NCLEX Pharmacology Archer Review Crash Course

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Pharmacology Archer Review Crash Course Welcome! ● If you have a question please enter it in the chat! I will do my best to answer questions as we go, but if I miss one will always circle back to yo... u! ● We will be taking two 10 minute breaks during the class ● Handouts & powerpoint slides are located in the ‘Handouts’ section of your GoToWebinar control panel. You can download and print them from here! ● Within one week of course completion you will receive an email with your OnDemand streaming link so that you may re-watch this course. You have access for 1 month! ● If you have any technical issues or questions about streaming, handouts, etc. please email Antianxiety Agents ● Short acting ○ Midazolam (Versed) ○ Diazepam (Valium) ● Intermediate - Long acting ○ Clonazepam (Klonopin) ○ Alprazolam (Xanax) ○ Lorazepam (Ativan) Ativan Therapeutic class: antianxiety agent Indication: anxiety, sedation, seizures Action: general CNS depression Nursing Considerations: ● Avoid alcohol ● Monitor for respiratory depression ● Antidote - flumazenil NCLEX Question The nurse is caring for a patient who is experiencing severe, acute anxiety prior to a scheduled endoscopy procedure. Which of the following medications is the healthcare provider most likely to order? A. Oxycodone B. Midazolam C. Clonazepam D. Haloperidol Answer: B A is incorrect. Oxycodone is an opioid pain medication prescribed for severe pain. It is not indicated in an acute anxiety attack. B is correct. Midazolam is a benzodiazepine used for acute anxiety attacks. Midazolam is preferred in this setting because of its rapid onset, about 2-5 minutes after IV administration, and short duration, only 3-8 hours. Midazolam would be the most useful choice for the patient experiencing an acute anxiety attack before or during a procedure. C is incorrect. Clonazepam is a long-acting benzodiazepine used for panic disorders, PTSD, and GAD. For this patient with an acute anxiety attack prior to a procedure, a long-acting benzodiazepine is not indicated. D is incorrect. Haloperidol is an antipsychotic used to address severe agitation and aggression associated with psychiatric disorders such as schizophrenia. It would not be useful for the patient experiencing a pre-procedural acute anxiety attack. Antiarrhythmics ● Amiodarone ● Adenosine ● Procainamide Adenosine Therapeutic class: Antiarrhythmic Indication: SVT Action: Slows conduction through the AV node, interrupts re-entry pathways through AV node, restoring normal sinus rhythm Nursing Considerations: ● There will be a period of asystole after administration ● Warn the patient - it will feel like someone kicked them in the chest! ● Warn the family - they will flatline on the monitor! ● Rapid push - or it will not work. ● Use with extreme caution in asthmatics. Anticoagulants ● Heparin ● Clopidogrel (Plavix) ● Warfarin ● Enoxaparin (Low-molecular weight heparin) Heparin ● Classification: Indirect Thrombin Inhibitor ○ Anticoagulant! ● How it works ○ Thrombin → converts fibrinogen to fibrin → Fibrin forms clots! ○ Antithrombin III inhibits Thrombin ○ Heparin ENHANCES antithrombin III ○ This stops thrombin from being activated, which therefore prevents clots from forming. ● This is the intrinsic coagulation pathway End result? SLOWS DOWN CLOTTING. Basic Information ● Uses ○ To prevent blood clots ■ Strokes ■ Chronic a-fib ■ Post-operatively ● Administration ○ Subcutaneous ○ Intravenous ● Titration ○ Patients on a heparin drip have aPTT levels drawn q4-6 hours to titrate the drip. Important Nursing Considerations ● Biggest side effect to monitor for = bleeding! ○ Hematuria - Pink tinged urine ○ Hematemesis - bloody vomitus ○ Bruising ○ Downtrending H&H ● Antidote = protamine sulfate Heparin Induced Thrombocytopenia and Thrombosis (HITT) ● Complication of Heparin therapy ● Usually occurs 5-10 days after Heparin exposure ● Suspect in any patient on Heparin who has an unexplained platelet drop ● Clinical manifestations: ○ Skin lesions at heparin injection sites ○ Chills ○ Fever ○ Dyspnea ○ Chest pain ● Complications - clotting! ○ DVT ○ PE ● Treatment ○ Discontinue ALL heparin and start a different anticoagulant! Warfarin Therapeutic class: Anticoagulant Indication: venous thrombosis, pulmonary embolism, A-fib Action: disrupts liver synthesis of Vitamin K dependent clotting factors Nursing Considerations: ● Monitor for bleeding ● Monitor PT and INR ○ Therapeutic PT: 1.3-1.5 ○ Therapeutic INR: 2.5-3.5 ● Antidote: Vitamin K ● Contraindicated during pregnancy NCLEX Question The nurse is caring for a pregnant client who is at 16 weeks gestation. She developed a pulmonary embolism and was initiated on heparin therapy two days ago. She is getting ready to be discharged. Which of the following medications do you expect the healthcare provider to order at discharge? A. Warfarin B. Rivaroxaban C. Apixaban D. Low Molecular Weight Heparin (LMWH) Answer: D A is incorrect. Warfarin is contraindicated during pregnancy. It can cause congenital disabilities, maternal