COMPLETE Nursing School Bundle_NurseInTheMaking_DIGITALDOWNLOAD

ANTICOAGULANTS cardiac meds Prevents new clots or prevents current clots from getting bigger! Anticoagulants do not dissolve clots & do not thin the blood. Anticoagulants are use for clients who are at an increased risk for CLOT FORMATION! WARFARIN Can a patient HEPARIN be on both at the same time? generic trade name YES! ACTION Commonly used warfarin Coumadin together. Gives time Heparin inhibits the formation of fibrin clots. Inhibits the conversion of fibrinogen to fibrin ACTION for Warfarin (inactivates factors needed for the clotting) ∙ Interferes with the production of vitamin K to kick in! ➥ used in the liver to make clotting factors USES ∙ short-term therapy ∙ ↓ of clotting factors II (prothrombin), VII, IX, and X. ∙ Works quickly (Prothrombin is required for the clotting) USES ROUTES Heparin is inactivated ∙ LONG-term therapy by gastric acid ∙ Works slowly (a few days to take effect) ∙ NOT given orally in the stomach ∙ GiveAn by injection (IV or subq) ∙ IV drip ROUTES COMMOMSOTN SAFE DURING PREGNANCY? YES! ∙ Orally ∙ IV A ANtidote: PROTAMINE SULFATE SAFE DURING PREGNANCY? NO! LOW MOLECULAR WEIGHT ANtidote: VITAMIN K HEPARIN (LMW) generic trade name LMW heparin is administered: enoxaparin Lovenox NURSING CONSIDERATIONS ∙ Subq in the belly dalteparin Fragmin ∙ Educate client to be consistent with their vitamin K ∙ 2 inches from the umbilicus suffix: -parin food intake (green leafy vegetables, liver, etc.) ∙ 90 degree angle! ∙ After subq injection, it's common to have bruising, irritation, & pain! ∙ Antibiotics increase the risk for bleeding ∙ Do not massage injection site after (they increase INR) For LMW heparins, we don't look at blood coags. We want to monitor platelet count! ∙ Will have freq. blood test to check Heparin Induced Thrombocytopenia (HIT) therapeutic range Should check platelets while on LMW. ∙ Educate to take the pill at the same time every day Normal PLT count: 150,000 - 450,000 Not On any anticoagulant: COAGULATION Interpretation: PT: 10 - 12 seconds INR: < 1 Abbbreviations: Numbers are TOO high = Patient will die aPTT: 30 - 40 seconds (increased bleeding) PTT: Prothrombin Time aPTT: Activated Partial Thromboplastin Time Numbers are LOW = Clots will GROW INR: International Normalized Ratio WARFARIN THERAPUTIC RANGE: HEPARIN THERAPUTIC RANGE: Measured with: INR 1.5 - 2 times the normal value Measured with: ªPTT 1.5 - 2 times the normal value INR: 2 - 3 ªPTT: 47 - 70 seconds INR: 2.5 - 3.5 (Heart valve replacement) © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. 201

DIGOXIN cardiac meds medication class: Cardiac Glycosides USES ACTION ∙ Heart failure ∙ Cardiogenic shock ∙ (+) Inotropic activity ∙ Antiarrhythmic • Increases the force of the contraction ∙ Atrial fibrillation = increased cardiac output TOXICITY ∙ (-) Chronotropic: beats slower therapeutic range: ∙ (-) Dromotropic: slows impulses sent 0.8 - 2.0 ng/ml > 2 = Think Toxic through AV node, able to squeeze more blood generic trade name digoxin Lanoxin SIGNS OF TOXICITY Report these to the HCP GI Symptoms EARLY SIGN causes of Toxicity? Nausea, vomiting, diarrhea Visual symptoms d Decreased potassium (HYPOkalemia) <3.5 mEq/L Blurred vision, yellow or green vision, halo effect around dark object ∙ Potassium wasting diuretics (Loop) taehlxmeDcrkoiegisdtotenxsdeionyblesiysly Neurological Symptoms i Injured kidneys g GFR decreased (the elderly) Headache, drowsiness, confusion, disorientation ANtidote: DIGIBIND NURSING CONSIDERATIONS The apical pulse The apical pulse is located at the fifth intercostal ∙ Hold the medication if must be assessed midclavicular space. • Adults: <60 bpm for 1 minute • The apex of the heart • Children: <70 bpm • Point of maximal • Infants: <90-110 bpm before impulse (PMI) ∙ Keep all appointments: adminstering • Mitral valve drug levels & electrolytes digoxin will be monitored © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. 202

