PHARMACOLOGY

REVIEW
FOR
FOR THE
THE NCLEX
NCLEX

© Archer Review, LLC

How would you rate your
current pharmacology
knowledge?
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The Cardiovascular
System
 Angiotensin Converting Enzyme
(ACE) Inhibitors [-pril]
enalapril, lisinopril, benazepril, captopril

Indication: Nursing Considerations:

Hypertension, CHF Side effects:
Dry cough, angioedema, headache, orthostatic hypotension,
Action: hyperkalemia, GI disturbances, change in taste
Blocks conversion of Education on signs/symptoms of angioedema - stop taking it!
angiotensin I to angiotensin II Report dry cough
(blocks vasoconstriction), Monitor blood pressure
increases renin levels, decreases Contraindicated during pregnancy and in conjunction with
aldosterone leading to potassium-sparing diuretics
vasodilation, and inhibits release Stop ACE inhibitors for at least 36 hours before starting
of ADH angiotensin receptor-neprilysin inhibitors (high-risk
angioedema!!)
 Angiotensin Receptor Blockers
(ARBs) [-artan]
losartan, irbesartan, valsartan, candesartan

Indication: Nursing Considerations:

Hypertension, CHF, DM nephropathy Side effects:
Headache, dizziness, orthostatic hypotension,
Action: hyperkalemia, GI disturbances
Block angiotensin II from working Monitor BP and fluid levels
(blocks vasoconstriction), causing Monitor renal and liver status
vasodilation and increased excretion Contraindicated during pregnancy and with
of water and sodium; reduces potassium sparing diuretics
preload and after load
 Calcium Channel Blockers
Act on the heart and blood vessels
verapamil, diltiazem
Indication:
Hypertension, angina, dysrhythmias Nursing Considerations:
(A fib/flutter) Side effects:
Constipation → increase dietary fiber/fluid intake
Action: Dizziness, facial flushing, headache, edema in
Blocks calcium channels in the heart ankles and feet
and blood vessels Interactions:
Enhances cardiac suppression of digoxin and
Results in: β-blockers; if given together, monitor closely!
Blood vessels → vasodilation, increased Caution in heart failure
coronary perfusion DO NOT GIVE in AV block
Heart → slow heart rate, slow AV node
conduction, decreased force of contraction
 Calcium Channel Blockers [-dipine]
Acts primarily on the blood vessels
nifedipine, amlodipine, felodipine, isradipine, nicardipine, nimodipine

Indication:
Hypertension, angina Nursing Considerations:
Side effects:
Action: Dizziness, facial flushing, headache, edema in
ankles and feet
Primarily blocks calcium channels
in the blood vessels Gingival hyperplasia→ use a soft bristle
toothbrush and have good dental care
Results in: Reflex tachycardia - can combine with a β-blocker
Blood vessels→ vasodilation, to prevent this side effect
increased coronary perfusion Does not cause constipation
Preferable for clients with HF or AV block
Interacts with grapefruit juice
The nurse is providing discharge
instructions to a client with accelerated
hypertension who has been newly started on
nifedipine. His home medications including
calcium supplements for osteoporosis,
omeprazole for heartburn, furosemide, and
lisinopril. Which statement(s) by the client
demonstrates the need for additional
teaching regarding nifedipine? Select all
that apply.
NCLEX Question
The nurse is providing discharge instructions to a client with accelerated hypertension
who has been newly started on nifedipine. His home medications including calcium
supplements for osteoporosis, omeprazole for heartburn, furosemide, and lisinopril.
Which statement(s) by the client demonstrates the need for additional teaching regarding
nifedipine? Select all that apply.

A. "My gums my swell because of this medication."

B. "I will avoid getting up too quickly from sitting or lying position."
C. "I will stop taking calcium supplements since they may negate the effects of
Nifedipine."
D. "It is highly likely I will experience constipation.”
E. "If I get cough and tongue swelling, I will hold Nifedipine.“
 Answer: C, D, & E
C is correct because calcium supplements do not interfere with the
effectiveness of calcium channel blockers (CCBs), and the client needs these
supplements for osteoporosis. Additional teaching is required if the client
plans to stop taking them.

D is correct because constipation is a rare side effect (less than 2%) of

Nifedipine. The statement that it is highly likely is inaccurate and requires
clarification.

