NCLEX Medication List

Generic (Brand) Clue Speaker Notes

Hydromorphone 1. This analgesic C Class: Opioid agonist
(Dilaudid) is used for a Indications: Moderate to severe pain.
client with SE: Respiratory depression, nausea
moderate to
severe pain. 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]
Insulin detemir 2. This Class: Long acting insulin [ Onset 1-2 hours, duration up to 24 hours]
(Levemir) medication Indication: Type 1 & 2 diabetes mellitus.
replaces a SE: Nausea, vomiting, hypoglycemia,
missing
pancreatic Ask: Is detemir given prior to meals to control postprandial blood
hormone. glucose?
Answer: No, peak time is 6-8 hours. [May be taken in evenings]
Metformin 3. This Class: Oral anti-diabetic; [biguanide]
(Glucophage) medication may Indication: Type 2 diabetes
cause a buildup SE: Anorexia, nausea, and diarrhea.
of lactic acid in
the body. [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.]

 Ask: Is hypoglycemia an expected effect?

 Answer: It is a rare occurrence unless combined with other
medications that lower glucose.

Methylergonovine 4. This Class: Ergot Alkaloid

(Methergine) medication Indication: Postpartum bleeding.
might be used SE: Nausea, headache; [life-threatening] hypertension
postpartum for a
woman who  Ask: What places a woman at risk for postpartum hemorrhage?
delivered twins.  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 5. This is a Class: Antineoplastic; Immunosuppressant

(Mexate) DMARD: disease Indication: Some types of cancer; rheumatoid arthritis (RA); psoriasis,
modifying anti- Crohn’s Disease
rheumatic drug. 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 6. This Class: Anticonvulsant
(Neurontin) medication is Indication: Partial seizures, neuropathic pain
approved for SE: Drowsiness, dizziness, fatigue
epilepsy but is
often used for  Ask: Why is gabapentin most effective 3 x/day?
neuralgia.  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 Class: Organic Nitrate

medication with Indication: Angina
tadalafil! (Cialis) SE: Headache, hypotension, tachycardia

 Ask: What safety precautions should the nurse implement?

 Answer: Fall Risk ( vasodilation causes dizziness)

Oxytocin (Pitocin) 8. This Class: Uterine stimulant

medication Indication: Induce or augment labor; post-partum hemorrhage
might be used to SE: Tachysystole, Uterine rupture, elevated BP, fetal hypoxia
induce or
augment labor.  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.

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.
Pantoprazole 9. This Class: Proton pump inhibitor (suffix: prazole)
(Protonix) medication is Indication: GERD
often used to SE: Diarrhea, osteoporosis, pneumonia
prevent GERD in
hospitalized Long-term therapy can cause:
clients. 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?
  Answer: Initially there is an alteration in GI flora/impairment of
WBCs

Risperidone 10. A decrease in Medication: Risperidone

(Risperdal) hallucinations Class: Atypical antipsychotic
and delusions Indication: Schizophrenia, acute bipolar mania, autism
should be seen SE: Weight gain, dyslipidemia, diabetes [ orthostatic hypotension and
with this sedation]. EPS risk increases with dose. EPS risk is substantial with depot
medication. 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 11. Prolonged Class: Glucocorticoid (suffix: solone)

(Solu-Medrol) use of this Indication: Inflammation
injection may SE: Euphoria, Infection, Cushing’s syndrome
cause Cushing’s
Syndrome.  Ask: What are symptoms of Cushing’s syndrome?
 Answer: Buffalo hump, moon face, general weakness,
(Note: IM or IV hypokalemia, hyperglycemia, hypernatremia
routes)
Budesonide/ 12. This inhaled Class: Glucocorticoid/bronchodilator. (suffix: terol)
formoterol medication is Indication: Prophylaxis in chronic restrictive airway diseases (asthma,
used to prevent COPD)
(Symbicort) asthma attacks. 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 13. This hormone Class: Hormone
(Synthroid) should be taken Indication: Hypothyroidism
after rising in the SE: Tachycardia, nervousness, insomnia
morning and
before eating.  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 14. A client with Class: Antibacterial – glycopeptide. (Vancomycin is NOT an

