1.

Calc q
2. Adverse effects of Corticosteroid (prednisone)
 Impaired wound healing
 Masking Infections ( ↓fever and pain)
 ↓potassium, ↑sugar
 Edema
 sodium / fluid retention
 Candidiasis (from using inhaler)
 N/V, anxiety, heart failure, weight gain, ↑ intraocular pressure, fragile skin

3. Adverse effects of prednisone

4. Adverse effects of anticoagulants (warfarin)
 HIT (heparin induced Thrombocytopenia) = ↓ platelets
 Bleeding
 Hematuria (blood in urine)
 Local irritation (from subcutaneous injection in Abdomen)

5. Goal of anticoagulation therapy (purpose)

 Prevent blood clots formation
 Reduce risk of stroke and heart attack
 Indications: deep vein thrombosis (DVT), pulmonary embolism (PE), Afib,
Cerebral vascular event (CVA) thrombosis, myocardial infarction(MI)

6. Calc q
7. What medications do you give for cough?
 Expectorants (guaifenesin): Productive cough (Viral and Bacteria)/ to loosen mucus.
 Antitussives (dextromethorphan): dry, non-productive coughs only.
 Decongestants (pseudoephedrine): coughs due to nasal or sinus congestion
 Bronchodilators (acute asthma attacks) and Corticosteroids (prednisone: treat
inflammation of the airway): coughs associated with asthma or COPD.

8. Nursing considerations before starting metformin

 First-line therapy choice for Type 2 DM.
 taken with meals (reduce GI upset).
 Discontinue metformin 48 hours before any radiological study involving iodine
 Do NOT cause Weight Gain
 Adverse effects typically go away within 7-14 days of starting the medication.

9. Adverse effects of Biguanides (metformin)

 Abdominal Bloating, cramping fullness
 Diarrhea
 Nausea
 Metallic take in mouth
  anorexia

10. Purpose (indication) and mechanism of anti-platelets (aspirin)

Indicationt:

 Venous Thrombosis, Angina, cerebral vascular accidents (CVA), MI

MOA::

 Interfere with platelet aggression VIA blocking the formation of Thromboxane

A2.

11. What do you do if you cause a med error?

 DOCUMENT the incident or near-miss and REPORT it immediately to the
patient's primary healthcare provider and your employer
 Monitor the Patient for any Adverse effect
 Reflection on the error
 Follow the facility procedure like filling out incident report

12. Know the angles of injection (e.g., transdermal, IM)

 Intradermal (ID): 10 -15 degrees angle.
 Subcutaneous (SubQ): 45 degrees (or 90 degrees for patients with little subcutaneous
fat).
 Intramuscular (IM): 90 degrees angle.
 Intravenous (IV): 25 degree angle
13. Who regulates meds in Canada?
 Health Canada

14. Contraindications to taking anticoagulants (warfarin)

 Allergy , Active internal bleeding, Severe hypertension
 Bleeding disorders
 Use of ASA/NSAIDs (↑ bleeding risk)
 Trauma (internal Bleeding)
 Intracranial hemorrhage (bleeding inside brain)
 Pregnancy

15. Contraindications to beta blockers “lol”

 Allergy
 Antacid (it ↓ B-blockers activity)
 Asthma (labetalol, propranolol: it constrict the airway)

16. Patient understanding in beta blockers (nursing consideration)

 cardiovascular assessment before administering.
 Kids: β-Blockers are the preferred drugs for treating hypertension.
 Kids: Do not administer if the heart rate (HR) is below <60 bpm
 Geriatic: individuals with weaker body regulation mechanisms (homeostatic mechanism)
are more sensitive to the blood pressure-lowering effects of beta blockers and other
antihypertensives.
 Adjust dosages in elderly patients due to potential renal impairment.

