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ATI Pharmacology Study Guide

TIPS: Study the generic names of medications. When in doubt with a food interaction: grape
fruit juice is usually the option. Herbal supplements: Many that start with “G” increase a
patient’s risk of bleeding. Most medications are contraindicated with pregnancy. Not safe to
drink alcohol with MOST medications. Patients in general should never stop medications
abruptly. In general, if dose is missed do not double up on next dose (birth control exception).
DO not chew or crush extended release medications (IMPORTANT). Antibiotics: make sure the
patient finishes their course of therapy, get culture before starting antibiotics (IMPORTANT).
Chapter One: Pharmacokinetics and Routes of Administration
Pharmacokinetics
Four Phases of Pharmacokinetics:
Absorption: How quickly or how well a medication is absorbed depends on the route.
- Oral: more slowly, depends on food in stomach, pH of gastric content. Liquid absorbs
more quickly than extended release
- Sublingual: Absorbed more quickly, placed under the tongue. Mucosa under tongue is
very vascular. Do not eat or drink until medication is completely absorbed.
- Inhalation: Absorption happens very quickly.
- Intradermal/topical: Absorption is slower. Lidocaine patch: slow steady release.
- Subcutaneous/intramuscular: Absorption depends on the solubility of the medication and
the blood perfusion at site
- IV: absorption happens immediately
Distribution: After absorption. Medication travels to the site of action. Medications need binding
proteins in order to be distributed to travel to site. Albumin is a common protein used to bind, if
pt.’s levels are low, will impact medication distribution.
Metabolism: Medication is inactivated or broken down into a less active form by enzymes. Most
happens in the liver. Bowel, lungs, and kidneys can also be involved.
- Infants have immature metabolism which increases risk for toxicity. Older adults have
problems with liver and kidneys which slow down metabolism, leads to higher risk of
toxicity
- First Pass Effect: Oral medications inactivated through first pass through the liver. May
need to give a higher dose for therapeutic effect to be felt
- Excretion: Primarily happens in the kidneys. If not working higher risk for toxicity
Minimum Effective Concentration and Therapeutic Index: Dosing- want to receive a medication
level that is above MEC and but be below level of toxicity. Some medications have a high
therapeutic index and some a low therapeutic index (vancomycin). To do this you take blood
samples of the medication’s trough levels and peak levels.
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Medication Half-life: The time the medication is reduced to 50%. Short half-life: eliminated
quickly. Long half-life: lingers in body and has increased risk of toxicity.
Agonist vs. Antagonist:
Agonist: medication designed to produce an action (morphine: bind to receptors and produce an
action)
Antagonist: medication designed to block an action (naloxone: bind to receptors to block action)
Routes of Administration:
- Oral: May need to mix with a little apple sauce or pudding to help with swallowing.
Patient should sit up right, help with swallowing: tuck chin into chest when swallowing.
Should never crush or chew enteric coated or extended release capsules
- Sublingual: Under the tongue. Do not eat or drink until completely absorbed
- Transdermal: Important to wash the skin with soap and water and dry before putting
patch. Remove old patch before putting new one on, rotate sites to prevent irritation.
Choose hairless area of skin.
- Eye medications: Surgical aseptic technique. Drops: place in the center of the
conjunctival sac. After that put gentle pressure on the nasolacrimal duct for 30-60
seconds. Never touch bottle to eye
- Ear drops: Place on unaffected sites. Adults: back and up. Children: back and down.
- G tube or NG tube: Flush the tube before and after each medication with 15-30mL of
sterile water. Flush at the end with the same
- Suppositories: Place the patient on left side, place in anus just past the external sphincter
and keep it inside of them for at least 5 minutes
- Inhalation: Metered dose inhaler: shake at least 5-6 times, breathe out, push inhaler,
breathe in 4-5 seconds, then hold breath for 10 seconds before exhaling. Dry powder:
Don’t shake, deep breath, hold
- IM injections: Under 2 years old use vastus lateralis muscle (IMPORTANT). After that
you can also use the ventrogluteal site, dorsal gluteal site or deltoid. Solution volume: 1-
3ml
- Intradermal injections: Low volumes of solutions, no more than 0.1ml, hold needle at a 5-
15 degree angle with bevel up
- Subcutaneous: needle 3/8 to 5/8 inch, 25- or 27-gauge needle and inject at a 45 or 90
degrees if obese.
- Intramuscular injection: needle length 1 to 1 ½ inches, 22 to 25-gauge needle with 90
degree angle. Some use a Z track injection: pull skin, inject needle, remove needle, let go
of skin.
- IV: 20 gauge catheter is standard (fluids, and blood can be given through them), trauma
patients need something bigger (16 gauge catheter). Child and older adults: 22 or 24
gauge catheter. Epidural: between 4th and 5th vertebrae.
Chapter Two: Safe Medication Administration and Error Reduction
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Safe Medication Administration

