Nclex RN Pharmacology review

Antiemetics

An antiemetic is a medication used in the treatment and/or prevention of nausea and vomiting.

Remember generic names are our friend because meds in the same classification often have
similar generic names but brand names can come and go.

Here are some common classes of antiemetics and their generic names notice the similarities in
the generic names:

5-HT3 receptor antagonists (serotonin antagonists)

Dolasetron (Anzemet)

Granisetron (Kytril , Sancuso)

Ondansetron (Zofran)

Tropisetron (Navoban)

Its Tron to the rescue!

Dopamine antagonists

Promethazine (Phenergan)

Prochlorperazine (Compazine)

Metoclopramide (Reglan): Now this one is different in generic name because it can have some
different side effects watch for extra-pyramidal side effects with metoclopramide.

Sometimes the generic names are not as helpful and you have to remember what meds fall under
certain classes. Antihistamines and cannabinoids are used as antiemetics as well:

Antihistamines (H1 histamine receptor antagonists)

Diphenhydramine (Benadryl)
Dimenhydrinate (Gravol, Dramamine)

Meclozine (Bonine, Antivert)

Cannabinoids

Cannabis - Medical marijuana, in the U.S., it is a Schedule I drug.

Dronabinol (Marinol) - a Schedule III drug in the U.S.

*Remember most antiemetics can cause sedation so watch out for additive effect if given with
narcotic analgesics and protect your client from injury.

Proton Pump Inhibitors (PPIs)

PPIs decrease stomach acid by inhibiting those gastric proton pumps that make the acid they
stop the acid at the pump!

Remember generic names are our friends because meds in the same class often have similar
generic names but brand names come and go:

Here are some common PPIs-

Omeprazole (brand names: Prilosec, Zegerid, Omepral, Omez)

Lansoprazole (brand names: Prevacid, Zoton, Inhibitol)

Dexlansoprazole (brand name: Kapidex, Dexilant)

Esomeprazole (brand names: Nexium, Esotrex)

Pantoprazole (brand names: Protonix, Somac, Pantozol, Zentro)

Think of a pump in your stomach just churning out the acid Zole is the nice guy who shuts off
the pump.

Zole is very friendly (well-tolerated by most clients) but can cause vitamin B-12 deficiency if
he stays around too long (with long-term use).
Erectile Dysfunction Agents

Erectile dysfunction (ED) meds act by increasing nitric oxide which opens and relaxes the blood
vessels of the penis causing increased blood flow (helping lead to getting and keeping an
erection).

Here is where the generic name is our friend again meds in the same class often have similar
generic names but brand names will come and go:

Here are some common ED meds-

Sildenafil (Viagra)

Vardenafil (Levitra)

Tadalafil (Cialis)

Notice these end in fil. Fil helps the nitric oxide to fil the penis.

While Fil is a great guy (well-tolerated by most clients) he does have a few side effects
headache, flushing, back pain and muscle aches (with Levitra), temporary vision changes,
including "blue vision" (with Viagra) and not all men can spend time with Fil. Men who have
heart problems, uncontrolled blood pressure problems, history of stroke, or a health problem at
can cause priapism cant hang out with Fil.

Antianemics

There are many causes of anemia and the antianemic prescribed will be based upon the cause.

With iron deficiency anemia, iron supplements are commonly prescribed. Beware though - Iron
is heavy stuff and shouldnt be taken lightly!

Iron can cause teeth staining (liquid form). Teach clients to dilute liquid iron with water or
juice, drink with a straw, and rinse mouth after swallowing.

Iron can cause staining of skin and other tissues with IM injections. If IM route must be used,
give IM doses deep IM using Z track technique.

Iron also has several drug administration interactions- of antacids or tetracyclines reduces
absorption of iron. Separate use by at least 2 hr.

Vitamin C increases absorption, but also increases incidence of GI complications. Avoid

vitamin C intake when taking medication.
 Instruct clients to take iron on an empty stomach such as 1 hr before meals to maximize
absorption. Stomach acid increases absorption. However, iron can cause GI distress(nausea,
constipation, heartburn) If intolerable, iron can be administered with food to increase compliance
with therapy but this does reduce absorption.

