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A high-yield walkthrough of the medication classes, mechanisms, safety rules, and priority actions that show up again and again in nursing pharmacology.
How to Use This Guide
- Each tab groups related drug classes so you can compare them side-by-side (e.g., H2 blockers vs. PPIs).
- Tap any flip card to reveal its meaning; tap any scenario to reveal the answer; tap accordion headers to expand.
- Quick Checks (green boxes) let you self-test inline; the Mastery Quiz tab is a full run-through.
- Track your progress with the checklist below — it saves automatically in your browser.
The one rule to rule them all
In pharmacology, the most-tested question is not "what drug?" but "what do I do first?" When a patient is unstable — respiratory depression, anaphylaxis, severe hypotension, uterine rupture, QT prolongation — the answer is almost always stop the drug / reverse it, then call for help.
Three-Day Study Plan
- Day 1: Analgesics & Opioids → Anti-Infectives. Focus on the MOA × safety pairs (e.g., opioid ↔ naloxone, warfarin ↔ metronidazole).
- Day 2: GI & Antiemetics → Respiratory → Neuro & Psych. Drill the "never stop abruptly" list and the narrow-window drugs.
- Day 3: Hormones → Fluids & TPN → Med Safety (pharmacokinetics + administration). Finish with the Mastery Quiz; target 90%+.
Mastery Checklist
Check off each objective as you master it. Progress saves automatically in this browser.
0 / 0 mastered (0%)
- NSAIDs — COX inhibition, GI/renal risks, acetaminophen as the safer alternative
- Acetaminophen — hepatotoxicity, max dose, acetylcysteine antidote
- Opioids — RR check, constipation, taper, toxicity triad + naloxone
- Gout — allopurinol for prevention vs. NSAIDs/colchicine for acute attacks
- Antibiotic principles — C. diff, birth-control interaction, anaphylaxis, side effect vs. allergy
- Bactericidal vs. bacteriostatic + class examples
- Sulfonamides (TMP-SMX) — UTI use, pregnancy avoidance
- Macrolides / fluoroquinolones / aminoglycosides / glycopeptides — key risks
- Metronidazole (metallic taste, warfarin), antiretrovirals (adherence), nystatin (swish & swallow)
- H2 blockers vs. PPIs vs. sucralfate; loperamide contraindications
- Antiemetics — metoclopramide (tardive dyskinesia) & ondansetron (QT)
- Bulk-forming laxatives (psyllium) — must be taken with water
- Albuterol (rescue) vs. fluticasone (controller) + correct inhaler technique
- Ipratropium (soy allergy), montelukast (black box), theophylline (narrow window)
- Lithium — narrow therapeutic window, kidney excretion, toxicity triggers
- Antipsychotics (EPS), TCAs (2nd line), benzodiazepines (flumazenil), diphenhydramine (anticholinergic)
- Corticosteroids — taper (adrenal crisis), long-term effects
- Oxytocin, testosterone, estradiol, finasteride, sildenafil safety points
- IV potassium (never push), IV fluid tonicity, TPN hyperglycemia & infection
- ADME, first-pass effect, loading doses, routes, crush rules, 6 rights
- Antidote pairs + drugs you must never stop abruptly
Analgesics & Opioids
NSAIDs, acetaminophen, opioids, their antidotes, and gout therapy — the pain-management cornerstones and their biggest dangers.
NSAIDs (ibuprofen, naproxen, ketorolac)
- MOA: inhibit the COX-1 and COX-2 enzymes, reducing prostaglandin synthesis → less pain, fever, and inflammation.
- Contraindications: peptic ulcer disease (PUD) and chronic kidney disease — NSAIDs irritate the GI lining and reduce renal perfusion.
- Adverse effects: gastric ulcers, GI bleeding (watch for positive fecal occult blood), and kidney injury.
- Key teaching: for a patient with gastric or renal problems, acetaminophen is the safer analgesic because it does not disrupt the stomach lining or kidneys.
Think "COX blocks the aches": NSAIDs block CycloOXygenase → fewer prostaglandins → less pain & swelling. Same enzyme that protects the stomach (COX-1), which is why ulcers are the trade-off.