Prescriptions:
- Routine order/standard prescription: for medications patient needs to take ongoing. As
the nurse, you can give medication 30 minutes before or after the time the medication is
prescribed.
- One time/single prescription: Medication is only given once and is not ongoing
- STAT prescription: Medication that the nurse needs to given right away for an
emergency
- PRN prescriptions: As needed, needs to be dose, frequency and what condition the
medication should be given
- Standing prescription: written for specific circumstances on specific units
Components of an Order (IMPORTANT)
Patients name, date and time of prescription, the name of the medication, the dose, the route, the
time and frequency of the medication, and physicians’ signature
Telephone orders: Have second nurse in on the call and read back what you heard the doctor say,
make sure all components are there. Sign off within 24 hours
Medication reconciliation: Gather information about what meds are taken at home. Done at
admission, when transferred to another unit, and at discharge.
Rights of Medication Administration:
- Right patient: correct patient identifiers (name, DOB, medical record number) NOT room
- Right medication
- Right dose
- Right time
- Right route
- Right documentation
- Patients RIGHT to refusal
Written prescriptions:
ISMP: list of abbreviations NOT to use.
Key:
- IU: international units
- U: units
- QOD/QD: every other day, every day
- SC/SQ: subcutaneous injection
Writing dose: “be a leader not a follower” 0.5 = yes .50 = no
Never administer medication someone else has prepared.
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Medication Error: Complete an occurrence report within 24 hours. Do NOT include in the
patients record and do NOT refer to it in the patient’s record. Document what was given, what
dose, and S/S of the patient. But not the report itself.
IV Therapy
Advantages:
- Pain: effects are felt almost immediately
Disadvantage:
- Wrong medication: cannot get that back
- Certain meds can irritate lining of vein: Vancomycin, Potassium
- Fail to maintain surgical aseptic with IV: could lead to local infection which could lead to
sepsis
IV Fluids:
- Continuous: On going (100ml/hr)
- Bolus: 500ml NS given in 1 hour
Do’s and Don’ts’s:
- Never give medication through IV tubing that is used for blood transfusions or TPN
(separate lines)
- Always verify compatibility of medications before running through the same line
- When putting an IV in for older patient use BP instead of taranakite
- Inserting IV: have patient hold hand below level of heart, start distally first, avoid back of
hand if you can
- Change peripheral IV sites per facilities policy (usually 72 hours)
- Fluids should not hang for over 24 hours unless it is a closed system (pressure bag).
Replace fluids and tubing every 24 hours, date and time, wipe all ports, document date
and time of assertion, document appearance
- Flush every 8-12 hours to help keep it patent
Complications:
- Infiltration: Non-vesicant solution (doesn’t damage veins) that ends up outside of vein.
Solution leaking outside of vein into surrounding tissue. S/S: pallor, pale, swelling, cool
temperate at site. Treatment: Stop infusion, remove catheter, elevate extremity, apply
cool or warm compress
- Hematoma: Usually when respiratory is doing an ABG blood draw. S/S: Ecchymosis
(bruising). Treatment: apply warm compress and elevate extremity
- Catheter embolism: Serious. Missing catheter tip when pulling out catheter. Always
inspect. If missing it can travel to lungs and cause PE. Treatment: place taranakite high
up on the arm, prepare for removal through x-ray or surgery.
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- Extravasation: Infiltration of IV when using a vesicant solution (damages tissue). S/S:

pain, erythema (redness), edema. Treatment: may need to administer antidote through IV
catheter before removing it
- Phlebitis: Inflammation of vein due to mechanical reasons or chemical reasons. S/S:
increased skin temp, erythema, and possible redline running up arm, vein feels hard.
Treatment: discontinue infusion, remove catheter, elevate extremity, and use combination
of warm and cold compresses
- Cellulitis: Uncommon. S/S: pain, warmth, edema, induration. *systemic symptoms:
fever, chills, malaise. Treatment: discontinue, remover catheter, elevate extremity, apply
warm compress 3-4 times a day, administer antibiotics, analgesics, and antipyretics
- Fluid overload: S/S: SOB, crackles in lungs, difficulty breathing, tachycardia. Treatment:
Slow down IV rate, raise HOB, give diuretics.
Anxiety Medications:
Benzodiazepines (Alprazolam, Diazepam, Lorazepam, Chlordiazepoxide):
- Used for anxiety, seizures, muscle spasms, alcohol withdrawal and induction and
maintenance of anesthesia.
- Action: Increase GABA in CNS
- Side effects: (IMPORTANT) sedation, amnesia, respiratory depression (IMPORTANT),
possible dependency and withdrawal
- Key points: Should be used SHORT term. Do not discontinue abruptly.
- Antidote: flumazenil.
Atypical Anxiolytics (Buspirone):
- Alternative for anxiety, panic disorder, OCD, PTSD
- Side Effects: Minimal, dizziness, nausea, headaches
- Key point: does not sedation and dependency is not likely. Can use for longer term.
- Full effects not felt for several weeks. May want to take with meals to avoid GI upset.
SSRI’s (Paroxetine, Sertraline, Fluoxetine):
- Can be used for both anxiety as well as depression, OCD and PTSD
- Inhibit serotonin reuptake which increases amount of serotonin in the body
- Side effects: Sexual dysfunction, weight gain, insomnia
- Key points: watch for serotonin syndrome (symptoms: agitation, hallucinations, fever,
diaphoresis and tremors). Do NOT take with St. John’s Wort (increases serotonin
syndrome). Effects are not felt for up to a month
Medications for Depression
SSRI’s (Paroxetine, Sertraline, Fluoxetine):
- Can be used for both anxiety as well as depression, OCD and PTSD
- Inhibit serotonin reuptake which increases amount of serotonin in the body
- Side effects: Sexual dysfunction, weight gain, insomnia
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- Key points: watch for serotonin syndrome (symptoms: agitation, hallucinations, fever,
diaphoresis and tremors. Do NOT take with St. John’s Wort (increases serotonin
syndrome). Effects are not felt for up to a month

Atypical Antidepressants (Bupropion [Wellbutrin], Trazadone):

- Used for depression and an aid to quit smoking.
- Bupropion side effects: insomnia (IMPORTANT), headache, GI distress, weight loss,
agitation, and seizures
- Trazadone side effects: sedation

Tricyclic Antidepressants (IMPORTANT) (Amitriptyline, Imipramine)

- Used for depression and neuropathy, fibromyalgia, anxiety, and insomnia
- Side effects: sedation, orthostatic hypotension, anticholinergic side effects (urinary
retention, constipation, dry mouth, blurry vision, photophobia, and tachycardia),
sweating, and seizures
- Key points: to counteract anticholinergic side effects- chew gum, wear sunglasses,
consume higher fiber diet and increase fluid intake.
- “Amy trips over a tricycle in the desert.” “Can’t see, can’t pee, can’t spit, and can’t
Sh*t.”

