ATI. Nclex Medication List PDF

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List of medications via ATI used on nclex...

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ATI/NCLEX Medication List Generic (Brand)

Hydromorphone (Dilaudid)

Insulin detemir (Levemir)

Metformin (Glucophage)

Clue 1. This analgesic is used for a client with moderate to severe pain.

2. This medication replaces a missing pancreatic hormone. 3. This medication may cause a buildup of lactic acid in the body.

Speaker Notes C Class: Opioid agonist Indications: Moderate to severe pain. SE: Respiratory depression, nausea Ask: What should the nurse do if the client has a respiratory rate of 10 while on IV Hydromorphone? Answer: Stop hydromorphone ; contact the provider [have naloxone on hand if needed, oxygen 2L/BNC] Class: Long acting insulin [ Onset 1-2 hours, duration up to 24 hours] Indication: Type 1 & 2 diabetes mellitus. SE: Nausea, vomiting, hypoglycemia, Ask: Is detemir given prior to meals to control postprandial blood glucose? Answer: No, peak time is 6-8 hours. [May be taken in evenings] Class: Oral anti-diabetic; [biguanide] Indication: Type 2 diabetes SE: Anorexia, nausea, and diarrhea. [Toxicity results in lactic acidosis. Glucophage is held 48 hours before and after iodinated contrast dye because the dye may cause renal failure, which would increase the harm from lactic acidosis.]  

Methylergonovine (Methergine)

4. This medication might be used postpartum for a woman who delivered twins.

Ask: Is hypoglycemia an expected effect? Answer: It is a rare occurrence unless combined with other medications that lower glucose.

Class: Ergot Alkaloid Indication: Postpartum bleeding. SE: Nausea, headache; [life-threatening] hypertension  

Ask: What places a woman at risk for postpartum hemorrhage? Answer: Uterine atony, laceration, impaired maternal clotting, retained placenta fragments

Common causes of uterine atony include:  Multiple gestation pregnancy (twins, large baby over-stretched uterus)  Long labor, grand multipara (overworked uterus)

Methotrexate (Mexate)

5. This is a DMARD: disease modifying antirheumatic drug.

Class: Antineoplastic; Immunosuppressant Indication: Some types of cancer; rheumatoid arthritis (RA); psoriasis, Crohn’s Disease SE: Nausea, vomiting, diarrhea, elevated LFTs, fatigue, renal failure, pulmonary fibrosis  

Ask: How does methotrexate improve symptoms of RA? Answer: Immunosuppression [reduces inflammatory processes]

Gabapentin (Neurontin)

6. This medication is approved for epilepsy but is often used for neuralgia.

Class: Anticonvulsant Indication: Partial seizures, neuropathic pain SE: Drowsiness, dizziness, fatigue  

Ask: Why is gabapentin most effective 3 x/day? Answer: Doses peak in 2-3 hrs

[Gabapentin is rapidly absorbed following oral dosing and reaches peak plasma levels in 2 to 3 hours] RA is an autoimmune condition. Methotrexate causes immunosuppression which will help decrease inflammation caused by RA.

Nitroglycerin

7. Don’t take this medication with tadalafil! (Cialis)

Class: Organic Nitrate Indication: Angina SE: Headache, hypotension, tachycardia  

Oxytocin (Pitocin)

8. This medication might be used to induce or augment labor.

Ask: What safety precautions should the nurse implement? Answer: Fall Risk ( vasodilation causes dizziness)

Class: Uterine stimulant Indication: Induce or augment labor; post-partum hemorrhage SE: Tachysystole, Uterine rupture, elevated BP, fetal hypoxia  

Ask: What is a tocolytic? Answer: The opposite of oxytocin: Relaxes myometrium

Examples of tocolytics: terbutaline, indomethacin, nifedipine, nitroglycerin, atosiban Maternal hypertension, uterine tachysystole, and late FHR decelerations or other signs of fetal distress may be indications to stop the oxytocin perfusion.

