NR 293 Exam 2

Student Name

Chamberlain University

NR-293: Pharmacology for Nursing Practice

Prof. Name

Date

NR 293 Exam 2 Comprehensive Study Guide

Overview of Medication Safety, Indications, and Patient Education

This study guide is designed to assist nursing students in preparing for the NR 293 Exam 2. It emphasizes the clinical understanding of various drug classes, focusing on their therapeutic purposes, contraindications, potential adverse reactions, drug interactions, and patient teaching considerations. By reviewing these core concepts, students can enhance patient safety, improve therapeutic outcomes, and minimize risks associated with pharmacological therapy.

When studying each medication or drug class, it is essential to:

• Identify the primary therapeutic use (indications).
• Recognize conditions in which the drug should not be used (contraindications).
• Understand possible adverse effects and how to monitor them.
• Be aware of drug-drug, drug-food, and drug-herbal interactions.
• Provide comprehensive patient teaching tailored to the patient’s needs and condition.

Analgesics and Related Medications

Opioid Analgesics — Morphine (Class II Narcotic)

Category	Details
Indications	Relief of moderate to severe pain, including post-surgical pain, cancer-related pain, and injury-related pain.
Contraindications	Known hypersensitivity to morphine; conditions such as severe respiratory depression, acute or severe bronchial asthma, paralytic ileus; caution in patients with epilepsy, heart disease, liver or kidney impairment, or during pregnancy/lactation.
Adverse Effects	Respiratory depression, constipation, sedation, nausea/vomiting, hypotension, pruritus (itching), urinary retention, and potential for dependence.
Interactions	Should not be taken with MAOIs within 14 days; avoid alcohol and other CNS depressants; monitor for interactions with certain herbal supplements and vitamins.
Safety/Patient Teaching	Educate on high risk for addiction; advise against driving or operating heavy machinery until response is known; stress bowel regimen to prevent constipation; avoid alcohol; monitor for signs of overdose (extreme sleepiness, slow breathing).

Non-Opioid Analgesics — Acetaminophen

Category	Details
Indications	Management of fever and mild to moderate pain; preferred in patients who cannot take NSAIDs due to gastrointestinal risks.
Contraindications	Severe liver disease, known hypersensitivity; avoid in chronic alcohol use due to hepatotoxicity risk.
Adverse Effects	Rare at therapeutic doses; hepatotoxicity in overdose; allergic reactions; rare cases of blood dyscrasias.
Interactions	May increase bleeding risk when taken with warfarin; monitor INR closely; avoid excessive alcohol.
Safety/Patient Teaching	Do not exceed 3,000 mg/day for adults and 2,000 mg/day for elderly or those with liver disease; will not treat inflammation; read labels to avoid accidental overdose from combination products.

Benzodiazepines — Diazepam (Class IV Controlled Substance)

Category	Details
Indications	Anxiety disorders, muscle spasms, status epilepticus, and alcohol withdrawal symptoms.
Contraindications	Narrow-angle or untreated open-angle glaucoma, severe respiratory insufficiency, severe liver disease, myasthenia gravis, sleep apnea; pregnancy and breastfeeding.
Adverse Effects	Sedation, dizziness, confusion, fatigue, ataxia, risk of dependence and withdrawal symptoms.
Interactions	Avoid with MAOIs, theophylline, certain antidepressants, seizure medications, and phenothiazines.
Safety/Patient Teaching	Warn about risk of dependence; avoid alcohol; do not stop suddenly to prevent withdrawal; caution when operating machinery; avoid use in pregnancy/breastfeeding unless benefits outweigh risks.

Barbiturates — Phenobarbital

Category	Details
Indications	Management of seizures, sedation, and prevention of withdrawal symptoms in barbiturate dependence.
Contraindications	Acute intermittent porphyria, severe liver or respiratory disease, previous barbiturate hypersensitivity, concurrent sodium oxybate use.
Adverse Effects	Drowsiness, dizziness, headache, agitation, nausea/vomiting, loss of appetite, dependency potential.
Interactions	Potentiates CNS depressants; interacts with phenytoin, valproate, sodium oxybate, and various respiratory/pain medications.
Safety/Patient Teaching	Avoid alcohol; warn about sedation; do not discontinue abruptly; monitor mood for signs of depression or suicidal ideation.

