Pharmacology Basic Medications

Question 1

Bronchodilators > Anticholinergics (Inhaled/Nasal) Indications Mode of Action Side Effects Patient Teaching

Answer

Ipratropium, tiotropium Indications: COPD, rhinitis (i.e., nasal congestion), asthma (off-label). MOA: Blocks ACh receptors in lungs, causing bronchodilation. Side Effects: Dry mouth, bitter taste, throat/nasal irritation. PT: ↑ Fluids. Suck on candy to help ↓ dry mouth. Anticholinergic considerations .

Question 2

Bronchodilators > Xanthine Derivatives Indications Mode of Action Contraindications Side Effects Interactions Nursing Care Patient Teaching

Answer

Theophylline, aminophylline Indications: Long-term control of asthma, COPD. MOA: ↑ cAMP, causing bronchodilation. Contraindications: Coronary artery disease (CAD). Side Effects: GI upset, headache, arrhythmias, seizures. Theo = God or god-like. If you take theophylline, which has very serious side effects, you may see God sooner vs. later. Interactions: Caffeine. NC: Therapeutic serum theophylline level is 10 – 20 mcg/mL. Report levels > 20 mcg/mL to provider. PT: Periodic blood draws are required during treatment to check serum levels. Avoid foods/drinks with caffeine!

Question 3

Bronchodilators > Beta₂ Adrenergic Agonists Indications Mode of Action Side Effects Patient Teaching

Answer

Albuterol, salmeterol Indications: Asthma, COPD. MOA: Binds to beta2 receptors in the lungs, causing bronchodilation. Side Effects: Chest pain, tachycardia, palpitations, tremors, anxiety. PT: If using along with an inhaled glucocorticoid, use bronchodilator first, wait 5 minutes, then use glucocorticoid. B before G. Short-acting beta2 adrenergic agonists (e.g., albuterol) are the only treatment for acute asthma attacks! Long-acting forms (e.g., salmeterol) should be taken daily for control of asthma. Eating salmon can help you live a LONG life. Salmeterol is LONG-acting. Albuterol is SHORT-acting, for Acute Asthma Attacks.

Question 4

Anti-inflammatories > Corticosteroids (Inhaled/Nasal) Indications Mode of Action Side Effects Nursing Care Patient Teaching

Answer

Beclomethasone, mometasone, budesonide, fluticasone Indications: Asthma, rhinitis (i.e., nasal congestion). MOA: Airway inflammation. Side Effects: Pharyngitis (i.e., sore throat), oral candidiasis, bone demineralization with long-term use, immunosuppression. NC: If used with a bronchodilator, administer bronchodilator first, wait 5 minutes, then administer the corticosteroid. PT: Rinse mouth with water after administration. Clean mouthpiece weekly. Do not use to treat asthma attacks. Do not stop this medication abruptly; it must be tapered. Infection precautions .

Question 5

Bronchodilators / Anti-inflammatories > Leukotriene Receptor Antagonists Indications Mode of Action Contraindications Side Effects Nursing Care Patient Teaching

Answer

Montelukast, zafirlukast Indications: Asthma, prevention of exercise-induced bronchoconstriction. Lou (lu) cast (kast) a spell on me and and relieved my asthma! MOA: Effect of leukotrienes, which airway inflammation and bronchoconstriction. Contraindications: Liver disease. Side Effects: Hepatotoxicity. Serious mental health side effects. NC: Monitor liver enzymes. PT: Take montelukast 2 hours before exercise.

Question 6

Antitussives Indications Mode of Action Contraindications Side Effects Patient Teaching

Answer

Benzonatate, codeine, dextromethorphan ABCD = Antitussives include Benzonatate, Codeine, Dextromethorphan. Indications: Dry cough. MOA: Cough suppression. Contraindications: Productive (“wet”) cough. Side Effects: Benzonatate: Sedation, constipation, GI upset. Codeine: Sedation, respiratory depression, hypotension, constipation, GI upset. Dextromethorphan: Dizziness, sedation at high doses. PT: Use a measuring spoon, not a kitchen spoon, to measure doses.

Question 7

Expectorants Indications Mode of Action Side Effects Patient Teaching

Answer

Guaifenesin Indications: Cough associated with respiratory infections. MOA: Thickness of respiratory secretions, makes coughs more productive. Guaifenesin helps you cough up all that gunk! Side Effects: GI upset, dizziness. PT: To improve cough production and thin secretions, take with a full glass of water and ↑ fluid intake.

Question 8

Mucolytics Indications Mode of Action Contraindications Side Effects Nursing Care

Answer

Acetylcysteine Indications: Pulmonary disorders with thick mucous secretions (e.g., cystic fibrosis), antidote for acetaminophen poisoning. Acetylcysteine is used for an acetaminophen overdose. MOA: Breaks up mucus. Contraindications: Use cautiously in patients with asthma. Side Effects: Bronchospasm, nausea, vomiting, rash. PT: Medication smells like rotten eggs, an expected finding.

Question 9

Decongestants Indications Mode of Action Contraindications Side Effects Nursing Care Patient Teaching

Answer

Pseudoephedrine, phenylephrine Indications: Rhinitis. MOA: Vasoconstriction of respiratory tract mucosa. Contraindications: Hypertension, CAD. Side Effects: Nervousness, palpitations, insomnia, rebound congestion. Interactions: Caffeine, stimulants. NC: Monitor HR and BP. PT: Because of the risk of rebound congestion, use sparingly.

Question 10

Antihistamines Indications Mode of Action Contraindications Side Effects Nursing Care Patient Teaching

Answer

1st Generation: diphenhydramine 2nd Generation: loratadine, cetrizine Indications: Allergies, motion sickness, urticaria (i.e., hives). MOA: Blocks the action of histamines. Contraindications: Use cautiously in patients with glaucoma. Side Effects: 1st generation: sedation, anticholinergic effects (e.g., dry mouth, constipation, urinary retention, photosensitivity). NC: Implement fall precautions due to sedation. PT: Do not drive or operate heavy machinery when taking 1st generation antihistamines. Anticholinergic considerations .

Question 11

Antihypertensives > Renin Inhibitors Indications Mode of Action Side Effects Nursing Care

Answer

Aliskiren Indications: Hypertension. MOA: Inhibits renin, which prevents angiotensinogen from being activated. Aliskiren kind of looks like Alice and Karen. Alice and Karen gang up to stop Angie (i.e., angiotensinogen). Side Effects: Hypotension, angioedema, GI upset. Fetal toxicity. NC: Monitor BP.

Question 12

Antihypertensives > ACE Inhibitors Indications Mode of Action Contraindications Side Effects Nursing Care Patient Teaching

Answer

Captopril, lisinopril Playing cards: When you get an ACE you get a thrill, ACE inhibitors end in -pril. Indications: Hypertension, heart failure, MI, diabetic nephropathy. MOA: Blocks conversion of angiotensin I to angiotensin II, causing vasodilation. Contraindications: Pregnancy. Side Effects: ACE: Angioedema, Cough, Elevated potassium, hypotension, dizziness. Fetal toxicity. NC: Monitor BP and potassium levels. PT: Change positions slowly.

Question 13

Antihypertensives > Angiotensin II Blockers Indications Mode of Action Contraindications Side Effects Nursing Care Patient Teaching

Answer

Losartan, valsartan Indications: Hypertension, diabetic nephropathy. MOA: Blocks action of angiotensin II, resulting in vasodilation. Contraindications: Pregnancy. Side Effects: Hypotension, cough, fatigue, GI upset. Sartan kind of looks like Satan…seeing Satan would likely make your BP drop (hypotension)! Fetal toxicity. NC: Monitor BP. PT: Change positions slowly.

Question 14

Antihypertensives > Aldosterone Antagonists Indications Mode of Action Side Effects Nursing Care

Answer

Eplerenone Indications: Hypertension, heart failure (post-MI). MOA: Inhibits the effect of aldosterone, which ↓ reabsorption of sodium and water. Eplerenone does an “epic” job of blocking aldosterone. Side Effects: Hyperkalemia, dizziness. NC: Monitor BP and potassium levels.

Question 15

Antihypertensives > Calcium Channel Blockers Indications Mode of Action Side Effects Nursing Care Patient Teaching

Answer

Verapamil, nifedipine, diltiazem Calcium channel blockers are “Very Nice Drugs” (Verapamil, Nifedipine, Diltiazem). Indications: Hypertension, angina, arrhythmias (verapamil, diltiazem), pre-term labor (nifedipine). MOA: Blocks calcium channels in the heart and blood vessels, leading to vasodilation, which ↓ HR and BP. Side Effects: Peripheral edema, hypotension, bradycardia, constipation. NC: Monitor BP and HR. Hold per provider’s order parameters (e.g., SBP < 90, HR < 60). PT: Do not consume grapefruit juice. Change positions slowly.

Question 16

Antihypertensives > Centrally Acting Alpha₂ Agonists Indications Mode of Action Side Effects Patient Teaching

Answer

Clonidine Indications: Hypertension. Don’t confuse cloZapine (which is for schiZophrenia) with cloNidine (which is Not!). MOA: ↓ Sympathetic outflow from CNS, which ↓ BP. Side Effects: 3 Ds of cloniDine: Dizziness, Drowsiness, Dry mouth. PT: Suck on hard candy to help ↓ dry mouth.

Question 17

Antihpertensives / Antianginals / Antiarrhythmics > Beta₁ Blockers Indications Mode of Action Side Effects Nursing Care Patient Teaching

Answer

Metoprolol, atenolol To remember that Metoprolol and Atenolol are cardioselective (beta1), remember that your MA (mother) will always be #1 in your heart. Indications: Hypertension, angina, heart failure, arrhythmias, MI. MOA: ↓ BP and HR by blocking beta1 (heart) receptors. Side Effects: Bradycardia, hypotension, erectile dysfunction. Ischemic heart disease possible if stopped abruptly. NC: Monitor BP and HR. Hold per provider’s order parameters (e.g., SBP < 90, HR < 60). PT: Change positions slowly. Do not stop medication suddenly (must taper!). May mask signs of hypoglycemia.

Question 18

Antihpertensives / Antianginals / Antiarrhythmics > Nonselective Beta Blockers Indications Contraindications Mode of Action Side Effects Nursing Care

Answer

Propranolol, labetalol, carvedilol Indications: Hypertension, angina, arrhythmias, MI. MOA: Blocks beta1 (heart) and beta2 (lung) receptors. ↓ BP and HR. Contraindications: Asthma. Please Listen Carefully: Propranolol, Labetalol, and Carvedilol are nonselective beta blockers and impact the lungs too! Side Effects: Bronchospasm, hypotension, bradycardia, erectile dysfunction. NC: Monitor BP and HR. Hold per provider’s order parameters (e.g., SBP < 90, HR < 60).

Question 19

Antihypertensives > Vasodilators Indications Mode of Action Side Effects Nursing Care

Answer

Nitroprusside Indications: Hypertensive crisis. MOA: ↓ BP through potent vasodilation. Nitroprusside might “pruss” (i.e., press) you into the ground when your BP rapidly decreases. Side Effects: Dizziness, GI upset. Hypotension, cyanide toxicity. NC: For severe hypotension, discontinue infusion (or ↓ infusion rate) and place patient in Trendelenburg position per facility policy.

Question 20

Antianginals > Nitrates Indications Mode of Action Side Effects Interactions Patient Teaching

Answer

Nitroglycerin, isosorbide dinitrate, isosorbide mononitrate Indications: Angina. MOA: Vasodilation, ↓ preload, afterload (at higher doses), and myocardial oxygen demand. Side Effects: Hypotension, headache, reflex tachycardia. Interactions: Erectile dysfunction medications (e.g., sildenafil). PT: Sublingual: Store in cool/dark place. Take up to 3 tablets. Place 1st under tongue, wait 5 minutes. If no relief, call 911. Take 2nd, wait 5 minutes. If no relief, take 3rd. Transdermal: Wear gloves, remove prior dose, rotate sites, place on hairless site.