Critical Safety
Ketorolac is an NSAID — it is not a "gentle" option. Avoid in CKD and PUD just like any other NSAID. Question the order rather than "giving a smaller dose."
Acetaminophen (Tylenol)
- Mechanism: central analgesic/antipyretic — no GI or renal effects, making it first choice in PUD and kidney disease.
- Toxic metabolite: overdose depletes glutathione, allowing NAPQI to damage the liver → hepatotoxicity.
- Antidote: acetylcysteine (replenishes glutathione, neutralizes NAPQI).
- Dosing limits: 4 g/day in healthy adults; 2 g/day in at-risk patients (liver disease, chronic alcohol use, malnutrition).
High-Yield: acetaminophen is hidden in many combination products (cold remedies, opioid-combo pills). Teach patients to read every label to avoid accidental overdose.
Opioids (morphine, codeine, hydromorphone)
- Priority assessment: respiratory rate before, during, and after administration. Hold if RR < 12/min and notify the provider.
- Most common side effect: constipation — it does not diminish with time. Manage with fluids, fiber, and a stool softener/laxative.
- Other effects: orthostatic hypotension (change positions slowly), sedation (avoid driving), and suppression of the cough reflex.
- Discontinuation: never stop abruptly — taper gradually to avoid withdrawal (muscle aches, sweating, insomnia, GI upset).
- COPD caution: opioids further depress an already-compromised respiratory drive — assess carefully and question the order if needed.
- Never combine: two opioids (or any CNS depressants) cause additive respiratory depression and overdose risk.
Toxicity Triad
Overdose = respiratory depression + pinpoint pupils (miosis) + decreased LOC. Give naloxone immediately. Naloxone is shorter-acting than most opioids — the patient may need repeat doses.
Gout: Allopurinol
- MOA: inhibits xanthine oxidase, lowering uric acid production.
- Role: long-term prevention, NOT acute attack treatment (acute flares use NSAIDs or colchicine). Continue even when asymptomatic.
- Teaching: drink plenty of water (prevents kidney stones); avoid purine-rich foods (shellfish, red meat, organ meats, alcohol).
- Report immediately: fever, sore throat, or rash — possible Stevens-Johnson Syndrome, a life-threatening hypersensitivity reaction.
Do Not Confuse
Allopurinol prevents gout by lowering uric acid; it does not relieve the pain of an active flare. A patient mid-flare needs an anti-inflammatory (NSAID/colchicine), not just their allopurinol.
Clinical Scenario
A patient who received IV morphine is found somnolent with a respiratory rate of 7 and pinpoint pupils.
Tap to reveal the priority action
Administer naloxone to reverse the opioid, then notify the provider. This is the classic opioid-toxicity triad. Expect improved breathing, alertness, and pupil dilation — and stay ready to redose, since naloxone wears off before many opioids do.
Quick Check
Which patient should NOT receive ibuprofen for a headache?
Ibuprofen is contraindicated in PUD — it worsens ulcers and can cause GI bleeding. Acetaminophen is the safer choice.
Anti-Infectives
General antibiotic principles plus the major classes — their mechanisms, side effects, and the safety flags each one is famous for.
Antibiotic Principles (Apply to Every Class)
- C. difficile: antibiotics wipe out normal gut flora, allowing C. diff to overgrow → severe watery diarrhea. Report new diarrhea during therapy.
- Contraception interaction: antibiotics can reduce hormonal-contraceptive effectiveness — teach a backup method (e.g., condoms) during treatment.
- Anaphylaxis: wheezing, hives, hypotension → stop the infusion, call the provider, give epinephrine.
- Side effect vs. allergy: side effects are expected and predictable; allergic reactions are immune-mediated, unexpected, and potentially life-threatening.
- Finish the full course — stopping early breeds resistance.
Bactericidal vs. Bacteriostatic
| Action | Meaning | Examples |
|---|---|---|
| Bactericidal | Kills bacteria directly | Penicillins, vancomycin, fluoroquinolones, gentamicin |
| Bacteriostatic | Stops growth; immune system clears the rest | Macrolides, tetracyclines, sulfonamides |
"CIDAL = kill" (think homi-CIDAL). Bacteriostatic drugs stall the bacteria so your own immune system can finish the job.
