01.04 Essential NCLEX Meds by Class

So throughout the entire MedMaster course, we’re going to be giving you tips, tricks and reference sheets and things to be able to answer the most essential NCLEX questions and to understand medications much more. What this lecture is intended to do is to kinda give you an overview of questions that most commonly appear on the NCLEX and side effects and things that are most often seen. Okay, so, this isn’t a comprehensive lecture by any means. But, what this really is, it just outline some of the classes, some of the medications that most often that like, if you’re gonna see a medication on the NCLEX, there’s a high probability that it will be one of these medications and will be over one of these side effects. Okay, so, let’s go ahead and dive in.

The first medications we’re gonna talk about are gonna be Analgesics. We’re gonna talk about 3 different ones. We’re gonna talk about Aspirin, NSAIDs and Morphines. Okay, so, with Aspirin, a couple of things to keep in mind here, it actually works as a blood thinner. So, we don’t wanna give aspirin with other anticoagulants, if possible, okay? We don’t wanna thin out the blood too much and cause a risk of bleeding and things like that. It’s also important to stop taking before surgery. So, this would be true for aspirin, with plavix and different medications, like that. That if a patient is on blood thinner, we want to avoid taking that prior to surgery and that will depend based on the medication. But keep in mind that with aspirin, they’re not going to, unless there’s some sort of emergent situation, we would like our patient off aspirin prior to surgery. It’s also important to not give to children, or not to give too much to children with a viral infection because this could actually lead to Reye’s Syndrome. And we’ll get into this more in different lectures and things. Remember, Aspirin, think Reye’s Syndrome.

With NSAIDs. Okay, with NSAIDS are gonna be contraindicated with GI ulcers. The reason for that is the NSAIDs can actually lead to GI bleeding. Okay, so, with patients with GI complications, we want to avoid NSAIDs.

Wih Morphine. We’ll go into morphine in so much detail in another lecture. But, morphine is gonna be a CNS depressant. That’s kinda how it works. So, with CNS depression, you’re thinking decreased respiration, decreased heart rate, etc. We would want to monitor a patient’s respiration very closely and make sure that they’re breathing at a sustainable rate, okay. Because, morphine is going to further decrease that. If they are already breathing very low, pressure is low, heart rate is low, it’d be important to avoid morphine, if possible.

Okay, Anticonvulsants. There’s a lot of different anticonvulsants. But, one that you’re going to see most often is gonna be Dilantin. Now, one of our lectures we’ll talk a little more about dilantin and what the therapeutic levels are, and things like that. But one of the things that you’ll see, well, there’s two things that you’re gonna see with Dilantins. Its gonna be your therapeutic levels, which we’ll get into later and we’ll provide a cheat sheet about that. And another thing is going to be that it can cause gingival hyperplasia or just gum hyperplasia. So, it’s important to have regular dental check-ups for them to use things like soft bristle toothbrush, to be very careful about flossing and things like that. Because with this gingival hyperplasia, this can lead to very severe mouth disorders. Okay.

Anti-inflammatory / Steroids. So, there’s a lot of these. A lot of these are gonna end in -sone. Deltasone, Prednisone. These medications, so, one of the things that I would like to stress to you a lot in different lectures is going to be, when we’re giving things like hormones and electrolyte replacements, and things like that, we’re giving them to replace something. Okay, so, like, with steroids, we’re giving steroids because our adrenal glands are not producing steroids the way they need to be. Okay, so, in situations of like Addison’s Disease, that’s gonna be adrenal insufficiency. And so, what happens when we start giving these hormones back to these patients, is we can, it can result in the opposite end of the spectrum. With steroid replacement, that’s going to end up with like Cushing like symptoms. The buffalo hump, and things like that. So, with steroids, prednisone, deltasone, and different steroids, what can happen is we’re giving it because of adrenal insufficiency. Once we start replacing that, it can get to the point of too much with would end up in Cushing like symptoms. So, monitor for buffalo hump, monitor for Grave’s type disease. And this is true with all different kinds of hormone replacement type medications. And truly, with any medications, we’re giving a medication because there’s a problem. And what can happen is, when we give too much of that medication, we can cause the opposite problem. So, it’s very important. That’s kinda what monitoring your patient, assessing your patient for the side effect is all about. Okay, but specifically, with steroids, some of the things to keep in mind, are the steroids can cause immunosuppression, it can cause hyperglycemia, and they can cause osteoporosis. So, those are the three things I really want you to keep in mind with any steroid. And again, a lot of these will end in -sone. S-O-N-E. It’s the immunosuppresion, the hyperglycemia, and the osteoporosis.