Question 21

Antiarrythmics > Cardiac Glycosides Indications Mode of Action Side Effects Nursing Care

Answer

Digoxin Indications: Heart failure, atrial fibrillation, atrial flutter. MOA: Positive inotropic effect (↑ force and efficiency of heart contractions) and negative chronotropic effect (↓ HR). When you dig a hole, go slow and strong. Side Effects: Arrhythmias, bradycardia, digoxin toxicity ( S/S: GI upset, fatigue, weakness, vision changes). NC: Check pulse before administration (do not administer if pulse < 60 bpm). Monitor digoxin levels during therapy (therapeutic range = 0.5 – 2 ng/mL). Treat bradycardia with atropine, toxicity with digoxin immune fab. Hypokalemia increases the risk of digoxin toxicity.

Question 22

Antiarrythmics > Class I & II Antiarrhythmics Indications Mode of Action Side Effects Nursing Care

Answer

Class I: Procainamide, lidocaine Class II: Atenolol, metoprolol, propranolol Class I: Sodium Channel Blockers: Indications: Ventricular arrhythmias and supraventricular tachycardia. MOA: Sodium channel blocker. Side Effects: Hypotension, arrhythmias, thrombocytopenia, leukopenia. Lupus-like syndrome. NC: Monitor EKG, vital signs, CBC levels. Therapeutic procainamide blood levels are 4 – 8 mcg/mL. Class II: Beta Blockers: Indications: Atrial fibrillation, atrial flutter, ventricular arrhythmias. (For details, see cards 42 – 43).

Question 23

Antiarrythmics > Class III Antiarrhythmics Indications Mode of Action Side Effects Nursing Care

Answer

Amiodarone Indications: Severe arrhythmias (e.g., ventricular fibrillation, ventricular tachycardia). Amy owes me one hundred dollars, but she is in the hospital with vfib on an amiodarone drip… so not a good time to collect. MOA: Potassium channel blocker. Side Effects: Hypotension, bradycardia, blue-gray skin discoloration, thyroid dysfunction. Pulmonary, hepatic, and cardiac toxicity. PT: Do not consume grapefruit juice. Sotalol (a non-selective beta blocker) is also considered to be a class III antiarrhythmic.

Question 24

Antiarrythmics > Class IV & Other Antiarrhythmics Indications Mode of Action Side Effects Nursing Care

Answer

Class IV: Verapamil, diltiazem Other: Adenosine Class IV: Calcium Channel Blockers: Indications: Atrial fibrillation, atrial flutter, supraventricular tachycardia. . Other Antiarrhythmics: Adenosine: Indications: Supraventricular tachycardia. Mom walked into my “den of sin” and ended up with supraventricular tachycardia. She needed adenosine to slow her heart down. MOA: ↓ Conduction time through the AV node. Side Effects: Facial flushing, shortness of breath, brief period of asystole after administration. NC: Monitor EKG rhythm.

Question 25

Antiarrythmics > Anticholinergic/Antimuscarinic Indications Mode of Action Side Effects

Answer

Atropine Indications: Sinus bradycardia, heart block, drying of secretions during surgery. Atropine is the trampoline to get your heart rate up! MOA: Antagonizes acetylcholine, ↑ HR. Side Effects: Anticholinergic side effects (e.g., blurred vision, dry mouth, urinary retention, constipation, tachycardia). Anticholinergic considerations .

Question 26

Anticoagulants > IV/Subcutaneous Anticoagulants Indications Mode of Action Side Effects Nursing Care

Answer

Heparin, enoxaparin Indications: Prevention and treatment of thromboembolic disorders (e.g., stroke, DVT, PE). MOA: Activates antithrombin, inhibiting thrombus formation. Prevents new clot formation. Does not break up existing clots. Side Effects: Bleeding, heparin-induced thrombocytopenia (HIT). Spinal/epidural hematomas (with spinal catheter). NC: Closely monitor aPTT. Therapeutic aPTT is 1.5 – 2 times baseline. Antidote is protamine sulfate! The “H” in Heparin looks like two “t“s put together, to remind you to monitor aPTT with Heparin. Bleeding precautions .

Question 27

Anticoagulants > Oral Anticoagulants: Coumarins Indications Mode of Action Side Effects Nursing Care Patient Teaching

Answer

Warfarin Indications: Prevention and treatment of thromboembolic disorders (e.g., DVT, PE, AFIB with thrombus). Prevention of complications following an MI. MOA: Antagonizes vitamin K, preventing formation of several clotting factors. Warfarin is going to war on vitamin K! Side Effects: GI upset, hepatitis. Life-threatening bleeding. NC: Closely monitor PT/INR levels. Therapeutic INR is 2 – 3 (takes 5 – 7 days to get to a therapeutic level). Antidote is vitamin K! PT: Maintain a consistent dietary intake of vitamin K. Bleeding precautions .

Question 28

Anticoagulants > Oral Anticoagulants: Factor Xa Inhibitors Indications Mode of Action Side Effects Nursing Care

Answer

Rivaroxaban, apixaban Indications: Prevention and treatment of blood clots (e.g., DVT and PE). ↓ Risk of stroke in patients with AFIB. MOA: Inhibits factor Xa, blocking the coagulation cascade. Rivaroxaban bans factor Xa and helps your blood flow like a river. Side Effects: Bleeding, ↑ liver enzymes (rivaroxaban only). Spinal/epidural hematoma (with spinal catheter), ↑ risk of thrombotic events with premature discontinuation. NC: Monitor liver function. Bleeding precautions .

Question 29

Antiplatelet Agents > Platelet Aggregation Inhibitors Indications Mode of Action Side Effects

Answer

Clopidogrel Indications: Prevention of MI, stroke in patients with acute coronary syndrome or peripheral vascular disease. MOA: Inhibits platelet aggregation. Think of a horse that clops its hoof on platelets to prevent them from aggregating. Side Effects: Bleeding, GI upset, rash. Bleeding precautions .

Question 30

Anticoagulants > Thrombin Inhibitors Indications Mode of Action Side Effects

Answer

Argatroban, dabigatran Indications: Prevention and treatment of thromboembolic disorders (dabigatran). Anticoagulation in patients with HIT (argatroban). MOA: Blocks thrombin receptors, which prevents activation of clotting factors and ↓ thrombus formation. Side Effects: Bleeding. Spinal/epidural hematoma (with spinal catheter). Bleeding precautions .

Question 31

Thrombolytics Indications Mode of Action Contraindications Side Effects Nursing Care

Answer

Alteplase, streptokinase, reteplase Indications: MI, stroke, PE, occluded central venous catheters. MOA: Converts plasminogen into plasmin, which breaks down fibrin in the clot, dissolving the clot. Alteplase goes to the place where there is a clot and breaks it up! Contraindications: History of hemorrhagic stroke, internal bleeding, recent trauma/surgery, severe hypertension. Side Effects: Bleeding. NC: For an ischemic stroke, administer within 3 hours of symptom onset. Closely monitor labs and vital signs. Bleeding precautions .

Question 32

Hemostatic Agent > Fibronolysis Inhibitors Indications Mode of Action Side Effects Nursing Care

Answer

Aminocaproic acid Indications: Hemorrhage. MOA: Inhibits fibrinolysis by preventing activation of plasminogen. Prevents the breakdown of clots and controls bleeding. Aminocaproic acid puts a “cap” on the bleeding (i.e., stops the bleeding). Side Effects: GI upset. Hypotension, bradycardia with IV administration. ↑ Risk of thromboembolism (e.g., DVT, PE). NC: Assess for bleeding and S/S of thromboembolism.

Question 33

Erythropoiesis Stimulating Agents Indications Mode of Action Contraindications Side Effects Nursing Care Patient Teaching

Answer

Epoetin alfa Indications: Anemia related to chronic kidney disease, HIV, chemotherapy. Taking epoetin alfa will fix your anemia so you can be a strong alpha male. MOA: Stimulates bone marrow to produce RBCs. Contraindications: Uncontrolled hypertension. Side Effects: Hypertension, headache, bone/joint pain, GI upset. Thromboembolic events (e.g., MI, stroke), tumor progression/recurrence. NC: Do not agitate vial. Monitor BP, Hgb/Hct, iron status. PT: Ensure adequate iron intake (i.e., dietary intake, iron supplementation)..

Question 34

Colony Stimulating Factor Indications Mode of Action Side Effects Nursing Care

Answer

Filgrastim Indications: Neutropenia related to chemotherapy. You fill up on neutrophils with filgrastim. MOA: Stimulates bone marrow to produce neutrophils. Side Effects: Bone pain, leukocytosis, GI upset, splenomegaly. NC: Do not agitate vial. Monitor CBC with differential, including absolute neutrophil count (ANC).

Question 35

Shock Medications > Adrenergics: Bronchodilator/Vasopressor Indications Mode of Action Side Effects Nursing Care

Answer

Epinephrine Indications: Anaphylaxis, cardiac arrest, septic shock. MOA: Stimulates alpha1 sites (vasoconstriction), beta1 receptors (↑ HR), beta2 receptors (bronchodilation). Side Effects: Hypertension, arrhythmias, angina, nervousness, tremor. NC: Closely monitor vital signs, EKG. When given for shock, correct hypovolemia before using vasopressors.

Question 36

Shock Medications > Adrenergics: Vasopressor Indications Mode of Action Side Effects Nursing Care

Answer

Norepinephrine Indications: Shock, severe hypotension. MOA: Stimulates alpha1 sites (vasoconstriction), beta1 receptors (↑ cardiac output). Side Effects: Hypertension, arrhythmias. Digital necrosis with high doses. NC: Closely monitor vital signs, EKG. When given for shock, correct hypovolemia before using vasopressors.

Question 37

Shock Medications > Adrenergics: Inotropic/Vasopressor Indications Mode of Action Side Effects Nursing Care

Answer

Dopamine Indications: Shock, sepsis, heart failure, renal failure. When you’re in shock you act like a dope and might need dopamine. MOA: Stimulates alpha1 receptors (vasoconstriction), beta1 receptors (↑ CO and HR), and dopaminergic receptors (↑ renal perfusion). Side Effects: Arrhythmias, angina. NC: For hemodynamic shock, correct hypovolemia before using vasopressors.

Question 38

Shock Medications > Adrenergics: Inotropic Indications Mode of Action Side Effects Nursing Care

Answer

Dobutamine Indications: Cardiogenic shock, heart failure. Doh! I just looked in the mirror and realized that butt is mine. Now I’m in shock and need dobutamine. MOA: Stimulates beta1 receptors (↑ cardiac output). Side Effects: Hypertension, arrhythmias, angina. NC: Monitor vital signs, EKG, hemodynamics (PAWP, CO, and CVP).

Question 39

Shock Medications > Colloid/Volume Expander Indications Mode of Action Contraindications Side Effects Nursing Care

Answer

Albumin Indications: Shock, hemorrhage, burns. MOA: Maintains osmotic pressure in the plasma. Albumin keeps all fluid in the vessels. Contraindications: Heart failure. Side Effects: Fluid overload (e.g., pulmonary edema, hypertension). NC: Assess for signs of fluid overload.

Question 40

Antilipemic Agents > Statins Indications Mode of Action Side Effects Nursing Care Patient Teaching

Answer

Atorvastatin, simvastatin, rosuvastatin Indications: Hypercholesterolemia, prevention of CAD. MOA: ↓ LDL production, ↑ HDL production. Side Effects: Hepatotoxicity, muscle pain, rhabdomyolysis. NC: Monitor liver function and CK levels. PT: Avoid alcohol and grapefruit juice. Report muscle pain or cola-colored urine immediately. Take short-acting statins (e.g., simvastatin) in the evening, as cholesterol is synthesized at night. “Statin” looks like “Satin” sheets that you crawl into at bedtime… the same time you take your statin drugs.