17. Nursing consideration for Lipitor (Anti- lipedemic “statin”)

 Anti- lipedemic: HMG-CoA Reductase Inhibitor atrovastatin calcium (Lipitor)
 Obtain a baseline serum lipid (cholesterol) profile (to know the drug effectiveness)
 Continuous monitoring of blood pressure for hypotension
 Effects not often seen for 6-8 weeks
 Obtain baseline serum liver profile (it can impact liver functions)
 Encourage low fat/ heart healthy diet

18. Potassium-Sparing Diuretics (spironolactone): nursing consideration

 Cardiovascular assessment before giving the medication.
 Monitor the patient's serum potassium levels (prevent hyperkalemia)
 Advise the patient to avoid high-potassium foods.
 Patients should report weight loss (more than 2 lb/week/ fluid loss).
 Adjust dosage on kids with renal failure
 Geriatic: Be aware of an increased risk of hyperkalemia in patients with renal
impairment; (monitor BUN and creatinine levels)

19. Nursing consideration for Tachyarrhythmia: Cardiac Glycoside (Digoxin)

  Cardiovascular assessment before administration.
 HOLD if apical pulse is less than <60 bpm.
 Antacids can ↓ absorption of digoxin; they should not be taken close together.
 Regularly monitor serum drug levels (risk for TOXICITY)
 Geriatic: risk of accumulation and toxicity in patients with renal impairment.
 Kids: given only small amount (risk for dosage errors)

20. Adverse effects of Digoxin

 Dysrhythmias, Nausea/vomiting (signs of toxicity)
 Visual disturbances (e.g., seeing green or yellow halos around lights) / means
concentrations is above the limit
 Signs of Neonate toxicity: Unusually slow heart rate (bradycardia)

21. Mechanism of action for anti hypertensives (diuretics, β-blockers, calcium channel
blockers, and renin-angiotensin system inhibitors)
 ACE Inhibitors: Block the conversion of angiotensin I to angiotensin II, lowering
vasoconstriction and aldosterone secretion.
 Angiotensin II Receptor Blockers (ARBs): Block angiotensin II receptors, reducing
vasoconstriction and aldosterone production.
 Beta-blockers: Decrease heart rate and cardiac output by blocking beta-adrenergic
receptors.
 Calcium Channel Blockers: Inhibit calcium ions from entering cardiac and smooth
muscle cells, reducing heart rate and relaxing blood vessels.
 Diuretics: Increase urine output to lower blood volume and reduce vascular resistance.

22. Adverse effects of ACE inhibitors “pril”

 Headache, Dizziness, Orthostatic hypotension, rash, hyperkalemia
 Dry cough (due to ↑ bradykinin) ACE inhibitors prevents breakdown of it it build up on
airway then makes the person cough
 Hyperkalemia (high potassium levels)
 Possible increased blood levels and effects in patients of African American descent
 Aldosterone causes reabsorption of sodium and water
 Protons and potassium get excreted into the urine.

23. Contraindications for laxatives

Bulk-Forming Laxatives
 Ensure adequate water intake
 Can be used daily, or as fiber supplement/ long term
 Onset (12 - 24 hrs) / Full effect (after 3 days)
 Be cautious in patients with swallowing difficulties.

Emollient Laxatives
 Take at bedtime (hs), pregnancy safe
  Onset:t 6-8 hr (mineral oil)/ 24-72 hrs (docusate sodium)
 This laxative can work at 1-2 days or up to 5 days
 Mineral oil should not be taken 2 hrs before meal
 Liquid stool softener maybe mix w/ milk or fruit juice
 Can work on 12 hours until 3 days

Hyperosmotic Laxatives
 Watch for signs of dehydration and electrolyte imbalance.
 Glycerin suppositories work quickly, within 15-30 minutes.
 Don't take more the 3 days
 Take with water 8 - 16 ounces (235- 470 ml)
 Lactolus onset: 24 - 48 hrs, Saline monster: 30 mins - 3 hrs

Saline Laxatives
 Onset: 30 mins- 3 hours.
 Can have antacid properties (magnesium hydroxide).