(Vancocin) an intestinal aminoglycoside, despite the common suffix, “mycin”.
infection caused Indication: Clostridium difficile, MRSA [drug of choice for client who has
by clostridium penicillin allergies.]
difficile is likely SE: Nephrotoxicity, “red man syndrome”
to receive this Many side effects:
medication. • 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/ 15. Clients Class: Antibiotic (an extended-spectrum penicillin)/beta-lactamase

tazobactam allergic to inhibitor (suffix: cillin)
penicillin should Indication: Bacterial infection
(Zosyn) not take this SE: GI upset, leukopenia.
medication.

 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
Generic /Brand Speaker Notes: Ask the group for answers. Focus on application of information
Clue as it might occur in an NCLEX question for an entry level nurse.
2 Clopidogrel / Plavix Class: Platelet Aggregation Inhibitor
Anti-platelet. Indication: Prevent stenosis after cardiac stent placement, MI & CVA prevention
Uses: prevent MI & SE: Abdominal pain, dyspepsia, diarrhea, rash bleeding, hemorrhage
CVA.
SE: bleeding,  Ask: What would you assess in a client taking clopiogrel?
hemorrhage.  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 Class: Mood stabilizer

Mood Stabilizer Indication: Bipolar disorder: control of manic episodes and prophylaxis
Use: BPD. SE: Tremors, polyuria
SE: tremors, polyuria. Toxicity: GI upset, CNS changes, convulsions, coma, death
Toxicity: GI upset,  Ask: What are the signs of toxicity?
CNS changes,  Answer: Vomiting, diarrhea, drowsiness, slurred speech
convulsions, coma,
death. 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

 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.
5 Haloperidol / Haldol Class: Antipsychotic
Antipsychotic. Indication: Schizophrenia; Acute psychosis; Tourette’s
Uses: schizophrenia; SE: Mild leukopenia, EPS (high risk), TD, laryngospasm, respiratory depression,
acute psychosis; NMS
Tourette’s.  Ask: What are the symptoms of neuroleptic malignant syndrome?
SE: neutropenia; high  Answer: Rigidity, sudden high fever, blood pressure instability
risk of EPS.  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’.

11 Zolpidem / Ambien  Class: Sedative-hypnotic (most widely-used)

Sedative-hypnotic.  Indication: Short-term treatment of insomnia
Use: insomnia.  SE: Dizziness, daytime drowsiness, sleep complex behaviors (like sleep-
SE: changes in driving), depression
behavior and mental  Ask: What changes in behavior and mental health may occur?
health; sleep walking.  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.

12 Esomeprazole / Class: Proton Pump Inhibitor (Almost chemically identical to omeprazole) (suffix:
Nexium prazole)
PPI. Indication: GERD, gastric ulcers
Uses: GERD; gastric SE: Same as omeprazole: pneumonia, osteoporosis/fractures, rebound
ulcer. heartburn when d/ced, vertigo, agitation, depression, N&V, diarrhea,
SE: headache; constipation, abd. pain, dry mouth
diarrhea;
osteoporosis.  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%.
14 Amiodarone / Class: Antidysrhythmic
Cordarone Indication: Approved only for recurrent V-fib and recurrent unstable V-tach; not
Antidysrhythmic. approved for A-fib but used widely to treat
Uses: a-fib; v-fib; v- SE: Lung damage, heart failure; liver and thyroid damage; toxicity can continue
tach. for weeks or months after drug is d/c’d due to very long half-life
SE: lung damage;
heart failure; liver &  Ask: What findings indicate respiratory failure?
thyroid toxicity.  Answer: Dyspnea, diminished breath sounds, rales, friction rub

Bradydysrhythmias can occur which could lead to hypotension.