Question 41

Antilipemic Agents > Cholesterol Absorption Inhibitors Indications Mode of Action Side Effects Nursing Care

Answer

Ezetimibe Indications: Hypercholesterolemia. MOA: Inhibits absorption of cholesterol in the small intestine. EZetimibe makes it EZ (easy) to bring down your cholesterol levels. Side Effects: Runny nose, sore throat, joint pain, hepatotoxicity. Muscle pain if combined with a statin. NC: Monitor liver function. Check CK levels if patient develops muscle pain.

Question 42

Antilipemic Agents > Bile Acid Sequestrants Indications Mode of Action Interactions Side Effects Patient Teaching

Answer

Colesevelam, cholestyramine Indications: Hypercholesterolemia. Cholestyramine and colesevelam will help reduce your cholesterol. MOA: Binds bile acids in the GI tract, ↓ LDL cholesterol. Interactions: Many medications, including oral contraceptives. Side Effects: Constipation, GI upset. PT: ↑ Fiber and fluid intake. Take with food and a full glass of water. Interferes with absorption of fat-soluble vitamins (A, D, E, K). Take other medications 1 hour before or 4 hours after taking a bile acid sequestrant.

Question 43

Antilipemic Agents > Fibric Acid Derivatives Indications Mode of Action Side Effects Nursing Care Patient Teaching

Answer

Gemfibrozil, fenofibrate Indications: Hypercholesterolemia. Just like eating a lot of fiber, gemfibrozil and fenofibrate will help decrease your cholesterol. MOA: ↓ Triglyceride production and transport. ↑ HDL levels. Contraindications: Gallbladder disease. Side Effects: GI upset, gallstones, hepatotoxicity, muscle pain. NC: Monitor liver function. PT: Take 30 minutes before breakfast and dinner.

Question 44

Antilipemic Agents > Water Soluble Vitamins Indications Mode of Action Contraindications Side Effects Nursing Care

Answer

Niacin (vitamin B3) Indications: Hypercholesterolemia. MOA: ↓ LDL and triglyceride synthesis. ↑ HDL levels. Contraindications: Use cautiously in patients with diabetes. Side Effects: Flushing of the face, GI upset, pruritus, hepatotoxicity, hyperglycemia. My face doesn’t look very nice because it’s flushed after taking niacin! NC: Monitor liver function.

Question 45

Vitamins / Minerals / Electrolytes > Antianemics: Water Soluble Vitamins Indications Mode of Action Nursing Care

Answer

Folic acid (Folate, vitamin B9) Cyanocobalamin (Vitamin B12) Folic Acid: Indications: Megaloblastic anemia, prevention of neural tube defects during pregnancy, folate deficiency. MOA: Supports production of RBCs, DNA/RNA, and amino acids Folic acid can mask a vitamin B12 deficiency, leading to deterioration in neurological function. Cyanocobalamin: Indications: Pernicious anemia, malabsorption of vitamin B12, dietary deficiency. Cynthia keeps babblin‘ about taking cyanocobalamin for her pernicious anemia. MOA: Supports production of RBCs, nerve cells, DNA. Severe deficiency due to malabsorption requires injections (vs. oral administration)!

Question 46

Vitamins / Minerals / Electrolytes > Antianemics: Iron Supplements Indications Mode of Action Side Effects Nursing Care Patient Teaching

Answer

Ferrous sulfate (PO), Iron dextran (IV/IM) Indications: Iron deficiency anemia. MOA: Essential component of hemoglobin. Side Effects: Oral: GI upset, constipation, teeth staining (drink with straw!), harmless dark green/black stools. IM: Staining at injection site, hypotension, flushing. Anaphylaxis (iron dextran). NC: Use Z-track method for IM injection. PT: Vitamin C ↑ iron absorption, calcium ↓ iron absorption. Take on empty stomach. ↑ Fiber and fluid intake to prevent constipation. Keep out of reach of children due to risk of fatal toxicity.

Question 47

Vitamins / Minerals / Electrolytes > Calcium Supplements Indications Mode of Action Side Effects Patient Teaching

Answer

Calcium carbonate, calcium citrate, calcium gluconate Indications: Calcium Carbonate and Citrate: Hypocalcemia, prevention of post-menopausal osteoporosis. Calcium Gluconate: Emergency treatment of hyperkalemia and hypermagnesemia. MOA: Electrolyte needed for bone/teeth formation, nerve/muscle function, clotting. Side Effects: Constipation, arrhythmias, bradycardia. PT: Sufficient vitamin D needed for calcium absorption! Expected range of Ca: 9 – 10.5 mg/dL.

Question 48

Vitamins / Minerals / Electrolytes > Potassium Supplements Indications Mode of Action Side Effects Nursing Care

Answer

Potassium chloride Indications: Hypokalemia. MOA: Electrolyte needed for maintenance of ICF, nerve/muscle function. Side Effects: Arrhythmias, weakness. IV: Irritation at IV site. PO: GI Upset NC: Administer IV potassium using an IV pump at a rate no faster than 10 mEq/hr. Initiate continuous EKG monitoring. Expected range of K: 3.5 – 5 mEq/L.

Question 49

Vitamins / Minerals / Electrolytes > Alkalinizing Agent/Antacid Indications Mode of Action Side Effects Nursing Care

Answer

Sodium bicarbonate Indications: Metabolic acidosis, peptic ulcer disease. MOA: Promotes acid-base balance by releasing bicarbonate ions. Neutralizes stomach acid. Side Effects: Metabolic alkalosis. NC: Monitor ABGs and electrolyte levels. Expected range of HCO3: 21 – 28 mEq/L.

Question 50

Vitamins / Minerals / Electrolytes > Potassium-Binding Agents Indications Mode of Action Side Effects Nursing Care

Answer

Sodium polystyrene sulfonate Indications: Hyperkalemia. MOA: Exchanges Na+ ions for K+ ions in the intestine, resulting in ↑ excretion of K+. Side Effects: Diarrhea or constipation, fecal impaction, nausea, vomiting, hypokalemia. NC: Monitor patient stools for constipation, as concurrent laxatives may be necessary. Expected range of K: 3.5 – 5 mEq/L.

Question 51

Vitamins / Minerals / Electrolytes > Magnesium Supplements Indications Mode of Action Side Effects Nursing Care

Answer

Magnesium chloride, magnesium gluconate, magnesium oxide Indications: Hypomagnesemia, preterm labor, pre-eclampsia, torsades de pointes. MOA: Electrolyte needed for nerve and muscle function. Slows uterine contractions. Side Effects: Diarrhea, magnesium toxicity ( S/S: ↓ DTRs, ↓ urine output, respiratory depression, hypotension). Too much magnesium brought Maggie to her knees (due to cardiac and respiratory depression). NC: Monitor for signs of toxicity. Calcium gluconate is the antidote for magnesium toxicity.

Question 52

Antianxiety Agents > Benzodiazepines Indications Mode of Action Side Effects Patient Teaching

Answer

Diazepam, lorazepam, midazolam, chlordiazepoxide Indications: Anxiety, seizures, muscle spasms, alcohol withdrawal, induction/maintenance of anesthesia. MOA: Enhances GABA effect in the CNS. Side Effects: Sedation, amnesia, respiratory depression. Pam takes lorazepam for her anxiety. She doesn’t drive her benz anymore because benzos cause sedation. Abuse, addiction, dependence, withdrawal (e.g., insomnia, irritability, seizures). PT: Do not discontinue abruptly. Short-term use only! Antidote is flumazenil.

Question 53

Antianxiety Agents > Atypical Anxiolytics Indications Mode of Action Side Effects Patient Teaching

Answer

Buspirone Indications: Anxiety. Taking a bus to a pier and sitting alone helps my anxiety (just like taking buspirone). MOA: Binds to serotonin and dopamine receptors in the brain. Side Effects: Dizziness, nausea, headache. PT: Take with the same amount of food each time to prevent a change in absorption level. Do not drink grapefruit juice. Full effects may not be felt for several weeks. Does not cause sedation. Dependency not likely, long-term use ok.

Question 54

Antidepressants > Tricyclic Antidepressants Indications Mode of Action Side Effects

Answer

Amitriptyline, imipramine Indications: Depression, neuropathy, fibromyalgia, anxiety, insomnia. MOA: ↑ Effect of serotonin and norepinephrine in the CNS. Side Effects: Sedation, orthostatic hypotension, anticholinergic effects (e.g., urinary retention, constipation, dry mouth, tachycardia, photophobia), arrhythmias, sweating, seizures. Suicidal thoughts/behaviors. Amy tripped over a tricycle in the desert. It is dry in the desert, like the anticholinergic effects of the tricyclic amitriptyline. Anticholinergic considerations .

Question 55

Antidepressants > Monoamine Oxidase Inhibitors (MAOIs) Indications Mode of Action Side Effects Patient Teaching

Answer

Phenelzine, tranylcypromine, isocarboxazid, selegiline Indications: Depression. MOA: Inhibits monoamine oxidase, which ↑ neurotransmitter levels. Side Effects: Agitation/anxiety, orthostatic hypotension. Suicidal thoughts/behavior, hypertensive crisis. Please Take It Seriously! Phenelzine, Tranylcypromine, Isocarboxazid, and Selegiline can cause a hypertensive crisis! PT: Do not eat foods rich in tyramine (e.g, aged cheese, avocados, bananas, red wine, salami/pepperoni, chocolate). Avoid caffeine. With phenelzine, you can’t eat life’s finer things because they contain tyramines. Interacts with MANY other medications (including OTC cold medications), which can result in severe hypertension. A “washout” period of at least two weeks is required before starting new medications.

Question 56

Antidepressants > Atypical Antidepressant/Smoking Deterrant Indications Mode of Action Side Effects

Answer

Bupropion Indications: Depression, smoking cessation. Bupropion…”be appropriate” and don’t smoke. MOA: Reuptake of dopamine and norepinephrine. Side Effects: Insomnia, headache, GI upset, weight loss, agitation, seizures. Suicidal thoughts/behaviors.

Question 57

Antidepressants > Atypical Antidepressant/Sleep Aid Indications Mode of Action Side Effects Patient Teaching

Answer

Trazodone Indications: Depression, insomnia. TraZodone helps me get some Zzz‘s. MOA: Serotonin antagonist and reuptake inhibitor. Side Effects: Sedation, hypotension, dry mouth. Suicidal thoughts/behaviors. PT: Avoid alcohol. Use hard candy or gum for dry mouth.

Question 58

Antidepressants / Antianxiety Agents > Selective Serotonin Reuptake Inhibitors (SSRIs) Indications Mode of Action Interactions Side Effects Nursing Care Patient Teaching

Answer

Paroxetine, sertraline, fluoxetine Indications: Anxiety, depression, OCD, PTSD. If you are the parent of a teen, you may need an SSRI (i.e., paroxetine, fluoxetine) to cope with depression/anxiety. MOA: Inhibits serotonin reuptake. Interactions: St. John’s wort (↑ the risk for serotonin syndrome). Side Effects: Sexual dysfunction, weight gain, insomnia. Suicidal thoughts/behaviors. NC: Assess for symptoms of serotonin syndrome (e.g., agitation, fever, diaphoresis, tremors). PT: Full effects not felt for 2 or more weeks.

Question 59

Antidepressants / Antianxiety Agents > Selective Serotonin & Norepinephrine Reuptake Inhibitors (SSNRIs) Indications Mode of Action Interactions Side Effects Nursing Care

Answer

Duloxetine, venlafaxine Indications: Depression, anxiety, neuropathic pain. I don’t need a deluxe apartment to be happy, I just need to take duloxetine for my depression. MOA: Inhibits serotonin and norepinephrine reuptake. Interactions: St. John’s wort (↑ the risk for serotonin syndrome). Side Effects: Fatigue, insomnia, GI upset (constipation, nausea), decreased libido. Suicidal thoughts/behaviors. NC: Monitor for signs of serotonin syndrome (e.g., agitation, hallucinations, fever, diaphoresis, tremors).