Sulfonamides — Sulfamethoxazole / TMP-SMX (Bactrim)
- Use: most commonly prescribed for urinary tract infections (also respiratory infections and PCP prophylaxis).
- Safety: avoid in the first trimester of pregnancy (birth-defect risk); use caution in kidney disease (higher toxicity risk).
Macrolides (azithromycin, erythromycin, clarithromycin)
- Recognition: end in "-mycin".
- MOA: bacteriostatic — bind the 50S ribosomal subunit to block bacterial protein synthesis.
- Use: respiratory infections; a common penicillin alternative.
Careful: gentamicin is an aminoglycoside (also ends in "-mycin") but is bactericidal at the 30S subunit — don't lump all "-mycin" drugs as macrolides.
Fluoroquinolones (ciprofloxacin, levofloxacin, moxifloxacin)
- Recognition: end in "-oxacin"; bactericidal (inhibit DNA replication).
- Absorption trap: antacids with calcium/magnesium/aluminum, and iron, chelate the drug. Space doses — take the antibiotic 2 hours before or 6 hours after antacids/iron. Avoid dairy close to the dose.
- Adverse effect: tendonitis and tendon rupture (especially the Achilles) — higher risk in older adults and those on corticosteroids.
Aminoglycosides — Gentamicin
- MOA: bactericidal — binds the 30S ribosomal subunit.
- Two critical toxicities: nephrotoxicity (rising BUN/creatinine, falling urine output) and ototoxicity (tinnitus, hearing loss, vertigo).
- Monitoring: peak and trough drug levels.
Vancomycin (glycopeptide)
- Red Man Syndrome: rapid infusion → histamine release → red flushing of face/neck/chest + itching. Not a true allergy. Slow or stop the infusion; give diphenhydramine if ordered.
- Prevention: infuse over at least 60 minutes.
- Toxicities: nephrotoxicity (oliguria, rising creatinine) and ototoxicity — monitor peak/trough levels and renal function.
Metronidazole (antiprotozoal / anaerobic)
- Expected side effects: GI upset, metallic taste, and dry mouth — reassure the patient these are normal and resolve after treatment.
- Key interaction: metronidazole increases warfarin's effect → higher bleeding risk — monitor INR and expect a warfarin dose adjustment.
Antiretrovirals (ART for HIV) & Nystatin
- ART #1 priority: adherence. Regimens use 2–3 medications; missed doses → viral resistance → treatment failure. Take with food to improve absorption; monitor liver enzymes and CD4 count.
- Nystatin (antifungal): binds ergosterol in the fungal membrane → cell death. For oral thrush: swish and swallow, then nothing by mouth for 30 minutes. Never given IV (too toxic).
Clinical Scenario
Ten minutes into a rapid IV vancomycin infusion, the patient's face, neck, and upper chest turn red and blotchy, and they report itching.
Tap to reveal the first action
This is Red Man Syndrome from too-rapid infusion — not anaphylaxis. Slow or stop the infusion, notify the provider, and give diphenhydramine if ordered. Prevent it next time by infusing over at least 60 minutes.
Quick Check
A patient on ciprofloxacin wants to take a calcium antacid for heartburn. Best instruction?
Calcium/magnesium/aluminum antacids and iron chelate fluoroquinolones, cutting absorption. Space the doses apart.
GI & Antiemetics
Acid control, mucosal protection, diarrhea management, nausea drugs, and laxatives — plus the toxicities each is known for.
Acid Control: H2 Blockers vs. PPIs vs. Sucralfate
| Drug | Class | MOA | Notes |
|---|---|---|---|
| Famotidine (-tidine) | H2 receptor antagonist | Blocks H2 receptors on parietal cells → less acid | Milder GERD; less potent than PPIs |
| Omeprazole (-prazole) | Proton pump inhibitor | Irreversibly blocks the H+/K+ ATPase proton pump | More potent; GERD, ulcers, Zollinger-Ellison |
| Sucralfate | Mucosal protectant | Coats the ulcer against acid/pepsin | Does NOT lower acid; empty stomach (1 hr before meals) |
Endings tell the class: -tidine = H2 blocker · -prazole = PPI. A PPI shuts down the "pump" itself, which is why it is the stronger acid suppressant.