NITROGLYCERIN (NTG) cardiac meds medication class: Antianginals USES ACTION ∙ Angina (chest pain) ∙ Prevent angina attacks ∙ vasodilator ∙ Acute coronary syndrome Dilators do the following: SIDE EFFECTS d Decrease blood pressure THE h = Headache H'S h = Hypotension (orthostatic) d Dilates vessels h = Hot flushing of the face d ↓ Vascular resistance vasodilation normal blood vessel D = decrease cardiac workload D = decrease oxygen consumption ∙ Rash CONTRAINDICATIONS PR EGNANC Y CATE ∙ Sublingual ∙ Known hypersensitivity to nitroglycerin C ∙ Tingling / burning sensation ROGRY ∙ Transdermal ∙ Allergy to adhesive (transdermal) ∙ Contact dermatitis ∙ Clients taking phosphodiesterase (PDE) inhibitors ALARMING SIGNS ∙ Head trauma, cerbral hemorrhage ∙ Severe anemia ∙ Lack of coordination Quick Vs. Slow onset ∙ Lightheadedness ∙ Pallor quick slow ∙ Irritable ∙ IV ∙ Nitro patch ∙ Sublingual tabs ∙ Nitro ointment ∙ Transligual spray ∙ Sustained-release tablets NURSING CONSIDERATIONS ∙ Monitor blood pressure ∙ Stop the medication if systolic BP drops below Do not take with phosphodiesterase (PDE) inhibitors 100 or the baseline drops below 30 mmHg (erectile dysfunction (ED) drugs) ∙ Increased risk for falls due to orthostatic hypotension Ends in \"-afil\" Like sildenafil (viagra) ∙ Educate: rise slowly when getting up Causes dangerously low blood pressure resulting in death Long-acting nitrates desirable outcome: The client can perform activities without chest pain (shower, get dressed, etc) PATIENT EDUCATION Topical & Transdermal Patch Sublingual NTG or Spray Sublingual or Buccal ∙ Remove prior dose 1 tab/spray sublingual ∙ Place buccal tablet between ∙ Rotate sites every 5 minutes, up to 3 doses. the cheek and gum ∙ Place over a clean/hairless area ∙ Wear gloves If angina is not relieved ∙ Place sublingual under the tongue ∙ Do not rub nitro ointment into the skin, or is worse 5 min after ∙ Rinse with water before the first dose, call 911! it can cause rapid absorption! placing the tablets in your cheek ∙ Patches can be worn in the shower ☞ Keep in original container (dark, glass bottle) in a dry, cool place. ☞ Do not swallow or chew these tablets 203 © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal.

CORTICOSTEROIDS Respiratory meds generic trade name ACTION prednisone Deltasone ☞ Anti-inflammatory effects! hydrocortisone Hydrocort ∙ They reduce the number of mast cells in the airway dexamethasone Ozurdex fluticasone Flovent HFA beclomethasone – THERAPUTIC USES flunisolide Aerospan ∙ COPD Can also be administered: ∙ Rheumatoid arthritis ciclesonide Zetonna ∙ Lupus IV, IM, PO, rectally, ocularly suffixes: -sone, -asone, -ide Topical Inhaled Corticosteroids Corticosteroids (ICSs) SIDE EFFECTS Dermatitis Chronic asthma S's of Steroids Rashes Nasal polyps Eczema & rhinitis Insect bites Steroids cause... PATIENT EDUCATION ☞ Sugar: Hyperglycemia (Long-term corticosteroid replacement) ☞ Soft Bones: Causes osteoporosis ☞ Sick: Decreased immunity / sepsis ☞ Report signs of an infection ☞ Sad: Depression ∙ Corticosteroids are immunosuppressing ☞ Salt: Water & salt retention (hypertension) and can cause an infection ☞ Sex: Decreased libido ∙ Since they are anti-inflammatory, it may ☞ Swollen: Water gain = weight gain hide the fact that the client has an infection ☞ Sight: Risk for cataracts ☞ Increase calcium in the diet ∙ Corticosteroids can cause osteoporosis & muscle weakness ☞ Yearly optometrist appointment ∙ Corticosteroids may cause cataracts ☞ Stress or surgery causes a decrease in cortisol ∙ You may need to increase your dose in times of stress ☞ Never stop steroids suddenly ∙ Slowly taper off the medication! IMPORTANT TEACHING! Taking After administration, rinse the Bronchodilators & Corticosteroids? mouth to decrease the risk of contracting a possible fungal 1 Bronchodilator first (to help open up the airways) infection from candidiasis 2 Wait 5 minutes MEMORY B comes before C 3 Administer the Corticosteroid TRICK in the alphabet THRUSH: a type of yeast infection a bc © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. 204

