Pharmacology Essentials
Pharmacological and Parenteral Therapies is one of the most heavily weighted areas on the NCLEX-RN. You are not expected to know every drug. You are expected to recognize major drug classes, their main dangers and the nurse's checks before and after giving them. Learning drug suffixes and a few key safety rules gets you most of the way.
Key facts
- -olol: beta blockers. Check heart rate and blood pressure, and watch for bronchospasm in clients with asthma.
- -pril: ACE inhibitors. Watch for a dry cough, angioedema and hyperkalemia.
- -statin: lipid lowering. Report unexplained muscle pain.
- -azole (prazole): proton pump inhibitors, which reduce stomach acid.
- Digoxin: check the apical pulse. Early toxicity signs include nausea and visual changes.
- Opioids: assess respirations and sedation. Naloxone reverses them.
Cardiovascular drugs
Before giving beta blockers, calcium channel blockers or digoxin, check the heart rate and blood pressure, and hold the dose and notify the provider according to the parameters. Digoxin toxicity is more likely with hypokalemia, so potassium levels matter.
Anticoagulants carry bleeding risk. Teaching points include watching for unusual bruising or dark stools, using a soft toothbrush, and for warfarin, keeping vitamin K intake consistent rather than eliminating it.
Endocrine drugs
Insulin questions test timing and hypoglycemia. Rapid-acting insulin should be matched with a meal. Signs of hypoglycemia include shakiness, sweating, confusion and a fast heart rate. A conscious client receives fast-acting carbohydrate.
Levothyroxine is usually taken on an empty stomach at the same time every day. Signs of too much hormone look like hyperthyroidism: palpitations, heat intolerance and insomnia.
High-alert safety checks
Use the rights of medication administration and two identifiers every time. High-alert drugs such as insulin, heparin, opioids and concentrated electrolytes often need extra checks under facility policy.
When an answer choice asks you to hold a medication, ask whether an assessment finding makes that drug unsafe right now. That is often the key to pharmacology questions.
- Naloxone: opioid reversal
- Flumazenil: benzodiazepine reversal
- Protamine: heparin reversal
- Vitamin K: warfarin reversal
Anti-infectives and others
Aminoglycosides and vancomycin can damage the kidneys and hearing, so trough levels and kidney function are monitored. Always ask about allergies before the first dose of any antibiotic, and watch for anaphylaxis.
Lithium has a narrow therapeutic range. Dehydration and low sodium intake raise the risk of toxicity. Teach clients to keep fluid and salt intake steady.
Practice: 3 original questions
1. Before giving digoxin, the nurse finds an apical pulse of 52/min. What should the nurse do?
Answer and rationale
Correct: B. Digoxin slows the heart rate. A rate below the typical threshold of 60 in adults means the dose is held and the provider notified.
2. A client taking lisinopril reports swelling of the lips. What should the nurse do first?
Answer and rationale
Correct: B. Angioedema from an ACE inhibitor can block the airway. Assessing the airway and holding the medication are the priorities.
3. Which finding in a client receiving IV morphine is the priority?
Answer and rationale
Correct: B. Respiratory depression is the most dangerous effect of opioids and may require naloxone.
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