Final Exam Review

-SSRIs- Selective serotonin reuptake inhibitors-block the reuptake of serotonin into the nerve terminal of
the CNS. More commonly used than TCAsless side effects. Used for major depressive disorders.
-Fluoxetine (Prozac), Fluvoxamine (Luvox), Sertraline HCl (Zoloft)-most commonly used,
Paroxetine (Paxil), Citalopram (Celexa), Escitalopram (Lexapro)
o An older client, who has been taking sertraline hydrochloride (Zoloft) for depression, is
experiencing a sudden onset of nausea, vomiting, abdominal cramps, and diarrhea. The
nurse suspects this client is experiencing:
o Adverse effect on the serum sodium level.
o Rational: Older clients are prone to developing hyponatremia as an adverse effect of
sertraline hydrochloride (Zoloft). The symptoms of nausea, vomiting, abdominal cramps, and
diarrhea are early manifestations of hyponatremia and need to be further evaluated in the
client.
-Many SSRIs interact with grapefruit juice.
-SEs headache, nervousness, restlessness, insomnia, diarrhea, blurred vision, mydriasis, tremors,
dry mouth, anorexia, nausea, weight loss, menstrual irregularities, sexual dysfunction.
-AEs- seizures, hyponatremia, dehydration, bleeding, osteopenia, suicidal ideation.
-Assess: Baseline VS and weight. Liver and renal function (BUN, creatinine, urine output, liver
enzymes). Health history of episodes of depression. Drug history. Assess for tardive dyskinesia, and
neuroleptic malignant syndrome (NMS).
-Observe for s/s of depression. VS. Orthostatic hypotension. Monitor for suicidal tendencies. Observe
for seizures.
-Teaching: Compliance is important. Full effectiveness may take 1-2 weeks. No alcohol. No
hazardous activities. Do not stop abruptly. Take with food for GI distress. Advise taking at night to
avoid sedative effects. (Nausea, headaches, drowsiness and nervousness).
-ACE inhibitors- angiotensin-converting enzyme inhibitors-block release of aldosterone, which promotes
sodium retention. Primarily used to treat HTN.

-Benazepril (Lotensin), Captopril (Capoten), enalapril maleate (Vasotec), fosinopril (Monopril),

Lisinopril (Prinivil, Zestril), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril),
Ramipril (Altace), trandolapril (Mavik).
-Usually given with a diuretic. Not during pregnancy. Dose reduction necessary for patients with
renal insufficiency.
-Most common SE: constant, irritating cough. Others include: nausea, vomiting, diarrhea,
headache, dizziness, fatigue, insomnia, hyperkalemia, and tachycardia.

-Should not be taken with potassium sparing diuretics.

-Assessment: Drug and herbal history. Baseline VS. Labs: serum protein, albumin, BUN,
creatinine, K+, and WBC.
-Intervention: Monitor BP. Monitor labs r/t renal function. Watch for hypoglycemic
reaction in DM patients. Report to HCP evidence of bruising, petechiae, and/or bleeding.
-Teaching: Abruptly discontinuing captopril could cause rebound HTN. HCP before
OTC. No salt substitute containing potassium. Warn about pregnancy and
contraindication. Rise slowly to avoid orthostatic hypotension. How to take BP and report
BP changes.

-Beta blockers-used as antihypertensive drugs, sometimes in combination with a diuretic. Reduce

HR, contractility and renin release.
-propranolol (Inderal), carvedilol (Coreg), acebutolol (Sectral), atenolol (Tenormin),
betaxolol (Kerlone), bisoprolol (Zebeta), metropolol (Lopressor).
-Use with caution on patients with preexisting bronchospasm.
-SE: increased pulse rate, markedly decreased BP, and in (noncardioselective blockers)
bronchospasm, dizziness, insomnia, depression, fatigue, nightmares and sexual
dysfunction.
-Assessment: Medical and herbal history. VS. Renal and liver function values.
-Intervention: VS. (BP and pulse). Labs: BUN, serum creatinine, AST, LDH.
-Teaching: Compliance. No abrupt discontinuation. No OTC without HCP. Teach patient
how to monitor BP, and radial pulse. Educate how to avoid orthostatic hypotension.
Report dizziness, slow pulse rate, changes in BP, heart palpitations, confusion, or GI
upset. May cause sexual dysfunction. Teach non-pharmacologic ways for lowering BP
(low sodium diet, exercise, relaxation techniques, smoking cessation).
-Do not abruptly discontinue as it could put the patient at risk for: rebound HTN, MI.
-Afrin-oxymetazoline-long acting decongestant. Taken twice a day (morning and evening).
-Oxymetazoline (Afrin) is an effective nasal decongestant, but overuse results in
worsening or rebound congestion. It should not be used more than every 4 hours. To
avoid future rebound congestion with nasal sprays, it is recommended that they be used
for no more than 3-5 days.
-Albuterol (Proventil) - a beta2-adrenergic agonist-To treat allergic reaction, anaphylaxis,
asthma, bronchospasm, severe hypotension, severe hypotension, cardiac arrest. Promotes CNS
and cardiac stimulation; strengthens cardiac contraction, increases cardiac rate and cardiac
output.
-SE- anorexia, nausea, vomiting, (nervousness, tremors, restlessness-most common),
agitation, sweating, headache, pallor, insomnia, weakness, dizziness.
-AR-Palpitations, tachycardia, hypertension, dyspnea, necrosis and gangrene of IV upon
infiltration. Ventricular fibrillation, pulmonary edema.
-Assess-baseline VS, drug history (contraindicated in narrow angle glaucoma and cardiac
dysrhythmias). Baseline glucose level.
-Interventions: VS (BP and HR). Monitor for dysrhythmias. Report SEs. Urinary output
and bladder for distention. Food to avoid nausea. Evaluate BSLs in DM patients.
-Teaching: HCP before OTC use. Compliance. Reporting side effects. Use of MDI.
-Montelukast (Singulair) leukotriene inhibitor. (Chemicals that are released when you breathe in
an allergen). For children, the nurse should instruct the parent to make sure the child chews the
entire tablet and does not swallow it whole.