Stimulant Laxatives
 Action starts in 6-10 hrs (oral administration), 15-120 mins (rectal administration)

Antidiarrheals
 Onset: 1-3 hrs
 Discontinue if no improvement within 48 hours.
 Should not exceed recommended dose
 If taking Bismuth = black stool expecte

FOR ALL
 Assess fluid and electrolyte levels.
 Increase dietary fiber (whole grains, bran, fruits, greens).
 Increase fluid intake.
 Caution against long-term use (7+days) to avoid dependence.
 Use cautiously in patients with renal impairment.
 Check for interactions with milk, juices, or antacids.

24. Adverse effects of using laxatives

Bulk-Forming Laxatives
 Potential for constipation if not taken with enough water.
 Increased flatulence.

Emollient Laxatives
 May cause cramping.
 Can result in diarrhea if overused.

Hyperosmotic Laxatives
  Possible dehydration due to increased stool water content.
 Electrolyte imbalances.
 Lower blood pressure.
 Belching / flatulence.

Saline Laxatives
 Electrolyte imbalances.
 Lower blood pressure.
 Muscle cramps.
 Dizziness.

Stimulant Laxatives
 Nausea and vomiting.
 Electrolyte imbalances.
 Dizziness.

Antidiarrheal Agents
 Minimal for absorbents.
 Anticholinergic effects for antimotility agents/opiates.
 Drowsiness with opiate use.
 Potential for abdominal cramps with opiate use.
 Dizziness with opiate use.

FOR ALL
 Gastrointestinal symptoms such as diarrhea, abdominal cramping, and nausea.
 Potential for electrolyte imbalances with improper use.

25. Nursing consideration for inhaled corticosteroids

 Rinse mouth after inhaled to prevent candidiasis

26. Nursing consideration for antihistamines

 What is antihistamine?
 Medication given for pt with cold or flu, and allergies. Helps with allergic reaction
symptoms.
 Classification
 Diphenhydramine (benadryl)
 Second generation
 Cetirizine (reactine)
 Loratadine (claritin)
 KIDS:
 May experience paradoxical excitement paradoxical excitement
 GERIATRIC(elderly):
 May cause confusion, dizziness, and hypotension
 Diphenhydramine is sometimes used as a sleeping aid for occasional use
 Avoid driving and use of heavy machinery
  Second generation antihistamines are ineffective treatment options for a cough (likely
due to the lack of anticholinergic activity and central nervous system penetrance that is
seen in first generation antihistamines

27. What do you do if a med used for cough is not working?

 Increase dosage

28. What do you do if someone is having an asthma attack?

What is Asthma?
 Increased responsiveness of the trachea and bronchi
 Narrowing of the airways
 Inflammation of smooth muscles
 Plugging of airways by thick mucus
 Medication used
 Beta-adrenergic-agonist
 Corticosteroids
 Antileukotriene
 Xanthine
 Anticholinergic
What to do
 Stay Calm: It's important to stay calm and help the person remain calm as well. Panic
can worsen asthma symptoms.
 Assess the Severity: Determine the severity of the asthma attack. Signs of a severe
attack include:
a. Difficulty speaking due to shortness of breath
b. Lips or fingernails turning blue
c. Rapid breathing
d. Chest retractions (skin pulling in between or below the ribs when breathing)
e. Inability to relieve symptoms with a quick-relief inhaler (such as albuterol)
 Administer Quick-Relief Medication (Short-Acting Beta Agonist): If the person has a
prescribed quick-relief inhaler (such as albuterol), help them use it immediately. Follow
the specific instructions provided by their healthcare provider or on the medication label.
 Help the Person Sit Upright: Assist the person in sitting in an upright position. This can
help improve breathing.
 Loosen Tight Clothing: If the person is wearing tight clothing around the chest or neck,
help them loosen it to ease breathing.
 Encourage Slow Breathing: Encourage the person to take slow, deep breaths.
Breathing too rapidly can worsen asthma symptoms.
 Stay with Them: Stay with the person and monitor their condition closely. If symptoms
worsen or if they have trouble speaking, seek emergency medical help immediately.
 If Necessary, Use a Spacer: If a spacer device is available and the person has trouble
using their inhaler directly, use the spacer to help deliver the medication effectively.
 Call Emergency Services: If the person's condition does not improve with quick-relief
medication, if they are unable to speak due to severe shortness of breath, or if you are
unsure about the severity of the attack, call emergency services (such as 911 in the
United States) immediately. Do not delay seeking professional medical assistance.