The client should not consume any grapefruit (can ↑ levels of medication).
16 Aripiprazole / Abilify NCLEX tip: when administering antipsychotics – think safety. What would you
Atypical look for? Fall risk, dizziness, impaired thinking/cognition, driving a motor vehicle.
antipsychotic. Class: Atypical antipsychotic (note that even though it has a “prazole” suffix, this
Uses: schizophrenia; is not a PPI)
BPD, major Indications: Schizophrenia; major depressive disorder; bipolar mania, autism.
depression; autism. SE: Anxiety, insomnia, agitation, EPS (low risk)
SE: headache; Low risk for EPS and neuroleptic malignant syndrome
agitation; EPS (low
risk).  Ask: What mental health safety concerns are associated with this
medication?
 Answer: Increased depression, suicidal ideation

20 Epoetin / Epogen, Class: Growth factor

Procrit Indication: Anemia of chronic kidney disease; chemotherapy-induced anemia
Colony stimulating (carefully – hgb ↑ 12 gm/dL due to epoetin is associated with accelerated
factor. tumor grow), HIV clients taking zidovudine, anemia in preoperative clients
Use: anemia from SE: HTN, thrombotic stroke, clotting of AV fistula
chronic kidney
disease; Risk for cardiovascular events are greatest when hgb exceeds 11gm/dL or the rise
perioperative. in hgb, within two weeks of receiving therapy, exceeds 1gm/dL; medication is
SE: blood clots. 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.
21 Risedronate / Class: Biophosphonate
Actonel Indication: Osteoporosis
Bisphosphonate. SE: Bone pain, leg cramps, colitis
Use: osteoporosis.
SE: jaw problems;  Ask: How is risedronate taken?
pain in bones,  Answer: With a full glass of water; after taking: must sit or stand and
muscles, and joints. 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.

22 Pregabalin / Lyrica Class: Anticonvulsant

Anticonvulsant. Indication: Post-herpatic and diabetic neuralgia, partial seizures, fibromyalgia
Use: neuralgia, SE: Dizziness (most frequent SE), somnolence, weight gain, blurred vision,
partial seizures, difficulty thinking, H/A, peripheral edema, dry mouth, ataxia
fibromyalgia.
SE: changes in  Ask: How would the nurse assess pain in a nonverbal patient
behavior or mood;  Answer: Observe for grimacing, guarding, restlessness; Determine if client
muscle twitching; can communicate by pointing, nodding, blinking. Consider if pain is
confusion. 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).

23 Aspart / Novolog Class: Insulin (Rapid-acting)

Insulin. Rapid – Indication: Type 1 and type 2 Diabetes Mellitus
acting. SE: Hypoglycemia
Use: Type 1 & 2
diabetes mellitus.  Ask: When is insulin aspart given in relationship to food?
SE: Hypoglycemia  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.
24 Diltiazem / Cardizem Class: Calcium Channel Blocker
Ca++ Channel Indication: HTN; Angina; A-fib; A-flutter; SVT
Blocker. Uses: HTN; SE: Heart failure; peripheral edema
angina; a-fib; a-  Ask: What are the signs and symptoms of heart failure?
flutter; SVT.  Answer: Weight gain, dyspnea, edema
SE: heart failure;
peripheral 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.
25 Varenicline / Chantix Class: Smoking cessation aid
Smoking cessation Indication: Aid efforts to stop smoking
aid. SE: Nausea, anorexia, unusual dreams, mood changes, suicidal thoughts
Use: Aid efforts to  Ask: How long will the client expect to take varenicline?
stop smoking.  Answer: 12 weeks
SE: change in
appetite; unusual The client should start taking 1 week prior to stop-smoking-date.
dreams. Blocks pleasant feelings from nicotine.

Down:
1 Furosemide / Lasix Class: Loop diuretic
Loop diuretic. Indication: Heart failure, renal or hepatic failure, uncontrolled HTN, pulmonary
Uses: renal failure; edema
heart failure. SE: Hypokalemia; ototoxicity
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.

3 Levofloxacin / Class: Antibiotic – Fluroquinolone
Levaquin Note: -floxacin is a common suffix for fluroquinolones
Fluoroquinolone. Indication: Pneumonia; Sinusitis; Skin infections
Uses: pneumonia, SE: Tendonitis, photosensitivity
sinusitis, skin
infection. Ask: What should the nurse do if a client experiences joint pain while taking
SE: tendonitis, levofloxacin?
photosensitivity. Answer: Hold the next dose, place client on bed rest, and call provider.