E is correct because cough and tongue swelling (angioedema) are side effects of
ACE inhibitors like Lisinopril, not CCBs. This misunderstanding also warrants
further education.
 Digoxin
Therapeutic class: Cardiac glycoside, inotrope

Indication:
CHF, A fib, A flutter, cardiogenic shock Nursing Considerations:
Toxicity:
Action: Early signs: nausea/vomiting, anorexia, vision
Acts on the sodium-potassium pump in changes (yellow/green halos)
the myocardium Late signs: bradycardia leading to fatal arrhythmias
Therapeutic lab level: 0.5-2 ng/mL; >2 toxic
Antidote: digoxin immune FAB
Positive inotrope Hypokalemia (K<3.5) can potentiate digoxin toxicity and
Increases contraction power, without lead to v-fib
increasing oxygen consumption Caution in clients concurrently taking loop or thiazide
Negative chronotrope diuretics
Slows HR by acting on SA node after Licorice extract acts like aldosterone (Na/water
stimulating the vagus nerve
Negative dromotrope
retention & K loss) → hypokalemia → dig toxicity
Monitor HR and BP prior to administration
Reduces the speed of conduction at AV node
 HMG-CoA Enzyme Inhibitors
[-statins]
atorvastatin, lovastatin, pravastatin, simvastatin

Indication:
Hyperlipidemia Nursing Considerations:
Side Effects:
Action: Myalgia, alteration of taste, insomnia, diarrhea,
Inhibits cholesterol synthesis in the liver abdominal cramping, photosensitivity
by inhibiting HMG-CoA Drug Interactions! Avoid grapefruit juice!
Works within 2 weeks, with max. effect in 6 weeks
NCLEX TIP! Take in evening due to majority of cholesterol being
produced at night
NEVER given in pregnancy
Monitor liver function
Monitor cholesterol levels Not given during pregnancy or breastfeeding
Know the difference in HDL, LDL, and
triglycerides
Total cholesterol is summation
The Hematological
System
 Indirect Thrombin Inhibitor (Injection)
heparin

Indication:
Stroke, MI, A fib, postoperatively, Nursing Considerations:
Side effects:
dialysis
Bleeding
Monitor for: hematuria, hematemesis, bruising,
Action: down-trending H&H
Inhibits intrinsic coagulation pathway Heparin Induced Thrombocytopenia and Thrombosis
to prevent clotting (HITT)
Occurs 5-14 days after heparin exposure and is
Important lab: aPTT accompanied by an unexplained drop in platelets
Clients on a heparin drip have aPTT levels STOP the heparin and switch to a different
drawn q 4-6 hours to titrate the drip anticoagulant to avoid clotting (DVTs, PEs)
Normal aPTT: 30-40 seconds Antidote: protamine sulfate
Therapeutic aPTT: 1.5-2.5x normal Dosed in “units”
Draw blood from the opposite arm of Religious/cultural considerations due to formulation
heparin infusion to avoid false values
 Low Molecular Weight Heparin
(LMWH)
enoxaparin

Indication: Nursing Considerations:

DVT prophylaxis Side effects:
Bleeding!!
Action: Not interchangeable with heparin, but same antidote
Contains an active anticoagulant Protamine sulfate
fraction of heparin - enhances Religious/cultural implications
antithrombin III, which stops thrombin No coagulation panel needed for monitoring - dose
from being activated, which therefore based on body size
prevents clots from forming Platelets still monitored... HITT!
Only given subcutaneously
Only anticoagulant that CAN be used in pregnancy
 Indirect Thrombin Inhibitor (Oral)
warfarin

Indication:
Venous thrombosis, pulmonary Nursing Considerations:
embolism, A fib Side effects: nausea, diarrhea, urticaria,
hypotension, fatigue, headache, alopecia
Action: Adverse events: hemorrhage, hematuria,
Disrupts liver synthesis of Vitamin K gum bleeding, petechiae
dependent clotting factors (VII, IX, Antidote: Vitamin K
and X and prothrombin) Education: the client needs to eat a stable
Important lab: PT and INR
amount of Vitamin K-rich foods!
Monitor PT and INR monthly or q 4-6 Monitor for bleeding
weeks once at a stable dose
Normal PT: 10-12 seconds
1.5 - 2.5x the normal on warfarin
Normal INR: 0.9 - 1.2 seconds
Therapeutic INR: 2-3
The nurse is collecting data on a client
who is taking prescribed digoxin and
furosemide. Which finding requires
follow-up?
NCLEX Question
The nurse is collecting data on a client who is taking prescribed digoxin
and furosemide. Which finding requires follow-up?