Lipase Inhibitors — Orlistat

Category	Details
Indications	Long-term weight management in combination with reduced-calorie diet; suitable for patients with BMI ≥30 or ≥27 with comorbidities.
Contraindications	Pregnancy, chronic malabsorption syndrome, cholestasis, hypersensitivity to orlistat.
Adverse Effects	Oily stools, flatulence with discharge, fecal urgency, abdominal pain, possible liver injury, kidney stones.
Interactions	May reduce absorption of fat-soluble vitamins; interacts with cyclosporine, levothyroxine, anticoagulants, antidiabetics.
Safety/Patient Teaching	Take multivitamins 2 hours before or after orlistat; follow a low-fat diet to reduce GI side effects; report signs of liver injury (jaundice, dark urine).

CNS Stimulants — Methylphenidate Hydrochloride

Category	Details
Indications	Attention Deficit Hyperactivity Disorder (ADHD), narcolepsy.
Contraindications	Glaucoma, severe anxiety, tics or Tourette’s syndrome, hyperthyroidism, severe cardiovascular conditions.
Adverse Effects	Insomnia, decreased appetite, abdominal pain, tachycardia, hypertension, nervousness.
Interactions	Avoid with MAOIs, antihypertensives, anticoagulants, seizure medications, alcohol.
Safety/Patient Teaching	Risk of dependence; monitor blood pressure and heart rate; avoid late-day dosing to prevent insomnia; report chest pain, vision changes, or mood changes.

Neurologic and Psychiatric Medications

Ergot Alkaloids

Category	Details
Indications	Management of acute migraine headaches and cluster headaches; sometimes used postpartum to control bleeding.
Contraindications	Pregnancy, breastfeeding, peripheral vascular disease, coronary artery disease, uncontrolled hypertension, sepsis.
Adverse Effects	Nausea, vomiting, muscle pain, paresthesia, chest pain, elevated blood pressure.
Interactions	Avoid concurrent use with macrolide antibiotics, protease inhibitors, triptans, and potent CYP3A4 inhibitors due to risk of vasospasm and ischemia.
Safety/Patient Teaching	Do not exceed recommended dose; avoid during pregnancy; report severe chest pain or weakness; avoid smoking due to vasoconstrictive effects.

Phenytoin

Category	Details
Indications	Prevention and control of seizures; sometimes used for certain cardiac arrhythmias.
Contraindications	Sinus bradycardia, SA block, second/third-degree heart block, Adams-Stokes syndrome, hypersensitivity to hydantoins.
Adverse Effects	Gingival hyperplasia, nystagmus, ataxia, rash, hepatotoxicity, blood dyscrasias.
Interactions	Reduces effectiveness of oral contraceptives, warfarin, and corticosteroids; interacts with alcohol, cimetidine, isoniazid, and certain antibiotics.
Safety/Patient Teaching	Maintain consistent dosing; do not stop abruptly; maintain good oral hygiene to prevent gum overgrowth; monitor serum levels.

Levodopa-Carbidopa

NR 293 Exam 2

Category	Details
Indications	Treatment of Parkinson’s disease and Parkinson-like symptoms.
Contraindications	Narrow-angle glaucoma, history of melanoma, MAOI use within 14 days, severe cardiovascular or pulmonary disease.
Adverse Effects	Nausea, dyskinesia, orthostatic hypotension, compulsive behaviors, hallucinations.
Interactions	MAOIs, antipsychotics, isoniazid, high-protein meals (reduce absorption).
Safety/Patient Teaching	Take at regular intervals; do not stop abruptly; avoid high-protein meals near dosing; report uncontrolled movements or mood changes.

Benztropine

Category	Details
Indications	Adjunct therapy in Parkinson’s disease; management of extrapyramidal symptoms from antipsychotic drugs.
Contraindications	Glaucoma, myasthenia gravis, obstructive bowel disease, urinary retention.
Adverse Effects	Dry mouth, blurred vision, constipation, urinary retention, confusion, decreased sweating.
Interactions	Other anticholinergics, phenothiazines, tricyclic antidepressants.
Safety/Patient Teaching	Avoid overheating; maintain hydration; monitor for confusion or hallucinations; avoid alcohol.

