses: BPH (urinary symptoms), hypertension. Adverse Effects: Orthostatic hypotension (especially first dose), dizziness, headache. Furosemide (Lasix) — Loop Diuretic ★ Loop diuretic. Biggest concern: Fluid and electrolyte depletion (HYPOKALEMIA) and OTOTOXICITY. MOA: Acts on ascending loop of Henle → inhibits Na/K/Cl reabsorption → potent diuresis. Uses: Edema (HF, renal/hepatic disease), hypertension, hypercalcemia. Adverse Effects: Hypokalemia, hypomagnesemia, ototoxicity (especially with aminoglycosides), hyperglycemia, hyperuricemia, orthostatic hypotension. Monitor: K+ levels before administration. Check K before giving. Patients with DM — monitor blood glucose. Interactions: Digoxin (hypokalemia → toxicity); aminoglycosides (nephrotoxicity/ototoxicity); lithium toxicity. Contraindications: Hypersensitivity to furosemide or sulfonamides, anuria, hepatic coma, severe fluid/electrolyte depletion. Cardiac Glycoside — Digoxin (Lanoxin) ★ AKA DIGOXIN. Monitor POTASSIUM level (Hypokalemia = TOXICITY). Monitor pulse for 1 FULL MINUTE. If pulse <60 = HOLD drug. ★ S/S of toxicity: Nausea, vomiting, vision changes (yellow/green halos), bradycardia, confusion. MOA: Inhibits Na-K ATPase pump → increases intracellular Ca → increases myocardial contractility (+ inotrope). Also slows AV conduction (– chronotrope). Uses: Heart failure, atrial fibrillation (controls ventricular rate). Therapeutic Range: 0.5–2.0 ng/mL. Narrow therapeutic index. Toxicity Antidote: Digibind (digoxin immune Fab) — for life-threatening toxicity. Predisposing Toxicity: Hypokalemia (most important!), hypomagnesemia, hypercalcemia, renal impairment. Interactions: Loop diuretics (hypokalemia → toxicity), quinidine, amiodarone. Monitor K with all diuretics. Calcium Channel Blockers (CCB) ★ Major side effect: CONSTIPATION. Monitor fluids, electrolytes, and add fiber. MOA: Block calcium entry into vascular smooth muscle and cardiac cells → vasodilation, decreased myocardial contractility, slowed conduction. Uses: HTN, angina, dysrhythmias, migraine, Raynaud's disease. Examples: Nifedipine (DHP — mainly vascular), verapamil, diltiazem. Adverse Effects: Constipation, peripheral edema, headache, dizziness, reflex tachycardia (DHP class). Nitroglycerin ★ Monitor BP. Max 3 doses, 5 minutes apart. If pain not relieved, call 911 after 2nd or 3rd dose. Class: Nitrate antianginal. MOA: Generalized vasodilation → reduces cardiac preload and afterload → reduces O2 demand of myocardium. Uses: Acute angina attack (SL or PO), angina prophylaxis (extended release). Adverse Effects: Hypotension, headache, reflex tachycardia, flushing. Nursing: Monitor BP before and after. Give SL, may repeat Q5min x3. If no relief after 3 doses — call 911. Heparin ★ Antidote: PROTAMINE SULFATE. Can be on Warfarin at the SAME time (bridging therapy). MOA: Activates antithrombin III → inhibits clotting factors → prevents clot formation. Route: Parenteral ONLY (IV or subcutaneous). Short half-life (1–2 hours). Monitoring: aPTT (activated partial thromboplastin time). Nursing: Two-RN check for IV doses. SC: give in deep fat (abdomen), 2 inches from umbilicus/scars/stomas. Do NOT aspirate or massage injection site. Warfarin (Coumadin) ★ Antidote: Vitamin K MOA: Inhibits Vitamin K reductase → inhibits synthesis of Vit K-dependent clotting factors (II, VII, IX, X). Route: Oral only. Takes several days for full therapeutic effect. Monitoring: PT-INR. Therapeutic INR: 2–3 (A-fib, DVT). 