Respiratory BRONCHODILATORS (SABA & LABA) meds Short-acting Beta2 agonists ACTION (SABAs) ☞ Broncho-Dilators Think Dilates (opens up) the bronchi generic trade name albuterol Proventil Albuterol When an agonist binds to the beta-2 receptors the is for sympathetic nervous system \"Fight or flight\"takes epinephrine Adrenalin Acute effect. The airways relax and dilate which increases oxygen flow which makes it easier to breathe. levalbuterol Xopenex Asthma Attacks terbutaline – To remember that To remember beta-1 receptors beta-2 receptors are in the lungs: found on the heart: Long-acting Beta2 agonists you have two lungs you only have one heart. (LABAs) Think BETA 1 Salmeterol BETA 2 generic trade name is for Slow (one heart) (two lobes) and Steady salmeterol – USES working formoterol Foradil a LONG time indacaterol Arcapta arformoterol Brovana ☞ Short-acting Beta2 agonists (SABAs) Acute symptom relief suffix: -terol ∙ Bronchospasms SIDE EFFECTS REMEMBER fTihgihnkt ∙ Asthma DysAfiurnwcatyion ∙ Tachycardia or flight! ☞ long-acting Beta2 agonists (lABAs) ∙ Palpitations Long-term management ∙ Cardiac arrhythmias ∙ COPD ∙ Chronic Bronchitis ∙ Hypertension ∙ Prevention of bronchospasms ∙ Nervousness & anxiety ∙ Insomnia PATIENT EDUCATION IMPORTANT TEACHING! Taking After administration, rinse the Bronchodilators & Corticosteroids? mouth to decrease the risk of contracting a possible fungal 1 Bronchodilator first (to help open up the airways) infection from candidiasis 2 Wait 5 minutes MEMORY B comes before C 3 Administer the Corticosteroid TRICK in the alphabet THRUSH: a type of yeast infection a bc © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. 205

(Xanthine derivatives) Respiratory BRONCHODILATOR (Methylxanthines) meds generic trade name ACTION aminophylline – ☞ Broncho-Dilators Dilates (opens up) the bronchi dyphylline Lufyllin Stimulate the central nervous system (CNS) to promote bronchodilation. oxtriphylline Choledyl SA Relaxation of the smooth muscles of the bronchi. theophylline Theochron USES suffix: -phylline ∙ Relief & prevention of bronchial asthma ∙ Tx of bronchospasms seen in COPD THEOPHYLLINE SIDE EFFECTS REMEMBER fTihgihnkt Therapeutic levels 10 - 20 mcg/dL ∙ Tachycardia ∙ Palpitations Toxic >20 mcg/dL ∙ ECG changes SIGNS OF TOXICITY ∙ Nervousness or flight! ∙ Tonic clonic seizures & anxiety ∙ Tachycardia & dysrythmias ∙ Irritable CHOLINERGIC BLOCKING (Anticholinergic) ALSO CALLED: ACTION ☞ Anticholinergic drugs ☞ Cholinergic blocking drugs block the ☞ cholinergic blockers Parasympathetic nerve that causes the ☞ parasympatholytic drugs airway to constrict. generic trade name By blocking this, it allows the airways to remain open. aclidinium Tudorza SIDE EFFECTS RESPIRATORY USES umeclidinium ipratropium Incruse amnteidcIhincohalatiniloeendrsgic Blocks secretions → Dry Inside Prevention of Atrovent Can't See - Blurred vision bronchospasms tiotropium Spiriva ☞ Can't Pee - Dysuria associated ☞ Can't Spit - Dry mouth with COPD suffixes: -tropium, -clindidiun ☞☞ Can't Poop - Constipation PATIENT EDUCATION Fluids, Fiber, Anticholinergic drugs are used for many ∙ Prevent constipation & Fruits other purposes as well, such as: ∙ Increase fluids & fiber Fill up the toilet! Parkinsonism, peptic ulcer, Vagal nerve–induced bradycardia & ∙ To help with the dry mouth, increase preoperative reduction of oral secretions. fluids & suck on hard candies. 206 © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal.

LITHIUM CARBONATE psychiatric meds MOOD STABILIZER: Known for its side effects and narrow therapeutic range THERAPEUTIC RANGE: 0.6 - 1.2 mEq/L uses adverse reactions Bipolar disorder Lithium is a Long-term treatment ✹ Nausea/drowsiness/fatigue Helps regulate the “mood swings” ✹ Thirst (depression & mania) toxicity! ✹ Dry mouth ✹ Weight gain OXICITY LEVEL ✸ Confusion ✸ Blurred vision PR S ✸ Diarrhea Mild: 1.5 - 2 mEq/L HOW DOES TOXICITY HAPPEN? TY CA✸ Tinnitus Moderate: 2 - 3 mEq/L ☞ Dehydration • Excessive sweating Ringing in ears causes ↑ lithium levels in blood such a high fever ✸ Slurred speech Severe: > 3 mEq/L ☞ Hyponatremia • Diarrhea • Diuretic therapy ✸ Coma ☞ Old age & kidney failure ↓ GFR = lithium builds up in the blood ✸ Convulsions ✸ Excessive urination ✸ Excessive thirst ✸ Tremors/ataxia education TEGORYDEGNANC Contraindication ✹ Carry ID that shows you are taking lithium ✹ Contraindicted in pregnancy & breastfeeding Contraceptives ✹ Educate on signs & symptoms of toxicity may be ✹ Renal/cardiovascular disease ✹ Educate and stress importance of taking prescribed medication regularly ✹ Dehydrated patients ✹ Serum lithium levels should be checked Excessive diarrhea or vomiting every 1-2 months ✹ Receiving diuretics ✹ Do not operate heavy machinery or drive ✹ Sodium depletion ✹ Educate on drinking plenty of water to avoid dehydration (therefore avoiding ✹ Hypersensitivity to tartrazine toxicity) ✹ Avoid NSAIDs ✹ Avoid starting a low salt diet ↓ renal blood flow = ↑ risk for toxicity Sudden ↓ in salt = ↑ in lithium © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. 207