Do Not Confuse
Sucralfate does not neutralize or reduce acid — it only protects the ulcer surface. It needs an empty stomach so the coating can adhere where the ulcer is.
Antidiarrheals — Loperamide
- MOA: slows bowel motility.
- Contraindicated in: infectious diarrhea, bloody stools, and C. diff — slowing motility traps the pathogen longer and prevents the body from clearing it.
- Concept: with an infection, diarrhea is the body's defense — don't shut it off.
Antiemetics — Metoclopramide & Ondansetron
- Metoclopramide (prokinetic/dopamine blocker): the most serious adverse effect is tardive dyskinesia — repetitive involuntary lip-smacking and tongue movements that can be irreversible. Report immediately.
- Ondansetron (5-HT3 antagonist): used for chemotherapy-induced, post-op, and pregnancy-related nausea. IV use can cause QT prolongation → life-threatening arrhythmias — stop the infusion if QT lengthens.
Critical Safety
If a patient on IV ondansetron develops QT prolongation with lightheadedness/dizziness, stop the infusion immediately and notify the provider. Never continue an infusion through a serious cardiac adverse effect.
Bulk-Forming Laxatives — Psyllium
- Critical teaching: take with at least 8 oz of water per dose. Without enough fluid, psyllium swells in the GI tract and can worsen constipation or cause obstruction.
- IBS caution: reintroduce gradually to limit gas and bloating.
Quick Check
A patient with infectious diarrhea and bloody stools is ordered loperamide. The nurse should:
Slowing motility in infectious or bloody diarrhea traps the pathogen and prolongs the illness. Hold and clarify.
Respiratory
Rescue vs. controller inhalers, bronchodilators, and the asthma/COPD medications — plus proper inhaler technique.
Albuterol — Short-Acting Beta-2 Agonist (SABA)
- MOA: stimulates beta-2 receptors in bronchial smooth muscle → bronchodilation. Onset 5–15 minutes.
- Use: acute asthma attacks and exercise-induced bronchospasm (take 15–30 minutes before exercise). PRN only — not a scheduled daily med.
- Expected side effects: tachycardia, palpitations, tremors (beta-2 receptors also live in the heart).
- Red flag: needing it more than 2×/week → poorly controlled asthma → notify provider.
Fluticasone — Inhaled Corticosteroid (ICS)
- Role: controller — daily prevention, not for acute attacks. (Use albuterol for acute bronchospasm.)
- Side effect: oral candidiasis (thrush) — white patches in the mouth. Prevent by rinsing the mouth with water after every use.
- Order matters: when using both, take the bronchodilator (albuterol) first to open airways, then the steroid so it penetrates deeper.
Rescue vs. Controller
Albuterol = fire extinguisher (fast, for the emergency). Fluticasone = smoke detector battery (daily, prevents the emergency). Know which is which — it is one of the most-tested distinctions.
Ipratropium — Anticholinergic Bronchodilator
- MOA: blocks muscarinic receptors in the airways → reduces bronchospasm and mucus secretion. Primarily for COPD.
- High-yield safety: inhaler formulations contain soy lecithin — ask about soy or peanut allergy before giving.
Montelukast — Leukotriene Receptor Antagonist
- MOA: blocks leukotrienes → less bronchoconstriction and airway inflammation. Used for prevention (asthma, allergic rhinitis) — not for acute attacks.
- Black box warning: serious psychiatric effects — mood changes, agitation, depression, suicidal thoughts. Report any mood change to the provider immediately.
Theophylline — Methylxanthine Bronchodilator
- Narrow therapeutic window — requires blood-level monitoring.
- Expected side effects: tachycardia, palpitations, arrhythmias.
- Toxicity: nausea, vomiting, restlessness, irritability, tremors, and seizures (resembles caffeine overdose).