Question 60

Bipolar Disorder Medications > Mood Stabilizer Indications Mode of Action Contraindications Side Effects Interactions Nursing Care Patient Teaching

Answer

Lithium Indications: Bipolar disorder. MOA: Affects sodium transport and neurotransmitter metabolism. Contraindications: Renal disease. Side Effects: Nephrotoxicity, fine hand tremors, polyuria, ↑ thirst, electrolyte imbalances, hypothyroidism, leukocytosis, GI upset, weight gain, fatigue. Lithium toxicity. Interactions: Diuretics, NSAIDs. NC: Monitor for S/S of toxicity (plasma levels > 1.5 mEq/L): coarse tremors, confusion, hypotension, seizures, tinnitus. Monitor serum levels of lithium, sodium, BUN, creatinine. PT: Maintain adequate fluid and sodium intake (↓ sodium intake = ↑ lithium levels). Avoid activities that cause excessive sweating. Report illnesses with vomiting. Therapeutic serum levels = 0.6 – 1.2 mEq/L.

Question 61

Bipolar Disorder Medications > Mood Stabilizers/Anticonvulsants: Valproates Indications Mode of Action Side Effects Nursing Care Patient Teaching

Answer

Valproic acid, divaloproex sodium, valproate sodium Indications: Bipolar disorder, seizures. MOA: ↑ GABA in CNS to ↓ manic episodes related to bipolar disorder and suppress seizure activity. Side Effects: GI upset, thrombocytopenia. Hepatotoxicity, pancreatitis, fetal risk. If you value your liver, be careful when taking valproic acid. NC: Monitor liver function (AST, ALT, LDH, bilirubin) and CBC levels during therapy. PT: Baseline liver labs needed prior to initiation of therapy.

Question 62

Bipolar Disorder Medications > Mood Stabilizers/Anticonvulsants: Others Indications Mode of Action Side Effects Nursing Care Patient Teaching

Answer

Carbamazepine, lamotrigine Indications: Bipolar disorder, seizures/epilepsy. Carbamazepine: MOA: ↓ Synaptic transmission in the CNS. Side Effects: Blood dyscrasias (anemia, leukopenia, thrombocytopenia), vision issues (nystagmus, diplopia). Stevens-Johnson syndrome, toxic epidermal necrolysis, aplastic anemia, agranulocytosis. NC: Monitor CBC levels. Lamotrigine: MOA: Inhibits sodium transport, stabilizing neuronal membranes. Side Effects: Dizziness, GI upset, photosensitivity. Serious rashes (e.g., Stevens-Johnson syndrome). PT: Wear sunscreen. ↓ Effectiveness of oral contraceptives.

Question 63

Antipsychotics > First Generation (Typical) Antipsychotics Indications Mode of Action Side Effects Nursing Care

Answer

Chlorpromazine, haloperidol, droperidol Indications: Control of positive symptoms (e.g., delusions, hallucinations) of schizophrenia. If you have schizophrenic hallucinations, you might need haloperidol. MOA: Alters the action of dopamine in the CNS. Side Effects: Extrapyramidal symptoms (EPS), neuroleptic malignant syndrome (NMS), agranulocytosis, anticholinergic effects, orthostatic hypotension, sedation, seizures. ↑ Risk of mortality in elderly with dementia-related psychosis. NC: Monitor vital signs. Anticholinergics (e.g., benztropine) can be used to control EPS. Muscle relaxants (e.g., dantrolene) can be used to treat NMS. Anticholinergic considerations .

Question 64

Antipsychotics > Second Generation (Atypical) Antipsychotics Indications Mode of Action Side Effects Nursing Care

Answer

Risperidone, olanzapine, clozapine Indications: Control of positive and negative symptoms (e.g., anergia, anhedonia, social withdrawal) of schizophrenia. Don’t confuse cloZapine (for schiZophrenia) with cloNidine (which is Not!). MOA: Serotonin and dopamine antagonist. Side Effects: Type 2 diabetes, weight gain, hypercholesterolemia, sedation, anticholinergic effects, ↓ libido, agranulocytosis. Suicidal thoughts/behaviors, ↑ mortality in elderly with dementia-related psychosis, severe neutropenia, seizures. NC: Monitor blood glucose and for signs of infection. Anticholinergic considerations , infection precautions .

Answer 65

Methylphenidate, amphetamine mixtures Indications: ADHD, conduct disorders, narcolepsy. MOA: CNS stimulation, which ↑ mental alertness and attention. Just like methamphetamines, methylphenidate and amphetamine mixtures will amp you up (due to CNS stimulation). Side Effects: Insomnia, arrhythmias, ↓ appetite, weight loss. Abuse, dependence. NC: Monitor weight during therapy. PT: Do not take at night. For children, periodic drug “holidays” (i.e., withholding medication on weekends and summer months) may be appropriate to ↑ growth and ↓ side effects during those times.

Answer 66

Disulfiram, naltrexone, acamprosate Indications: Alcohol use disorder (promotes abstinence). MOA: Dilsulfiram: Causes many unpleasant side effects (e.g., vomiting, sweating, palpitations, hypotension) if alcohol is ingested. Naltrexone: Suppresses craving for alcohol. Acamprosate: ↓ Abstinence symptoms (e.g., anxiety, restlessness). I was sent to a camp to stop drinking alcohol, and I was given acamprosate to decrease my abstinence symptoms. These medications are NOT intended to treat acute alcohol withdrawal.

Answer 67

Buprenorphine, methadone Indications: Opioid withdrawal and maintenance of opioid use disorder. Management of severe chronic pain. MOA: Binds to opiate receptors in the CNS, ↓ pain via CNS depression. Side Effects: Sedation, confusion, constipation, hypotension. Abuse, addiction, life-threatening respiratory depression. NC: Naloxone is the antidote to these medications! Monitor pain level, vital signs, respiratory status. PT: ↑ Fiber and fluid intake to prevent constipation.

Answer 68

Varenicline Indications: Smoking cessation. Varenicline makes your veins clean of nicotine. MOA: Competitively binds to nicotine receptors, resulting in a ↓ desire to smoke. Side Effects: Anxiety, insomnia, GI upset, muscle pain. Serious neuropsychiatric events. NC: Monitor patient closely for depression and/or suicidal thoughts.

Answer 69

Acetaminophen Indications: Mild to moderate pain, fever. MOA: Inhibits prostaglandin synthesis. Side Effects: GI upset. Hepatotoxicity. NC: Administer acetylcysteine for overdose! PT: Do not exceed 4 g/day. Read medication labels as many OTC medications contain acetaminophen. Acetaminophen does not decrease inflammation.

Answer 70

Ibuprofen, naproxen, ketorolac, indomethacin Indications: Mild to moderate pain, fever, inflammation. MOA: Analgesia by ↓ inflammation. Contraindications: Pregnancy, peptic ulcer disease (PUD), bleeding disorders. Side Effects: GI upset, nephrotoxicity. GI bleeding, ulceration, perforation. ↑ Risk of cardiovascular thrombotic events(e.g., MI, stroke). Interactions: Corticosteroids, alcohol (concurrent use ↑ risk of GI bleed).

Answer 71

Celecoxib Indications: Osteoarthritis, rheumatoid arthritis. With celecoxib, you can celebrate without arthritis pain. MOA: Inhibits COX-2 enzyme, which ↓ synthesis of prostaglandins. ↓ Pain and inflammation. Contraindications: Allergy to NSAIDs or sulfonamides. Side Effects: Rash. Cardiovascular thrombotic events (e.g., MI, stroke), GI risk (e.g., bleeding, ulcers, perforation).

Answer 72

Aspirin Indications: Pain, inflammation, fever, Kawasaki disease, prevention of thrombotic events. MOA: Inhibits prostaglandin synthesis, ↓ inflammation, ↓ platelet aggregation. Contraindications: Pregnancy, peptic ulcer disease, bleeding disorders, during/following febrile illness in children (due to risk for Reye’s syndrome). Side Effects: Tinnitus, GI bleeding, GI upset, rash. ASPIRIN Side Effects = Abdominal pain, Salicylism, Peptic ulcer disease, Intestinal blood loss, Reye’s syndrome, Itchy rash, Noise (tinnitus). NC: Monitor for salicylism (e.g., tinnitus, vomiting, diarrhea, respiratory alkalosis).

Answer 73

Pregabalin. gabapentin Indications: Neuropathy, fibromyalgia, restless leg syndrome, seizures. Pregabalin prevents Gabby’s neuropathic pain. MOA: Inhibits excitatory neuron activity. Side Effects: Dizziness, drowsiness, dry mouth, edema, potential for abuse. PT: Avoid alcohol. Discontinue gradually.

Answer 74

Fentanyl, morphine, hydromorphone, oxycodone, hydrocodone Indications: Moderate to severe pain, promotion of sedation. MOA: Binds to opioid receptors in the CNS. Side Effects: Sedation, GI upset (especially constipation), hypotension, urinary retention. Life threatening respiratory depression, addiction, abuse, neonatal opioid withdrawal syndrome. NC: Monitor pain level, vital signs, respiratory status. Administer naloxone for overdose! Naloxone reverses analgesia and causes immediate withdrawal (e.g., hypertension, tachycardia, agitation). You may need to RUSH to give naloxone to your patient in response to: Respiratory depression, Urinary retention, Sedation, Hypotension. PT: Increase fluid and fiber intake.

Answer 75

Lidocaine Indications: Painful conditions or procedures involving the skin and mucous membranes (e.g., IV insertion). MOA: Blocks conduction of pain impulses in a circumscribed area. Side Effects: Burning or erythema at site of application. NC: For EMLA cream, apply 1 hour before procedure and cover with occlusive dressing.

Answer 76

Ergotamine Indications: Migraine headaches, cluster headaches. Ergotamine: Her got a migraine. MOA: Intracranial vasoconstriction. Contraindications: Peripheral vascular disease, CAD, uncontrolled hypertension. Side Effects: GI upset, hypertension. Peripheral ischemia.

Answer 77

Sumatriptan Indications: Migraine headaches, cluster headaches. MOA: Intracranial vasoconstriction. A sumo wrestler tripped and sat on my head, causing vasoconstriction (like sumatriptan). Contraindications: Peripheral vascular disease, CAD, uncontrolled hypertension. Side Effects: Dizziness/vertigo, warm/tingling sensation. Cardiovascular thrombotic events; GI bleeding, ulceration, perforation.

Answer 78

Timolol Indications: Glaucoma (primarily open angle). Timolol is for the eye. Tim stuck his finger in my eye and laughed out loud (lol). MOA: Non-selective beta blocker, ↓ aqueous humor production and intraocular pressure (IOP). Side Effects: Temporary stinging of the eye. NC: Do not touch eye with applicator, hold lacrimal duct for 1 minute after application to prevent systemic effects. Normal IOP = 10 – 21 mmHg.

Answer 79

Acetazolamide Indications: Glaucoma, heart failure, altitude sickness. I can see at the zoo because acetazolamide fixed my glaucoma. MOA: Inhibits carbonic anhydrase in the eye (resulting in ↓ aqueous humor secretion and IOP) and in the kidneys (leading to excretion of Na, K, HCO3, and water). Side Effects: Flu-like symptoms, GI upset, electrolyte imbalances (Na and K), hyperchloremic acidosis. NC: Monitor electrolytes. PT: Take with food to minimize GI upset. Normal IOP = 10 – 21 mmHg.

Answer 80

Pilocarpine, acetylcholine Indications: Open angle glaucoma. Now that pilocarpine fixed my glaucoma, I can see your big pile ‘o crap by the door. MOA: ↓ IOP by improving aqueous humor outflow. Side Effects: Stinging, eye pain. NC: Do not touch eye with applicator, hold lacrimal duct for 1 minute after application to prevent systemic effects. Normal IOP = 10 – 21 mmHg.

Answer 81

Travoprost, latanoprost Indications: Open angle glaucoma. MOA: ↓ IOP by improving aqueous humor outflow. Side Effects: Irritation, ↑ eyelash growth, eye color change (↑ in iris pigmentation). Let’s raise our glasses and say “Prost!” (i.e., cheers in German) now that my glaucoma is fixed AND I have longer/thicker eyelashes. NC: Do not touch eye with applicator, hold lacrimal duct for 1 minute after application to prevent systemic effects. Normal IOP = 10 – 21 mmHg.