Pantoprazole (Protonix)

9. This medication is often used to prevent GERD in hospitalized clients.

Uterine tachysystole is defined as more than 5 contractions within a 10 minute period, a series of contractions lasting more than 2 minutes each, or contractions of normal duration that occur within 1 minute of each other. Class: Proton pump inhibitor (suffix: prazole) Indication: GERD SE: Diarrhea, osteoporosis, pneumonia Long-term therapy can cause: Osteoporosis and fractures (may inhibit calcium absorption) C-diff, hospital-acquired infections Hypomagnesemia Rebound reflux after discontinuing Gastric cancer, with very long-term use 

Ask: When and why is a client at risk for pneumonia when using pantoprazole?

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Risperidone (Risperdal)

10. A decrease in hallucinations and delusions should be seen with this medication.

Answer: Initially there is an alteration in GI flora/impairment of WBCs

Medication: Risperidone Class: Atypical antipsychotic Indication: Schizophrenia, acute bipolar mania, autism SE: Weight gain, dyslipidemia, diabetes [ orthostatic hypotension and sedation]. EPS risk increases with dose. EPS risk is substantial with depot form  

Ask: Why does the client using risperidone need routine blood tests? Answer: To monitor for elevated cholesterol and hyperglycemia

Follow-up by asking students about normal cholesterol level: Less than 200 mg/dL Methylprednisolone

(Solu-Medrol)

Budesonide/ formoterol (Symbicort)

11. Prolonged use of this injection may cause Cushing’s Syndrome. (Note: IM or IV routes) 12. This inhaled medication is used to prevent asthma attacks.

Class: Glucocorticoid (suffix: solone) Indication: Inflammation SE: Euphoria, Infection, Cushing’s syndrome  

Ask: What are symptoms of Cushing’s syndrome? Answer: Buffalo hump, moon face, general weakness, hypokalemia, hyperglycemia, hypernatremia

Class: Glucocorticoid/bronchodilator. (suffix: terol) Indication: Prophylaxis in chronic restrictive airway diseases (asthma, COPD) SE: GI upset, infection  

Ask: Why does this medication place the client at risk for infection? Answer: Immunosuppression [Steroids suppress the immune system.]

This medication is administered by inhalation Discontinuing abruptly may cause adrenal insufficiency

Levothyroxine (Synthroid)

13. This hormone should be taken after rising in the morning and before eating.

Class: Hormone Indication: Hypothyroidism SE: Tachycardia, nervousness, insomnia  

Ask: Why is levothyroxine prior to eating breakfast ? Answer: Absorbed best when taken on an empty stomach; ↑ metabolic rate may cause interference with sleep

Many drug interactions • Many GI drugs reduce the effect of thyroid hormone • Some antiepileptics, rifampin, sertraline increase effect • Thyroid hormone accelerates breakdown of warfarin and increases cardiac response to catecholamine's (epinephrine, dopamine, dobutamine) • Can ↑ requirements for digoxin and insulin

Vancomycin (Vancocin)

14. A client with an intestinal infection caused by clostridium difficile is likely to receive this medication.

Class: Antibacterial – glycopeptide. (Vancomycin is NOT an aminoglycoside, despite the common suffix, “mycin”. Indication: Clostridium difficile, MRSA [drug of choice for client who has penicillin allergies.] SE: Nephrotoxicity, “red man syndrome” Many side effects: • Major toxicity: nephrotoxicity → renal failure • Ototoxicity is rare and usually reversible • Thrombophlebitis • Immune mediated thrombocytopenia • Rapid IV infusion can cause ‘Red man syndrome’ characterized by flushing, rash, chills, pruritus, urticarial, tachycardia, and hypotension (collectively known as “red man syndrome”) Infuses over 1 hr  

Ask: What labs would the nurse monitor for signs of nephrotoxicity? Answer: Blood urea nitrogen (BUN): 10-20 mg/dL, serum creatinine: 0.6-1.2 mg/dL

NOTE: Peak and trough levels drawn to monitor therapeutic levels Draw trough level 15 minutes prior to administration, Draw peak level 30 minutes after IV administration

Piperacillin/ tazobactam (Zosyn)

15. Clients allergic to penicillin should not take this medication.

Class: Antibiotic (an extended-spectrum penicillin)/beta-lactamase inhibitor (suffix: cillin) Indication: Bacterial infection SE: GI upset, leukopenia.