29. Adverse effects of inhaled corticosteroids

 Impaired wound healing
  Masking of infections (normal inflammatory response is altered; reduced fever or
pain in a client)
 Hypokalemia
 Hyperglycemia (r/t increased insulin resistance)
 Peptic ulcers
 Edema
 Sodium/fluid retention
 Nausea
 Anxiety
 Weight gain
 Heart failure
 Increased intraocular pressure
 Fragile skin
 Candidiasis (inhaler use)
30. Calc q
31. Know about drug legislation

32. What do you need to know about giving meds to ped clients?
 If drugs are being mixed with food or liquid, use only small amount
 Medicine can also be given through nipples or droppers
 Toddlers:
 allow to choose on method of delivery- spoon, dropper, syringe, and allow to help
 Position: Semi-Fowler's or sitting
 Instruct client to place tablets/ capsules at the back of the throat and to follow with
enough liquid
 Administer liquid medications after pills Remain with the client until all the medications
are taken. Check the client's mouth
 Check the client 30-60 minutes later for effects of medication.

33. Know what synergistic is

 A synergist is a substance that enhances or potentiates the effects of another drug or
medication.
34. What do you do if there's an adverse effect with Levofloxacin?
1. **Stop Taking Levofloxacin:**
- If the adverse effect is severe or potentially life-threatening, stop taking levofloxacin
immediately. Do not continue the medication without consulting a healthcare professional.

2. **Seek Medical Attention:**

- Contact a healthcare provider or seek medical attention promptly, especially if the adverse
effect is serious or if you are unsure about its severity.
- If the adverse effect is an allergic reaction (e.g., rash, swelling, difficulty breathing), seek
emergency medical care.

3. **Report Adverse Reactions:**

- Report the adverse reaction to the healthcare provider who prescribed levofloxacin or to the
appropriate healthcare authority.
- Reporting adverse reactions helps monitor drug safety and can contribute to improving
patient care.
4. **Follow Medical Advice:**
- Follow the advice and instructions provided by the healthcare provider. They may
recommend alternative medications, treatments for managing the adverse effect, or further
evaluation if needed.

5. **Monitor Symptoms:**
- Monitor your symptoms closely after stopping levofloxacin and seek medical attention if new
or worsening symptoms develop.
- Keep track of any changes in your health and communicate them to your healthcare
provider.

6. **Avoid Self-Medication:**
- Do not attempt to treat or manage the adverse effect on your own without medical guidance.
- Avoid taking other medications, supplements, or remedies unless approved by a healthcare
professional.

7. **Inform Healthcare Providers:**

- Inform other healthcare providers about the adverse reaction to levofloxacin, especially if you
are prescribed medications or treatments in the future.

35. Know what prophylaxis and empirical therapy are

36. Contraindications for anti diarrheal medications

 Children
 Acute GI condition (Ulcerative colitis)
 Cirrhosis
 Diarrhea from poisoning
 ASA (A, AT)
 Hematochezia

37. Mechanism of action for pepto bismol

Various MOAs to reduce the
number of loose stools:
1.↓GI motility
2.Adsorbents: coat GI toprotect it
3.Modifiers of electrolyte andfluid transport
4.Atypical: anti-inflammatory,antacid, absorbent, andantibiotic properties (MOA not well
understood)

38. Nursing consideration for Imodium

Patients should follow a bland diet
 Onset 1-3 hours; d/c if no improvement within 48 hours
 Patients should drink adequate fluids and take other medications 2-3 hours after
taking antidiarrheal
 Patients should not exceed recommended dose
 Black stools (bismuth preparations)

39. Contraindications for pepto bismol

 Children
  Acute GI condition (Ulcerative colitis)
 Cirrhosis
 Diarrhea from poisoning
 ASA (A, AT)
 Hematochezia