ANTIDEPRESSANT DRUGS psychiatric meds SSRIs SNRIs / DNRIs Selective serotonin Serotonin / Norepinephrine reuptake inhibitor & USES ACTION Inhibits uptake Think Dopamine / Norepinephrine reuptake inhibitor smiley of serotonin = ↑ serotonin serotonin Affects serotonin, norepinephrine & dopamine • Depression • OCD • Depressive episodes • Fibromyalgia • Anxiety • Eating disorders • Anxiety disorders • Diabetic neuropathy pain NEURO GI • Headache SIDE EFFECTS • Tremors • Nausea • Urinary retention NEURO GI • Difficulty sleeping • Dry mouth / thirst • Sexual dysfunction • Headache • Dry mouth/thirst • Constipation • Dizziness • Dehydration 3 S’s of SSRIs • Vertigo • Constipation SEROTONIN SYNDROME • Photosensitivity • Nausea/diarrhea • Serotonin syndrome • Too much serotonin • Tightness in muscles • Agitation/tremors • Sexual dysfunction in the brain • Difficulty walking • Insomnia • Stomach issues • Mental changes • Tachycardia • ↑BP & temp NURSING CONSIDERATIONS • May take 4-6 weeks to take effect ofimcopEomdonrupttclhaiaanetneccee • May take 4-6 weeks to take effect • Take medication in the morning • First line drug for depression/anxiety • Do not mix with TCAs or MAOIs SUICIDE WARNING • Zyban is used for smoking cessation. Do not use it while taking bupropion A client who had suicidal plans may now have the for depression – it could cause overdose. energy due to the medication to carry out the plans! generic trade name generic trade name DRUG TABLE sertraline Zoloft bupropion Zyban & Wellbutrin citalopram Celexa duloxetine Cymbalta escitalopram Lexapro Prozac venlafaxine Effexor XR fluoxetine Viibryd milnacipran Savella vilazodone nefazodone – suffixes: -talopram, -oxetine, -zodone suffixes: -faxine, -zodone, -nacipran © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. 208

ANTIDEPRESSANT DRUGS psychiatric meds TCAs MAOIs Tricyclic antidepressants Monoamine oxidase inhibitor Blocks reuptake of serotonin Blocks monoamine oxidase which causes ↑ in ACTION USES & norepinephrine in the brain epinephrine, norepinephrine, dopamine, & serotonin, which causes stimulation of the CNS! • Depressive episodes • Neuropathy Depression • Bipolar disorder • Enuresis • OCD • Constipation NEURO HYPERTENSIVE CRISIS • Dry mouth • Orthostatic hypotension • Drowsiness wcicotplhnireodpncbirttaelCsieuo-.ae.mtn.uixgosssiisneovitsn!erinehwpgleadiacttehairertrlndytiasc • Dizziness • Headache SIDE EFFECTS • Blurred vision • Blurred vision • Stiff neck • Orthostatic hypotension • Nausea / vomitting • Urine retention GI • Fever • Cardiotoxic • Constipation • Dialated pupils blomoeddtpoiSrceea↓eslskhuerlep • Dry mouth • Nausea/ vomiting • May take 2- 3 weeks to take effect ofimcopEomdonrupttclhaiaanetneccee • Can take up to 4 weeks to reach NURSING CONSIDERATIONS • WAIT 14 days after being off MAOIs therapeutic levels to start taking TCAs • Educate on the signs • Amoxapine is not an antipsychotic drug & symptoms of HTN crisis but similar to these drugs, it may cause • Avoid foods with Tyramine • Aged cheese TD & NMS (D/C the drug immediately • Fermented meats if these symptoms occur) • Chocolate • Caffeinated beverages • Sour cream & yogurt generic trade name amitriptyline — generic trade name DRUG TABLE amoxapine — phenelzine Nardil tranylcypromine Parnate clomipramine Anafranil isocarboxazid Marplan protriptyline Vivactil nortriptyline Pamelor suffixes: -triptyline, -pramine © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. 209