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Ask: What client allergy should alert the nurse? Answer: Allergy to penicillin. [Zosyn is a combination drug and classified as an extended release penicillin. ]

Crossword       

A completed crossword follows the Speaker Notes. Down numbers, in the left column, are shaded in grey. Crossword slides open with the location on the crossword. Next to animate is: Class, Indications, and Use. These are also on the HO. Please ask the group for their answer/s. Fly in the answer. Fly in, ask, and discuss the application question.

Across

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Generic /Brand Clue Clopidogrel / Plavix Anti-platelet. Uses: prevent MI & CVA. SE: bleeding, hemorrhage.

Speaker Notes: Ask the group for answers. Focus on application of information as it might occur in an NCLEX question for an entry level nurse. Class: Platelet Aggregation Inhibitor Indication: Prevent stenosis after cardiac stent placement, MI & CVA prevention SE: Abdominal pain, dyspepsia, diarrhea, rash bleeding, hemorrhage  

Ask: What would you assess in a client taking clopiogrel? Answer: H&H, epistaxis, bruising and bleeding

Clopidogrel is a platelet aggregation inhibitor; platelets can’t aggregate, or ‘stick together’. This reduces the risk of clot formation. Must stop 5 days prior to elective surgery. 4

Lithium / Eskalith Mood Stabilizer Use: BPD. SE: tremors, polyuria. Toxicity: GI upset, CNS changes, convulsions, coma, death.

Class: Mood stabilizer Indication: Bipolar disorder: control of manic episodes and prophylaxis SE: Tremors, polyuria Toxicity: GI upset, CNS changes, convulsions, coma, death  Ask: What are the signs of toxicity?  Answer: Vomiting, diarrhea, drowsiness, slurred speech Reinforce the following information with students:  Therapeutic level is 0.4-1.4 mEq/L.  A level > 2mEq/L is considered toxic; >2.5 mEq/L death can occur  S/S of toxicity include: tremor, ataxia, dysarthria, nystagmus, renal impairment 

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To avoid toxicity sodium intake should be consistent (lithium is a salt); hyponatremia precipitates toxicity. NSAIDS also can cause toxicity. Dehydration can put the client at risk for toxicity For that reason caffeine should be avoided because of the diuretic effect. Lithium is pregnancy Category D – should only be used when there are no alternatives and the benefits clearly outweigh the risks.

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Haloperidol / Haldol Antipsychotic. Uses: schizophrenia; acute psychosis; Tourette’s. SE: neutropenia; high risk of EPS.

Class: Antipsychotic Indication: Schizophrenia; Acute psychosis; Tourette’s SE: Mild leukopenia, EPS (high risk), TD, laryngospasm, respiratory depression, NMS  Ask: What are the symptoms of neuroleptic malignant syndrome?  Answer: Rigidity, sudden high fever, blood pressure instability  Follow-up: What are signs of EPS? Dystonia; akathisia (can’t sit still); tardive dyskinesia. What is Tourette’s syndrome? Involuntary movements and vocalizations called ‘tics’.

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Zolpidem / Ambien Sedative-hypnotic. Use: insomnia. SE: changes in behavior and mental health; sleep walking.

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Class: Sedative-hypnotic (most widely-used) Indication: Short-term treatment of insomnia SE: Dizziness, daytime drowsiness, sleep complex behaviors (like sleepdriving), depression Ask: What changes in behavior and mental health may occur? Answer: Sleep complex behaviors: sleep walking, sleep driving, sleep eating, etc.); depression

Drugs affecting the CNS should be avoided: alcohol, antidepressants, anti-seizure, and tranquilizers. Zolpidem is absorbed very quickly; it should be taken right at bedtime. 1 2

Esomeprazole / Nexium PPI. Uses: GERD; gastric ulcer. SE: headache; diarrhea; osteoporosis.