2.5–3.5 (prosthetic valves). Antidote: Vitamin K. Interactions: Highly protein-bound — interacts with many drugs (ASA, NSAIDs increase bleeding risk). Vitamin K-containing foods decrease efficacy. Enoxaparin (Lovenox) — LMWH ★ Anticoagulant. Give 2 inches away from umbilicus (subcutaneous). Do NOT rub after injection. MOA: Factor Xa inhibitor — more predictable than heparin. Route: Subcutaneous only. Does not require lab monitoring (unlike heparin). Antidote: Protamine sulfate. Phenylephrine HCl (Neo-Synephrine) Class: Alpha-1 adrenergic agonist — sympathomimetic decongestant. Uses: Nasal congestion, hypotension, ophthalmic mydriasis. Adverse Effects: Increased BP, headache, reflex bradycardia, restlessness. Caution: HTN, cardiac disease, diabetes, hyperthyroidism. GROUP 5: RESPIRATORY / PULMONARY DRUGS Albuterol (Ventolin, ProAir) ★ SABA — for asthma, COPD, emphysema. Used ONLY during ACUTE attacks. NOT for prophylaxis. MOA: Selective beta-2 agonist → bronchodilation (relaxes bronchial smooth muscle). Onset: 15–30 minutes after inhalation. Uses: Acute asthmatic attacks, exercise-induced bronchospasm (15–30 min before activity). Status asthmaticus. Adverse Effects: Palpitations, headache, tremor, nervousness, tachycardia, restlessness, insomnia. Caution: Cardiac disease, HTN. Avoid caffeine/stimulants. Antagonized by beta-blockers. Nursing: If used too frequently, loses beta-2 specificity → stimulates beta-1 (increased HR, anxiety, nausea). Montelukast (Singulair) — Leukotriene Receptor Antagonist ★ LTRA — maintenance of asthma. Monitor LIVER functions. Used for DAILY long-term maintenance. NOT for acute attacks. MOA: Blocks leukotriene receptors → prevents bronchoconstriction, inflammation, mucus production. Uses: Long-term asthma prevention (adults/children ≥12), allergic rhinitis, exercise-induced asthma. Adverse Effects: Headache, nausea, diarrhea, dizziness, insomnia, liver function changes. Nursing: Take every night on continuous schedule. Assess liver function before and throughout therapy. Improvement seen in ~1 week. Ipratropium (Atrovent) Inhaler ★ Anticholinergic bronchodilator — MAINTENANCE drug for COPD. NOT for acute asthma. Goal: bronchodilation. MOA: Muscarinic antagonist (anticholinergic) → inhibits mucus secretions and causes bronchodilation. Uses: COPD maintenance, chronic bronchitis. Often combined with albuterol (Combivent). Adverse Effects: Bitter taste (rinse mouth), cough, hoarseness, epistaxis (intranasal form). Note: Slow and prolonged action. NOT for rescue (acute) use. Beclomethasone Inhaler (Qvar) ★ Steroid inhaler — causes ORAL CANDIDA (rinse mouth after use). Cannot stop abruptly. For CHRONIC asthma — NOT acute attacks. Class: Inhaled corticosteroid — anti-inflammatory. MOA: Reduces local airway inflammation; increases responsiveness to beta-adrenergic stimulation. Uses: Chronic asthma prevention. May take several weeks for full effects. Adverse Effects: Pharyngeal irritation, oral fungal infections (candidiasis), dry mouth. Nursing: ALWAYS rinse/gargle mouth with water after use. If using beta-agonist + corticosteroid inhaler — give beta-agonist FIRST (several minutes before) to open airways. GROUP 6: ENDOCRINE — DIABETES & THYROID Insulin (Including Glargine) ★ Glargine (Lantus) = Long-acting insulin — given at BEDTIME. Types: Rapid-acting (lispro/aspart), Short-acting (regular), Intermediate (NPH), Long-acting (glargine/detemir). Glargine (Lantus): Basal insulin — given at bedtime (same time each night). Do NOT mix with other insulins. Nursing: Rotate injection sites. Monitor blood glucose. Know signs of hypoglycemia (shakiness, diaphoresis, confusion). Always have glucose source available. Metformin ★ Decreases amount of glucose made by the