Pharmacology NCLEX Clinical Study Booklet · 11 cards
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Anticoagulants. Anticoagulant Heparin
Monitor aPTT (therapeutic 1.5–2.5× control) Antidote: protamine sulfate Watch HIT (heparin-induced thrombocytopenia) Warfarin (Coumadin)
Monitor PT/INR (therapeutic 2–3) Antidote: vitamin K Consistent vitamin K intake; many interactions LMWH & DOACs
Enoxaparin: SubQ, no routine monitoring, don't expel the air bubble DOACs (apixaban, rivaroxaban): fewer monitoring needs Bleeding precautions for all NCLEX Tip PT/INR monitors warfarin; aPTT monitors heparin. Protamine reverses heparin; vitamin K reverses warfarin. Watch for bleeding.
Insulin. Endocrine Types & Onset
Rapid (lispro, aspart): ~15 min — give with food Short (regular): the only insulin given IV Intermediate (NPH): cloudy; Long (glargine): no peak, don't mix Administration
Mixing: draw clear (regular) before cloudy (NPH) — 'RN' Rotate sites; SubQ High-alert — independent double-check Hypoglycemia (<70)
Shaky, diaphoretic, confused, tachycardic Conscious: 15 g fast carbs; unconscious: IV D50 / IM glucagon NCLEX Tip When mixing insulins, draw up the clear (regular) before the cloudy (NPH). Only regular insulin can be given IV.
Digoxin. Cardiac Use & Level
Treats heart failure and atrial fibrillation Therapeutic level 0.5–2.0 ng/mL (narrow) Check apical pulse for 1 full minute; hold if <60 Toxicity
N/V, anorexia, visual changes (yellow-green halos) Bradycardia, dysrhythmias Hypokalemia potentiates toxicity; antidote: digoxin immune Fab Nursing Points
Monitor potassium and digoxin level Teach pulse-taking and toxicity signs NCLEX Tip Check the apical pulse for a full minute before digoxin — hold if <60 bpm. Hypokalemia increases the risk of digoxin toxicity.
Opioids. Analgesic Use & Action
Moderate-to-severe pain Bind opioid receptors in the CNS Morphine, hydromorphone, fentanyl, oxycodone Adverse Effects
Respiratory depression (hold if RR <12) Sedation, constipation, hypotension Urinary retention, nausea Nursing Points
Monitor respiratory rate & sedation Antidote: naloxone Constipation prophylaxis (bowel regimen) NCLEX Tip Assess respiratory rate before giving opioids — hold and reassess if RR <12. Naloxone reverses overdose; always start a bowel regimen.
Corticosteroids. Anti-inflammatory Use & Examples
Anti-inflammatory / immunosuppressant Prednisone, methylprednisolone, hydrocortisone -sone / -olone suffix Adverse Effects
↑glucose, ↑infection risk, ↓immune response Osteoporosis, fluid retention, HTN Mood changes, cushingoid features, GI ulcers Nursing Points
NEVER stop abruptly — taper (adrenal suppression) Take with food; monitor glucose, weight, infection Signs of infection may be masked NCLEX Tip Never stop corticosteroids abruptly — taper to prevent adrenal crisis. They raise glucose and infection risk and mask signs of infection.
Beta Blockers. Antihypertensive Use & Action
HTN, angina, dysrhythmias, HF, post-MI Block beta receptors → ↓HR, ↓BP -olol suffix (metoprolol, atenolol) Adverse Effects
Bradycardia, hypotension Fatigue, bronchospasm (caution in asthma) Mask hypoglycemia signs Nursing Points
Hold for HR <60 or low BP (check parameters) Do NOT stop abruptly (rebound HTN/tachycardia) Teach to rise slowly (orthostatic) NCLEX Tip Hold beta blockers for a heart rate <60 and never stop them abruptly (rebound). They can mask hypoglycemia and cause bronchospasm.
ACE Inhibitors / ARBs. Antihypertensive Use & Action
HTN, heart failure, renal protection (diabetes) ACE inhibitors (-pril); ARBs (-sartan) Block the renin-angiotensin system Adverse Effects
ACE: dry cough, angioedema (stop the drug) Hyperkalemia First-dose hypotension Nursing Points
Monitor potassium & renal function Avoid in pregnancy (teratogenic) Rise slowly; report cough / swelling NCLEX Tip ACE inhibitors cause a dry cough and can cause angioedema (stop the drug). Both raise potassium — avoid in pregnancy.
Antibiotics. Antimicrobial Key Classes
Penicillins (-cillin), cephalosporins Fluoroquinolones (-floxacin), tetracyclines (-cycline) Aminoglycosides (-mycin/-micin), macrolides, vancomycin Watch For
Aminoglycosides & vancomycin: nephro/ototoxic (monitor peak/trough) Fluoroquinolones/tetracyclines: avoid dairy/antacids; photosensitivity Vancomycin: 'red man syndrome' if infused too fast Nursing Points
Culture BEFORE the first dose Complete the full course Assess for allergies & C. diff NCLEX Tip Obtain cultures before the first antibiotic dose and teach clients to finish the full course. Monitor aminoglycosides/vancomycin for nephro- and ototoxicity.
Diuretics. Antihypertensive Types
Loop (furosemide): potent; wastes K⁺ Thiazide (HCTZ): wastes K⁺ Potassium-sparing (spironolactone): retains K⁺ Adverse Effects
Loop/thiazide: hypokalemia, dehydration, ↑glucose/uric acid Potassium-sparing: hyperkalemia Ototoxicity (loop, high dose) Nursing Points
Monitor potassium, I&O, daily weight, BP Give in the morning (avoid nocturia) Teach potassium intake (loop/thiazide) NCLEX Tip Loop and thiazide diuretics waste potassium (watch hypokalemia); potassium-sparing diuretics retain it (watch hyperkalemia). Monitor K⁺ and daily weight.
Antidotes & Reversal Agents. Safety Common Pairs
Heparin → protamine; Warfarin → vitamin K Opioids → naloxone; Benzodiazepines → flumazenil Acetaminophen → acetylcysteine More Pairs
Digoxin → digoxin immune Fab Magnesium → calcium gluconate Iron → deferoxamine Nursing Points
Know antidotes for high-alert drugs Keep reversal agents accessible Monitor closely after administration NCLEX Tip Memorize the high-yield antidote pairs: heparin-protamine, warfarin-vitamin K, opioid-naloxone, benzo-flumazenil, acetaminophen-acetylcysteine.
High-Alert Medication Safety. Safety High-Alert Drugs
Insulin, heparin / anticoagulants, opioids Concentrated electrolytes (KCl), chemotherapy Require independent double-checks Rights of Administration
Right patient (2 identifiers), drug, dose, route, time Right documentation, reason, response, to refuse Safety Practices
Never give a med you didn't prepare Question unclear / unsafe orders NEVER give IV potassium by push NCLEX Tip High-alert meds (insulin, heparin, opioids, concentrated KCl, chemo) require independent double-checks. Never give IV potassium as a push.
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