MAOI’S (Phenelzine, and Tranylcypromine):

- Used for depression
- Side effects: agitation, anxiety, orthostatic hypotension, and hypertensive crisis
(IMPORTANT)
- Key points: Interact with almost all other meds including OTC cold meds would
result in hypertensive crisis. Do not consume foods high in tyramine (aged cheese,
avocado, bananas, red wine, smoked meats, salami, pepperoni, and chocolate), will
result in hypertensive crisis.

Medications for Bipolar Disorders

Mood Stabilizers (Lithium):
- Used for bipolar disorder
- Side effects (IMPORTANT): GI upset, fine hand tremors, polyuria, weight gain,
kidney toxicity, and electrolyte imbalance (sodium)
- Key points: Important to monitor Lithium serum levels (high risk for toxicity due to
low level therapeutic index). Should NOT go over 1.5, if it does then they are at risk
for toxicity. Symptoms for toxicity: course tremors, confusion, hypotension, seizures,
and tinnitus.
- Teaching: patient should not take diuretics or anticholinergic meds, or NSAIDS.
Contraindicated in kidney disease. Closely monitor sodium intake, and are drinking
2-3L of fluid per day, and adequate sodium intake (no diuretics or anticholinergics
with Lithium). Decrease sodium and fluid increases risk for toxicity.
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Antiepileptic Medications (Carbamazepine, Valproic Acid):

- Used to treat seizures and bipolar
- Carbamazepine key side effects: blood dyscrasias (anemia (RBC decrease),
leukopenia (WBC decrease), and thrombocytopenia (platelet decrease)), vision issues
(double vision and nystagmus), hypoosmolality, and rash. Monitor CBC levels
- Valproic Acid key side effects: GI upset, hepatic toxicity- liver damage
(IMPORTANT), pancreatitis, and thrombocytopenia

Medications for Psychotic Disorders

Schizophrenia Symptoms:
- Positive (symptoms present that should not be there): hallucinations, delusions,
strange motor movements, speech alterations, and agitation
- Negative (symptoms not present that should be there): (5 A’s) Affect (flat), Alogia
(decrease thought or speech), Anergia (lack of energy), Anhedonia (lack of pleasure),
Avolotion (lack of motivation for activities)
Conventional (Chlorpromazine [Benzo], Haloperidol [Haldol]):
- Used for schizophrenia or other psychotic behaviors
- Mainly control the positive symptoms.
- Side Effects: LOTS! 1. Extrapyramidal side effects: dystonia, Parkinson’s symptoms
(shuffling gait, rigidity), 2. Tardive dyskinesia (lip smacking, tongue rolling). 3.
Neuroleptic malignant syndrome (fever, blood pressure up and down, dysrhythmias,
muscle rigidity. 4. Agranulocytosis (decrease in neutrophils- more prone to
infections). Also: anticholinergic side effects, orthostatic hypotension, sedation, and
seizures
- Key points: monitor vital signs carefully. Showing signs of EPS give Benztropine
(anticholinergic) will reduce symptoms. NMS symptoms give muscle relaxant
(Dantrolene).

Atypical antipsychotics (Risperidone, Clozapine, Olanzapine):

- Used for schizophrenia (treats both positive and negative)
- Side effects: Diabetes, weight gain, increased cholesterol, sedation, orthostatic
hypotension, anticholinergic side effects, and menorrhagia (unusual bleeding with
periods), decreased libido.
- Clozapine: increase risk for agranulocytosis
- Key points: Risperidone can be give IM every 2 weeks, avoid alcohol

ADHD Medications
ADHD (Methylphenidate [Ritalin], Amphetamine mixture [Adoral])
- ADHD also for conduct disorders
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- Side effects: (IMPORTANT) decreased appetite and weight loss. Insomnia

(IMPORTANT), dysrhythmias.
- Key points: DO NOT give at night. Give immediately before or after meals. Monitor
weight periodically

Medications for Alcohol Withdrawal and Abstinence

Alcohol Withdrawal (Benzodiazepines [Lorazepam, Diazepam], Carbamazepine, Clonidine,
Beta Blockers):
- KEY: Starts within 4-12 hours after last drink; peaks around 24-48 hours. Most
important question: when their last drink was
- Benzodiazepines used to help stabilize vital signs, decrease risk of seizures, and
decrease withdrawal symptoms
- Carbamazepine (also used for antiseizure and bipolar) to decrease risk of seizures
- Clonidine helps decrease BP and HR. Decrease autonomic response
- Beta Blockers (LOL) to decrease autonomic response to decrease BP and HR. Also
decreases cravings

Alcohol Abstinence (Disulfiram, Naltrexone, and Acamprosate):

- Disulfiram taken and drink alcohol they will get disulfiram reaction (nausea,
vomiting, sweating, heart palpitations).
- Naltrexone suppresses cravings of alcohol, can be given in a monthly IM injection
- Acamprosate decreases abstinence symptoms (anxiety, restlessness etc.).

Withdrawal medications for Opioid and Nicotine (Methadone, Bupropion, Nicotine

replacements, Varenicline):
- Methadone: used for opioid withdrawal and long-term maintenance.
- Nicotine withdrawal: Bupropion (also atypical antidepressant), Nicotine replacement:
gum, patch, nasal spray. Varenicline (Chantix): Used to reduces cravings and
withdrawal symptoms, monitor closely for signs of depression and suicidal thoughts

Medications for Myasthenia Gravis and Parkinson’s Disease

Myasthenia Gravis: There is not enough acetylcholine in the neuromuscular junction which
causes muscle weakness. Cholinergic medications help to improve the strength and mobility.
S/S: muscle weakness

Cholinergic Medications (Neostigmine, Pyridostigmine, Edrophonium):

- Used for Myasthenia gravis
- Can reverse neuromuscular blocking agents
- Mode of action: increases acetylcholine at the receptor sites by inhibiting
cholinesterase (enzyme that breaks down acetylcholine)
- Side effects: too much acetylcholine (increased salivation, diarrhea, N/V, sweating,
and bradycardia). Cholinergic crisis: muscle weakness as well (ANTIDOTE:
Atropine)
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- Edrophonium: key medication used to diagnose MG, if muscle weakness disappears