Answer 82

Brimonidine Indications: Open angle glaucoma. MOA: ↓ IOP by decreasing aqueous humor production and improving outflow. Side Effects: Stinging, eye pain, drowsiness. NC: Do not touch eye with applicator, hold lacrimal duct for 1 minute after application to prevent systemic effects. Normal IOP = 10 – 21 mmHg.

Answer 83

Donepezil Indications: Alzheimer’s disease. Don’t forget things (like your Pez dispenser) when you take donepezil. MOA: ↑ ACh (by inhibiting cholinesterase), which may improve memory and cognition. Side Effects: Headache, diarrhea, nausea. PT: Take at bedtime. Donepezil does not cure Alzheimer’s disease.

Answer 84

Memantine Indications: Alzheimer’s disease. Memantine may help improve your memory. MOA: Binds to NMDA receptors, preventing binding of glutamate (an excitatory neurotransmitter), which may ↓ symptoms of cognitive decline. Side Effects: Dizziness, headache, diarrhea. PT: Memantine does not cure Alzheimer’s disease.

Answer 85

Neostigmine, pyridostigmine Indications: Improves strength/mobility in myasthenia gravis, reversal of neuromuscular blocking agents. MOA: ↑ ACh at receptor sites by inhibiting cholinesterase. Side Effects: Excess ACh, causing increased salivation, diarrhea, nausea, vomiting, sweating, bradycardia. Cholinergic side effects cause SLUDGE: Salivation, Lacrimation, Urination, Defecation, GI distress, Emesis. NC: Antidote is the anticholinergic atropine. Edrophonium is another cholinergic given to patients to diagnose myasthenia gravis (vs. cholinergic crisis).

Answer 86

Carbidopa/Levodopa Indications: Parkinson’s disease to ↓ tremors and muscle rigidity. MOA: ↑ Dopamine in the CNS. Carbidopa is the car which leaves levodopa at the brain to ↑ dopamine. Side Effects: Dyskinesias (tics), orthostatic hypotension, dark urine and sweat, nausea/vomiting, psychosis. PT: Avoid high protein meals as they ↓ the effectiveness of carbidopa/levodopa.

Answer 87

Benztropine Indications: Parkinson’s disease to ↓ tremors and muscle rigidity. MOA: ↓ ACh in the CNS. I pine for a benz, but driving is hard with Parkinson’s. Maybe taking benztropine will help with my tremors! Side Effects: Anticholinergic effects (e.g., urinary retention, constipation, dry mouth, blurred vision, tachycardia). Anticholinergic considerations .

Answer 88

Phenytoin, fosphenytoin Indications: Seizure disorders. MOA: Sodium channel blocker. Side Effects: Gingival hyperplasia, vision issues, dizziness, GI upset. Your gums look “pheny” (funny) because they are so overgrown after taking phenytoin. NC: Monitor phenytoin blood levels during therapy (therapeutic range is 10 – 20 mcg/mL). PT: ↓ Effectiveness of oral contraceptives.

Answer 89

Topiramate, levetiracetam Indications: Seizure disorders. Topiramate: MOA: ↑ GABA (inhibitory neurotransmitter), ↓ glutamate (excitatory neurotransmitter), sodium channel blocker. Side Effects: Vision issues, dizziness, drowsiness, metabolic acidosis. NC: Monitor serum bicarbonate before and during therapy. Levetiracetam: MOA: Modulates neurotransmitter release. Side Effects: Behavioral abnormalities, fatigue, agranulocytosis, Stevens-Johnson syndrome. NC: Assess for rash.

Answer 90

Zolpidem, eszopiclone Indications: Insomnia. Zolpidem and esZopiclone help you catch some Zzz’s… MOA: ↑ GABA in the CNS, promoting sedation/sleep. Side Effects: Daytime sleepiness, dizziness, abnormal thinking/behavior. Complex sleep behaviors (e.g., sleep walking/driving). PT: Allow for at least 7 – 8 hours of sleep.

Answer 91

Pentobarbital, phenobarbital Indications: Preoperative sedation, seizures, medication-induced coma for high ICP. I climbed over barbed wire to get to the pentagon, and the secret service knocked me out with some pentobarbital. MOA: ↑ GABA, resulting in CNS depression. Side Effects: Drowsiness, lethargy, hypotension, respiratory depression. NC: Monitor vital signs, have resuscitation equipment at bedside.

Answer 92

Propofol Indications: Induction and maintenance of general anesthesia. Sedation of intubated patients. If you are given propofol, someone will have to prop you up (because you will be knocked out!). MOA: Potentiates the effect of GABA. Side Effects: Amnesia, bradycardia, hypotension, respiratory depression. NC: Monitor VS continuously. Discard unused portions of propofol after 6 hours due to risk of bacterial contamination. This medication sedates but does not control pain!

Answer 93

Succinylcholine, pancuronium, rocuronium Indications: Adjunct to anesthesia in surgery or intubation procedures. MOA: Blocks ACh at the neuromuscular junction, causing skeletal muscle paralysis. Side Effects: Respiratory arrest, apnea, malignant hyperthermia ( S/S: muscle rigidity, high fever). Muscle pain following surgery with succinylcholine. Cardiac arrest, hyperkalemic rhabdomyolysis (succinylcholine). Treatment of malignant hyperthermia includes administering oxygen and dantrolene (skeletal muscle relaxant), as well as cooling measures.

Answer 94

Dantrolene Indications: Muscle spasticity related to spinal cord injury, cerebral palsy, MS. Prevention and treatment of malignant hyperthermia. Dan got run over by a trolley, and sadly became a paraplegic. He needs dantrolene for muscle spasms. MOA: Prevents release of calcium in skeletal muscles (inhibiting muscle contraction) to ↓ muscle spasticity. Contraindications: Liver disease. Side Effects: Drowsiness, muscle weakness, GI upset. Hepatotoxicity. NC: Monitor for signs of liver damage.

Answer 95

Baclofen Indications: Muscle spasticity caused by spinal cord injury or diseases, TBI, cerebral palsy, MS. If you have a back injury that causes spinal cord damage, you might need baclofen for muscle spasms. MOA: Enhances GABA in CNS to reduce muscle spasticity. Side Effects: Drowsiness, dizziness, weakness, nausea, constipation. PT: Do not discontinue abruptly. Avoid alcohol and other CNS depressants. Increase fiber and fluid intake.

Answer 96

Alendronate Indications: Osteoporosis, Paget’s disease. MOA: Prevents bone resorption by inhibiting osteoclast activity. Side Effects: Esophagitis, GI upset, musculoskeletal pain. Alen drones on and on about how alendronate gave him esophagitis. NC: Monitor bone density. PT: Take on empty stomach in morning with at least 6 – 8 fl oz of water. Sit upright (or ambulate) for 30 minutes after taking to prevent esophageal ulceration. Ensure adequate intake of calcium and vitamin D, perform weight-bearing exercises.

Answer 97

Raloxifene Indications: Postmenopausal osteoporosis, reduces risk of breast cancer. Raloxifene helps “fix” osteoporosis (fix is spelled backwards). MOA: Binds to estrogen receptors, ↓ bone resorption. Contraindications: History of thromboembolism. Side Effects: Hot flashes, leg cramps. Thromboembolism (e.g., PE, DVT, stroke). NC: Monitor bone density. PT: Report symptoms of thromboembolism to provider immediately. Ensure adequate intake of calcium and vitamin D, perform weight-bearing exercises.

Answer 98

Calcitonin Salmon Indications: Postmenopausal osteoporosis, hypercalcemia, Paget’s disease. MOA: Prevents bone resorption by inhibiting osteoclast activity. Increases renal excretion of calcium. Calcitonin tones down calcium levels in the blood! Side Effects: GI upset. Injection: Inflammation at injection site, flushing of face and hands. Nasal spray: Nasal irritation, rhinitis. NC: Monitor bone density. PT: Ensure adequate intake of calcium and vitamin D, engage in weight-bearing exercise.

Answer 99

Colchicine Indications: ↓ Pain and inflammation in an acute gout attack. Colchicine: “Hey man, cool chicken. OUCH! That chicken just pecked my gouty toe.” MOA: Interferes with WBC functions to ↓ inflammation. Side Effects: GI upset, thrombocytopenia. PT: Do not consume grapefruit juice.

Answer 100

Probenecid Indications: Chronic gout. Your chronic gout would probably benefit from probenecid. MOA: Inhibits renal reabsorption of uric acid. Side Effects: GI upset, kidney stones. NC: Monitor uric acid levels and renal function during therapy. PT: Encourage fluid intake to prevent stone formation.

Answer 101

Allopurinol Indications: Chronic gout. Allopurinol: Purify and get rid of all of that uric acid. MOA: Inhibits uric acid production. Side Effects: GI upset, rash (e.g., Stevens-Johnson syndrome), hepatotoxicity, nephrotoxicity. NC: Monitor renal and liver function during therapy. PT: Takes 2 or more weeks for symptom improvement.

Answer 102

Insulins Indications: Diabetes (type 1 and type 2). Types of insulin Insulin Type Onset Peak Duration RAPID-acting Insulin lispro, insulin aspart 5 – 15 min 30 min 3 – 5 hrs SHORT-acting Regular insulin 30 – 40 min 90 – 120 min 6 – 8 hrs INTERMEDIATE-acting NPH 1 – 4 hrs 4 – 8 hrs 12 hrs LONG-acting Insulin glargine, insulin detemir 1 – 2 hrs None 12 – 24 hrs NC: Monitor for hypoglycemia ( S/S: tachycardia, diaphoresis, shakiness, headache, weakness). Only regular insulin may be given IV. PT: Rotate injection sites to prevent lipohypertrophy!

Answer 103

Glipizide, glyburide Indications: Type 2 diabetes. Glipizide/glyburide: think of gleefully riding down a slide (with blood sugars coming down). MOA: Increases insulin release from pancreas. Contraindications: Known sulfa allergy. Side Effects: Hypoglycemia, photosensitivity, GI upset. PT: Take 30 minutes before a meal. Do not consume alcohol. Wear sunscreen.

Answer 104

Repaglinide Indications: Type 2 diabetes. MOA: Increases insulin release from pancreas. Side Effects: Hypoglycemia, angina. PT: Take 3 times a day, eat within 30 minutes of dose.

Answer 105

Metformin Indications: Type 2 diabetes. MOA: ↓ Glucose production in liver, ↓ intestinal absorption of glucose, ↑ insulin sensitivity. Side Effects: GI upset, metallic taste, lactic acidosis. A construction foreman (who takes metformin) drinks out of his metal thermos, and gets a metallic taste. NC: Hold metformin prior to procedures requiring contrast dye and for 48 hours after the procedure. Discontinue metformin 48 hours prior to procedures requiring NPO or contrast dye. Monitor for signs of lactic acidosis (e.g., nausea, vomiting, fatigue, muscle cramps, abdominal pain, tachypnea, hypotension). PT: Take with a meal. Do not consume alcohol.

Answer 106

Pioglitazone Indications: Type 2 diabetes. MOA: ↓ Insulin resistance and glucose production. ↑ Glucose uptake. Contraindications: Heart failure. Side Effects: Fluid retention, edema, elevated LDLs, hepatotoxicity. With pioglitazone, you end up in the “pig zone” and feel a little like a pig with fluid retention and edema. Congestive heart failure.

Answer 107

Acarbose Indications: Type 2 diabetes. MOA: Inhibits glucose absorption in the GI tract. Acarbose will prevent absorption of carbs (i.e., glucose). Contraindications: GI disorders. Side Effects: GI upset, hepatotoxicity. PT: Take 3 times a day with meals w/ the first bite of food.