Methylxanthine = "liquid caffeine." Picture the toxicity as a caffeine OD: jittery, tachycardic, and (at the extreme) seizing.
Inhaler Technique (Metered-Dose Inhaler)
- Shake the canister; remain upright.
- Exhale gently, then inhale slowly and deeply.
- Hold your breath 5–10 seconds.
- Wait 1–2 minutes before a second puff.
Spacers
A spacer holds the aerosol so particles slow down — giving the patient more time to inhale and getting more medication into the lungs (less in the mouth/throat). Great for kids, older adults, and anyone with poor technique.
Quick Check
A patient has both albuterol and fluticasone inhalers. Correct order during an acute attack?
Bronchodilator first opens the airways, then the steroid penetrates deeper. Reversing the order wastes the steroid.
Neuro & Psych
Mood stabilizers, antipsychotics, antidepressants, antihistamines, and benzodiazepines — the CNS drugs and their monitoring.
Lithium — Mood Stabilizer
- Therapeutic range: 0.6–1.2 mEq/L (narrow window — needs monitoring).
- Excretion: by the kidneys. Rising creatinine → reduced clearance → accumulation and toxicity → hold and notify the provider.
- Toxicity triggers: dehydration, low-sodium diet, and NSAIDs all raise lithium levels. Encourage consistent fluid and sodium intake.
- Onset: takes days to weeks for full effect — stay consistent.
Antipsychotics — Risperidone (2nd-gen / atypical)
- EPS symptoms to report: abnormal face/arm/leg movements, muscle stiffness, tremors, restlessness (akathisia), and spasms (dystonia).
- Discontinuation: never stop abruptly → withdrawal symptoms and rebound psychosis.
- Side effect: weight gain and metabolic changes — address concerns with the provider rather than stopping on their own.
Tricyclic Antidepressants (TCAs) — amitriptyline, nortriptyline
- Place in therapy: second-line — used when SSRIs (first-line) fail or aren't tolerated.
- Profile: more anticholinergic effects and sedation than SSRIs; dangerous in overdose (cardiac arrhythmias).
- Off-label: chronic pain, neuropathy, migraine prevention.
Diphenhydramine — First-Generation Antihistamine
- Dual action: blocks H1 histamine receptors (allergy) and has anticholinergic effects.
- Anticholinergic side effects: urinary retention, dry mouth, constipation, tachycardia, blurred vision.
- Caution: worsening asthma; glaucoma (raises intraocular pressure); high fall/confusion risk in older adults (Beers Criteria).
- Bonus use: its anticholinergic action can reduce Parkinson's tremors by countering the acetylcholine excess from dopamine loss.
Benzodiazepines — Diazepam
- Overdose antidote: flumazenil — competitively blocks benzodiazepine receptors and reverses CNS depression.
Antidote pairs (know cold): opioids → naloxone · acetaminophen → acetylcysteine · benzodiazepines → flumazenil.
Quick Check
Which factor increases a patient's lithium toxicity risk?
Dehydration and NSAIDs reduce renal lithium clearance, raising levels toward toxicity. Encourage consistent fluids and sodium.
Hormones
Corticosteroids, reproductive hormones, and the smooth-muscle and prostate drugs — each with a signature safety point.
Corticosteroids — Prednisone (systemic)
- Never stop abruptly: long-term use suppresses the adrenal glands → abrupt stop = adrenal crisis (severe hypotension, cardiovascular collapse). Taper gradually.
- Long-term effects: hyperglycemia, weight gain, moon face, osteoporosis (supplement calcium/vitamin D), GI irritation (take with food), and increased infection risk (immunosuppression).
- Mindset: steroids manage symptoms — they don't cure the underlying disease.
Oxytocin — Labor & Delivery
- Effect: stimulates uterine smooth muscle → strong, regular contractions (also used postpartum for hemorrhage control).
- Emergency: severe, constant abdominal pain + rigid abdomen during infusion = possible uterine rupture → stop the infusion immediately and notify the provider.
Critical Safety
During oxytocin, severe abdominal pain is never "normal labor pain." Stop the drip, call for help, and assess maternal vitals and fetal status. Do not increase the rate.