-TB dugs- mycobacterium tuberculosis- prophylactic drug therapy or antitubercular drugs. Multi
drug therapy is more effective against TB. Combinations can include the following: 1. Isoniazid
and rifampin. 2. Isoniazid, rifampin and ethambutol. 3. Isoniazid, rifampin, and pyrazamide.
-Prophylactic drug therapy is contraindicated in persons with liver disease.
-Isoniazid (INH)-main antitubercular-prophylactic therapy.
- -SE: drowsiness, tremors, rash, blurred vision, photosensitivity, tinnitus,
dizziness, nausea, vomiting, dry mouth, constipation.
- -AR: psychotic behavior, peripheral neuropathy (can be reversed with
pyridoxine-vitamin B6), vitamin B6 deficiency, hyperglycemia, blood
dycrasias, thrombocytopenia, agranulocytosis, hepatotoxicity.
Not for patients with liver disorder; INH, rifampin and streptomycin all cause
hepatotoxicity.
Assessment: History of TB and TB tests. General medical history. Bilirubin, BUN and
creatinine tests. Assess s/s of peripheral neuropathy.
Intervention: Admin INH 1 hour before meals. Give vitamin B6 to prevent peripheral
neuropathy. Serum liver enzyme levels. Collect sputum specimens. Encourage eye
exams. Compliance.
Teaching: Compliance is essential. No antacids or alcohol. Medical appointments for
sputum testing. Talk to HCP if planning pregnancy. Report numbness, tingling, or
burning of hands and feet (peripheral neuritis). Avoid sunlight. Body fluid may turn
red-orange-normal.
-Claritin-loratadine- Second generation antihistamine (also called non-sedating antihistamines).
-For allergic rhinitis (stuffy nose) and urticarial (hives). Long acting H-1 blocking effect.
Longer half-life (7-15 hours)can take less frequently.
Dry up secretions, reduce sneezing.
-Asthma and asthma medications:
-Inflammation Blockers-address one or more of the chemicals release upon exposure to a
triggering event for asthma
-Leukotriene receptor antagonists-effective in reducing the inflammatory symptoms of
asthma caused by environmental and allergic stimuli (exercise induced asthma)not for
treatment of acute asthmatic attack.
- -Only for prophylactic and maintenance drug therapy for chronic asthma.
- -Zafirlukast (Accolate) and montelukast (Singulair) - Maintenance therapy for
chronic asthma. Reduce inflammation within bronchial tubes and airways.
- Assess: Baseline VS and med history. Assess decreased breath sounds, wheezing,
cough and sputum production. Note confusion, and restlessness due to hypoxia.
Determine hydration status.
- Intervention: Monitor respirations. Lung sounds. Cyanosis. Provide adequate
nutrition. AST and ALT tests (may be elevated).

Teach: s/s of allergic reaction. Liver function tests. Herb Alert: St. Johns wort,
black or green tea, guarana. Stop smoking. Alleviate anxiety. Medic Alert tag.
-Glucocorticoids-inhaledbeclomethasone (Beclovent)good for maintenance
-Oral, for short term illness.
-IV, for acute illness.
-not for treatment of acute asthmatic attack (not for rescue)
Mucolytics-acetylcysteine (Mucomyst)
-Given by inhalation atleast 5 minutes after a bronchodilator.
-Liquefy and loosen thick secretions in the airway so they can be coughed loose and
eliminated.
-Nausea, vomiting are common.
-Fun Fact: antidote for Tylenol.
Theophylline-low therapeutic index. Maintenance of chronic asthma and other COPDs.
Declined use due to serious SEs (dysrhythmias, convulsions, cardiorespiratory collapse).
Not for seizure, cardiac, renal or liver disease patients.
Children & asthma: Cromolyn and nedocromil. Sometimes glucocorticoids for moderate
to severe asthmatic state.
Older adults & asthma: Must be closely consideredbeta2-adrenergic agonists and
methylxanthines (theophylline) can cause tachycardia, nervousness and tremors.

-Robitussin (guaifenesin)-expectorant-loosen bronchial secretions s they may be eliminated by

coughing. Teach patient to: increase fluid intake to atleast 8 glasses a day to help loosen mucus.
-Benylin DM-dextromethorphan Hydromorbide-antitussiveprovides temporary suppression of
non-productive cough and loosens secretions.
-non-narcoticwidely used in OTC cold remedies.
-SE: nausea, drowsiness, fatigue, sedation.
-Contraindication in COPD patients or patients with chronic productive cough.
-Diabetes Mellitus I & II drugs (Type I-insulin dependent, Type II-non-insulin dependent)
-Insulin:-administering: RN-Regular, then NPH. (clear before cloudy)
- -Rapid acting (clear)-insulin lispro (Humalog), insulin aspart (NovoLog), insulin
glulisine (Apidra)
o -Onset of action (5-15 minutes), peak (30 minutes to 1 hour), duration (2-4 hours)
- -Short-acting insulin (clear)-Regular (Humulin R, Novolin R, regular insulin)
o -Onset of action (30-60 minutes), peak (2-3 hours), duration (3-4 hours)
- -Intermediate-acting (cloudy)-Insulin isophane NPH (Humulin N, Novolin N)
o -Onset of action (2-4 hours), peak (4-12 hours), duration (18-24 hours)
- -Long-actingInsulin glargine (Lantus)
o -Onset of action (1 hours), duration (24 hours), administered at bedtime. Keep at
room temp b/c injecting cold insulin is painful
- -Combinations-composed of short and intermediate-acting or rapid and intermediate
acting. (i.e.: Humulin 70/30 (isophane NPH 70%, regular 30%)