Instruct clients to space doses at approximately equal intervals throughout day to most
efficiently increase red blood cell production.

Inform clients to anticipate a harmless dark green or black color of stool.

Instruct clients to increase water and fiber intake (unless contraindicated), and to maintain an
exercise program to counter the constipation effects.

Encourage concurrent intake of appropriate quantities of foods high in iron (liver, egg yolks,
muscle meats, yeast).

Statins

HMG CoA Reductase Inhibitors also known as statins are some of the most prescribed
medications in this country.

Statins are used to treat primary hypercholesterolemia, for prevention of coronary events
(primary and secondary), for protection against MI and stroke for clients with diabetes, and to
help increase HDL levels in clients with primary hypercholesterolemia.

Remember LDL is the bad cholesterol and HDL is the good cholesterol (HDL helps keep the
bad cholesterol from building up in artery walls). You want your LOW (LDL)LOW and your
HIGH (HDL) HIGH.

Statins are another example that generic names are our friends check out these common
statins-

Atorvastatin (Lipitor)

Simvastatin (Zocor)

Lovastatin (Mevacor)

Pravastatin (Pravachol)

Rosuvastatin (Crestor)

Fluvastatin (Lescol)
While statins are a wonderful addition to our pharmaceutical arsenal, they are not without risk.
When you think statins think that we need to protect the liver and muscles stat:

There is a risk of hepatotoxicity. It is important to obtain a baseline liver function and to monitor
liver function tests after12 weeks and then every 6 months and to avoid alcohol.

There is also a risk of myopathy and peripheral neuropathy. Clients should be told to report
muscle weakness and/or aches, pain, tingling and tenderness. CK levels will be monitored
periodically during treatment as well.

Anticoagulants

Anticoagulants prevent the formation of blood clots by interfering with the clotting cascade,
thereby preventing coagulation. The use of this class of medications is contraindicated with
active bleeding, such as with bleeding disorders, ulcers, or hemorrhagic brain injuries.
HEPARIN and COUMADIN are the two main anticoagulant medications. See the acrostics
below for helpful hints and important facts about these drugs.

HEPARIN

H eparin sodium prevents thrombin from converting fibrinogen to fibrin. It is administered IV or

SQ.

E noxaparin (Lovenox) is a low-molecular weight heparin. It has the same action as heparin, but
has a longer half-life. It is administered via subcutaneous injection.

P rotamine sulfate is the antidote for heparin.

A dminister heparin when there is the likelihood of clot formation, such as with myocardial
infarction or deep-vein thrombosis.

R isk for bleeding is the major side effect that clients should be educated about. Clients should
be educated to monitor for bleeding, including bleeding gums, bruises, hematuria, and petechiae.

I nstruct clients to avoid corticosteroid use, oral hypoglycemic agents, salicylates, NSAIDs,
green leafy vegetables, and foods high in Vitamin K.

N ormal activated partial thromboplastin time (aPTT) is 20 to 36 seconds, but to maintain a

therapeutic level of anticoagulation while on heparin, the aPTT should be 1.5 to 2 times the
normal value (60 to 80 seconds).

COUMADIN
C oumadin (generic name Warfarin sodium) interferes with coagulation factors by antagonizing
vitamin K.

O ral administration is typically used. Clients may need continued heparin infusion via IV until
therapeutic effect of Coumadin is experienced (may take3-5 days).

U se is contraindicated in clients with low platelet counts or uncontrolled bleeding.

M ephyton (trade name vitamin K) is the antidote for Coumadin.

A dvise clients to avoid foods that are high in vitamin K, and avoid the use of acetaminophen,
glucocorticoids, and aspirin. Clients should wear a medical alert bracelet indicating warfarin use.

D oses are typically taken once daily.