Testosterone & Estradiol
- Testosterone (androgen): in female patients, watch for virilization — deepening voice, increased body hair, clitoral enlargement, menstrual changes. Report to the provider (dose may need adjusting).
- Estradiol (estrogen): contraindicated with a history of thromboembolic events (DVT, PE, stroke). No smoking — smoking sharply raises clot, stroke, and MI risk on estrogen.
Finasteride — 5-Alpha Reductase Inhibitor (BPH)
- MOA: reduces DHT → shrinks the prostate. Takes weeks to months for full effect.
- If unable to empty the bladder: refer to the provider for lab work and a prostate exam — don't just reassure or double the dose.
- Teratogenic — no handling by pregnant people; no blood donation while taking it.
Sildenafil — PDE-5 Inhibitor (erectile dysfunction)
- Absolute contraindication: nitrates (nitroglycerin, isosorbide). Both cause vasodilation; together → severe, life-threatening hypotension. No dose adjustment makes it safe.
Critical Safety
Sildenafil + nitroglycerin is a "never" combination. Always ask about nitrate use before giving a PDE-5 inhibitor, and hold + notify the provider if there is any overlap.
Clinical Scenario
A patient on long-term prednisone tells you they stopped taking it three days ago "because they feel fine now."
Tap to reveal the priority action
Notify the provider immediately. Abrupt corticosteroid withdrawal can trigger adrenal crisis — life-threatening hypotension. Prednisone must be tapered gradually; feeling better is not a reason to stop cold.
Fluids & TPN
Electrolyte safety, IV fluid tonicity, and total parenteral nutrition — the "small mistakes, big consequences" corner of nursing.
IV Potassium — The Safety Classic
- Rule: never IV push or bolus. Infuse slowly (about 10–20 mEq/hour) and always diluted.
- Why: rapid potassium → cardiac arrest and fatal arrhythmias. Monitor with continuous cardiac monitoring.
Critical Safety
Potassium chloride given IV push = cardiac arrest. This is one of the single most-tested medication-safety rules in nursing. Also question potassium in anyone with renal failure.
IV Fluid Tonicity
| Type | Example | Purpose |
|---|---|---|
| Isotonic | 0.9% NaCl, Lactated Ringer's | Fluid resuscitation without shifting compartments |
| Hypotonic | 0.45% NaCl | Lowers elevated sodium (hypernatremia) by shifting water into cells |
| Hypertonic | 3% NaCl | Treats severe hyponatremia / cerebral edema (pulls water out of cells) |
Memory Hook
Hypotonic = "hypo" pulls water INTO cells (treats hypernatremia). Hypertonic = pulls water OUT of cells (treats cerebral edema). Isotonic = stays put (resuscitation).
Total Parenteral Nutrition (TPN)
- Most frequent complication: hyperglycemia — TPN's high dextrose content. Monitor glucose frequently; sliding-scale insulin may be needed.
- Infection risk: the high glucose is an ideal medium for bacteria/fungi. Fever, chills, or redness at the line site = line infection → strict aseptic technique for all line care.
Quick Check
Which IV-fluid choice is correct for a patient with hypernatremia?
Hypotonic fluid dilutes the extracellular space and shifts water into cells, lowering serum sodium. Hypertonic saline would make it worse.
Med Safety: Pharmacokinetics & Administration
How drugs move through the body (ADME) and how to give them safely — the fundamentals behind every other tab.
Pharmacokinetics — ADME
A → D → M → E = Absorption → Distribution → Metabolism → Excretion
- Absorption: drug enters the bloodstream from the administration site (first step).
- Distribution: drug travels via blood to target tissues.
- Metabolism: breakdown, primarily in the liver.
- Excretion: elimination, primarily by the kidneys (urine).
First-Pass Effect
- Definition: an oral drug is absorbed from the gut → travels to the liver via the portal vein → the liver metabolizes part of it before it reaches the systemic circulation → reduced bioavailability.
- Liver disease: less metabolism → more drug reaches the blood → higher toxicity risk.