psychiatric ANTIANXIETY DRUGS (ANXIOLYTICS) meds BENZODIAZEPINES USES ACTION generic trade name Xanax Bipolar disorder Binds to cell receptors alprazolam Ativan enhancing the effects of lorazepam Valium Benzos are mainly diazepam prescribed for: GABA clonazepam Klonopin • acute anxiety chlordiazepoxide Librium • sedation/muscle relaxant GABA • seizures (inhibitory neurotransmitter) suffixes: -zolam, -zepam • alcohol withdrawal slows/calms the activity of ANTIDOTE: FLUMAZENIL Not a first-line drug for treating the nerves in the brain long-term psychiatric anxiety conditions MEMORY I FLU fast in my MercedesBENZ TRICK ADVERSE DRUG REACTIONS (ADRs) NURSING CONSIDERATIONS • Mild drowsiness, sedation TO HELP WITH ADRs • Lightheadedness, dizziness, ataxia • Visual disturbances Take at night if it makes you dizzy/drowsy • Anger, restlessness Rise slowly from sitting or lying • Nausea, constipation, diarrhea Do not drive or operate heavy machinery • Lethargy, apathy, fatigue • Dry mouth Fluids, fiber, & exercise! Give with food to ↓ GI upset SYMPTOMS OF WITHDRAWAL Sips of water, suck on hard candy, chewing sugar-free gum Withdrawals typically happen when the medication is stopped abruptly or taken NURSING CONSIDERATIONS for >3 months • Not meant for long term therapy • ↑ Anxiety • Agitation because ↑ risk for physical & • ↑ HR • Seizures/tremors psychological DEPENDENCE • ↑ BP • Insomnia • ↑ Temp/sweating • Vomiting • Use of long term therapy leads to • ↓ Memory • Muscle aches TOLERANCE Larger doses of the drug are required to achieve the desired outcome • Must be TAPERED ↓ the dosage gradually. NEVER stop the medication abruptly! CONTRAINDICATIONS & PRECAUTIONS NONBENZODIAZEPINES • Pregnant, laboring & lactating women ACTION Depends on the drug • Elderly (↑ chance of dementia) PRE GNANCY CAT buspirone (Buspar) generic trade name • Impaired liver or kidney function acts on serotonin receptors buspirone Buspar d hydroxyzine (Vistaril) doxepin Silenor • Debilitation EGORY acts on the hypothalamus & hydroxyzine Vistaril brainstem reticular formation meprobamate – © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. 210

ANTIPSYCHOTICS psychiatric meds Most commonly used for psychosis (schizophrenia) REVIEW: Why are SGAs better than FGAs? SGAs work on both positive & negative symptoms, and have a lower risk of developing tardive dyskinesia (TD) FIRST GENERATION SECOND GENERATION ANTIPSYCHOTICS (FSGAs) ANTIPSYCHOTICS (SGAs) Also called typical/conventional Also called atypical generic trade name generic trade name chlorpromazine – risperidone Risperdal clozapine Clozaril haloperidol Haldol quetiapine Seroquel loxapine Adasuve ziprasidone Geodon aripiprazole Abilify ACTIONS ACTIONS • Blocks/inhibits dopamine from being • Acts on both serotonin & dopamine in the brain released in the brain • Helps diminish positive symptoms of schizophrenia • Helps diminish positive symptoms of schizophrenia & helps negative symptoms as well! SIDE EFFECTS SIDE EFFECTS OF BOTH SIDE EFFECTS • Higher risk of TD, EPS, & NMS • Anticholinergic effects • Lower risk of TD, EPS & NMS • Orthostatic hypotension • Photophobia • ↑ Weight • Photosensitivity • ↑ Cholesterol • Sedation/lethargy • ↑ Triglyceride • ↑ Blood sugar TARDIVE DYSKINESIA (TD) • Involuntary movements of the face, tongue, or limbs that may be irreversible. EXTRAPYRAMIDAL SYNDROME (EPS) • Parkinson’s like symptoms • Akathesia (restlessness) • Dystonia (muscle twitching) NEUROLEPTIC MALIGNANT SYNDROME (NMS) • Combination of symptoms: EPS, high fever, & autonomic disturbance • One can recover 7-10 days after DC of medication, but it can be fatal if not treated in time CONTRAINDICATIONS NURSING CONSIDERATIONS • Hypersensitivity • Parkinson’s disease ☞ Educate that it may take SGAs FGAs • Teach S&S of TD, EPDS, & NMS! • Comatose client • Liver problems 6 - 10 weeks to take effect • Advise the client to get up slowly • Depressed • Coronary artery • Bone marrow ☞ Tell client about adverse • Check labs disease reactions and emphasize (blood sugar, LDL, triglycerides) depression • Hyper or that adherence is very • Blood dyscrasias important • To decrease the risk of gaining weight, hypotension advise the client about exercise, low-calorie diet, & monitor their weight. © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. 211

LEVOTHYROXINE endocrine meds generic trade name ACTION levothyroxine Synthroid ☞ The exact mechanisms are not fully known Levothyroxine increases the metabolic rate of tissues MEMORY think THYroid synthetic THYroid SIDE EFFECTS TRICK MEDICATION CLASS Anxiety hyperstahmyeraosidism! ☞ Synthetic Hormone ☞ GI upset ☞ Sweating ☞ Weight loss ☞☞ Heat intolerance THERAPEUTIC USES THERAPEUTIC RESPONSE ∙ Treats hypothyroidism no longer showing signs ∙ Thyroid-stimulating hormone of hypothyroidism suppression ☞ Normal heart rate (60 - 100 BPM) ∙ Thyroid diagnostic testing ∙ Hormone supplement after ☞ Improved energy levels (not fatigued) ☞ Normal skin (not cool or pale) thyroidectomy ✘ Should not be used as a weight loss regimen PATIENT EDUCATION SAFE DURING PREGNANCY? YES! ∙ It may take 8 weeks to see the full effect imcpomoEordnptulaticanhanceteceeof Do not stop the medication if ∙ Report signs of hyperthyroidism symptoms resolve. Thyroid hormone is needed for fetal brain development! ∙ Tachycardia, heart palpitations, weight loss, insomnia, anxiety ∙ Monitor T4 & T3 levels ∙ Take once a day (in the morning before breakfast) ∙ Take at the same time everyday ∙ Take on an empty stomach MEMORY Levothyroxine is a Life Long therapy TRICK © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. 212