Okay, with anti-coagulants, there’s a couple of anti-coagulants that you really just have to know. This is true with nursing and this is gonna be true with nursing school, clinicals, nursing pharmacology and during in med-surg, etc. You just have to know heparin and warfarin. Okay, heparin and warfarin are two major anticoagulants that work very differently but they’re both incredibly important to know. With heparin, we’re gonna be monitoring our aPTT and our antidote is gonna be Protamine Sulfate. With warfarin, we’re gonna be monitoring our PT and our INR, and we’re looking for therapeutic levels with that, depending on the patient’s condition. Okay, we’ll get into that later as well. And our antidote for warfarin is gonna be Vitamin K. Okay, so, keep those two anticoagulants in mind as well as their antidote. It’s very important.

Okay, there’s a couple of Anti-Parkinsonian drugs. For whatever reason, NCLEX really likes this Anti-Parkinsonians. The two that you need to know are gonna be Benzatropine, and this Benzatropine helps with extra pyramidal symptoms. There isn’t a cure for Parkinson’s, these drugs don’t cure Parkinson’s, what they do, is they help with some of the symptoms, basically. They help control symptoms. So, benzatropine helps with extrapyramidal symptoms, those extrapyramidal symptoms will be like a lip smacking, the pill rolling, you know, when you hear that type of symptoms on your patient, think Parkinsons automatically, the tongue and things like that. Another one is carbidopa/levodopa. This is a very important medication to know because it can actually cross the blood brain barrier. And this is really effective in the absence of tremors. So, those are two things to keep in mind with these two Anti-Parkinsonian medications.

With Beta Blockers, so, Beta Blockers. We have a much longer video and we talked a lot of different beta blockers throughout this course, but keep in mind, beta blockers, a lot of times, they’re gonna end with the suffix -olol. It’s important to not discontinue beta blockers abruptly, generally discontinue them slowly, kinda educate your patient about that and can masks the signs of hypoglycemia. So, if you have a patient who’s on beta blockers, especially if they already have a history of a you know, Diabetes or low blood sugars, that it is important to monitor their blood sugars especially while in the hospital.

Okay, so, potassium supplements. Again, like I said, with the steroids, when we give supplements, it’s important to keep in mind that we can have the opposite problem. And we know with potassium, hypokalemia is incredibly dangerous but hyperkalemia, as well, is incredibly dangerous for the heart. It can lead to lethal arrythmias. So, with potassium chloride, before giving potassium chloride supplement, make sure you check the lab, and if your most recent potassium level is several days old, it would be prudent of you to draw a repeat potassium level just to see where you’re at. If your potassium are already at 5.9, and you’re about to give 40 mEq of potassium, you can really run the risk of pushing your patient dangerously hyperkalemic. Okay, so, monitor your labs, check your labs before you give it and never give IV push. This medication burns and it needs to be given very slowly. So, never give an IV push. And then use caution with potassium-sparing diuretics like spironolactone, because spironolactone and other potassium-sparing diuretics are going to preserve potassium and drive up our potassium level. So then, as we’re doing that, we’re also giving potassium supplements, we need to be careful there. Also, do not administer to patient with renal failure and kinda just check with your physician first if your patient is in like stage 3 / 4 / 5 Renal Failure. Just kinda check with your physician and see if that’s something that they want to do.

So, some respiratory drugs to keep in mind. Again, remember, we’re talking, there’s a lot of respiratory drugs, we’re gonna talk about a lot of them. But, we’re gonna be talking about medications and you just have to know these different side effects for. One of these is theophylline. So, theophylline. I think I probably have only given theophylline once or twice, it’s not an incredibly common medication, it’s more common with neonates with helping them be able to breathe and things. But, we don’t really give it a lot with adults. But, theophylline, one thing to keep in mind is monitor for tachycardia. It works like a stimulant and it has similar effects of like caffeine. So, think, when you took a bunch of caffeine, you have palpitations, you might be breathing, you might have jitters. So, theophylline, think of it as if you have just taken up a huge amount of caffeine, you just drink 10 redbulls or something, what it would do to you. So, with your patient you wanna monitor for tachycardia after taking theophylline.

Okay. Cardiac Glycosides. The cardiac glycoside you really need to keep in mind is digoxin, right? The first thing I want you to keep in mind is the importance of assessing the pulse for 60 seconds prior to administration. You wanna check the pulse for a full minute and determine where the pulse is. And you don’t wanna give it if your pulse is under 60. Toxicity, toxicity, toxicity. This is a huge one for NCLEX. So, what will likely asks is a question something about your patient is experiencing. Yellow/green visual disturbances, you know, and then you’ll either have to identify that digoxin is the medication, that it’s side effect, etc. This is a good sign that your patient might be experiencing digoxin toxicity. So, you need to hold the medication, let the physician know that they’re experiencing this yellow/green halos and you probably draw dig- level and figured out where it’s at. And then you can treat the patient as needed.