40. Adverse effect of nitroglycerin/nitrates

 Headache
 Hypotension; orthostatic
 Tachycardia
 Contact dermatitis (with transdermal patch)

41. Nursing considerations for beta blockers

 Thorough cardiovascular assessments is required prior to administration
 Kids:
o Preferred drug for treatment of hypertension
o Do not administer if HR is <60 bmp
 Geriatric
o Susceptible to the effects of antihypertensives r/t poor homeostatic mechanisms
o Dosage may require reduction r/t renal impairment

42. What do you do before giving meds to anyone?

1. **Assessment:**
- Perform a thorough assessment of the patient, including their medical history, current
medications, allergies, vital signs, and any specific concerns related to the medication being
administered.
- Consider the patient's age, weight, organ function (e.g., liver, kidneys), and other relevant
factors that may impact medication dosing and response.

2. **Prescription Review:**
- Review the medication order or prescription to ensure accuracy, including the correct drug
name, dosage, route of administration, frequency, and any special instructions.

3. **Medication Preparation:**
- Prepare the medication according to the prescription or manufacturer's instructions. This
includes measuring the correct dosage, reconstituting if necessary, and ensuring the medication
is in the appropriate form (e.g., tablets, liquid, injectable).

4. **Verification:**
- Verify the patient's identity using at least two identifiers (e.g., name, date of birth, medical
record number) to prevent medication errors.
- Confirm any allergies the patient may have and ensure that the prescribed medication is safe
for them.

5. **Education and Informed Consent:**

- Educate the patient (or caregiver) about the medication, including its purpose, expected
benefits, potential side effects, and how to take it correctly.
 - Obtain informed consent from the patient or their authorized representative before
administering the medication, explaining the risks and benefits in a language and manner they
can understand.

6. **Administration:**
- Administer the medication using the prescribed route (e.g., oral, intravenous, intramuscular)
and technique. Follow aseptic procedures for sterile medications and proper disposal of sharps
or unused medications.
- Document the administration details, including the time, dosage, route, any observed effects
or adverse reactions, and the patient's response.

7. **Monitoring:**
- Monitor the patient closely after medication administration for any adverse reactions,
therapeutic effects, or changes in vital signs. Follow any specific monitoring protocols
recommended for the medication.

8. **Follow-Up:**
- Schedule follow-up assessments as needed to evaluate the medication's effectiveness,
monitor for side effects or complications, and adjust treatment if necessary.
- Communicate with the healthcare team and document all relevant information accurately in
the patient's medical record.

 Checking if they have allergies is also good

43. Adverse effects of Gentamicin

 Nephrotoxicity (drug accumulation in the proximal tubule cells)
 Ototoxicity (damage to the human mitochondrial ribosomes within inner ear hair cells)
 Skin rash (IgE vs. T-cell mediated)
 Headache (motion-related headache; damage to vestibular apparatus)
 Dizziness (damage to vestibula apparatus)

44. Procedures of administering insulin

  Subcue injections
 Areas (atleast have an inch of fat)
 Stomach
 Buttocks
 Outer thigh

45. Out of all anti diabetic meds, know which ones do not cause hypoglycaemia
 Biguanide
 Dipeptidyl Peptidase 4 (DPP-4) Inhibitor (gliptins)
 GLP-1 Receptor Agonist (Incretin)
 Sodium Glucose Co- Transporter (SGLT2) Inhibitor
 α-glucosidase Inhibitors
 Thiazolidinediones

46. What do you do for a diabetic pt who recently became unwell?

 Assess patient
 Vital signs
 LOC
 Appearance
 PQRSTU
 Check their blood glucose
  If low:
Give them 15g of carbohydrates
Check again after 15 mins
If it is still low, repeat until their blood glucose level becomes normal
 If normal
 Give them a meal
47. Nursing considerations (Nursing process) for a diabetic

1. **Assessment:**
- Gather comprehensive data about the patient's diabetes, including their medical history, type
of diabetes (Type 1, Type 2, gestational diabetes), duration of diabetes, current medications,
allergies, coexisting conditions, lifestyle factors (diet, exercise), and previous diabetes-related
complications.
- Perform a physical assessment, including vital signs, weight, height, BMI, skin integrity (for
signs of neuropathy or foot ulcers), cardiovascular status, neurological status, eye examination
(for diabetic retinopathy), and renal function (if applicable).
- Assess the patient's knowledge and understanding of diabetes, self-management practices,
psychosocial factors (emotional well-being, support systems), and cultural considerations that
may impact their care.