A. Night sweats and headache

B. Vomiting and halos around lights
C. Fatigue and dry, flaky skin
D. Low blood pressure and dark urine
 Blood Administration
Blood is administered as a medication… so follow the same “rights”!
Checked by 2 RNs to ensure compatibility and correct order
Client should have an active Type & Screen to determine compatibility
Blood should be administered with special blood tubing that has a filter with a larger
gauge IV
Normal saline is the approved compatible IV fluid to infuse with/after blood
Ensure vital signs are taken before, during, and after infusion, or as per hospital policy
Baseline vitals are crucial to determine if your client is having a reaction!!
Closely monitor client for the first 30 minutes, which is the most likely time a reaction
could occur
NCLEX TIP!

PRBCs must
be given
within 4 hours!
 Transfusion Reactions
If a reaction is suspected, first STOP the infusion!
Remove tubing with the blood and flush the IV only if it
is the only IV access
Blood product and all tubing should be returned to
lab/blood bank
Follow hospital policy to initiate the Rapid Response
team
Prepare to administer diphenhydramine and oxygen (if
needed) and treat the client’s symptoms
Use leukocyte-reduced blood products when possible
Decreases chance of febrile reaction
Signs of Transfusion Reaction
“REACTION”
R ash
E levated temperature
A nxiety, Apprehension
C hills
T achypnea
I ncreased pulse
O liguria
N ausea
The Respiratory
System
 H₁ Antagonists [-ine]
diphenhydramine, chlorpheniramine, clemastine, promethazine, hydroxyzine,
loratadine, fexofenadine

Indication: Nursing Considerations:

Allergies, anaphylaxis, sedation Side effects:
Hypotension, tachycardia, anorexia, urinary retention,
Action: prolongation of the QTc interval, photosensitivity
Blocks H₁ receptors: decreases Monitor for drowsiness
flushing, edema, secretions, Anticholinergic effects
itching, and pain Extreme caution with clients who have BPH or glaucoma
Possible paradoxical excitation (also seen in OD)
Education:
Don’t give with other CNS depressants (alcohol, opioids)
Take at night and avoid driving etc.
Take with food to reduce GI side effects
 Glucocorticoids
Indication: Action:
Asthma, COPD Decreases inflammatory mediators, ORAL AGENTS
infiltration of inflammatory cells, and
vascular permeability (to decrease edema). methylprednisolone, prednisolone,
prednisone
Suppresses the inflammatory response!
Nursing Considerations:
Side effects: fluid retention, muscle
INHALED AGENTS wasting, metabolic disturbances,
immunosuppression
budesonide, ciclesonide, Systemic therapy is used in acute
fluticasone
attacks
Nursing Considerations: Best to use < 10 days
Side effects: oral fungal infections, hoarseness, vocal Long-term use - risk of adrenal
cord disturbances suppression, osteoporosis,
Can cause oral candidiasis: rinse/gargle after use! hyperglycemia, PUD, and growth
Not for acute attack: take on a schedule and take suppression
SABA 1st! (5 min before) NEVER stop abruptly!
Education on inhalers and spacers Stress dose needed in times of high
stress if used chronically
 Anti-Asthmatics:
Rescue vs. Maintenance Drugs
RESCUE MEDS - INHALER OR NEBULIZER

Albuterol: beta adrenergic bronchodilator

Terbutaline: beta-adrenergic
Ipratropium: anticholinergic bronchodilator, decreases respiratory secretions

RELIEVER DRUGS (BUT NOT RESCUE MEDS)

Salmeterol: Long-acting, onset in 20 min, often combined with steroids

MAINTENANCE/CONTROLLER MEDICATIONS
Guaifenesin: expectorant
Prednisone, methylprednisolone: corticosteroids
Montelukast: leukotriene modifiers
Theophylline: phosphodiesterase enzyme inhibitors
Medications for Pain
 Opioids
morphine, fentanyl, hydromorphone, methadone, oxycodone

Indication: Nursing Considerations:

Sedation, anesthesia, pain Side effects:
Sedation, constipation, urinary retention,
Action: hypotension, respiratory depression
Binds to opiate receptors in the Buprenorphine is given to prevent opioid
CNS and alters perception of withdrawal
pain while producing a general Antidote for toxicity: Naloxone
depression of the CNS Contraindicated in clients with head injuries due to
the sedative effects masking signs of increased ICP
NCLEX TIP!
Fall precautions
Controlled substance that can cause tolerance,
Fentanyl patch use:
Rotate sites, re-secure if the patch is
physical dependence, and addiction
coming off, always wear gloves IV morphine is 3x the strength of PO morphine
Non-Opioid Analgesics
Aspirin
Acetaminophen
NSAIDs
 NSAIDs
ibuprofen, naproxen, indomethacin, ketorolac, celecoxib