Levofloxacin, and other fluroquinolones, may cause tendonitis and/or tendon

rupture during therapy and up to several months after therapy ends.
[Associated with tendonitis/tendon rupture ]

6 Atorvastatin / Lipitor Tip: Suffix: -statin.

Statin. Class: Statin (suffix: statin)
Uses: lower Indication: Lower cholesterol & LDL levels; Raise HDL levels.
cholesterol & LDL; SE: Rhabdomyolysis; hepatotoxicity
raise HDL.
SE: rhabdomyolysis;  Ask: What labs should be assessed for side effects?
hepatotoxicity.  Answer: LFT: ALT/AST; rhabdomyolysis: myoglobin, CK

Follow-up:
What labs should be assessed for effectiveness? Cholesterol, LDL/HDL,
triglygerides
Grapefruit, alcohol are contraindicated.

7 Sildenafil / Viagra Tip: suffix –afil

Phosphodiesterase Class: Phosphodiesterase inhibitor (suffix: afil)
inhibitor. Indication: Erectile dysfunction
Use: ED. SE: Hypotension, priapism, flushing, HA
SE: flushing, erection
lasting >4 hours, MI. Ask: Why is sildenafil contraindicated with NTG?
Answer: Life-threatening hypotension can occur.

The client must wait 24 hours after sildenafil to take a nitrate; Sildenafil is
absolutely contraindicated in men who are already taking nitrates
8 Sertraline / Zoloft Class: SSRI
SSRI. Indication: Depression, OCD, PTSD, Panic attacks
Uses: depression, SE: Insomnia, agitation, weight gain, sexual dysfunction; suicidal thoughts
OCD, PTSD, panic  Ask: How many days should the client be instructed to wait when
attacks. stopping an MAOI and starting Sertraline?
SE: weight changes,  Answer: MAOI should be withdrawn at least 14 days prior to
drowsiness, loss of starting sertraline (and the reverse – sertraline should be withdrawn at
libido, hallucinations, least 14 days prior to starting an MAOI) due to risk of serotonin
insomnia. syndrome
Follow-up:
Ask students for s/s of serotonin syndrome: Fever, excessive sweating, agitation,
diarrhea, heart and blood pressure changes, myoclonus, hyperreflexia, tremors,
and loss of coordination

Note: SSRI’s should not be stopped suddenly. Use in children and adolescents
may cause suicidal ideation. Alcohol should be avoided.

9 Fentanyl / Duragesic Class: Narcotic (opioid) analgesic

transdermal Indication: Chronic pain; surgical analgesia, control of breakthrough pain in
Narcotic Analgesic. clients taking other opioids
Use: chronic pain not SE: Respiratory depression, sedation, constipation, urinary retention
responding to other Ask: How long is the patch worn?
analgesics. Answer: 72 hours
SE: addiction, The transdermal patch (Duragesic) is worn for 3 days; full analgesic effect takes
respiratory 24 hours; short-term pain med may be required during that time.
depression. Follow-up:
Ask students about considerations re: patch: Direct heat (heating pads, electric
blankets) at the site should be avoided since it accelerates absorption due to
vasodilation, as do fever, sunbathing and strenuous exercise.
Available in parenteral, transmucosal, transdermal, intranasal forms
High abuse potential; client may develop opioid tolerance
.
10 Fluticasone / Flonase Tip: suffix –sone.
Corticosteroid. Class: Glucocorticoid (suffix: sone)
Uses: seasonal and Indication: Prophylaxis for asthma, allergic rhinitis
perennial rhinitis. SE: Oropharyngeal candidiasis, hoarseness
SE: nausea,  Ask: How often should the client use fluticasone?
dizziness, epistaxis.  Answer: Daily, on a regular basis

Fluticasone/salmeterol (Advair) is a commonly prescribed inhaler used for

asthma. Salmeterol is a long-acting beta 2 agonist (LABA) that causes
bronchodilation.
Eliminate grapefruit from diet.
The client should gargle after using medication to minimize chance of developing
candidiasis