liver. HOLD 48 hours before AND after procedures (contrast dye risk — lactic acidosis). Class: Biguanide antidiabetic. MOA: Decreases hepatic glucose production; increases insulin sensitivity. Use: Type 2 diabetes mellitus (first-line). Adverse Effects: GI upset (N/V/D), lactic acidosis (rare but serious), B12 deficiency with long-term use. Hold: 48 hours before AND after any procedure using IV contrast dye. Levothyroxine ★ Hypothyroidism. If dose isn't in therapeutic range, up the dose until symptoms resolve. MOA: Synthetic T4 (thyroxine) replacement. Use: Hypothyroidism — lifelong therapy typically required. Nursing: Give on empty stomach (30–60 min before breakfast). Monitor TSH, T4 levels. Do not stop abruptly. Adverse Effects: Signs of hyperthyroidism if overdosed: palpitations, weight loss, insomnia, heat intolerance. GROUP 7: GASTROINTESTINAL DRUGS Bismuth Subsalicylate (Pepto-Bismol) ★ Used for diarrhea. Side effect: TONGUE DISCOLORATION (also dark/black stools). MOA: Adsorbent — coats GI tract walls, binds causative bacteria/toxins, eliminated in stool. Adverse Effects: Tongue discoloration, dark/black stools, increased bleeding time, tinnitus, constipation. Avoid: Children/teenagers with chickenpox or flu (risk of Reye's syndrome — contains salicylate). Lactulose (Enulose) ★ Liver drug to bring down AMMONIA (ammonium) levels in hepatic encephalopathy. MOA: Osmotic laxative that traps ammonia in the colon for elimination. Use: Hepatic encephalopathy (reduces serum ammonia), chronic constipation. Adverse Effects: Abdominal bloating, electrolyte imbalances, diarrhea, rectal irritation. Total Parenteral Nutrition (TPN) ★ Change tubing every 24 hrs. Two nurses check off. Monitor blood glucose. Dedicated line — do NOT piggyback other meds. Route: Central line ONLY (PICC, subclavian, internal jugular) due to high osmolarity. Strict asepsis required. Monitoring: Blood glucose every 6 hours (sliding scale insulin often needed). Daily electrolytes (K, Na, Mg), BUN/Creatinine, LFTs, daily weights, strict I&Os.; NEVER stop abruptly: Risk of rebound hypoglycemia. Keep 10% dextrose available. 2-RN check: High-alert medication — verify bag ingredients with another RN. GROUP 8: ANTI-INFECTIVES (ANTIBIOTICS & ANTIVIRALS) Vancomycin ★ Antibiotic for MRSA. Monitor: liver function (ALT/AST), ototoxicity, nephrotoxicity (BUN/Creatinine). Peak and trough. Infuse over 60 mins to prevent RED MAN SYNDROME. MOA: Inhibits cell wall synthesis — bactericidal against gram-positive bacteria. Use: MRSA, gram-positive infections, C. diff colitis (oral form). Monitoring: Trough levels (narrow therapeutic index). Renal function (BUN/Cr). Hearing (ototoxicity). Red Man Syndrome: Flushing/itching of head, neck, face, upper trunk with rapid infusion. Prevent by infusing over ≥60 minutes. Antihistamine may be ordered. Ciprofloxacin — Fluoroquinolone ★ Anti-infective. Treats anthrax (bacteria). Black box warning for people UNDER 18 (tendon rupture risk). MOA: Bactericidal — alters bacterial DNA, causing death. Uses: Gram-negative infections, UTI, respiratory infections, GI infections, anthrax, bone/joint infections. Black Box Warning: Tendonitis and tendon rupture (especially Achilles). Avoid in <18 and elderly. Adverse Effects: Headache, dizziness, nausea, prolonged QT interval, photosensitivity, altered glucose. Levofloxacin — Fluoroquinolone ★ Antibiotic — treats pneumonia, bronchitis, kidney, prostate infections. Class: Fluoroquinolone — same class as ciprofloxacin. Same Black Box Warning: Tendonitis/tendon rupture. Avoid in under 18. Gentamicin — Aminoglycoside ★ Monitor for ototoxicity and nephrotoxicity. Peak and trough levels required. Class: Aminoglycoside — bactericidal, prevents protein synthesis. Uses: Serious gram-negative infections (Pseudomonas, E. coli, Klebsiella). Toxicities: Nephrotoxicity (monitor BUN/Cr) and Ototoxicity (monitor hearing/balance). Must monitor drug peak/trough levels. Nursing: Monitor urinary output, kidney function, hearing, balance. Zidovudine (Antiviral — HIV) ★ Antiviral drug. Used when patient has HIV and is PREGNANT. Prevents HIV from passing to fetus. Class: Nucleoside reverse transcriptase inhibitor (NRTI). Use: HIV treatment; prevention of maternal-fetal HIV transmission. GROUP 9: PSYCHIATRIC & MENTAL HEALTH DRUGS 9A — ANTIDEPRESSANTS ★ BLACK BOX WARNING for ALL antidepressants: Increased risk of suicidal ideation — especially in children and young adults during first few weeks of therapy. SSRIs — Sertraline (Zoloft), Paroxetine (Paxil) ★ Sertraline (Zoloft): Antidepressant, mood stabilizer. Therapeutic result = INCREASE IN MOOD. ★ Paroxetine (Paxil): FIRST LINE treatment of antidepressants. MOA: Selectively blocks serotonin reuptake → increases serotonin at synapse. Uses: Depression (first-line), OCD, panic disorder, PTSD, social anxiety, premenstrual dysphoric disorder. Adverse Effects: Weight gain, sexual dysfunction, insomnia, agitation, dry mouth. Serotonin Syndrome Risk: Fever, tremors, agitation, diaphoresis — do NOT combine with MAOIs. 14-day washout period required. Do NOT stop abruptly: Taper to avoid discontinuation syndrome. Interactions: MAOIs (14-day washout!), digoxin, warfarin, St. John's Wort. SNRIs — Venlafaxine (Effexor) ★ In male patients: ERECTILE DYSFUNCTION side effect. MOA: Blocks reuptake of both serotonin AND norepinephrine. Uses: Major depression, GAD, social anxiety. Adverse Effects: Hypertension (NE effect), nausea, dry mouth, erectile dysfunction in males. Monitor: Blood pressure. Take with food to minimize GI upset. TCAs — Imipramine (Tofranil) ★ Side effects: CONSTIPATION, dry mouth. Anticholinergic effects. 2–3 weeks to see therapeutic results. MOA: Inhibits reuptake of serotonin/norepinephrine; blocks acetylcholine receptors. Uses: Depression (second-line after SSRIs), enuresis in children. Adverse Effects: Anticholinergic effects (dry mouth, constipation, urinary retention, blurred vision), sedation, cardiac dysrhythmias. Overdose DANGER: Highly lethal — cardiotoxic. Baseline ECG required. Contraindications: Post-MI, cardiac dysrhythmias, narrow-angle glaucoma. Avoid within 14 days of MAOIs. MAOIs — Monoamine Oxidase Inhibitors ★ Stay away from foods HIGH IN TYRAMINE. Headache, hypertension, nausea, vomiting = TOXICITY (hypertensive crisis). MOA: Inhibits MAO enzyme → dopamine, serotonin, and NE not broken down → higher levels in brain. Uses: Treatment-resistant depression (second-line). Tyramine Foods to AVOID: Aged cheeses (cheddar, blue, Swiss), smoked/cured meats, red wines, yeast extracts, fava beans, sausage, pepperoni. 14-day Washout: Must wait 14 days between stopping SSRI and starting MAOI (or vice versa) — prevent serotonin syndrome. Examples: Isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), selegiline (Emsam). 