Class: Proton Pump Inhibitor (Almost chemically identical to omeprazole) (suffix: prazole) Indication: GERD, gastric ulcers SE: Same as omeprazole: pneumonia, osteoporosis/fractures, rebound heartburn when d/ced, vertigo, agitation, depression, N&V, diarrhea, constipation, abd. pain, dry mouth  

Ask: When is esomeprazole taken? Answer: 1 hour prior to eating (allows medication to reach effective level prior to eating and stimulation of gastric acid).

Change in gastric acid affects absorption of nutrients and medications; Examples: calcium and B12 absorption are impaired. Use of PPI for >1 year may increase hip fracture by 44%.

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Amiodarone / Cordarone Antidysrhythmic. Uses: a-fib; v-fib; vtach. SE: lung damage; heart failure; liver & thyroid toxicity.

Aripiprazole / Abilify Atypical antipsychotic. Uses: schizophrenia; BPD, major depression; autism. SE: headache; agitation; EPS (low risk).

Class: Antidysrhythmic Indication: Approved only for recurrent V-fib and recurrent unstable V-tach; not approved for A-fib but used widely to treat SE: Lung damage, heart failure; liver and thyroid damage; toxicity can continue for weeks or months after drug is d/c’d due to very long half-life  

Bradydysrhythmias can occur which could lead to hypotension. The client should not consume any grapefruit (can ↑ levels of medication). NCLEX tip: when administering antipsychotics – think safety. What would you look for? Fall risk, dizziness, impaired thinking/cognition, driving a motor vehicle. Class: Atypical antipsychotic (note that even though it has a “prazole” suffix, this is not a PPI) Indications: Schizophrenia; major depressive disorder; bipolar mania, autism. SE: Anxiety, insomnia, agitation, EPS (low risk) Low risk for EPS and neuroleptic malignant syndrome  

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Epoetin / Epogen, Procrit Colony stimulating factor. Use: anemia from chronic kidney disease; perioperative. SE: blood clots.

Ask: What findings indicate respiratory failure? Answer: Dyspnea, diminished breath sounds, rales, friction rub

Ask: What mental health safety concerns are associated with this medication? Answer: Increased depression, suicidal ideation

Class: Growth factor Indication: Anemia of chronic kidney disease; chemotherapy-induced anemia (carefully – hgb ↑ 12 gm/dL due to epoetin is associated with accelerated tumor grow), HIV clients taking zidovudine, anemia in preoperative clients SE: HTN, thrombotic stroke, clotting of AV fistula Risk for cardiovascular events are greatest when hgb exceeds 11gm/dL or the rise in hgb, within two weeks of receiving therapy, exceeds 1gm/dL; medication is held if either of these occur  

Ask : What labs should the nurse monitor? Answer: H&H, CBC, BUN, potassium, iron

What is erythropoietin? Hormone released by kidneys when O2 levels are low. Stimulates production of RBCs. Routes: SQ or IV.

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Risedronate / Actonel Bisphosphonate. Use: osteoporosis. SE: jaw problems; pain in bones, muscles, and joints.

Class: Biophosphonate Indication: Osteoporosis SE: Bone pain, leg cramps, colitis  

Ask: How is risedronate taken? Answer: With a full glass of water; after taking: must sit or stand and remain NPO for 30 minutes to one hour

Note: The delayed release tablets must be taken immediately after breakfast. Follow-up: Ask students what increases risk for osteoporosis: Heredity, immobility, menopause, Paget’s disease, Cushing’s What diet is important? One high in calcium and vitamin D. 2 2

Pregabalin / Lyrica Anticonvulsant. Use: neuralgia, partial seizures, fibromyalgia. SE: changes in behavior or mood; muscle twitching; confusion.