Antihypertensive. So, we’re gonna talk specifically just about this one, magnesium sulfate. Magnesium sulfate can be used with pre-eclampsia. Remember, pre-eclampsia is like high blood pressure during pregnancy. I almost forgot the word pregnancy there for a second. So, but, it’s highblood pressure during pregnancy. So, what we’ll want to do, we’re gonna monitor deep tendon reflexes. We can actually lose deep tendon reflexes with magnesium sulfate. So, you wanna be very careful to monitor these deep tendon reflexes in these patients and you also want to assess for respiratory depression. Mag Sulfate can actually lead to respiratory depression, so you wanna monitor that prior to the patient, you know, getting into respiratory failure, or anything like that.

Another one here real quick, is diuretics. So, we’re gonna talk a lot about diuretics. And the biggest thing I want you to keep in mind with diuretics is going to be electrolyte levels, okay? With thiazide diuretics, loop diuretics and other diuretics, one of the things you’re gonna be monitoring foremost is going to be potassium wasting. These diuretics are going to rid the body of potassium. Okay. So, we’re gonna wanna monitor our potassium levels, make sure we’re not wasting or losing too much potassium. On the other hand, there’s a class of medication known as potassium sparing diuretics. The one that I want you to know is Spironolactone. And what this does, is it actually say, it does not waste that potassium, it keeps that potassium, we’ve talked about this just a second ago. But, you’re gonna wanna monitor your potassium level for the opposite effect, okay. Of having too much potassium, okay.

Psychotropic drugs. There’s a lot of Psychotropic drugs to know. But the biggest ones you really wanna keep in mind are gonna be lithium, MAOI’s and Disulfiram. So, lithium. The biggest thing I want you to keep in mind is gonna be that there’s a therapeutic range for it. It’s 0.8 - 1.2. We’ll talk about that a bit more. But you wanna be in that range in order for the drug to have the maximum effect in this for your patient. You’re also wanna increase fluid intake if the patient is taking lithium. With MAOI’s, monoamine oxidase inhibitors. The number one thing to keep in mind is going to be avoid foods that are high in tyramine. Now, prior to nursing school, you probably never even heard of tyramine. That’s okay. Tyramine can be found in things like aged cheeses, wine, pickled meats, things like that. So, just avoid foods that are high in tyramine. It can be detrimental to patient if they take, if they’re taking MAOI’s and using, eating foods like these. Another thing to keep in mind is that, with MAOI and other psychotropics and stuff, you want to have about a 14-day window between discontinuing the MAOI and starting like the SSRI or something like that. So, you really need that 14-day window where they’ve stopped the MAOI, wait about two weeks, then they can start their SSRI or their other psychotropic or anti-depressant or whatever. Another one is Disulfram. Disulfram is an awesome drug, I like it because we give it to patients who, it’s called Antibuse, I think that’s a really easy name to remember because it’s like anti-abuse, anti-alcoholic abuse. So, we wanna give it to patients who are alcoholics, try to help them stop drinking alcohol. So, because of this, they need to avoid alcohol and take up all kinds. Because if they take alcohol while using disulfram, they’re going to have this massive vomiting, the massive sickness, and everything, and that is to help them stop drinking. But because of that, they really have to take alcohol intake. They really need to be careful with mouthwashes and over the counter cough suppressants because these can also create this disulfram reaction.

Maternity drugs. One of the maternity drugs you need to know, you have to know is Oxytocin. So, one big thing to keep in mind about oxytocin, the purpose of oxytocin is to help the uterus contract. Okay, we’re trying to create this contraction of the uterus to help kinda push the baby out. Now, that’s gonna cause a whole lot of things we need to keep and watch with our baby. But also, you need to keep in mind that you need to assess the uterus for tetanic contraction, what that is, is it can create this constant state of contraction where the muscle does not relax. Normally, with contractions, just think, it’s kinda like flexing your muscle. You relax it, it rest, and it flexes again. What can happen with oxytocin or pitocin is that the muscle can go into this constant state of contraction which is very unhealthy for the patient. Okay, so keep that in mind. That’s what you are assessing for, with your patient taking oxytocin.