- IV route: bypasses first-pass metabolism (100% bioavailability). Sublingual also largely bypasses it (e.g., nitroglycerin for chest pain).
Routes, Loading Doses, and Names
- Speed of onset (fastest → slowest): IV > IM > subcutaneous > oral. IV = immediate, 100% bioavailability.
- Loading dose: a high initial dose to rapidly reach therapeutic levels (for long-half-life drugs or when speed is critical); maintenance doses follow.
- Generic vs. trade name: the generic name is the same active ingredient regardless of manufacturer; a trade name belongs to one maker. Both are FDA-approved and equally effective.
Safe Administration Rules
- 6 Rights: right patient (2 identifiers), drug, dose, route, time, documentation — verify against the MAR and check allergies/contraindications first.
- Never crush: enteric-coated (EC), sustained-release (SR), and extended-release (ER/XR) forms — crushing causes dose dumping (entire dose released at once).
- Pediatric liquids: use an oral syringe for accuracy — never a kitchen spoon.
- Sublingual: bypasses first-pass metabolism for fast action (nitroglycerin under the tongue).
Antidotes & "Never Stop Abruptly"
Opioids
Tap
Naloxone
Reverses respiratory depression & sedation
Acetaminophen
Tap
Acetylcysteine
Replenishes glutathione, neutralizes NAPQI
Benzodiazepines
Tap
Flumazenil
Reverses CNS depression
Never stop abruptly: corticosteroids (adrenal crisis) · opioids (withdrawal) · antipsychotics (rebound psychosis). Always taper under supervision.
Quick Check
Which medication must NOT be crushed before administration?
Crushing extended/sustained-release forms dumps the whole dose at once, risking overdose. EC coatings also must not be crushed.
Mastery Quiz
A concept-based check across every tab. Aim for 90%+ before you call it mastered.
Pharmacology Core Concepts
Question 1
Which mechanism explains how ibuprofen and other NSAIDs reduce pain, fever, and inflammation?
Correct! NSAIDs block COX-1/COX-2, lowering prostaglandins — the mediators of pain, fever, and swelling. This is the shared MOA of ibuprofen, naproxen, ketorolac, and aspirin at anti-inflammatory doses.
Question 2
A patient with a history of peptic ulcer disease asks for an OTC pain reliever. Which is the safest choice?
Correct! Acetaminophen does not disrupt the gastric lining or kidneys, unlike NSAIDs. It is the preferred analgesic for patients with PUD or renal impairment.
Question 3
Which patient is at highest risk for acetaminophen-induced liver injury?
Correct! Chronic alcohol use, liver disease, and malnutrition increase the risk of acetaminophen hepatotoxicity (via the toxic metabolite NAPQI). Max daily dose is lower (2 g/day) for at-risk patients; the antidote is acetylcysteine.
Question 4
A patient is unresponsive with pinpoint pupils and a respiratory rate of 6 after receiving an opioid. What should the nurse give first?
Correct! Respiratory depression + pinpoint pupils + decreased LOC is the opioid-toxicity triad. Naloxone is the opioid antagonist. Remember it is shorter-acting than many opioids, so the patient may need repeat doses.
Question 5
Which side effect of morphine never fully resolves with continued use and requires a proactive bowel regimen?
Correct! Constipation is the most common opioid side effect and does NOT diminish over time. Prevent it with fluids, fiber, and a stool softener or stimulant laxative.
Question 6
A patient on combined oral contraceptives starts a broad-spectrum antibiotic. What teaching is essential?
Correct! Antibiotics can reduce hormonal-contraceptive effectiveness. Teach a backup method during treatment to prevent unintended pregnancy.
Question 7
Severe, watery diarrhea that begins during antibiotic therapy most likely indicates which problem?
Correct! Antibiotics disrupt normal flora, allowing C. diff to overgrow and cause severe diarrhea/colitis. Report new or worsening diarrhea during therapy.
Question 8
A patient develops hives, wheezing, and hypotension minutes after an IV antibiotic is started. Priority action?
Correct! Wheezing, hives, and hypotension are anaphylaxis — stop the drug immediately, call for help, and give epinephrine. Allergic reactions are immune-mediated and life-threatening, unlike expected side effects.