bleeding, stillbirths, and miscarriages. B and C are incorrect. Rivaroxaban and Apixaban belong to the class of Factor Xa inhibitors. These are newer anticoagulants and are not safe in pregnancy. D is correct. Low Molecular Weight Heparin is the drug of choice for anticoagulation in pregnancy. It does not cross the placenta and therefore does not cause fetal harm. Anticonvulsants ● Phenytoin (Dilantin) ● Carbamazepine ● Divalproex ● Gabapentin ● Lamotrigine ● Levetiracetam (Keppra) Phenytoin Therapeutic class: Anticonvulsant Indication: Seizures Action: blocks sustained high frequency repetitive firing of action potentials Nursing Considerations: ● Therapeutic level: 10-20 mcg/mL ● Side effect: gingival hyperplasia ○ Regular dental check-ups ○ Use soft bristle toothbrush ● Antacids can reduce the effect of phenytoin and should be avoided. NCLEX Question The nurse is educating a patient who is taking phenytoin. To make sure phenytoin does not fail, which over-the-counter medication should the nurse advise the patient not to take at the same time? A. Acetaminophen B. Ibuprofen C. Calcium Carbonate D. Ranitidine Answer: C A is incorrect. Acetaminophen and Phenytoin can be taken together without any concern for therapeutic failure. B is incorrect. Ibuprofen and Phenytoin can be taken together without any concern for therapeutic failure. C is correct. Calcium Carbonate (Tums) should not be taken at the same time as Phenytoin because taking them together can decrease the effects of phenytoin. Antacids containing calcium carbonate reduce the bioavailability of phenytoin by reducing the rate of absorption and amount of intake. If the patient needs both phenytoin and calcium carbonate, they should be administered at least 2-3 hours apart. D is incorrect. Ranitidine and Phenytoin can be taken together without any concern for therapeutic failure. Instead, Ranitidine can increase the effects of Phenytoin, so the patient should be monitored for any phenytoin related side effects. Antidepressants ● SSRIs ○ Fluoxetine ○ Sertraline ○ Escitalopram ○ Citalopram ● TCAs ○ Amitriptyline ○ Nortriptyline ○ Protriptyline ● MAOIs ○ Tranylcypromine ○ Isocarboxazid ○ Phenelzine ○ selegiline SSRIs Examples: Fluoxetine, Sertraline, Escitalopram, Citalopram Indication: Depression Action: Prevent reuptake of serotonin increasing the availability of serotonin in the body. Nursing Considerations: ● Monitor for serotonin syndrome ○ Hypertension, confusion, anxiety, tremors, ataxia, sweating. ● Suicide precautions important for 2-3 weeks ○ When the patient’s mood starts to improve, they are are an inreased risk for suicide ○ Why? They now have the energy to follow through with a plan. TCA’s Examples: Amitriptyline, Nortriptyline, Protriptyline Indication: Depression Action: Prevents the reuptake of norepinephrine and serotonin increasing these neurotransmitters in the body.. Nursing Considerations: ● Monitor for anticholinergic side effects ○ Dry mouth, constipation, urinary retention Monoamine Oxidase Inhibitors Examples: tranylcypromine, isocarboxazid, phenelzine, selegiline Indication: Depression Action: blocks monoamine oxidase enzymes to increase the levels of ALL neurotransmitters ( dopamine, norepinephrine, epinephrine, serotonin) Nursing Considerations: ● Avoid foods that are high in tyramine. ○ Aged cheeses ○ Wine ○ Pickled meats ● Side effect - hypertensive crisis Mood Stabilizers ● Lithium Lithium Indication: Mania Action: Inhibits excitatory neurotransmitters such as dopamine and glutamate, and promotes GABA-mediated neurotransmission. Nursing Considerations: ● Do not administer with NSAIDS ● Monitor drug levels: ○ Therapeutic level - 0.5-1.5mEq/L ● Encourage adequate fluid intake ● Side effects: ○ Seizures, arrhythmias, fatigue, confusion, nausea, anorexia, hypothyroidism, tremors Antipsychotics ● Haloperidol ● Quetiapine ● Olanzapine Haloperidol Therapeutic class: Antipsychotic Indication: Schizophrenia, mania, aggressive behavior, agitation Action: Inhibits the effects of dopamine Nursing Considerations: ● Monitor for extrapyramidal side effects ● Tardive dyskinesia ● Neuroleptic malignant syndrome ● Can prolong the QT interval ○ Weekly EKG Antihistamines ● Diphenhydramine ● Promethazine ● Cimetidine ● Famotidine ● Ranitidine Diphenhydramine Therapeutic class: Antihistamine Indication: Allergy, anaphylaxis, sedation Action: Antagonizes effects of histamine, CNS depression Nursing Considerations: ● Monitor for drowsiness ● Anticholinergic effects Antihypertensives ● ACE inhibitors ○ Captopril ○ Enalapril ○ Lisinopril ● Angiotensin II Receptor Blockers ○ Losartan ● Calcium Channel Blockers ○ Amlodipine ○ Diltiazem ○ Nifedipine ○ Verapamil ● Beta-blockers (next class) Enalapril Therapeutic class: ACE inhibitor Indication: Hypertension, CHF Action: Blocks conversion of angiotensin I to angiotensin II, increases renin levels and decreases aldosterone leading to vasodilation Nursing Considerations: ● Can cause a dry cough - should be discontinued if it does. ● Monitor BP ● Contraindicated during pregnanc [Show More]

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