Class: Anticonvulsant Indication: Post-herpatic and diabetic neuralgia, partial seizures, fibromyalgia SE: Dizziness (most frequent SE), somnolence, weight gain, blurred vision, difficulty thinking, H/A, peripheral edema, dry mouth, ataxia  

Ask: How would the nurse assess pain in a nonverbal patient Answer: Observe for grimacing, guarding, restlessness; Determine if client can communicate by pointing, nodding, blinking. Consider if pain is expected with client’s condition. Remind students that non-verbal patients are more likely to have their pain needs neglected. (Students may come up with additional answers.)

NCLEX tip: effectiveness is assessed based upon the ‘use’ of a medication. For example, what would the nurse assess if pregabalin is used for: Fibromyalgia? Reduction in the S&S of pain, headache, fatigue, depression, etc. Partial seizures? Reduction in seizure activity. Diabetic neuralgia? Reduction in pain (not blood glucose levels). 2 3

Aspart / Novolog Insulin. Rapid – acting. Use: Type 1 & 2 diabetes mellitus. SE: Hypoglycemia

Class: Insulin (Rapid-acting) Indication: Type 1 and type 2 Diabetes Mellitus SE: Hypoglycemia  

Ask: When is insulin aspart given in relationship to food? Answer: 5-10 minutes before eating a meal.

Follow-up: What is the onset/peak/duration of action? Onset 10-20 minutes; Peak 40-50 minutes; Duration 3-5 hours Note: NovoLog Mix 70/30 (aspart/aspart protamine) is given 15 minutes prior to a meal.

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Diltiazem / Cardizem Ca++ Channel Blocker. Uses: HTN; angina; a-fib; aflutter; SVT. SE: heart failure; peripheral edema.

Varenicline / Chantix Smoking cessation aid. Use: Aid efforts to stop smoking. SE: change in appetite; unusual dreams.

Down: 1 Furosemide / Lasix Loop diuretic. Uses: renal failure; heart failure. SE: hypokalemia; ototoxicity.

Class: Calcium Channel Blocker Indication: HTN; Angina; A-fib; A-flutter; SVT SE: Heart failure; peripheral edema  Ask: What are the signs and symptoms of heart failure?  Answer: Weight gain, dyspnea, edema How does this medication work? Diltiazem produces vasodilation and a reduction in heart rate (in part by ‘calming’ SA & AV node). Which VS is important to check? BP. Why? Vasodilation which may decrease BP. Pulse. Why? Diltiazem affects the conductivity in the heart. What assessment findings may indicate heart failure? Weight gain, dyspnea, edema. Class: Smoking cessation aid Indication: Aid efforts to stop smoking SE: Nausea, anorexia, unusual dreams, mood changes, suicidal thoughts  Ask: How long will the client expect to take varenicline?  Answer: 12 weeks The client should start taking 1 week prior to stop-smoking-date. Blocks pleasant feelings from nicotine.

Class: Loop diuretic Indication: Heart failure, renal or hepatic failure, uncontrolled HTN, pulmonary edema SE: Hypokalemia; ototoxicity Ask: How would the nurse assess for ototoxicity? Answer: Observe for s/s of hearing loss: Indifference, turning up volume on TV, irritability when conversing (students may come up with others) Remind students that a baseline hearing test may be indicated prior to medication initiation. A client received IV furosemide. After 15 minutes there is no increase in UO. What should the nurse do? Check for obstruction of the catheter tubing; listen to lung sounds. UO should increase within 5 minutes of IV furosemide. A client received oral furosemide. After 15 minutes there is no increase in UO. What would the nurse do? Continue to assess. UO should increase about 60 minutes after an oral dose of furosemide. 

Note: furosemide is available in oral, sublingual, IV and IM routes.

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Levofloxacin / Levaquin Fluoroquinolone. Uses: pneumonia, sinusitis, skin infection. SE: tendonitis, photosensitivity.

Class: Antibiotic ...