Indication: Nursing Considerations:

Mild to moderate pain, Side effects: nausea, GI distress, ulceration can lead to GI
inflammation, fever (but NCLEX bleed (given with antacids)
likes acetaminophen for fever Can cause prolonged bleeding
better), osteoarthritis, rheumatoid Typically avoided in trauma and surgical clients
arthritis Can cause peptic ulcers/stomach irritation due to
prostaglandin interference in the stomach lining
Action: IV ketorolac is the only one used for moderate to severe
Block prostaglandins that cause pain
inflammation, pain, and fever IV indomethacin or ibuprofen are given in infants to induce
closure of patent ductus arteriosus
Pain control is similar among most It can cause lithium toxicity when given in combination
NSAIDs, but some have more anti- with lithium
inflammatory effects than others Indomethacin can be given to treat preterm labor
 Acetylsalicylic Acid - Aspirin
Therapeutic class: NSAID/salicylate

Nursing Considerations:
Indication: Side effects: nausea from irritation to the stomach lining, vomiting, petechiae,
Mild to moderate pain, increased PT time
Salicylism = ASA toxicity that causes nausea, tinnitus, headache, delirium,
stroke and MI prophylaxis
hyperventilation, pulmonary edema
OD causes respiratory depression and acidosis, leading to coma and death
Action: Sodium bicarbonate is the treatment for acidosis and fluid resuscitation
Inhibits prostaglandin Risk of bleeding
production to treat fever Caution with other anticoagulants; discontinue 5-7 days before surgery
and inflammation; Caution with pediatric clients - Reye’s syndrome can occur with viral infections
decreases platelet The only time it is commonly used in pediatrics is in Kawasaki's disease
Given to MI clients to chew before arriving in the ER
aggregation leading to “Baby aspirin” = 81 mg
decreased clotting Not called that any more due to confusion with peds --> Low dose ASA is given
to reduce MI, stroke, TIA risk
It is contraindicated in 3rd trimester of pregnancy, but sometimes low dose ASA is
used to prevent preeclampsia
 Acetaminophen
Therapeutic class: antipyretic, non-opioid analgesic

Nursing Considerations:
Indication: Toxicity
Mild to moderate pain, fever Nausea and vomiting, flu-like symptoms, elevated liver
enzymes, followed by liver damage and death
Action: Treatment: gastric aspiration and lavage, activated
Inhibit the synthesis of charcoal, or n-acetylcysteine (antidote)
prostaglandins, which play Max daily dose = 4g
a role in transmission of Monitor liver function
pain signals and fever 3g max daily dose for clients with liver dysfunction
response Check labels for OTC medications, as many contain
acetaminophen
No anti-inflammatory action Cirrhosis and fatty liver disease can occur in clients with
alcoholism
What are the major
adverse effects associated
with long-term use of
NSAIDs?
 Answer: Major adverse effects
associated with long-term use of
NSAIDs includes: GI ulcers, bleeding,
renal impairment, increased risk of
cardiac events and increased
bleeding risk.
What condition can be
caused by administering
acetylsalicylic acid (Aspirin)
to pediatric clients?
NCLEX Question
What condition can be caused by administering acetylsalicylic acid
(Aspirin) to pediatric clients?

A. Sickle Cell Anemia

B. Kawasaki’s Disease
C. Cystic Fibrosis
D. Reye’s Syndrome
 Answer: Reye’s Syndrome. This can
occur in children who are given
Aspirin at the same time as a viral
infection like a cold or flu. This
condition causes swelling in the liver
and brain.
The Nervous
System
 Primary Antiepileptic
phenytoin

Indication:
Nursing Considerations:
All types of seizures, can be
Side effects: Gingival hyperplasia, dizziness, ataxia, visual
given IV and to treat status
disturbances, imbalance, rashes, hirsutism, birth defects
epilepticus
(pregnancy category D), folic acid deficiency and anemia,
dysrhythmias/bradycardia, hypotension, hyperglycemia
Action: Toxicity:
Blocks sustained high-frequency Nystagmus, gait issues, mental status changes
repetitive firing of action Regular dental check-ups, use soft bristle toothbrush
potentials by prolonging the Don’t give with antacids - decreases levels
inactivation of Na channels Causes minimal sedation
Therapeutic level 10-20 Weekly labs are needed until the therapeutic level is
mcg/mL (severe toxicity seen reached, then monitor every 3 months
at 40 mcg/mL)
 Lorazepam
Therapeutic class: Benzodiazepine