MG was causing it, if not it is a cholinergic crisis

Parkinson’s Disease: Not enough dopamine and too much acetylcholine

Dopamine Agonist (Levodopa/Carpodopa [Sinemet]):
- Used for Parkinson’s, helps to decrease tremors and muscle rigidity (key symptoms)
- Mode of action: Increases dopamine levels in CNS. Levodopa is converted to
dopamine and Carbodopa prevents the breakdown of Levodopa
- Side Effects: N/V, drowsiness, dyskinesias (ticks), orthostatic hypotension, darkening
of urine and sweat, possible psychosis
- Key points: High protein meals decrease effectiveness
Anticholinergic (Benztropine):
- Brings down acetylcholine in CNS. Helps to decrease tremors and muscle rigidity
- Anticholinergic side effects: Dry mouth, dry eyes, blurry vision, urinary retention,
and constipation
- Key points: To counter act anticholinergic side effect: chew gum, wear sunglasses,
and increase fluid and fiber intake
Antiepileptic. Glaucoma, and Otitis Externa Medications:
Antiepileptic (Phenytoin, Lamotrigine, Carbamazepine, Valproic Acid):
- Phenytoin side effect: (IMPORTANT) gingival hyperplasia (gums enlargement, not
receding), double vision, nystagmus, rash, ataxia, hypotension
- Key points: serum Phenytoin levels need to be monitored routinely because of narrow
therapeutic range (10-20 mg/mL). Frequent blood draws. Will decrease effectiveness
of oral contraceptives.
Glaucoma
Antiglaucoma agent – topical beta blocker (Timolol):
- Used for open angle glaucoma.
- Nonselective beta blocker. Decreases aqueous humor production which decreases
IOP.
- Minimal side effects: temporary stinging of eye
- Key points: Don’t touch applicator to eye, hold gentle pressure at nasal lacrimal duct
for 30-60 seconds. Overdose: systemic effects
Antiglaucoma agent – Carbonic Anhydrase Inhibitor (Acetazolamide):
- Also treats heart failure and altitude sickness
- Causes diaphoresis and lowers IOP by decreasing aqueous humor secretion
- Side effects: Flu like symptoms, GI upset, and electrolyte imbalance (Sodium and
Potassium)
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- Key points: administer with food, monitor electrolytes

- “I see a zoo”
Otitis Externa
Ear Drops (Ciprofloxacin with Hydrocortisone):
- Swimmers ear
- Key points: Roll container gently, position on unaffected side, keep on side for 5
minutes after, lightly pack ear with cotton, educate to dry ear canal after swimming or
bathing.
Neuromuscular Blocking Agents and Muscle Relaxants
Neuromuscular blocking agents (Succinylcholine, Pancuronium):
- Used as adjunct to anesthesia during surgery, intubation procedures
- Block acetylcholine at neuromuscular junction which causes neuromuscular paralysis
- Side effects: respiratory arrest, apnea, muscle pain following surgery.
(IMPORTANT) malignant hyperthermia (S/S: muscle rigidity and fever) treatment of
MH is administer 100% oxygen, implement cooling measures, and administer muscle
relaxant (Dantrolene)
Muscle Relaxant – Direct Acting (Dantrolene):
- Used to treat muscle spasms related to spinal cord injury, cerebral palsy, or MS; also
for malignant hyperthermia
- Prevents release of Calcium in skeletal muscle which inhibits muscle contraction in
term reduces muscle spasms
- Side effects: drowsiness, muscle weakness, GI upset, possible hepatic toxicity
- Key points: Monitor for signs of liver damage (liver enzymes)
Muscle Relaxant – Centrally Acting (Baclofen):
- “If you pull out your BACK you might need Baclofen”
- Used for muscle spasms related to spinal cord injury, cerebral palsy, MS, and for MH.
- Enhances affect of GABA in CNS to reduce muscle spasms
- Side effects: Drowsiness, GI upset (nausea), constipation
- Key point: increase fiber and fluids to decrease constipation
Urinary Tract Stimulants, Antispasmodics and Sedative/Hypnotic Agents
Urinary Tract Stimulants (Bethanechol):
- Used for non-obstructive urinary retention. Stimulates cholinergic receptors in GU tract
which allows for bladder emptying
- “Beth has a shy bladder”
- Side effects: Cholinergic side effects (flushing, sweating, urinary urgency, N/V,
bradycardia, hypotension
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- Key points: 1 hour before or 2 hours after meals to minimize N/V