9B — ANXIOLYTICS / SEDATIVES Benzodiazepines — Lorazepam (Ativan), Alprazolam (Xanax), Temazepam (Restoril) ★ CNS depressant — tell patient it causes drowsy sedated effect. NO driving. Take at night. Worry about DEPENDENCY and withdrawal. ★ Alprazolam (Xanax) overdose: use FLUMAZENIL (Romazicon) as antidote. ★ Lorazepam (Ativan): Benzo used for anxiety. ★ Temazepam (Restoril): For patients with INSOMNIA. MOA: Potentiates GABA (inhibitory neurotransmitter) → CNS depression. Uses: Anxiety, seizures, alcohol withdrawal, insomnia (Temazepam), muscle relaxation. Adverse Effects: Sedation, respiratory depression, dependence, tolerance, 'hangover' effect. HIGH ABUSE POTENTIAL: Schedule IV. Avoid alcohol. DO NOT stop abruptly: Risk of seizures (withdrawal) — possible death if stopped cold turkey. Antidote: Flumazenil (Romazicon). Pregnancy: Category D — all benzos. Types by duration: Long-acting: Diazepam, clonazepam. Intermediate: Lorazepam, alprazolam, temazepam. Short-acting: Midazolam, triazolam. Flumazenil (Romazicon) ★ ANTIDOTE for benzodiazepine overdose. MOA: Competitive antagonist at benzodiazepine receptor site — reverses CNS depression. Use: Reversal of benzo sedation/overdose. Buspirone ★ Used in nursing homes. Give with meals to prevent GI upset. Can be CRUSHED. Used for depression and anxiety. NOT for acute relief (takes 2–4 weeks for effect). LOW abuse potential, no sedation. MOA: Unclear — binds to serotonin/dopamine receptors (not GABA like benzos). Use: Generalized anxiety disorder (GAD) — NOT for acute anxiety. Adverse Effects: Dizziness, headache, nausea — minimal compared to benzos. 9C — MOOD STABILIZERS Lithium (Lithibid) ★ Antipsychotic/mood stabilizer — treats bipolar disorder (mania). Monitor labs: HYPONATREMIA (sodium). Narrow therapeutic range. MOA: Alters ion transport; may inhibit dopamine. Potentiates serotonergic neurotransmission. Therapeutic Range: 0.6–1.2 mEq/L (maintenance). Narrow index — monitor levels regularly. Use: Bipolar disorder (drug of choice for mania), often combined with antipsychotics. Adverse Effects: Fine hand tremors, polyuria, hypothyroidism, weight gain. CRITICAL: Maintain CONSISTENT salt and water intake! Low sodium → kidneys reabsorb lithium → TOXICITY. Avoid NSAIDs (decrease lithium excretion → toxicity). Avoid low-sodium diet. S/S Toxicity: Coarse tremors, vomiting, diarrhea, drowsiness, confusion, seizures. 9D — ANTIPSYCHOTICS Haloperidol (Haldol) — Typical Antipsychotic ★ HIGH risk for EPS and Tardive Dyskinesia. MOA: Strong dopamine D2 receptor blockade in brain. Uses: Schizophrenia, acute psychosis, Tourette's syndrome, unprovoked aggression in children. Adverse Effects: EPS (dystonia, akathisia), tardive dyskinesia, QT prolongation. Neuroleptic Malignant Syndrome (NMS): Life-threatening — high fever, lead-pipe rigidity, altered consciousness. Routes: Oral, IM immediate-release, and IM depot (monthly). Chlorpromazine — Typical Antipsychotic (Phenothiazine) ★ Side effects: Dry mouth and constipation. EPS risk. 'Thorazine shuffle' (Parkinson-like gait). Uses: Schizophrenia, schizoaffective disorder, severe N/V, intractable hiccups. Adverse Effects: Dizziness, drowsiness, orthostatic hypotension, EPS, NMS, photosensitivity. Taper: Gradually withdraw over 2–3 weeks. Risperidone (Risperdal) — Atypical Antipsychotic ★ Antipsychotic. Monitor BASELINE liver and renal function. MOA: Blocks D2 and serotonin 5-HT2A receptors. Uses: Schizophrenia (≥13 yrs), bipolar mania (≥10 yrs), autism-related irritability (ages 5–16). Adverse Effects: EPS, weight gain, hyperglycemia, hyperprolactinemia (gynecomastia, galactorrhea), orthostatic hypotension. Metabolic: Monitor weight, blood glucose, cholesterol regularly. Combined with: Often combined with lithium or valproate. Alprazolam (Xanax) — also listed under Benzos above ★ Benzo overdose: use FLUMAZENIL See full Benzodiazepine section above for complete information. Paroxetine (Paxil) — also listed under SSRIs above ★ FIRST LINE treatment of antidepressants