NUR 3145 NCLEX Pharm 2025
(Pharmacology) Comprehensive Guide |
Grade A | 100% Correct -The Ultimate
Guide for Yr. (2026/2027)
*NCLEX rule*
1. Focus on what kills or harm the client
2. When asked about adverse effects or client education always think about safety
*memory trick* If antibiotics are too high the kidneys will die, if antibiotics too low then
infection will grow.
*anytime you give a drug for the first time always stay with the client and monitor
them for side effects*
Top 8 drugs to avoid w/ pregnant clients
1. Anything Radioactive - RAIU ( to decrease overactive thyroid)
2. Methotrexate ( meth NO trexate)
3. Ace inhibitors ( pril )
4. ARBS ( sartan)
5. tetracycline ( antibiotic)
6. Medications that start with Sulf like sulfonamide ( it can SUFfocate the baby)
7. Misoprostol ( miscarriage)
8. Vitamin A ( isotretinoin) * they would want to see two negative test before you
give this drug*
● Drugs that are not to be taken with other medications:
1. Iron
2. Anti-acids ( sodium bicarbonate, magnesium hydroxide, calcium
carbonate )
*subcutaneous = S and its looks like a 5 so give a subq injection with 25 gauge needle*
* IM injections = 1 inch needle ( 22 gauge has a 1 inch needle )
, Drug Toxicity & Antidotes
15 & 20
* if it has a 1 and a 5, a 2 and a 0, it’s most likely toxic*
● Top 4 toxic drugs on the NCLEX:
1. Lithium = 1.5 or more is toxic
2. Digoxin = 2.0 or more is toxic
3. Theophylline = 20 or more is toxic
4. Phenytoin = 20 or more is toxic
Lithium Toxicity S/S:
- Extreme thirst
- Excess urination
- Vomiting & diarrhea
Digoxin Toxicity S/S:
- Dizziness ( lightheadedness )
- Difficulty reading ( blurred vision) *Vision changes are an early sign of
toxicity*(any vision change)
- Nausea & vomiting
Theophylline Toxicity S/S:
- Tonic- clonic seizure * educate the client they might have seizure on this med*
Phenytoin Toxicity S/S:
- Ataxia ( unsteady gait )
- Hand tremors
- Slurred speech
* older clients are most at risk for toxicity, and also renal failure clients*
● Antidotes:
1. Naloxone - for opioids ( give every 30 min to an hour) (oxycodone,
fentanyl, hydromorphone, morphine)
2. Flumazenil - for benzodiazepines ( Lam & pam)
3. Acetaminophen - acetylcysteine
, 4. Calcium gluconate - magnesium sulfate
5. Protamine sulfate - Heparin
6. Vitamin K - Warfarin
Blood Thinners
Antiplatelets = aspirin & clopidogrel
Anticoagulants = heparin, enoxaparin, warfarin
Thrombolytics (use to dissolve clots) = TPA, & anything ending in ase ( alteplase )
* needs to be given within 3 - 4.5 hours after onset of symptoms ( brain clot )*
* no new injections or IV’s while on these*
*do not give to clients who has active bleeding ( ulcer), or clients who had past bleeding
( post op from surgery or surgery within the last 2 weeks), or recent trauma (brain
bleed)*
*can give to woman on their menstrual cycle*
*if the name has a p in it then it can lower the platelets*
*heparin acts in a hurry and warfarin has a weaker start* Both are started at
the same time until warfarin takes full effect. Warfarin comes in pill form &
heparin and enoxaparin comes in injections form. Warfarin (INR) = 2-3
- If client has a mechanical heart valve then the range is 2.5-3.5
Heparin (PTT) = 46-70
● Vitamins or herbal supplements clients on blood thinners should avoid: (EGGOS)
1. Vitamin E
2. Ginseng, garlic, and ginkgo
3. Omega 3 fish oil
4. St. John’s Wort
S/S of bleeding:
- Black tarry stool, hematuria ( blood tinged urine), ecchymosis ( bruising)
At home education:
- Prevent falls, well light halls & remove any rugs, soft bristle toothbrush, no
flossing, use stool softener when constipation, electrical razor, avoid naproxen,
(Pharmacology) Comprehensive Guide |
Grade A | 100% Correct -The Ultimate
Guide for Yr. (2026/2027)
*NCLEX rule*
1. Focus on what kills or harm the client
2. When asked about adverse effects or client education always think about safety
*memory trick* If antibiotics are too high the kidneys will die, if antibiotics too low then
infection will grow.