Answer 108

Semaglutide, tirzepatide Indications: Type 2 diabetes, obesity. MOA: ↑ Insulin secretion, ↓ glucagon release. Slows gastric emptying. ↓ Appetite, promotes satiety. Side Effects: GI upset (e.g., nausea, vomiting, abdominal pain), dyspepsia, acute kidney injury, acute pancreatitis, cholecystitis. ↑ Risk of thyroid cancer. NC: Monitor HgbA1C, weight. Advise patient to hold dose 1 week before surgery (or per order). PT: Proper injection technique. Eat small, nutrient-dense meals. ↑ Fluid and fiber intake. Avoid high-fat foods. Strength training, dietary protein to preserve muscle/bone mass.

Answer 109

Glucagon Indications: Severe hypoglycemia when patient is unable to take oral glucose. When the glucose is gone, give glucagon. MOA: Stimulates breakdown of glycogen into glucose. Side Effects: GI upset. NC: Administer subcutaneous, IM, or IV. Provide an oral carbohydrate as soon as patient is able to safely swallow.

Answer 110

Levothyroxine, liothyronine Indications: Hypothyroidism. MOA: Acts as a synthetic form of thyroid hormones. Levothyroxine will level up your thyroid levels. Side Effects: When dose is too high, hyperthyroidism ( S/S: anxiety, GI upset, sweating, weight loss, heat intolerance). NC: Monitor T3, T4, and TSH levels. PT: Take on empty stomach with a full glass of water before breakfast. Requires lifelong treatment.

Answer 111

Propylthiouracil (PTU) Indications: Graves’ disease, preparation for a thyroidectomy. MOA: Blocks synthesis of thyroid hormones. Propylthiouracil (PTU) Prevents Thyroid from being Up too high. Side Effects: Agranulocytosis, GI upset, rash. When dose is too high, hypothyroidism ( S/S: lethargy, weight gain, cold intolerance, bradycardia, depression). Hepatotoxicity. NC: Monitor CBC levels and liver function.

Answer 112

Strong iodine solution Indications: Hyperthyroidism, thyrotoxicosis, preparation for thyroidectomy. MOA: Inhibits thyroid hormone production and release. Side Effects: GI upset, hypothyroidism, iodism ( S/S: metallic taste, stomatitis, severe GI upset), hypersensitivity (e.g., rash, pruritus). PT: Mix solution with juice to improve bitter taste. Radioactive iodine can also be used, which can cause radiation sickness; contact with others should be limited.

Answer 113

Somatropin Indications: Growth hormone (GH) deficiencies. Sommer wants that basketball trophy, so she is taking somatropin for her growth hormone deficiency. MOA: Stimulates growth and protein synthesis. Side Effects: Hyperglycemia, pancreatitis. NC: Administer IM or subcutaneous, rotate injection sites. For pediatric GH deficiency, stop treatment prior to epiphyseal closure. Monitor growth rate and bone age frequently. PT: Report persistent, severe abdominal pain.

Answer 114

Vasopressin, desmopressin Indications: Diabetes insipidus. MOA: ↑ Reabsorption of water in the kidneys, leading to ↓ urine output and ↑ urine osmolality. Vasopressin will help to suppress all that urine (it decreases urine output). Side Effects: Fluid volume excess, pounding headache. NC: Monitor I&Os, urine specific gravity. Normal urine output is 0.5 – 1.5 mL/kg/hr.

Answer 115

Prednisone, methylprednisolone, hydrocortisone, dexamethasone Indications: Variety of illnesses (e.g., asthma, autoimmune disorders, inflammatory disorders). MOA: ↓ Inflammation, suppresses immune response. Interactions: NSAIDs. Side Effects: Bone loss, weight gain/fluid retention, hyperglycemia, hypokalemia, infection, peptic ulcer disease (PUD), adrenal gland suppression. NC: Monitor for infection and PUD ( S/S: coffee ground emesis, tarry stools). PT: Periods of stress may require additional doses. Do not stop suddenly (must taper slowly). Take vitamin D and calcium supplements. Infection precautions .

Answer 116

Fludrocortisone Indications: Adrenocortical insufficiency (e.g., Addison’s disease). MOA: Causes reabsorption of sodium and water and excretion of potassium in the kidneys. Increases blood pressure. Fludrocortisone helps “flood” your body with more salt and water! Side Effects: Hypertension, edema, hyperglycemia, hypokalemia, infection, PUD, adrenal gland suppression. PT: Do not stop suddenly (must taper slowly). Abrupt discontinuation can cause an Addisonian crisis. Infection precautions .

Answer 117

Ranitidine, famotidine Indications: Duodenal and gastric ulcers, GERD, Zollinger-Ellison syndrome. MOA: Blocks H2 receptors in the stomach, reducing gastric acid secretion. Ranitidine helps your stomach feel better when you dine. Side Effects: Headache, GI upset.

Answer 118

Omeprazole, pantoprazole Indications: Duodenal and gastric ulcers, GERD, Zollinger-Ellison syndrome. I’m going to take omeprazole and pray my ulcer pain goes away. MOA: ↓ Gastric acid secretion. Side Effects: GI upset, C. diff, bone fractures (with long-term use). PT: Report diarrhea, abdominal pain, bloody stools.

Answer 119

Sucralfate Indications: Duodenal ulcers. MOA: Forms a thick paste with stomach acid that adheres to ulcers. Sucralfate gets “sucked” down into ulcers. Side Effects: Constipation. PT: Take 1 hour before meals and at bedtime (4 times a day). Increase fluid and fiber intake.

Answer 120

Aluminum hydroxide Indications: Peptic ulcer disease, GERD. MOA: Neutralizes stomach acid. Side Effects: Constipation. PT: Take after meals and at bedtime, 1 – 2 hours before or after other medications. Take Antacids After meals.

Answer 121

Misoprostol Indications: Prevention of gastric ulcers in patients taking NSAIDs. Also induces labor by ripening the cervix. MOA: ↓ Stomach acid secretion, ↑ production of protective mucus and bicarbonate. Causes uterine contractions. Side Effects: Dysmenorrhea, GI upset. Miscarriage, premature birth, birth defects. NC: Assess women of childbearing age for pregnancy before administration for ulcer prevention. Misoprostol will cause a miscarriage!

Answer 122

Docusate sodium, docusate calcium Indications: Prevention of constipation. MOA: Draws water into stool, resulting in softer stool. The doc said if you ate more fiber, you wouldn’t need docusate to soften your stool! Side Effects: Mild cramping, diarrhea. PT: Take with a full glass of water. Increase fiber intake, fluid intake, and mobility to promote regularity.

Answer 123

Psyllium, methylcellulose Indications: Constipation, prevention of straining, management of chronic watery diarrhea. MOA: Combines with water in intestines to soften stool and increase bulk. Side Effects: Mild cramping, nausea, vomiting. PT: Take with a full glass of water, followed by another glass. Increase fiber intake, fluid intake, and mobility to promote regularity.

Answer 124

Bisacodyl, sennosides Indications: Constipation, bowel prep before surgery or procedure. MOA: Stimulates peristalsis. Bisacodyl will help you do your “Business” (BM). Side Effects: Cramping, nausea, vomiting. PT: Take with a full glass of water. Take at night for results in the morning. Increase fiber intake, fluid intake, and mobility to promote regularity.

Answer 125

Magnesium hydroxide, magnesium citrate, polyethylene glycol Indications: Constipation, bowel prep before a surgery or a procedure. MOA: Draws water into intestine, promotes peristalsis. Side Effects: Cramping, bloating, diarrhea, hypermagnesemia (with magnesium hydroxide and magnesium citrate). NC: Monitor for signs of Mg toxicity with magnesium hydroxide or magnesium citrate.

Answer 126

Lactulose Indications: Hepatic encephalopathy (due to build up of ammonia in the body). MOA: Draws water into intestine, promotes peristalsis. Lowers pH in the colon, promoting ammonia excretion. Lactulose will cause you to “lose” stool as it gets rid of excess ammonia from the body. Side Effects: Cramping, bloating, diarrhea. PT: Mix with juice to improve taste.

Answer 127

Loperamide, diphenoxylate/atropine Indications: Diarrhea. Loparamide: MOA: Inhibits peristalsis and prolongs transit time. Side Effects: Constipation, drowsiness, dry mouth. Diphenoxylate/Atropine: MOA: Reduces GI motility. Side Effects: Anticholinergic side effects (e.g., constipation, dry mouth, urinary retention, tachycardia, blurred vision), dependence with prolonged use. Anticholinergic considerations .

Answer 128

Ondansetron Indications: Nausea, vomiting. I threw up on Dan, better get me some ondansetron. MOA: Blocks serotonin receptors in the chemoreceptor trigger zone (CTZ). Side Effects: Headache, constipation, diarrhea, QT prolongation. Administer prior to chemotherapy (vs. treating nausea/vomiting that is already occurring).

Answer 129

Promethazine, meclizine Indications: Nausea and vomiting, motion sickness. MOA: Blocks effects of histamine. Anticholinergic activity. Side Effects: Drowsiness, dry mouth. PT: When used for motion sickness, take 1 hour before conditions that cause motion sickness. Anticholinergic considerations .

Answer 130

Metoclopramide Indications: Nausea, vomiting, gastroparesis, GERD. MOA: Accelerates gastric emptying. Side Effects: Drowsiness, GI upset, extrapyramidal symptoms ( S/S: rigidity, tremors, restlessness). Tardive dyskinesia. PT: Take 30 minutes before meals and at bedtime.

Answer 131

Alosetron, lubiprostone Alosetron is for “loose” stools. Lubiprostone is for stone-like poop. Alosetron: Indications: IBS with diarrhea. MOA: ↑ Firmness of stool and ↓ urgency. Side Effects: Constipation. Ischemic colitis, constipation complications. Lubiprostone: Indications: IBS with constipation MOA: ↑ Fluid secretion in intestine and intestinal motility. Side Effects: Diarrhea, nausea, headache.

Answer 132

Sulfasalazine Indications: IBS, Crohn’s disease, ulcerative colitis. MOA: Inhibits prostaglandin synthesis, which ↓ colon inflammation. Contraindications: Known sulfa allergy. Side Effects: Blood dyscrasias (e.g., anemia, agranulocytosis, thrombocytopenia), GI upset, rash, headache, crystalluria, fever. NC: Monitor CBC. PT: May cause orange-yellow discoloration of urine/skin.

Answer 133

Simethicone Indications: Relief of painful gas in the GI tract. If you get gas after an ice cream cone, you may need to take some simethicone. MOA: Causes gas bubbles to merge, allowing them to be passed as belching or flatus. Side Effects: No significant side effects. PT: Take after meals and at bedtime.

Answer 134

Pancrelipase Indications: Pancreatic insufficiency related to pancreatitis, cystic fibrosis, GI bypass surgery. MOA: Facilitates the digestion of fat, carbohydrates, and proteins in the GI tract. Pancrelipase helps break down food when your pancreas isn’t getting the job done. Side Effects: Diarrhea, nausea, abdominal pain. PT: Take immediately before or with meals and snacks. Swallow pills whole (do not crush). If pill is difficult to swallow, open pill and sprinkle on acidic food (e.g., applesauce).

Answer 135

Bethanechol Indications: Non-obstructive urinary retention. MOA: Stimulates cholinergic receptors, which causes contraction and emptying of the urinary bladder. Beth has a “shy” bladder and needs bethanechol to urinate. Side Effects: Cholinergic symptoms (e.g., flushing, sweating, urinary urgency, nausea, vomiting, hypotension). Cholinergic symptoms cause SLUDGE: Salivation, Lacrimation (i.e., excessive tear production), Urination, Defecation, GI upset, Emesis. PT: Take 1 hour before or 2 hours after meals to minimize nausea/vomiting.

Answer 136

Oxybutynin Indications: Overactive bladder (e.g., urinary frequency and urgency, nocturia). Oxybutynin is buttin’ in to stop the bladder from tremblin’. MOA: Inhibits ACh in the bladder, which ↓ urinary urgency and frequency. Side Effects: Anticholinergic symptoms (e.g., dry mouth, urinary retention, constipation, blurred vision, tachycardia). Anticholinergic considerations .