Note: fluticasone/salmeterol (Advair) is a commonly prescribed inhaler used for

asthma. Salmeterol is a long-acting beta 2 agonist (LABA) that causes
bronchodilation.
13 Propranolol / Inderal  Tip: suffix –olol.
Non-selective beta
blocker. Class: Beta blocker/Antihypertensive
Uses: HTN; Indication: HTN, angina, dysrhythmias, MI, acute anxiety (“stage fright”)
dysrhythmias; SE: Bradycardia, AV heart block, heart failure, bronchoconstriction,
migraine, many depression
others. • Tip: suffix –olol.
SE: bradycardia, • Contraindicated or used with extreme caution for clients with restrictive
hypotension. airway diseases, diabetes (inhibits glycogenesis), depression, heart failure,
heart block, severe allergy (can inhibit the action of epinephrine)
• Can cause rebound cardiac excitation resulting in tachycardia and
ventricular dysrthymias

 Ask: What is the black box warning for propranolol?

 Answer: Exacerbation of angina/MI if abruptly discontinued

First dose effect may cause fainting due to severe hypotension; the client should
be forewarned and advised not to drive or engage in other hazardous activities
for 12-24 hours; taking at bedtime can help minimize risk

 When might the nurse hold this medication? Systolic BP below 100, pulse
below 60 or client is showing signs of hypoxia.
15 Donepezil / Aricept Class: Cholinesterase inhibitor
Cholinesterase Indication: Mild to severe Alzheimer’s Disease
inhibitor. Use: Mild SE: Nausea, vomiting, diarrhea, GI bleeding, anorexia, dizziness,
to severe AD. bronchoconstriction, bradycardia
SE: may decrease
reaction time. Ask: What important teaching is needed?
Answer: Take donepezil at bedtime, may cause vivid unusual dreams,
implement safety precautions

Should be taken daily, at bedtime.

Low dose is started initially and slowly increased to minimize side effects of
nausea, diarrhea, dizziness, bronchoconstriction, and bradycardia. Should be
used cautiously in clients with asthma or COPD.
Do not discontinue suddenly as respiratory failure may result.
17 Lisinopril / Zestril Tip: suffix -pril
ACE inhibitor. Class: ACE Inhibitor (suffix -pril)
Uses: HTN, MI. Indication: Hypertension, heart failure, acute MI
SE: persistent cough, SE: Persistent dry cough, hyperkalemia, renal failure, fetal injury, angioedema
angioedema. Remind students of first dose effect (fainting due to hypotension) of
antihypertensives
 Ask: Should women use a reliable form of birth control while taking this
Lisinopril?
 Answer: Yes, black box warning of being associated with fetal
injury/death
Angioedema: swelling in the face, throat, tongue could close airway (could also
occur in extremities). Cough is annoying and may require a change in medication
but is not life-threatening.

18 Rifampin / Rifadin Class: Antibiotic

Antimycobacterial. Indication: TB, leprosy (Hansen’s disease) and to eliminate meningococcal
Uses: TB, some other bacterium (Neisseria meningitidis) from the nasopharynx from asymptomatic
infections. carriers, but should not be used for active disease.
SE: hepatotoxicity. SE: EPS, angioedema, hepatotoxicity

 Ask: How would the nurse assess liver toxicity?

 Answer: ↑ LFT, jaundice, dark urine, light stools, RUQ pain

When prescribed for TB, rifampin is often used with other medications such as
ethambutol and isoniazid.
Can decrease effectiveness of birth control pills.
Causes body secretions to turn orange and can permanently stain contact lenses.
Monitor blood sugar in diabetic clients.

19 Enoxaparin / Tip: suffix –parin. Low molecular weight heparin (LMW) heparin.
Lovenox Class: Anticoagulant (low molecular weight heparin --LMW)
Anticoagulant.
Use: DVT prevention. Indication: DVT prevention, ischemia prevention in unstable angina and MI
SE: bleeding; SE: Bleeding, severe neurological injury if given to patient undergoing any
neurological type of spinal injection or puncture.
impairment.
Tip: suffix –arin
Levels cannot be monitored with aPTT
All LMW heparins are administered subQ
Dosing is based on body weight

Ask: What is the antidote for enoxaparin?

