NCLEX Medication Study Guide

 Antidotes (examples below):

• Beta blockers: Calcium Gluconate
• Opioids: Naloxone (Narcan)
• Heparin: Protamine Sulfate
• Acetaminophen: N-acetylcysteine (NAC)
• Benzodiazepines: Flumazenil
• Warfarin: Vitamin K

Adverse Effects & Common Reactions (examples below):

• Ace Inhibitors: Dry cough & angioedema
• Atropine: Anticholinergic effects, sun sensitivity
• Beta Blockers: Bradycardia, bronchospasms
• Dilantin: Gingival hyperplasia
• Fluoroquinolone’s: Tendon rupture
• HMG-CoA reductase (Statins): Myalgias, rhabdomyolysis
• Metformin: Lactic acidosis, Renal failure, GI sx
• NSAIDS: GI bleed, Renal failure
• Diuretics: Electrolyte imbalances (especially potassium/sodium)
• Potassium sparing diuretics: (spironolactone): Avoid any potassium supplements
• Anticholinergics: Can’t see, pee, sh*t, spit
• Prednisone: Insomnia, weight gain, mood changes, swelling, hyperglycemia, leukocytosis, immunosupression, thin skin, straie, hypokalemia, Cushing like symptoms
• Opioids: (ex: morphine): Respiratory depression, constipation, itching
• Theophylline: Arrhythmias

Patient Teaching (examples below):

• Antacids:
  • Can cause constipation.
  • Causes decreased absorption when combined with certain meds.
  • Give 2-3 hours after medication
• Antibiotics:
  • Use backup protection can make oral contraceptive less effective.
  • Report excessive diarrhea-possible c-diff
• Aspirin:
  • Don’t give <18 years old–>Reyes syndrome
• Beta blockers:
  • Do not discontinue abruptly can lead to rebound hypertension
• Dilantin:
  • Frequent dentist visits may cause gingival hyperplasia
• Digoxin:
  • If you have yellow halos in your vision this may be digoxin toxicity

• NSAIDS:
  • Take with food, watch for coffee ground tarry looking stools may indicate GI bleed
• Prednisone:
  • If have diabetes may need to monitor glucose more often for hyperglycemia
  • Causes insomnia
• SSRI:
  • Do not stop abruptly as may cause withdrawal sx
  • May cause sexual dysfunction such as erectile dysfunction
• Warfarin:
  • Use soft tooth brush & electric razor
  • Caution with Vitamin K foods (ex: leafy greens like spinach, may make warfarin not as effective)
  • High intake can decrease INR (subtherapeutic)

Toxicity-Key Points:

• Digoxin:
  • In toxicity may experience: yellow halos (vision), appetite loss, hyperkalemia
• Lithium:
  • Hyponatremia can cause toxicity
  • GI sx often first
  • Lethargy, AMS later
  • May need dialysis
• Vancomycin:
  • Renal failure, tinnitus (nephrotoxicity &  ototoxicity)

Labs to Know for Meds:

• Coumadin: PT/INR
• Digoxin: Potassium
• Heparin: PTT
• HCTZ: Potassium
• Lasix: Potassium, hyponatremia
• Lithium: TSH, Creatinine levels
• Statins: Liver enzymes

Know Medication Indications:

• Acyclovir: Antiviral
• Atropine: Symptomatic bradycardia
• Cogentin: EPS
• Digoxin: CHF, Atrial Fibrillation
• Dilantin: Seizures
• Disulfiram (Antabuse): Alcohol aversion therapy
• Epogen: Stimulates RBC production (ESRD patients)
• Lithium: Bipolar
• Furosemide: CHF
• Morphine: General pain, chest pain
• Oxytocin: Stimulates labor
• Sinemet: Parkinsons
• Theophylline: COPD/Asthma
• Warfarin: PE, DVT, Heart valve replacements, Atrial fibrillation

Medication & Diagnosis Contraindication/Caution:

• Ace Inhibitors: Renal artery stenosis, hyperkalemia, renal failure, pregnancy
• Anticholinergic: Avoid in BPH & glaucoma
• Beta Blockers: Caution in asthma & COPD (bronchoaspams), and in diabetes (masks hypoglycemia symptoms)
• Digoxin: Caution in hypothyroidism-very sensitive to effects of Digoxin. May need lower dose
• Fluoroquionolones: Myasthenia gravis
• NSAIDS: PUD
• SSRI: <25 yrs old (increased suicidal ideation), MAOI use
• Statins: Rhabdomyolysis
• Steroids: Infection (can worsen)
• Theophylline: Loop diuretics can increase or decrease theophylline levels

Medication Nursing Knowledge:

• Aminoglycosides: (ex: gentamycin, neomycin):
  • If a patient complains of tinnitus and or they have renal failure- this can indicate toxicity
• Atropine:
  • Caution in cardiac patients can cause ventricular fibrillation
• Chemotherapy agents:
  • Wear gloves
• Congentin treats EPS:
  • Extrapyramidal symptoms
• Clinadmycin:
  • Notorious for C-diff
• Beta blockers:
  • May need to check glucose more often- masks hypoglycemia.
  • Check heart rate before giving- causes bradycardia
• Grapefruit juice and many medications
  • Simply avoid this with most all medications
• Lithium:
  • Hyponatremia can cause toxicity.
  • Avoid low sodium diets, getting overheated (sweating)
• Magnesium sulfate:
  • Check deep tendon reflexes
• Metronidazole (Flagyl):
  • No drinking while on this medication
• MAOI Inhibitors:
  • No tyramine containing foods as can cause hypertensive urgency.
  • A few to avoid:
    • Aged cheese (ex: swiss & blue cheese)
    • Cured meats (ex: sausage)
    • Smoked/processed meats (ex: corned beef, hot dogs)
    • Pickled/fermented: (ex: sauerkraut, pickles)
    • These are a few, there are more to avoid
• Morphine:
  • Watch for respiratory depression and altered mental status
• Warfarin:
  • Monitor for bleeding-check gums, skin (petechiae), stools, hematuria.
  • May need to be held if hemoglobin dropping.

Medication Combinations to Avoid:

• MAOI Inhibitors & SSRI:
  • Should wait at least 2 weeks in between taking–serotonin syndrome
• Warfarin:
  • Caution with antibiotics as some can increase INR (ex: fluoroquionolones)
  • Taking with meds like aspirin increase risk for bleeding
  • Note that prednisone can increase INR with warfarin (1)
• Ace Inhibitors & ARBs:
  • Increased risk renal failure & hyperkalemia
• St John’s Wort & SSRI:
  • Increased risk serotonin syndrome
  • Important to note that St John’s Wort interacts with a lot of meds
• Simvastatin (any statins) & Gemfibrozil (1):
  • Increased risk for rhabdomyolysis
  • Also avoid combining statins with amiodarone, macrolides, calcium channel blockers
• Bactrim (TMP/SMX) & ACE inhibitors (-end in “-pril”):
  • Increased risk for hyperkalemia (1)
  • Also avoid taking Bactrim with ARBs as can cause same thing (1)
• Levothyroxine & many meds can interfere with absorption (1):
  • Estrogen
  • Calcium
  • Magnesium
  • Statins
  • PPIs

*This is not an all-inclusive list. We recommend studying from a variety of sources.

REFERENCES:

1. https://www.medscape.com/features/slideshow/dangerous-drug-combinations#page=5