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PHARMACOLOGY STUDY GUIDE
Core Lab Values, Pharmacokinetics, and “Global” Test Concepts
● WBC: 4,000–11,000/mm³ ● RBC: ○ Female: 4.2–5.4 million/mm³ ○ Male: 4.7–6.1 million/mm³ ● Hemoglobin (Hgb): ○ Female: 12–16 g/dL ○ Male: 14–18 g/dL ● Hematocrit (Hct): ○ Female: 37%–47% ○ Male: 42%–52% ● Low WBCs = infection risk. ● Low RBC/Hgb/Hct = anemia, fatigue, poor oxygen delivery. ● Low platelets = bleeding risk. ● Normal INR, coagulation ○ INR is the key monitoring lab for warfarin ○ Normal INR is about 1 if not anticoagulated; common therapeutic warfarin range is often 2–3 depending on indication. ● Normal prothrombin time 11–15 sec ○ PT is part of warfarin monitoring and reflects the extrinsic clotting pathway. ● Normal HbA1c ~ ○ Good general normal reference. ● Phenytoin level 10–20 mcg/mL ○ Below range = poor seizure control. ○ Above range = toxicity risk. ● Concept of half-life ○ Half-life = time it takes for half the drug to leave the body. ○ The longer the half-life, the longer the drug lasts and the more cautious you are with accumulation. ● Drugs metabolized in liver and excreted in kidneys ○ Liver dysfunction raises risk for impaired metabolism. ○ Kidney dysfunction raises risk for impaired excretion and drug buildup. ● Renal dosing is lower due to impaired kidney function ○ This is a major exam concept: if kidneys are impaired, many drugs need dose reduction or extra monitoring.
High-Yield Nursing Implications
● Before starting many meds, assess renal and hepatic function because they affect safety, toxicity, and dosing. This was reinforced throughout multiple decks including antibiotics, antifungals, antivirals, adrenergics, adrenal drugs, and antineoplastics. ● Drug classes that especially require CBC monitoring include antithyroid drugs, immunosuppressants, antineoplastics, and some anti-infectives because of leukopenia, thrombocytopenia, or agranulocytosis risk.
Tips & Tricks
● Kidney problem? Think drug accumulation and lower dose. ● Liver problem? Think toxicity and impaired metabolism. ● If a question gives abnormal CBC values, ask: ○ Is this an infection risk? ○ Is this a bleeding risk? ○ Is this a fatigue/oxygenation problem? ● “Which lab matters most?” is usually tied to the organ that clears the drug or the major toxicity of that drug.
Hematologic Drugs, CBC support, and Nursing Interventions for Low Counts
● Epoetin alfa: stimulates RBC production ○ Correct. ○ Epoetin alfa and darbepoetin alfa are erythropoiesis-stimulating agents (ESAs) that stimulate RBC production in bone marrow. ○ Used for anemia with chronic kidney disease, chemotherapy, and some HIV-related treatments. ● Filgrastim: WBCs ○ Correct. ○ Filgrastim stimulates WBC production and is used for leukopenia/neutropenia, especially with cancer therapy. It can cause bone pain and leukocytosis; do not agitate the vial and monitor CBC. ● Nursing interventions related to low CBC values ○ Low WBCs/neutropenia: fever is a red flag; monitor for infection, chills, tachycardia, breath sound changes, productive cough, and abnormal urine changes. ○ Low platelets/thrombocytopenia: monitor for petechiae, purpura, ecchymosis, gingival bleeding, unusual bleeding. ○ Low RBCs/anemia: monitor fatigue, weakness, shortness of breath, pallor, activity intolerance.
Extra Expansion from PowerPoints
● ESAs require monitoring of BP, iron levels, hemoglobin, and hematocrit. ● ESAs are less effective if the patient does not have enough iron stores or functioning bone marrow.
○ Tacrolimus: lymphoma risk, hepatic artery thrombosis. ○ Azathioprine: bone marrow suppression, lymphoma. ○ Basiliximab: c ytokine release syndrome; premedicate. ● General adverse effects: ○ opportunistic infections ○ HTN ○ nephrotoxicity ○ hepatotoxicity ○ leukopenia/thrombocytopenia ○ post-transplant diabetes ○ edema ○ dysrhythmias ○ seizures.