I NR and PT are monitored for clients who are taking Coumadin. Depending on intent of
therapy, PT should be 1.5 to 2 times control and INR should be 2-3. Target INR is 3 to 4.5 for
clients with a mechanical heart valve.

N o Coumadin for pregnant women! Oral anticoagulants fall into Pregnancy Risk Category X.
Heparin maybe safely used in pregnancy.

Antiplatelets

PRIORITY POINT: Recall that this class of medications increases a clients risk for
bleeding because of their prevention of platelet aggregation. Nursing interventions and
client education focus on the clients increased risk for bleeding.

Names to Know:

Aspirin (Ecotrin)

Clopidogrel (Plavix)

Pentoxifylline (Trental)

How they work: Antiplatelets prevent platelets from clumping together by inhibiting enzymes
and factors that normally cause arterial clotting.

What they are used for: These medications are used to prevent myocardial infarction and
stroke. Low dose therapy (81 mg) is effective for prevention of strokes and MI.

How are they given: These medications are most commonly taken orally. They may also be
administered IV.
Nursing Interventions:

WATCH FOR BLEEDING.

These medications should be taken with food.

These medications should be used cautiously in clients with peptic ulcer disease and in clients
with severe renal/hepatic disorders.

What do clients who are taking these medications need to know?

Observe for signs of weakness, dizziness, and headache and report them if they occur. These
may be signs of hemorrhagic stroke.

Bleeding time should be assessed carefully. Coffee ground emesis or bloody, tarry stools should
be reported. Watch for bruising, petechiae, and bleeding gums.

What interactions may occur?

Avoid concurrent use of mediations that enhance bleeding, including NSAIDs, heparin,and
warfarin.

Corticosteroids should be avoided as they may increase aspirin effects.

Concurrent use of aspirin may reduce hypertensive action of beta blockers.

Thrombolytic Agents

In order to truly appreciate this drug tip, you need to familiarize yourself with the
Ghostbusters. If you havent heard the theme song, cue it up before reading further. We
promise it will be worth it.

PRIORITY POINT: If the Ghostbusters had a medication class of choice, this would be it!
Thrombolytic Agents are CLOT BUSTERS. They work QUICKLY to restore circulation.
As such, they increase a clients risk for bleeding.

Who you gonna call? Streptokinase (Streptase). Call right away! These medications must be
administered within 4 to 6 hours of onset of symptoms.

If theres something strange in your neighborhood: Thrombolytic agents dissolve clots that
have already been formed. These medications convert plasminogen to plasmin, which destroy
fibrinogen and other clotting factors.
Whats the goal? Restoration of circulation, as evidenced by relief of chest pain, and reduction
of initial ST segment injury pattern as shown on ECG.

Whats the risk? Increased bleeding. These medications should only be given while the client is
closely monitored. Baseline platelet and blood counts (including aPTT, PT, and INR) shouldbe
carefully assessed. Venipunctures and SQ and IM injections should be limited.

After the clot has left the building: Administer beta blockers to decrease myocardial oxygen
consumption and reduce the incidence and severity of reperfusion arrhythmias.

Herb/Botanical Therapy

Herbal supplements are widely used and have much less precise dosages than more regulated
medications. Clients may not mention herbal supplements as a part of their medication history, so
it is important to ask clients specifically if they are taking any supplements in addition to
prescription or over the counter medications. Here are a few common herbal therapies:

Echinacea:

Used to treat the common cold.

With chronic use, echinacea can decrease positive effects of medications for TB, HIV, or cancer.

Ginger root:

Used to decrease nausea of morning sickness, motion sickness, and nausea induced by surgery.

May also decrease the pain and stiffness of rheumatoid arthritis.

These medications suppress platelet aggregation.

Should be used cautiously in pregnancy.

Ginkgo biloba:

Promotes vasodilation and may be used to increase recall ability and mental processes.

Used commonly with dementia and Alzheimers Disease.

May also be used for erectile dysfunction in clients who take SSRIs and experience impotence
as a side effect.