-SE: Hypoglycemia, dizziness, confusion, slurred speech, nervousness, anxiety, agitation,

tremors, uncoordination, sweating, tachycardia, seizures.
-Hyperglycemia: extreme thirst, dry mucous membranes, poor skin turgor, polyuria,
fruity breath, fatigue, tachycardia, Kussmaul respirations.
-Interventions: Monitor VS and glucose levels. Teach s/s of hypo/hyperglycemia. Encourage
compliance with diet, insulin, exercise. Teach how to check BSLs. Teach how to administer
insulin. (Insulin pumps, pen injectors, jet injectors)
Oral antidiabetic drugs: to treat type II diabetes.
- First generation sulfonylureas
o -Short acting: tolbutamide (Orinase)
o -Intermediate-acting: tolazamide (Tolinase)
o -Long acting: chlorpropamide (Diabinese)
- -Second generation sulfonylureas
o -Glimepiride (Amaryl)
o -Glipizide (Glucotrol, Glucotrol XL)
- Nonsulfonylureas-biguanide: Metformin (Glucophage)
o Decreases hepatic production of glucose from stored glycogen.
- Alpha-Glucosidase Inhibitors: Acarbose (Precose), Miglitol (Glyset).
- Thiazolidinediones: Pioglitazone (Actose), Rosiglitazone (Avandia)-contraindicated in
symptomatic heart disease and Class II and IV CHF.
- Meglitinides- Repaglinide (Prandin) and nateglinide (Starlix)
- Hyperglucemics- Glucagon- for insulin induced hypoglycemia. (SubQ, IM, IV)
-DDAVP-desmopressin acetate- intranasal or by injection. To treat DI (diabetes insipidus)
-DI- when there is a deficiency of ADH (antidiuretic hormone) and large amounts of
water are --excreted by the kidneyscan lead to severe volume deficit.
-Thyroid- secretes T4 and T3- metabolism.
-Hypothyroidism-`decrease in thyroid hormone secretion. Myxedema- severe
hypothyroidism.
- -lethargy, apathy, memory impairment, emotional changes, slow speech, edema in eyelids
and face, dry skin, weight gain, constipation.
- -Drug therapy: -synthetic TRH preparations: Levothyroxine sodium (Synthroid) is drug
of choice, Liothyronine (Cytomel), Liotrix (Thyrolar).
- -ADPIE: Obtain drug history. Record VS (temperature, HR, BP usually decrease).
Monitor weight. Teach that certain food inhibit thyroid secretion. HCP before OTC.
Teach s/s of hyperthyroidism (tachycardia, chest pain, palpitations).
-Hyperthyroidism- increase in T4 and T3 levels-cause Graves disease or thyrotoxicosis.
Surgery or drug therapy.
- -Drug therapy: Propylthiouracil (PTU) and methimazole (Tapazole)-useful for thyrotoxic
crisis and in preparation for thyroidectomy.

-ADPIE: Assess of s/s of thyroid crisis (thyroid storm). Teach to take with meals. Drug
compliance. Teach SE of hypothyroidism.

-Parathyroid- PTH regulates calcium levels in the blood.

-Hypoparathyroidism-hypocalcemia (by PTH deficiency)-s/s of tetany (twitching of
mouth, tingling and numbness of fingers, carpopedal spasm, spasmodic contraction,
laryngeal spasm)
- -Calcitrol- a vitamin D analogue to treat hypoparathyroidism and manage
hypocalcemia.
-Hyperparathyroidim-can be caused by malignancies of the parathyroid glands or ectopic
PTH secretion due to lung cancer, hyperthyroidism, or prolonged immobility.
- -Treated by synthetic calcitonin.
- Calcium levels: 4.5-5.5 mg/dL (ionized or free flowing calcium in the blood) or 8-10
mg/dL (total calcium)
-Prednisone (Deltasone)- Adrenal hormone-a glucocorticoid- used to treat many diseases and
health problems including: anti-inflammatory, allergic, and debilitating conditions.
-Decreases inflammatory occurrence, an immunosuppressant, to treat dermatologic
disorders by suppressing inflammation and adrenal function.
-Assess: Baseline VS. Labs: serum electrolytes and BSLs. Weight and urine output.
Medication history-can intensify-glaucoma, cataracts, peptic ulcers, psychiatric problems,
or DM.
-Interventions: Administer only as ordered. Weight. Labs (K+ decreases, BSLs increase).
Watch s/s of hypokalemia (nausea, vomiting, muscle weakness, abdominal distention,
paralytic ileus, irregular HR)
-Teach: Importance of drug compliance. Do not abruptly stop. Teach drug tapering for
short-term use. Avoid persons with respiratory infections (they suppress immune system).
Advise eating food rich in potassium.
-Levothyroxine Sodium (Synthroid)
-To treat hypothyroidism, myxedema, and cretinism.
-SE: nausea, vomiting, anorexia, diarrhea, cramps, tremors, nervousness, irritability,
insomnia, headache, weightloss, diaphoresis, amenorrhea.
-AR: tachycardia, HTN, palpitations, osteoporosis, seizures.
-Contraindications: thyrotoxicosis, MI, severe renal disease, adrenal insufficiency.
Caution with: Cardiovascular disease, HTN, angina pectoris, DM, osteoporosis.
-Acthar-Repository Corticotrpin-adrenocorticotropic hormone (ACTH)
-Used to diagnose adrenal gland disorders, to treat adrenal gland insufficiency, and as an
anti-inflammatory drug in the treatment of allergic response. Also treats acute MS.
-SE: N&V, diarrhea, constipation, mood swings, petechiae, water and sodium retention,
hypokalemia, hypocalcemia, acne.