Nursing implications
● Monitor: ○ WBC count ○ renal function ○ hepatic function ○ signs of infection ○ signs of anemia/bleeding ○ vital signs ○ baseline ECG when indicated. ● PowerPoint note: if WBC drops below 3000/mm³, contact HCP and the drug may need to be discontinued.
Tips & Tricks:
● Immunosuppressants do not “fix” immunity; they lower it on purpose. ● Fever, sore throat, or new infection symptoms are major warning signs. ● Grapefruit and herbal interactions matter with some transplant meds.
HIV, Antivirals, and Antiretroviral Therapy
● HIV take ARVs and monitor viral (low) load and (high) CD4 count ○ HAART usually includes at least 3 drugs from different classes. ○ Goal is to reduce viral load; goal of viral load <50 copies/mL. ○ Your “CD4 high is good” is exactly the right clinical idea. ● Example points: ○ Zidovudine (AZT): bone marrow suppression; can be used in pregnancy/newborn. ○ Tenofovir: lactic acidosis, severe hepatomegaly. ○ Maraviroc: hepatotoxicity, GI effects, URI-type symptoms.
○ Indinavir: nephrolithiasis; take in acidic environment, empty stomach, drink plenty of fluid. ● Antivirals overall: ○ can be hard to use because viruses live inside host cells. ○ renal and hepatic dysfunction increase risk.
Influenza and Respiratory Antivirals
● Oseltamivir : used for influenza A/B if given early; caution with renal dysfunction. ● Best prevention remains vaccination.
Tips & Tricks:
● HIV therapy is not one drug. ● Viral load low = good. ● Bone marrow suppression is a classic issue with zidovudine. ● Renal function matters with several antiviral drugs.
Antibiotics: big patterns, nursing interventions, sulfonamides, aminoglycosides, tetracyclines, vancomycin
Core Antibiotic Concepts
● Antibiotics treat bacterial infections. ● Get culture and sensitivity before starting therapy whenever possible. ● Therapeutic response = fever/WBC/redness/drainage/pain improve. ● Watch for superinfection and resistance.
● Antibiotics — nursing interventions ○ Assess allergies, organ function, immune status, and interactions. ○ Obtain cultures before therapy. ○ Teach patients to take exactly as prescribed and not stop early. ● Adverse effects in sulfonamide ○ Broadly important and very testable. ○ Sulfonamides can cause: ■ photosensitivity ■ hemolytic/aplastic anemia ■ thrombocytopenia ■ Stevens-Johnson syndrome / epidermal necrolysis ■ GI upset
● “Monitor peak and trough” screams aminoglycosides and sometimes vancomycin. ● Sulfa + sun = trouble. ● Tetracyclines + dairy/iron/antacids = bad absorption. ● Ceftriaxone + calcium infusions = avoid. ● Red Man syndrome = vancomycin infusion reaction, not the same as anaphylaxis.
Antifungals and Amphotericin B
● Antifungal Drugs, Amphotericin B (IV drug — side effects) ○ Fungal infections are more common in immunocompromised patients, people with AIDS, transplant patients, cancer patients, and people on immunosuppressants or broad-spectrum antibiotics. ○ Systemic antifungals can be toxic to the host, so labs matter. ● Azoles ○ Treat systemic and topical fungal infections. ○ Can cause liver toxicity. ○ Use caution with renal/hepatic dysfunction, pregnancy, lactation. ● Fluconazole ○ Better tolerated than amphotericin B. ○ If rash/itching occurs during infusion, stop infusion, check vital signs, contact HCP. ● Echinocandins ○ Hepatic toxicity, hypersensitivity, bone marrow suppression. ● Amphotericin B ○ The deck stresses renal/hepatic toxicity, bone marrow suppression, rash, and GI effects; avoid combining with other nephrotoxic drugs.
Nursing implications
● Baseline and ongoing: ○ CBC ○ renal function ○ hepatic function ○ culture of infected area.