ANTITHYROID DRUGS endocrine meds METHIMAZOLE PROPYLTHIOURACIL (PTU) generic Trade name generic methimazole Tapazole propylthiouracil (PTU) MEDICATION CLASS MEDICATION CLASS Prevents Thyroid ☞ First-line antithyroid drugs ☞ First-line antithyroid drugs from being Up ACTION ☞ USES Treats hyperthyroidism ☞ Inhibits the manufacture of thyroid hormones ☞ Treats thyrotoxicosis ☞ Treats Graves' disease ☞ Does not affect existing thyroid hormones circulating in the blood (autoimmune disease that or stored in the thyroid gland causes hyperthyroidism) ☞ Used before thyroidectomy surgery (shrinking it before the surgery) SIDE EFFECTS PATIENT EDUCATION imcopmEoordpntulaitcanhancetceeeof ☞ Hay fever ☞ It may take 1-2 weeks to ☞ Skin rash see the full effect ☞ Headache ☞ Nausea & vomiting ☞ Report signs of hypothyroidism ☞ Paresthesias (Bradycardia, weight gain, lethargy, cold intolerance, depression) SYSTEMIC ADVERSE REACTIONS ☞ Report signs & symptoms of an infection to the health care provider Risk for: Increased (Fever, sore throat, etc.) risk for ☞ Agranulocytosis infection ☞ Do not abruptly stop the medication ☞ Drug-induced hepatitis (could cause thyroid storm ) livMeronvaitloures PREGNANCY CONSIDERATIONS YPREGNANCY C ATEGOR ☞ Use with extreme caution during pregnancy D because they can cause hypothyroidism in the fetus Remember: ☞ If it's necessary, propylthiouracil is the preferred drug The fetus needs thyroid (does not cross the placenta) hormone for proper brain development © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. 213

INSULIN TYPES endocrine meds rapid GENERIC BRAND NAME 5 - 30 min 30 - 90 min HIGHEST RISK Lispro Humalog ONSET: 3 - 5 hrs FOR HYPOGLYCEMIA Aspart Novolog PEAK: Glulisine Apidra DURATION: ONLY INSULIN GIVEN IV short Humulin R ONSET: 30 - 60 min Novolin R PEAK: 2 - 4 hrs regular goes right CLEAR Regular DURATION: 5 - 7 hrs MEMORY Intermediate 1 - 2 hrs 4 - 12 hrs TRICK into the vein CLOUDY NPH Humulin N ONSET: 18 - 24 hrs Novolin N PEAK: NEVER GIVE IV DURATION: long LOWEST RISK FOR HYPOGLYCEMIA Glargine Lantus ONSET: 1 - 2 hrs Detemir Levemir PEAK: None Do not mix with DURATION: 24 hrs+ any other insulin Long think Lonely MEMORY TRICK MIXING REGULAR INSULIN & NPH INSULIN ADMINISTRATION Inject Inject ∙ Must be given subcut or IV Air ∙ Insulin is destroyed by the GI tract Air CRLegEuAlRar CLONUPHDY so it can not be given PO ∙ Remove all air bubbles ∙ Rotate site 1 inch from previous site ∙ Common sites: back of arms, thighs & abdomen (at least 2 inches away from the belly button) CLONUPHDY CRLegEuAlRar Withdraw Withdraw COMPLICATIONS Insulin Insulin ∙ Hypoglycemia (especially with rapid insulin) ∙ Weight gain how to remember this order? ➥ Insulin is a growth hormone \"You are Not Retired, you are an RN\" ∙ Lipoatrophy (loss of subcut fat) © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. 214

manedtiic-gatoiuotns ALLOPURINOL VS. COLCHICINE musculoskeletal Meds ALLOPURINOL COLCHICINE generic trade name generic trade name allopurinol Aloprim, Zyloprim, colchicine Mitigare, Colcrys Lopurin MEDICATION CLASS MEDICATION CLASS ☞ Uric acid inhibitors ☞ Antigout agent THERAPEUTIC USES THERAPEUTIC USES ☞ Relieves acute gout attacks ☞ Prevents gout attacks ☞ Also Prevents gout attacks as well ☞ Does not help with →acuptereavettnatcskgsoutfoNr TaOackuTeteaNsapStAitrIaiDncsks, ∙ Does not help with pain relief, only helps decrease inflammation foNr TaOackuTeteaNsapStAitrIaiDncsks, Allopurinol Colchicine → for aCute ☞ SIDE EFFECTS gout attacks GI upset: Nausea, vomiting, abdominal pain, diarrhea same GI side effects SIDE EFFECTS ☞ Skin rash ☞ GI upset: Nausea, vomiting, abdominal pain, diarrhea EDUCATION ☞ ADVERSE REACTION: Risk for Bone Marrow suppression Stop the medication if a RASH occurs EDUCATION ∙ This may indicate a hypersensitivity reaction (Stevens-Johnson syndrome) Gulp a lot of fluid during the day Gulp a lot of fluid during the day (2-3 L/day) (2-3 L/day) & take the medication with a glass of water & take the medication with a glass of water No Organ meats No Organ meats Urine output up to 2 L/day Urine output up to 2 L/day takes several months to take effect takes several months to take effect ∙ Uric acid deposits can cause ∙ Uric acid deposits can cause kidney stones kidney stones ∙ Fluids help prevent this ∙ Fluids help prevent this ∙ Allopurinol + aspirin = ↑ uric acid levels ∙ Take acetaminophen instead © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. 215