Answer 137

Phenazopyridine Indications: Pain, frequency, urgency associated w/ UTI. Pyro = “burning fire.” Phenazopyridine can decrease the “burning” feeling of a UTI. MOA: Acts as a local anesthetic on the urinary tract. Not an antibiotic, does not treat a UTI. Side Effects: Orange/red discoloration of urine and other bodily fluids (e.g., tears) during treatment. PT: Can cause staining of soft contact lenses. Urine discoloration can stain clothes, bedding.

Answer 138

Furosemide Indications: Pulmonary edema, edema (related to heart failure, liver disease, kidney disease), hypertension. MOA: Blocks reabsorption of Na, Cl, and water in the ascending loop of Henle, causing rapid diuresis. Furosemide furiously gets rid of excess sodium and water. Side Effects: Dehydration, electrolyte imbalances (e.g., hypokalemia, hyponatremia), hypotension, ototoxicity, hyperglycemia, rash. NC: Administer several hours before bed if possible to prevent disruption of sleep, infuse at 20 mg/min, weigh patients daily, monitor I&Os and electrolytes. PT: Consume foods high in potassium (e.g., bananas, dark leafy greens, potatoes, cantaloupe, tomatoes).

Answer 139

Hydrochlorothiazide Indications: Hypertension, edema (related to heart failure, liver disease, kidney disease). MOA: Blocks reabsorption of Na, Cl, and water at the distal convoluted tubule. Hydrochlorothiazide gets rid of water (“hydro”) and NaCl (sodium chloride). Side Effects: Dehydration, hypokalemia, hyponatremia. NC: Administer several hours before bed if possible to prevent disruption of sleep, weigh patients daily, monitor I&Os/electrolytes. PT: Consume foods high in potassium (e.g., bananas, dark leafy greens, potatoes, cantaloupe, tomatoes).

Answer 140

Spironolactone Indications: Heart failure, hypertension. MOA: Blocks aldosterone, promoting excretion of sodium and water, but retention of potassium. Spironolactone spares potassium! Contraindications: Severe kidney failure. Side Effects: Hyperkalemia, amenorrhea, gynecomastia, impotence. Tumors. NC: Monitor potassium levels and EKG. PT: Avoid salt substitutes containing potassium.

Answer 141

Mannitol Indications: ↑ Intracranial pressure (ICP), ↑ intraocular pressure (IOP), edema. MOA: ↓ ICP and IOP by ↑ serum osmolality. I had a headache (due to increased ICP). I took mannitol, and “man, it all went away”. Side Effects: Heart failure, pulmonary edema, renal failure, dehydration, electrolyte imbalances (e.g., Na, K), phlebitis. NC: Monitor weight, I&Os, electrolytes. Expected range for ICP: 5 – 15 mmHg. Expected range for IOP: 10 – 21 mmHg.

Answer 142

Conjugated estrogen, estradiol Indications: Contraception, post-menopausal osteoporosis, dysmenorrhea (combination estrogen/progesterone), prostate cancer. MOA: Binds to estrogen receptors to ↓ hot flashes and vaginal dryness. Inhibits bone resorption. Contraindications: Smoking, hypertension, high risk for embolic events, estrogen-dependent cancer. Side Effects: Embolic events (e.g., DVT, PE, MI, stroke), hypertension, weight gain, edema, increased risk of some cancers.

Answer 143

Medroxyprogesterone, norethindrone Indications: Contraception (alone or with estrogen), dysmenorrhea. MOA: Inhibits gonadotropin production, preventing follicular maturation and ovulation. Contraindications: Patients at high risk for embolic events. Side Effects: Embolic events (e.g., DVT, PE, MI, stroke), menstrual changes, edema, increased risk of breast cancer. Decreased bone mineral density with injectable medroxyprogesterone. PT: With injectable medroxyprogesterone, take calcium and vitamin D supplements to reduce bone loss.

Answer 144

Oxytocin, dinoprostone Indications: Induction or enhancement of labor. Oxytocin is also used for postpartum hemorrhage. MOA: Uterine stimulant. Side Effects: Painful contractions, uterine tachysystole, uterine rupture. NC: Closely monitor contractions (should be 60 – 90 seconds in duration, every 2 – 3 minutes) and maternal/fetal vital signs. Magnesium sulfate can be used to relax the uterus.

Answer 145

Methylergonovine, carboprost Indications: Prevention and treatment of postpartum hemorrhage. MOA: Uterine stimulant. Contraindications: Methylergonovine: Hypertension. Carboprost: Asthma. Side Effects: Hypertension (methylergonovine only), abdominal pain, nausea, vomiting.

Answer 146

Terbutaline Indications: Preterm labor (delays but does not prevent labor), COPD, asthma. When flying, turbulence delays arrival time (just like terbutaline delays arrival of the baby). MOA: Relaxation of the uterus, bronchodilation. Side Effects: Tachycardia, angina, hypokalemia, dysrhythmias, restlessness, tremor. Maternal and fetal distress if used > 48 – 72 hours. NC: Used for pregnancies < 37 weeks gestation. Short-term use only. Other tocolytics include magnesium sulfate and nifedipine.

Answer 147

Testosterone Indications: Delayed puberty in males, hypogonadism, postmenopausal breast cancer. MOA: Promotes development of male sex organs and maintenance of male secondary sex characteristics. Contraindications: Prostate cancer. Side Effects: Acne, edema, liver dysfunction, ↑ Hct and Hgb, premature epiphyseal closure. In women, causes deepening of voice, baldness, hirsutism (i.e., male-patterned body hair growth). High abuse potential.

Answer 148

Finasteride Indications: Benign prostatic hyperplasia (BPH), baldness. Finasteride: Think of checking out a guy in his sports car. “Yeah, he has a fine ride, but he is bald with BPH.” MOA: Prevents conversion of testosterone, resulting in reduced prostate size and increased hair growth. Side Effects: Erectile dysfunction, gynecomastia. Do not handle medication during pregnancy!

Answer 149

Tamsulosin, doxazosin Indications: Benign prostatic hyperplasia (BPH), baldness. Doxazosin is also used for hypertension. MOA: Relaxes the smooth muscles of the prostate, resulting in improved urine flow. Tamsulosin will help you lose urine. Side Effects: Hypotension, dizziness, headache, issues with ejaculation. NC: Monitor BP. PT: Take at the same time every day.

Answer 150

Sildenafil, tadalafil Indications: Erectile dysfunction, pulmonary hypertension. MOA: ↑ Blood flow to the corpus cavernosum, vasodilation of the pulmonary vasculature. Sildenafil will help you “fill” out down there. Contraindications: Use cautiously in men with cardiovascular disease. Side Effects: Headache, flushing, priapism (i.e., prolonged erection), MI. Interactions: Nitrates (may cause life-threatening hypotension). PT: Do not take with other nitrates (e.g., nitroglycerin)!

Answer 151

Methotrexate Indications: Rheumatoid arthritis, psoriasis, cancers, dissolution of ectopic pregnancy. T-rex has rheumatoid arthritis in his tiny arms, so he has to take methotrexate to decrease swelling and pain. MOA: Inhibition of folic acid metabolism (causing death of rapidly replicating cells), immunosuppression. Side Effects: Infections, hepatotoxicity, bone marrow suppression, GI upset, stomatitis. Fetal death. NC: Monitor liver function, CBC levels. Bleeding precautions , infection precautions .

Answer 152

Cyclosporine Indications: Prevention of organ rejection in transplant patients, ulcerative colitis, rheumatoid arthritis, psoriasis. MOA: Inhibits T-cell activation. Side Effects: Hepatotoxicity, nephrotoxicity, GI upset, hirsutism, hypertension, tremor. Infections, neoplasia. NC: Monitor liver and renal function. Infection precautions .

Answer 153

Hydroxychloroquine Indications: Rheumatoid arthritis, lupus, malaria. MOA: Inhibits protein synthesis, ↓ inflammation. Side Effects: GI upset, vision changes, seizures, agranulocytosis. NC: Monitor CBC levels during therapy. PT: Take with meals to ↓ GI upset. Infection precautions .

Answer 154

Etanercept Indications: Rheumatoid arthritis, psoriasis. MOA: Inactivates tumor necrosis factor (TNF), ↓ inflammation. Side Effects: Injection site reaction. Infections, malignancy. NC: Monitor CBC levels during therapy. PT: No live vaccines during therapy. Infection precautions .

Answer 155

Infliximab, adalimumab Indications: Rheumatoid arthritis, psoriasis, Crohn’s disease, ulcerative colitis. MOA: ↓ Activity of tumor necrosis factor-alpha (TNF-alpha), ↓ inflammation. Side Effects: Infusion-related reactions (e.g., fever, rash). Infections, malignancy. NC: Administer acetaminophen, antihistamines per orders to reduce risk of infusion reactions. Infection Precautions

Answer 156

Doxorubicin Indications: Solid tumors. MOA: Inhibition of RNA/DNA synthesis (causing death of rapidly replicating cells), immunosuppression. Side Effects: GI upset, alopecia, red discoloration of urine/sweat/tears. Cardiac toxicity, AML, bone marrow suppression. Ruby = red; Doxorubicin causes red discoloration of secretions. Heart = red (cardiac toxicity). NC: Monitor cardiac function, CBC levels. Administer antiemetics for nausea/vomiting. Bleeding precautions , infection precautions .

Answer 157

Vincristine Indications: Variety of tumors/cancers. MOA: Stops cell division during mitosis (causing death of rapidly replicating cells). Side Effects: Peripheral neuropathy, GI upset, alopecia. Phlebitis at IV site. Vin = wine in French. If you drink too much wine, you can’t feel your arms and legs (neuropathy). NC: Administer antiemetics for nausea/vomiting, monitor for signs of neuropathy. Does not cause severe bone marrow suppression.

Answer 158

Cyclophosphamide Indications: Variety of tumors/cancers. MOA: Inhibits protein synthesis (causing death of rapidly replicating cells). Side Effects: Bone marrow suppression, hemorrhagic cystitis, GI upset, alopecia. Cyclophosphamide can cause cystitis. NC: Monitor for blood in urine and CBC levels. Give antiemetics for nausea/vomiting. Wear gloves when handling, and wash hands immediately after handling. PT: Increase fluid intake during therapy. Bleeding precautions , infection precautions .

Answer 159

Leuprolide Indications: Prostate cancer, endometriosis. MOA: ↓ Testosterone levels. ↓ Spread of prostate cancer. ↓ Pain and lesions in endometriosis. Side Effects: Hot flashes, gynecomastia, bone pain, decreased libido, GI upset. Dr. Lou lied to me about the side effects of leuprolide! He didn’t tell me about hot flashes, gynecomastia, etc. NC: Monitor PSA (should be < 4.0 ng/mL) and testosterone levels of male patients during therapy. PT: Increase calcium intake. Infection precautions .

Answer 160

Tamoxifen Indications: Prevention and treatment of breast cancer. Tammy is a foxy lady who is fighting breast cancer. MOA: Competes with estrogen for binding sites in the breasts, stopping growth of estrogen-dependent cancer. Contraindications: Prior thromboembolism. Side Effects: Hot flashes, vaginal bleeding, hypercalcemia, bone pain, ↑ risk of uterine and endometrial cancer. Thromboembolism. NC: Monitor CBC and calcium levels during therapy. PT: Report calf pain, chest pain, or shortness of breath. Infection precautions .

Answer 161

Interferon alpha-2b Indications: Cancers and viral infections (e.g., hepatitis). MOA: Enhances the body’s immune response to tumors/viruses. Slows cancer proliferation. Interferon Interferes with cancer by enhancing the body’s immune response. Side Effects: Flu-like symptoms (e.g., fever, muscle aches, chills, lethargy), bone marrow suppression, cardiotoxicity, hepatotoxicity, dyspnea, alopecia, GI upset. Psychiatric, autoimmune, ischemic, and infectious disorders. NC: Monitor CBC levels, cardiac and liver function throughout therapy. Bleeding precautions , infection precautions .