Tips & Tricks
● Amphotericin B = think “terrible” kidneys. ● Antifungals are not “lightweight antibiotics”; many are high-toxicity drugs. ● Rash during IV antifungal infusion matters.
Benzodiazepines and CNS depressants
● Benzos for anxiety, seizures, alcohol use
○ Also used for sedation, sleep induction, muscle relaxation, agitation relief, anesthesia adjunct, and acute seizure disorders. ● Status epilepticus: use benzos ● Side Effects: constipation, respiratory depression, hypotension, and potential for abuse ○ Expand slightly: ■ common deck effects: drowsiness, dizziness, cognitive impairment, lethargy, fall risk, hangover effect. ■ severe respiratory depression and hypotension are especially concerning when combined with other CNS depressants like opioids/alcohol. ● Benzos antidote = Flumazenil. ● Benzodiazepines act via GABA receptors and depress CNS activity. ● Contraindications include allergy, narrow-angle glaucoma , and pregnancy. ● Interactions: ○ alcohol ○ opioids ○ azole antifungals ○ macrolides ○ verapamil/diltiazem ○ grapefruit juice.
Nursing implications
● Avoid alcohol and other CNS depressants. ● Fall precautions and safety precautions matter. ● Older adults are high risk for sedation and falls. ● For sleep drugs, patients should allow enough time for sleep and avoid taking them if they must wake in less than 6–8 hours.
Tips & Tricks
● Benzo overdose antidote = flumazenil. ● Opioid overdose antidote = naloxone. ● Don’t mix benzos with alcohol or opioids. ● For seizures/status epilepticus, benzos are a classic first-line rescue answer.
Opioids, Morphine, Naloxone, Tramadol, Acetaminophen
● Morphine Sulfate: pain control; side effects respiratory depression, constipation, hypotensive ○ Side effects: ■ CNS depression ■ N/V ■ urinary retention ■ miosis
● Respiratory depression is the biggest opioid emergency. ● Itching after morphine may occur and is not automatically an allergy. ● Acetaminophen toxicity = liver damage, antidote acetylcysteine. ● Tramadol trap = seizure risk.
Antidiarrheals and Laxatives
● Miralax — constipation, bowel prep; monitor electrolytes, many stools ○ Miralax/polyethylene glycol is an osmotic laxative that pulls water into the intestine, causing bowel distention, peristalsis, and evacuation. Electrolyte imbalance is the big nursing issue. ● Adsorbents ○ Bismuth subsalicylate, activated charcoal. ○ Can increase bleeding time. ● Anticholinergic antidiarrheals ○ Decrease GI motility. ○ Can cause urinary retention, blurred vision, confusion, tachy/brady changes. ● Opiate antidiarrheals ○ Loperamide, diphenoxylate/atropine. ○ Can cause sedation, constipation, respiratory depression, bradycardia, hypotension, urinary retention. ● Probiotics ○ Replace missing GI flora.
Nursing Implications
● Do not give bismuth subsalicylate to children/teens with chickenpox because of Reye syndrome risk. ● Assess fluid volume, I&O, mucous membranes. ● Anticholinergic agents should be avoided with glaucoma, BPH, urinary retention, recent bladder surgery, cardiac issues, and myasthenia gravis.
Tips & Tricks
● Laxatives and diarrhea drugs can both mess up fluids/electrolytes. ● Bismuth = dark stools, but also salicylate-related cautions. ● Long-term laxative use = bowel dependency/decreased tone.
Acid-Controlling Drugs
● Antacids drugs (sodium, magnesium, aluminum, etc.) (when contraindicated) decreases absorption of other meds ○ Correct and strongly supported by the deck. ○ Antacids neutralize acid but do not stop acid production.
○ They can interfere with absorption of many medications through chelation and altered gastric/urinary pH. ● Magnesium antacids : avoid in renal failure. ● Calcium antacids : constipation, kidney stones, rebound hyperacidity. ● Aluminum/calcium : constipation. ● Magnesium : diarrhea. ● High sodium products : avoid in heart failure or hypertension. ● Give most other drugs 1–2 hours apart from antacids.