Indication: Nursing Considerations:

Anxiety, sedation, seizures Side effects:
Hangover effect, drowsiness, confusion,
Action: ataxia, nausea, constipation, rashes
General CNS depression Avoid alcohol
Monitor for respiratory depression
Antidote - flumazenil
Can cause dependency
The Renal
System
 Diuretics
LOOP DIURETICS

bumetanide, furosemide General Nursing Tips:

Main function is to get rid of
sodium and water in CHF, as
they are the leading cause of
POTASSIUM SPARING DIURETICS
edema and heart/pulmonary
congestion
spironolactone Take in the morning
Monitor potassium and
electrolytes
THIAZIDE DIURETICS Monitor BP

hydrochlorothiazide
 Loop Diuretics [-ide]
bumetanide, furosemide, torsemide

Indication: Nursing Considerations:

Increases urinary output, Side effects:
edema, CHF, and blood Nausea, hypotension, hypokalemia, hyperuricemia
pressure management (think gout), hyperglycemia, hypocalcemia,
metabolic alkalosis (due to sodium bicarb
Action: reabsorption)
Acts on the loop of Henle Monitor potassium levels
and decreases sodium Use care with digoxin and lithium
reabsorption, causing Monitor for ototoxicity from furosemide
excretion of more sodium Administer SLOWLY!
and water
 Thiazide Diuretics [-thiazide]
chlorothiazide, chlorthalidone, hydrochlorothiazide, indapamide, metolazone

Indication:
Nursing Considerations:
Hypertension, CHF
Monitor electrolyte levels
Potassium
Action:
Calcium
Acts on the distal tubule to block
Monitor BP
the reabsorption of sodium so
more sodium is excreted and
water follows
 Potassium Sparing Diuretics
triamterene, amiloride, spironolactone, eplerenone

Indication: Nursing Considerations:

Hypertension, edema, Monitor potassium levels and BP - can cause
swelling, hypokalemia hyperkalemia
Weakest diuretics; often combined with a loop or
Action: thiazide diuretic at lower doses
Block sodium channels in the
distal parts of the nephron -
Aldosterone antagonists
This ‘spares’ potassium
The Gastrointestinal
System
 H2 Receptor Antagonists [-tidine]
cimetidine, famotidine

Indication:
Nursing Considerations:
Short term treatment of gastric and duodenal
Side effects:
ulcers, GERD, Zollinger-Ellison syndrome,
Constipation, diarrhea, nausea, abdominal pain,
conditions causing hypersecretion of stomach
headaches, blistering/peeling skin
acid, chronic NSAID/ASA use, GI distress, stress
Clients with renal impairment are more likely to have
ulcer prevention during mechanical ventilation
CNS impairments like agitation, confusion,
disorientation, & lethargy
Action:
Severe adverse effects: arrhythmias, agranulocytosis,
Blocks the release of histamine (found in mast
aplastic anemias
cells within GI mucosa), which cause secretion of Monitor CBC, kidney function, and liver enzymes
gastric acid and pepsin when it binds with H2 Don’t give with antacids: separate by at least 1 hour
receptors in the mucosal parietal cells. Peak absorption of famotidine is within 2-3 hrs
When blocked, acid secretion is blocked Teach clients to increase fiber and fluids to combat
potential constipation
 Proton Pump Inhibitors [-prazole]
omeprazole, esomeprazole, lansoprazole, pantoprazole

Indication:
Nursing Considerations:
Ulcers, GERD, hypersecretion of HCl,
Side effects:
H. pylori (with antibiotics)
Headache, abdominal pain, diarrhea,
nausea, and constipation
Action:
Give 30-60 minutes before meals
Inhibits the exchange of hydrogen Report black tarry stools
and potassium ions, thereby reducing Interacts with many other drugs!
the secretion of HCl
 GI Protectant
sucralfate