 -AR: edema, ecchymosis, osteoporosis, muscle atrophy, growth retardation, decreased

wound healing, cataracts, glaucoma, seizures, menstrual irregularities, HTN. Life
threatening: pancreatitis, ulcer perforation.
-Antibiotics and antimicrobials inhibit bacterial growth or kill bacteria and other
microorganisms.
-narrow spectrum (usually effective against one type of organism) and broad spectrum
(tetracycline and cephalosporins-effective against gram positive and gram negative
organisms.
-Adverse reactions to antibacterials- allergic reactions, superinfection or organ toxicity.
-Overuse of penicillin lead to tolerance, requiring stronger antibiotics to be made.
-Amoxicillin and dicloxacillin broad spectrum to treat respiratory tract infections, UTI,
otitis media and sinusitis.
- ADPIE: Assess allergy to penicillin. Lab results (liver). Urine output. C&S. Epi available
in case of allergic reaction. Teach s/s of allergic reaction.
-Cephalosporins: fungus that acts as a broad spectrum antibacterial- large doses are nephrotoxic
in patients with renal disorders.- cefazolin (Ancef) and cefaclor (Ceclor)
ADPIE: Assess allergies to penicillin or cephalosporins. Lab results (especially liver
enzymes). Urine output. C&S tests. Teach to report s/s of superinfections. Encourage use
of ingesting probiotic yogurts, buttermilk and such. Comply with entire course of
medication. Teach SE.
-Antifungal therapy-fungal infections can be superficial/local, often opportunistic.
-Oral candidiasis-Thrush-Mycostatin swish and swallow
-Vaginal candidiasis-Monistat cream, suppository or oral Diflucan.
-Prevention and treatment of GI fungal infection-IV Diflucan.
-Prototypes: Nystatin (Mycostatin), Fluconazole (Diflucan)
-Metronidazole (Flagyl)-used for treatment of a variety of GI conditions (H. Pylori, postop GI surgery patients).
For serious systemic fungal infections-Amphotericin B (Fungizone)- extremely toxic:
nephrotoxic, thrombophlebitis. Fever, chills, nausea, vomiting, hypotension.

-Pyridium-phenazopyridine hydrochloride
-a urinary analgesic, works by relieving urinary pain, burning sensation, frequency and
urgency that are symptomatic of lower UTIs.
-SE: GI disturbances, hemolytic anemia, nephrotoxicity, and hepatotoxicity. Harmless
reddish orange urine due to the dye. Alters glucose urine test.
-UTI drugs
-UTI: Microbial infection. Cause pain and inflammation, bladder spasm, urgency.

 -Urinary antiseptics/antiinfectives/antibiotics- nitrofurantoin (Macrodantin)take with

food. Increase fluids. No antacids. Rinse mouth after taking because it stains teeth. Urine
may appear brownish.
- Bactrim and Cipro.
-Urinary antispasmodics- oxybutynin (Ditropan)-do not use if patient has glaucoma. Do
not use in cardia, renal, hepatic and prostate patients.
-Urinary analgesicsphenazopyridine (Pyridium)- relieves pain, burning and
frequency/urgency. Turns urine reddish-orange. Watch CBC, liver and renal function.
Treatment: Nitrofurantoin (Macrodantin), Trimethoprim-sulfamethoxazole (Bactrim,
Septra), Fluoroquinilones (Noroxin), Ciprofloxacin (Cipro), Fosfomycin tromethamine
(Monurol)-single dose.
Severe UTI- IV drug therapy followed by oral drug therapy.
Preventing UTIs: Hydration, Cranberry juice, hygiene and toileting habits.
Assess: history of UTI. Urine output and pH (5.5 is desired but alkalinization is nt
recommended). Encourage to avoid antacids. Increase fluids. Report s/s of superinfection.
-Tetracyclines- bacteriostatic, broad spectrum.
-Drug of choice for H. Pylori treatment (along with metronidazole and bismuth
subsalicylate).
-Continuous use has resulted in bacterial resistance to the drugs.
-Prototype: doxycycline (Monodox)-avoid sun exposure, discoloration of developing
permanent teeth.
-ADPIE: Assess VS and urine output. Report abnormal findings. Labs-BUN, creatinine,
aspartate aminotransferase, alanine aminotransferase, bilirubin. History if dietary intake.
C&S. Administer 1-2 hours before meals for optimal absorption. Teach patient to store
away from light and heat. Teach of photosensitive effect. Report s/s of superinfection.
Teach effective oral hygiene. Avoid milk products, iron and antacids.
-Any patient who breaks out in a massive rash, while on antibiotics, what do you do?
Call HCP, make sure you have an airway.
-Antivirals
-HIV, Herpes (HSV 1-cold sores. 2-genital herpes, STD. 3-chicken pox and shingles. 4Epstein-Barr virus. 5-CMV)
- -Herpes-acyclovir (Zovirax)-for cold sores and shingles (PO, IV, and topical) and
valocyclovir (Valtrex) for shingles and genital herpes (PO)
-Antiviral (non-HIV) drugs-inhibit viral replication.
-Influenza- amantadine (Symmetrel)-for flu prevention and oseltamivir (Tamiflu)- for
treatment of flu within 48 hours of symtoms.
-Antivirals can have CNS effects and GI SEmonitor CBC and renal function.