PPIs
● PPIs irreversibly block the proton pump and shut down acid secretion. ● Uses: GERD, ulcers, NSAID-induced ulcers, H. pylori regimens, Zollinger-Ellison, stress ulcer prophylaxis. ● Adverse effects: ○ C. diff/GI infections ○ osteoporosis/fractures with long-term use ○ pneumonia ○ magnesium depletion.
Sucralfate
● Protective barrier over ulcer base. ● May cause constipation. ● Give other drugs at least 2 hours before sucralfate.
Misoprostol
● Prevention of NSAID-induced gastric ulcers. ● Can cause abdominal cramps and diarrhea.
NCLEX tips and traps
● Renal insufficiency + antacid = avoid magnesium. ● Calcium carbonate must be chewed thoroughly. ● Omeprazole granules should not be crushed/chewed.
Thyroid and Antithyroid Drugs
● Propylthiouracil — hyperthyroidism (thyroid needs iodine to convert hormones T3-> T4) ○ The deck specifically teaches that antithyroid drugs inhibit incorporation of iodine into tyrosine, which blocks production of T3 and T4 precursors. Your note about iodine dependence is pointing in the right direction.
Hypothyroid Replacement
Cardiovascular/Autonomic Drugs from Your Notes
● Warfarin antidote: vitamin K ● Heparin antidote: protamine sulfate ● Epinephrine: tachy, hypertensive ● Adenosine: resets heart, causes asystole so SA node can take over — feeling of impending doom ● Adrenergic drugs — act like epinephrine ● Cholinergic — act like acetylcholine; atropine for cholinergic crisis ● Nitroglycerin — angina, vasodilators, side effects: headache, hypotension; sublingual/IV/topical ● Furosemide — loop diuretic (rapid onset) ● Diuretics decrease BP ● Antihypertensives: CCB constipation/edema; beta blockers brady; ACE angioedema/cough/K; no ACE + ARB together ● NSAIDs — kidney function, ulcers, gastric bleeding
What the PowerPoints reinforced
● Adrenergics are sympathomimetics that mimic NE/EPI/dopamine. ● Alpha effects = vasoconstriction. ● Beta1 = increased HR/contractility. ● Beta2 = bronchodilation/smooth muscle relaxation. ● Dopaminergic receptors can increase blood flow to renal/mesenteric/coronary/cerebral beds. ● Adrenergic adverse effects include dysrhythmias, chest pain, BP changes, tachycardia, tremor, anxiety, hypokalemia, and pulmonary issues depending on receptor profile. ● Epinephrine is a nonselective adrenergic agonist used in emergencies/ACLS.
NCLEX tips and traps
● Vitamin K = warfarin antidote ● Protamine sulfate = heparin antidote ● Adenosine brief asystole is expected; the “impending doom” sensation is a classic teaching point from your note. ● Nitroglycerin → expect headache and hypotension; have patient sit down. ● ACE inhibitor cough and angioedema are very testable. ● NSAIDs: think GI bleed + kidney injury.
Respiratory/Allergy Meds
● Different antihistamines' side effects dry everything, drowsiness ○ Correct.
○ The antiemetic deck reinforces sedation, dry mouth, urinary retention, and constipation with H1 blockers like diphenhydramine, dimenhydrinate, and meclizine. ● Topical decongestants work quickly but are addictive and cause rebound congestion ○ Good exam note. This is a classic rhinitis medicamentosa concept. ● Guaifenesin ○ Expectorant: helps loosen and mobilize secretions.
Tips & Tricks
● “Dry everything + sleepy” = first-generation antihistamine pattern. ● Meclizine is especially associated with motion sickness/vertigo. ● Rebound congestion happens with overuse of topical nasal decongestants.
Antiemetics
● Antiemetics work by blocking different vomiting pathways. ● Classes in the deck: ○ anticholinergics ○ antihistamines ○ antidopaminergics ○ prokinetics ○ serotonin blockers ○ cannabinoids.
