ATI Retake Study Guide - Pharmacology Nursing Lab Values and Drugs PDF

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Notes that helped me pass the Nursing Pharmacology ATI retake. Full of lab values and drug notes. Self made....

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Normal lab values: Hemoglobin 12-18 Hematocrit 37-52 (high hematocrit=dehydration) RBC 4.2-6.1 WBC 5-10 Platelets 150,000-400,000 Phenytoin 10-20 PT: effective range with warfarin 11-12.5 INR: effective range with warfarin is 2-3 aPTT 70-120 seconds (effective=60-80 seconds during heparin treatment) ALT 8-20 AST 5-40 Albumin 3.5-5 Ammonia 15-45 Bilirubin 0.1-1 Sodium 135-145 Potassium 3.5-5

Bicarb 21-28 HDL 35-80 LDL below 100 Total cholesterol below 200 (above 240=high) Triglycerides: less than 150 is good Calcium 9-10 (Hypocalcemia= muscle twitching and dysrhythmias) Chloride 98-106 Tobramycin peak is 5-10 BUN 10-20 Creatinine 0.6-1.3 GFR 90-120 Creatinine clearance should be above 87 for females, and above 107 for males (87-139) Magnesium 1.3-2.1 (Magnesium too high=give calcium gluconate) Low magnesium: muscle aches pH 7.35-7.45

Urine pH 4.6-8 Urine specific gravity 1.010-1.030 ***If specific gravity is greater than 1.030: dehydration Lithium level 0.6-1.2 Digoxin 0.5-2 Diuretics: can cause hypokalemia (take with potassium) Lab for gentamicin – Creatinine 0.6-1.2 Lab for gemfibrozil – Creatinine K 22-200 Colorectal cancer lab=hemoglobin 9.1 Aminoglycoside lab – Creatinine 0.6-1.2 and BUN 7-20 Angina labs – Creatinine K males 39-308 Females 26-192

Acetaminophen: can increase effects of warfarin

Acetylcystine (Mucomyst): for Tylenol OD *give mixed with flavored ice drink to disguise taste Drink it through a straw

Adenosine: AE: tachycardia/dyspnea Alendronate (Fosamax): for osteoporosis Take in morning with full glass of water Sit up for 30 minutes after

Allopurinol (Zyloprim): for gout stop if patient has fever Drink 3000 mL of fluid daily Give with meals or soon after

Aminoglycosides = ototoxicity Amitriptyline: AE: dry mouth and urinary retention, orthostatic hypotension, tachycardia

Amoxicillin should not be taken with penicillin Antibiotics cause prolonged bleeding

Antitussive: for dry, nonproductive cough Aspirin: AE: tinnitus (Also hyperventilation=toxicity/respiratory alkalosis)

Atenolol (Tenormin): check BP prior to giving Atorvastatin: causes rhabdomyolysis (monitor CK) *avoid grapefruit juice

Atropine: CI: glaucoma (causes blurry vision) Baclofen: for muscle spasms Side effect=slurred speech (also drowsiness, dizziness, weakness, nausea) *don’t take with antihistamines *Take with milk or meals

Benztropine (Cogentin): for Parkinson’s: can cause constipation, dry mouth, nausea

Bethanecol: a cholinergic: given for inability to void

Bleomycin: antineoplastic medication Will do pulmonary function studies

Busulfan (Myeleran): can cause increase in uric acid level

Captopril (ACE inhibitor): for hypertension *don’t use salt substitutes (high in potassium) Take on empty stomach (1 hr before or 2 hr after meals)

Carafate (sucralfate): take one hour before meals and at bedtime

Carbidopa/levodopa (Sinemet): take with food to prevent nausea *Don’t take with high-protein meal

Carbamazepine: can cause leukopenia (monitor WBCs) and bruising *contraindicated in clients with liver disease

Ceftazidime: CI: penicillin allergy

Cefoxitine: cephalosporin: don’t take with penicillin/amoxicillin (Renal system/check creatinine)

Chlordiazepoxide: for alcohol withdrawal Chlorpromazine (for schizophrenia): AE: orthostatic hypotension Can cause urinary retention

Cimetidine (Tagamet): (for GERD) - AE is confusion Cipro: can cause tendon rupture. Ototoxic Clarithrimycin: can cause metallic taste Clonazepam (Klonopin): For seizures Clozapine: check WBC, platelets, RBCs, neutrophils (before giving, monitor cholesterol)

Colchicine: for gout Contraindicated in clients with renal failure (also GI or hepatic disorders, and blood dyscrasias) *eat low purine foods like organ meats, sardines, scallops, shrimp