-Fentanyl (Duragesic)- transdermal opioid analgesic. Comes in various strengths. Short acting
potent opioid analgesic. May be used with short-term surgery. Changed every 3 days.
-Fentanyl citrate (Sublimaze)-used as a narcotic agonist for pain relief during labor. Watch for
respiratory depression in neonates if drug is used during labor. IV drug-administer over 3-5
minutesto fast can cause muscle rigidity.
-Atropine classic anticholinergic. Used primarily as preoperative medication to decrease
salivary secretions. As an agent to increase HR when bradycardia is present.
-SE: dry mouth, decreased perspiration, blurred vision, tachycardia, constipation and
urinary retention, nausea, headache, dry skin, abdominal distention, hypotension or
hypertension, impotence, photophobia.
-Contraindicated in narrow angle glaucoma, obstructive GI disorders, MI, tachycardia,
ulcerative colitis.
-ADPIE: Baseline VS, urine output, medical history, drug history. Monitor BS during
drug therapy. Fluid I&O. Assess bowel sounds. Mouth care in case of dryness. Direct
patients to avoid hot environments.
-Alprazolam (Zanax)-benzodiazepine-to treat anxiety and panic disorders.
-ADPIE: Obtain drug history. Baseline VS. History of insomnia or anxiety disorders.
Assess renal function. Monitor VS during drug therapy especially s/s of respiratory
depression. Observe for adverse reactions. Teach: non-pharmacologic ways to induce
sleep. Encourage to avoid alcohol, antidepressants, antipsychotic, and opioid drugs while
on benzodiazepines.
-Morphine-effective against acute pain from MI, cancer, and dyspnea resulting from pulmonary
edema. May be used as preoperative medication.
-Effective in relieving severe pain but can cause respiratory depression, orthostatic
hypotension, miosis, urinary retention, rash, blurred vision, bradycardia, flushing,
euphoria, pruritus. Hypotension, urticarial, seizures, ileus. Respiratory depression,
increase intracranial pressure.
-ADPIE: Obtain medical history, drug history, VS (especially respirations), urinary
output, assess type of pain. Administer before pain reaches peak levels. Monitor VS at
intervals (RR <10/min may indicate respiratory distress). Urine output. Bowel sounds.
Pupil changes. Antidote: Narcan. Teach not to consume alcohol or CNS depressants.
Teach non-pharmacologic pain relief measures. Teach to report dizziness and ambulate
with caution.
-Digoxin (Lanoxin)- to treat HF, atrial fibrillation.
-SE: anorexia, N&V, diarrhea, abdominal pain, headache, blurred vision (yellow-green
halos), diplopia, photophobia, drowsiness, dizziness, fatigue, confusion. AR: braducardia,
visual disturbances, atrioventricular block, cardiac dysrhythmias.

 -Digitalis toxicity-caused by overdose or accumulation of digoxin. S/S-anorexia,

diarrhea, N&V, bradycardia, premature ventricular contraction, cardiac dysrhythmias,
headaches, malaise, blurred vision, visual illusions, confusion, delirium.
-phenytoin and lidocaine are effective in treating digitalis induced ventricular
dysrhythmias.
-Digoxin immune Fab (ovine, Digibind) may be given to treat severe digitalis toxicity.
-Warfarin sodium (Coumadin)-anticoagulant to prevent blood clotting.
-SE: anorexia nausea, vomiting, diarrhea, abdominal cramps, rash, alopecia, fever,
stomatitis.
-AR: Purple toe syndrome, hemorrhage.
-Antidote: Vitamin K- In the WARfarin, we K+ill.
-Tests: PT (prothrombin timenormal 11-15 seconds) and INR(international normalized
rationormal 1.3-2, on anticoagulants: 2-3, with prosthetic heart valves-up to 3.5).
-Heparin-indicated for anticoagulant effect when a thrombosis occurs because of DVT,
pulmonary embolism (PE), or an evolving stroke. Primary use is to prevent venous thrombosis
which can lead to PE or stroke.
-Administered SubQ because it is poorly absorbed in GI mucosa.
-Antidote: protamine sulfate.
-Before heparin is discontinued, oral warfarin therapy is begun.
-SE: itching, burning, chills at injection site. Bleeding, ecchymosis, hematuria,
angioedema, osteoporosis, stroke, heparin induced thrombocytopenia.
-Tests: PTT (partial thromboplastin time 60-70 secs) it takes two tts to make an
Heparin) and activated partial thromboplastin time (aPTT: 20-35 secs, on anticoagulant:
30-85sec)
A patient is taking warfarin 5mg per day for A-fib. Patients INR is 3.8. The nurse would
consider this result to be?- Elevated

-For anticoagulants: ADPIE: History of abnormal clotting problems. Drug and herbal history.
Baseline PT and INR for warfarin. Monitor VS. Monitor PT/PTT/aPTT/INR. Examine for s/s of
bleeding or ecchymosis in mouth, urine, and stool. Teach patient to alert dentist of anticoagulant
use. Advise soft toothbrush. Shave with electric razor. Warn against smoking. HCP before OTC.
-Diet: Avoid large amounts of green leafy vegetables (vitamin K), caffeine and alcohol.
-Simvastatin (Zocor)-antihyperlipidemic-HMG-CoA reductase inhibitor- decreases concentration
of cholesterol, decreases LDL, and slightly increases HDL cholesterol.
-May cause GI disturbances, headaches, muscle cramps, and fatigue are early complaints.
Should report muscle aches or weakness which can lead to rhabdomyolosis, a muscle
disintegration which can be fatal.