Urinary Tract Antispasmodic (Oxybutynin):
- Used for overactive bladder symptoms – frequency, urgency, and nocturia
- Inhibits acetylcholine in bladder therefore reducing urinary urgency and frequency
- Side effects: anticholinergic (dry mouth, urinary retention, constipation, blurred
vision)
- Key points: increase fiber and fluid, heard candy
Insomnia Medication (Zolpidem):
- Ambien. Increases affect of GABA in CNS, helps to promote sedation and sleep
- Side effects: day time sleepiness, dizziness
- Key points: Have full 8 hours dedicated for sleeping before taking
Sedative/Hypnotic Agents (Pentobarbital, Propofol, Midazolam):
- Used for the induction and maintenance of anesthesia, for moderate/conscious
sedation, or intubation
- Causes CNS depression and loss of consciousness
- Side effects: respiratory and cardiovascular depression. Propofol: risk for pain at IV
site and risk for bacterial contamination (use vials within 6 hours)
- Key points: monitor for S/S of infection, have resuscitation equipment readily
available, continually monitor ECG and vital signs
Bronchodilators, Inhaled and Oral Glucocorticoids
Beta 2 Adrenergic Agonists (Albuterol, Salmeterol):
- Albuterol: short acting and for acute episodes of asthma
- Salmeterol: long acting, not used for acute episodes
- Mode of action: binds to beta 2 receptors in airway smooth muscle which results in
bronchodilation
- Side effects: tachycardia (expected finding – not #1 priority), angina, and tremors
- Key points: Always use Beta 2 agonists before glucocorticoids (wait FIVE minutes in
between). “Salmon live a longer life”
Xanthine (Theophylline):
- Long term control of asthma or COPD. Increase C-amp which results in
bronchodilation.
- Minor side effects: GI upset
- MANY serious side effects: Dysrhythmias and seizures
- “Theo = god like, you may see God sooner than expected because of side effects”
- Key points: Monitor serum levels very closely, narrow therapeutic range.
Inhaled Anticholinergic (Ipratropium):
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- Used for asthma or COPD. Blocks acetylcholine receptors in airway smooth muscle
which causes bronchodilation
- Side effects: dry mouth, hoarseness (not systemic anticholinergic)
- Increase fluids and suck on sugar free candy
Inhaled Glucocorticoids (Beclomethasone):
- Used for asthma alone or with beta 2 agonist. Decreases inflammation locally
- Side effects: hoarseness, candidiasis (fungal infection)
- Key points: after using, rinse mouth out with water, used after bronchodilator
Oral Glucocorticoids (Prednisone):
- IMPORTANT!
- Used for wide variety of chronic illnesses such as asthma, autoimmune disorders and
inflammatory disorders.
- Mode of action: decreases inflammation and suppresses immune response
systemically
- Side effects: (IMPORTANT): bone loss, weight gain, fluid retention, hyperglycemia,
hypokalemia, increased of infection, muscle weakness, PUD, adrenal gland
suppression
- Key points: Periods of stress require additional doses, never discontinue suddenly
(tapper slowly), monitor for S/S of infection, avoid NSAIDS (cause bleeding)

Expectorants, Mucolytics, Decongestants, and Antihistamines

Leukotriene Modifiers (Montelukast [Singular], Zafirlukast):
- Used to treat asthma or prevent exercised induced Broncho restriction
- Decrease effects of leukotrienes which reduces inflammation in airway and
bronchoconstriction
- “Lukast meds will decrease effect of leukotrienes”
- Side effects: Z – increase in liver enzymes and avoid taking with food, M – take in
evening or 2 hours before exercising.
Antitussives Opioids (Codeine):
- Used for non-productive couch, decreases cough reflex
- Side effects: Opioid like (sedation, respiratory depression, constipation, GI upset, and
possible dependence)
- Key points: change positions slowly, avoid alcohol, increase fiber and fluid intake
Expectorants (Guaifenesin [Mucinex]):
- “Gauif sounds like cough”
- Treats non productive cough associated with respiratory infections, thins secretions,
makes cough more productive
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- Side effects: GI upset, drowsiness, and rash

- Key points: Increase fluid intake to thin secretions
Mucolytics (Acetylcysteine):
- IMPORTANT
- For pulmonary disorders with thick secretions (cystic fibrosis), antidote for
acetaminophen poisoning
- “Acetyl antidote for acetam”
- Improves the flow of secretions in respiratory tract
- Side effects: Bronchospasms, N/V, possible rash
- Key points: Smells like rotten eggs, caution in patients with asthma
Decongestants (Phenylephrine, Pseudoephedrine):
- Used for rhinitis (nasal congestion), causes vasoconstriction of respiratory tract
mucosa
- Side effects: Agitation, nervousness, palpitations, possible rebound congestion
Antihistamines (Diphenhydramine 1st gen [Benadryl], Loratadine 2nd gen):
- Used for nasal congestion, mild allergic reactions, and motion sickness. Blocks
histamines release which reduces mucus secretions
- Side effects: 2nd: minimal. 1st: sedation, anticholinergic side effects (dry mouth,
constipation, and urinary retention)
Nasal Glucocorticoids (Mometasone, Fluticasone, Budesonide):
- Used for rhinitis, decreases inflammation in nasal passageway
- Side effects: headache, nasal burning, and pharyngitis (sore throat)
Diuretics
Loop Diuretics (Furosemide):
- Used for pulmonary edema, HF edema, liver disease, or kidney disease, or HTN
- Blocks reabsorption of sodium chloride and water at ascending loop of henle which
cause rapid diuresis.
- “FUR (furiously) gets rid of sodium and water”
- Side effects: Dehydration, hypotension, electrolyte imbalance (hyponatremia and
hypokalemia), ototoxicity, hyperglycemia
- Key points: administer during the day (not at night), infuse 20mg/min (slowly), weigh
daily, monitor I and O’s, and electrolytes, encourage to eat high in potassium
Thiazide Diuretics (Hydrochlorothiazide):
- Used for HTN, edema (HF, kidney or liver disease.
- Blocks reabsorption of sodium chloride and water and DCT tubule
- Side effects: Dehydration, hypokalemia, hyperglycemia. No risk of ototoxicity
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- Key points: give at day, weigh daily, monitor I and O’s and electrolytes, encourage
foods high in potassium
Potassium Sparing Diuretics (Spironolactone):
- Used for HF, HTN. Contraindicated with severe kidney failure
- Blocks aldosterone which promotes secretion of sodium and water but allows
retention of potassium
- Side effects: hyperkalemia, amenorrhea, gynecomastia, and impotence
- Key points: Watch potassium levels closely, avoid salt substitutes (IMPORTANT)
- “SPIR will lift SPIRIT because you won’t lose potassium”
Osmotic Diuretics (Mannitol):
- Used for edema, increased intercranial or intraocular pressure
- Reduces ICP and IOP by increasing serum osmolality which draws fluid into
interstitial fluid and plasma
- “I had a headache due to ICP, but MAN it ALL went away”
- Side effects: HF, pulmonary edema, renal failure, dehydration, electrolyte imbalances
(sodium and potassium)
- Key points: Need to use filter needle and filter IV tubing, monitor weight, I and O’s
and electrolytes
RASS and Blood Pressure Medications
RASS System: BP medications block some part of the pathway.
- BP is too low: kidneys releases renin, renin converts angiotensin I which is converted
to angiotensin II through ACE. Angiotensin II: Causes vasoconstriction, causes
adrenal cortex to release aldosterone, aldosterone causes kidneys to reabsorb sodium
and water in the body which helps to bring up BP.
- Spironolactone: Blocks aldosterone: No reabsorption at the kidneys which helps to
bring down BP
ACE Inhibitors (Captopril, Lisinopril):
- “pril” most. Used for HTN, HF, MI, and diabetic nephropathy
- Blocks conversion of angiotensin I to angiotensin II (through ACE, blocking enzyme)
- Side effects: Key – 1. Angioedema 2. Cough 3. Elevated potassium (ACE).
Hypotension (too much), possible rash
- Key points: Monitor BP, change positions slowly to prevent orthostatic hypotension
Angiotensin II Receptor Blockers (Losartan, Valsartan)
- Works at different point in the RASS system. Used for HTN, HF, MI, and Diabetic
nephropathy
- Blocks angiotensin II receptor which helps with vasodilation
- Side effects: angioedema, GI upset, and hypotension
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Calcium Channel Blockers (Diltiazem, Verapamil, Nifedipine)