See full SSRI section above for complete information. GROUP 10: WOMEN'S HEALTH & REPRODUCTIVE DRUGS Oral Contraceptives ★ If missed dose: double up NEXT DAY and use BACKUP protection. ★ CONTRAINDICATIONS: Women over 35 who smoke, DVT history, thromboembolic disorders. MOA: Estrogen inhibits FSH (suppresses follicle formation). Progestin suppresses LH surge (no ovulation) + thickens cervical mucus. Benefits: Reduces ovarian/endometrial cancer, ectopic pregnancy, PID, dysmenorrhea. Contraindications: Pregnancy, thromboembolic disorder history, stroke/heart disease, breast cancer, liver/kidney disease, undiagnosed vaginal bleeding, smokers >35 yrs, severe hypercholesterolemia. Adverse Effects: Thromboembolism (most serious), nausea (most common), HTN, headache, weight gain. NuvaRing — Transvaginal Contraceptive ★ Transvaginal contraceptive ring — combination hormonal contraceptive. MOA: Same as oral combination contraceptive — estrogen + progestin. Use: Monthly insertion (worn 3 weeks, removed 1 week for withdrawal bleed). Oxytocin (Pitocin) ★ Used to INDUCE labor in patients who are FULL TERM. MOA: Stimulates uterine contractions. Uses: Labor induction (full-term), postpartum hemorrhage control. Nursing: Monitor FHR, uterine contractions, maternal BP and HR continuously. Have emergency equipment available. Folic Acid (Vitamin B9) ★ Folic acid (B9): DECREASE can lead to neuro defects (neural tube defects in fetus). Role: Essential for DNA synthesis, cell division, prevention of neural tube defects (spina bifida). Deficiency Symptoms: Megaloblastic anemia, anorexia, fatigue, stomatitis, diarrhea, alopecia. Supplementation: All women of childbearing age/pregnancy should take folic acid. GROUP 11: CHEMOTHERAPY / ONCOLOGY Chemotherapy ★ Monitor WBC count. Patient MUST be hydrated. Must have a PORT and cath for chemo (special equipment, special gloves). ★ Patient is at risk — NEUTROPENIC because chemo kills both good AND bad WBCs. Key Nursing Concerns: • Monitor WBC/ANC (absolute neutrophil count) — neutropenia risk. • Ensure adequate hydration before, during, and after administration. • Central access (port) required — hazardous materials; special PPE (gown, gloves, goggles). • Neutropenic precautions: protective isolation, no fresh flowers/fruits, mask use. • Monitor for infection signs (fever may be only sign in neutropenic patient — EMERGENCY). GROUP 12: STEROIDS, STATINS & MISCELLANEOUS Prednisone — Corticosteroid ★ Monitor for HYPERGLYCEMIA and glucose levels. Must be tapered down — CANNOT stop abruptly. MOA: Synthetic glucocorticoid — suppresses immune response and inflammation. Uses: Inflammation, autoimmune disorders, multiple sclerosis exacerbations, asthma. Adverse Effects: Hyperglycemia (monitor blood glucose), immunosuppression, weight gain, fluid retention, osteoporosis, adrenal suppression. CRITICAL: Never stop abruptly — must taper. Abrupt discontinuation → adrenal crisis. Statin Drugs (HMG-CoA Reductase Inhibitors) ★ Myopathy (muscle pain). RHABDOMYOLYSIS (serious). Take AT NIGHT. 2–4 weeks to see therapeutic results. Long-term use can lead to OSTEOPOROSIS. Notify HP if muscle symptoms occur. MOA: Inhibit HMG-CoA reductase → reduce cholesterol synthesis in liver. Uses: Hypercholesterolemia, cardiovascular disease prevention. Examples: Atorvastatin, simvastatin, rosuvastatin, pravastatin. Adverse Effects: Myopathy, rhabdomyolysis (muscle breakdown → renal failure), hepatotoxicity. Interactions: Avoid grapefruit juice. Macrolide antibiotics increase statin levels (rhabdomyolysis risk). Nursing: Report unexplained muscle