 -ADPIE: Assess VS and baseline serum chemistry values. Medical history (some statins
are contraindicated in liver disorders). Monitor blood lipid levels (desired cholesterol
value is <200mg/dL, triglyceride <150mg/dL, LDL <100mg/dL, LDL >60mg/dL. Teach
patient to comply with drug regimen. Take with meals for GI discomfort. Explain lab
tests. Annual examinations and reporting changes in visual acuity. Encourage low-fat
diet.
-Anticonvulsants
-Hydantoins-Phenytoin (Dilantin)-See below.
-Barbiturates-Phenobarbital- treats partial seizures, grand mal seizures, acute episodes of
status epilepticus seizures, meningitis, toxic reactions, and eclampsia. Risk sedation and
tolerance to drug. Taper slowly.
-Succinimide-Ethosuximide (Zarontin)-AR: blood dycrasias, renal and liver impairment,
and systemic lupus erythematosus.
-Benzodiazepines: Clonazepam-effective in controlling petit mal (absence) seizures.
Clorazepate dipotassium-administered in adjunctive therapy for treating partial seizures.
Diazepam- Primarily prescribed for treating acute status epilepticus. Must be IV for
desired response. Short term effects-need other anticonvulsants need to be given during
or immediately after administration.
-Iminostilbene- Carbamazepine-effective in refractory seizure disorders that have not
responded to other anticonvulsant therapyused for grand mal and partial seizures and a
combination of both. Used also for psychiatric disorders.
-Valproate- Valproic acid (Depakote)- used to treat petit mal, grand mal, and mixed type
seizures. No established safety in children younger than 2. Caution with liver disorders.
Anticonvulsants and patient teaching.
-Phenytoin- To prevent tonic-clonic (grand mal) and complex partial seizure. SEheadache, diplopia, confusion, dizziness, sluggish, decreased coordination, ataxia, slurred
speech, rash, anorexia, N&V, hypotension, pink/brown discoloration of urine.
Anticonvulsant teachings: shake suspension form thoroughly before use to adequately
administer medication. Advise patient not to drive or perform hazardous activity as
drowsiness may occur. Monitor serum phenytoin levels. No alcohol. Herb Alert: Ginkgo,
Evening Primrose and borag. Do not stop abruptly. Oral hygiene. Therapeutic serum
levels 10-20 mcg/mL)
-Patient teaching- Shake suspension thoroughly to mix medication.
-Advise patient not to drive or perform hazardous activities.
-Female patients and pregnancy-contact HCP. May have teratogenic effect.
-Monitor serum phenytoin levels.
-Avoid alcohol and other CNS depressants.
-Herb Alerts: Evening primrose and borag, Gingko.
-Encourage Medic Alert.
-No abruptly stopping drug therapy, withdraw gradually to prevent seizure
rebound and status epilepticus.
-Antiparkinsons

 -Anticholinergics-Parasympatholyticiinhibit the release of acetylcholine: Benztropine

(Cogentin), Trihexyphenidyl HCL (Artane), Biperiden (Akineton)-reduce rigidity of
some of the tremors, minimal effect on bradykinesia (slow movement), used to treat drug
induced parkinsonism, or pseudoparkinsonism.
-Monitor VS. Urine output. Increase fluid intake, fiber, and exercise to avoid
constipation. Observe involuntary movements. No alcohol, cigarettes, caffeine, and
aspirin for GI irritation. Encourage ice chips, hard candy, and gum for dry mouth.
Sunglasses for photophobia.
-Dopaminergics-Cabidopa-levdopa (Sinemet) converted to dopamine. SE: fatigue,
insomnia, dry mouth, blurred vision, orthostatic hypotension, palpitations, dysrhythmias,
urinary retention, nausea, vomiting, dyskinesia, psychosis, severe depression.
Contraindicated in narrow angle glaucoma.
-Dopamine agonists- Amantadine (Symmetrel)-also antiviral drug for influenza A.
Stimulates dopamine receptors. Can be taken alone or with levodopa or anticholinergic.
Used for early treatment of Parkinsonism as drug tolerance develops.
-Monitor: orthostatic hypotension, administer drug with low protein foods. Avoid:
Vitamin B6, alcohol, other depressants. Do not abruptly discontinue. Assess for suicidal
tendencies. Monitor blood cell counts, liver and kidney function

-Benzodiazepines:
-Lorazepam (Ativan)-most frequently prescribed benzodiazepine. Used to control anxiety and
to treat status epilepticus, for preoperative sedations, for substance withdrawal.
-Diazepam (Valium)-Benzodiazepine for manaegement of anxiety, muscle spasms, alcohol
withdrawal, status epilepticus, and preoperative sedation.
-ADPIE: Assess for suicidal ideation. Obtain history of anxiety reaction. Determine
support system (if any). Drug history. Observe for SE and recognize tolerance and
dependency. Advise not to operate dangerous equipment or drive. No alcohol or CNS
depressants or narcotics. Teach non-pharmacologic ways of relieving stress. Response to
drug may take 1-2 weeks. Teach compliance.
-SE: drowsiness, dizziness, weakness, confusion, blurred vision, nausea, vomiting,
anorexia, restlessness, hallucinations, anterograde amnesia, sleep-related behaviors.
Hyper/hypotension, bradycardia, respiratory depression.
-Propofol (Diprivan)- for induction of anesthesia, may be used with general anesthesia. Short
duration of action. May cause hypotension and respiratory depression. Pain at injection siteso
may be mixed with lidocaine to decrease pain. IV anesthetic also used for maintenance of
anesthesia or conscious sedation for minor surgery.
-Obtain baseline VS. Drug and health history. Monitor postoperative state and report
excessive unresponsiveness. Observe pre-op and post-op urine output.
-Antipsychotics-syndrome discussed in class.