Question 9
Which statement correctly classifies antibiotic action?
Correct! Bactericidal agents kill directly (vancomycin, penicillins, fluoroquinolones, gentamicin). Bacteriostatic agents stop growth so the immune system can clear the rest (macrolides, tetracyclines, sulfonamides).
Question 10
A patient on ciprofloxacin should avoid taking which of these within 2 hours of the antibiotic dose?
Correct! Calcium/magnesium/aluminum antacids and iron chelate fluoroquinolones, reducing absorption. Space them — antibiotic 2 hours before or 6 hours after.
Question 11
A patient develops red flushing of the face and neck during a rapid IV vancomycin infusion. What is the best action?
Correct! Red Man Syndrome is histamine release from rapid infusion — not a true allergy. Slow/stop the infusion and consider diphenhydramine. Prevent by infusing over at least 60 minutes.
Question 12
Which finding should the nurse report promptly during gentamicin therapy?
Correct! Aminoglycosides cause ototoxicity (tinnitus, hearing loss, vertigo) and nephrotoxicity (rising BUN/creatinine). Monitor peak/trough levels and renal function.
Question 13
Sulfamethoxazole should be avoided in which patient?
Correct! Sulfamethoxazole can increase birth-defect risk and is avoided in pregnancy, especially the first trimester. It remains a go-to for UTIs in non-pregnant patients.
Question 14
A patient needs rapid relief of acute bronchospasm. Which inhaler should they use?
Correct! Albuterol is the rescue bronchodilator with onset in 5–15 minutes. Fluticasone and montelukast are controllers for prevention, not acute relief.
Question 15
A patient on inhaled fluticasone develops white patches in the mouth. What prevents this?
Correct! White patches = oral candidiasis (thrush) from local immunosuppression. Rinsing the mouth after each use washes residual steroid off the mucosa.
Question 16
A patient on montelukast reports new, persistent low mood and thoughts of self-harm. What should the nurse do?
Correct! Montelukast carries a black-box warning for serious psychiatric effects including suicidal thoughts. Any mood change must be reported to the provider immediately.
Question 17
Which finding most suggests theophylline toxicity?
Correct! Theophylline has a narrow window. Toxicity looks like caffeine overdose: nausea, vomiting, restlessness, tremors, and seizures. Tachycardia/palpitations are expected side effects, not necessarily toxicity.
Question 18
A patient on lithium has a creatinine of 2.8 mg/dL. What is the priority action?
Correct! Lithium is cleared by the kidneys. Rising creatinine means reduced clearance and lithium accumulation → toxicity. Hold and notify immediately (therapeutic range 0.6–1.2 mEq/L).
Question 19
A patient on long-term prednisone says they plan to stop it now that they feel better. Best response?
Correct! Abrupt corticosteroid withdrawal can cause adrenal crisis — life-threatening hypotension. Prednisone suppresses the adrenal glands and must be tapered slowly.
Question 20
Which drug combination is an absolute contraindication?
Correct! Sildenafil + nitrates causes severe, life-threatening hypotension (both are vasodilators). This is an absolute contraindication — no dose adjustment makes it safe.
Question 21
A patient in labor on IV oxytocin reports severe, constant abdominal pain and the abdomen feels rigid. Priority action?
Correct! Severe constant pain + rigid abdomen suggests uterine rupture — a life-threatening emergency. Stop the infusion immediately, call for help, and assess maternal vitals and fetal status.
Question 22
Which statement about IV potassium is correct?
Correct! IV potassium is never pushed. Rapid administration causes cardiac arrest and fatal arrhythmias. Dilute it, infuse slowly, and monitor the rhythm.
Question 23
Which route bypasses first-pass metabolism?
Correct! IV drugs enter the bloodstream directly with 100% bioavailability, bypassing the liver's first-pass metabolism that oral drugs undergo. Sublingual administration also largely bypasses it.
Question 24
Which set of antidote pairs is correct?
Correct! The three high-yield antidote pairs: naloxone for opioids, acetylcysteine for acetaminophen, and flumazenil for benzodiazepines.
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