pain/weakness/dark urine immediately. Vitamin C (Ascorbic Acid) ★ Overdose can cause CRYSTALS FORMED IN URINE (crystalluria/kidney stones). Role: Iron absorption, folic acid conversion, carbohydrate metabolism, wound healing, immune function. Overdose SE: CNS toxicity, renal crystalluria (kidney stones), GI upset, skin changes. QUICK REFERENCE: TOP MUST-KNOW FACTS Drug Category Top Must-Know Fact Acetaminophen Analgesic Antidote: Acetylcysteine. Max 4g/day. NSAIDs Anti-inflammatory GI bleed/PUD/bruising → notify HP Drug Category Top Must-Know Fact Meperidine Opioid Antidote: Naloxone. Assess respirations. Naloxone Opioid Antidote Give if RR <10. Fast onset IV/nasal. Methadone Opioid For opioid withdrawal maintenance. Colchicine Antigout Acute gout. SE: diarrhea, N/V. Digoxin Cardiac Glycoside Hold if HR <60. Monitor K+. Toxicity: N/V, visual halos. Furosemide Loop Diuretic Biggest concern: Hypokalemia + Ototoxicity. Nitroglycerin Nitrate Max 3 doses, 5 min apart. Call 911 if no relief. Warfarin Anticoagulant Antidote: Vit K. Monitor INR. Heparin Anticoagulant Antidote: Protamine sulfate. Enoxaparin LMWH 2 inches from umbilicus. Do NOT rub. Captopril/ACE-I Antihypertensive Dry cough, angioedema. Monitor BP. Renal protection. Atenolol Beta Blocker Monitor HR/BP. Hold if HR <60. Taper off. Doxazosin Alpha Blocker BPH. Lie down after dose — orthostatic hypotension. CCB Antihypertensive Major SE: constipation. Add fiber. Albuterol SABA ACUTE attacks ONLY. Not for prophylaxis. Montelukast LTRA Long-term maintenance. Monitor LFTs. Beclomethasone Inhaled Steroid Rinse mouth after. Not for acute attacks. Metformin Antidiabetic Hold 48h before/after contrast procedures. Glargine Insulin (long-acting) Give at bedtime. Levothyroxine Thyroid Hypothyroidism. Adjust dose until symptoms resolve. Vancomycin Antibiotic (MRSA) Infuse over 60 min. Monitor renal + hearing. Ciprofloxacin Fluoroquinolone BBW: Tendon rupture. Avoid <18. Sertraline/Paxil SSRI First-line antidepressant. Monitor serotonin syndrome. Venlafaxine SNRI Erectile dysfunction in males. Monitor BP. Imipramine TCA Constipation, dry mouth. Cardiotoxic in overdose. MAOIs Antidepressant Avoid tyramine foods. 14-day washout. Lithium Mood Stabilizer Range 0.6–1.2. Keep sodium consistent. Haloperidol Typical Antipsychotic High EPS/tardive dyskinesia risk. Risperidone Atypical Antipsychotic Monitor liver/renal, weight, glucose. Benzodiazepines Anxiolytic Antidote: Flumazenil. No abrupt stop. Buspirone Anxiolytic GAD. Takes 2–4 wks. Low abuse potential. Phenytoin Anticonvulsant Range 10–20. Gingival hyperplasia. Valproic Acid Anticonvulsant Liver disease contraindication. Monitor LFTs. Phenobarbital Barbiturate Narrow TI. Induces liver enzymes. Levodopa/Carbidopa Anti-Parkinson Avoid B6/protein. Orange urine/sweat. Donepezil Anti-Alzheimer's Give at bedtime. Watch bradycardia (falls). Drug Category Top Must-Know Fact Benztropine Anticholinergic Treats EPS. Watch urinary retention. Prednisone Corticosteroid Monitor glucose. Taper — never stop abruptly. Statins Antilipemic Myopathy/rhabdomyolysis. Take at night. Atropine Anticholinergic Antidote for cholinergic crisis. Oxytocin Uterotonic Full-term labor induction. Chemotherapy Antineoplastic Monitor WBC. Port required. Neutropenic precautions. TPN Nutrition Two-RN check. Change tubing Q24h. Monitor glucose. Bismuth Antidiarrheal Tongue/stool discoloration. Avoid in kids with flu. Study Tip: Red drug names in the table = drugs highlighted in your study card. ★ Red text throughout = direct key notes from your index cards. All slide content has been incorporated.