 -Typical antipsychotics: phenothiazines and nonphenothiazines. Phenothiazines and

thioxanthenes block norepinephrine, causing sedative and hypotensive effects early in
treatment. Butyrophenones block neurotransmitter dopamine.
-Atypical antipsychotic: Clozapine (schizophrenia and other disorders for patients who do
not respond to typical antipsychotics. Decreased SEs.
-Phenithiazines: Aliphatic: Chlorpromazine (Thorazine)-SE: strong sedation, severe
orthostatic hypotension, moderate EPS.
-Piperazine: Fluphenazine (Prolixin) and perphenazine (Trilafon)- SE: low sedation,
strong antiemetic and severe EPS.
o -Fluphenazine (Prolixin): block dopamine receptors in brain. Manages symptoms
of schizophrenia. No alcohol or other CNS depressants. Kava Kava increases
EPS. SE: sedation, dizziness, headache, seizures, dry mouth, nasal congestion,
blurred vision, photosensitivity, urinary retention.
-Pipieridines: thioridazine HCL (Mellaril)- SE: few EPS.
-Nonphenothiazines: Haloperidol (Haldol)-blocks dopamine receptors. Treats acute and
chronic psychosis, dementia, schizophrenia, Tourettes syndrome. Contraindicated:
narrow angle glaucoma, severe kidney, liver and cardiovascular disease, blood dycrasias.
SE: sedation, headache, seizures, EPS, dry mouth, blurred vision, photosensitivity,
tachycardia, orthostatic hypotension, dysrhythmias, urinary retention.
That syndrome we learned in class: EPS-extrapyramidal syndromepseudoparkinsonism symptoms: stooped posture, masklike features, rigidity, tremors at
rest, shuffling gait, bradykinesiam, pill-rolling motion of the hand. Treatmentantiparkinson drug such as Cogentin.
o -Acute dystonia: muscle spasms of face, tongue, neck and back, facial grimacing,
involuntary upward eye movements, laryngeal spasms.
o -Akathisia: Constant motion (pacing)
o -Tardive dyskinesia (TD): Protrusion and rolling of tongue, chewing action.
-Neurokleptic Malignant Syndrome (NMS): rare, potentially fatal condition. Altered
mental status, muscle rigidity, sudden high feverm BP fluctuations, tachycardia,
dysrhythmias, rhabdomyolysis, acute renal failure, respiratory failure, coma.
o -Treatment: immediate withdrawal of antipsychotics, hydration, hypothermic
blankets, antipyretics, benzodiazepines, muscle relaxants. (Dantrolene).
-Lactulose: Saline laxative that is not absorbed, draws water into the intestines to form a soft
stool. Decreases serum ammonia level and is useful in liver diseases such as Cirrhosis. Avoid
magnesium salts, as hypermagnesemia can result from continued use of magnesium salts causing
symptoms of: drowsiness, weakness, paralysis, complete heart block. Common side effects with
excess lactulose: diarrhea, flatulence, cramps, nausea, vomiting. Diabetic patients should avoid
lactulose, because it contains glucose and fructose.
-Nexium (esomeprazole)- PPI (proton-pump inhibitor)-medical treatment of GERD also used in
combination drug therapy to treat H. pylori. Neutralizes gastric contents and reduces gastric acid
secretion.

 --Patient is taking esomeprazole magnesium (Nexium) for erosive GERD. Which should
the nurse include in the patient teaching? ANSWER- this medication decreases stomach
acid secretion.
-For H. Pylori: treatment requires dual, triple, sometimes quadruple drug therapy for bacteria to
be completely eradicated. Combinations such as: amoxicillin (Amoxil), tetracycline
(Achromycin V), clarithromycin (Biaxin), omeprazole (Prilosec), lansoprazole (Prevacid),
metronidazole (Flagyl), bismuth subsalicylate (Pepto-Bismol), and ranitidine bismuth citrate
(Titrec). A 7-14 day treatment. Protocol treatment: Metronidazole (or amoxicillin), omeprazole
(or lansoprazole) and clarithromycin.
- Aldactone- (spironolactone)- Vasodilator, treats fluid retention (aldosterone increases fluid
storage) in patients with congestive heart failure, cirrhosis, and kidney problems.
-Potassium sparing diuretic to treat moderate to severe HF. Occurrence of hyperkalemia
is rare unless patient is taking 50mg/dl a day and had renal insufficiency.
-Furosemide (Lasix)-loop diuretic-to treat fluid retention/overload caused by HF, renal
dysfunction, cirrhosis, HTN, acute pulmonary edema.
-ADPIE: History of drugs taken daily. Assess VS, serum electrolytes, weight and urine
output. Note sensitivities to sulfonamides. Interventions: Urinary output should be atleast
30ml/h. Weigh patient for monitor fluid loss. Monitor VS and be alert for a decrease in
BP. Administer IV slowly as hearing loss may occur. Observe for s/s of hypokalemia (less
than 3.5 mEq/L): weakness, abdominal distention, leg cramps, and/or cardiac
dysrhythmias. Monitor serum potassium levels especially if patient is taking digoxin as
this could increase risk for digitalis toxicity.
-Teach patient to take in the morning to avoid nocturia. Rise slowly to prevent dizziness.
Take with food to avoid nausea.
A patient is taking digoxin (Lanoxin) 0.25 mg and furosemide (Lasix) 40 mg. The patient
tells the nurse, There are yellow halos around the lights. Which action will the nurse
take?
o
Evaluate digoxin levels.
What is the best information for the nurse to provide to the patient who is
receiving spironolactone (Aldactone) and furosemide (Lasix) therapy?
o
This combination promotes diuresis but decreases the risk of hypokalemia.
The nurse is assessing a patient who is taking furosemide (Lasix). The patients
potassium level is 3.4 mEq/L; chloride is 90 mmol/L, and sodium is 140 mEq/L.
Based on the nurses understanding of the laboratory results, what prescribed therapy
can the nurse anticipate administering?
o Administer 2 mEq potassium chloride per kilogram per day IV.