- “very nice drugs”
- HTN, angina. Blocks calcium channels in the blood vessels and the heart leading to
vasodilation and decreased HR
- Side effects: Bradycardia, hypotension, dysrhythmias, constipation, and peripheral
edema
- Key points: NO grapefruit juice, monitor BP and HR carefully
Alpha and Beta Blockers and Blood Pressure Medications
Alpha I receptors: primarily in blood vessels. Activation causes vasoconstriction which increases
BP
Alpha II receptors: Decrease sympathetic outflow which causes vasodilation and a decrease in
HR
Beta I receptors: In the heart, activation causes heart rate to go up and contractility to increase (1
heart)
Beta II receptors in the lungs: Activation causes bronchodilation (2 lungs)
Alpha I Receptor Agonists (Prazosin, Doxazosin):
- Blocks Alpha I receptors which leads to vasodilation.
- Used for HTN and BPH.
- Key side effect: hypotension (change position slowly)
Centrally Acting Alpha 2 Agonists (Clonidine):
- Decrease sympathetic outflow which decreases HR, cardiac output and BP
- Used for HTN
- Side effects: Drowsiness and dry mouth
- Key points: Suck on hard candy and increase fluid intake
Beta I Blockers (Metoprolol, Atenolol):
- “OLOL”
- Used for HTN, Angina, HF, and MI
- Mode of action blocks Beta I receptors in the heart which helps to decrease BP and
HR
- Side effects: Bradycardia, decreased cardiac output, hypotension, and fatigue, erectile
dysfunction
- Key points: change position slowly, take BP and pulse at home daily
Nonselective Beta Blockers (Propranolol, Carvedilol, Labetalol):
- Affects both beta I and beta II receptors
- Used for HTN, angina, arrythmias, and MI. Decrease BP and HR, also cause
bronchoconstriction. NEVER give to patients with asthma
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- Side effects: Fatigue, hypotension, bradycardia, decreased cardiac output,

bronchoconstriction
Vasodilator - For Hypertensive Crisis (fprusside):
- Works by causing direct vasodilation of arteries and veins (rapidly decreases BP) in
both the preload and afterload
- Side effects: Hypotension, cyanide poisoning, thiocyanate toxicity
Digoxin, Adrenergic Agonists and Nitroglycerin
Cardiac Glycosides (Digoxin):
- Used to treat HF, A fib. Has a Inotropic effect – cause the heart to contract more
forcefully and more efficiently; And chronotropic effect – which decreases HR
- “if mom has HF, call her up and say, ‘mom, did’gya pick up your prescription for
digoxin’”
- Side effects: dysrhythmias, bradycardia. Risk for toxicity (IMPORTANT) S/S: GI
upset, fatigue, weakness, vision changes (halos, green/yellow light)
- Key points: check pulse before giving (hold under 60/min). Discharge: take pulse
prior to taking. Monitor levels (0.5-2.0). Hypokalemia can increase risk for digoxin
toxicity (eat foods high in potassium). Treat bradycardia with atropine. Overdose:
treat with digoxin immune Fab (Digibind)
Adrenergic Agonists (Epinephrine, Dopamine, Dobutamine):
- Epinephrine: activates receptors on alpha I beta I and II. Used for cardiac arrest,
asthma. Causes bronchodilation and vasoconstriction (increases BP and HR and
cardiac output). Code blue: bringing Epi
- Dopamine: Used for shock and HF. Mainly works on beta I. Improves kidney blood
flow in low doses and increase HR and cardiac output
- Dobutamine: Used for HF, effects Beta I receptors, effects cardiac output, less effect
on HR or BP.
- Side effects: hypertensive crisis (increase BP), dysrhythmias, and angina
Antianginal Medication (Nitroglycerin):
- Used for angina. Vasodilation: decreases preload and myocardial oxygen demand
- Side effects (IMPORTANT): headache, orthostatic hypotension, reflex tachycardia
- Key points: Administer sublingual, store in cool dark place, in chest pain: place one
under their tongue and let it dissolve, rest and wait FIVE minutes to see if pain goes
away. If it does not, put another one under their tongue and call 911, wait another
FIVE minutes and then take third dose if pain continues. Giving topically: remove
prior dose before putting on, place over clean hairless area, avoid touching
medication.
Antidysrhythmic Medications
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KEY SIDE EFFECT: HYPOTENSION