musculoskeletal BISPHOSPHONATES VS. CALCITONIN (SALMON) Meds BISPHOSPHONATES CALCITONIN (SALMON) generic trade name alendronate Binosto generic trade name calcitonin (salmon) Miacalcin etidronate Didronel ibandronate Boniva pamidronate Aredia risedronate Actonel suffix: -Dronate MEDICATION CLASS MEDICATION CLASS ☞ Hormone ☞ Hypocalcemic agent ☞ Bone resorption inhibitors Calcitonin helps tone down MODE OF ACTION calcium levels in the blood! ☞ Bisphosphonates inhibit normal & abnormal MODE OF ACTION bone resorption which leads to increased bone mineral density! ☞ Inhibits osteoclasts (Cells that cause bone breakdown) THERAPEUTIC USES ☞ ↓ the rate of bone breakdown ☞ Builds bone density & prevents bone fractures THERAPEUTIC USES ☞ Treats & prevents osteoporosis ☞ Treats & prevents postmenopausal (postmenopausal & long term use of steroids) ☞ osteoporosis ☞ Treats paget's disease Treats hypercalcemia ☞ Treats hypercalcemia ∙ Too much calcium in the bloodstream (we want it in the bones, not in the bloodstream) SIDE EFFECTS ☞ GI upset: Nausea, diarrhea, dyspepsia, acid reflux, abdominal pain EDUCATION ∙ Take with a full glass of water on an ESOPCHACAUAGSNIETIS! empty stomach ∙ Stay upright for 30 minutes SIDE EFFECTS ∙ Separate iron, antacids, & multiple abdseoTcrhrpeetasiesoen ☞ GI upset vitamins at least 30 minutes apart from ☞ intranasal route taking bisphosphonates Nasal irritation & nasal dryness ∙ Encourage increased intake of CALCITONIN calcium & vitamin D (SALMON) ∙ Encourage weight-bearing exercises EDUCATION to preserve bone mass ∙ Encourage increased intake of \"If you don't use it, you lose it!\" calcium & vitamin D NURSING CONSIDERATIONS ∙ Encourage weight-bearing exercises ☞ Monitor serum calcium levels before, during, to preserve bone mass & after therapy Normal calcium: \"If you don't use it, you lose it!\" 9 - 11 mg/dL © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. 216

TEMPLATES & PLANNERS BROUGHT TO YOU BY © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. 217

nursing diagnosis nursing diagnosis supporting data supporting data goals patient info goals medical history nursing diagnosis nursing diagnosis supporting data supporting data goals goals 218 © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal.

Course Tracker COURSE: ASSIGNMENT/PROJECT DUE DATE SCORE SUBMITTED © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal.

Test /Quiz Tracker COURSE: CHAPTERS/TOPICS COVERED GRADE PASSED? TEST DATE YES NO © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO 220

HOURLYPlanner MONTH: SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY PRIORITIES PRIORITIES PRIORITIES PRIORITIES PRIORITIES PRIORITIES PRIORITIES 6 AM 6 AM 6 AM 6 AM 6 AM 6 AM 6 AM 7 AM 7 AM 7 AM 7 AM 7 AM 7 AM 7 AM 8 AM 8 AM 8 AM 8 AM 8 AM 8 AM 8 AM 9 AM 9 AM 9 AM 9 AM 9 AM 9 AM 9 AM 10 AM 10 AM 10 AM 10 AM 10 AM 10 AM 10 AM 11 AM 11 AM 11 AM 11 AM 11 AM 11 AM 11 AM 12 PM 12 PM 12 PM 12 PM 12 PM 12 PM 12 PM 1 PM 1 PM 1 PM 1 PM 1 PM 1 PM 1 PM 2 PM 2 PM 2 PM 2 PM 2 PM 2 PM 2 PM 3 PM 3 PM 3 PM 3 PM 3 PM 3 PM 3 PM 4 PM 4 PM 4 PM 4 PM 4 PM 4 PM 4 PM 5 PM 5 PM 5 PM 5 PM 5 PM 5 PM 5 PM 6 PM 6 PM 6 PM 6 PM 6 PM 6 PM 6 PM 7 PM 7 PM 7 PM 7 PM 7 PM 7 PM 7 PM 8 PM 8 PM 8 PM 8 PM 8 PM 8 PM 8 PM 9 PM 9 PM 9 PM 9 PM 9 PM 9 PM 9 PM PRODUCTIVITY METER PRODUCTIVITY METER PRODUCTIVITY METER PRODUCTIVITY METER PRODUCTIVITY METER PRODUCTIVITY METER PRODUCTIVITY METER BAD GOOD GREAT! BAD GOOD GREAT! BAD GOOD GREAT! BAD GOOD GREAT! BAD GOOD GREAT! BAD GOOD GREAT! BAD GOOD GREAT! NURSEINTHEMAKING LLC