-LABS:

BUN (Blood Urea Nitrogen)-7-20mg/dL

Creatinine-0.7-1.3mg/dL
Sodium-135-145mEq/L
Potassium-3.7-5.2mEq/L

-Antiulcer medications:
-Tranquilizers: Chlordiazepoxide (Librium), Clidinium bromide (Quarzan)they reduce
vagal stimulation, decrease anxiety.
-Anticholinergics: Propantheline (Pro-Banthine)inhibits the release of HCL by
blocking acetylcholine and histamine. Take before meals.
-Antacids: neutralize hydrochloric acid and reduce pepsin activity. Sodium bicarbonate
(Alka-Seltzer), calcium carbonate (Tums), magnesium (Mg) hydroxide/aluminum
hydroxide (Maalox), aluminum(Al) hydroxide (Aphojel).
o -ADPIE: evaluate pain. Check patients renal function. Assess for fluid/electrolyte
imbalances (phosphate and calcium levels). Drug history. Shake suspension well
and follow with water. Monitor electrolytes. Teach to report pain, coughing or
vomiting blood. Encourage drinking water after antacid. Take 1-3 hours before
meals and at bedtime. Report constipation or diarrhea. Avoid foods that increase
gastric irritation.
-Histamine 2 blockers Cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid),
nizatidine (Axid). Redice gastric acid by blocking H2 receptors of parietal cells in
stomach. Promote healing of ulcer by eliminating cause.
o -SE: headaches, dizzinessm diarrheam constipation, reversible impotence,
gynecomastia.
o -ADPIE: Evaluate pain, GI complaints, mental status, electrolyte imbalances.
Monitor gastric pH (>5 is desired), BUN and creatinine. Give drug before meals
and at bedtime. Teach to report pain, coughing or vomiting of blood. Importance
of drug compliance. Eat foods rich in vitamin B12.
o Cimetidine interacts with oral anticoagulants, theophylline, caffeine, phenytoin,
diazepam, propranololm phenobarbital and calcium channel blockers.
-Proton pump inhibitors (PPIs)-Omeprazole (Prilosec), lansoprazole (Prevacid),
rabeprazole (Aciphex), pantoprazole (protonix), esomeprazole (Nexium),
dexlansoprazole (Dexilant) reduce gastric acid by inhibiting hydrogen/potassium
ATPase. SE: headache, insomnia, dizziness, dry mouth, flatulence, abdominal pain.
-Pepsin inhibitors-Sucralfate (Carafate)-combines with protein to form thivk paste
covering ulcer, protects from acid and pepsin. SE: constipation. Give 30 minutes before
meals and at bedtime.
o -ADPIE: Evaluate pain. Renal function. Fluid and electrolyte imbalances. Gastric
pH. Administer on an empty stomach. Advise to take drug as ordered. 4-8 weeks for
optimal ulcer healing. Increase fluid, dietary bulk and exercise to avoid constipation.

Educate on relaxation techniques. Monitor for sever, persistent constipation. Try to

avoid liquids and food that enhance GI irritation.
-Nitro-antianginal to control angina pectoris. SE: N&V, headache, blurred vision,
dizziness, syncope, weakness, diaphoresis, flushing, confusion, pallor, rash, dry mouth,
palpitations, tolerance. Hypotension, reflex tachycardia, paradoxical bradycardia,
circulatory collapse.
o -ADPIE: Baseline VS. Health and drug history. Monitor VS (hypotension). Sitting
or lying down when administering for first time. Sips of water before sublingual.
Administer for chest painif it continues after 5 minutes, call 911. No alcohol.
Keep nitro away from light. Teach on taking medication. Patch-once a day, rotate
area, avoid hairy areas. Suggest acetaminophen to avoid headache. Instruct how to
monitor HR.
o A patient who has angina is prescribed nitroglycerin. Which are appropriate nursing
interventions for nitroglycerin?
- Have patient sit or lie down when taking medication
- Teach patient who has taken a tablet to call 911 in 5 minutes if chest pain persists
- Warn patient against drinking alcohol while taking medication
Metroprolol Tartrate (Lopressor) (Beta blocker) to manage hypertension, angina
pectoris, and post-myocardial infarction. Bradycardia, dizziness and GI distress may
occur.
o -ADPIE: See page 1-2
o A patient is prescribed a beta blocker. The nurse acknowledges that beta blockers
are as effective as antinginals because they do what?
Decreases heart rate and myocardial contraction
o A healthcare provider is planning to discontinue a patients beta blocker. Which
instruction will the nurse give the patient regarding the beta blocker?
The beta blocker should not be abruptly stopped. Should be tapered
down correctly.