Cromolyn for asthma: take 15 min before exercise Cyclobenzoprine (Flexeril): don’t stop abruptly Cyclophosphamide (Neosar): Take on empty stomach increase fluid to 2000-3000 mL daily (can cause hemorrhagic cystitis)

Cyclosporine (Sandimmune): AE is hypertension *Avoid grapefruit juice

Dantrolene: treats muscle spasms *mix with 60 mL of sterile water *AE: liver failure *CI in cirrhosis patients

Desmopressin: AE=drowsiness, water intoxication, hyponatremia

Daunorubicin: Nausea and vomiting are frequent side effects toxic effects=crackles on lung auscultation, bone marrow suppression

Diazepam: given in alcohol withdrawal Digoxin: have nausea? Check apical pulse! Pulse rate less than 60? Hold medication (AE: fatigue, bradycardia, anorexia, N&V, visual problems, heart defects) Monitor potassium (hypokalemia) Antidote=digoxin immune FAB Digoxin: Hold if HR is less than 60 Don’t take digoxin with St. John’s Wort Digoxin effective=sinus rhythm Digoxin ineffective=dysrhythmia Digoxin toxicity=yellow vision, N&V Eat high-potassium foods

Diltiazem (for A fib): CI=hypotension Diphenhydramine: aspirate to check for IV patency before giving

Dopamine: increases systolic BP Doxycycline: CI: pregnancy Edrophonium: improvement in muscle strength: myasthenia gravis (confirmed when injecting it)

Enalapril: causes increased potassium (hyperkalemia) (AE=angioedema, dry cough, loss of taste, dizziness, headache, drowsiness, insomnia, dry mouth, N/V/D)

Enoxaparin: given after surgery to prevent thromboembolism

Epoietin alfa: for reversal of anemia Therapeutic effect=hematocrit 30-33 AE: high BP

Erythromycin: ototoxic. Can cause hepatotoxicity. Also nausea, vomiting, diarrhea *don’t take with grapefruit juice

Etoposide (VePesid): side effect= orthostatic hypotension

Famotidine: smoking makes less effective. Take at bedtime. Inhibits gastric acid secretion

Fentanyl: avoid grapefruit juice Ferrous sulfate (feosol): take with OJ It causes constipation Don’t take with dairy or antacids Take in between meals

Filgrastim: allergic reaction=dyspnea Fludrocortisone: AE=hypokalemia Flumazenil: reverses effects of diazepam Fluoxetine: take acetaminophen with it, NOT ibuprofen

Fluticasone: do WB exercises

Furosemide (Lasix): take with food or milk *dangle feet off bed before getting up Frequent side effects are nausea and photosensitivity. AE=tinnitus, hypotension, hypokalemia, tender/swollen joints *monitor for hyperuricemia Check potassium level prior to giving

Garamycin: for radiologic studies (Toxic to kidney)

Gentamicin: ototoxic (tinnitus) and nephrotoxic Glargine insulin (Lantus): take once daily, at same time every day

Glucocorticoid: AE=osteoporosis Glulisine: fast acting (works within 15 minutes) Haloperidol (Haldol): AE: extrapyramidal symptoms like akathisia. Inform doctor if taking benzodiazepines or Xanax *toxic effect is excess salivation

*client should lie down after taking (orthostatic hypotension) *give IM with large needle into large muscle

HCTZ: lowers BP HCTZ: can lose potassium HCTZ AE=bradycardia Heparin: 5 cm (2 inches) from umbilicus, above iliac crest *apply firm pressure for 1-2 minutes but don’t massage 25-26 gauge, 3/8 inch needle *DC heparin if platelets less than 150,000

Docusate sodium (Colace): stool softener Hepatitis B causes joint pain also Hepatitis C = avoid acetaminophen Heroin: pinpoint pupils Hydroxychloroquine: blurred vision is an adverse effect (toxicity)

Hydroxyurea: report hemoglobin 7, platelets 75,000, potassium 5.2

Hydroxyzine: AE: dry mouth Immune globulin: give in deltoid or thigh Isoniazid: monitor AST Isosorbide mononitrate: CI: Low BP Isotretinoin: for acne Don’t take with vitamin A

Lactulose: lowers ammonia level by removing it from colon

Lasix: take with potassium Levothyroxine (Synthroid): Take on an empty stomach Don’t take with soy OD=tremor

Indication of thyrotoxicosis=chest pain

Lisinopril: ACE inhibitor. therapeutic if BP is 120/80 Causes cough, hypotension. Don’t use NSAIDs

Lithium: don’t take with diuretics, caffeine, alcohol, or NSAIDs (AE=seizures and arrhythmias) *increase sodium intake) *Therapeutic levels are 0.6-1.2 Discontinued 1-2days before surgery

Lyrica: used for epilepsy, anxiety, migraine, and neuropathic pain

Magnesium sulfate: for management of preeclampsia Toxicity signs: respiratory depression, loss of DTRs

Metoclopramide: increases peristalsis Can cause spasm/twitching

Metformin: AE: myalgia

Methotrexate: Chemo drug and for rheumatoid arthritis and ectopic pregnancy (monitor platelets and CBC) (thrombocytopenia). Watch for symptoms of gout. May see hair loss.