Indication:
Nursing Considerations:
Short-term treatment of duodenal or
Side effects:
gastric ulcers, peptic esophagitis, Constipation; can also cause diarrhea, nausea,
NSAID/ASA-induced GI damage dry mouth, rashes, headaches, and drowsiness
Teach clients to take sucralfate on an empty
Action: stomach 1 hour before meals or 2 hours after meals
Promotes healing of ulcers by and at bedtime; often given up to 4 times a day
providing a barrier over them Antacids decrease the effectiveness of sucralfate
Creates a paste when exposed to Monitor blood sugar in clients with diabetes
hydrochloric acid and binds to Sucralfate contains sucrose!
proteins that are excreted by Many drugs need to be separated from sucralfate
damaged cells in ulcerated tissue by 2 hours to ensure their absorption
The Endocrine
System
 Insulin
Indication:
Subcutaneous Injection Sites
Clients with Type I and Type II Diabetes Mellitus;
hyperkalemia
Nursing Considerations:
Side effects:
Hypoglycemia, blurry vision
Always dosed in units and using insulin syringes
High alert medication - 2 RN check!
Rotate injection sites

Keep away from heat and direct

sunlight
Roll NPH (suspension)
Never freeze insulin
Store in the refrigerator until ready for
use
When actively using, keep at room
temperature
At room temperature:
Good for one month
 Biguanides
metformin

Indication: Nursing Considerations:

Type II Diabetes Mellitus Side effects:
GI issues (diarrhea, nausea/vomiting, gas)
Action: Black box warning for lactic acidosis: fatigue, myalgias,
respiratory or abdominal distress should be reported to
Decreases hepatic glucose
PHCP immediately
production, decreases GI glucose Do not give to clients with renal or hepatic impairment
absorption, increases cells Monitor: blood glucose (but does NOT cause hypoglycemia!),
sensitivity to insulin BUN, Creatinine
→ lowers blood glucose Take with food
Hold 24 hours before and 48 hours after IV contrast
administration
 Thyroid Hormone Replacements
levothyroxine

Indication: Nursing Considerations:

Hypothyroidism Side effects:
Signs and symptoms of
Action: hyperthyroidism
Replacement for thyroid Take every day, at the same time, on an
hormone empty stomach
Separate from other medications
Don’t stop taking abruptly
 Anti-Thyroid Medications
IODINE RADIOACTIVE IODINE
(Lugol’s Solution) Indication:
Indication: Diagnosing and treating hyperthyroidism
Preoperatively before thyroidectomy
Thyroid storm Action:
Kills thyroid gland cells
Action: Emits gamma and beta rays that can be picked up on diagnostic
Reduces size and vascularity of the thyroid gland imaging and the beta radiation destroys overactive tissue

Nursing Considerations: Nursing Considerations:

Can cause teeth staining Bodily fluids are radioactive for 24 hours following the procedure

methimazole, propylthiouracil
Indication: Nursing Considerations:
Hyperthyroidism Side effects:
Bleeding, rash, fever, myalgias, jaundice, nausea,
Action: agranulocytosis
Decreases the amount of T₃ and T₄ that are secreted Monitor for signs and symptoms of hypothyroidism
SLIDO SLIDE NEXT
Mental Health
 Selective Serotonin Reuptake
Inhibitors - SSRIs
fluoxetine, sertraline, escitalopram

Indication: Nursing Considerations:

Depression, post traumatic stress Side effects:
disorder, obsessive compulsive Nausea, diarrhea, dry mouth, anorexia,
disorder sexual dysfunction, decreased libido,
headache, nervousness, insomnia, tremors
Action: Monitor for serotonin syndrome
Prevents reuptake of serotonin Hypertension, confusion, anxiety, tremors,
increasing the availability of ataxia, sweating
serotonin in the body Suicide precautions important for 2-3 weeks
When the client's mood starts to improve,
they are at an increased risk for suicide
Why? They now have the energy to follow
through with a plan
 Tricyclic Antidepressants - TCAs
[-triptyline]
amitriptyline, nortriptyline, protriptyline

Indication:
Depression
Action:
Prevents the reuptake of norepinephrine and serotonin,
increasing these neurotransmitters in the body

Nursing Considerations:
Don’t abruptly discontinue
Suicide precautions important for 2-3 weeks
When the client's mood starts to improve, they
are at an increased risk for suicide
Why? They now have the energy to follow
through with a plan
 Lithium
Therapeutic class: Mood stabilizer

Indication: Nursing Considerations:

Mania Side effects:
Seizures, arrhythmias, fatigue,
Action: confusion, nausea, anorexia,
Inhibits excitatory hypothyroidism, tremors
neurotransmitters such as Do not administer with NSAIDs
dopamine and glutamate, and Monitor drug levels:
Therapeutic level: 0.6-1.2 mEq/L
promotes GABA-mediated
Encourage adequate fluid intake
neurotransmission Maintain consistent salt intake
SLIDO SLIDES NEXT
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