Antidysrhythmic Medications Class I (Procainamide, Lidocaine):
- Used for SVT, VTAC, atrial flutter, and v fib. Serve as a sodium channel blocker
- Side effects: lupus, leukopenia, thrombocytopenia, and arrhythmias
- “Relative who was Pro McCain, got upset that John McCain lost and ended up in
VTAC”
Antidysrhythmic Medications Class II (Propranolol):
- Used for afib, atrial flutter, proximal SVT, HTN, and angina. Nonselective
- Side effects: Bradycardia, fatigue, weakness, and bronchospasms
- Key point: Never use with asthma
Antidysrhythmic Medications Class III (Amiodarone):
- Used for a fib, ventricular fibrillation, ventricular tachycardia. Potassium channel
blocker
- Side effects: Bradycardia, pulmonary toxicity, visual disturbances, GI upset, liver
toxicity, thyroid dysfunction
Antidysrhythmic Medications Class IV (Verapamil, Nifedipine, riazem):
- Calcium channel blocker. Used for A fib, atrial flutter, SVT, HTN, and angina.
- Side effects: Bradycardia, GI upset.
Antilipemic (Cholesterol Lowering) Medications
Statins (Atorvastatin, Simvastatin):
- Hypercholesteremia, prevent MI. Decreases production of LDL, increase production
of HDL
- Side effects (IMPORTANT): Hepatotoxicity, muscle pain, risk for GI upset
- Key points: administer with the evening meal (sysnthesize at night), monitor liver
function and CK levels. Tell top avoid alcohol.
Cholesterol absorption Inhibitor (Ezetimibe):
- Used for high cholesterol. Inhibits absorption of cholesterol in the SI.
- “Ezetimibe makes cholesterol ZIP through the intestines”
- Side effects: Hepatotoxicity and muscle pain
- Key points: monitor liver function and CK levels
Bile Acid Sequestrant (Colesevelam):
- Used for high cholesterol. Binds bile acid in the intestines which causes increased
secretion of cholesterol
- Side effects: Constipation (IMPORTANT)
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- Key points: increase fiber and fluids, take with food and full glass of water. Interferes
with absorption of fat-soluble vitamins (ADEK), interferes with oral contraceptives.
Niacin (Niacin, Nicotinic Acid):
- Used for lower cholesterol. Decreases lipoprotein and triglyceride synthesis.
- Side effects: flushing of face, GI upset, hepatotoxicity, and hyperglycemia
- Key points: Monitor liver function, and blood glucose levels
Fibrates (Gemfibrozil):
- Decrease triglyceride production and transport and increases HDL
- Side effects: GI upset, gall stones, hepatoxicity, muscle pain
- Key points: Give 30 minutes before breakfast and dinner, monitor liver function and
CK levels
Antiplatelet, Thrombolytic Medications; Erythropoietic and Leukopoietic Medications
Antiplatelet (Aspirin, Abciximab, Clopidogrel):
- Used for prevention of MI or stroke. Inhibit platelet aggregation
- “Horse CLOPing on platelets”
- Side effects: GI upset, bleeding (IMPORTANT), Aspirin: tinnitus
- Key points: NEVER give aspirin to children with a fever, contraindicated in bleeding
disorders
Thrombolytic Medications (Alteplase, Reteplase):
Used to BREAK up clots
- “if you trying to break up a clot, you have come to the right PLASE”
- Used in MI, stroke, PE, or occluded central IV. Convert plasminogen to plasmin
which breaks up fibrinogen
- Side effects: BLEEDING, contraindicated: hemorrhagic stroke, internal bleeding,
recent surgery or trauma, severe hypertension
- Key points: Administer within 3 hours of onset of symptoms, closely monitor labs
and vital signs, limit venipunctures
Erythropoiesis Growth Factors (Epoetin Alfa):
- Used for treatment of anemia, increase production of RBC in patients with CKD,
HIV, or chemo. Stimulates bone marrow to increase production of RBC
- “Erythrocytes = RBC”
- Side effects: HTN (IMPORTANT)
- Key points: increased risk for DVT, stroke, or MI, do not agitate vial, monitor BP and
H&H twice a week, need sufficient iron levels
Leukopoietic Growth Factor (Filgrastim):
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- Used to treat neutropenia. Increases neutrophils and decreases risk of infection.