May interact with medications that lower the seizure threshold, such as antihistamines,
antidepressants, and antipsychotics.
 May interfere with coagulation.

Valerian:

Increases GABA to prevent insomnia.

Promotes sleep with increased effect over time. There is a risk of dependence.

May cause drowsiness and depression.

Should be used cautiously in clients with mental health disorders.

Avoid use in pregnancy or while breastfeeding.

Black cohosh:

Acts on the female reproductive system as an estrogen substitute.

May be used instead of estrogen therapy during menopause.

Increases the effects of antihypertensive medications and may increase effect of estrogen
medications.

Increases hypoglycemia in clients who are taking insulin or other medications for diabetes.

THE BOTTOM LINE: Clients who are taking herbal supplements should be advised to
speak to their provider about possible interactions or adverse reactions that may occur.

Insulins

Insulins are used to manage diabetes mellitus, a chronic illness that results from an absolute or
relative deficiency of insulin. There are various insulins that are available to manage diabetes.
For each type of insulin, you will need to know the onset, peak, and duration. NCLEX questions
may focus on when clients need to be assessed after insulin administration. Assessment should
occur frequently, but especially during the PEAK of insulin action, as this is when hypoglycemia
is most likely to occur. Signs and symptoms ofabrupt-onset hypoglycemia include tachycardia,
palpations, diaphoresis, and shakiness. Gradual onset hypoglycemia may manifest with
headache, tremors, or weakness.

Well CLIMB TO THE PEAKstarting FAST and ending SLOW.

FASTEST: Rapid acting insulins:Lispro (Humalog).

ONSET: Less than 15 minutes.

PEAK: 30 minutes to 1 hour.

DURATION: 3 to 4 hours.

FAST: Short acting insulins: Regular (Humulin R).

ONSET: 30 minutes to 1 hour.

PEAK: 2 to 3 hours.

DURATION: 5 to 7 hours.

SLOW: Intermediate-acting insulins: NPH insulin (Humulin N).

ONSET: 1 to 2 hours.

PEAK: 4 to 12 hours.

DURATION: 18 to 24 hours.

SLOWEST: Long-acting insulins: Insulin glargine (Lantus).

ONSET: 1 hour

PEAK: None

DURATION: 10 to 24 hours.

Many students look for ways to more easily remember all of the ranges associated with insulin. It
is helpful to think generally rather than trying to recall all exact numbers when memorizing this
information, and, if you can only remember one thing about each insulin, CLIMB TO THE
PEAK. Pick one number from each time frame (onset, peak, duration) to help reduce the values
that youre trying to memorize. Remember that onset, peak, and duration build sequentially as
you move from one type of insulin to another, so it may be helpful to remember, for example,
that onset times go from 15 minutes, to 30 minutes, to 1 hour (trend: all onsets are less than an
hour). Peak times go from 30 minutes, to 2 hours, to 4 hours (trend: even numbers). Finally,
duration goes from 3 hours, to 5 hours, to 24 hours. If you always organize your thoughts by
O.P.D.(onset, peak, and duration), starting FAST (rapid acting) and ending SLOW (long
acting) when studying the different types of insulin, these tips will be helpful. The key is
consistencylooking at values in the same order every time.
Test taking tips:

Dealing with the dreaded Select All That Apply question:

These are tough. Try to make them true false questions so that you don't miss any correct
choices. Read the question, read the first choice - ask yourself is it true or false (is it correct or
not). If so check it. Read the question again and the next choice - ask yourself is it true or false.
Is that true for all of the choices? Dont allow the info from one answer choice influence you.
Only the info in the stem of the question should be considered when picking your answers.

Prioritization Tip:

To avoid some common pitfalls when answering priority questions, be aware of the following:

Never perform ABC checks blindly without considering whether airway, breathing or circulation
issues are acute versus chronic or stable versus unstable. For example, a client who is
quadriplegic and on a ventilator has chronic airway/breathing problems. However, if there is not
an acute consideration such as pneumonia, the client should be considered chronic and stable.
This client would not be the nurses first priority.