*anytime you give a drug for the first time always stay with the client and monitor
them for side effects*
Top 8 drugs to avoid w/ pregnant clients
1. Anything Radioactive - RAIU ( to decrease overactive thyroid)
2. Methotrexate ( meth NO trexate)
3. Ace inhibitors ( pril )
4. ARBS ( sartan)
5. tetracycline ( antibiotic)
6. Medications that start with Sulf like sulfonamide ( it can SUFfocate the baby)
7. Misoprostol ( miscarriage)
8. Vitamin A ( isotretinoin) * they would want to see two negative test before you
give this drug*
● Drugs that are not to be taken with other medications:
1. Iron
2. Anti-acids ( sodium bicarbonate, magnesium hydroxide, calcium
carbonate )
*subcutaneous = S and its looks like a 5 so give a subq injection with 25 gauge needle*
* IM injections = 1 inch needle ( 22 gauge has a 1 inch needle )
, Drug Toxicity & Antidotes
15 & 20
* if it has a 1 and a 5, a 2 and a 0, it’s most likely toxic*
● Top 4 toxic drugs on the NCLEX:
1. Lithium = 1.5 or more is toxic
2. Digoxin = 2.0 or more is toxic
3. Theophylline = 20 or more is toxic
4. Phenytoin = 20 or more is toxic
Lithium Toxicity S/S:
- Extreme thirst
- Excess urination
- Vomiting & diarrhea
Digoxin Toxicity S/S:
- Dizziness ( lightheadedness )
- Difficulty reading ( blurred vision) *Vision changes are an early sign of
toxicity*(any vision change)
- Nausea & vomiting
Theophylline Toxicity S/S:
- Tonic- clonic seizure * educate the client they might have seizure on this med*
Phenytoin Toxicity S/S:
- Ataxia ( unsteady gait )
- Hand tremors
- Slurred speech
* older clients are most at risk for toxicity, and also renal failure clients*
● Antidotes:
1. Naloxone - for opioids ( give every 30 min to an hour) (oxycodone,
fentanyl, hydromorphone, morphine)
2. Flumazenil - for benzodiazepines ( Lam & pam)
3. Acetaminophen - acetylcysteine
, 4. Calcium gluconate - magnesium sulfate
5. Protamine sulfate - Heparin
6. Vitamin K - Warfarin
Blood Thinners
Antiplatelets = aspirin & clopidogrel
Anticoagulants = heparin, enoxaparin, warfarin
Thrombolytics (use to dissolve clots) = TPA, & anything ending in ase ( alteplase )
* needs to be given within 3 - 4.5 hours after onset of symptoms ( brain clot )*
* no new injections or IV’s while on these*
*do not give to clients who has active bleeding ( ulcer), or clients who had past bleeding
( post op from surgery or surgery within the last 2 weeks), or recent trauma (brain
bleed)*
*can give to woman on their menstrual cycle*
*if the name has a p in it then it can lower the platelets*
*heparin acts in a hurry and warfarin has a weaker start* Both are started at
the same time until warfarin takes full effect. Warfarin comes in pill form &
heparin and enoxaparin comes in injections form. Warfarin (INR) = 2-3
- If client has a mechanical heart valve then the range is 2.5-3.5
Heparin (PTT) = 46-70
● Vitamins or herbal supplements clients on blood thinners should avoid: (EGGOS)
1. Vitamin E
2. Ginseng, garlic, and ginkgo
3. Omega 3 fish oil
4. St. John’s Wort
S/S of bleeding:
- Black tarry stool, hematuria ( blood tinged urine), ecchymosis ( bruising)
At home education:
- Prevent falls, well light halls & remove any rugs, soft bristle toothbrush, no
flossing, use stool softener when constipation, electrical razor, avoid naproxen,