Antifungal. We’re just gonna talk about one medication here. We’re gonna talk about Amphotericin B. Some things to keep in mind here are, assess for hearing, this is true with like vancomycin, amphotericin, you’re gonna wanna assess for ototoxicity. And the way to do that is gonna be assess hearing and that can happen when you can get like a ringing in the ears, and that’s how you kinda assess ototoxicity. So, you wanna give it a IV Piggyback slow for a couple of hours, monitor for renal damage. So, when we talk about medications that can cause renal damage, one thing you’ll want to keep in mind is that we need to increase fluid intake. If we increase fluid intake, we’re going to help flash that through the kidneys and preserve kidney function. That’s true when we give dyes to our patient for like CT’s and things like that as we want to increase fluid intake, flash the medication out of the kidneys. We also monitor renal labs like BUN, Creatinine, Creatinine Clearance, etc., to monitor your renal function. You also will assess potassium levels again and can cause renal damage.

Okay, Anticholinergics. So, we have a very great lecture video that Tarang does and covers on your autonomic nervous system. But, we’ll talk really quickly about anticholinergic. What you need to keep in mind here is fight or flight system. You really need to understand the fight or flight system. If you don’t understand that, we can’t help you with ton. But once you understand the fight or flight system reaction, you can begin to understand anticholinergics much more. So, what things like atropine are going to do, is it’s gonna create this fight or flight response, okay. When we’re ready to fight, imagine a lion chasing. When a lion chases you, you don’t want your bowels to be flowing. So, your bowel motility is gonna slow down, your eyes are gonna dilate really large, you can see your surroundings, your heart rate is gonna be up, you’re gonna brochodilation, so you can breathe and get all the air you need to run away. So, when we give these anticholinergics, we’re going to have this fight or flight type response. So, with atropine, okay think, anticholinergic. GI motility is gonna slow. Again, we just talked about this, we just said this. Your eyes are going to dilate, and because of that, you’re gonna want to avoid glaucoma patients. Heart rate is gonna raise. Bronchodilation is going to occur. So, these are all things that you’re gonna do watch in patients that are receiving atropine. One thing that we also do with patients with end of life-type care, is we can give them atropine drops. And, we’ll give those atropine drops like under the tongue, one or two drops and that’s going to help with secretions. It’s gonna stop secretions, help them be able to breathe easier on their way out or as they’re very sick. Or just have a tremendous amount of secretions. One thing that you’ll see every year on my floor, we have new entrance coming and stuff, you see these atropine drops and we’ll put it right in the eye. Yes, optometrist use this to dilate pupils for eye exams. When we give it in an ICU type setting, we’re not giving it for the eyes. So, what will happen is, they’ll put it in the eye, these patient’s eyes will go into like 9 or 10, just so massively dilated, but that’s not what we’re giving it for an ICU. In ICU, we’re giving it to stop these secretions, okay. So, that’s atropine.

Oncology medications. Okay, just in general. This is just in general rule of thumb. When you’re giving oncology medication, you want to use extreme caution. Always wear glove and mask while mixing and administering, and you should not do this unless you’re really certified to give oncology medications.

Anti-Gout Medications. When you hear the word Allopurinol, think anti-gout, okay. There’s multiple gout medications, DMARDs and everything. But what we’re gonna talk about is allopurinol. With allopurinol, also, you wanna avoid organ meats. These organ meats are what may have lead to the gout, this purine, this high purine diet. So, with allopurinol, we’re going to avoid organ meats. We’re gonna avoid more purine. The patient will have increased urine output because we’re having them increase their urine intake. Okay, so. That’s kinda what you wanna keep in mind with allopurinol.

Okay, so last slide here, we’re gonna talk the difference between miotics and mydriatics. Okay. Miotics and mydriatics, okay, these are both ophthalmic medications, one to constrict the pupils, one to dilate the pupils. But one we use with glaucoma and one to avoid with glaucoma. Okay, miotics constrict, okay. MIOTIC - Constrict. Used with glaucoma and it help increase the outflow of aqueous humor. It’s like a help with glaucoma, that helps relieve that pressure in the eyeball and it helps the patient relieve that pain and be able to see better. Mydriatics, this dilate the pupil. So, we’re gonna avoid with glaucoma, because it can increase intraoccular pressure. We increase that intraocculae pressure, we run the risk of causing more symptoms of glaucoma. So, myotics constrict, used for glaucoma. Mydriatics dilate, avoid with glaucoma.

Okay, so, that’s kinda really it for this lecture. These are just highly likely medications that you can see on exams and on the NCLEX. If you have any questions, be sure to let us know. But I think this video will greatly assist you.