Answer: Protamine sulfate
 Fill-in-the-Blank

Generic Speaker Notes

(Brand)
1 Adenosine Class: Antidysrhythmic
(Adenocard) Indications: Paroxysmal SVT
SE: Bradycardia, dyspnea, hypotension, flushing, chest discomfort

 Ask: What client outcome should the nurse expect?

 Answer: Conversion to normal sinus rhythm

Note: IV administration of adenosine is not within the PN scope of practice.

What should the nurse monitor? VS, EKG, lung sounds, UO.
2 Dutasteride Class: 5-alpha-reductase inhibitor
(Avodart) Indication: Benign prostatic hypertrophy
SE: Decreased ejaculate, decreased libido

 Ask: Should clients using dutasteride donate blood?

 Answer: No; Dutasteride is teratogenic.

NOTE: It is pregnancy category X. Blood donation should not occur for at least six moths after
discontinuing because donated blood might be given to a pregnant woman. Pregnant woman
should not handle dutasteride as it is absorbed through the skin.

3 Warfarin Class: Anticoagulant (Suffix: arin)

(Coumadin) Indication: Prophylaxis for thrombosis, TIAs and MI
SE: Black Box Warning: Serious/fatal bleeding events (Category X)

 Ask: Should foods containing vitamin K be avoided while taking warfarin?

 Answer: No. Clients should maintain a consistent intake of Vitamin K. Increasing or
decreasing intake will require a change in warfarin dosage.

Many medications adversely interact with warfarin (ex. Aspirin, amiodarone, phenytoin,
rifampin). Clients should wear a Medic Alert bracelet and inform provider(s) of warfarin use.
Note: there are lots of follow-up questions to ask students:
Q: What are foods that are high in vitamin K?
A: green leafy vegetable, mayonnaise, canola oil, soybean oil.
Q: What is the antidote for warfarin overdose?
A: Vitamin K
Q: What bleeding precautions can be taken by clients?
A: Use a soft toothbrush, use an electric razor.
Q: What is the therapeutic INR level?
A: 2-3
What are foods that are high in vitamin K? green leafy vegetable, mayonnaise, canola oil,
soybean oil.
Not safe in pregnancy. A client who is pregnant and requires anticoagulant therapy will have a
change in therapy to heparin or lovenox.
4 Phenytoin Class: Antieplileptic
(Dilantin) Indication: Seizures
SE: Gingival hyperplasia, thrombocytopenia

 Ask: Is a client taking Phenytoin susceptible to Stevens Johnson Syndrome?

 Answer: Yes, (flu like S&S, skin rash) instruct client to stop taking medication and
notify provider

Follow-up:
Q: Is a client taking Phenytoin susceptible to Stevens Johnson Syndrome?
A: Yes, (flu like S&S, skin rash) and they should stop taking medication and notify provider
Phenytoin is a teratogen, Pregnancy Category D:only used if seizure control is not possible
other medications
Phenytoin has many medication interactions (ex. Warfarin, oral contraceptives,
glucocorticoids, cimetidine). Patient should be instructed to avoid alcohol – increases the CNS
depressant actions of phenytoin and decreases phenytoin levels.

5 Metronidazole Class: Antiprotozoal, antimicrobial, amebicide

(Flagyl) Indication: Amoebiasis, trichomoniasis, giardiasis , Drug of choice for C-Difficele
SE: Nausea, headache, metallic taste, dark urine. These are unpleasant but do not require
discontinuing the medication.

 Ask: Why is alcohol contraindicated with this drug?