Chemo. Cause bone marrow to increase production
- Side effects: bone pain, leukocytosis (high WBC level), enlarged spleen
- Key points: don’t agitate vial, monitor CBC levels twice a week.
Anticoagulants
Anticoagulants – IV (Heparin)
- Administer subcut. or IV. Low molecular (loxenox). Used for stroke, PE, DVT, and
other fast coag. Conditions. Activates antithrombin which inhibits thrombus
formation. PREVENTS new clots
- Side effects (IMPORANT): Bleeding, HIT (immune reaction of micro clots which
use up platelets, cut off circulation), hypersensitivity
- Key points: closely monitor aPTT levels (1.5-2 times base line) Base line 30-40
seconds (MAX therapeutic around 80 seconds). Antidote: Protamine (IMPORTANT),
monitor for S/S of bleeding (dark emesis, tarry stools), use soft tooth brush and
electric razor
Anticoagulants – Oral (Warfarin):
- Used for VT, a fib with thrombus, prevent MI, TIA, PE, and DVT. Antagonize
vitamin K which prevents formation of several clotting factors
- “Warfarin going to WAR with vitamin K”
- Side effects: Bleeding, GI upset, possible hepatitis
- Key points: closely monitor PT INR levels (ther. 2-3). Takes 3-5 days to get to
therapeutic levels why Heparin is started at beginning as well and then stopped at
discharge. Antidote: vitamin K. Maintain steady intake of vitamin K, monitor for
bleeding and use soft tooth brush and electric razor. Normal PT: 11-12.5 seconds
(ther. 18-24 seconds)
Factor XA Inhibitor (Rivaroxaban):
- Used to prevent DVT, PE, or stroke in patient with a fib. Inhibits factor Xa which
blocks coagulation cascade
- “Makes your blood flow like a RIVer”
- Side effects: bleeding, elevated liver enzymes
- Key points: monitor liver function and H&H
H2 Receptor Antagonists, PPIs, Sucralfate, Prostaglandins (GI MEDS)
PUD: H. pylori leading cause. Treated with multiple meds (2-3 antibiotics) and H2 receptor
antagonists, PPIs, antacids
Histamine 2 Receptor Antagonists (suctidine, Famotidine):
- “If you DINE it may cause pain”
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- Used for ulcers, GERD, zollinger ellison disease (increase secretion of GI acid).
Blocks H2 receptors which reduces GI acid secretion
- Side effects: Risk for bacterial colonization in the stomach and respiratory tract, (d/t
decreased acid)
PPI (Omeprazole, Pantoprazole):
- Used for ulcers, GERD, zollinger ellison disease. Inhibits an enzyme need for
secretion
- Side effects: GI upset, long term: osteoporosis
Mucosal Protectant (Sucralfate):
- Used for duodenal ulcers. Reacts with stomach acid to form a thick paste that adheres
to ulcers
- “Med with SUC down into ulcers and protect”
- Side effects: Constipation (IMPORTANT)
- Key points: Administer: 1 hour before meals and at bedtime (4x), increase fluids and
fiber
Antacids (Aluminum Hydroxide, Magnesium Hydroxide, Sodium Bicarbonate, Calcium
Carbonate):
- Used for PUD, GERD. Neutralize stomach acid
- Side effects: Vary – Aluminum and calcium (constipation), Mag (diarrhea)
- Key points: high maintenance med: 1 hr before and 3hr after meals, at bedtime, make
sure 1 hr before or after meds
Prostaglandins (Misoprostol):
- Used in prevention of gastric ulcers in patients who take long term NSAIDs, ripen
cervix. Decrease stomach acid secretion and increase protective mucus in body
- Side effects: Dysmenorrhea, miscarriage (IMPORTANT), GI upset
- Key points: Never give to pregnant woman, run pregnancy test before giving
- “MISO pregnant so MI not taking”
Antiemetics, Antidiarrheal Medications and Prokinetic Agents
Antiemetics (Ondansetron):
- Treat N/V related chemo, radiation, post-op. Blocks serotonin receptors in CTZ.
- Side effects: Headaches, dizziness, GI upset
- Key point: Administer prior to chemotherapy
- “I threw up on DAN”
Laxatives (Psyllium, Docusate Sodium, Bisacodyl, Magnesium Hydroxide):
- Psyllium: bulk forming laxative
- Docusate: Surfactant
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- Bisacodyl: Stimulant
- Mag.: Osmotic. Draws water into intestines (monitor for mag. Toxicity)
- Key points: used for constipation. NOT used for bowel obstruction. Increase fluid,
fiber, and exercise
Laxative used for Hepatic Encephalopathy (Lactulose):
- Lowers pH in colon which promotes ammonia secretion
- Side effects: GI upset, electrolyte imbalance, hyperglycemia
Antidiarrheal (Loperamide, Diphenoxylate plus Atropine)
- Stimulate opioid receptors in intestines which cause decrease in motility and increase
in reabsorption of sodium and water
- Side effects: constipation, drowsiness. HIGH dose D and A can cause opioid and
anticholinergic side effects
Prokinetic Agents (Metoclopramide):
- Used for N/V, gastric paresis, GERD. IMPORTANT: accelerates gastric emptying
and blocks dopamine and serotonin receptors in CTZ.
- Side effects: drowsiness, GI upset, EPS symptoms (rigidity, tremors, twitching,
tardive dyskinesia, and restlessness)
ATI Review:
- Administration of iron supplements: Ferrous sulfate. Take on an empty stomach (1
hour before meals) to maximize absorption. Take with food if GI upset occurs. Space
doses in equal intervals. Dilute with juice or water, drink with a straw and rinse
mouth after. Increase fiber and water. Eat foods high in iron (liver, egg yolks, muscle
meats, yeast, grains, green leafy veggies). Sit up for 15 minutes after, rinse mouth
- Using an Epi pen:
- rivaomycin Lactobionate care: Used for severe infections or cannot take oral dose.
Monitor liver functions and PT/INR if on warfarin. a nurse is planning care for a
client who has a prescription for erythromycin lactobionate IV bolus. which of the
following actions should the nurse include in the plan of care? Monitor for hearing
loss
- Adverse effects of Clindamycin: vomiting, diarrhea, stomach pain, joint pain, vaginal
itching and discharge, skin rash, heart burn, sore throat, changes in bowel habits
- Adverse effect of Carbamazepine: blood dyscrasias (anemia (RBC decrease),
leukopenia (WBC decrease), and thrombocytopenia (platelet decrease)), vision issues
(double vision and nystagmus), hypoosmolality, and rash. Monitor CBC levels
- Monitoring for adverse effects in antirheumatic medications: Increase risk for
infection, hepatic fibrosis, bone marrow suppression, stomatitis, GI ulcers, toxicity
(pruitus, rash, stomatitis), renal toxicity, blood dyscrasias, hepatitis, GI discomfort,
HF, blindess
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- Priority findings for a client who received Dinoprostone: Urine stimulant. Also
promotes cervical ripening and stimulate contractions
- Reporting adverse effects of Furosemide: Dehydration, hypotension, electrolyte
imbalance (hyponatremia and hypokalemia), ototoxicity, hyperglycemia
- Interactions with antigout medication: Colchicine: Grapefruit juice. nenecid:
Salicylates such as Aspirin. Allopurinol: slows metabolism of warfarin which
increases risk for bleed)
- Priority adverse effect of epidural anesthesia: Decreased gastric emptying resulting in
nausea and vomiting, unable to eliminate bowel and bladder, bradycardia,
tachycardia, hypotension, respiratory depression, allergic reaction, pruritus, elevated
temp.
- Administering IV Methylprednisolone: prevention of mucus.
- Identifying a need for a dosage increase of levothyroxine: Bradycardia, cold
intolerance, impaired short-term memory
- Client education about MAOI’s: Avoid aged cheese, smoked fish, pepperoni, salami,
bananas. Interact with almost all other meds including OTC cold meds would result in
hypertensive crisis. Do not consume foods high in tyramine (aged cheese, avocado,
bananas, red wine, smoked meats, salami, pepperoni, and chocolate), will result in
hypertensive crisis.
- Depressive disorders: dietary teaching:
- Parenteral medications: Vastus lateralis – under 2, ventral gluteal – over 2.