Amantadine (Viral M2 Channel Inhibitor/Dopamine Agonist)

Category	Details
Indications	Prevention and treatment of influenza A; management of Parkinson’s disease and drug-induced extrapyramidal symptoms.
Contraindications	Untreated narrow-angle glaucoma, severe heart, kidney, or liver disease, epilepsy.
Adverse Effects	Dizziness, insomnia, nausea, orthostatic hypotension, mottled skin.
Interactions	Diuretics, anticholinergics, CNS stimulants.
Safety/Patient Teaching	Do not stop suddenly; avoid alcohol; monitor for mood changes; report urinary retention.

Risperidone

Category	Details
Indications	Schizophrenia, bipolar disorder, irritability in autism.
Contraindications	Hypersensitivity, caution in elderly with dementia (increased mortality risk), cardiovascular disease.
Adverse Effects	Weight gain, sedation, orthostatic hypotension, extrapyramidal symptoms, tardive dyskinesia.
Interactions	Carbamazepine, clozapine, fluoxetine, furosemide, levodopa.
Safety/Patient Teaching	Rise slowly from sitting; maintain hydration; monitor for involuntary movements; avoid overheating.

Haloperidol

Category	Details
Indications	Schizophrenia, Tourette’s disorder, severe behavioral problems.
Contraindications	Parkinson’s disease, severe CNS depression, coma.
Adverse Effects	Extrapyramidal symptoms, sedation, QT prolongation, neuroleptic malignant syndrome.
Interactions	CNS depressants, anticholinergics, QT-prolonging drugs.
Safety/Patient Teaching	Report muscle rigidity or fever immediately; avoid alcohol; do not stop abruptly.

MAOIs (Monoamine Oxidase Inhibitors)

Category	Details
Indications	Depression unresponsive to other treatments.
Contraindications	Cardiovascular disease, pheochromocytoma, severe liver/renal impairment.
Adverse Effects	Orthostatic hypotension, insomnia, hypertensive crisis with tyramine foods.
Interactions	SSRIs, sympathomimetics, tyramine-rich foods, many prescription drugs.
Safety/Patient Teaching	Avoid aged cheese, cured meats, fermented soy; report headache or palpitations; allow washout period before starting other antidepressants.

Mood Stabilizers, Antidepressants, and Other Psychiatric Medications

Lithium

Category	Details
Indications	Maintenance treatment of bipolar disorder; acute manic episodes.
Contraindications	Severe cardiovascular or renal disease, dehydration, sodium depletion, pregnancy (especially first trimester).
Adverse Effects	Tremor, polyuria, weight gain, nausea, hypothyroidism, toxicity (confusion, ataxia, seizures).
Interactions	Diuretics, NSAIDs, ACE inhibitors increase lithium levels; caffeine may decrease levels.
Safety/Patient Teaching	Maintain consistent fluid and sodium intake; monitor serum lithium levels regularly; recognize early signs of toxicity.

SSRIs (e.g., Fluoxetine, Sertraline)

Category	Details
Indications	Major depressive disorder, anxiety disorders, PTSD, OCD.
Contraindications	Concurrent MAOI use or within 14 days, known hypersensitivity.
Adverse Effects	Nausea, insomnia, sexual dysfunction, serotonin syndrome (agitation, hyperreflexia, fever).
Interactions	MAOIs, triptans, other serotonergic drugs, St. John’s wort.
Safety/Patient Teaching	May take several weeks for full effect; report symptoms of serotonin syndrome; avoid abrupt discontinuation.

Tricyclic Antidepressants (e.g., Amitriptyline)

Category	Details
Indications	Depression, neuropathic pain, migraine prevention.
Contraindications	Recent MI, MAOI use, narrow-angle glaucoma.
Adverse Effects	Anticholinergic effects (dry mouth, constipation), orthostatic hypotension, cardiac arrhythmias.
Interactions	MAOIs, alcohol, CNS depressants, anticholinergics.
Safety/Patient Teaching	Avoid alcohol; rise slowly from sitting; may cause drowsiness; monitor for suicidal thoughts.