 Answer: Metronidazole has disulfiram-like reactions with alcohol which may be
dangerous.
Symptoms include severe nausea, copious vomiting, flushing, HA, sweating, thirst, blurred
vision and hypotension; BP can potentially drop to shock levels; lasts 30 minutes to several
hours

Metronidazole is used to treat trichomoniasis. This is a sexually transmitted protozoal

infection, Symptoms in a woman include a green/yellow odiferous vaginal discharge, vaginal
itching, and dyspareunia. Men may not have symptoms. Both partners require treatment to
prevent re-infection.
It is the drug of choice for amebiasis and giardiasis

6 Gentamicin Class: Aminoglycoside antibiotic (suffix: micin)

(Gentamicin) Indications: Bacterial infections, topically for skin infections
SE: Nephrotoxicity, ototoxicity

 Ask: What lab work is done to evaluate the therapeutic effects or toxic levels?
 Answer: Peak/Trough

(Ask as f/u, when peak and trough are drawn; peak ~ 30 minutes after IV administration;
trough drawn ~ 30 minutes before IV administration).
Reserved for serious infections due to toxic risk

Monitor: hearing and balance (inner ear functions), and kidney function.
Neuromuscular blockade can cause potentially fatal respiratory depression. Clients at highest
risk are those with myasthenia gravis and those receiving a muscle relaxant or general
anesthetic.
7 Digoxin Class: Cardiac Glycoside, Inotrope
(Lanoxin) Indications: Heart failure, cardiac dysrhythmias
SE: Dysrhythmias, anorexia, nausea, fatigue, yellow tinge to vision
[client may report this as blurred vision, yellow tinge to vision, appearance of halos around
dark objects]
Ask: What should the nurse monitor?
Answer: Digoxin levels, potassium levels, apical pulse rate

The apical pulse must be auscultated for one full minute, prior to administering the
medication; potassium level must be monitored as hypokalemia as it can cause potentially
fatal dysrhythmias, most commonly from diuretics that are commonly used with digoxin.
Digoxin works by improving heart contractility and reducing heart rate.

Those commonly prescribed in the past, it is now considered a second line drug. Diuretics and
either an ACE inhibitor, ARB or beta blocker are first line for treatment of HF (note: Beta
blockers used to be contraindicated for HF, but, with carefully controlled dosage, they can
improve symptoms and prolong life)
The therapeutic range for Digoxin is very narrow – 0.8 – 2.0 ng/mL; toxicity occurs at a level
=/> 2.4 ng/mL

8 Memantine NMDA Antagonist

(Namenda) Use: Moderate to Severe Alzheimer’s disease (AD)
SE: dizziness, headache, confusion, constipation
 Ask: What medication might be used for mild AD?
 Answer: Donepezil

Unlike cholinesterase inhibitors (such as donepezil), Memantine is approved for moderate to

severe AD only. It does not benefit clients with mild AD.
It is generally well tolerated with only small percentages of the side effects listed above.
Sodium bicarbonate causes urine to become more alkaline and can decrease renal excretion of
memantine, leading to toxic levels.

Memantine should be avoided in clients with renal failure.

9 Oxycodone Opioid Analgesic
(Oxycontin) Use: Moderate to severe pain

SE: respiratory depression, constipation, urinary retention, cough suppression, miosis,

sedation, euphoria
Oxycodone tablets should not be broken, crushed, or chewed

 Ask: What should the nurse monitor?

 Answer: Respirations, BP (orthostatic hypotension), urine output

Oxycodone has high abuse potential, but concerns shouldn’t interfere with treatment of pain.
New formulations are available that discourage abuse (turns into a blob if exposed to fluid
making it difficult to inject; burns nasal passages if crushed and snorted)
10 Montelukast Class: Leukotriene Modifier
(Singulair) Use: Asthma maintenance and prophylaxis, prevention of exercise induced bronchospasm,
relief of allergic rhinitis
SE: mood changes, suicidal thoughts/actions

Ask: What medication would the nurse expect to give for acute asthma?
Answer: Albuterol, levalbuterol, perbuterol
[Ipratropium (Atrovent), an anticholinergic, and glucocorticoids may also be used.]

Montelukast is not indicated for acute asthma attacks.

Used for clients 1 year and older for asthma maintenance and prevention. Used in clients at
least 15 years old to prevent exercise-induced bronchospasm.