Answer 162

Azithromycin, erythromycin Indications: Bacterial infections. MOA: Inhibits protein synthesis, slowing bacterial growth (i.e., bacteriostatic). Side Effects: GI upset, dysrhythmias (e.g., torsades de pointes), ototoxicity, rash. PT: Take on an empty stomach with a full glass of water. Antibiotic considerations .

Answer 163

Clindamycin Indications: Serious bacterial infections. MOA: Inhibits protein synthesis. Bactericidal or bacteriostatic, depending on concentration. Side Effects: GI upset, diarrhea, superinfection. C. difficile. NC: Monitor bowel movements. Antibiotic considerations .

Answer 164

Gentamicin Indications: Serious bacterial infections. MOA: Inhibits protein synthesis, bactericidal. Side Effects: Ototoxicity, vertigo, ataxia. Nephrotoxicity, neurotoxicity. Gentamicin is the opposite of gentle. It causes ototoxicity and nephrotoxicity. NC: Monitor patients for tinnitus and hearing loss. Monitor kidney function (e.g., creatinine, BUN, urinalysis) and peak/trough blood levels. Administer IM or IV. Antibiotic considerations .

Answer 165

Doxycycline, tetracycline Indications: A wide variety of bacterial infections (e.g., acne, lyme disease, STIs, Rocky Mountain spotted fever). MOA: Prevents protein synthesis, inhibiting bacterial growth (bacteriostatic). Contraindications: Pregnancy, children < 8 years old. Side Effects: GI upset, tooth discoloration in children and fetuses, hepatotoxicity, photosensitivity, superinfection (e.g., C. diff). Tetris has a lot of little blocks that look like teeth. Tetracycline treats lots of infections and causes discoloration of teeth. Interactions: ↓ Effectiveness of oral contraceptives. PT: Wear sunscreen. Dairy products, foods high in calcium and iron, and antacids ↓ absorption. Antibiotic considerations .

Answer 166

Vancomycin Indications: Serious bacterial infections, antibiotic-associated C. diff. MOA: Destroys bacterial cell wall, causing cell death. Side Effects: Ototoxicity, nephrotoxicity, infusion reactions (i.e., vancomycin flushing syndrome or “red man syndrome”), phlebitis. “Vein”comycin causes infusion reactions and phlebitis. NC: Monitor trough levels (and possibly peak levels). Dose may need to be adjusted depending on creatinine levels. If an infusion reaction occurs, decrease infusion rate per order. Antibiotic considerations .

Answer 167

Penicillin G, Amoxicillin Indications: Bacterial infections. MOA: Weakens bacterial cell wall, causing cell death. Contraindications: History of allergies to penicillin or cephalosporins. Side Effects: GI upset (e.g., diarrhea, nausea, vomiting), allergic reaction (e.g., dyspnea, rash), superinfection (e.g., C. diff). NC: Monitor for allergic reaction. Monitor bowel function. Antibiotic considerations .

Answer 168

Piperacillin/tazobactam Indications: Moderate to severe bacterial infections (e.g., penicillin-resistant bacteria). MOA: Piperacillin weakens the bacterial cell wall, causing cell death. Tazobactam inhibits beta-lactamase (an enzyme that destroys penicillin). Contraindications: History of allergies to penicillin or cephalosporins. Side Effects: Diarrhea, superinfection (e.g., C. diff), allergic reaction, phlebitis, hepatotoxicity, nephrotoxicity. NC: Monitor for allergic reaction, bowel function, liver and renal labs. Antibiotic considerations .

Answer 169

Cephalexin, ceftriaxone, ceftazidime, cefepime Indications: Bacterial infections. MOA: Weakens bacterial cell wall, causing cell death. Contraindications: History of penicillin allergy. Side Effects: GI upset, allergic reaction (e.g., dyspnea, rash), superinfection (e.g., C. diff). PT: Do not consume alcohol during therapy. Antibiotic considerations .

Answer 170

Imipenem/cilastatin, meropenem Indications: Serious bacterial infections (broad spectrum). MOA: Destroys bacterial cell wall, causing cell death. Contraindications: Possible cross-sensitivity in patients with penicillin or cephalosporin allergy. Side Effects: GI upset, rash, superinfection (e.g., C. diff), seizures. Antibiotic considerations .

Answer 171

Ciprofloxacin, levofloxacin Indications: Bacterial infections (e.g., UTIs, bone/joint infections, respiratory infections, anthrax). MOA: Inhibits bacterial DNA synthesis. Side Effects: Diarrhea, superinfection (e.g., C. diff), photosensitivity, ↑ liver enzymes (e.g., AST, ALT, LDH, bilirubin). Tendon rupture. A fox bit my heel and ruptured my tendon! NC: Monitor bowel movements. PT: Wear sunscreen. Antibiotic considerations .

Answer 172

Trimethoprim/sulfamethoxazole Indications: Bacterial infections (e.g., UTIs, bronchitis, pneumonia, otitis media). MOA: Inhibits bacterial folic acid synthesis. Contraindications: Sulfa allergy. Side Effects: GI upset, blood dyscrasias, photosensitivity, crystalluria, Stevens-Johnson syndrome. NC: Monitor CBC levels. PT: Wear sunscreen, increase fluid intake (to prevent crystalluria). Antibiotic considerations .

Answer 173

Nitrofurantoin Indications: Urinary tract infections. MOA: Inhibits bacterial enzymes involved in the synthesis of DNA, RNA, and cell wall protein. Side Effects: GI upset, pulmonary toxicity, peripheral neuropathy, brown discoloration of urine. PT: Take with food. Antibiotic considerations .

Answer 174

Metronidazole Indications: Bacterial and protozoal infections (e.g., giardiasis). MOA: Inhibits DNA and protein synthesis, effective against anaerobic bacteria. Side Effects: GI upset, metallic taste, dark urine, dizziness, headache. Metronidazole gives you a metallic taste. PT: Do not consume alcohol. Antibiotic considerations .

Answer 175

Rifampin, isoniazid, pyrazinamide, ethambutol A RIPE orange: Rifampin, Isoniazid, Pyrazinamide, Ethambutol. Orange: the color of your secretions when using rifampin. Indications: Tuberculosis. MOA: Bactericidal/bacteriostatic against mycobacteria. Side Effects: Rifampin: Orange secretions, GI upset. ↓ Effectiveness of oral contraceptives. Isoniazid: Neuropathy. Pyrazinamide: Arthralgia (i.e., joint pain). Ethambutol: Changes in vision. E for Ethambutol, E for Eyes. Hepatotoxicity (all medications). NC: Monitor for signs of liver damage. PT: Report visual acuity changes, get vision screenings. Use an alternate method of birth control. Long-term therapy required. Do not consume alcohol. Don’t get TIPSY when taking TB meds. Antibiotic considerations .

Answer 176

Amphotericin B, ketoconazole, fluconazole Indications: Systemic fungal infections. MOA: Disruption of fungal cell membrane. Side Effects: Amphotericin B: Highly toxic (given only for life-threatening fungal infections). Fever, chills, nausea/vomiting, nephrotoxicity, ↑ liver enzymes, phlebitis. Ketoconazole: Hepatotoxicity, GI upset, arrhythmias. Fluconazole: Hepatotoxicity, GI upset, rash. Amphotericin B will “terrorize” your body (i.e., it is very toxic). NC: Administer test dose of amphotericin B for prior to administration. Monitor for liver dysfunction ( S/S: pale stools, dark urine, n/v, fatigue, jaundice).

Answer 177

Acyclovir, valacyclovir, ganciclovir, oseltamivir, zanamivir Medications that end in vir inhibit viral replication and are used to treat viral conditions. Acyclovir and Valacyclovir: Indications: Herpes, varicella-zoster viruses. Side Effects: Phlebitis, GI upset, nephrotoxicity. PT: This does not cure herpes or varicella zoster. Ganciclovir: Indications: Cytomegalovirus. Side Effects: Phlebitis, GI upset, nephrotoxicity, bone marrow suppression. Oseltamivir and Zanamivir: Indications: Influenza A and B. Side Effects: GI upset. PT: Administer within 48 hours of influenza symptom onset.

Answer 178

Highly Active Antiretroviral Therapy (HAART) Indications: Human immunodeficiency virus (HIV) type 1. MOA: Three or more medications used simultaneously to inhibit viral replication, with each medication targeting different stages of the viral replication cycle. Select Medications: Abacavir, atazanavir, delavirdine, dolutegravir, enfuvirtide, maraviroc, zidovudine. Side Effects: Anemia, lipodystrophy, hyperlipidemia, sleep disturbances, dizziness, headache. NC: Assess HIV viral load and CD4+ count prior to initiating therapy, then every 4 – 8 weeks until the patient has an undetectable viral load. Monitor BMI and waist circumference. PT: HAART does not cure HIV.

Answer 179

Bacitracin, mupirocin Bacitracin: Indications: Minor skin injuries (e.g., burns, cuts, scrapes). MOA: Inhibits bacterial wall synthesis. Side Effects: Allergic contact dermatitis. PT: Clean affected area. Apply a small amount 1 – 3 times daily. Mupirocin: Indications: Skin infections (e.g., impetigo). MOA: Inhibits bacterial protein synthesis. Side Effects: Burning, stinging. PT: Clean affected area. Apply a small amount 3 times daily.

Answer 180

Clotrimazole, miconazole, nystatin Indications: Tinea pedis (i.e., athlete’s foot), tinea cruris (i.e., jock itch), tinea corporis (i.e., ringworm), tinea capitis (i.e., fungal infection on the scalp), cutaneous candidiasis. That “azole” touched me with his athlete’s foot. Now I might need clotrimazole. MOA: ↓ Integrity of the fungal cell wall. Side Effects: Stinging, redness. PT: Apply BID for 2 – 4 weeks. For tinea capitis, use selenium sulfide shampoo.

Answer 181

Silver sulfadiazine, mafenide acetate Indications: Burns (2nd and 3rd degree); prevents wound sepsis. Silver Sulfadiazine: MOA: Broad antibacterial and antifungal activity. Side Effects: Leukopenia, burning/itching, skin discoloration. NC: Monitor CBC levels. Mafenide Acetate: MOA: Bacteriostatic, penetrates eschar. Mafenide is like the mafia takin’ down the eschar! Side Effects: Pain, burning/itching, metabolic acidosis. NC: Monitor acid-base balance.

Answer 182

Coal tar, salicylic acid, corticosteroids Indications: Psoriasis. Coal Tar: MOA: Slows growth of skin cells, ↓ itching/inflammation. Side Effects: Photosensitivity, staining of clothes, cancer (with high doses). Salicylic Acid: MOA: Keratolytic (softens and removes scales). Side Effects: Mild burning, stinging. Corticosteroids: MOA: Decreases immune response and inflammation. Side Effects: Burning, itching, irritation.

Answer 183

Benzoyl peroxide, clindamycin, tretinoin, isotretinoin Indications: Acne. Benzoyl Peroxide and Clindamycin (Topical): MOA: Topical antibiotics effective against P. acnes. Side Effects: Dryness, skin irritation. PT: Benzoyl peroxide can bleach hair and fabric. Tretinoin (Topical): MOA: Stimulates turnover of epithelial cells. Side Effects: Photosensitivity, skin irritation. PT: Avoid sun exposure and wear sunscreen. Isotretinoin (Oral): MOA: Inhibits sebaceous gland function, used for severe acne. Side Effects: Cheilitis, dry skin, dry mouth, photosensitivity. PT: Do not use during pregnancy. Two negative pregnancy tests before therapy begins and monthly tests required. Use sunscreen and skin moisturizers.

Answer 184

Permethrin Indications: Pediculosis (i.e., lice), scabies. I hope this permethrin permeates my skin to get rid of these bugs! MOA: Neurotoxin, paralysis of the nervous system of insects. Side Effects: Skin irritation. PT: Lice: Shampoo with 1% permethrin. Remove nits with nit comb. Scabies: Apply from head to toe, wash after 8 – 14 hours. Treat entire family. To prevent reinfestation, wash clothing/linens in hot water. Place linens that cannot be washed in tightly sealed bags for two weeks.

Pharmacology Basic Medications

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