Metoclopramide (Reglan): AE: sedation CI: GI obstruction, hemorrhage, perforation Used for emesis/nausea after surgery, chemo, radiation

Metoprolol (for BP): may be difficult to detect low BS *use with caution in those with heart failure

Misoprostol (Cytotec): relieves epigastric pain Montelukast: take 2 hours prior to exercise-induced bronchospasm

Morphine sulfate: suppresses cough reflex *client should cough and deep-breathe

Nitroglycerin sublingual: common to have headache

Nitroglycerin patch: remove every 12-14 hours, before bedtime

Omeprazole: for heartburn take before breakfast, one hour before meals. Drink cool glass of water after taking (Use backup birth control) (Avoid alcohol and NSAIDs)

Phenelzine (MAOI): don’t take with tyramine foods (yogurt, aged cheeses, processed meats, red wine) (CI: kidney disease, CHF)

Phenytoin: can cause hyperplasia (overgrowth of gum tissue), skin rash like Stevens-Johnson’s, constipation *therapeutic level is 10-20 (if level is higher, may have nystagmus and slurred speech) Flush IV with saline after injection to reduce venous irritation Give undiluted, slowly over 1 minute, about 50 mg/min

Prednisone: if AE, use on alternate days (AE: sore throat, osteoporosis, stress fractures) Take in morning If taking NPH insulin with it, increase NPH insulin

*glucocorticoids raise blood sugar

Pregabalin: contraindicated if breastfeeding Propranolol: CI: asthma. Also hypotension Psyllium=for constipation Take with a glass of water and add additional liquid

PTU: for Graves’ disease Ranitidine (Zantac): Suppresses secretion of gastric acid *take at night

Retrovir: give in pregnancy at 14 weeks. Give to infant at birth and for six weeks thereafter

Simvastatin: AE is muscle weakness Singular: for bronchospasm (use prior to exercise) Saw palmetto: for BPH/urinary health

Spironolactone: potassium-sparing diuretic: expect decreased sodium levels but increased potassium

Sulfasalazine: check CBCs Sumatriptan: AE: chest pressure, slow/difficult speech (Give no more than 12 mg every 24 hrs)

Tamoxifen: can cause leg tenderness/thromboembolism, hit flashes

Theophylline: AE: tachycardia *avoid chocolate, caffeine, cola *Take in morning

Tricyclic antidepressants cause dry mouth Trimethoprim sulfate: take with lots of water Tylenol OD: give acetylcystine (Mucomyst) Upper GI bleed=low BP

Valproic acid: used for seizures, migraines, bipolar disorder (Monitor for signs of hepatotoxicity) Take same time every day Don’t take with carbonated beverage or antacid

Vancomycin: can cause kidney failure Slow rate for redman syndrome

Verapamil: can cause low BP and constipation *can be taken without food

Warfarin (Coumadin): can cause N, V and D (Wear medical alert bracelet) (Acetaminophen can increase effects) Target INR: 2-3 Don’t take “G” with it or feverfew Don’t take with high vitamin K foods (spinach, fish, liver, coffee, and tea)

Zolpidem: use short term Zyrtec: antihistamine *side effect is drowsiness (also blurred vision, dry mouth, constipation, urinary retention)

Controlled substance not all used: return to pharmacy Allergy skin testing: antihistamines should be discontinued three days before Older adults: excretion of medication is lowered Don’t take feverfew while pregnant Don’t take St. John’s Wort with oral contraceptives Black cohosh is for menopausal symptoms Ginkgo biloba may suppress coagulation and cause bleeding gums Don’t take saw palmetto with antiplatelet agents Signs of circulatory overload (unit of PRBC after surgery): dyspnea, cough, rales, tachycardia, JVD Giving PRBCs: prime tubing using 0.9% sodium chloride MMR vaccine: give subcu in outer aspect of upper arm

Acute hemolytic reaction: signs are hypotension, chest pain, back pain, tachypnea, apprehension Regular and NPH insulin administered together: 1) Roll NPH between palms of hands 2)Inject air in NPH vial 3)Inject air into regular insulin vial 4)Withdraw regular insulin 5)Add NPH insulin to syringe IV infiltration: pallor, cool Elevate extremity Apply warm or cool compress Restart IV proximal to site...