Neuromuscular Blockers and Anesthetics

Succinylcholine

Category	Details
Indications	Skeletal muscle relaxation during surgery or intubation.
Contraindications	History of malignant hyperthermia, major burns or trauma (risk of hyperkalemia), penetrating eye injuries.
Adverse Effects	Apnea, bradycardia, malignant hyperthermia, hyperkalemia.
Interactions	Certain anesthetics, aminoglycosides, calcium channel blockers.
Safety/Patient Teaching	Used in controlled settings only; monitor for malignant hyperthermia postoperatively.

Malignant Hyperthermia (Management)

Category	Details
Indications	Medical emergency triggered by certain anesthetics or succinylcholine.
Treatment	Immediate discontinuation of triggering agents; administer dantrolene sodium; supportive cooling measures; treat metabolic acidosis.
Safety/Patient Teaching	Family members should inform providers of history; genetic counseling may be considered.

Neuromuscular Blocking Drugs — General

Category	Details
Indications	Facilitate intubation, optimize surgical conditions.
Contraindications	Similar to succinylcholine depending on class (depolarizing vs. non-depolarizing).
Adverse Effects	Hypotension, respiratory paralysis.
Safety/Patient Teaching	Used only under anesthesia; mechanical ventilation required until effects wear off.

Gout Medications

Allopurinol

Category	Details
Indications	Prevention of gout attacks, management of hyperuricemia in cancer therapy.
Contraindications	Hypersensitivity.
Adverse Effects	Rash (can be severe, e.g., Stevens-Johnson syndrome), GI upset, hepatotoxicity.
Interactions	Azathioprine, mercaptopurine, warfarin.
Safety/Patient Teaching	Take with food to minimize GI upset; maintain adequate hydration; report rash immediately.

Colchicine

Category	Details
Indications	Acute gout flares, prophylaxis of gout.
Contraindications	Severe renal, hepatic, or GI disease.
Adverse Effects	Diarrhea, abdominal pain, nausea, bone marrow suppression.
Interactions	CYP3A4 inhibitors, statins, certain antibiotics.
Safety/Patient Teaching	Take at first sign of flare; avoid grapefruit juice; monitor for muscle pain.

Anticoagulants and Antiplatelets

Warfarin

Category	Details
Indications	Prevention and treatment of thromboembolism, atrial fibrillation, mechanical heart valves.
Contraindications	Pregnancy, active bleeding, recent surgery with high bleeding risk.
Adverse Effects	Bleeding, purple toe syndrome.
Interactions	Many drug and food interactions (especially vitamin K–rich foods).
Safety/Patient Teaching	Maintain consistent vitamin K intake; monitor INR; avoid alcohol and risky activities.

Aspirin

Category	Details
Indications	Antiplatelet therapy, pain, inflammation, fever.
Contraindications	Children with viral illness (Reye’s syndrome), bleeding disorders, GI ulcers.
Adverse Effects	GI bleeding, tinnitus (salicylism), hypersensitivity reactions.
Interactions	Anticoagulants, NSAIDs, corticosteroids.
Safety/Patient Teaching	Take with food; report unusual bleeding; avoid use in children with flu/chickenpox.

Hematology

Folic Acid

Category	Details
Indications	Prevention and treatment of folate deficiency, prevention of neural tube defects.
Contraindications	Untreated vitamin B12 deficiency (can mask symptoms).
Adverse Effects	Rare; may cause rash, nausea.
Safety/Patient Teaching	Take before and during pregnancy; encourage folate-rich foods.

Iron Supplements

Category	Details
Indications	Iron-deficiency anemia.
Contraindications	Hemochromatosis, hemosiderosis, hemolytic anemia.
Adverse Effects	Constipation, dark stools, nausea.
Interactions	Decreased absorption with calcium, coffee, tea; increased with vitamin C.
Safety/Patient Teaching	Take with vitamin C for absorption; avoid taking with dairy; keep away from children (toxic in overdose).

NR 293 Exam 2