MMOONNTTHH: : PlaMMnOONnNTTeHHLrLYY YYEEAARR: : © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. NNUURSRESIENINTHTEHMEMAKAKINING GL2LCL2C2

MONDAY: TO DO LIST TUESDAY: WEEKLY Planner WEDNESDAY: THURSDAY: NOTES FRIDAY: SATURDAY: TESTS / EXAMS PROJECTS / ASSIGNMENTS SUNDAY: qSELF-CARE © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal.

disease: PATHOLOGY SIGNS & SYMPTOMS RISK FACTORS COMPLICATIONS DIAGNOSIS TREATMENT © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. 224

PHARMACOLOGY TEMPLATE drug class: trade name ACTION generic name suffixes or prefixes: THERAPEUTIC USES antidote: CONTRAINDICATIONS SIDE EFFECTS NURSING CONSIDERATIONS PATIENT EDUCATION © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal.

226 NCLEX Study Schedule Month: NCLEX Date: SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY S AT U R D AY Subject: Subject: Subject: Subject: Subject: Subject: Subject: Body System: Body System: Body System: Body System: Body System: Body System: Body System: # of Practice Questions: # of Practice Questions: # of Practice Questions: # of Practice Questions: # of Practice Questions: # of Practice Questions: # of Practice Questions: Self Care: Self Care: Self Care: Self Care: Self Care: Self Care: Self Care: Subject: Subject: Subject: Subject: Subject: Subject: Subject: Body System: Body System: Body System: Body System: Body System: Body System: Body System: # of Practice Questions: # of Practice Questions: # of Practice Questions: # of Practice Questions: # of Practice Questions: # of Practice Questions: # of Practice Questions: Self Care: Self Care: Self Care: Self Care: Self Care: Self Care: Self Care: Subject: Subject: Subject: Subject: Subject: Subject: Subject: © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. Body System: Body System: Body System: Body System: Body System: Body System: Body System: # of Practice Questions: # of Practice Questions: # of Practice Questions: # of Practice Questions: # of Practice Questions: # of Practice Questions: # of Practice Questions: Self Care: Self Care: Self Care: Self Care: Self Care: Self Care: Self Care: Subject: Subject: Subject: Subject: Subject: Subject: Subject: Body System: Body System: Body System: Body System: Body System: Body System: Body System: # of Practice Questions: # of Practice Questions: # of Practice Questions: # of Practice Questions: # of Practice Questions: # of Practice Questions: # of Practice Questions: Self Care: Self Care: Self Care: Self Care: Self Care: Self Care: Self Care: Subject: Subject: Subject: Subject: Subject: Subject: Subject: Body System: Body System: Body System: Body System: Body System: Body System: Body System: # of Practice Questions: # of Practice Questions: # of Practice Questions: # of Practice Questions: # of Practice Questions: # of Practice Questions: # of Practice Questions: Self Care: Self Care: Self Care: Self Care: Self Care: Self Care: Self Care:

Dear future nurse, You may be stressed, you may feel tired, and you may want to give up. Nursing school is hard, there's no doubt about it. Everyone cries, everyone has meltdowns, and there will be moments you don't feel qualified for the task at hand. But take heart, the challenge only makes you stronger. Put in the work, show up on time, and find an amazing study group. You got this! – Kristine Tuttle, BSN, RN You got this, future nurse! By purchasing this material, you agree to the following terms and conditions: you agree that this ebook and all other media produced by NurseInTheMaking LLC are simply guides and should not be used over and above your course material and teacher instruction in nursing school. When details contained within these guides and other media differ, you will defer to your nursing school’s faculty/staff instruction. Hospitals and universities may differ on lab values; you will defer to your hospital or nursing school’s faculty/staff instruction. These guides and other media created by NurseInTheMaking LLC are not intended to be used as medical advice or clinical practice; they are for educational use only. You also agree to not distribute or share these materials under any circumstances; they are for personal use only. © 2021 NurseInTheMaking LLC. All content is property of NurseInTheMaking LLC and www.anurseinthemaking.com. Replication and distribution of this material is prohibited by law. All digital products (PDF files, ebooks, resources, and all online content) are subject to copyright protection. Each product sold is licensed to an individual user and customers are not allowed to distribute, copy, share, or transfer the products to any other individual or entity, they are for personal use only. Fines of up to $10,000 may apply and individuals will be reported to the BRN and their school of nursing.

SCAN ME!