2. **Diagnosis:**
- Analyze the assessment data to identify actual or potential nursing diagnoses related to
diabetes and its management. Nursing diagnoses for a patient with diabetes may include:
- Risk for unstable blood glucose levels related to medication non-adherence.
- Impaired skin integrity related to diabetic neuropathy.
- Deficient knowledge about diabetes self-care management.
- Risk for ineffective peripheral tissue perfusion related to peripheral vascular disease.
- Risk for impaired vision related to diabetic retinopathy.
- Risk for impaired renal function related to diabetes and hypertension.

3. **Planning:**
- Establish measurable and achievable goals in collaboration with the patient to address
identified nursing diagnoses and promote optimal diabetes management and health outcomes.
- Develop a care plan that includes specific nursing interventions, patient education strategies,
lifestyle modifications, medication management, and interdisciplinary referrals as needed.
- Prioritize interventions based on the patient's immediate needs, level of risk, and desired
outcomes.

4. **Implementation:**
- Implement the care plan by carrying out nursing interventions to address the identified
nursing diagnoses and promote diabetes self-management.
- Monitor blood glucose levels regularly according to the patient's individualized plan (e.g.,
fasting, pre-meal, post-meal, bedtime).
- Administer insulin or oral antidiabetic medications as prescribed, ensuring accurate dosing,
timing, and route of administration.
- Educate the patient and their family/caregivers about diabetes self-care, including proper
nutrition, physical activity, glucose monitoring, medication adherence, foot care, and recognizing
signs of hypo/hyperglycemia.
- Assist the patient in developing a personalized diabetes meal plan with guidance from a
registered dietitian.
 - Collaborate with other healthcare providers (physicians, nurse practitioners, pharmacists) to
coordinate care, adjust treatment plans, and address complications or comorbidities.
- Provide emotional support, counseling, and resources to help the patient cope with the
challenges of living with diabetes and promote self-efficacy.

5. **Evaluation:**
- Evaluate the patient's response to nursing interventions and the effectiveness of the care
plan in achieving the established goals and outcomes.
- Monitor and document the patient's progress, including improvements in blood glucose
control, adherence to medication and self-care practices, resolution of nursing diagnoses or
complications, and overall health status.
- Revise the care plan as needed based on ongoing assessment data, changes in the
patient's condition, feedback from the patient and healthcare team, and achievement of goals.
- Provide feedback to the patient, reinforce positive behaviors and outcomes, address barriers
or challenges, and empower the patient to continue managing their diabetes effectively.

Special Considerations
 Children and adolescents
o Diet restrictions, activity levels and compliance with instructions
 Pregnant women
o Healthy lifestyle to reduce the risk of type 2 diabetes-balanced diet, regular
exercise and weight maintenance
 Elderly
o Visit to diabetes healthcare professional on a regular basis to discuss diabetes
management and its impact on overall health
o Regular tests for blood pressure, cholesterol and eye health

48. Know the best time to take a Sulfonylurea

 Should not be taken at bedtime
 Should be taken no more than 30 minutes prior to eating (often taken TID)
 Meals and snacks should be taken routinely

49. Mechanism of action for topical medications

1. **Absorption and Penetration:**

 - Upon application, topical medications are absorbed and penetrate the skin or mucous
membranes to reach their target tissues.
- The extent of absorption depends on various factors, including the medication's chemical
properties (lipophilicity, molecular weight), formulation (cream, ointment, gel), skin integrity, and
the presence of occlusive dressings or enhancers (e.g., penetration enhancers).