High-Yield Examples
● Scopolamine ○ Motion sickness. ○ Patch behind ear 4 hours before travel; lasts 72 hours. ● Meclizine ○ Vertigo/motion sickness favorite. ● Promethazine / prochlorperazine ○ Can cause EPS, sedation, hypotension, dry mouth, constipation. ○ Promethazine contraindicated in children <2. ● Metoclopramide ○ Used in GERD/delayed gastric emptying/N/V. ○ Risk of EPS and tardive dyskinesia. ● Ondansetron ○ Chemo/post-op N/V. ○ Can prolong QT; monitor ECG if indicated.
Nursing Implications
● EPS from dopamine blockers/prokinetics → discontinue and give anticholinergic per order.
Tips & Tricks
● Steroids mask infection. ● Steroids raise glucose. ● Steroids plus NSAIDs = ulcer/GI bleed danger. ● Abrupt stop = adrenal crisis.
Antineoplastics and methotrexate
● Methotrexate — immunosuppressant used for autoimmune disorders/cancers ○ Correct. ○ In the oncology deck, methotrexate is listed under antimetabolites , which interfere with DNA synthesis in the S phase. ● Antineoplastics have narrow therapeutic index and are highly toxic. ● Main nursing priorities: ○ bone marrow suppression ○ renal/hepatic toxicity ○ GI mucosal injury ○ extravasation risk ○ fluid/electrolyte imbalance from N/V/D. ● Methotrexate/antimetabolites: ○ Adverse effects include bone marrow suppression, alopecia, renal/hepatic impairment, and GI toxicity. ○ Monitor CBC, renal, and hepatic function. ○ Frequent mouth care, antiemetics, and small meals. ○ Avoid pregnancy during therapy and for 6 months after. ● Other important chemo pearls: ○ Cyclophosphamide can cause hematuria. ○ Cisplatin can cause hearing loss. ○ Doxorubicin can cause cardiotoxicity and red urine/sweat. ○ Bleomycin can cause pulmonary fibrosis.
Tips & Tricks
● Chemo affects all rapidly dividing cells , not just cancer cells. ● Fever + chemo = think neutropenia/infection. ● Extravasation is an emergency. ● Methotrexate questions often center on bone marrow suppression, mucositis, renal/hepatic monitoring.
Urinary System Drugs
● UTI drugs in this deck: fosfomycin, nitrofurantoin, trimethoprim; use caution with renal dysfunction, pregnancy, lactation. ● Antispasmodics for overactive bladder: ○ anticholinergic agents relax detrusor muscle by blocking parasympathetic activity. ○ contraindications include glaucoma, myasthenia gravis, obstructive urinary problems. ○ mirabegron can cause HTN. ● Phenazopyridine ○ topical urinary analgesic. ○ turns urine reddish-orange, can stain contacts. ○ renal/hepatic toxicity risk. ○ should not be used >2 days.
Tips & Tricks
● Orange urine with phenazopyridine is expected. ● Mirabegron = watch BP. ● Anticholinergic urinary drugs worsen urinary retention and glaucoma.
Herbs, Vitamins, Supplements, and Garlic
● Garlic — anti-inflammatory, hypertension, cholesterol, interacts with other drugs ○ Very well supported. ○ Garlic lowers LDL/triglycerides/cholesterol, raises HDL, suppresses platelet aggregation, and acts as a vasodilator to lower BP.
Must-Know Garlic Safety
● Adverse effects: ○ bad breath ○ body odor ○ GI symptoms. ● Increased bleeding risk with: ○ NSAIDs ○ heparin ○ warfarin. ● Decreases effectiveness of: ○ cyclosporine ○ saquinavir (HIV).
Supplement Warnings
● St. John’s wort lowers effectiveness of oral contraceptives, cyclosporine, warfarin, digoxin, calcium channel blockers, steroids, and some HIV/cancer meds. ● Ginkgo/ginger/feverfew can also increase bleeding risk.
● Bleeding traps ○ warfarin/heparin ○ garlic/ginkgo/ginger/feverfew ○ bismuth subsalicylate caution. ● Electrolyte issues ○ laxatives ○ diuretics ○ steroids ○ amphotericin B. ● Do not crush/chew ○ delayed-release PPI granules. ● Separate from antacids ○ many drugs, especially tetracyclines and other meds with absorption issues.