2. **Local Effects:**
- Topical medications exert their effects locally at the site of application, allowing for targeted
therapy and minimizing systemic exposure and side effects.
- They may act on the skin, subcutaneous tissues, hair follicles, sweat glands, or mucous
membranes, depending on the medication's intended purpose and mechanism of action.

3. **Therapeutic Actions:**
- The specific mechanism of action of a topical medication depends on its pharmacological
properties and therapeutic class. Some common mechanisms include:
- Anti-inflammatory action: Corticosteroids reduce inflammation by inhibiting inflammatory
mediators and immune responses.
- Antimicrobial action: Antibiotics, antifungals, and antivirals target and kill or inhibit the
growth of microorganisms (bacteria, fungi, viruses).
- Analgesic action: Topical analgesics provide pain relief by blocking nerve conduction or
modulating pain signaling pathways.
- Antipruritic action: Anti-itch medications relieve itching and irritation by suppressing
histamine release or blocking itch receptors.
- Keratolytic action: Agents like salicylic acid promote skin exfoliation and treat conditions like
acne or psoriasis.
- Moisturizing and emollient action: Moisturizers hydrate the skin, improve barrier function,
and soothe dry or irritated skin.

4. **Duration of Action:**
- The duration of action of a topical medication varies based on factors such as drug
concentration, formulation, frequency of application, skin type, and patient response.
- Some medications provide immediate relief or effects, while others may require consistent
use over time to achieve therapeutic benefits.

5. **Metabolism and Elimination:**

- After exerting their effects, topical medications may undergo local metabolism within the skin
or mucous membranes before being eliminated or absorbed into systemic circulation to a lesser
extent.
- Metabolism and elimination pathways vary depending on the medication and may involve
enzymatic degradation, local tissue clearance, or systemic absorption followed by systemic
metabolism and excretion.

50. Adverse effects for penicillin

 Rash
 Pruritus
 N/V/D
 Allergic reaction

51. Nursing considerations for tetracycline (UTI, Pneumonia, Meningitis , Otitis Media)
  Avoid dairy, iron, preparations or anti-diarrheals meds (can decrease
tetracycline)
 Avoid sunlight (r/t discoloration of teeth)
 Take the medicine full course
 Do not give under children of 8
 Not safe for pregnant people
 Check for allergies

52. Nursing considerations for metronidazole

 Take with food and milk

 Do not consume alcohol during on meds or after 24 hrs after last dose
(might cause flushing, palpitations, N/V)
 GI upset is the most common side effect

53. Know how to properly take an antibiotic

 Perform Culture and Sensitivity before giving antibiotic meds to the pt.
 Must finish the whole medication
 Consistency of taking antibiotic (Timing of taking antibiotics)
 Food and Drink some antibiotic requires food and drink while some dont.
 Storage of antibiotics (fridge, room temp)
 Monitoring side effects
 Making sure about the contraindications and interactions
 Follow up with HCP if the treatment works or contact HCP if and adverse effects is
experiencing.
54. Calc q
55. Calc q
56. Calc q
Nursing considerations for antithyroid meds
(methimazole-daily dosing,propylthiouracil-multiple doses per day)
 Give the drug with meals to reduce GI effects
 Watch signs for hypothyroidism
 WOF: Agranulocytosis
 Instruct patient to report skin eruptions
 The drug should be stopped if severe rash develops
 Cervical lymph nodes becomes enlarged
 Avoid foods high in iodine or potassium
 Warn the patient against the use of the OTC medication
 Store the drug in a light-resistant container
 Monitor for weight and PR regularly
 Treatment for thyrotoxic crisis
 Meds takes 4-8 weeks to work
 Monitor WBC and thyroid function
57. What do you need to know about a child before administering med?
 Consent from the parents what yis being administered before giving
the child
 Make sure that you have the proper dosage of medication for the
children's age
 Consider the children's age and the form of medicine (liquid, tablet )
 Understand the correct route of administration
 Make sure the child is taking its medicine on time
 Communicate to the children and family about the effects of the
medication
 Monitor for any adverse effects
 Emergency preparedness
 Document: Meds, time, effects

58. Calc q
59. Know why someone would be on two anticoagulants
 Increased Risk of Blood Clots - provide stronger anticoagulation to prevent clot
formation.
 Treatment resistance- some patient one anticoagulant wont work so they might
require a dual therapy for preventing clot formation.
 Specific conditions- APS and or specific to heart valve replacements .
 Transitioning between medication
 Pre surgery option- before surgery procedure therapy can enhanced clot
protection after post-op.

60. Antidotes for both heparin and warfarin

 Warfarin - Vitamin K
 Heparin - Protamine Sulfate

61. Know which lab values that you need for anticoagulants
Coagulation Normal values:
 0.9-1.2 INR( International Normalize Ratio) Medication that impacts INR is
Warfarin (Coumadin)
 28-38 secs Activated Partial Thromboplastin Time (aPTT) Heparin impacts a
aPTT

62. Know what rebound effect is

 A rebound effect refers to the phenomenon where the symptoms of a
condition worsen or return after discontinuing or reducing the dosage of a
medication intended to treat those symptoms. This worsening typically
occurs temporarily and can be more severe than the original symptoms.
 Rebound effects are often observed with medications that act on the body's
regulatory systems, such as those affecting neurotransmitters, hormones, or
immune responses. When these medications are abruptly stopped or their
dosage is significantly reduced, the body may overreact, leading to a rebound
in symptoms
63. Know the terminology found within Pharmacokinetics
 The movement of a drug in the body.

64. Know the terminology around Pharmacodynamics

 How the drugs affect your body. (therapeutic effect and toxic effect)

65. Mechanism of action for levothyroxine

 Medication works in the same manner as naturally occurring thyroid

hormones (i.e. effect on metabolic rate, body temperature, heart rate,
etc.)
 Synthetic version of T4
 T4 (inactive) is converted to T3 (active)
 Synthetic T4 is preferred over synthetic T3, because the liver, gut
and brain can control how quickly T4 is converted into T3

66. What do you do to someone experiencing hypoglycemia?

 Pt. conscious - 15g of carbs with protein or a full meal after then check for
blood glucose level

 Pt. unconscious 50% Dextrose in water (D50W) administered via IV route

only when with a nurse or Glucagon 1mg SL/IV/IM or nasally. This
increases blood level from 3-12mmol within 60min.

67. Invokana (med) know what it does (select all)

 Induce glycosuria; the SGLT2 system in the proximal tubule

reabsorbs 90% of filtered glucose, inhibiting this system will excrete
approx. 60% of glucose via the urine
 Increases insulin sensitivity and decreases gluconeogenesis

68. Know all about mech of action for all of the oral anti diabetic meds (select all)
1. Gluconeogenesis Inhibition: Reduces liver's glucose production.
2. Intestinal Glucose Absorption Reduction: Limits post-meal glucose spikes.
3. Insulin Sensitivity Enhancement: Improves cells' response to insulin.
4. Glycolysis Stimulation: Facilitates glucose metabolism within cells.
5. Glucagon Suppression: Lowers hormone levels that raise blood glucose.
6. GLP-1 Hormone Action: Enhances glucose regulation, aided by DPP-4 inhibition.
7. Insulin Secretion Stimulation: Promotes insulin release, aiding glucose uptake.
8. Glycosuria Induction: Increases glucose excretion via urine.
9. α-Glucosidase Inhibition: Reduces carbohydrate absorption, controlling post-meal
glucose.
 10. Insulin Receptor Sensitivity Enhancement: Improves insulin's effectiveness in tissues.
11. β-cell Function Preservation: Some agents may help maintain pancreatic insulin
production

69. Procedures of administering insulin (select all)

(Know onset, peak and duration for Novalin ge Toronto)

 Insulin can not be given orally; must be given subcutaneously or IV (regular insulin)
 Insulin can be stored at room temperature or in the fridge
 Injection sites can not be used more than once a month (must move at least ½ inch from previous
site)